Coarctation

Coarctation of the aorta (CoA) is a congenital condition characterized by the narrowing of the aorta, which is the major artery that carries oxygen-rich blood from the heart to the rest of the body. This narrowing typically occurs just after the arteries that branch off to the upper body and before the arteries that supply blood to the lower parts of the body. The condition is significant because it can impede the flow of blood, leading to various health issues.

Causes and Pathophysiology

Coarctation of the aorta is most commonly a congenital condition, meaning it is present at birth. The exact cause of CoA is not well understood, but it is thought to involve genetic factors that affect the development of the aorta during fetal growth. The condition is often associated with other congenital heart defects, such as bicuspid aortic valve, patent ductus arteriosus, and ventricular septal defect.

Pathophysiologically, the narrowing of the aorta increases the pressure upstream of the constriction, which can lead to hypertension in the upper body. The lower body, however, may receive less blood flow, which can result in lower blood pressure in the legs and lower extremities.

Symptoms and Diagnosis

Symptoms of coarctation of the aorta can vary depending on the severity of the narrowing. In infants, severe coarctation can lead to life-threatening issues such as heart failure and difficulty breathing. Older children and adults may experience high blood pressure, headaches, muscle weakness, and leg cramps or cold feet.

Diagnosis of CoA often involves a combination of physical examinations, where a significant difference in blood pressure between the arms and the legs may be noted, and imaging studies. Echocardiography, MRI scans, and CT scans are commonly used to visualize the structure of the aorta and confirm the diagnosis.

Treatment

Treatment for coarctation of the aorta depends on the age at diagnosis and the severity of the condition. In infants and young children, surgical repair is often required to correct the narrowing and prevent complications. Procedures may include resection of the narrowed segment and end-to-end anastomosis or patch aortoplasty. In some cases, balloon angioplasty and stenting may also be used, particularly in older children and adults.

Long-term follow-up care is crucial for individuals with CoA, as they may be at risk for re-narrowing (recoarctation) or developing aneurysms at the repair site. Regular monitoring through imaging and clinical evaluations is necessary.

Prognosis

With timely and appropriate treatment, the prognosis for individuals with coarctation of the aorta is generally good. Many lead normal lives with few restrictions. However, lifelong monitoring is essential to manage potential long-term complications such as hypertension, recoarctation, and increased risk of cardiovascular disease.

See Also

• Congenital heart defect
• Cardiovascular disease
• Hypertension