What is Coarctation of the Aorta?
Coarctation of the aorta is a congenital defect in which the body's main artery — the aorta — is narrowed. The narrowing is usually located in the descending aorta, just below where the left subclavian artery branches off. As a result the upper body receives blood normally, while the lower body — legs and kidneys — is underperfused.
Coarctation of the aorta accounts for 5–8% of all congenital heart defects. It occurs twice as often in boys as in girls.
"Coarctation of the aorta is a very unusual defect. After surgery, hypertension almost always either persists or develops later. For this reason parents must take this into account and continue to see a cardiologist periodically throughout their child's life."
Symptoms
Symptoms depend on age:
- In newborns: severe heart failure, weakness, pallor, feeding difficulties, weak pulse in the legs
- In older children: headaches, high blood pressure in the arms, fatigue and coldness in the legs
- In adolescents: frequent headaches, shortness of breath on exertion, nosebleeds
The characteristic diagnostic sign is a difference between arm and leg blood pressure: high in the arms, low in the legs.
Treatment Methods
1. Surgical resection
The traditional method — the narrowed segment is surgically excised and the two ends of the aorta are joined. The primary choice in newborns and infants.
2. Balloon angioplasty and stenting
A catheter-delivered balloon dilates the narrowing; a stent may be placed if needed. Used in older children and for recurrent coarctation.
Important for parents: After successful treatment of coarctation the child leads a normal life — but the risk of arterial hypertension persists throughout life. Regular blood pressure monitoring and cardiology follow-up are mandatory. This protects against unexpected cardiovascular problems.
Why Does Hypertension Persist?
Almost every parent asks this question. The answer lies in several mechanisms: prolonged narrowing alters the renal renin-angiotensin system, impairs aortic elasticity, and causes structural changes in the vessel walls. Because of this, even after the coarctation is repaired, blood pressure may not normalise.
This is not a failure of treatment. It is a characteristic feature of this defect. Knowing — means protecting.
When is intervention needed for coarctation?
In newborns with severe symptoms — immediately. In older children a pressure difference between arm and leg above 20 mmHg is an indication. The method is chosen individually based on age, degree and location of the narrowing.
Can coarctation recur?
Yes, especially when surgery was performed in early infancy. As the child grows the treated area may narrow again. Regular echocardiographic follow-up is therefore mandatory.
Can the child play sport after treatment?
Intense physical activity is not recommended before treatment. After successful treatment and with blood pressure monitoring, physical activity is permitted. Each child is assessed individually.
Can coarctation be detected before birth?
Yes, prenatal echocardiography can detect this defect, although the diagnosis is sometimes made after birth. A murmur on paediatric examination and a pressure difference between arm and leg are grounds for suspicion.