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Aortic Coarctation

DEFINITION

Aortic coarctation is the medical name for a narrowing of part of the largest blood vessel in the body, the aorta. The aorta is the large blood vessel that comes off of the heart to deliver blood to the organs of the body. Narrowing of the aorta can be a problem because the size of the tube through which the blood can flow is smaller, causing the heart to have to pump harder to push the blood forward. Most often, coarctation of the aorta is a congenital condition (a condition present at birth) though it can occur later in life due to atherosclerosis (hardening of the arteries due to cholesterol plaque buildup). Sometimes people with coarctation of the aorta also have other congenital heart defects like bicuspid aortic valve (a valve that normally has three valves instead has only two), ventricular septal defect (a hole between the two large chambers of the heart), patent ductus arteriosis (presence of a vessel that should go away before birth), aortic valve stenosis (narrowing of the aortic valve), and mitral valve stenosis (narrowing of the mitral valve). The narrowing in the aorta can range from mild to severe with mild cases sometimes not detected until adulthood. The cause of aortic coarctation is not known. The narrowing of the aorta generally happens after the arteries to the arms and neck have left the aorta, but before the arteries to the legs have left the aorta. As a result, people with coarctation of the aorta have high blood pressure in the arms but lower blood pressure in the legs. People with a genetic condition called Turner Syndrome are much more likely to have aortic coarctation. If left untreated, coarctation of the aorta can cause kidney failure, elevated blood pressure, aortic rupture, stroke, coronary artery disease, and cerebral aneurysm (bulging of the vessels in brain).

SYMPTOMS
High blood pressure, pale skin, shortness of breath, fatigue, headache, leg cramps, cold feet, weakness, nosebleed, fainting, pain in the legs

DIAGNOSIS
Diagnosis of aortic coarctation begins with a history and physical exam with your doctor. Your doctor will likely take your blood pressure in your arms and legs to compare the two. Worse cases of coarctation of the aorta are generally detected in childhood by pediatricians. If your doctor suspects that you may have aortic coarctation, he or she may want to do some additional testing such as a chest x-ray, echocardiogram (ultrasound or sonogram of the heart), electrocardiogram (EKG) or a picture called magnetic resonance imaging (MRI). Sometimes, your doctor may also recommend a cardiac catheterization, where a small catheter is placed in a large vein in the leg then advanced to the heart to pass dye into the heart and take pictures of where it goes which can help determine the degree of narrowing of the aorta.

TREATMENT
Medications do not generally treat coarctation of the aorta, but do often help with blood pressure management to some degree. Most often, treatment of coarctation of the aorta is done through either an intervention called balloon angioplasty or surgery. With balloon angioplasty, a catheter is advanced through the heart to the aorta. Once in place in the aorta, the cardiologist inflates a balloon inserted through the catheter which helps expand the aorta. At that point, a mesh metal stent may be placed in the aorta in order to keep it open. Surgery for coarctation of the aorta is performed by a cardiothoracic surgeon. Surgical options include end-to-end anastamosis (essentially cutting out the narrowed section of the aorta and reattaching the two cut ends together), patch arthroplasty (cutting through the narrowed area and adding a synthetic material to widen the aorta), left subclavian flap angioplasty (instead of synthetic material, another vessel called the left subclavian artery is used to widen the aorta), and bypass graft repair (which involves removing the narrowed area of the aorta and replacing it with a plastic graft). Even after repair, you may require medication to treat high blood pressure.

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