What is Coarctation of the Aorta

Coarctation of the Aorta is mainly found in the aorta, which is the main artery from the heart. The most common site is the arch of the aorta (just after it leaves the heart).

Statistics on Coarctation of the Aorta

It occurs in less than 1 in 2000 live births.

Risk Factors for Coarctation of the Aorta

The causes and origins of congenital heart defects is not understood but several factors are known to be associated:

1) Maternal drug abuse, alcohol abuse and radiation exposure.
2) Maternal infection, particularly rubella.
3) Genetic abnormalities.
4) Chromosomal abnormalities (septal defects are associated with Trisomy 21- Down’s syndrome, and Turners Syndrome).

Progression of Coarctation of the Aorta

Severe coarctation can lead to hypertension. There is usually high blood pressures to the upper limbs (arms) and head, coupled with low blood pressures in the legs (below the block in the aorta).

Depending on the severity of the narrowing, heart failure occurs earlier or later in the disease.

How is Coarctation of the Aorta Diagnosed?

Chest x-ray: May show the indentation of the coarctation with dilatation near the lesion. Evidence of heart failure may be seen. There may be evidence of rib erosion secondary to collaterals in adults.

ECG: Shows evidence of left ventricular hypertrophy.

Prognosis of Coarctation of the Aorta

Severe heart failure early in life has a poor prognosis without corrective surgery. Other mortality is associated with cerebrovascular accidents (strokes) due to the high blood pressures, and endocarditis and emboli associated with turbulent flow.

How is Coarctation of the Aorta Treated?

The treatment is surgical and involves removing the coarctation and re-joining the two ends of the aorta. This usually resolves the hypertension unless renal damage has occurred.

Medical management of heart failure should be dictated by the clinical picture.

Coarctation of the Aorta References

[1] Anderson et al. Paediatric Cardiology. Churchill Livingstone 1987.
[2] Behrman, Kliegman, Jenson. Nelson Textbook of Paediatrics 17th Ed. Saunders 2004.
[3] Hurst’s The Heart 8th Edition, McGRAW-HILL 1994.
[4] Kumar and Clark, Clinical Medicine 4th Edition, W.B SAUNDERS 1998.
[5] Rudolph et al. Rudolphs’s Paediatrics (21st edition). McGraw-Hill 2003.