Aortic Coarctation

Signs and Symptoms

Aortic coarctation is a narrowing of part of the aorta, the artery that sends oxygenated blood from the heart to the rest of the body. Many coarcations may not produce symptoms until later in life. However, some defects are so severe that babies born with them will need immediate treatment.

When the aorta is too narrow, it restricts blood flow to the lower part of the body and increases blood pressure above the narrowing. This means the heart has to work harder to circulate blood to the rest of the body. The left ventricle may become swollen and weak due to the strain, resulting in congestive heart failure, when one or more chambers of the heart "fail" to keep up with the volume of blood flowing through them. One of the symptoms of congestive heart failure is breathlessness. Children born with aortic coarctation often have other heart abnormalities such as deformed aortic valves, patent ductus arteriosus or ventricular septal defect.

High blood pressure above the narrowing also can result in high blood pressure in the arteries that branch out from the aorta, including those in the arms and brain. This may increase the risk for a stroke.

Below the narrowing, the blood pressure may be too low, resulting in problems in feeding enough blood into organs such as the kidneys.

Diagnosis

If a child doesn't have severe symptoms at birth, aortic coarctation may go unnoticed until a child is older. Your pediatrician may suspect a problem if he or she hears a distinctive murmur or if there is high blood pressure in the arms and low pressure in the legs.

Tests to determine whether a coarctation is present include:

• Electrocardiogram (ECG or EKG)
• Chest X-ray to see the heart's size
• Echocardiogram
• Possibly a cardiac catheterization to inject a dye into the heart and to see on a moving picture X-ray how the heart and aorta are functioning

Treatment

In the past, coarctation repair involved heart surgery through an incision in the side of the chest that required five to seven days in the hospital for recovery. It is now possible to correct coarctation without surgery in a procedure called a cardiac catheterization.

The heart catheterization consists of placing a long, thin, hollow plastic tube, called a catheter, into the blood vessel in the groin and passing it through vessels into the heart's chambers. The catheter is used to gather blood samples, take pressure measurements and inject dye for X-ray movies. Modern imaging technology allows doctors to see where the catheter is going and how the heart is functioning.

The size of the aorta narrowing is measured and an appropriate size stent, an expandable slotted metal tube, is selected. Sometimes, more than one stent will be needed for complete repair. If the narrowing is too close to the head and neck vessels, stent repair may not be possible. Surgical repair would then be necessary and will be scheduled for another time.

After an appropriate stent has been selected, it is placed over a deflated balloon at the catheter's tip. When the balloon reaches the site of the narrowing, it is expanded to widen the artery. The stent is left in place to support the newly widened artery walls and the catheter and balloon are withdrawn.

Complications during the procedure are rare and almost all can be treated immediately. These include blood loss requiring a transfusion, allergic reaction to X-ray dye requiring medication, aneurysm and improper stent position requiring retrieval by catheter or surgery. There is a small risk of blockage of the groin vessels used for catheterization, which ordinarily responds to medication. Complications after the procedure, such as breakage, movement or infection of the stent, are extremely rare.

The catheterization and stent placement take approximately three to four hours. Your child will be admitted to the hospital the morning of the procedure and be discharged the following morning.