Aortic Coarctation

Aortic coarctation is a narrowing of a section of the aorta that hinders blood flow through it. This causes the heart to work harder, pumping with greater force to ensure adequate circulation to the lower half of the body. The coarctation is usually located in the descending thoracic aorta. Generally, it is a congenital malformation present from birth, often associated with other heart defects.

Based on the segment where the coarctation occurs, it is classified as:

• Preductal coarctation: Located proximal to the ductus arteriosus, the vessel that connects the aorta to the pulmonary artery.
• Ductal coarctation: Located at the insertion of the ductus arteriosus.
• Postductal coarctation: The narrowing is distal to the ductus arteriosus.

Depending on the presence or absence of associated lesions, the types are:

• Simple aortic coarctation: Occurs in isolation.
• Complex aortic coarctation: Occurs along with associated conditions.

In some cases, symptoms appear from birth (neonatal aortic coarctation), while in others, they do not manifest until childhood (pediatric aortic coarctation) or even adulthood.

Symptoms

The symptoms of aortic coarctation depend on the degree of narrowing. When mild, it is often asymptomatic and may not be diagnosed until adolescence or adulthood. If symptoms appear, they include:

• Chest pain
• Headaches
• High blood pressure and a difference in blood pressure between the arms and legs
• Nosebleeds
• Leg pain or cramps
• Cold feet
• A heart murmur may be present

Infants with moderate coarctation may present the following symptoms:

• Rapid or difficult breathing
• Accelerated heart rate
• Pale skin
• Difficulty feeding
• Irritability or lethargy

Causes

The exact causes of aortic coarctation are not fully understood, and it is believed to result from various abnormalities during fetal development. In rare cases, it may not be congenital and instead be caused by other factors, such as trauma, inflammation of the arteries (Takayasu arteritis), or severe artery hardening (atherosclerosis).

Risk Factors

Aortic coarctation is often associated with the presence of other congenital heart conditions, such as:

• Turner syndrome: A chromosomal disorder that causes heart malformations.
• Bicuspid aortic valve: The aortic valve has two leaflets instead of three.
• Subaortic stenosis: A narrowing in the left ventricular outflow tract below the aortic valve.
• Patent ductus arteriosus: The ductus arteriosus remains open after birth.
• Ventricular septal defect: An opening in the septum between the ventricles allows oxygen-rich blood from the left side to mix with oxygen-poor blood from the right side.
• Mitral valve stenosis: A narrowing of the mitral valve that restricts blood flow between the left atrium and ventricle.

Complications

Untreated aortic coarctation can lead to:

• Chronic high blood pressure: The most common complication, which can cause serious health problems in the medium and long term.
• Left ventricular hypertrophy due to the increased effort required to maintain normal systolic function.
• Weakening of the aorta or arteries in the arms or brain due to excessive pressure.
• Aneurysms, ruptures, and spontaneous tears resulting from arterial weakening, potentially leading to hemorrhages, strokes, or other vascular events.
• Organ damage due to reduced blood supply in severe cases of coarctation.
• In newborns, it can lead to heart failure or death.

Prevention

Since aortic coarctation is a congenital malformation with no established cause, it cannot be prevented. However, early detection of associated heart diseases can facilitate a timely diagnosis.

Which Doctor Treats Aortic Coarctation?

Aortic coarctation is treated in cardiovascular medicine and surgery units.