Coarctation of the Aorta (CoA) is a congenital heart defect characterized by the narrowing of the aorta, which is the main artery carrying blood from the heart to the rest of the body. This narrowing typically occurs in the part of the aorta that is near the ductus arteriosus, a blood vessel that is present in fetuses and normally closes shortly after birth.

The narrowing in the aorta caused by CoA can significantly affect blood flow. It can lead to increased blood pressure above the constriction and reduced blood flow to the lower part of the body. The severity of the symptoms and the degree of the blood pressure difference depend on how much the aorta is narrowed.

Symptoms

In infants, severe CoA can present early with symptoms like:

  • Poor feeding

  • Failure to thrive

  • Respiratory distress

  • Heavy sweating

  • Irritability

In milder cases, or when CoA is not diagnosed until later in childhood or even adulthood, symptoms might include:

  • High blood pressure

  • Headaches

  • Muscle weakness

  • Leg cramps or cold feet

  • Nosebleeds

  • Chest pain

Diagnosis

Coarctation of the aorta is often diagnosed through physical examination and confirmed with imaging tests such as:

  • Echocardiogram: An ultrasound of the heart, which can reveal the narrowing of the aorta.

  • Chest X-ray: May show a heart with a characteristic shape due to the enlargement of parts of the heart and aorta.

  • MRI or CT scan: Provides detailed images of the heart and aorta.

  • Cardiac catheterization: Involves threading a thin tube through the blood vessels to the heart to measure pressure and take detailed pictures.

Treatment

The treatment of CoA depends on the age at diagnosis and the severity of the condition:

  • In newborns and young infants with severe CoA, treatment often involves prostaglandin E1 medication to keep the ductus arteriosus open, allowing better blood flow until surgery can be performed.

  • Surgical treatment is generally required to repair the narrowing. This can involve removing the narrowed section and reconnecting the two ends of the aorta, or enlarging the narrowed area with a patch.

  • In older children and adults, less invasive procedures like balloon angioplasty and stent placement may be used.

Long-term Outlook

After treatment for CoA, regular follow-up with a cardiologist is important. There can be long-term issues such as high blood pressure, re-narrowing of the aorta, or problems with the aortic valve. Early detection and treatment of CoA generally lead to a good long-term prognosis.