Causative & risk factors
Coarctation of the aorta is usually a congenital condition i.e. it is present since birth. Rarely aortic coarctation may arise as a result of atherosclerosis, Takayasu’s arteritis or trauma.
This condition usually coexists with other congenital heart defects such as stenosis of the aortic or mitral valve or patent ductus arteriosus. About 1 in 10 females with Turner’s syndrome have coarctation of the aorta.
Due to narrowing, the blood flow to the different body parts is affected. The narrowing of the aorta may be such that the blood pressure in the head and the upper limbs is much higher than the lower limbs.
The blood pressure in the heart rises which causes thickening of the left ventricle and damage to the heart muscle.
Clinical presentation
Many patients with coarctation of the aorta are asymptomatic. Babies with coarctation of the aorta are usually irritable, pale, breathless and sweat profusely.
Adult patients may experience non-specific symptoms such as headache, weakness, breathlessness and leg cramps. Some may experience frequent miscarriages and kidney trouble. On examination, they are found to have high blood pressure in the arms.
Untreated coarctation of the aorta can lead to heart failure, aortic rupture, cerebral aneurysm, stroke, coronary artery disease and death.
Investigations
An electrocardiogram and echocardiogram are performed to study the heart function. Imaging tests like chest X-ray, CT scan or MRI scan are done. Cardiac catheterization is performed to identify the severity of narrowing in the aorta.
Treatment
Anti-hypertensive drugs are prescribed to reduce the blood pressure.
Balloon angioplasty and stenting can be performed out to relieve coarctation of the aorta. A catheter is introduced in the aorta. The balloon contained within the catheter is inflated in the area of narrowing. Later the catheter and balloon are removed.
Surgery to repair coarctation of aorta involves removal of the narrow portion of the aorta and sewing the ends together (resection and anastomosis). Patch aortoplasty is another procedure in which a synthetic patch is attached to widen the aorta. Other procedures such as angioplasty or bypass graft repair may be needed in some patients.
Patients with aortic coarctation are prone to develop endocarditis and hence precautions must be taken to prevent the same.
