COARCTATION OF THE AORTA (COA)
Coarctation of the Aorta is a narrowing of the main artery (the aorta) that carries blood to the body. This narrowing affects blood flow where the arteries break out to carry blood along different vessels to the upper and lower parts of the body. CoA can lead to high blood pressure or heart damage.

More details for parents of children with CoA

What is it?
In this condition, the aorta (the main artery that carries blood from the heart to the body) is narrowed or tightened.

What causes it?
In many children, the cause isn't known. Some children may have other heart defects together with coarctation.

How does it affect the heart?
Coarctation prevents blood flow from the heart to the lower part of the body. Blood pressure goes above the constriction. The blood pressure is much higher than normal in the left pumping chamber (left ventricle) and the heart needs to work harder to pump blood through the constriction in the aorta. This can lead to thickening (hypertrophy) and damage to the overworked heart muscle.

How does the coarctation affect my child?
Normally no symptoms exist at birth, but they can develop as early as the first week after delivery. A baby may have congestive heart failure or high blood pressure.

If the obstruction is mild, the heart won't be too overworked and symptoms may not happen. In certain children and adolescents, coarctation is found only after high blood pressure is discovered.

What can be done about the coarctation?
The coarctation obstruction can be resolved using surgery or catheterization.

In the course of cardiac catheterization, a unique catheter containing a balloon is positioned in the constricted region. Then the balloon is inflated for a while, stretching the constricted area open. The balloon and catheter are then detached.

Surgery is often used to resolve coarctation. A surgeon doesn't have to open the heart to fix the coarctation. It can be repaired in several ways. One way is for the surgeon to remove the narrowed part of the aorta. Another option is to sew a patch over the narrowed area using part of the blood vessel to the arm or a graft of a synthetic substance.

An infant with a serious coarctation should have surgery to relieve the obstruction. This may alleviate heart failure in infancy and prevent problems later, such as developing high blood pressure as an adult due to the coarctation.

What will my child need in the future?
The outlook after the procedure is favourable, but long-term follow-up by a pediatric cardiologist is required. Rarely, coarctation of the aorta may re-occur. Then another procedure to mitigate the obstruction may be needed. Also, blood pressure may remain high even when the aorta's narrowing has been repaired.

What about preventing endocarditis?
Children with coarctation of the aorta may have a chance of developing endocarditis. Your child's cardiologist may suggest that your child takes antibiotics before certain dental procedures for a period of time after coarctation repair.

What causes it?
The area where coarctation of the aorta happens is usually in the same spot where the ductus arteriosus closes. At times, during normal closure of the ductus in the first week of life, tissue can increase and cause a narrowing.

How does coarctation affect the heart?
Coarctation of the aorta can lead to high blood pressure in the heart. This can make the muscle of the heart's main pumping chamber (left ventricle) to become thick. Eventually, the function of the heart muscle could depreciate if the condition isn't treated.

What if coarctation is still present? Should it be repaired in adulthood?
Yes, coarctation can be repaired at any age and should be treated as soon as it's diagnosed depending on the severity of the coarct. Adolescents and adults with coarctation can usually be treated by cardiac catheterization.

Problems you may have
High blood pressure is the most common issue adults have. It can be present even if your coarctation was successfully repaired. High blood pressure is very common if the coarctation is repaired after five years old. Patients treated in childhood are at risk for redeveloping the coarctation (recoarctation) and may need catheterization. Most patients with recoarctation of the aorta after initial repair normally don't have symptoms, which makes regular evaluation by a physician all the more important. Many times the region will narrow to a degree, or other portions of the aorta may enlarge (aneurysms) with a likeliness to rupture. These may require to be addressed with further intervention. Patients may develop coronary artery disease, leaving them susceptible to heart attacks. There may even be a great risk of having an aneurysmal blood vessel in the head.

Endocarditis Prevention
Although infection of a coarctation can happen, it isn't likely. Very often, patients may develop an infection of a coexisting abnormal aortic valve. All patients are required to practice good oral care.

Pregnancy
Women with repaired coarctation can be pregnant with low risk. The exclusion is if there's a residual (leftover) narrowing of the aorta or if there's high blood pressure or an enlarged region of the aorta. It's best to plan ahead and have a detailed check-up including an imaging study of the aorta to detect these issues before becoming pregnant and control the issues before conception.

Will I need more surgery?
The need for surgery or catheterization relies mainly on the level of pressure in your arms and legs when you're resting and, under some situations, during exercise. If your arm and leg blood pressures are normal and equal, you perhaps won't need more intervention. If your blood pressure is elevated in your arms and more than 20 mmHg higher than in your legs, it is likely, that further intervention will be required. When problems happen, more and more institutions use catheters instead of surgery, which is much easier for the patient.