About Coarctation

COARCTATION

Coarctation (ko-ahrk-TAY-shun) of the aorta or COA – is a narrowing of the aorta, the large blood vessel that branches off the heart and delivers oxygen-rich blood to your body.

COA can be either present at birth or discovered in childhood or even adulthood. Since the narrowing of the aorta is usually located after arteries that branch to the upper body, coarctation can lead to normal or high blood pressure in the head and arms and low blood pressure and weak pulses in the legs and lower body.

Severe coarctation can result in not enough blood getting to the lower body and can result in extra work on the left ventricle. This extra work can weaken the ventricle and cause heart failure.

COA often occurs along with other heart defects. While treatment is usually successful, it’s a condition that requires careful lifelong follow-up.

It is estimated that 1 in 5000 babies in just the United States are born every year have coarctation of the aorta. Therefore, there are approximately 20,000 to 40,000 people with the condition in the United States alone. It is probable that Europe, Australia and Asia have another 60,000 COA survivors, while many African and South American countries lack the ability to repair COA resulting in preventable deaths.

CAUSES

No one knows specifically what causes COA. Material smoking has been linked to congenital heart defects as well as certain anti-depressants. Studies have also been done of air pollution in cities and near farming and the relation to birth, including heart, defects. Some institutions in the US and internationally are researching providing pregnant mothers with supplemental oxygen to correct or lesson defects in utero!

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TREATMENT

Treatment options depend on the severity of the defect. People with COA will sometimes have a bicuspid valve, ASD, VSD, or hypoplastic aortic arch or more rarely serious defects like Shone’s complex or other cardiac or genetic defects.

A simple coarctation on the descending arch of the aorta has been repaired by surgery for over 70 years! The typical route of repair absent any other defect that needs repair is through the side or a thoracotomy.

LONG TERM OUTCOMES

After repair, it’s important to advocate for careful follow-up with a cardiologist who specialties in congenital defects (and even better if they have research interests in coarctation).

Regular echocardiograms, stress tests, MRAs, ECGs, blood work, etc should be discussed with the cardiologist as to how often they are necessary and compared with other patients and institutions. In addition to re-coarctation, there appears to be increase risk for COA survivors of aortic dissection or aneurism, cerebral aneurism and early coronary artery disease.

Know your insurance – try to have the best insurance you can – so if you need to go to an experienced hospital or physician for help you can. If you can’t afford that insurance, have a plan in place for getting the care you need.