Coarctation of the aorta

In the normal heart, blood flows to the body through the aorta, which connects to the left ventricle and arches over the top of the heart. In coarctation of the aorta, the aorta is pinched (in medical terms, coarcted) at a point somewhere along its length. This pinching restricts blood flow from the heart to the rest of the body. Often, the baby also has other heart defects, such as a narrowing of the aortic arch (in medical terms, transverse aortic arch hypoplasia).

Diagram 2.9 Coarctation of the aorta 1 - pinched or coarcted aorta Flow patterns are normal but are reduced below the coarctation. Blood pressure is increased in vessels leaving the aorta above the coarctation. The broken white arrow indicates diminished blood flow through the aorta.

Usually no symptoms are apparent at birth, but can develop within a week of birth with the closure of the ductus arteriosus. The possible consequences of this condition are poor feeding, an enlarged heart, an enlarged liver and congestive heart failure. Blood pressure also increases above the constriction.

Timing of surgery depends on the degree of coarctation. Surgery may be delayed with mild coarctation (which sometimes is not detected until adolescence). However, if a baby develops congestive heart failure or high blood pressure, early surgery is usually required. A baby with severe coarctation should have early surgery to prevent long-term high blood pressure.

The coarctation can be repaired in a number of ways without opening the heart. The surgeon can remove the narrowed part of the aorta and sew the ends together, thereby creating an anastomosis. (An anastomosis is the surgical formation of a connection between two normally distinct structures.) Alternatively, the surgeon can cut the narrowed section open and sew a patch over the opening.