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Coarctation of the Aorta: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Coarctation of the aorta is a congenital heart defect affecting the main artery that transports blood from the heart to the rest of the body. It is the narrowing of the aorta that makes the heart work harder to pump blood. If not treated, coarctation of the aorta can cause serious complications, including high blood pressure, heart failure, stroke, and aneurysm.

Causes of Coarctation of the Aorta

There is no clear cause of coarctation of the aorta, but it is usually present at birth. It may be due to genetic factors, infections, or drugs which affect the development of the aorta. It is common for coarctation of the aorta to occur in combination with other heart defects, such as bicuspid aortic valves, holes in the walls of the lower chambers of the heart (ventricular septal defects), or holes in the walls of the upper chambers (atrial septal defects).

In rare cases, coarctation of the aorta can develop in later life as a result of traumatic injury, atherosclerosis, or inflammation of the arteries (Takayasu arteritis).

Symptoms of Coarctation of the Aorta

The symptoms of coarctation of the aorta depend on the severity and location of the narrowing. Some people may not have any symptoms and may appear healthy. Others may have symptoms that vary from mild to severe.

Babies with severe coarctation of the aorta may show symptoms shortly after birth, such as:

• Difficulty breathing

• Difficulty feeding

• Heavy sweating

• Irritability

• Pale or blue skin due to poor blood circulation

Older children and adults with mild coarctation of the aorta may have symptoms that include:

• High blood pressure in the arms

• Low blood pressure or weak pulse in the legs

• Chest pain

• Headache

• Leg cramps or cold feet

• Muscle weakness

• Nosebleeds

• Shortness of breath

• Dizziness or fainting

Diagnosis of Coarctation of the Aorta

Coarctation of the aorta can be diagnosed by a physical exam and various tests that show the structure and function of the heart and blood vessels. These tests may include:

• Echocardiogram: This test uses sound waves to create images of the heart and aorta. It can show the location and severity of the coarctation, as well as other heart defects.

• Electrocardiogram (ECG or EKG): This test measures the electrical activity of the heart. It can show signs of thickening of the walls of the lower heart chambers (ventricular hypertrophy) due to increased pressure.

• Chest X-ray: This test creates images of the heart and lungs. It can show a narrowing or bulging of the aorta, or an enlarged heart.

• Magnetic resonance imaging (MRI) of the heart and blood vessels uses magnetic fields and radio waves to create detailed images. MRI can reveal the extent of coarctation and its effects on other vessels in the body.

• These tests use X-rays to create cross-sectional or three-dimensional images of the body. They show how the aorta and other vessels are arranged and how blood flows through them.

• In cardiac catheterization, a thin, flexible tube (catheter) is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. An X-ray image of the arteries is made visible by injecting dye through the catheter. As a result, blood pressure and oxygen levels can be measured in different parts of the heart and aorta, and the degree of coarctation can be determined.

Treatment of Coarctation of the Aorta

The goal of treatment for coarctation of the aorta is to restore normal blood flow and prevent complications. Treatment options include:

• There is no cure for coarctation of the aorta, but medications can relieve symptoms or prepare for surgery.

• A balloon angioplasty is a minimally invasive procedure in which a catheter with a balloon at its tip is inserted into a narrowed aorta and inflated to widen it. In infants, children, and adults who have mild to moderate coarctation of the aorta or in severe cases, a metal mesh (stent) can be placed to keep the artery open.

• As a definitive treatment for coarctation of the aorta, surgery is the only option available. In these procedures, the narrowed section of the aorta is removed and the two ends are connected (resection), or another artery or synthetic material is used to expand the narrowed section (patch aortoplasty, subclavian flap aortoplasty, or bypass grafting). When balloon angioplasty is not effective or causes complications, surgery can be performed on newborns, infants, children, or adults with severe or complex coarctation of the aorta.

Prevention of Coarctation of the Aorta

There is no known way to prevent coarctation of the aorta, as it is usually a congenital defect. However, some steps that may reduce the risk of developing or worsening the condition include:

• Avoiding smoking, alcohol, or drugs during pregnancy

• Getting regular prenatal care and screening for congenital heart defects

• Treating infections or illnesses that may affect the development of the fetus

• Maintaining a healthy weight and blood pressure

• Eating a balanced diet and exercising regularly

• Avoiding activities or sports that may cause chest trauma or strain the heart

• Having regular check-ups and follow-ups with a cardiologist

Most people with coarctation of the aorta can lead normal and active lives with proper diagnosis and treatment.