January 26, 2023 Author : José Roquette The aorta is the largest artery in the body. It begins in the heart and carries oxygenated blood from the left ventricle to the systemic circulation. Coarctation of the aorta is a localized stenosis or narrowing of the caliber of this artery , usually near the insertion area of the ductus arteriosus. It is estimated that it occurs in 4 out of every 10 000 newborns, being more common in males than in females; In most cases it is a congenital defect, that is, it is present at birth; It is a developmental disorder occurring during pregnancy, but its cause is not known; In many cases, other congenital heart defects are also present; More frequently the stenosed area of the aorta is posterior to origin of the arteries that irrigate the head and arms, but it can also be anterior, although this is rare; Depending on its severity, coarctation of the aorta can be detected at birth or be identified later, even in adulthood; Coarctation of the aorta is associated with hip pathology in adults. Possible complications of coarctation of the aorta Coarctation of the aorta causes a reduction in the normal flow of blood . Depending on the location, extend and severity of the stenosed area, the symptoms it causes, and its consequences are more or less serious. Mild coarctation of the aorta may have no symptoms and may be accidentally diagnosed in adulthood during a medical exam performed for another reason. A marked reduction in blood flow causes an overload on the left ventricle: To be able to pump blood, the left ventricle has to contract harder; Over time, there is an increase in pressure in the left ventricle, its muscle walls become increasingly thick and in the long term weakened, and cardiac arrest can occur. Possible complications of coarctation of the aorta are serious and include, for example, aneurysms of the aorta or a cerebral artery, cerebral hemorrhage, dissection (rupture) of the aorta, coronary disease, stroke. Symptoms and diagnosis of coarctation of the aorta Coarctation of the aorta is often diagnosed at birth or shortly afterwards when there are symptoms or signs that raise suspicion , for example: Low values of oxygen in the blood by oximetry; Breathing difficulty; Difficulty eating; Excess sweat; Pulse and blood pressure changes, including lower blood pressure in the lower limbs; Cardiac changes on auscultation. In young people and adults , coarctation of the aorta can also have other symptoms, for example: Chest pain; Headache; Hypertension, sometimes with different values when measured in the legs or arms, which is related to the location of the stenosis before or after the origin of the arteries that irrigate the head and arms; Leg cramps, muscle weakness; Frequent nosebleeds. When there is a suspicion of coarctation of the aorta, an echocardiogram is usually performed, which can reveal structural problems of the heart and vessels, as well as blood flow disorders. Other tests that may be prescribed are: Chest X-ray; Electrocardiogram; Cardiac magnetic resonance imaging: Angiography. Treatment of coarctation of the aorta Regardless the age at which the diagnosis of a coarctation of the aorta, it must be treated by restoring the caliber of the aorta . Treatment can be done by: Cardiac surgery In this surgery, the stenosed area of the aorta is removed and the two ends with normal caliber are then connected reconstructing the artery and allowing normal blood flow. Balloon or stent angioplasty In this procedure, a catheter that carries a balloon or a stent is introduced into a femoral artery (in the groin) and directed to the stenosed area. Once in place, the balloon or stent is expanded to widen the aorta. Angioplasty can be reserved for restenosis, which can occur after surgery, often many years later. All people with diagnosed coarctation of the aorta, whether or not they have symptoms, whether or not have been treated, need lifelong cardiology follow-up . Meet the cardiac surgery clinical team from Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
