The signs and symptoms of coarctation of the aorta depend on its seriousness. Children with serious aortic narrowing tend to show signs and symptoms earlier in life, while mild cases may not be diagnosed until adulthood.

Babies with severe coarctation of the aorta usually begin having signs and symptoms shortly after birth. These include:

• Pale skin
• Irritability
• Heavy sweating
• Difficulty breathing

Left untreated, aortic coarctation in babies may lead to heart failure and death.

Older children and adults with the condition often don't have symptoms, because they tend to have less severe narrowing of the aorta. If signs or symptoms appear, the most common sign is high blood pressure (hypertension) measured in the arm. Signs and symptoms may include:

• High blood pressure (hypertension)
• Shortness of breath, especially during exercise
• Headache
• Muscle weakness
• Leg cramps or cold feet
• Nosebleeds

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Coarctation of the aorta generally begins before birth. Although aortic coarctation can occur anywhere along the aorta, most people with the condition have what's called "juxtaductal" coarctation. This means that the coarctation is located near a blood vessel called the ductus arteriosus. Shortly after birth, the ductus arteriosus naturally closes. While it's not certain what causes coarctation of the aorta, it's possible that some of the tissue from the ductus arteriosus moves into the wall of the aorta. As the ductus arteriosis closes, it may cause the aorta to narrow.

Rarely, coarctation of the aorta may develop later in life. Severe hardening of the arteries (atherosclerosis) or a condition causing inflamed arteries (Takayasu's arteritis) may narrow your aorta, leading to aortic coarctation.

Coarctation of the aorta usually occurs beyond the blood vessels branching off the aorta to your upper body and before the blood vessels leading to your lower body. This often means you'll have high blood pressure in your arms, but low blood pressure in your legs and ankles.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Coarctation of the aorta often occurs along with other congenital heart defects, although doctors don't know what causes multiple heart defects to form together. If you or your child have any of the following heart conditions, you're more likely to have aortic coarctation:

• Bicuspid aortic valve. The aortic valve separates the left ventricle of the heart from the aorta. A bicuspid aortic valve has two leaflets instead of three.
• Ventricular septal defect. In this condition, there's a hole in the wall that separates the two ventricles of the heart. Oxygen-poor blood from the right ventricle mixes with oxygen-rich blood from the left ventricle, which pumps blood out to the body.
• Patent ductus arteriosus. While a baby is still in the womb, the ductus arteriosus is a blood vessel connecting the left pulmonary artery to the aorta, allowing blood to bypass the lungs. Shortly after birth, the ductus arteriosus usually closes. If it remains open, it's called a patent ductus arteriosus.
• Aortic valve stenosis. This is a narrowing of the valve that separates the left ventricle of the heart from the aorta. This means your heart has to pump harder to get adequate blood flow to your body. Over time, this can thicken the muscle of your heart and lead to heart failure.
• Mitral valve stenosis. This is a narrowing of the valve that lets blood flow through the left side of your heart. This means blood may back up into your lungs, causing shortness of breath or lung congestion. Like aortic valve stenosis, this condition can also lead to heart failure.

Coarctation of the aorta is also more common in those who have certain genetic conditions, such as Turner syndrome. Women and girls with this syndrome have 45 chromosomes, with one missing or incomplete X chromosome, instead of 46. About 10 percent of women and girls with Turner syndrome have aortic coarctation.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Seek medical help if you or your child have the following signs or symptoms:

• Severe chest pain
• Fainting
• Sudden shortness of breath
• Unexplained high blood pressure

While experiencing these signs or symptoms doesn't necessarily mean that you have a serious problem, it's best to get checked out quickly. Early detection and treatment may help save your life.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The age at which people with coarctation of the aorta are diagnosed depends on the severity of the condition. If the aortic coarctation is severe, it's usually diagnosed during infancy.

Adults and older children tend to have milder cases and usually appear healthy until a doctor detects:

• High blood pressure in your arms
• A blood pressure difference between your arms and legs
• A weak or delayed pulse in your legs
• A heart murmur — an abnormal whooshing sound caused by turbulent blood flow

Diagnostic tests
Tests to confirm a diagnosis of coarctation of the aorta include:

• Chest X-ray. X-rays produce pictures by passing an X-ray beam through your body, which is absorbed in different amounts by body structures. A chest X-ray may show an enlarged heart or a narrowing in the aorta at the site of the coarctation.
• Echocardiogram. Echocardiograms use high-pitched sound waves to produce an image of the heart. Sound waves bounce off your heart and produce moving images that can be viewed on a video screen. An echocardiogram may detect the location and severity of the aortic coarctation and can show other heart defects, such as a bicuspid aortic valve.
• Electrocardiogram (ECG). An ECG test records the electrical activity in your heart each time it contracts. During this procedure, patches with wires (electrodes) are placed on your chest, wrists and ankles. The electrodes measure electrical activity, which is recorded on paper or a computer monitor. If the coarctation of the aorta is severe, the ECG will show that you might have a thickened heart muscle (ventricular hypertrophy).
• Magnetic resonance imaging (MRI). An MRI scan is a test that uses a magnetic field and pulses of radio wave energy to make pictures of the body. An MRI of the chest will reveal the location of the coarctation of the aorta and determine whether it affects other blood vessels in your body.
• Cardiac catheterization. During this procedure, your doctor inserts a thin flexible tube (catheter) into an artery or vein in your groin and threads it up to your heart. A dye is injected through the catheter to make your heart structures visible on X-ray pictures. Cardiac catheterization helps determine the severity of the aortic coarctation.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Untreated coarctation of the aorta frequently leads to complications. Several of the complications are a result of long-standing high blood pressure caused by the aortic coarctation.

Complications of coarctation of the aorta include:

• High blood pressure
• Stroke
• Rupture of the aorta
• Premature coronary artery disease — narrowing of the blood vessels that supply the heart
• Cerebral aneurysm — weakened or bulging artery in the brain

In addition, if the coarctation of the aorta is severe, the heart may not be able to pump adequate blood to the organs of the body, resulting in the failure of organs such as the kidneys or liver.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Treatment options for coarctation of the aorta depend on your age when you're diagnosed and how narrowed your aorta is. Other heart defects may be repaired at the same time as aortic coarctation. Treatment approaches usually consist of surgery or a procedure called balloon angioplasty.

Surgery
There are several open-heart surgical techniques to repair aortic coarctation. Your doctor can discuss with you which type is most likely to successfully repair your or your child's condition. The options include:

• Resection with end-to-end anastomosis. This method involves removing the narrowed segment of the aorta (resection) followed by connecting the two ends of the aorta together (anastomosis).
• Patch aortoplasty. Your doctor may treat your coarctation by cutting across the constricted area of the aorta and then attaching a patch of synthetic material to widen the blood vessel. Patch aortoplasty is useful if the coarctation involves a long segment of the aorta.
• Left subclavian flap angioplasty. A portion of the blood vessel that delivers blood to your left arm, the left subclavian artery, may be used to expand the narrowed area of the artery.
• Bypass graft repair. This technique involves bypassing the narrowed area by inserting a plastic tube called a graft between the portions of the aorta.

Balloon angioplasty and stenting
Balloon angioplasty is an option for initially treating aortic coarctation or for treating re-narrowing (re-coarctation) that has occurred after surgery. During this procedure, your doctor inserts a thin flexible tube (catheter) into an artery in your groin and threads it up through your blood vessels to your heart. An uninflated balloon is placed through the opening of the narrowed aorta. When the balloon is inflated, the aorta widens and blood flows more easily. In some cases, a mesh-covered hollow tube called a stent is inserted to keep the narrowed part of the aorta open.

Medication
Medication isn't used to repair coarctation of the aorta, but may be used to control blood pressure before surgery. Although repairing aortic coarctation improves blood pressure, many people will still need to take medication even after a successful surgery.

Babies with severe coarctation of the aorta may receive a drug called prostaglandin E. This drug helps keeps the ductus arteriosis open, providing a bypass for blood flow around the constriction, until the coarctation is repaired.

After treatment
The most common long-term complication of coarctation of the aorta is high blood pressure. Although your blood pressure usually falls after the aortic coarctation has been repaired, it may still remain higher than normal. Occasionally, the segment of the aorta that has been repaired will become weak and bulge (aortic aneurysm) and may eventually rupture. In some cases, the coarctation will recur, possibly even years after treatment, but it's possible to have additional surgeries or procedures to correct the re-narrowing.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Coarctation of the aorta can't be prevented, because it's usually present at birth. However, if you or your child has a condition that increases the risk of aortic coarctation, such as Turner syndrome, another heart defect or a family history of congenital heart disease, early detection can help. Discuss the risk of aortic coarctation with your doctor.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Although coarctation of the aorta may be repaired, the condition requires careful follow-up throughout adulthood to help prevent complications and to monitor for recurrences. Here are a few tips for managing your condition:

• Get regular exercise. Regular exercise helps to lower blood pressure. Talk to your doctor about whether you need to restrict certain physical activities, such as weightlifting, which may temporarily raise your blood pressure.
• Consider pregnancy carefully. Before becoming pregnant, talk to your doctor to determine if you can undergo pregnancy safely. Women with aortic aneurysms due to coarctation of the aorta, even after repair of the coarctation, are at high risk of aortic rupture during pregnancy and delivery. If you have had aortic coarctation repair and are considering becoming pregnant, careful management of your blood pressure is important to help keep you and your baby healthy.
• Prevent endocarditis. Endocarditis is an inflammation of the inner lining of the heart or of its structures, caused by a bacterial infection. People with coarctation of the aorta are at risk of this infection because the abnormal tissue at the site of the coarctation is a good location for bacterial growth. Antibiotics had once been recommended before dental procedures to prevent endocarditis. But guidelines released in 2007 suggest that antibiotics likely are helpful only for those having major dental procedures who are most at risk of a poor outcome from infective endocarditis. Ask your doctor how the new guidelines apply to you.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.