Introduction
Coarctation of the aorta (COA) is when the aorta becomes narrow or constricted. The aorta is the largest blood vessel in the body and carries blood away from the heart to the rest of the body. When the aorta becomes too narrow, the left side of the heart must work harder to pump blood through.
COA is a congenital defect. This means there is a difference in how your child’s heart develops during pregnancy.
Untreated COA can cause:
- high blood pressure
- the heart to grow larger than normal
- coronary artery disease
- kidney problems
- dissection or rupture of the aorta – a life-threatening condition where the aorta tears apart.
Some children will have COA that does not cause any symptoms. Other children may need surgery to treat the condition.
Signs and symptoms
Symptoms of COA can range from very mild, to severe.
Some children will not have any symptoms at all. The condition can sometimes be found during a check-up with your child's doctor.
Children with COA might have symptoms like:
- high blood pressure that is not caused by anything else
- a heart murmur - an abnormal sound that comes from the heart
- a weak pulse or heartbeat in the groin area
- cold legs and feet
- difficulty breathing
- difficulty feeding from the breast or bottle
- heavy sweating
- skin that is more pale than usual
- headaches
- chest pain
- muscle weakness.
See your local doctor if your child shows any signs or symptoms of COA.
Go to your nearest emergency department or call triple zero (000) for an ambulance if your child has abnormal chest pains or difficulty breathing.
Diagnosis
Your child's doctor will take a medical history and check your child's symptoms. They will refer you to a heart specialist, or cardiologist, to test for and diagnose COA.
The cardiologist will listen to your child's heart and pulse and check their blood pressure. They will also order tests and scans like:
- echocardiogram — a test that uses sound waves to create a picture of the heart and its circulation
- x-ray, MRI, and CT scans – to take detailed photos of the heart's structure.
COA is usually found early, but some children may not have symptoms until they are older.
Treatment
Once COA is diagnosed, it needs to be treated quickly.
Severe cases of COA are usually found shortly after a baby is born and need immediate surgery to fix.
Most children who have surgery to fix COA will recover well but will still need to see their cardiologist regularly throughout their lives.
Surgery
Surgery to treat COA aims to:
- make the narrow part of the aorta bigger
- remove the narrow part and reconnect the ends of the aorta.
To make the narrow part of the aorta bigger, your child’s surgeon will do a procedure called a balloon angioplasty or dilation. Balloon angioplasty is a closed heart procedure, which means it can be done without opening your child’s heart or chest wall.
The balloon angioplasty is done under a general anaesthetic. This means your child will be asleep and will not feel any pain during surgery.
In the balloon angioplasty, a long, thin tube called a catheter is inserted into a blood vessel in your child’s leg or arm.
On the end of the catheter is a tiny balloon. The balloon is inflated once the catheter reaches the narrow part of the artery.
The inflated balloon opens the blood vessel, allowing blood to flow through normally. The balloon is then removed.
Sometimes, the surgeon will place a small tube-shaped wire cage where the artery has been widened. This is called a stent. The stent is used to make sure the aorta does not become narrow again.
Management
Care after surgery
Most symptoms of COA should go away very soon after surgery because the blockage in the aorta is gone.
Your child may take a week or two to feel better after surgery, and they will need to avoid some physical activities for several weeks or months while their body heals.
Your child may need to continue medication for high blood pressure after surgery. This should settle down in time.
COA can sometimes return after treatment, so your child must have regular appointments with their cardiologist to check their blood pressure and any symptoms.