Coarctation of the aorta

What is coarctation of the aorta?

Coarctation of the aorta means part of your aorta is narrower than it should be. The narrowing stops your blood from flowing as easily as it should, so your heart works harder to pump blood through the body. This can cause your left ventricle (one of your heart’s main pumping chambers) to become thicker and your heart to become weaker.

The aorta is the main artery in your body. It carries blood filled with oxygen and nutrients away from your heart to the rest of your body.

Coarctation of the aorta is a type of congenital heart disease, which means it’s something you’re born with. Many people with coarctation of the aorta live a normal life, but over time it can cause other problems with your heart like heart failure and high blood pressure.

What are the symptoms of coarctation of the aorta?

Symptoms are different for adults and children who have coarctation of the aorta. It may first be noticed in childhood if you have high blood pressure or difficulty breathing, caused by your heart working harder.

Most adults who find out they have coarctation of the aorta will not have any symptoms. It’s often picked up during a routine test like having your blood pressure checked.

If you do get symptoms, they may include:

• high blood pressure
• shortness of breath
• tiredness in legs
• leg cramps or cold feet.

High blood pressure

High blood pressure is one of the most common symptoms of coarctation of the aorta in adults. If you have coarctation of the aorta, your blood pressure is often higher in the top part of your body like your arms and lower in your legs and ankles. This is because the narrowed part of your aorta is usually found after your blood has already been sent to the upper part of your body. So, your upper body gets much more blood while the lower body gets less.

If your doctor thinks you might have coarctation of the aorta, they may check your blood pressure in your arms and legs to see if there’s any difference.

How is coarctation of the aorta diagnosed?

Coarctation of the aorta is a condition that you're born with. It can sometimes be diagnosed before you’re born during an ultrasound (a test that creates detailed images of a baby during pregnancy).

It's not always noticed before or when you're born, however. It can also be first noticed and diagnosed later on in your life. This sometimes happens during tests done by your doctor like listening to your chest or taking your blood pressure. Your doctor will send you for extra tests if they notice something abnormal. The tests may include:

• CT scan
• ECG
• MRI
• chest X-ray
• echocardiogram.

Your doctors may ask you to have a certain type of heart catheterisation to assess your heart in more detail. Speak to your doctor if you have questions about this test, other tests or diagnosis.

Learn more about risk factors for congenital heart disease.

Heart murmur

Some people with coarctation of the aorta have an extra noise when their heart beats. This is called a heart murmur and it’s caused by your blood not flowing smoothly through your heart. Your doctor may hear this when they listen to your chest and send you for an echocardiogram to check if everything’s okay with your heart.

How is coarctation of the aorta treated?

There are different options for treating coarctation of the aorta. The treatment depends on the size and location of your coarctation. You can discuss your best option with your doctors and they’ll explain what’s going to happen and answer any questions you may have.

Balloon dilatation and stenting

The most common treatment for coarctation of the aorta is balloon dilatation and stenting. This procedure involves keyhole surgery, where you’ll usually be put under local anaesthetic (you’ll be awake but not feel any pain). Sometimes you may be given general anaesthetic (you’ll be asleep) but this will be discussed with you before the procedure. The procedure usually goes like this:

• Doctors put a balloon into a thin tube (a catheter). They make a small cut in the top of your leg so they can put the catheter into your artery. Then they push the catheter up until it gets to the narrowed area in your aorta.
• The balloon inside the catheter is blown up to open the narrow part of the aorta.
• A stent (a small tube made of metal mesh) is pushed into the narrowed part of the aorta to keep it open. The balloon is let down and taken out along with the catheter. The stent stays inside the aorta, keeping it open.

Most people can go home within a few days of having this procedure. Before you leave hospital, your recovery team will have a chat with you about your recovery and what you can and cannot do. It’s normal to feel tired afterwards but most people find that they’re back to normal after a few days.

Surgery

Surgery may be an option if balloon dilatation and stenting is not suitable for you. There are a few options to repair your coarctation through surgery:

• End-to-end repair. The narrowed part of your aorta is cut out and the ends are stitched back together again.
• Patch repair. The narrow part of your aorta is opened and a patch made of a special material is stitched into place to make it wider.
• Subclavian flap repair. The narrow part of your aorta is opened and the blood vessel that delivers blood to your left arm (called the subclavian artery) is folded over and stitched into place to widen the narrowed area.
• Conduit repair. A tube called a conduit is attached from the top of the aorta to the bottom. Blood can then flow through this tube without having to go through the narrowed part of the aorta.

For each of these surgeries, you’ll be given a general anaesthetic. If you're worried about surgery, read our tips to help you feel better.

Living with coarctation of the aorta

After it’s been repaired, most people living with coarctation of the aorta live a normal life. You’ll be offered appointments at a congenital heart disease specialist clinic, where they check your heart for the rest of your life. Even if you feel well, going to these appointments is important because you may get changes in your heart before you get symptoms.

There are a few other things to keep in mind when living with coarctation of the aorta, like:

Re-coarctation of the aorta

Even if you’ve had your aorta repaired before, it’s possible to get coarctation of the aorta again at any point in your life. This is called ‘re-coarctation of the aorta’ and it happens because the same part of the aorta narrows or another part gets too large. You may need to have treatment to repair the aorta again if this happens.

Rib notching

When diagnosing coarctation of the aorta, you may hear your doctor mention something called ‘rib notching’. This is when your left ventricle (because it’s thickened) pushes against your ribs, moving them slightly.

Rib notching does not cause you any harm because the movement is so small and can only be seen on a chest X-ray. Not everyone with coarctation has this, but your doctor may mention it because it can help them diagnose you.

Staying active

Most people who have had their coarctation repaired can enjoy exercise. It’s still best to talk to your doctor or cardiology team about the activity you’d like to do. There are some activities that might not be suitable because they put too much strain on your heart.

Find out why staying active can help you sleep better, be more energetic and reduce stress.

Emotional support

Living with a congenital heart disease like coarctation of the aorta can be uncertain and emotionally challenging for you and your loved ones. Learn about different ways of coping from people who know. 

Family planning

If you’re pregnant or planning to have a family, it's important to let your doctor know so you can get support and specialist care. There may be more risk of problems if you have coarctation of the aorta.

Endocarditis

This is a rare infection that causes inflammation of the valves and inner lining of the heart. People with congenital heart conditions, including coarctation of the aorta, have an increased risk of endocarditis. To reduce the risk of developing endocarditis, your doctor or dentist might recommend antibiotics before or after any surgeries or procedures.

Heart Helpline and more support

If you have any questions or concerns, speak to your healthcare team. You can talk to them about anything, even if it feels uncomfortable or embarrassing. Most people feel much better once they do.

Here are some other ways you can get support:

• Learn more about congenital heart disease.
• Speak to our cardiac nurses on Heart Helpline by phone, callback, email or online chat (Monday to Friday, 9am to 5pm).
• Talk with others with heart conditions by joining a support group or online community.