Aortic Arch Conditions
The aorta is the major artery that carries blood away from the heart to the body. Coarctation of the aorta is a type of congenital heart disease in which the aorta is narrowed. The normal aorta leaves the heart and goes up toward the head. In the upper part of the chest it then arches and goes down to the rest of the body. The appearance of the aorta in the chest is like a candy cane. The blood vessels that supply blood to the head and arms come off the arch of the aorta. A coarctation is a narrowing in the aorta near the takeoff of the blood vessel going to the left arm. This occurs where the aortic arch descends toward the body.
The most common problem caused by coarctation of the aorta is high blood pressure (hypertension). In many cases, the hypertension does not cause symptoms but is identified during routine doctor's visits.
In many patients, there are no symptoms. In some cases though, symptoms may develop and the symptoms that develop are different in each age group. In infants, coarctation of the aorta can cause heart failure and shock. In children and adolescents, some patients may have chest pain with exercise, cold legs or easily tired legs with exercise. Heart failure is uncommon though. Adults may have many of the same symptoms as children and adolescents, but are more likely just to have high blood pressure without any symptoms at all. Rarely, adults with high blood pressure caused by coarctation of the aorta may have chest pain, heart attacks, strokes or heart failure.
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CAUSES AND RISK FACTORS
WHO GETS COARCTATION OF THE AORTA?
Anyone can be born with coarctation of the aorta, but it is more common in males than females. Patients with abnormal aortic valves are more likely to have coarctation of the aorta. The normal aortic valve has three leaflets, but some valves have two leaflets and are called bicuspid valves. About 5% of patients with bicuspid valves have coarctation of the aorta but about 50% of patients with coarctation of the aorta have bicuspid valves. Patients with certain chromosomal abnormalities are more likely to have coarctation of the aorta. Women with Turner syndrome are more likely to have coarctation of the aorta.
WHAT HAPPENS BECAUSE OF COARCTATION OF THE AORTA?
The narrowing in the aorta prevents blood flow from getting to the abdomen and legs normally. In order to get blood to the lower body, the blood pressure above the coarctation has to rise. Even with higher blood pressure above the coarctation, severe coarctation results in decreased blood flow to the lower body. In order to get blood to the lower body, other blood vessels get bigger to allow blood to go around the obstruction. These are called "collaterals" and they can help make sure there is adequate blood flow to keep the abdominal organs and legs healthy. The impact of coarctation depends on how severely narrowed the aorta is. The high blood pressure that develops above the coarctation can be measured by checking the blood pressure in the arms. As with any other patient with high blood pressure, patients with coarctation can have problems related to the high blood pressure. Patients with high blood pressure due to coarctation are often much younger than the usual patient with high blood pressure.
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High blood pressure is the first clue that coarctation might be present. Normally, blood pressure in the legs is higher than the pressure in the arms. The narrowing of the aorta between the arms and legs causes the blood pressure in the legs to be lower. This difference in blood pressure is typical of coarctation of the aorta, and is an easy test to do at a doctor's office. If coarctation of the aorta is suspected, tests that can image the aorta will make the diagnosis. These tests include echocardiograms, CT scans, MRIs and cardiac catheterization. In infants with heart failure or shock, an echocardiogram is the first test used to make the diagnosis.
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Medications may be needed to control blood pressure before fixing the coarctation of the aorta. In adults with a mild coarctation of the aorta, medications may be all that is necessary, but most patients need a procedure to fix the coarctation. The goal of repair is to relieve the obstruction to blood flow. This is most commonly done with surgery. The surgeon can remove the narrowed area and either sews the ends back together, put a tube in the place where the narrowing was or use a patch to open up the area.
Newer technology has been developed to open the narrowed area with a balloon and/or stent. This is done with a catheter placed from the leg, which is removed after the procedure. The doctors taking care of a patient can decide whether surgery or a balloon procedure is best for that patient.
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OUR VASCULAR SURGEONS
Make an appointment at one of our Westchester Heart & Vascular locations. For physician information or to find a physician, call (877) WMC-VEIN (877-962-8346).
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