Coarctation of the aorta

For a minority of patients who have no symptoms and a relatively mild obstruction, regular observation and monitoring by a cardiologist with expertise in congenital heart disease may be all the treatment that is necessary for coarctation of the aorta, an abnormally narrow aorta. A typical evaluation would include a thorough physical exam, electrocardiogram, chest X-ray, echocardiogram, and an exercise test. An MRI or CT scan may be necessary to get a more detailed look at the narrowed portion of the aorta. A Holter monitor or event recorder may also be used to check for irregular heart rhythms. More detail about these tests can be found in the Testing section.

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Most people however, need treatment to survive beyond their mid-30s. Heart surgery has been the standard treatment for coarctation of the aorta for over 35 years; however, heart catheterization techniques are now available as well. Selecting a procedure depends on many factors, including the patient's overall health, the severity of the symptoms, as well as the size, location, and degree of obstruction. Catheterization is used for selected patients whose anatomy is favorable and who wish to avoid an operation. For some, heart surgery remains the preferred treatment option.

Catheterization, using balloon angioplasty, is a treatment alternative for some people. Once the catheter is in place, an inflatable balloon device is inserted into the narrowed segment of the aorta. The device is inflated to mechanically widen the aorta and improve blood circulation. In some instances, a small metal tube called a stent may be placed in the narrowed area after the dilation to help maintain the blood flow pathway. It is not unusual for a surgical repair performed in childhood to need to be redone in adulthood with coarctation of the aorta.

Surgeons usually use one of three general procedures to repair a coarctation depending upon the individual patient's anatomy in relation to the section of the aorta involved in the defect. An end-to-end anastomosis involves removing the narrowed section of the aorta and then reconnecting the two ends. Other repairs involve opening the aorta and placing a Dacron patch to widen the narrowed area: This is called a patch augmentation procedure. Alternatively, a tube graft can be used to replace the narrowed portion of the aorta with a Dacron tube. Occasionally, the surgeon may bypass the narrowed section completely by connecting a tube from the ascending aorta above the aortic valve to the descending aorta beyond the coarctation. This is known as an ascending-to-descending aortic bypass graft.

Although medications cannot widen the aorta, they are commonly prescribed to treat hypertension associated with coarctation of the aorta. Residual hypertension is very common even after an excellent surgical repair. ACE inhibitors, vasodilators, beta-blockers, or calcium channel blockers are frequently used. More detail can be found in the section on Medication.