Aortic Coarctation

What are the symptoms of coarctation of the aorta?

The symptoms of aortic coarctation depend on how narrow the aorta has become. Some infants have no symptoms because the coarctation (narrowing) is very mild. But symptoms can appear within the first two weeks of birth if the coarctation is moderate or severe and the ductus arteriosus (a special fetal blood vessel) closes.

Symptoms of aortic coarctation in infants

Symptoms in infants include:

Fast pulse.

Fatigue.

Gray or pale skin.

Heavy sweating.

Irritability.

Rapid or labored breathing.

Trouble breathing.

Trouble with feeding.

Severe coarctation in infants can lead to shock and even death if not recognized and treated promptly.

Symptoms of aortic coarctation in children

Most children don’t have any symptoms. They’re usually diagnosed after their provider notices they have high blood pressure.

Some children may have symptoms if their blood pressure is too high in their upper body or too low in their lower body. These include:

Headaches.

Nosebleeds.

Leg pain during exercise.

Symptoms of aortic coarctation in adults

Symptoms in adults are usually due to recoarctation of the aorta. This is aortic narrowing that returns sometime after a previous repair. Symptoms may include:

Headaches.

Kidney problems.

Frequent miscarriages.

Lack of energy when using your legs.

But these symptoms are linked with many other health issues in adults. So, having these symptoms doesn’t mean you have aortic coarctation. Call a healthcare provider to discuss any symptoms you have. They’ll give you a physical exam and run tests to diagnose what’s wrong.

What causes coarctation of the aorta?

The exact cause of coarctation of the aorta isn’t fully known. However, congenital heart defects are often caused by genetic changes that happen before birth. Babies with Turner syndrome have a higher risk of aortic coarctation and other defects that affect the left side of their heart.

Sometimes, environmental factors play a role in causing heart defects, too. These are factors related to the birthing parent. They include:

Having diabetes.

Being infected with rubella while pregnant.

Using recreational drugs, especially cocaine.

Using certain prescription medications, including anti-seizure drugs.

Being over age 35.

The role of the ductus arteriosus

The ductus arteriosus may cause coarctation of the aorta. The ductus arteriosus is a small artery that connects the fetal aorta and pulmonary artery. It helps your fetus get enough oxygen-rich blood during gestation when their lungs aren’t working yet.

Once your baby is born, their lungs start working. That means they don’t need the ductus arteriosus anymore. So, it usually closes up within a few days of birth. But when it closes, something may go wrong. Some tissue from the ductus arteriosus may blend in with tissue from their aorta. When this tissue tightens to close up the ductus arteriosus, it may narrow their aorta as well and lead to coarctation.

What is the most common site of coarctation of the aorta?

Coarctation of the aorta usually occurs in your baby’s descending aorta near their ductus arteriosus. But it can also happen in other parts of their aorta. These include other areas of the aortic arch or further down in your baby’s chest or belly.

Your baby’s aorta is a long, curved blood vessel that arches upward from the top of their heart and then curves down through their chest and belly. It’s shaped like a walking cane with a round handle. The “handle” curves upward (ascending aorta) and then downward (descending aorta). The top of that curve is called the aortic arch.

The location of aortic coarctation matters because it affects your baby’s symptoms. You can think of your baby’s aorta like a main road that has lots of intersections. At each intersection, another artery or group of arteries connects with the aorta and carries blood in a different direction.

Aortic coarctation often occurs between two major intersections. The first is where arteries branch off to the upper body. The second is where arteries branch off to the lower body. So, blood leaves your baby’s heart and travels along just fine. It reaches the first intersection and easily flows into the arteries that lead to your baby’s upper body. Meanwhile, some blood keeps moving along in their aorta. And soon it runs into trouble.

It’s like when construction forces a five-lane highway down to one lane. Only so many cars can pass through. It's the same with your baby’s aorta. That pinched, narrowed part can only let a little blood pass through. So, it’s harder for blood to reach the second intersection, where arteries carry blood to your baby’s lower body. The coarctation slows down blood flow in those arteries.

This is why the blood pressure in your baby’s arms and upper body will be high. But the blood pressure in their lower body and legs will be low. This blood pressure difference is a red flag that leads to an aortic coarctation diagnosis.