Coarctation of the aorta (COA) is a congenital heart defect that causes a part of the aorta, the primary artery in the human body to be narrower than usual. The aorta is responsible for blood circulation throughout the body. Dr Praveen Reddy B, Assistant Professor, Department of Cardiovascular and Thoracic Surgery, Amrita Hospital, Kochi, Kerala, says that people with this condition experience disruption in blood circulation to the lower half of their body, which can result in serious health issues. This condition could also cause multiple vascular complications, including a higher risk of brain strokes.
Complications due to coarctation of the aorta
Coarctation of the aorta leads to blood pressure variations, especially in the upper half of the body as the free flow of blood to the lower half is impaired. “As a result, the blood pressure in the left ventricle is higher than normal, and the heart has to work harder than usual to pump blood through this constriction. The overexertion of the heart could lead to hypertrophy (thickening) of the heart muscle and cardiac health complications,” shares Dr Srinivasa Prasad, senior consultant, interventional cardiologist, Fortis Hospital, Bannerghatta Road, Bangalore.
COA in infants
Dr Prasad explains that when a baby is in the mother’s womb, the right side of the heart handles the pumping of blood. As the fetus does not have functional lungs, oxygenated blood is supplied to them by the mother’s blood circulation.
As soon as the baby is born, their lungs get activated, so the left side of the heart must take over the function of pumping oxygenated blood. “But when there is a constriction in the aorta, resistance is felt on the left side of the heart (resistance develops in the blood vessels when something obstructs the smooth flow of blood),” says Dr Prasad. He adds that in such situations, the baby’s heart may not be able to tolerate this pressure and might start showing heart failure symptoms.
Coarctation of the aorta in adults
Coarctation of the aorta is seen in adults in rare cases. Moreover, sometimes those diagnosed with this condition and treated during childhood can develop it again later in life.
In adults, impaired blood circulation forces the heart to pump faster, leading to an increase in blood pressure. “One will observe increased blood pressure (BP) in the upper limbs, while the BP might be normal in the lower half of the body,” says Dr Prasad. Hence, in those living with this condition, blood pressure-related complications show up gradually.
People with COA might also have some abnormal swelling of blood vessels in the brain, called cerebral aneurysm. “These can suddenly rupture and cause intracranial bleeding and stroke,” adds Dr Prasad.
Symptoms of COA
Dr Reddy explains that for this condition, symptoms can vary depending on many factors. The most common presentation is a total circulatory failure. “The effects of coarctation start showing a few days or weeks after a baby is born. The child could present with circulatory shock, which requires emergency intervention,” he adds. In addition, babies with serious COA may have pale skin, irritability, heavy sweating and difficulty in breathing.
In babies and older people with COA, the pulse is significantly weaker in the legs and groin compared to the neck and arms, and a heart murmur can also be picked up through a stethoscope. Dr Prasad says that doctors usually suspect that young adults (less than 35 years of age) who have high BP and headaches could have COA. “Coarctation stenting, when performed at the right time, can ensure that their BP comes to normal. Following this, they can lead a completely normal life,” he adds. According to American Heart Association, adults with COA as well as with high blood pressure in the arms may also have headaches, renal problems, frequent miscarriages or lack of energy when using their legs.
Collateral blood circulation to naturally circumvent aortic complications
Experts explain that in the rare cases when coarctation is not very severe, a collateral switch development around the blocked area can be beneficial. Collateral circulation is the body’s way of working around a blockage in blood flow. Coronary collaterals, or natural bypasses, are connections between portions of the same or different coronary arteries.
Treatment of coarctation of aorta
Dr Prasad explains that if a newborn diagnosed with coarctation of the aorta is struggling to breathe, a surgical procedure that removes the narrowed portion of the artery and reconnects both ends of the aorta is recommended to ensure smooth blood circulation. He adds that the correction of this coarctation abnormality can be a near-cure. However, in case of a recurrence, an angioplasty is performed to keep the artery open for blood flow. Usually, balloon angioplasty is performed, where a catheter fitted with a balloon is inflated to open up the artery, after which a stent is placed in it to ensure that the artery stays open without any blockage.
What precautions should one with COA take?
“There is no way of predicting or preventing coarctation of the aorta. However, in some cases, it can be detected in a fetal scan performed as early as 20-21 weeks of gestation,” says Dr Reddy. He adds that COA, when detected, should be treated immediately as it is a life-threatening condition.
Experts emphasize that the success rate for intervention and surgery is good. If COA is detected in time and surgical interventions are taken, it can be managed. “Chances of needing further procedures after timely surgery is less,” says Dr Reddy.
Experts state that regular monitoring and keeping blood pressure in control is very important, as it can help in the long run and prevent any complications.
Takeaways
- Coarctation of the aorta is a genetic condition that causes the aorta to be narrower than usual.
- COA causes constriction of blood flow to the lower limbs or organs below the constriction.
- In a few days or weeks after a baby is born, the effects of coarctation start showing.
- Timely intervention is important. Early detection can help the baby live a healthier and longer life.
- When diagnosed with this condition, regular health checkups with your doctor and keeping your blood pressure under control are very important.
