Coarctation of the Aorta

This is a narrowing in the main artery to the body usually just below the origin of the left artery. It may be associated with abnormalities of the ventricular septum, aortic and mitral valves. The narrowing eases the work on the left ventricle, raises the pressure in the top half of the body, and reduces it in the lower half. If severe, it can present early in life with breathlessness, difficulty in feeding and occasionally, very rapid deterioration in the baby’s health. More moderate obstruction produces a murmur, high blood pressure, and weak pulses in the legs. With mild obstruction, a soft murmur is often picked up at school, and examination reveals weak pulses in the legs.

If the child has symptoms or high blood pressure, operation to relieve the obstruction is necessary at that stage. If the obstruction is very mild, regular review in Out¬patients is necessary. The operation is carried out ugh the left chest, without using the heart/lung machine. The narrow area can be directly removed, occasionally it is patched with artificial material or the first part of the left arm artery may be used to effect the repair.

Long term follow-up is necessary to check on blood pressure and for any evidence of re-narrowing. This re-narrowing is more likely to occur if the operation is performed during the first few months of life. If this happens, then balloon stretching of a narrow area with a catheter test may be necessary or very occasionally, further re-operation.

Some centres have recently been stretching initial coarctation with balloon catheters in older children and in young adults, ballooning and stenting of the narrow area has been used with very encouraging early results. Antibiotic prophylaxis is required long term as coarctation is frequently associated with aortic and mitral valve problems.

Coarctation of the aorta

Victoria & Tasmania