Coarctation of the Aorta

This defect refers to a narrowing of the aorta just beyond the takeoff of the left subclavian artery (the artery which supplies blood to the left arm). The diagnosis is generally made after the discovery of elevated blood pressure in the arms and diminished blood pressure or pulses in the lower extremities. A murmur may also be present. Coarctation of the aorta can be associated with other cardiac abnormalities, such as a bicuspid aortic valve, ventricular septal defect, subaortic stenosis, or a dilated aorta.

Patients with significant coarctation of the aorta may be offered surgical repair or a stent. There are several different forms of surgical repair, including:

• Excision of the narrowed segment of the aorta with an end-to-end anastomosis
• Subclavian turndown, in which the left subclavian artery is used in the repair
• Patch aortoplasty, in which the narrowed segment of aorta is enlarged with a patch
• Use of a bypass graft

All of these repairs require ongoing follow up to detect any potential late problems such as recurrent narrowing at the site of repair, the development of a localized bulge, or aneurysm, at the repair site, or worsening of an associated defect.

Patients found to have a significant residual coarctation should undergo correction of this abnormality. Whether this should be done with surgery or with a stent will depend on the specific anatomy and the experience of the ACHD team.

Patients who underwent repair later in life may have persistent hypertension requiring treatment. Women with coarctation of the aorta should undergo careful evaluation prior to pregnancy.