Coarctation of the Aorta

Coarctation of the aorta

The aorta is the main blood vessel that carries blood from the heart to the rest of the body. Coarctation of the aorta is a condition where there is a narrowing of the aorta. This narrowing acts like a dam, causing high blood pressure in the top half of the body and reducing blood flow to the rest of the body.

Unrepaired Coarctation

Surgically Repaired Coarctation

This condition is usually picked up in childhood, but is occasionally diagnosed for the first time in adulthood, usually because someone is noted to have high blood pressure.

Treatment in childhood

If your coarctation was picked up in childhood it will usually have been treated with an operation, moistly done through the side of the chest and these usually have good long-term outcomes. For older children/teenagers and adults, insertion of stents to ‘open’ the narrowing via a ‘keyhole’ technique is the usual treatment.

Follow up in adult life

We recommend that everybody who has had a coarctation repair is followed up lifelong. This is because we see the following problems in some patients;

• High blood pressure – we know that if you had a coarctation repair in childhood, even with good results, you still have a higher chance of developing high blood pressure at an earlier age – this can lead to early heart disease or stroke.
• Re-narrowing at the site of the previous coarctation – the material used to repair the coarctation may not have expanded as you grew, therefore some patients develop
  re-narrowing and some require further treatment for this.
• Aneurysm formation – some patients develop a weakness and swelling of the aortic wall at the site of the previous surgery.
• Aortic valve problems – many patients with coarctation of the aorta also have abnormalities of the aortic valve (main outlet valve of the heart).

We usually recommend that you have routine MRI surveillance. These are repeated around every 2-5 years depending on what we see on the first scan and type of repair. Sometimes a CT scan can be required.

It is important to keep an eye on your blood pressure from time to time. Sometimes we may request a 24 hour blood pressure monitor but we would recommend buying your own blood pressure monitor and self-monitoring.

Treatment in adult life

If you are found to have a coarctation in adult life you will be assessed to see if it is suitable for treatment with a keyhole technique to place a stent in the narrowing. If you have had a previous coarctation repair and we find it is re-narrowed and you have high blood pressure we will discuss with you whether you should have further treatment. Blood pressure control is very important.

Maintaining a healthy lifestyle and taking medication as prescribed is very important in reducing your risks associated with high blood pressure in the long-term.

Coarctation of the Aorta – YouTube

Important points to consider

• Exercise: Regular exercise, to a moderate level, is encouraged. It is good for overall health and can also help to keep blood pressure lower / under control. Activities such as walking, cycling, and swimming are ideal and it is important to warm up and cool down. It is best to avoid really intense cardiovascular exercise, for example distance running, or sudden ‘bursts’ of strenuous activity.
• Heavy weight lifting should be avoided, but it is usually okay to go to do low level weights at the gym, ensuring that you are able to do 3 sets of 12-15 repetitions without any strain/breath-holding.
• Remember it’s important to come for your review appointments.
• To reduce your risk of infection in the heart (infective endocarditis) you must look after your teeth. Please visit the dentist at least once every 12 months. If you need invasive dental treatment within 6 months of stent insertion, you need to take antibotics before your dental treatment. Please ask your doctor or specialist nurse if this applies to you.
• Do have your blood pressure checked in the right arm only. The blood pressure in your left arm is likely to be falsely low.
• Talk to us before you get pregnant. This is to enable the cardiologist to assess your heart in more detail prior to pregnancy and to arrange further tests if necessary.
• The chances of having a baby born with congenital heart disease are slightly increased from the general population if you have congenital heart disease yourself. The risk is generally quoted as being about 4-5%, compared to 1% for the general population. Your cardiologist can discuss this with you in clinic prior to planning a family. We can offer a specialised scan of your unborn baby’s heart at 18-20 weeks, which can detect any major abnormality of the heart.
• Insurance: It can be difficult for people with congenital heart disease to get some types of insurance. Travel insurance may be more expensive and people who have congenital heart disease often struggle to get any type of life insurance. There are some more sympathetic insurers who can be identified and contacted through the Somerville Heart Foundation. We would recommend seeking advice from a specialist insurance advisor before applying for life insurance.

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