The aorta is the body's major artery that carries oxygen-rich blood to the whole body except the lungs. The upper branches of the aorta carry blood to the upper body (arms and head). After which, blood goes to the lower body (abdomen and legs) by the descending aorta. The narrowed segment called coarctation is usually located on the descending thoracic aorta, right after the origin of the left subclavian artery. This narrowing can increase blood pressure in your arms and head and reduce blood pressure in your legs, thus seriously straining your heart. Aortic valve abnormalities often accompany coarctation.
Mild coarctation of the aorta rarely has symptoms. However, if the narrowing becomes severe, you may not tolerate exercise well and may experience headache or leg cramps after exertion. At the same time, you may also experience dizziness or palpitations. Do inform your cardiologist of any activity-related symptoms.
The cause of coarctation of aorta is unknown and it usually begins before birth and rarely develops late in life.
While doctors do not know what causes multiple heart defects to form together, coarctation of the aorta often occurs along with other congenital heart defects. You are more likely to have aortic coarctation if you or your child have certain heart conditions, such as
bicuspid aortic valve,
patent ductus arteriosus, holes in the wall between left and right sides of the heart,
aortic valve stenosis,
aortic valve regurgitation,
mitral valve stenosis or
mitral valve regurgitation.
In most cases, you are not required to limit your activity if your arm and leg blood pressures are normal. However if your blood pressure is still high, you may need to avoid certain strenuous exercise. Please ask your cardiologist if you should limit any activity.
Prevention of Infective Endocarditis (IE)
The incident of IE in congenital patient is higher than general population. Therefore it is important for congenital patient to maintain good oral, dental and skin hygiene as primary prevention. Cosmetic tattooing and piercing are discouraged due to the risk of IE. Antibiotic prophylaxis is considered for patient at highest risk for IE before surgery and dental procedures. Please discuss with your congenital team for the latest update on the antibiotic prophylaxis.
Family planning and pregnancy
Women with repaired coarctation rarely encounter any difficulties except if there is residual aortic valve abnormality, hypertension or significant residual coarctation. Please consult your cardiologist before starting a family.
The coarctation narrowing can be repaired by surgery or non-surgical balloon dilation. Aortic coarctation may reoccur even after successful surgical repair or balloon dilation done in infancy or adulthood. Recurrent coarctation can be treated either surgically or non-surgically using balloon dilation or stenting.
Even after coarctation repair, your blood pressure may still be high or you may be at risk of developing high blood pressure (hypertension) in later years. Regular blood pressure monitoring in both arms and legs are performed during your routine cardiology visits. Periodical investigations are also performed to check for re-coarctation.
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