Coarctation is a narrowing (stenosis) of an artery, most commonly referring to coarctation of the aorta: a localised narrowing of the aorta, typically just beyond where the subclavian artery branches off to supply the left arm. This narrowing restricts blood flow to the lower body and forces the heart to pump much harder to maintain adequate circulation.
Coarctation of the aorta is a congenital heart defect and one of the more common congenital cardiac conditions, accounting for approximately 5 to 8% of all congenital heart disease. It may be detected antenatally by fetal echocardiography, present in the newborn period with circulatory collapse when the ductus arteriosus closes, or be picked up incidentally in older children and adults through hypertension or a heart murmur. The classic finding on examination is a significant difference in blood pressure between the arms and legs.
Treatment is by open surgical repair (resection of the narrowed segment and reconstruction of the aorta) or by catheter-based intervention (balloon dilation and stenting), depending on the anatomy and the patient’s age. Both approaches achieve excellent results in most cases. After successful repair, re-narrowing (re-coarctation), persistent hypertension, and aortic aneurysm formation at the repair site can occur, requiring lifelong follow-up.
Adults with repaired coarctation are at elevated cardiovascular risk and are cared for in adult congenital heart disease (ACHD) specialist services. Regular blood pressure monitoring, imaging of the repair site, and management of cardiovascular risk factors are standard elements of long-term care.
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