Coarctation of the Aorta | Diagnosis & Treatment

How is coarctation of the aorta diagnosed?

The first line of diagnosis for coarctation of the aorta is a clinical exam, beginning with obtaining the child’s vital signs. The pediatric cardiologist obtains a four-limb blood pressure — measuring the blood pressure in both arms and both legs.

Coarctation of the aorta is suspected when the doctor notes a lower blood pressure in the legs. The child’s leg or foot pulses will be weak and therefore difficult for the doctor to feel. Other tests that help with the diagnosis — or with planning for treatment — may include:

Can coarctation of the aorta be diagnosed prenatally?

Coarctation of the aorta can sometimes be detected prenatally by fetal echocardiogram. But the aorta isn’t usually obstructed in the fetus because of the open ductus arteriosus (the fetal connection that ensures blood flow between the aorta and the pulmonary artery). The obstruction can become evident after birth once the ductus arteriosus closes.

How is coarctation of the aorta treated?

Coarctation of the aorta is treated by removing or patching the narrow part of the vessel. Newborns who are very sick and require care in the cardiac intensive care unit (CICU) may need urgent repair of the coarctation. 

For most infants, surgery is the standard treatment. The surgeon cuts out the narrowed segment and sews the two healthy ends of the aorta back together, establishing normal blood flow through the vessel. 

If the child also has a large ventricular septal defect, our surgeons usually repair the defect at the same time as the coarctation. If there's a bicuspid aortic valve, it will need to be followed by your cardiologist to make sure that no blockage (stenosis) or leakage (regurgitation) develop later.

Some patients have narrowing of the aortic arch as well. In this case, our surgeons will repair the arch and coarctation at the same time using the heart/lung machine. Depending on the anatomy, this repair can be achieved with all natural tissue or a patch.

In a small percentage of patients, the narrowing can return. In that small number of cases, a catheterization with balloon dilation is very effective. Rarely, a stent is required.

What is the long-term outlook for children with coarctation of the aorta?

The long-term outlook for children with coarctation of the aorta is excellent. Nearly all children who've had surgery for coarctation of the aorta will live normal, healthy lives.