Coarctation of the Aorta

Coarctation of the aorta refers to a distinct area of the aorta that is narrowed or constricted. In some children, the entire aortic arch (the part of the aorta that distributes blood to the upper body) is narrowed -- this is called aortic arch hypoplasia. These conditions make it difficult for blood to pump through the aorta and to the rest of the body. Left untreated, the heart’s left ventricle becomes too thick, which can lead to life-threatening complications.

Diagnosing Coarctation of the Aorta and Aortic Arch Hypoplasia
Severe cases of coarctation of the aorta are usually identified shortly after birth. The most common signs include low levels of oxygen in the blood, and/or higher blood pressure readings in your child’s arms compared to their legs. In milder cases, it may take months or years before signs or symptoms appear.

An echocardiogram -- an ultrasound of the heart’s structure -- usually confirms a diagnosis. In some cases, doctors may recommend an electrocardiogram, a chest X-ray, a CT scan or angiogram, cardiac catheterization, or other tests or procedures.

Coarctation of the aorta and aortic arch hypoplasia are treated with different surgical approaches.

Thoracotomy and Coarctectomy
A procedure called a lateral thoracotomy is a common approach for an uncomplicated case of coarctation. Compared with traditional open-heart surgery, a thoracotomy is less invasive for two main reasons. First, it does not require the use of a heart-lung bypass machine. Second, surgeons remove the narrowed portion of the aorta (this is called a coarctectomy) through a small incision on the side of the chest between the ribs, instead of through the breastbone. Then they use special stitching techniques to rejoin the two ends of the blood vessel and reduce the risk of future narrowing. 

Sternotomy
A sternotomy is usually recommended to repair aortic arch hypoplasia. This open-heart surgery requires separating the sternum (or breastbone) to access the heart. Pediatric heart surgeons remove or open the narrowed segment of the aorta, and then use a patch to create a new aortic arch that allows better blood flow.

If your child requires a sternotomy, they may benefit from an advanced method called Sustained Total All-Region (STAR) perfusion. This technique, developed at Duke, keeps the heart beating, does not require lowering the patient’s body temperature, and maintains blood flow to all organs throughout the surgery. In addition to providing surgeons with real-time feedback about the heart’s function during the procedure, STAR perfusion has been shown to reduce bleeding after surgery and speed recovery.  

Endovascular Angioplasty
During this minimally invasive procedure, an interventional cardiologist makes a small incision in the groin, inserts a thin, flexible tube called a catheter into a blood vessel, and guides it to the narrowed part of the aorta. Then a small balloon on the end of the catheter is inflated to expand the area. In some cases, a mesh metal tube called a stent is left behind to keep the aorta open.

Endovascular repair is best for children who are unable to undergo surgery or older patients with a repeat coarct.

Follow-Up Care
Even after repairing the coarct surgically, your child may still have high blood pressure and need anti-hypertensive medication. Your doctor will recommend regular follow-up appointments to monitor blood pressure and check for signs of a repeat coarct.

Among the Best Surgical Outcomes in the U.S.
Duke is one of the nation's best hospitals for newborns and children with congenital heart defects. Our pediatric heart surgeons perform hundreds of operations every year on very sick patients who require advanced, complex care. Our patient survival rates are among the highest in the U.S. 

Advanced Surgical Techniques
Our pediatric cardiac surgeons have expertise in (and in some cases have pioneered) advanced techniques for repairing children’s hearts -- from the tiniest newborns through young adults. 

Team Approach
Your child’s care team will include pediatric heart surgeons, pediatric cardiologists, interventional cardiologists, imaging specialists, anesthesiologists, and others who collaborate to provide the highest standard of care. Every child undergoing heart surgery at Duke is evaluated by this team of specialists, who recommend the best treatment approach for your child.