Coarctation of the aorta is a narrowing in the body’s main artery that makes the heart pump against extra resistance. The condition is usually present at birth, but its timing can feel unpredictable: some babies become critically ill within days, while others reach adolescence or adulthood before anyone notices a problem. The reason is simple—your body can temporarily “work around” the narrowing by raising blood pressure above it and building collateral vessels below it, until that compensation fails.
What makes coarctation important is not only the narrowing itself, but the lifelong effects it can leave behind: upper-body hypertension, strain on the left ventricle, and a higher risk of aortic complications even after a successful repair. This guide explains how coarctation develops, what symptoms to watch for at different ages, how it is diagnosed, which treatments work best, and how to stay healthy long-term.
Table of Contents
- What is coarctation of the aorta?
- What causes it and who gets it?
- Symptoms and complications by age
- How is it diagnosed?
- Treatment options and timing
- Living with coarctation long term
What is coarctation of the aorta?
Coarctation of the aorta (often shortened to “CoA”) is a fixed narrowing of the aorta, most commonly near the aortic isthmus—just beyond the branches that supply the head and arms and near where the ductus arteriosus connects in fetal life. Think of it as a kink or tight segment in a high-pressure hose: blood flow beyond the narrowing falls, while pressure before it rises. The heart’s left ventricle, which pumps blood into the aorta, must work harder, often leading to thickening of the heart muscle (left ventricular hypertrophy).
Why location matters
The typical pattern is high pressure above the narrowing and lower pressure below it. That distribution explains classic findings:
- Higher blood pressure in the arms than the legs
- Stronger pulses in the arms than in the femoral arteries
- Cold feet, leg fatigue, or poor growth of lower-limb circulation in severe cases
Over time, the body can develop “detour routes” called collateral vessels, especially through intercostal and internal mammary arteries. Collaterals can improve leg perfusion but may also mask symptoms until adolescence or adulthood.
Different clinical forms
Clinicians often describe coarctation in functional terms:
- Critical (ductal-dependent) coarctation in newborns: blood flow to the lower body relies on the ductus arteriosus staying open. When the ductus closes in the first days of life, the baby can rapidly deteriorate.
- Discrete coarctation: a short, tight segment that causes a significant pressure gradient.
- Long-segment hypoplasia: a longer narrowed portion of the arch, sometimes seen with other arch abnormalities.
- Recurrent coarctation (recoarctation): re-narrowing after prior repair, which can happen months to years later.
What “repair” does—and does not—mean
Repair removes the obstruction or reduces it dramatically. However, coarctation is often a lifelong aortic condition, not just a one-time blockage. Even after an excellent repair, many patients remain prone to upper-body hypertension, exercise-induced blood pressure spikes, aortic dilation, or aneurysm formation. That is why long-term follow-up is part of the diagnosis, not an optional extra.
What causes it and who gets it?
Coarctation of the aorta is usually congenital, meaning it arises during fetal development. The exact cause is not always identifiable, but several well-described patterns explain why it occurs and why it often appears alongside other heart abnormalities.
How the narrowing forms
Two mechanisms are commonly discussed:
- Developmental arch abnormality: the aortic arch does not grow to the expected diameter in a segment, leaving a narrowed area that becomes more important as blood flow demands rise after birth.
- Ductal tissue involvement: tissue related to the ductus arteriosus can extend into the aortic wall near the isthmus. When the ductus constricts after birth (a normal transition), that tissue can tighten the adjacent aorta, worsening the obstruction.
Both mechanisms can coexist, which helps explain why some newborns become symptomatic precisely when the ductus closes.
Common associated heart conditions
Coarctation is frequently part of a broader left-sided heart pattern. Conditions that commonly occur with CoA include:
- Bicuspid aortic valve: a two-leaflet aortic valve instead of three, which can later lead to stenosis, regurgitation, or aortic dilation.
- Ventricular septal defect (VSD): a hole between the ventricles that can change symptoms and timing of intervention.
- Aortic arch hypoplasia: a smaller-than-normal arch segment.
- Mitral valve abnormalities and complex left-sided lesions in syndromic cases.
These associations matter because they influence surgical approach, imaging strategy, and long-term surveillance.
Risk factors and populations with higher prevalence
Most cases are sporadic, but higher risk is seen in certain settings:
- Turner syndrome: coarctation and bicuspid aortic valve are notably more common.
- Family history of congenital heart disease: the risk is higher than in the general population, though coarctation is not usually inherited in a simple pattern.
- Male sex: coarctation is diagnosed more often in males, though females can be affected, especially in syndromic contexts.
What does not cause coarctation
Coarctation is not caused by exercise, diet, stress, or typical infections. Those factors can affect how it presents (for example, high blood pressure being discovered during a sports physical), but they do not create the narrowing. The more practical question is: who is at risk for complications once coarctation exists? The biggest predictors are obstruction severity, age at diagnosis, associated lesions (especially bicuspid aortic valve), and long-term blood pressure control after repair.
Symptoms and complications by age
Coarctation can look like completely different conditions depending on age. Newborns may present with shock. Teenagers may look like “healthy athletes with high blood pressure.” Adults may present with headaches or early cardiovascular disease. Understanding age patterns helps you recognize when coarctation should be on the checklist.
Newborns and infants
Critical coarctation often becomes obvious in the first week or two of life, particularly as the ductus arteriosus closes. Typical signs include:
- Poor feeding, sweating, or tiring during feeds
- Rapid breathing or grunting
- Pale or cool lower body, weak femoral pulses
- Decreased urine output
- Lethargy or sudden collapse
This can progress to heart failure and shock quickly. It is a medical emergency.
Children and adolescents
Many children have few symptoms until a clinician measures blood pressure or checks pulses. Clues include:
- High blood pressure in the arms (sometimes discovered during routine checks)
- Headaches, nosebleeds, or dizziness
- Leg fatigue, cramps, or “heaviness” during running
- Cold feet or poor endurance compared with peers
- A heart murmur detected on exam
Older children may also develop collateral circulation, which can reduce leg symptoms but does not eliminate the risks of hypertension and aortic strain.
Adults
Adults may present with:
- Persistent hypertension, especially if it began young or resists typical medications
- Headaches or migraine-like symptoms
- Exercise intolerance or chest discomfort
- Leg claudication (pain with walking that improves with rest)
- A new murmur or abnormal imaging found incidentally
In some adults, coarctation is discovered only after complications occur.
Complications clinicians watch for
Key complications—both before and after repair—include:
- Systemic hypertension: often persists even after successful repair, especially if diagnosed later in life.
- Left ventricular hypertrophy and heart failure: from chronic pressure overload.
- Aortic aneurysm or dissection: the aortic wall may remain vulnerable, particularly near repair sites or in people with bicuspid aortic valve–related aortopathy.
- Recoarctation: re-narrowing after repair, which can be silent until blood pressure rises again.
- Stroke risk factors: severe hypertension and vascular fragility can increase risk over time.
- Endocarditis (select contexts): risk varies; it is not a universal concern for every repaired patient, but it remains part of clinical decision-making.
Red flags that need urgent evaluation
Seek urgent care for severe chest/back pain, fainting, sudden severe headache with neurologic symptoms, rapidly worsening shortness of breath, or signs of shock in an infant. These symptoms require immediate evaluation regardless of known history.
How is it diagnosed?
Diagnosis starts with a careful physical exam but usually depends on imaging to define anatomy, severity, and associated lesions. Because coarctation can be missed for years, clinicians often rely on a few high-yield “tells” that prompt targeted testing.
Physical exam clues that matter
The classic findings arise from the pressure difference across the narrowing:
- Arm blood pressure higher than leg blood pressure
- Delayed or weak femoral pulses compared with radial pulses (radio-femoral delay)
- A systolic murmur, often heard on the back between the shoulder blades
- Signs of left ventricular strain in more advanced disease
A practical point: accurate blood pressure measurement is part of diagnosis. Clinicians may repeat measurements in both arms and at least one leg, using appropriate cuff sizes and calm conditions.
Echocardiography as the first-line test
Transthoracic echocardiography is often the starting imaging tool, especially in children. It can:
- Visualize parts of the aortic arch and the narrowed segment
- Estimate gradients using Doppler flow velocities
- Evaluate the left ventricle and detect hypertrophy or dysfunction
- Identify associated defects (bicuspid aortic valve, VSD, arch hypoplasia)
Echo may be limited in older patients because the distal arch and descending aorta can be difficult to image fully.
CT or MRI for full anatomic mapping
Cross-sectional imaging is often used to define:
- Exact location and length of narrowing
- Aortic arch anatomy and collateral vessels
- Repair-site anatomy (after surgery or stenting)
- Aneurysms, dilation, or other aortic wall concerns
MRI is often preferred for repeated surveillance because it avoids radiation, while CT can provide very high spatial resolution and is sometimes favored for stent evaluation or urgent settings.
Cardiac catheterization when hemodynamics or intervention is planned
Catheterization can directly measure the pressure gradient across the coarctation and evaluate the entire aorta. It is commonly used when:
- Noninvasive tests are inconclusive
- Planning stent placement or balloon angioplasty
- Assessing complex anatomy or suspected recoarctation
Diagnosis is more than “yes or no”
Clinicians document severity using multiple inputs: measured gradients, imaging-defined narrowing, ventricular response, and symptoms. A person with extensive collaterals can have a lower measured gradient but still have significant anatomic disease. That is why experienced centers integrate anatomy and physiology rather than relying on one number.
Treatment options and timing
Treatment is aimed at relieving obstruction, protecting the aorta, and reducing long-term cardiovascular risk. The “best” approach depends on age, anatomy, associated defects, and whether this is native coarctation or recurrent narrowing after prior repair.
Emergency stabilization in newborns
In critical neonatal coarctation, the immediate goal is restoring blood flow to the lower body and reducing cardiac strain. Typical steps include:
- Maintain or reopen the ductus arteriosus with prostaglandin infusion under intensive monitoring.
- Support breathing and circulation as needed (oxygen, ventilation, careful fluids, and medications that support heart function).
- Rapid imaging to define anatomy and plan intervention.
This is time-sensitive because organ perfusion can decline quickly when ductal flow disappears.
Surgical repair
Surgery is common in infants and young children and in complex arch anatomy. Techniques vary, but the intent is the same: remove or bypass the narrowed segment while preserving a durable aortic shape. Common approaches include:
- Resection with end-to-end anastomosis (often favored in many pediatric repairs)
- Extended end-to-end repair for longer narrowing and arch involvement
- Patch augmentation in selected settings (used cautiously because certain patch strategies have been associated with aneurysm risk)
- Subclavian flap techniques in selected cases
Surgical decisions also account for associated heart defects that may be repaired in the same operation.
Catheter-based therapy: balloon angioplasty and stenting
In older children, adolescents, and adults, transcatheter options are often considered:
- Balloon angioplasty: can widen the narrowed segment but may carry risks of recoil or aneurysm formation depending on anatomy and age.
- Stent placement: commonly used in adolescents and adults because it can provide a controlled, stable expansion and can be re-dilated later as needed. Covered stents may be chosen in higher-risk anatomy to reduce rupture risk.
The choice between surgery and stenting is individualized. A center’s experience matters, as does the patient’s aortic size, curvature, and wall characteristics.
Managing hypertension before and after repair
Blood pressure control is a treatment pillar, not an afterthought. Even after successful relief of obstruction, many patients have persistent hypertension or exercise-induced blood pressure surges. Clinicians often use:
- Beta-blockers, ACE inhibitors/ARBs, or calcium channel blockers (tailored to the patient)
- Home blood pressure monitoring with clear targets
- Exercise testing in some patients to assess blood pressure response under stress
What to expect after intervention
Most patients experience improved leg perfusion and reduced gradients, but follow-up remains essential. Repair does not “graduate” you from care; it changes the risk profile and shifts attention to surveillance for recoarctation, aneurysm formation, and long-term blood pressure control.
Living with coarctation long term
Long-term management focuses on protecting the aorta and reducing cardiovascular risk over decades. Many people feel well after repair, which can make follow-up feel optional. In coarctation, follow-up is part of prevention: it catches silent problems before they become emergencies.
Follow-up testing you can expect
A typical long-term plan may include:
- Regular clinic blood pressure checks and review of home readings
- Periodic echocardiography to track ventricular function and associated valve disease (said differently: it is not just about the repair site)
- Cross-sectional imaging (MRI or CT) at intervals to evaluate the repair segment and the rest of the aorta for dilation or aneurysm formation
- Rhythm assessment if palpitations occur or if the heart has remodeled
Your schedule depends on age, repair type, blood pressure control, and any aortic or valve findings.
Hypertension: the long-term “main character”
Coarctation-related hypertension is often more than a simple mechanical issue. Even after repair, vascular stiffness and altered baroreceptor signaling can persist. Practical strategies include:
- Measure blood pressure correctly (rested, seated, correct cuff size).
- Track trends, not single numbers; share logs with your clinician.
- Treat sleep apnea and avoid heavy stimulant use if blood pressure is difficult to control.
- Aim for a heart-healthy diet pattern with sodium awareness and adequate potassium intake through foods when medically appropriate.
For many patients, consistent blood pressure control is the single most effective step to reduce later stroke and aortic complication risk.
Exercise and activity guidance
Most people can and should be active. However, recommendations vary by anatomy and blood pressure response. Common themes include:
- Favor aerobic conditioning (walking, cycling, swimming) and gradual progression.
- Be cautious with very heavy isometric lifting (max-effort power lifting) if blood pressure spikes are a concern.
- Consider an exercise test if you are returning to intense sport, have symptoms, or have a history of hypertension.
The goal is safe fitness, not restriction by default.
Pregnancy and family planning
Pregnancy increases blood volume and cardiac output, which can stress the aorta and blood pressure control. Many patients do well with careful planning, but the safest course is:
- Pre-pregnancy evaluation of aortic anatomy and blood pressure control
- Medication review (some antihypertensives are not used in pregnancy)
- Coordinated care with maternal-fetal medicine and adult congenital cardiology when appropriate
When to seek medical care quickly
Call urgently for chest/back pain, fainting, sudden severe headache, new neurologic symptoms, rapidly worsening shortness of breath, or markedly elevated blood pressure with symptoms. If you have a repaired coarctation and develop new leg fatigue or a rising arm-to-leg blood pressure difference, contact your clinician—recoarctation can be subtle at first.
References
- 2020 ESC Guidelines for the management of adult congenital heart disease 2021 (Guideline)
- Coarctation of the Aorta: Modern Paradigms across the Lifespan 2023 (Review)
- 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines 2022 (Guideline)
- A Systematic Review and Meta-analysis on Stenting for Aortic Coarctation Management in Adults 2025 (Systematic Review)
- Coarctation of the Aorta 2024 (Clinical Overview)
Disclaimer
This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. Coarctation of the aorta can become urgent—especially in newborns, during pregnancy, or when severe hypertension or aortic complications occur. If you or your child develops severe chest or back pain, fainting, sudden severe headache, neurologic symptoms, marked shortness of breath, signs of shock, or rapidly worsening weakness, seek emergency care. Always discuss testing intervals, exercise limits, blood pressure targets, and treatment decisions with a qualified clinician who can evaluate your individual anatomy and risks.
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