Annex A > Chapter 3 - Developments in the UK, in the Diagnosis and Treatment of Congenital Heart Abnormalities in Children, 1984-1995 > The specific heart abnormalities and procedures referred to in the Inquiry > Coarctation of the Aorta
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Coarctation of the Aorta
Figure 2: Coarctation of the Aorta 
The problem
38 There is a narrowing of the aorta, usually just below the first main branches of the aorta to the head and arms. Coarctation of the Aorta usually occurs on its own, with no other associated abnormality. Commonly it is recognised in a baby between the ages of around 1 to 4 weeks. The narrowing causes the left ventricle to work much harder than normal in order to pump blood to the lower part of the body. Consequently the left ventricle may fail to pump blood adequately (heart failure). If the narrowing is less severe, the baby may not show signs of heart failure, but over a period of months or occasionally years, will usually develop a high blood pressure in the upper part of the body. This can have all of the serious complications commonly found in older people with high blood pressure. These complications include stroke, coronary artery disease, heart failure and kidney failure.
Diagnosis
39 The baby becomes very breathless and unwell. Coarctation is usually suspected when the cardiologist cannot feel the pulses in the legs. The diagnosis is confirmed by echocardiography. Occasionally it is necessary to proceed to cardiac catheterisation in order to be certain of the diagnosis.
Management
40 In the newborn baby who is in heart failure, an operation is undertaken as an emergency in order to relieve the narrowing of the aorta. It is almost always a closed operation but in some cases it may be necessary to use heart-lung bypass. The expected survival rate after surgery during the 1980s was reasonably good. It has improved during the 1990s, largely due to better facilities for accurate diagnosis, newer techniques and, particularly, improvements in post-operative care. It was less good during the 1970s, largely because post-operative intensive care was less sophisticated. Occasionally, coarctation can occur in association with several other common congenital heart abnormalities and when it does, the risks are compounded over and above the expected sum of the risks for coarctation and the other abnormality.
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