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Health condition · Clinically reviewed

Coarctation of the aorta, a narrowing that shapes a lifetime of care.

From the collapsing neonate to the young adult with unexplained hypertension - one anatomic problem, two very different stories, and a shared need for lifelong ACHD follow-up.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against ESC adult congenital heart disease guidance, NICE and specialist ACHD centre standards.

  • 03

    Current for 2026

    Reflects modern UK practice including endovascular stenting, cardiac MRI planning and lifelong ACHD follow-up.

Key facts

Coarctation of the aorta at a glance.

The essentials, in plain English - what it is, who it affects, and how it is treated in the UK today.

  • What it is

    A congenital narrowing of the aortic arch, typically at or just distal to the left subclavian artery near the ductus arteriosus insertion (juxtaductal).

  • How common

    Accounts for roughly 5 to 8 per cent of all congenital heart disease, with a male predominance.

  • Two clinical faces

    Critical (infantile, preductal) collapsing neonate versus adult (juxtaductal, postductal) hypertension and murmur presentation.

  • Key association

    Bicuspid aortic valve in around 50 to 80 per cent of patients, and coarctation in around 30 per cent of Turner syndrome.

  • Anatomic gold standard

    Cardiac MRI or CT angiography for 3D planning, arch dimensions, collaterals and aneurysm surveillance.

  • Treatment

    Surgery for neonates and complex arches; balloon angioplasty and stent placement increasingly first line in older children and adults.

Why this guide matters

A lifelong diagnosis, not a one-off repair.

Coarctation can be fixed, but the aorta, the valve above it and the blood pressure that goes with it all need long-term attention.

  • It sits in a family of anomalies

    Bicuspid aortic valve, VSD, PDA and Shone complex often travel together - looking for one means looking for all.

  • It is a hypertension diagnosis

    Blood pressure often stays raised after repair. Long-term control protects the heart, brain and repaired aorta.

  • It needs an ACHD centre

    Adult congenital heart disease centres bring together the surgery, imaging and cardiology that keep patients well for decades.

How the diagnosis is made

From four-limb BP to a full anatomic map.

The steps a UK paediatric or ACHD team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Four-limb blood pressure

    An arm to leg gradient greater than 20 mmHg raises immediate suspicion and drives further imaging.

  2. 02

    Assessing

    Femoral pulses and radiofemoral delay

    Weak or absent femoral pulses and radiofemoral delay are hallmarks in older children and adults.

  3. 03

    Assessing

    Auscultation and general exam

    Interscapular systolic murmur, ejection click of a bicuspid valve, and Turner features guide the differential.

  4. 04

    Confirming

    Chest X-ray

    Cardiomegaly, rib notching of the third to eighth ribs and the classic 3 sign of the aortic arch may be seen.

  5. 05

    Confirming

    Echocardiogram

    The bedside gold standard for the gradient and for associated bicuspid valve, VSD or PDA.

  6. 06

    Confirming

    Cardiac MRI or CTA

    The anatomic gold standard for arch geometry, collateral vessels and aneurysms before intervention.

  7. 07

    Screening

    Head and neck MRA plus genetics

    Circle of Willis screening for berry aneurysms and karyotype or microarray to look for Turner, Marfan or Loeys-Dietz.

Typical timeline: from suspicion to a full anatomic map in days, not weeks.

Symptoms

What coarctation actually looks like.

The classic mix of neonatal collapse, weak femoral pulses, unexplained hypertension and interscapular murmurs - and the features that mean it is time to escalate.

  • Neonatal collapse

    Critical coarctation presents with shock, cyanosis, acidosis and poor feeding as the ductus arteriosus closes.

  • Weak or absent femoral pulses

    A classic sign at every age, often with radiofemoral delay in older children and adults.

  • Differential saturations

    A gap between upper and lower limb oxygen saturations in a newborn can be the first clue.

  • Unexplained hypertension

    Young adults with high blood pressure, headache and nose bleeds should always have coarctation excluded.

  • Interscapular systolic murmur

    A murmur heard between the shoulder blades, sometimes with continuous collateral bruits over the chest wall.

  • Leg fatigue and cool feet

    Reduced flow beyond the narrowing can cause claudication style leg fatigue on exercise.

  • Asymptomatic murmur in childhood

    Many are picked up during routine examination for another reason before symptoms develop.

  • Red flag - heart failure or stroke

    Late presentations can include heart failure, intracranial haemorrhage, aortic rupture or endocarditis.

Treatment

How coarctation is treated in the UK.

Prostaglandin and surgery for the critical neonate, catheter based angioplasty and stents for older children and adults, and lifelong ACHD follow-up for everyone.

  • Prostaglandin E1 infusion

    For the critical neonate, prostaglandin maintains ductal patency and systemic perfusion while surgery is arranged.

  • Resection and end-to-end anastomosis

    The classic Crafoord repair, and extended end-to-end for arch hypoplasia, remains the mainstay in infants.

  • Subclavian flap aortoplasty

    The Waldhausen technique uses the left subclavian artery as a flap to widen the narrowed segment in small infants.

  • Interposition graft or bypass

    A tube graft or left subclavian to descending aortic bypass is used for long segment or complex disease.

  • Balloon angioplasty

    For older children and adults with native or recurrent coarctation, delivered in a specialist congenital cath lab.

  • Endovascular stent placement

    Covered or bare stents are increasingly first line in older children and adults, with excellent short and mid term results.

  • Hybrid and arch reconstruction

    Combined surgical and catheter approaches, with sternotomy for arch reconstruction in complex anatomy.

  • Lifelong ACHD follow-up

    Adult congenital heart disease review for recoarctation, aneurysm at the repair site, residual hypertension and LV hypertrophy.

What this guide is based on

The sources behind every claim on this page.

UK and European specialist society standards and national commissioning guidance, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, cardiologist or ACHD team knows your history and imaging and can tell you which parts apply to you. If in doubt, get seen.

  • European Society of Cardiology. Guidelines for the management of adult congenital heart disease.

  • NICE. Clinical knowledge summaries and specialist commissioning for congenital heart disease.

  • NHS England. Congenital heart disease service standards and ACHD network specifications.

  • Turner Syndrome Support Society and BSPED. Cardiac screening and surveillance in Turner syndrome.

Red flags

When coarctation needs urgent attention.

Most people with coarctation are followed safely in ACHD clinics. These are the situations that cannot wait.

  • Neonatal collapse

    Shock, acidosis and absent femoral pulses in a newborn need emergency prostaglandin and specialist transfer.

  • Severe uncontrolled hypertension

    Very high blood pressure in a young adult, especially with a differential between arms and legs, needs urgent assessment.

  • Sudden severe headache

    A thunderclap headache in someone with known coarctation raises the possibility of a ruptured berry aneurysm.

  • Chest or interscapular pain

    New tearing pain in a patient with prior repair may signal aneurysm formation or dissection at the repair site.

  • Fever with a known cardiac lesion

    Prolonged fever raises the possibility of infective endocarditis and needs blood cultures and echocardiography.

  • Heart failure symptoms

    New breathlessness, orthopnoea or leg swelling deserves urgent cardiology review to exclude decompensation.

  • Pregnancy with unrepaired coarctation

    High risk pregnancy that needs joint ACHD and specialist obstetric input before conception where possible.

  • Turner syndrome diagnosis

    Every new Turner diagnosis needs cardiac screening for coarctation, bicuspid valve and aortopathy.

  • Post-repair loss of pulses

    New weakening of femoral pulses or a rising arm to leg gradient can mean recoarctation and needs imaging.

Living with it

A repaired aorta, a long life to plan for.

Four things make the biggest day-to-day difference - staying inside the ACHD network, treating blood pressure properly, moving within sensible limits, and planning pregnancy in advance.

A quiet reminder

A repair is a beginning, not an ending.

Regular follow-up catches recoarctation, aneurysm and hypertension long before they cause harm.

  1. 01 Follow-up

    Stay in the ACHD network

    Lifelong adult congenital heart disease follow-up picks up recoarctation, aneurysm and hypertension early.

  2. 02 BP

    Treat blood pressure properly

    Hypertension often persists after repair. Beta blockers, ACE inhibitors or ARBs are commonly used long term.

  3. 03 Exercise

    Move, within sensible limits

    After a successful repair most activity is unrestricted. Intense isometric work is avoided if there is an aortic aneurysm.

  4. 04 Plan

    Plan pregnancy in advance

    Pre-conception counselling with an ACHD centre and specialist obstetric team keeps mother and baby safer.

Frequently asked

Everything we get asked about coarctation.

Quick answers on presentation, imaging, surgery, stents, hypertension and pregnancy.

  • What is coarctation of the aorta?

    A congenital narrowing of the aortic arch, most often just beyond the left subclavian artery near where the ductus arteriosus inserts. It obstructs blood flow to the lower body and drives high blood pressure above the narrowing.

  • How is it usually picked up?

    Critical coarctation shows up as neonatal collapse when the ductus closes. Milder forms are found later as a murmur, unexplained hypertension in a young adult, weak femoral pulses or a large arm to leg blood pressure gradient.

  • What conditions are associated with it?

    Bicuspid aortic valve is the most common association, seen in around 50 to 80 per cent of patients. Around 30 per cent of Turner syndrome patients have coarctation, and links exist with VSD, PDA, LVOT obstruction, aortic root aneurysm and berry aneurysms of the Circle of Willis.

  • How is it treated?

    Critical neonates need prostaglandin E1 to keep the duct open and urgent surgical repair, typically resection with end-to-end anastomosis or a subclavian flap aortoplasty. Older children and adults are often treated with balloon angioplasty and stent placement in a specialist congenital cath lab.

  • Does treatment cure the problem?

    Repair relieves the obstruction but coarctation is a lifelong diagnosis. Around 10 to 20 per cent of patients develop recoarctation, some develop aneurysms at the repair site, and residual hypertension is common. Regular ACHD follow-up is essential.

  • What about pregnancy and endocarditis?

    Pregnancy is possible after successful repair but needs pre-conception counselling, blood pressure and aortic imaging, and delivery planning with a specialist obstetric team. Routine endocarditis prophylaxis is not recommended after repair under current UK guidelines, but any prolonged fever needs prompt review.

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