Recurrent narrowing of the aorta at the site of the original surgical repair

The aorta sometimes narrows down from the scar that forms at the original surgical site. Alternatively sometimes the aorta at the repair site (or adjacent to the repair site) does not grow well enough.

Recurrent coarctation will usually cause high blood pressure and will make the heart muscle pump harder to get blood past the narrowed area. Both of these issues can cause major problems in the longer term.

Recurrent narrowing can often be opened up with a heart catheter procedure to implant a stent (a tube made of a wire mesh) to hold open the narrowed area. Some people will need another operation to fix the narrowing.

There isn’t usually anything you can do to stop this from happening. Making sure your blood pressure is monitored regularly is important as high blood pressure is often the first sign of recurrent coarctation.

The blood pressure in your body is higher than normal for someone your age.

It can be a sign of recurrent narrowing at the coarctation repair site, but it is also common in people who’s coarctation repair site is fine.

We know that the blood vessels never function in a completely normal way after coarctation repair and we think that this makes people more prone to developing high blood pressure.

Although most people with high blood pressure feel fine, in the longer term it puts you at increased risk of heart attacks and strokes, and can also cause weakness of the heart muscle.

We would generally do tests like an echo scan or MRI to make sure that you do not have recurrent narrowing at the coarctation repair site. If this looks OK, then we would usually recommend lifestyle changes and/or blood pressure lowering medicines.

There are several things that you can do to improve your blood pressure. Firstly, doing regular exercise and remaining active. Secondly avoiding becoming overweight. Thirdly being careful to eat a healthy diet, particularly avoiding too much salt in your diet and not drinking too much alcohol.

The aortic valve normally has three parts, called cusps, which open and close to control blood being pumped out of the heart. With a bicuspid valve, there are only two parts to the valve, rather than three.

Between 50-75% of people with coarctation of the aorta are also born with a bicuspid aortic valve.

Bicuspid aortic valves are more likely to become leaky (aortic regurgitation) or to become stiff and not open as well as they should (aortic stenosis). With time, both of these conditions can cause people to become sick, and can cause problems with the function of the heart. People with bicuspid aortic valves also frequently develop enlargement of the first part of the aorta, which can be dangerous if it becomes severe.

If a bicuspid aortic valve becomes severely leaky or severely narrowed then you may need an operation to replace the valve. Likewise if your aorta becomes severely enlarged, that may require surgery too.

Bicuspid aortic valve is something that is present from birth, so there is nothing that you can do to avoid it. If you do have a bicuspid valve then you should have monitoring to make sure that it is not becoming leaky or narrowed. Your doctor will advise how this will be done.