Midaortic Syndrome

Midaortic syndrome is a very rare condition in which part of the aorta (the heart’s largest blood vessel) that runs through the chest and abdomen becomes narrow. This can lead to lower blood flow in the chest, abdomen and lower limbs.

Midaortic syndrome is also sometimes called narrowing or coarctation of the abdominal aorta. A related condition called renovascular hypertension is high blood pressure that results from decreased blood flow to the kidneys. Both of these conditions are potentially life threatening and require expert care.

Watch this video of Heung Bae Kim, MD, co-director of the Midaortic Syndrome and Renovascular Hypertension Center at Boston Children's Hospital, explaining midaortic syndrome in more detail.

Most children with midaortic syndrome also have renovascular hypertension and have very high blood pressure that can be very difficult to control. Other symptoms of midaortic syndrome vary depending on the individual child but can include:

• Headaches
• Seizures
• Vision changes
• Abdominal pain that begins after a meal
• Discomfort or weakness in the legs after exercise
• Failure to grow properly

Some children with midaortic syndrome have related conditions, such as:

• Alagille syndrome
• Moyamoya disease
• Neurofibromatosis
• Williams syndrome

Clinicians use a number of tests to diagnose midaortic syndrome. In addition to measuring your child’s blood pressure, our doctors may recommend:

• Angiography
• Ultrasound
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)

The best treatment approach for midaortic syndrome depends on your child’s unique case. Our physicians will consider a number of factors in weighing treatment options, including:

• Your child’s age and overall health
• Specific symptoms
• Which blood vessels are affected and how extensively
• Whether your child also has renovascular hypertension

We may recommend one or more of the following treatments for your child:

• Medication to control blood pressure and improve the function of the heart, kidneys or both
• Minimally invasive endovascular treatments that offer faster recovery times, such as angioplasty or stenting (the placement of a special tube called a stent in a narrowed artery to hold it open).
• Bypass graft surgery, an operation that makes detours that go around narrowed arteries to create new paths for blood flow
• Autotransplantation, which moves one or both kidneys to a new location to improve blood flow
• Kidney transplant, which is performed when both kidneys are damaged to the point of causing irreversible kidney failure

MAGIC and TESLA procedures

In addition, Boston Children's physicians have pioneered two surgical procedures to treat midaortic syndrome in eligible patients: Mesenteric Artery Growth Improves Circulation (MAGIC) and Tissue Expander Stimulated Lengthening of the Arteries (TESLA).

Midaortic syndrome is a serious condition that requires urgent and thoughtful attention and care. The Midaortic Syndrome and Renovascular Hypertension Center at Boston Children’s Hospital is largest and most experienced multidisciplinary program dedicated to diagnosing and treating children with these conditions. Our team of specialists draws on expertise from nephrology, interventional radiology, cardiology, and vascular surgery to care for children with midaortic syndrome.

Our skilled clinicians offer highly precise diagnostic tests and innovative treatments for midaortic syndrome, including minimally invasive endovascular techniques such as angioplasty and stenting. Some patients may be eligible for MAGIC or TESLA, two pioneering approaches that were developed here at Boston Children’s.