What is Coarctation of the Aorta?
Coarctation of the Aorta is a congenital anomaly whereby the aorta is narrow and this put the left ventricle under a lot of stress. Coarctation might be found in isolation or with additional cardiac lesions, such as ventricular septal defect, bicuspid aortic valve, patent ductus arteriosus, atrioventricular canal defects, transposition of the great arteries, or left-sided obstructive heart defects, including hypoplastic aortic arch.
Since it is generally present by birth, it is also referred as congenital defect and the intensity may range from mild to severe. In many cases it might not be detected until adulthood.
Symptoms of Coarctation of the Aorta
Symptoms of Coarctation of the Aorta depends on the severity of the condition and mostly people doesn’t show any symptoms at all. Children with serious aortic narrowing may show signs and symptoms earlier in life, but mild cases with no symptoms probably won’t be examined until adulthood. If aortic Coarctation is left untreated might lead to heart failure or death. Children with severe coarctation of the aorta may begin having signs and symptoms shortly after birth, some of the symptoms of coarctation of Aorta include:
- Pale skin
- Difficulty breathing
- Heavy sweating
- Difficulty in feeding
- Cold feet and/or legs
Patients with less severe symptoms may skip diagnosis and the signs and symptoms in early stages of the life. Here are some of the indications to consult a doctor:
- Unexplained high blood pressure
- Severe chest pain
- Sudden shortness of breath
Causes Coarctation of the Aorta:
Doctors are not sure about how congenital heart defect like coarctation of aorta may occur and it’s usually considered a chance mechanism. Though some congenital heart defects may have a genetic link that causes heart problems to occur more often in certain families.
It’s rare to develop coarctation of the aorta later in life. Traumatic injury might lead to coarctation of the aorta. Rarely but possibly true, severe hardening of the arteries (atherosclerosis) or a condition causing inflamed arteries (Takayasu’s arteritis) can narrow the aorta, leading to aortic coarctation.
The enlargement (dilatation) of the aorta to greater than 1.5 times than the normal size is known as Aortic aneurysm. Aortic aneurysm are mostly located in the abdominal aorta, but can possibly be found in the thoracic aorta. This cause weakness in the wall of the aorta and increase the risk of aortic rupture.
Why is it a Concern?
Coarctation of the aorta causes several problems if left untreated:
- Left ventricle needs to work harder in effort to move blood through the narrowing in the aorta. Eventually as a result of this, left ventricle is no longer able to handle the extra workload, and it fails to pump blood to the body efficiently.
- Children may have headaches from too much pressure in the vessels in the head, or may experience cramps in the legs or abdomen from too little blood flow in that region. The kidneys may not make adequate urine since they require a certain amount of blood flow and a certain blood pressure to perform this task.
- Walls of the ascending aorta, any of the arteries in the head and arms or aortic arch may become weakened by high pressure. Spontaneous tears in any of these arteries can cause a stroke or uncontrollable bleeding.
Methods used to Diagnose Coarctation of Aorta
Diagnosis of the aorta coarctation requires various tests and these may include:
- Echocardiogram: This is an ultrasound imaging of the heart which will reveal the narrowing in the aorta. Even the pressure on either side of the narrowing as well as the force with which the heart is contracting and how strong the heart muscle is pumping can be measure. This scan could be able to tell any other heart defects which may also be congenital.
- Chest X-ray: It may show that they fluid on the lungs if there is heart failure. It may also show some ‘notching’ (or grooves) on the ribs if collateral blood vessels have developed.
- Electrocardiogram (ECG): ECG records the electrical activity of the heart. People with coarctation of the aorta shows deviation in the results from the healthy functioning heart.
- Magnetic resonance imaging (MRI): Details of the structure of the heart and the large blood vessels around it can be obtained by using magnetic rays.
- Cardiac catheterization: In Cardiac catheterization is a thin, flexible, hollow tube is used. This tube is passed in the chambers of heart as well as the main blood vessels of the heart (coronary arteries). This helps to obtain the difference in pressure on either side of the narrowing which can be measured to look at how severe the coarctation is.
Treatment for Coarctation of the Aorta
The specific treatment for Coarctation of the aorta will be determined by your doctor according to the severity of the symptoms including Child’s overall health and medical history, extent at which disease is spread and Child’s tolerance for specific medications, procedures, or therapies. With the repair of narrowed vessels Coarctation of the aorta is treated. Some of the options are as follows:
- Interventional Cardiac Catheterization (Balloon Angioplasty): In this procedure the child is sedated and a thin and flexible tube known as catheter is inserted into a blood vessel in the groin and guided to the inside of the heart. Once the catheter is in the heart, the cardiologist will pass an inflated balloon through the narrowed section of the aorta so the area will be stretched open. A small device, called a stent, may be placed in the narrowed area after the balloon dilation to keep the aorta open.
- Repair through Surgery: coarctation of the aorta can be repaired through surgery and the procedure is performed under general anesthesia. The narrowed area is either surgically removed, or made larger with the help of surrounding structures or a patch.
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