Aortic coarctation


Aortic coarctation

Description, Causes and Risk Factors:

The aorta is the major artery that carries blood away from the heart to the body. Here is how a healthy heart and aorta work: Blood that needs oxygen comes from all over the body and enters the right side of the heart, which pumps it to the lungs. The lungs fill the blood with oxygen, and this oxygen-rich blood returns from the lungs to the left side of the heart. The left side of the heart finishes by pumping the blood out through the aorta. From the aorta, the blood travels through arteries that reach all of the body's organs and tissues, bringing them oxygen. Then the blood returns to the heart through veins and restarts the cycle.

Aortic coarctation

Aortic coarctation is a narrowing of the aorta most commonly found just distal to the origin of the left subclavian artery. Most patients with coarctation have juxtaductal coarctation. Older terms, such as preductal (infantile-type) or postductal (adult-type) are often misleading. Other cardiac defects may also occur when coarctation is present, typically occurring on the left side of the heart. When a patient has a coarctation, the left ventricle has to work harder. Since the aorta is narrowed, the left ventricle must generate a much higher pressure than normal in order to force enough blood through the aorta to deliver blood to the lower part of the body. If the narrowing is severe enough, the left ventricle may not be strong enough to push blood through the coarctation, thus resulting in lack of blood to the lower half of the body.

Coarctation of the aorta is also more common in people who have certain genetic conditions, such as Turner syndrome. Women and girls with this syndrome have 45 chromosomes, with one missing or incomplete X chromosome, instead of 46. About 10 percent of women and girls with Turner syndrome have aortic coarctation.

This condition represents 5-10% of all congenital cardiac lesions. It represents 7% of critically ill infants with heart disease.

Aortic coarctation may also be seen with other congenital heart defects, such as:

    Bicuspid aortic valve.

  • Defects in which only one ventricle is present.

  • Ventricular septal defect.

  • Patent ductus arteriosus.

  • Aortic valve stenosis.

  • Mitral valve stenosis.

Symptoms:

In milder cases, symptoms may not develop until the child has reached adolescence. Symptoms include:

    Chest pain.

  • Cold feet or legs.

  • Dizziness or fainting.

  • Decreased ability to exercise.

  • Failure to thrive.

  • Leg cramps with exercise.

  • Nosebleed.

  • Poor growth.

  • Pounding headache.

  • Shortness of breath (SOB).

Diagnosis:

Tests to diagnose this condition may include:

    Chest x-ray.

  • Cardiac catheterization and aortography.

  • Echocardiography is the most common test to diagnose this condition, and it may also be used to monitor the patient after surgery.

  • Heart CT may be needed in older children.

  • MRI or MR angiography of the chest may be needed in older children.

  • Both Doppler ultrasound and cardiac catheterization can be used to see if there are any differences in blood pressure in different areas of the aorta.

Treatment:

Treatment options for aortic coarctation depend on your age when you are diagnosed and how narrowed your aorta is. Other heart defects may be repaired at the same time as aortic coarctation. Treatment approaches usually consist of surgery or a procedure called balloon angioplasty.

    Resection with end-to-end anastomosis. This method involves removing the narrowed segment of the aorta (resection) followed by connecting the two ends of the aorta together (anastomosis).

  • Patch aortoplasty. Your doctor may treat your coarctation by cutting across the constricted area of the aorta and then attaching a patch of synthetic material to widen the blood vessel. Patch aortoplasty is useful if the coarctation involves a long segment of the aorta.

  • Left subclavian flap angioplasty. A portion of the left subclavian artery, the blood vessel that delivers blood to your left arm, may be used to expand the narrowed area of the artery.

  • Bypass graft repair. This technique involves bypassing the narrowed area by inserting a plastic tube called a graft between the portions of the aorta.

  • Balloon angioplasty is an option for initially treating aortic coarctation or for treating re-narrowing (re-coarctation) that has occurred after surgery. During this procedure, your doctor inserts a thin flexible tube (catheter) into an artery in your groin and threads it up through your blood vessels to your heart. An uninflated balloon is placed through the opening of the narrowed aorta. When the balloon is inflated, the aorta widens and blood flows more easily. In some cases, a mesh-covered hollow tube called a stent is inserted to keep the narrowed part of the aorta open.

Although aortic coarctation may be repaired, the condition requires careful follow-up throughout adulthood to help prevent complications and to monitor for recurrences.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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