Coarctation of aorta

The aorta is the main and largest artery in the body. It exits the left ventricle and travels through the chest and abdomen, distributing oxygenated blood throughout the body.

Aortic coarctation is a congenital disease, that is, it appears from birth and is characterized by a narrowing of the initial section of the aorta, after its exit from the left ventricle.

How is it produced?

It is a congenital heart malformation in which genetic and environmental factors have been implicated.

In aortic coarctation, the aorta having a narrower section supplies less blood and, therefore, less oxygen to the arterial branches that leave it. This causes the blood pressure to be higher above the narrowing and lower below it and the heart has to make a greater effort to move the blood through that section, which causes later cardiac repercussions. On the other hand, there is an increased risk of infection in both the heart and the aorta. The walls of the aorta and its branches can also be weakened by high pressure, which can lead to bleeding and fissuring.

Symptoms

The consequences of coarctation depend on the degree of tightness that partially or totally prevents blood flow to the lower part of the body and its location.

The more severe the narrowing, the greater the symptoms in the child and the sooner the problem will become apparent. Thus, in the most severe cases the symptoms appear in babies, in milder cases it can go unnoticed until adolescence. Symptoms can be very varied and can include: lack of development and growth, shortness of breath, difficulty feeding the baby, chest pain, cold feet and legs, dizziness, fainting, nosebleeds, weak or absent pulses in the feet , etc. Mild narrowing may not cause any symptoms. Often, high blood pressure or a heart murmur is simply detected during a physical exam of a school-age child or adolescent.

Diagnosis

The diagnosis is based on the physical examination where the difference in pulse and pressure between the upper and lower extremities is verified and on the confirmation of the coarctation using imaging techniques.

The fundamental tests for its diagnosis are echocardiography, nuclear magnetic resonance and arteriography.

Echocardiography identifies the site of obstruction and the type of coarctation, as well as the degree of narrowing and possible associated abnormalities.

Treatment

Coarctation of the aorta can be cured with surgery, and symptoms improve quickly after surgery.

Treatment options include:

Surgical treatment, that is, repair of the narrowest artery course. The narrowed area is surgically removed. If it is a small section, the two ends of the aorta can be reconnected, which is called an anastomosis. If the excised area is larger, a tube, a synthetic material graft or tissue from the patient can be used to join the two ends.

Interventional cardiology procedures, called balloon angioplasty, may also be used. Its goal is to dilate the narrowed segment of the artery without surgery. To do this, a catheter is inserted through a blood vessel until it reaches the area of ​​the stenosed (narrow) aorta through the arterial system. Once there, a small balloon is inflated at the end of the catheter, allowing the area to dilate. The catheter and deflated balloon are then removed. A device called a stent can also be left in place, which is a small wire mesh that allows the stretch to be kept dilated.

Most children with surgical repair of the coarctation of the aorta lead healthy lives.

Prevention

There are no preventive measures since it is a disease of unknown cause that appears from birth.

Intensive Medicine Specialist