Coarctation Of The Aorta (Aortic Coarctation)
Narrowing of the major blood vessel aorta at a point before where it is joined by the ductus arteriosis is termed as coarctation of the aorta.
- The narrowing of aorta significantly reduces the amount of blood reaching the lower half of the infant’s body.
- Heart murmurs, as well as a lower blood pressure in the legs when compared to that of the hands, are the usual symptoms, but some infants remain asymptomatic.
- The symptoms, when present, indicates this condition, but an echocardiography and a chest x-ray help confirm the diagnosis of aortic coarctation.
- Treatment involves surgical correction, and occasionally, drug therapy.
The flow of blood to the lower parts of the infant’s body is significantly decreased by aortic coarctation, resulting in measurable difference between the blood pressure in the hands and legs. The blood pressure in the legs becomes abnormally low, while the hands register an abnormally high blood pressure which persists in the upper parts of the body. A heart murmur indicating this condition also may be present. Coarctation should be treated; without proper treatment it causes high blood pressure and enlargement of the heart, eventually leading to heart failure. In children, coarctation of the aorta can cause bacterial endocarditis and brain hemorrhage. The aorta may rupture too. Other defects like aortic valve stenosis, and septal defects affecting the atria and ventricles, are usually present in infants who have aortic coarctation.
If coarctation is mild to moderate, it may remain asymptomatic. In rare cases, nose bleeds and headaches may be caused by the increased blood pressure in the upper parts of the body. Reduced blood flow to the legs may result in pain due to inadequate oxygen supply to the leg muscles during exercise.
If aortic coarctation is severe in the infant, the blood reaches the aorta through the ductus arteriosus which connects the pulmonary artery to the aorta at the point past the narrowing of the aorta. As long as the ductus arteriosus remains open, usually up to two weeks after birth, there will not be any symptoms of coarctation in the infant. When the alternate blood supply to the aorta stops with the closure of the ductus arteriosus, a sudden dramatic change takes place with almost complete loss of blood supply to the lower parts of the body, resulting in extremely low pressure. Potentially fatal heart failure too may occur.
When the doctor detects a heart murmur and differences in blood pressure or pulse between the infant’s arms and legs, coarctation is investigated. ECG, x-rays and echocardiography are tests used to diagnose the condition accurately.
If coarctation of the aorta is severe, it requires immediate emergency surgery to enlarge the narrowed portion of the aorta. As soon as the condition is detected, prostaglandin is administered to the newborn to reopen the ductus arteriosus, or to prevent its closure, so as to prolong the blood supply to the aorta. Alprostadil is a drug used for this purpose. Other drugs which strengthen the pumping action of the heart are also given. When the infant grows up, the surgery may have to be repeated. Instead of open heart surgery, balloon angioplasty may be done and a stent can be implanted to keep the aorta widened. If the symptoms due to aortic coarctation are mild, surgery is often postponed for three to five years.
This Video Explains Aortic Coarctation:
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Yasser Elnahas
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