All about Coarctation of the aorta
Coarctation of the aorta is a heart defect present at birth. In this condition, there is a constriction or narrowing in the aorta.
Aorta is the main artery supplying blood to the entire body. The narrowing prevents the proper flow of blood from the heart to lower parts of the body.
If the narrowing is severe, the heart will find it very tough to pump blood. It will also lead to heart failure later. Most of the babies with this problem will need emergency heart surgery or a balloon catheter procedure to repair the defect.
What causes the coarctation of the aorta?
Coarctation is a developmental disorder present at birth. We do not know the exact reason for this. There are some factors affecting mothers that increase the risk. Some of them are
- Family history of heart defects
- Mother on certain medications
- German measles in early pregnancy
- Diabetes in mother
- IVF pregnancy
- Anomaly scan showing a defect in any other organ system of the fetus (brain, gut, kidney, etc.).
Coarctation is more common in babies with Turners syndrome, a genetic disorder.
It usually occurs close to the ductus arteriosus, which is an artery that is present only while a child is in the womb. After birth, this artery closes by itself. Scientists believe that coarctation may happen during this due to pinching of the walls of the aorta.
Signs and Symptoms
The symptoms usually depend on how severe the obstruction to blood flow through the aorta is. If there is severe narrowing, the symptoms will show at a very early stage, usually soon after birth. If the obstruction is mild, the symptoms will appear later in life.
Some of the common symptoms in infants are
- Pale skin
- Difficulty in breathing or fast breathing
- Profuse sweating
- Severe irritability
- Difficulty in feeding
If the narrowing is less severe, the infant will have signs and symptoms only as they grow up. Some of the common ones are
- High blood pressure in the arms and low BP in the legs.
- Headaches- It is due to an increase in the blood pressure in the head
- Pain in the legs after playing
Very often, children will not have any clear signs except high blood pressure. Hence it is recommended that you get the child’s BP checked at every visit to the pediatrician after three years.
Complications of Coarctation
If the patient does not get the right treatment at the right time, there are chances of complications.
Some of the common ones include
- Enlargement of the heart and weakening- The heart may enlarge due to an increase in workload. After a point, the pumping also weakens.
- A threat to life as blood supply to the body is compromised, and acid level in the blood increases.
- High blood pressure- The blood pressure in the upper part of the body and head will be more than in the lower part of the body.
Diagnosis of Coarctation
Echocardiogram- This procedure provides a clear image of the structure of the heart and the blood vessels close to it. Coarctation is usually visible in great detail through this test. Often, this is the only test the doctor will need before planning treatment.
Other useful tests include
- X-ray chest
- CT or MRI scans of the heart
Treatment of Coarctation:
Various units around the world differ in their approach to the patient with coarctation. In general, the plan will be as per the age of the child.
Surgery is the best option for a newborn or an infant. In the case of an older infant, the doctor may do a balloon angioplasty of the coarctation if the part of the aorta above the coarctation is normal. If this part, arch of the aorta, is also narrow, then only surgery will help.
For older children, the doctor would go for balloon angioplasty or stent placement.
Surgery for coarctation of the aorta
There are different surgeries for repairing a coarctation of the aorta. Your doctor will decide on the best type of surgery by assessing various factors. These include your age, size, and location of the coarctation, the anatomy of the aorta, etc.
Some of the common surgeries are
- Resection with end to end anastomoses surgery- In this, your surgeon will cut off the portion of the aorta that is narrow (Resection). The next step is to join together the two ends with special sutures(anastomoses).
- Subclavian aortoplasty- In this surgery, the surgeon uses a part of the subclavian artery to repair the area with coarctation.
- Patch aortoplasty- You will have this surgery if the coarctation is large. During the operation, the surgeon will first cut the aorta at both ends of the coarctation. The surgeon will then place and sew a synthetic patch at both ends.
- Tubular bypass graft surgery- The surgery aims to bypass the narrow portion, rather than removing it. The surgeon will place a graft that allows the bypassing of the coarctation.
- Balloon Angioplasty: An interventional pediatric cardiologist performs this. The doctor will insert a long narrow tube into the artery through the groin vessels. Once it reaches the area of contraction, the balloon inflates, thus widening the area.
- Stenting: The doctor will insert a steel wire mesh (or a stent). The balloon attached to it inflates such that it hugs the inner wall of the aorta and props the narrow spot open. However, a stent is not ideal for a small child.
Like any other developmental defect of the heart, your child will need to have periodic check-ups in the pediatric cardiac OPD. There will not be any restrictions on diet or activity for your child. Your pediatric cardiologist may suggest special tests as your child grows