Coarctation of Aorta

What is Coarctation of Aorta?

It is a type of disorder that relates to narrowing down of aorta, the large vessel of blood that emerges from the heart and delivers blood rich oxygen to other parts of the body. Due to coarctation, the heart has to pump harder to push blood through the narrow aorta. The coarctation blocks the normal flow of blood to the body. The narrowing down of aorta is usually spotted when the arteries move towards the upper body. If this condition is too severe in nature, sufficient blood may not be able to reach the lower parts of the body. Because of intense pumping, the heart’s wall thickens while the muscles of the heart weaken. If aorta does not widen, the heart might get so weak that it could lead to a heart failure too.

The coarctation of aorta does not occur alone, but is accompanied with some other defects of the heart. It is a congenital defect that is present at the time of birth, but it may not be detected until later in life. Some children might overcome the effects of the disease and grow normally while some others may have to undergo surgeries for repair and take medical treatment to lessen the symptoms and normalise the flow of blood through the body. This defect constitutes 5-8% of the heart defects that are congenital.

This disease is one of the most commonly occurring heart diseases and is diagnosed in adults under the age of 40. In moderate cases, symptoms might not manifest themselves, until the child reaches his adolescence. The symptoms include:

Pain in the chest.
Cold legs or feet.
Breathlessness.
Bleeding in the nose.
Fainting.
Thriving issues.
Cramps in the leg due to exercising.
Inability to exercise.
Improper growth.
Headache.

Causes

As the defect is congenital, particular reasons for narrowing of the aorta are not known. If the defect occurs later in life, which is rare, it can be due to:

Traumatic Injury.
Hardening of arteries.
Condition leading to inflamed arteries.

Risks

A child is likely to have the defect in case it suffers from certain other heart conditions like:

Bicuspid aortic valve: The aortic valve has two flaps instead of three.
Patent ductus arteriosus: There is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus.
Aortic valve stenosis: Narrowing of the valve that separates the left ventricle from the aorta.
Aortic valve regurgitation: Aortic valve does not close properly, which leads to a backward flow of blood.
Mitral valve stenosis: Narrowing of valve between left atrium and left ventricle.
Mitral valve regurgitation: Mitral valve does not close properly leading to backward flow of blood into the left atrium.

Prevention

There is no possible prevention of the defect, as it develops at the time of birth. However in case of family history early detection may help.

How is it diagnosed?

The coarctation is often detected at the time of first examination of the new-born. Many newborns with this disease might show no symptoms, whereas many of them might have trouble while feeding and...

Echocardiogram
Electrocardiogram
X-ray of the chest
Cardiac catheterization

How is it treated?

Certain open-heart surgical techniques are adopted. At Medanta, the surgery options could include:

Resection with end-to-end anastomosis

This procedure shall remove the narrowed section of the aorta, followed by the connection of the two ends of aorta together.
Bypass graft repair

This method shall involve evading the compressed section by passing a tube known as a graft, between parts of the aorta.
Patch aortoplasty

The coarctation might also be treated by creating an incision across the area where the compressed aorta is. This technique is helpful, if the long segment of aorta is involved.
Balloon angioplasty and stenting

This technique is a kind of option for treating the compression of arteries. In this procedure, the doctor positions an uninflated balloon with the help of the narrowed aorta. The aorta is able to widen and blood is able to flow easily when the inflated balloon is placed.
Medication

No medication as such is required to repair this condition of coarctation. Medications can be given to control blood pressure that needs to be taken care of during surgery. Also, medication might be prescribed to keep the ductus arteriosus open.