What is coarctation of the aorta?
Left ventricle pumps pure blood into a large vessel known as aorta. It gives of branches to supply blood to upper part of body and arms. It then curves down and supply lower part of body including abdomen, and legs. In case of coarctation of aorta, there is severe narrowing of aorta just after origin of branches to upper part of body. When baby is in womb, it does not creates any problem as there is another supply in form of arterial duct. After birth, the arterial duct shrinks with in a few days and blood supply to lower body is suddenly compromised. Heart also have to take extra effort to pump blood against extra load.
Coarctation can be seen in isolation or along with bicuspid aortic valve, ventricular septal defect, patent ductus arteriosus and complex cardiac defects like TGA/ DORV/ CCTGA/ HLHS/ single ventricle etc.
What are the signs and symptoms of coarctation of the aorta?
Coarctation of aorta has varied presentation. More severe form can present with in first few days of life. Presentation is generally catastrophic and occur along with closure of arterial duct. Symptoms include
- Labored or rapid breathing
- Pale or gray appearance
- Weak femoral artery pulse (taken in the groin area)
- Heavy sweating
- Poor weight gain
- Heart murmur
- Heart failure
If the narrowing is mild, coarctation of the aorta symptoms may go unnoticed until the child is older or even an adult. In those cases, symptoms can include:
- High blood pressure
- Cold feet or legs
- Difficulty exercising
- Dizziness
- Fainting
- Nosebleeds
- Headaches
- Leg cramps
- Heart murmur
How is coarctation of the aorta diagnosed in children?
- Fetal echo: Coarctation can be suspected on fetal echo. It can help to plan a delivery to take care of emergency.
- Echocardiogram: diagnostic modality.
- Electrocardiogram(ECG): a record of the electrical activity of the heart
- Pulse oximetry in neonate
- Cardiac catheterization:
- Cardiac MRI/ CT scan:
What are the treatment options for coarctation of the aorta?
Depending upon age, over all health status, coarctation is addressed with eith surgery or cath lab. During surgery the narrowed segment is augmented with either patch or it is removed and health part is stitched to healthy.
In cath lab a paediatric cardiologist will either dilate the narrowed segment with a balloon or place a stent ( spring scaffold) across it to strengthen it.
Different surgical techniques
Dilatation of coarctation with stent.
What is the follow-up care for coarctation of the aorta?
After surgery or cardiac intervention, there is improvement in symptoms. The aorta grows well with time. In a few cases, there me be inadequate growth of aorta which can be tackled with balloon dilatation or stent. A few patients with this disease may develop abnormal dilatation of aorta and are at risk of dissection. They need long term care with echocardiography and other imaging modalities.