What is the coarctation of aorta?

The birth defects in the heart that hamper its normal functioning are called congenital heart diseases. Coarctation of the aorta is a defect that occurs at birth. Aortic coarctation is a congenital (present at birth) heart condition that involves narrowing the aorta, the large artery used to carry oxygen-rich (red) blood to the body. Also known as aortic coarctation or aortic stenosis, this condition makes it harder for the heart to pump blood through the narrowed part. This can make it harder for the heart to pump blood through the aorta, leading to high blood pressure and other complications.

Diagnosis of Coarctation of Aorta

Severe coarctation of the aorta is usually diagnosed shortly after birth. Individuals with mild coarctation of aorta, who are adults or older children, may not exhibit any noticeable symptoms and may seem to be in good health. In a few cases of isolated coarctation, the narrowing can cause symptoms within the first few days of life. When the ductus arteriosus (a short vessel that connects the aorta with the fetal pulmonary artery) closes, the left ventricle suddenly has over resistance. This can lead to heart failure and shock. Symptoms develop quickly as the ductus arteriosus closes.

The constriction may only be seen once the child is a few years old. In elderly patients, the reason for coarctation is due to a heart murmur or because of high blood pressure.

The diagnosis of coarctation is confirmed by echocardiography. The doctor examines the anatomy of the aorta. He also evaluates other heart abnormalities that may be present.

More tests, such as

- a cardiac MRI or CT scan,
- Electrocardiogram (ECG, EKG), and
- Echocardiogram can sometimes be used to check for narrowing.

Treatment of Coarctation of Aorta

Medication- In some cases, prostaglandins may be given to keep the ductus arteriosus open and improve blood flow. Other medications, such as antibiotics, NSAIDs, etc., are used.

Balloon Angioplasty and Stenting- A graft or one of the patient's arteries can fill the space if a large part of the aorta has been removed. The grafts can be artificial or taken from a deceased donor. Sometimes doctors try to stretch the narrowed part of the aorta using a balloon that expands in the blood vessel. It can be done instead of surgery but has a higher failure rate.

Surgery- In case of severe obstruction, surgery is necessary. The sequence of surgical techniques of coarctation of the aorta are:

- Interposition graft: The narrowed part of the aorta is severed (cut), and a synthetic material graft (in place of aortic tissue) is used to link the ends.
- End-to-end anastomosis: Then, resection of the narrowed part of the aorta and reconnection of the two ends is done.
- Patch augmentation: After this opening, the narrowed part of the aorta and sewing a patch to widen the aorta are done.
- Subclavian flap repair: To alleviate the stenosis in the aorta, the left subclavian artery is surgically opened at the constriction site, then closed and stitched to widen the aortic passage.
- Ascending to descending aorta bypass graft: Synthetic material is placed and sewn in the aorta forwards and backward. The tube bypasses the blockage, allowing blood to flow through the tube to the lower body.

Management of Coarctation of aorta

- Routine check-up: Physical examination may reveal hypertension, aortic constriction, and heart failure.
- Cardiac Imaging Studies: Echocardiography, cardiac MRI, or cardiac CT scans can be used to identify coarctation of the aorta aneurysm, coronary artery disease, and aortic valve problems and to assess the left ventricle.
- Monitoring Ambulatory Blood Pressure: It can identify hypertension that occurs during daily activities and is not evident during clinic visits.
- Exercise test: The blood pressure measurements obtained during exercise make it possible to evaluate the retraction of the aorta and the severity of hypertension during physical activity.
- If normal, cholesterol should be checked annually after that. You can lower your cholesterol level with lipid-lowering medication, a healthy diet, and exercise if your cholesterol level is high.
- Holter Monitor: The Holter monitor records every heartbeat over 24 hours to assess abnormal heart rhythms.

When to Consult a Doctor

You can also get in touch with the expert cardiology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

FAQs

Q. What tests are needed for coarctation of the aorta? A. Many tests are needed depending on symptoms and other factors. Some tests are Physical examination, Imaging tests, Electrocardiogram (ECG or EKG), Cardiac catheterisation, etc.

Q. Are there any dietary or activity restrictions in the coarctation of the aorta? A. There are generally no specific dietary restrictions for individuals with coarctation of the aorta. However, individuals need to maintain a healthy and balanced diet to support overall cardiovascular health in terms of activity restrictions; individuals with coarctation of the aorta may need to avoid or limit strenuous physical activities that may put excessive strain on the heart and blood vessels.

Q. How long can you live with the coarctation of the aorta? A. Thanks to the improvement in diagnosis and repair can lead to a long and healthy life. However, Untreated coarctation of the aorta can lead to serious complications, such as heart failure, high blood pressure, stroke, and aortic aneurysm, significantly reducing life expectancy.

Q. Will there be any limitations after the treatment of coarctation of the aorta? A. After treatment of coarctation of the aorta, individuals may need to take certain precautions and be aware of potential limitations. With appropriate treatment and management, however, many individuals with coarctation of the aorta can lead active and healthy lives.

Q. Can coarctation of the aorta be cured? A. Treatment can effectively manage coarctation of the aorta, but it cannot cure the condition. Therefore, individuals with coarctation of the aorta will likely require ongoing monitoring and management to prevent complications.

Reference

- https://www.narayanahealth.org/blog/what-is-cyanotic-congenital-heart-disease/
- https://www.mountsinai.org/health-library/diseases-conditions/coarctation-of-the-aorta
- https://www.nationwidechildrens.org/conditions/coarctation-of-the-aorta
- https://www.mayoclinic.org/diseases-conditions/coarctation-of-the-aorta/diagnosis-treatment/drc-20352535