Coarctation of the Aorta

Coarctation of the aorta is the disease which develops due to narrowing of the aortic arch, the main blood artery that delivers blood from the left ventricle of the heart to the rest of the body. Or in other words Coarctation of the aorta is a narrowing of the aorta between the upper-body artery branches and the branches to the lower body. Coarctation of the aorta is diagnosed in both newborns and adults. Coarctation of the aorta is a constricted segment of the aorta that obstructs blood flow to the body.

Coarctation of the aorta is a congenital (present at birth) heart defect involving a narrowing of the aorta. The aorta is the large artery that carries oxygen-rich (red) blood from the left ventricle to the body. Aortic coarctation is narrowing of the aorta in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts.A severe narrowing of the aorta, causing a decrease in blood flow to the lower part of the body. This narrowing is a congenital defect and can be corrected with surgery.Coarctation of the Aorta a congenital heart defect that results in narrowing of the aorta. The ductus arteriosus is a blood vessel that is normally present in a fetus and has special tissue in its wall that causes it to close in the first hours or days of life.

Coarctation of the Aorta is thought that coarctation may be caused by the presence of extra ductal tissue extending into the adjacent aorta which results in aortic narrowing as the ductal tissue contracts. This blockage can increase blood pressure in your arms and head, reduce pressure in your legs and seriously strain your heart. Aortic valve abnormalities often accompany coarctation.The aorta is the body's main artery. Coarctation of the aorta is distributes oxygen-rich blood to all parts of the body except the lungs.Coarctation occurs most commonly in a short segment of the aorta just beyond where the arteries to the head and arms take off, as the aorta arches inferiorly toward the abdomen and legs. The "coarctation" is a narrowing of the aorta, typically found just after the vessels are given off to the left arm. This is a cause of high blood pressure, as the kidneys do not "see" as high of a blood pressure as they would like.

Cause of Coarctation of the Aorta

Some common causes of Coarctation of the Aorta :

• The aorta carries blood from the heart to the vessels that supply the body with blood and nutrients. If part of the aorta is narrowed, it is hard for blood to pass through the artery. People with this condition often have high blood pressure in the upper body and arms (or one arm) and low blood pressure in the lower body and legs.
• Aortic coarctation is more common in persons with certain genetic disorders, such as Turner's syndrome . However, it can also be due to birth defects of the aortic valve, such as a bicuspid aortic valve.
• Similar to most forms of congenital heart disease (CHD), multifactorial influences appear to affect the occurrence and severity of coarctation, including genetic abnormalities such as Turner syndrome (45,X), in which 15-20% of patients have CoA. Familial patterns of inheritance of coarctation have been reported, as well as other left heart obstructive lesions.

Coarctation of the aorta Symptoms

If cardiac failure does not occur in infancy, there are usually no symptoms until the hypertension produces left ventricular failure or cerebral hemorrhage; the latter may also occur from associated cerebral aneurysms. Strong arterial pulsations are seen in the neck and suprasternal notch. Hypertension is present in the arms, but the pressure is normal or low in the legs. This difference is exaggerated by exercise. Femoral pulsations are weak and are delayed in comparison with the brachial pulse. Patients with large collaterals may have relatively small gradients but still have severe coarctation. Late systolic ejection murmurs at the base are often heard better posteriorly, especially over the spinous processes. There may be an associated aortic insufficiency murmur due to a bicuspid aortic valve. Here are the list of Coarctation of the aorta Symptoms :

• shortness of breath (dyspnea)
• difficulty in feeding
• poor weight gain
• fatigue
• feeling of lameness in their legs

Coarctation of the aorta Prognosis & Treatment

Cardiac failure is common in infancy and in older untreated patients; it is uncommon in late childhood and young adulthood. Most untreated patients with the adult form of coarctation die before age 50 from the complications of hypertension, rupture of the aorta, infective endarteritis, or cerebral hemorrhage (associated in some cases with congenital cerebral aneurysms). Aortic dissection also occurs with increased frequency in coarctation.

Resection of the coarcted site has a surgical mortality rate of 1–4%. The risks of the disease are such, however, that all coarctations in patients up to age 20 years should be resected. In patients under 40 years of age, surgery is advisable if the patient has refractory hypertension or significant left ventricular hypertrophy. The surgical mortality rate rises considerably in patients over age 50, making surgery of doubtful value. Balloon angioplasty of the stenosis has been accomplished successfully and may become the procedure of choice, but aortic tears have been described. About one-fourth of corrected patients continue to be hypertensive years after surgery and they have all the complications associated with hypertension.

Some most common treatment methods of Coarctation of the Aorta:

• Surgery is usually recommended. The narrowed part of the aorta will be removed. If the problem area was small, the two free ends of the aorta may be re-connected. This is called anastomosis . If a large part of the aorta was removed, a Dacron graft (a synthetic material) is used to fill the gap
• The rate of recurrent coarctation after surgical repair decreases in older children, approaching zero by age 3 years. While surgery may be necessary for some patients for recurrence, the majority of cases may be managed with balloon dilation as the initial approach. 
• Your child's age, overall health, and medical history
• Extent of the disease
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the defect
• Your opinion or preference
• The narrowing can be removed by surgery or sometimes by a nonsurgical balloon dilation in the cardiac catheterization lab. Aortic coarctation may return even after successful surgery or balloon dilation.
• Recurrent coarctation is usually treated with nonsurgical balloon dilation or by implanting a stent using cardiac catheterization.

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