CHDFNigeria
Definition
Coarctation of the aorta (CoA) is a condition where the aorta (the main artery that carries blood from the heart to the rest of the body) becomes narrowed. It occurs in two forms: an infant and an adult form. The narrowing happens just after the aortic arch, the part that gives off branches to the head and arms, and before the ductus arteriosus (a vessel present during fetal life that usually closes after birth). According to the National Library of Medicine, CoA is a narrowing of the thoracic aorta at the isthmus, the region of insertion of the fetal ductus arteriosus. Either in isolation or in association with other cardiac defects, CoA is one of the more common lesions in congenital heart disease (CHD) with an incidence of 3–4 cases per 10,000 live births and a 2:1 male predominance.
Causes
The exact cause of CoA is unknown, but it happens during fetal development. It can occur alone or with other heart defects, such as VSD, PDA, Bicuspid Aortic Valve, or Aortic Stenosis, or genetic conditions, especially Turner syndrome (a condition in females where one X chromosome is missing or incomplete).
Signs and symptoms
How CoA present depends on how severe the narrowing is and the age of the patient.
In infants (babies):
- Trouble feeding
- Breathing problems
- Unusual tiredness (lethargy)
- Bluish skin color (cyanosis)
- Weak or missing pulses in the legs (femoral pulses)
In Adults:
- High blood pressure, mostly in the arms
- Frequent headaches
- Nosebleeds
- Leg pain or tiredness when walking (claudication)
- Cold feet
Diagnosis
Simple physical examination including blood pressure check, can point towards diagnosis of CoA. Difference in blood pressure check in both arms and legs can suggest CoA. Othe investigations include:
Echocardiogram with Doppler, to show blood flow.
Chest X-ray.
Cardiac MRI or CT scan
Cardiac catheterization
Management
The goal is to open the narrowed part of the aorta and let blood flow normally.
- Balloon angioplasty: A balloon is used to stretch the narrow area. Often done in older children or adults.
- Stenting: A metal tube (stent) is placed in the narrow part to keep it open, especially if the problem comes back after earlier treatment.
- Surgery: The narrow part is cut out and the two ends are sewn together, many times, a patch or graft is used.
Complication
If CoA is not treated or not treated well, it can cause serious problems:
- High blood pressure (after treatment).
- Heart failure.
- Aortic aneurysm: Bulging of the aorta wall, which can rupture.
- Stroke.
- Endocarditis: Infection in the heart.
Re-coarctation: The aorta becomes narrow again after treatment.
