Coarctation of the aorta is a congenital heart defect that restricts blood flow to the body, causing symptoms such as difficulty breathing and heart murmur. Severe cases require immediate treatment, usually through surgery to remove the narrowed portion of the aorta. Less serious cases may not need to be repaired, but require monitoring for signs of increased hypertension. Children with this condition may require lifelong follow-up with cardiologists.
Coarctation of the aorta is a congenital heart defect that requires aggressive treatment in approximately 50% of cases. The aorta is the main artery responsible for carrying blood from the left side of the heart to the body. This oxygen-rich blood provides energy and allows the body to develop normally.
When coarctation of the aorta is present, the aorta is too narrow just below the area that supplies the smaller arteries leading to the upper and lower halves of the body. This area is called the juxta-ductal position. During fetal life and shortly after birth, the ductus, positioned just over the area of narrowing, allows blood to pass easily to the body.
Once the duct closes, usually in the first day after a baby is born, the coarctation of the aorta begins to severely restrict blood flow to the body. Initially, mild coarctation of the aorta may not be apparent. A large amount of narrowing, however, can cause heart and systemic failure, as the body cannot get the oxygen it needs.
A baby with severe coarctation of the aorta usually has symptoms shortly after birth. Your child may have blue or pale mucous membranes. The blue may be particularly noticeable in the nail beds and around the eyes and nose. The baby will not be able to eat well and will have difficulty breathing. Also, doctors will notice a significant heart murmur.
Children with severe coarctation of the aorta need immediate treatment to restore proper blood flow in the body. To treat this condition, there are several options. The choice of treatment depends on the nature of the coarctation and also on the surgeon’s comfort level with the various surgical options.
Most often, emergency surgery for coarctation of the aorta involves cutting the aorta, removing the narrowed portion, and reattaching the aorta. In some cases, a portion of a pig, donor, or bovine valve may be needed to make the aorta long enough. However, this is rare and not preferable, as that part of the valve will not grow.
Less frequently, the surgeon may be able to correct the coarctation of the aorta by cutting the aorta, widening it, and then placing a band-aid over the enlarged area. Both surgical options require a heart-lung bypass, and while the operation is serious, the recovery rate is very good. Children may need to take blood thinners and blood pressure medications, as coarctation often causes high blood pressure in the arms.
If the coarctation of the aorta isn’t serious, parents may not even be aware that their child has it. When it does not cause problems for the child’s health or growth, it may not need to be repaired. However, the coarctation can get worse, so cardiologists usually choose to place a small tube to widen the aorta so the condition doesn’t get more serious. When no surgery is attempted, the cardiologist will closely follow the patient for signs of increased hypertension and left ventricular hypertrophy.
Coarctation of the aorta may be present with other left-sided defects, most often a bicuspid aortic valve, which may require replacement later. Children with this condition require lifelong follow-up with cardiologists, but when the condition is uncomplicated by other defects, life expectancy is quite good.
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