Normal

Coarctation

What is Coarctation Of The Aorta?

The aorta is the largest artery (blood vessel) in the body. It carries red oxygenated blood from the heart around the body. Coarctation of the aorta is narrowing of this blood vessel. It increases the work of the heart and the left pumping chamber may become thickened causing left ventricular hypertrophy.

Symptoms

Affected babies are usually well at birth because blood bypasses the narrowed area via a special tube called a ductus arteriosus which is present in all foetuses. This tube closes at any time after birth, usually sometime in the first week. Once this tube closes babies with severe coarctation can become extremely sick as insufficient blood passes around the body. Initially there may be feeding difficulties, quickly followed by breathlessness, pallor and collapse. Milder forms of coarctation can present later in asymptomatic babies and children with a heart murmur. High blood pressure is usually a feature.

Diagnosis

A clinical examination will usually reveal a heart murmur and absent pulses in the legs. An echocardiogram will diagnose coarctation. A chest X-ray and an ECG will also be performed.Some patients may also have a scan performed.

Treatment

Sick babies will require immediate treatment with a medicine called prostaglandin which will reopen the ductus arteriosus. Help with respiration via a ventilator may also be temporarily required. As soon as safely possible the baby must be transferred to a specialist paediatric cardiac unit. The Royal Brompton Hospital where Dr Naqvi works, has a world famous children’s cardiac unit with a specialist paediatric cardiac intensive care.

Babies and young children usually require cardiac surgery to remove the narrowed part of the aorta. Older children and selected babies (those too sick to be best suited for surgery) may undergo cardiac catheterisation (keyhole procedure via a leg artery) under general anaesthetic with stretching of the narrowed area using a balloon. Older children and adults may also have a metal stent inserted over the balloon. Dr Naqvi works with an excellent team of NICOR audited congenital cardiac surgeons and interventionalists and if needed will refer your child to the one who is best for your child’s heart.

Hypertension (high blood pressure) may require treatment with medicines for a period after the surgery or catheter.

With improvements in fetal ultrasound some babies are diagnosed with coarctation before they are born. After birth they are routinely commenced on prostaglandin medicine to keep the ductus arteriosus open. They are electively transferred to a paediatric cardiac unit for further treatment.

Mild coarctations are less common but these can be followed in the outpatient clinic after assessment by an experienced paediatric cardiologist. These may require treatment later in life.

Coarctation can be associated with other cardiac problems which may also require treatment.

Cardiac Surgery

Keyhole Procedure

Stent on a Balloon Catheter

Prognosis

The outlook for children with coarctation is very good in the vast majority of cases. Lifelong medical follow up will be required as recurrence of narrowing can occur. Dr Naqvi has cared for many babies and children with coarctation and has followed them up until adulthood. She says “Having coarctation of the aorta early in life does not stop children doing well in sports or from having a happy full life.

I know many, including some who very sick at presentation, who are in school teams and some have even been in county teams. I even know patients who have achieved 10 A stars at GCSE despite having heart problems in childhood.” Lifelong medical follow up with check-ups is recommended. Click Here to read a true life experience from an individual who has had coarctation of aorta.

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Disclaimer: The opinions and facts shown in this article are as accurate and up to date as possible, but are provided as general “information resources”, which may not be relevant to individual persons. This article is not a substitute for individual assessment and always take advice from a paediatric cardiologist who is familiar with the particular person.