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Back to Cardiovascular Diseases
Coarctation of the aorta
Coarctation is a congenital deformity that involves the presence of a
stenosis (tight ring-like area) in the aorta at a point usually after the
left subclavian artery (one of its branches). There is a high association
with Turner syndrome and bicuspid aortic valve.
Hemodynamics
Normally the heart pumps blood through the aorta to
reach the rest of the body. In the presence of a tightness or (stenosis)
the normal flow of blood is hindered leading to the build up of pressure
behind the stenosis. If the stenosis occurs after the left subclavian
this leads to decreased blood pressure in the lower limbs and high blood
pressure in the upper limbs & upper 1/2 of the body. If the stenotic band
is situated before the left subclavian these changes may affect the right
limb and upper 1/2 of the body.
Coarctation of the aorta eventually leads to the appearance
of collaterals, which are vessels that open up as a result of the pressure
build up and attempt to create alternate pathways for the blood flow around
the ring-like tightness.
Symptoms and signs
High blood pressure in a young patient or painful legs
on walking due to lack of blood supply to the legs (a condition known as
intermittent claudication) usually warrants further investigation. The presence
of a large difference between blood pressure in different limbs and the
presence of collaterals (e.g. in intercostal areas) can help make the diagnosis clearer.
A harsh, late systolic murmur may be heard in the
back.
Diagnosis
1. EKG shows left ventricular hypertrophy.
2. Chest x-ray may show rib notching due to
collaterals.
3. Doppler ultrasound readily diagnosis the condition
once suspected.
4. Transeophageal echo may help in some cases
5. MRI
6. Angiography can measure the gradient across the
coarctation.
Treatment
Most patients have already been treated by childhood,
rarely does it appear in adults while investigating hypertension or intermittent
claudication.
1. Surgery
Surgical correction is the 1st choice of treatment
as the natural history of the disease is progressive. If the child is asymptomatic
it is preferable to wait till 4-6 years of age.
2. Balloon angioplasty
In cases of recurrence a
balloon is inserted in the ring to widen it.
3. Endocarditis prophylaxis
Endocarditis prophylaxis should be given to all
patients after surgical correction.
4. Ant-hypertensive therapy
Twenty percent of patients remain hypertensive
after surgical correction and require blood pressure control
medications.
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