This leaflet provides information for parents and carers about coarctation of the aorta in children and the management and treatment of this condition.
Coarctation of the aorta
This is a serious heart condition in which there is a narrowing in the main artery (the aorta) which comes off the heart to feed the body with blood.
The narrowing usually occurs just after the aorta has given off branches to supply the head and arms with blood, preventing normal circulation to the lower half of the body. In some children the coarctation is not apparent early in life but gradually develops over time (sometimes weeks, sometimes years).
The narrowing in the aorta makes it harder for the heart to pump and causes high blood pressure in the blood vessels in the head and the arms, so the muscle of the left sided pumping chamber (the left ventricle) becomes thickened and if the coarctation is not treated heart failure, stroke or death may eventually occur.
Here’s a video explaining about Coarctation
Coarctation of the Aorta – YouTube
Coarctation of the Aorta – YouTube. Transcript
as the aorta leaves the heart it
initially heads upwards
but then arches around to head downwards
through the chest and lower body
as it arches around it gives off
arteries to the head
and arms co-octation of the aorta
is a narrowing of a part of the aorta
most commonly this narrowing occurs
after it has given off the branches to
the head and the arms
just as it begins its descent to the
rest of the body
coarctation can become evident at any
age
if the narrowing is very severe it can
become obvious shortly after birth
when poor blood flow to the lower part
of the body can cause small babies to
become very unwell
coarctation often causes high blood
pressure
and later on in life it is a diagnosis
of high blood pressure that most
commonly leads to a co-occupation being
discovered
although it should be noted that high
blood pressure is very common
but is only very rarely caused by
coarctation
we explained the treatment of
coarctation in a separate video
Here’s a video about the treatment of Coarctation
Coarctation of the Aorta – Treatment. YouTube
Coarctation of the Aorta – Treatment
in this video we explain how coarctation
of the aorta can be treated
a separate video explains what
coarctation of the aorta is
coarctation can be treated either by
surgery
or in a keyhole technique in general
surgery is used in babies and young
children
and the keyhole technique in older
children and adults
surgery is most frequently performed by
opening the chest from the left
side although sometimes the chest has to
be opened from the front
through the breastbone a number of
different techniques are used to repair
a coarctation surgically
the most common involves removing the
narrowed section of the aorta
and sewing the two ends together this is
called
an end-to-end repair an alternative
technique
is called the subclavian flap repair
the left subclavian artery is the blood
vessel that supplies blood to the left
arm
the subclavian artery is cut opened up
and used to enlarge the area around the
coarctation
the left arm still manages to get an
adequate blood supply from other blood
vessels
although the pulses in the left arm may
be difficult to feel
in patients who have had a subclavian
flap repair
a further type of repair involves sewing
in a patch of material around the
co-octation to enlarge the narrowed area
the final type of surgical repair which
is only rarely performed
often for longer narrowings involves
removing the narrowed section of aorta
and replacing it with a tube called an
interposition
graft treating coarctation with the
keyhole method
involves inserting a tube into an artery
in the groin
while the patient is asleep through this
tube
a metal cage called a stent is
positioned within the narrowed area
and expanded with a balloon the narrowed
area becomes wider
and the stent helps to keep it open
occasionally just a balloon is inflated
to widen a narrowing
without using a stent x-rays are used to
guide the keyhole procedure
the keyhole technique can be used to
treat coarctation
that either has not been treated before
or that has previously been treated by
surgery if some narrowing remains or has
reoccurred
however a co-occupation has been treated
lifelong follow-up is important
you
Tests
Initially simple tests such as an ultrasound scan of the heart (an “echocardiogram”), and an x-ray of the chest are required. Sometimes a CT scan is required.
Treatment
Some babies are suspected to have coarctation before they are born and some become unwell in the first month of life as the ductus arteriosus closes (this is a connection between the 2 main blood vessels coming from the heart and can bypass the narrowing). In these cases, a medication called Dinoprostone can be commenced to open the duct and stabilise the baby whilst they wait for surgery.
Treatment is necessary to repair the coarctation. The narrowing can be repaired surgically (cutting out the narrowing and sewing the ends back together or using a patch of material to enlarge the narrowing).
Some older children are suitable for “keyhole” treatment where the narrowing is stretched open with a balloon passed up from the artery at the top of the leg, or the narrowing is propped open using an expandable metal mesh tube (a stent) inserted from the artery at the top of the leg.
If your child requires either of these procedures the surgeon or cardiologist will discuss this in clinic including the risks and potential complications.
Other abnormalities
Some children with coarctation will have other heart abnormalities such as a hole between the main pumping chambers or a narrow heart valve. If present, these other abnormalities sometimes don’t need treatment early on in life but need to be watched as the child grows.
Sometimes further surgery may be needed for such abnormalities later. Some patients with coarctation also have a chromosome abnormality. Tests for these are often performed routinely, particularly if the child has more than one suspected abnormality. It can take some weeks to get the results of these tests.
Follow up after operation
When repair has been necessary during childhood sometimes the narrowing in the aorta can recur as time goes by, sometimes needing further treatment. Even many years after treatment it is possible to develop a weakness in the wall of the aorta (called an aneurysm), which can be serious and can also require further surgery. Even after a good result from treatment high blood pressure is common in later life. For all these reasons lifelong follow up is necessary.
Endocarditis
There is a small risk of infection occurring in the aorta or on one of the heart valves (called endocarditis). This can happen even years after the operation and can be caused by infection of the teeth or gums. It is very important to have good dental care and visit the dentist regularly (every 6-12 months). Infection can occur with ear and body piercing and tattooing and can sometimes lead to endocarditis, so these procedures are best avoided.
For more information about endocarditis please see the link below:
