Coarctation of the aorta is a narrowing of the aorta of the heart or the main and largest blood vessel. Aortic narrowing can occur at one or more locations along the aorta. Coarctation of the aorta can cause an increase in blood pressure and damage to the heart.
Severe coarctation of the aorta may be seen in the newborn. This condition makes the muscles in the left ventricle of the heart work harder to pump blood out of the heart. If left untreated, this condition will make the walls of the heart thicken, the heart muscle will weaken, and lead to heart failure.
Causes of Aortic Coarctation
Coarctation of the aorta is a type of congenital heart disease. In most cases, the cause of coarctation of the aorta is uncertain. This condition is thought to be related to a combination of genetic and environmental factors, including exposure to chemicals or drugs during pregnancy. Coarctation of the aorta can occur at the same time as other congenital heart disease.
This condition is most commonly found in infants. However, coarctation of the aorta can also occur in adulthood. Coarctation of the aorta in adults is usually due to Takayasu's arteritis and atherosclerosis.
Coarctation of the aorta often occurs in the branch of the aorta that drains blood to the head, neck, or upper body, and is near the ductus arteriosus (part of the fetal blood vessel that connects the aorta to the pulmonary artery).
The narrowing of the aorta in this area will cause the blood pressure in the arms to tend to be higher than the blood pressure in the legs and ankles.
Risk factors for coarctation of the aorta
Some of the factors that can increase the risk of a baby suffering from coarctation of the aorta are:
- Have another congenital heart disease, such as patent ductus arteriosus, arterial septal defectventricular septal defect, or valvular heart disease
- Have a genetic disorder, such as Turner syndrome
In addition, the baby's risk of developing congenital heart disease also increases if the pregnant woman smokes, takes drugs, such as anti-seizure drugs, has lupus, or has uncontrolled diabetes.
Symptoms of Aortic Coarctation
Symptoms of coarctation of the aorta vary, according to the severity of the narrowing of the aorta that occurs. In mild coarctation of the aorta, symptoms may not appear until the child becomes a teenager or adult. Some of the symptoms that can appear are:
- Hypertension
- Headache
- Weak muscles
- Chest pain
- Hard to breathe
- Leg cramps
- Feet feel cold
Meanwhile, in severe cases of coarctation of the aorta, symptoms may appear shortly after the baby is born or several months after birth. Symptoms of coarctation of the aorta in infants include:
- Difficulty breathing
- Difficulty breastfeeding
- Skin looks pale
- Very sweaty
- Baby looks restless
When to go to the doctor
Go to the doctor or hospital emergency room immediately if you or your child experience the following symptoms:
- Severe chest pain
- Weak and faint
- Shortness of breath and difficulty breathing
- Pale
Women who have coarctation of the aorta and are planning to become pregnant also need to discuss their pregnancy plans with their doctor to prevent complications.
Diagnosis of Aortic Coarctation
The doctor will ask questions about the patient's complaints and medical history, both to the family and directly to the patient. After that, the doctor will perform a chest and heart examination.
During the examination, the doctor may find a heart murmur and a difference in blood pressure in the arm and leg. These things can be a marker of coarctation of the aorta.
To confirm the diagnosis, the doctor will perform the following investigations:
- Electrocardiogram (ECG), to see the electrical activity of the heart as well as to detect left ventricular hypertrophy
- Echocardiogram or ultrasound of the heart, to determine the location and severity of coarctation of the aorta, as well as to see the presence of other heart disorders
- Scans with chest X-ray, CT scan, and MRI, to see the location, severity, and effect of coarctation of the aorta on the heart
- Cardiac catheterization, to determine the narrowing of the aorta that occurs
Aortic Coarctation Treatment
Treatment aims to widen the narrowed aorta. The treatment procedure is adjusted according to the patient's age and the severity of the aortic narrowing experienced. Treatment methods that can be done include:
Drugs
Medications are given to control blood pressure before and after surgery. In infants with severe coarctation of the aorta, administration of the drug is intended to ductus arteriosus keep it open, until the coarctation can be corrected.
After the coarctation of the aorta is repaired, the doctor can give antibiotics to prevent infection.
Balloon angioplasty and fitting stent
This procedure can be performed on coarctation of the aorta for the first time or for coarctation that recurs after surgery. In this procedure, a balloon is placed at the entrance of the narrowed aorta, then the balloon is inflated to allow the aorta to widen so that blood can flow smoothly.
Usually, balloon angioplasty is often followed by ring placement (Fig.stent). The ring is placed so that the narrowed part of the aorta can remain open.
Operation
There are several surgical techniques that can be performed to treat coarctation of the aorta, including:
- Resection with end-to-end anastomosis, to cut the narrowed part and connect the two ends of the blood vessel
- Bypass graft repair by inserting an additional blood vessel (graft), to help blood flow to the narrowed aorta
- Patch aortaplasty by cutting the narrowed aorta, then attaching synthetic additives to widen the blood vessels
- Subclavian flap aorticoplasty by taking part of the blood vessel from the left arm, to help widen the narrowed aorta
After treatment, the patient needs to undergo regular check-ups with the doctor. If needed, the doctor will perform periodic scans to monitor the patient's condition.
Complications of Aortic Coarctation
Complications that can occur in patients with coarctation of the aorta are:
- Hypertension
- Left ventricular hypertrophy
- stroke
- Aortic aneurysm
- Aortic dissection or tear
- Brain aneurysm
- Heart failure
- Coronary heart disease at a young age
- Kidney illness
- Endocartitis
Prevention of Aortic Coarctation
Coarctation of the aorta is difficult to prevent because the cause is unknown. However, you can adopt a healthy lifestyle to maintain a healthy heart, for example by:
- Exercise regularly 20-30 minutes every day
- Eat fiber-rich foods, such as fruits and vegetables
- Reducing the consumption of saturated fat contained in chicken skin or red meat
In addition, patients with coarctation of the aorta who have undergone surgery are prone to endocarditis, so it is advisable to prevent endocarditis by following the therapy given by the doctor and always maintaining healthy teeth and mouth.
If you have other disorders that may be associated with coarctation of the aorta, such as Turner syndrome or other congenital heart disease, consult your doctor immediately. Early detection of coarctation of the aorta is the best way to prevent complications.
