Coarctation of Aorta

There is a big vessel in heart that is known as AORTA that suppliesblood to body including lower part of the body.

Whenever there is narrowing or obstruction in the distal part of this vessel (specially near to the vessel that supplies blood to left arm: Left subclavian artery), it is known as coarctation of aorta.

Narrowing can be at single point (discrete coarctation) or may be associated with isthmic hypoplasia etc.

When there is very severe narrowing at the coarctation of aorta segment, it is known as criticalcoarctation of aorta. Generally it is seen in newborn babies and babies may be in shock like state with dependency on PDA for their survival.

Presentation depends on severity of narrowing and age of presentation. In neonates, it often presents as a duct dependent lesion in the form of critical COA. Babies can have difficulty in feeding, shortness of breath, poor skin colour with decreased urine output. In late infancy or childhood including adolescents: children are generally asymptomatic and detected incidentally by pediatrician by hearing an abnormal heart sound on examination. Older child may have high blood pressure (hypertension), headache, bleeding from nose, leg cramps or pains, blurring of vision, loss of consciousness etc.

Coarctation of aorta can be diagnosedby doing PEDIATRIC ECHOCARDIOGRAPHY.

In bigger children or adolescents, CT angiography may need to be done for defining the stenosis in detail as well as in planning the treatment.

Treatment of choice in coarctation of aorta depends on severity of its stenosis.In severe coarctation of aorta:

In newborns and early infancy: When pumping of main chamber of heart is decreased then immediate ballooning of coarctation of aorta segment needs to be done. If pumping is good then treatment of choice is by doing SURGERY.

In Older infancy or children: Ballooning of stenosis or narrowing is the treatment of choice.

In adolescents or adults: If weight of patient is more than 25-30 kilogram then coarctation of aorta is treated by putting a stent across the narrowing or else ballooning needs to be done.

No medicine can cure it.

After ballooning/stenting: one month then 3, 6, 12 months after the procedure.

After surgery: after 3 days for wound dressing, then 1, 3, 6, 12 months after surgery.

By cardiac angiography from blood vessels of thigh that are connected with the heart. Ballooning is done in a beating heart. This procedure is generally done under conscious sedation.

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