Coarctation of the aorta in children and newborns

One of the frequently occurring and quite dangerous heart defects is aortic pathology, called coarctation. It represents the narrowing of the aorta, the largest vessel in the body of a person extending from the left ventricle. This defect is diagnosed in 7-15% of children with congenital heart disease. At the same time, detection of coarctation in boys occurs 2-5 times more often. Most often, aortic stenosis in children is detected at the site of its arc, but the thoracic or abdominal part of this vessel may also contract.

In most cases, coarctation of the aorta in children develops due to a violation of the formation of this vessel, when the child is in the womb. This can contribute to such factors:

• The proximity of the arterial duct. During its closure, some of the ductal tissues draw the aortic wall into the process, which can cause both an arc break due to a pronounced contraction and a slight coarctation.
• Heredity. Aortic narrowing is detected in approximately 10–20% of babies with such chromosomal abnormalities as Shereshevsky-Turner syndrome.

Depending on the changes in the child’s body, there are two variants of coarctation:

1. Children's;
2. Adult.

A feature of this type of pathology is the unclosed arterial duct, which normally functions in the fetus in utero to discharge blood from the right heart to the aorta, bypassing the pulmonary circulation (pulmonary vessels).

In this form, the arterial duct is usually completely closed, and the narrowing divides the aorta into two parts - the wide aorta above the site of coarctation with increased blood pressure and the extended portion of the aorta below the narrowing, in which the pressure is lowered. To compensate for the condition, bypass paths (collateral) begin to develop, delivering blood from the heart to part of the aorta above the stenosis.

In addition, the work of the left ventricle is enhanced, and the blood pressure in the vessels of the upper body increases. Since blood vessels are lowered in vessels below the belt, this activates the renal mechanism of increasing blood pressure, which is additionalIt increases the pressure of the blood vessels above the belt and increases the risk of hemorrhage.

Manifestations of this defect depend on the degree of narrowing of the aortic lumen. If it is small, the child may:

• Chest pains.
• Headaches.
• Weakness.
• Cool to the touch limbs.
• Limping during physical exertion.

In the following video, they are available and understandably talk about the symptoms of the disease and about the methods of treatment.

As well as valve stenosis, coarctation may be complicated:

• Aortic rupture.
• Pulmonary hypertension.
• Infectious endocarditis.
• Stroke
• Hypertension.
• Heart failure.
• Pulmonary edema.

Suspected coarctation of the aorta arises when the child increases blood pressure, determines the intense pulse in his arms and barely palpable in the legs, and when the doctor listens to a soft noise over the child's aorta. To clarify the diagnosis, children spend:

• Echocardiography to visually identify the location of the narrowing.
• Phonocardiography for recording tones and noise when the heart is working.
• Electrocardiography to determine abnormalities of the heart and left ventricular overload.
• Chest X-ray to determine the state of the heart as well as the lungs.
• Catheterization of the heart and aorta to measure blood pressure above narrowing, as well as below the place of stenosis.

This heart disease is mainly treated surgically, since no medicine can eliminate the cause of this pathology. Children with coarctation require urgent surgical intervention if:

• The index of systolic blood pressure in the lower extremities differs from that on the hands by more than 50 units.
• The defect manifested itself immediately after childbirth, and the baby had a pronounced increase in blood pressure, and decompensation of the heart’s work occurred.

The operation for coarctation may be:

1. Removal of the site of coarctation followed by suturing of the ends of the aorta. This method is used for a small area of ​​narrowing.
2. Plastic surgery of the vessel, in which the child uses a prosthesis or subclavian artery. This method is in demand for a large area of ​​stenosis.
3. Installation of a shunt from a vascular prosthesis for the possibility of blood flow to bypass the narrowing.
4. Balloon plastics and stent placement at the site of stenosis so that the aorta does not close after manipulation.

If the stenosis is small, the child will have a normal life, and its duration will not be shortened. The same prognosis is given with timely surgical treatment of coarctation. When expressed narrowing without surgery, life expectancy is reduced to 30-35 years.

Coarctation of the aorta is quite a serious disease, and it certainly needs to be treated. You can learn more about the disease by watching the next video.