COARCTATION OF AORTA, symptoms, diagnosis and treatment

1. COARCTATION
OF
AORTA
MOHAMMAD AHSAN UL HAQ MASOODI
Group 43

2. 1. Definition:
⬢ A narrowing of the large blood vessel
(aorta) that leads from the heart.
⬢ Coarctation of the aorta is usually present
at birth (congenital) and may occur with
other heart defects.
.
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3. ⬢ Coarctation of the aorta is a birth defect in which a part of the aorta is
narrower than usual. If the narrowing is severe enough and if it is not
diagnosed, the baby may have serious problems and may need surgery or
other procedures soon after birth. For this reason, coarctation of the aorta is
often considered a critical congenital heart defect. The defect occurs when a
baby’s aorta does not form correctly as the baby grows and develops during
pregnancy. The narrowing of the aorta usually happens in the part of the blood
vessel just after the arteries branch off to take blood to the head and arms,
near the patent ductus arteriosus, although sometimes the narrowing occurs
before or after the ductus arteriosus. In some babies with coarctation, it is
thought that some tissue from the wall of ductus arteriosus blends into the
tissue of the aorta. When the tissue tightens and allows the ductus arteriosus
to close normally after birth, this extra tissue may also tighten and narrow the
aorta.
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4. Occurance:
The Centers for Disease Control and Prevention (CDC)
estimates that about 2,200 babies are born with
coarctation of the aorta each year in the United States1.
In other words, about 1 in every 1,800 babies born in the
United States each year are born with coarctation of the
aorta.
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5. 5
The causes of heart defects, including
coarctation of the aorta, among most
babies are unknown. Some babies have
heart defects because of changes in their
genes or chromosomes. Heart defects,
like coarctation of the aorta, are also
thought to be caused by a combination of
genes and other risk factors, such as
things the mother comes in contact with
in the environment, what the mother eats
or drinks, or medicines the mother uses.
CAUSES AND RISK FACTORS

6. *DEVELOPMENTAL FACTOR :
1. Underdevelopment or hypoplasia of aortic
arch or isthmus
Definition of hypoplasia
• Proximal arch: 60% of ascending aorta
• * Distal arch : 50% of ascending aorta
• * Isthmus : 40% of ascending aorta
• 2. Presence of ectopic ductal
tissue in the aorta

7. *MORPHOLOGY:
1. LOCALIZATION STENOSIS
*More than 50% reduction in cross sectional area
• *Shelf, projection, infolding of aortic media into the lumen opposite the ductus arteriosus
• * Usually intimal hypertrophy (intimal veil) extends the shelf circumferentially and further
narrows the lumen (Rodbard)
• 2. TUBULAR HYPOPIASIA
• * Severe with lesser narrowing
• * Proximal aortic & arterial wall
• * Distal aortic arch narrowing* Fetal flow pattern (Rudolph
COARCTATION OF AORTA:
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8. COARCTATION OF AORTA
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⬢ * PATHOPHYSIOLOGY
⬢ • Narrowed aorta produces increased left ventricular
afterload and wall stress, left ventricular hypertrophy, and
congestive heart failure.
⬢ • Systemic perfusion is dependent on the ductal flow and
collateralization in severe coarctation

9. SIGN AND SYPMTOMS
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10. SYMPTOMS IN CHILDREN
⬢ Fast pulse.
⬢ Fatigue.
⬢ Gray or pale skin.
⬢ Heavy sweating.
⬢ Irritability.
⬢ Rapid or labored breathing.
⬢ Trouble breathing.
⬢ Trouble with feeding.
⬢ Severe coarctation in infants can lead to shock and
even death if not recognized and treated promptly. 10

11. SYMPTOMS IN ADULTS
⬢ Symptoms in adults are usually due to recoarctation of the
aorta. This is aortic narrowing that returns sometime after
a previous repair. Symptoms may include:
⬢ Headaches.
⬢ Kidney problems.
⬢ Frequent miscarriages.
⬢ Lack of energy when using your legs.
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12. Diagnosis
*Echocardiogram can often detect the location and severity of the aortic
coarctation and show other heart defects, such as a bicuspid aortic valve. Doctors
often use echocardiograms to diagnose coarctation of the aorta .
*Chest X-ray might show an enlarged heart, a narrowing in the aorta at the site of
the coarctation and an enlarged section of the aorta past the narrowed area.
*Magnetic resonance imaging (MRI) can reveal the location and severity of the
coarctation of the aorta, determine whether it affects other blood vessels in your
body, and detect whether you have other heart defects.
*Computerised tomography (CT) scan allows your doctor to see the location and
severity of the coarctation of the aorta, determine whether it affects other blood
vessels in your body, and detect other heart defects.
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13. 13
TREATMENT
The coarctation narrowing can be repaired by
surgery or non-surgical balloon dilation. Aortic
coarctation may reoccur even after successful
surgical repair or balloon dilation done in infancy
or adulthood. Recurrent coarctation can be
treated either surgically or non-surgically using
balloon dilation or stenting.

14. All Treatment options :
1. Resection and anastomosis
2. Bypass graft repair
3. Patch arthroplasty
4. Balloon angioplasty
5. Stenting
6. Medications - cannot cure the condition but is often
used to keep the ductus open and control blood
pressure during surgery
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15. Complications of aortic coarctation repair
⬢ Recoarctation (recurrent coarctation). The same part of the aorta
narrows again later on. The risk is 5% to 10% after surgery and 11%
to 15% after either form of balloon angioplasty.
⬢ Aortic aneurysm. The walls of the aorta bulge outward.
⬢ Pseudoaneurysm. There’s a contained leak within the aortic wall.
⬢ Scar tissue. Scar tissue forms at the repair site and causes the
aorta to narrow again. This happens most often in infants who had
emergency surgery for severe coarctation.
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16. COARCTATION OF AORTA
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