Coarctation of the aorta

Coarctation of the aorta is a congenital constriction or a complete aortic rupture. The frequency of coarctation of the aorta is 6.3-15% of all heart defects. The first description of this congenital heart disease refers to 1750. In boys, this disorder occurs 3-5 times more often than in girls.

An open arterial duct is found in more than 60% of children in the first year of life with coarctation of the aorta. Isolated coarctation of the aorta is characteristic of older children. Often, this vice is combined with a two-fold valve of the aorta, deformation of the mitral valve. Coarctation of the aorta may be due to the presence of aortic membrane in the lumen or the narrowing of the vessel itself.

With coarctation of the aorta in the vessels that extend from the aorta to the site of its constriction, the pressure is increased( upper limbs, head and neck).In vessels that depart from the aorta after the site of its constriction, the pressure is reduced( abdominal organs, lower extremities).

The manifestation of heart disease is determined by the age, the anatomical changes that occur, and also the combination with other congenital heart defects. In young children, coarctation of the aorta is often accompanied by pulmonary heart disease from the first days of life, when paleness, severe shortness of breath, possible stagnant wheezing in the lungs, which simulates the clinic of pneumonia. The border of the heart is widened. When listening to the work of the heart, characteristic noise is determined. Detection of this disease helps determine the pulse on the hands and feet. In this case, there is a lack or sharp decrease in the pulse on the femoral arteries and a strained pulse on the arteries of the hands.

Older children often define "arterial hypertension of unknown origin" for a long time, sometimes they show an increased arterial pressure by chance. Complaints in such cases are reduced to a headache, repeated nasal bleeding. Children always have cold feet, they are prone to "freezing" in winter, quickly fatigue when loaded. The examination shows a good physical development with a disproportion of the muscular system: the muscles of the upper half are developed excessively with a relative underdevelopment of the pelvic muscles and lower limbs. Systolic( "upper") arterial pressure on the legs will be 50-60 mm Hg. Art.lower than on the hands( normal ratio is the opposite), with normal diastolic( "lower") arterial pressure. This is the main sign of coarctation of the aorta. Less often the arterial pressure on legs or foots in general is not defined or determined. On hands, blood pressure fluctuates between 130 and 180 mm Hg. Art.and higher. Such high blood pressure can cause sudden hemorrhage in the brain with the development of hemiparesis.

Additional methods of examination are ECG, chest X-ray. The diagnosis is confirmed by aortography and catheterization of the heart cavities, during which the place of narrowing is determined.

In children of the first months and years of life, vice is often severe, which makes it necessary to perform surgical intervention at an early age. If the course of the defect is not severe, then in order to avoid a new narrowing in the correction site, it is better to postpone the operation to 6-14 years. At this age, even in the absence of complaints and a moderate increase in blood pressure, coarctation of the aorta is an indication for the operation. After the operation, an increase in blood pressure is maintained, which requires the use of drugs that reduce it.

To avoid the development of life-threatening complications, aortic narrowing is subject to prompt treatment. The optimal age of children for the operation from 7 to 10 years, according to some other clinics from 7 to 15 years. When the child is in serious condition, surgery can be performed in infancy. In this case, the plastic of the narrowed aorta is flapped with a patch of the left subclavian artery of the child. At an older age, removal of the narrowed section and simple stitching of the end-to-end aorta can be performed. Sometimes a graft is used. The most dangerous complication of the operation of correcting the constriction of the aorta is a violation of the blood supply to the spinal cord. In 0.4% of cases, persistent paralysis of the lower extremities occurs. The average mortality in this operation is about 9%.The results of the operation are good.