Coarctation of the aorta

Diagnosis

Severe aortic coarctation may be detected while the baby is still in the womb with ultrasound or right after birth. How soon a doctor can detect aortic coarctation depends on how severe the disease is.

Mild aortic coarctation, on the other hand, is generally asymptomatic in adults and older children and does not affect their health.

A diagnosis of coarctation of the aorta is performed by looking for any of the following signs:

• High blood pressure in the arms
• The legs have a lower blood pressure than the one of the arms
• The legs have a weak or delayed pulse
• Heart murmur, or a whooshing sound

Coarctation of the aorta can be diagnosed with any of the following tests:

• Echocardiogram: This test helps to locate aortic coarctation and determine its severity to determine the necessary treatment. Sound waves are used to make moving images of the heart, which can help confirm if the heart has any other congenital conditions, such as a bicuspid aortic valve.
• Electrocardiogram (ECG or EKG): In case of severe aortic coarctation, this test helps determine if the walls of the lower heart chambers are thickening, knows as ventricular hypertrophy. The test can be quickly completed without causing pain by measuring the electrical activity of the heart through sensors attached to the chest or the arms or legs and using wires to connect the sensors to a machine where the results appear or are printed out.
• Chest X-ray: Aortic coarctation can be determined with this procedure as it creates images of the heart and lungs, where the narrowed aorta at the area of the coarctation can be found.
• Cardiac magnetic resonance imaging (MRI): This test is useful for helping the medical team make a treatment plan as it creates detailed images of the heart and blood vessels by using magnetic fields and radio waves making it easier to locate which area of the aorta is narrowing, assess its severity, see if any other blood vessels have been injured with the disease as well as find other heart disorders.
• Computerized tomography (CT) scan: This test shows detailed cross-sectional images of the body by using X-rays.
• CT angiogram: With a dye and special X-rays, the test is useful for planning for treatment, locating the disease and measuring its severity level as it shows blood flowing in the veins and arteries as well as affected blood vessels.
• Cardiac catheterization: The test helps to assess how severe the blockages in the heart arteries are by inserting a thin and flexible tube into a blood vessel in the groin or wrist before guiding the tube to the heart. The surgeon then injects dye through the catheter which flows to arteries of the heart to allowing to see the vessels more easily on X-ray images or video. Sometimes a doctor also uses this catheterization process to treat coarctation of the aorta.

Treatment

Coarctation of the aorta can be treated in many ways, such as medications to keep the conditions in control and surgery to get the aorta fixed. A cardiovascular surgeon or a cardiologist will choose the best treatment for you based on your age of the time the disease is found and the severity of the disease.

In certain cases, the medical team will treat aortic coarctation together with other congenital heart issues if they have found any of them in your body.

Medication

Your doctor might prescribe blood pressure medications before surgery to repair the aorta to enhance the efficiency of the surgery. You might be prescribed blood pressure medications before or after repair surgery. Even in case of a successful surgery which helps normalize your blood pressure, you might still need to take the medications after the surgery.

In case of treating a baby with severe aortic coarctation, a doctor might prescribe a medication that keeps its ductus arteriosus open so that blood can flow through a narrowing area of the aorta until surgery is done.

Surgery

Aortic coarctation can be treated as following:

• Balloon angioplasty and stenting: This procedure is usually chosen first and it uses a thin and flexible catheter with an uninflated balloon inserted into an artery in the groin. The doctor will then use X-rays to guide the catheter through the blood vessels to the heart and then to the area affected by aortic coarctation. The doctor will inflate the balloon at the catheter to widen the aorta to allow blood to flow through the artery. The doctor might also try to prevent
  aortic re-narrowing by placing a stent in the affected area to keep the artery open.
• Resection with end-to-end anastomosis: In this procedure, the doctor tries to remove the narrowed area of the aorta (resection) before connecting the two normal parts of the aorta (anastomosis).
• Subclavian flap aortoplasty: A doctor tries to widen the narrowed part of the aorta using a part of the left subclavian artery, which is responsible for delivering blood to the left arm.
• Bypass graft repair: the surgeon changes the direction of blood in the area and the aorta affected by aortic coarctation by using a graft.
• Patch aortoplasty: This option is recommended for those whose coarctation affects a long area of the aorta. The surgeon will try to expand the affected area by cutting across the vessel to attach a synthetic material there.