Full Answer
Coarctation occurs most commonly in a short segment of the aorta just beyond where the arteries to the head and arms take off, as the aorta arches inferiorly toward the chest and abdomen. This portion of the aorta is called the "juxtaductal" aorta, or the part near where the ductus arteriosus attaches.
Coarctation of the aorta can cause high blood pressure in the heart. This can cause the muscle of the heart's main pumping chamber (left ventricle) to become thick. Eventually, the function of the heart muscle could deteriorate if the condition isn't treated.
The diagnosis of coarctation is usually confirmed with echocardiography, which can define the anatomy of the aorta and evaluate for other cardiac anomalies that may also be present. Occasionally other tests, such as a cardiac MRI or CT scan, may be used to document the presence of a coarctation.
The outlook after surgery is favorable, but long-term follow-up by a pediatric cardiologist is needed. Rarely, coarctation of the aorta may recur. Then another procedure to relieve the obstruction may be needed. Also, blood pressure may stay high even when the aorta's narrowing has been repaired.
The provider will use a stethoscope to listen to the heart and check for murmurs. People with aortic coarctation often have a harsh-sounding murmur that can be heard underneath the left collar bone or from the back. Other types of murmurs may also be present.
Coarctation of the aorta is generally present at birth (congenital). Although the condition can affect any part of the aorta, the defect is most often located near a blood vessel called the ductus arteriosus.
Coarctation of the aorta is the most common cardiac defect associated with Turner syndrome.
Overview. Aortic coarctation can be classified as preductal coarctation, ductal coarctation, and postductal coarctation depending upon the coarctation's anatomic relationship to the ductus arteriosus. All classifications involve narrowings of the aorta that directly impact the aortic hemodynamics.
The ductus arteriosus is formed from the left 6th aortic arch during embryonic development and attaches to the final part of the aortic arch (the isthmus of aorta) and the first part of the pulmonary artery.
Patency of the arterial duct plays an important role in the majority of cases with severe neonatal aortic coarctation, allowing blood flow to reach the lower body (right-to-left shunt).
Careful simultaneous palpation of upper and lower extremity pulses may help confirm suspected coarctation. In older children, adolescents, and adults, coarctation of the aorta is best diagnosed clinically based on simultaneous palpation of femoral and brachial pulses.
left ventricleThe aorta is the largest blood vessel in the body. This artery is responsible for transporting oxygen rich blood from your heart to the rest of your body. The aorta begins at the left ventricle of the heart, extending upward into the chest to form an arch.
Abnormal blood pressure is often the first sign of COA. During a physical exam, a doctor may find that a child with a coarctation has higher blood pressures in the arms than in the legs. The doctor also might hear a heart murmur or notice that the pulse in the groin is weak or hard to feel.
Bilateral symmetrical rib notching, readily appreciated on the chest image, is diagnostic of aortic coarctation. It is the result of obstruction of blood flow at the narrowed aortic segment, in conjunction with collateral blood flow through the intercostal arteries.
Coarctation of the aorta is usually diagnosed by echocardiogram (ultrasound pictures of the heart). Cardiac magnetic resonance imaging), cardiac CT (computerized tomography scan), and cardiac catheterization angiography also show aortic narrowing.
A normal aortic valve is tricuspid. Five types of bicuspid valve are shown, with Type 1 being most prevalent. A bicuspid valve forms when the tissue surrounding one of the cusps (leaflets) of the valve fuses during fetal development.
Most activities are likely safe, and encouraged. Heavy isometric exercise, such as power weightlifting, may be a particular concern especially in patients who have enlargement of the aorta since it raises the blood pressure quickly. See the section on Physical Activity and Exercise for more information.
Women with repaired coarctation can carry a pregnancy with low risk. The exception is if there's a residual (leftover) narrowing of the aorta or if there's high blood pressure or enlarged areas of the aorta. It's best to plan ahead and have a thorough check-up including an imaging study of the aorta to detect these problems before becoming pregnant, and control the problems before conception. See the section on Pregnancy for more information.
Although infection of a coarctation can occur, it isn't likely. More commonly, patients may develop infection of a coexisting abnormal aortic valve. All patients are advised to practice good oral care.
High blood pressure is the most common problem adults have. It can be present even if your coarctation was successfully fixed. High blood pressure is more common if the coarctation was repaired after five years old. Patients treated in childhood are at risk for redeveloping the coarctation (recoarctation) and may require catheterization. Most patients with recoarctation of the aorta after initial repair usually don't have symptoms, which makes regular assessment by a physician all the more important. Many times the area will renarrow to a degree, or other portions of the aorta may enlarge (aneurysms) with potential to rupture. These may need to be addressed with further intervention. Patients may develop coronary artery disease, leaving them vulnerable to heart attacks. There may even be an increased risk of having an aneurysmal blood vessel in the head.
Coarctation of the aorta is common in some patients with chromosomal abnormalities, such as Turner 's syndrome . In the presence of a coarctation, the left ventricle has to work harder, since it must generate a higher pressure than normal to force blood through the narrow segment of aorta to the lower part of the body.
Coarctation occurs most commonly in a short segment of the aorta just beyond where the arteries to the head and arms take off, as the aorta arches inferiorly toward the chest and abdomen. This portion of the aorta is called the "juxtaductal" aorta, or the part near where the ductus arteriosus attaches. It is also called the aortic isthmus.
Coarctation may also occur with other cardiac defects, typically involving the left side of the heart. The defects most commonly seen with coarctation are bicuspid aortic valve and ventricular septal defect. Coarctation may also be seen as a part of more complex single ventricle heart defects. Coarctation of the aorta is common in some patients ...
It is also called the aortic isthmus. The ductus arteriosus is a blood vessel that is normally present in a fetus and has special tissue in its wall that causes it to close in the first hours or days of life. Coarctation may be caused by the presence of extra ductal tissue extending into the adjacent aorta which results in aortic narrowing as ...
Coarctation of the aorta is a narrowing of the aorta, the main blood vessel carrying oxygen-rich blood from the left ventricle of the heart to all of the organs of the body.
In these older patients, coarctation is often first suspected because of a heart murmur or high blood pressure. Coarctation is suspected when the physician is unable to feel pulses in a child’s legs. High blood pressure in the arms (but not the legs) may be detected.
Potential complications of surgery, although uncommon in children, are damage to downstream organs, particularly the kidneys or the spinal cord.
as the 1 st and 2 nd posterior intercostal arteries arise from the costocervical trunk (a branch of the subclavian artery) and do not communicate with the aorta, these are not involved in collateral formation, and the 1 st and 2 nd ribs do not become notched.
if unilateral right rib notching. then the coarctation lies distal to the brachiocephalic trunk but proximal to the origin of the left subclavian artery.
it is due to thickening of the aortic media and typically occurs just distal to the ligamentum arteriosum ( a remnant of the ductus arteriosus)
It can be primarily divided into two types: infantile (pre-ductal) form. characterized by diffuse hypoplasia or narrowing of the aorta from just distal to the brachiocephalic artery proximal to the level of ductus arteriosus.
the coarctation is distal to the origin of the left subclavian artery, therefore collaterals form on the left. collaterals cannot form on the right, as the aberrant right subclavian artery arises after the coarctation.
ANS: D Clinical manifestations of coarctation of the aorta include hypertension noted in the upper extremities with decreased or absent pulses in the lower extremities. Children may also have cool mottled skin and occasionally experience leg cramps during exercise.
Truncus arteriosus. ANS: D Truncus arteriosus is the failure of the large embryonic artery, the truncus arteriosus, to divide into the pulmonary artery and the aorta, which results in a single vessel arising from both ventricles, providing blood flow to the pulmonary and systemic circulations.
ANS: A Older children who have an unrepaired septal defect with a left-to-right shunt may become cyanotic because of pulmonary vascular changes secondary to increased pulmonary blood flow. Left-to-right shunts are usually acyanotic.
Cerebral hypertension. ANS: A Initially, the newborn usually exhibits symptoms of HF. Cor pulmonale, pulmonary hypertension, and cerebral hypertension are not associated with coarctation of the aorta. A parent asks the healthcare professional to explain why a child diagnosed with Tetralogy of Fallot squats frequently.