Description of aortic coarctation
Coarctation of the aorta among the congenital malformations of the heart and great vessels. This is a narrowing of the aorta,the main artery leaving the heart that allows blood nourishing the whole organism.
The constriction may be located at different locations and from which then derives the symptoms and severity of disease.
Often it occurs in combination with other heart defects and exhibits soon after birth.
In some cases, it can be known only in later years and in those cases where the bottleneck is not so serious.
When the disease leads to overloading of the heart, which must perform work against greater resistance of pipes narrowing of the aorta. Furthermore, there is insufficient blood circulation in the lower body, the upper half is blood supply normally.
Disease takes 5 to 10% of congenital heart defects and men (boys) are affected 2 times more than women (girls).
The high frequency of occurrence in women with Turner syndrome.
Causes of aortic coarctation
Given that this is a congenital defect, to its formation occurs even in the period before birth.
The aorta is divided into several parts according to its course. Withdraws from the heart of the ascending aorta, which then forms an arc and turns down. In place of the arch of the aorta artery supplying blood resign upper limbs and head. Coarctation of the aorta is the involvement of itsdescending part, the one that follows an arc.
At this point, before birth formed an additional communication between the aorta and the pulmonary vascular system. The clutch is designed so that in the period before birth sufficient flow of blood through the body and all the blood did not flow through the lungs, which does not need a baby before birth. Oxygen is supplied with blood because his mother.
This coupling, called arterial dučej (Bottali duct, ductus arteriosus) is normally closes itself several days after birth. It is for this reason that, when the lungs begin to operate, not depleting the blood that there must aerate and also, therefore, to prevent back flow of blood from the aorta to the pulmonary vascular bed, and it was not overloaded (which would then in healthy individuals occurred because after birth in the aorta pressure exceeds the pressure in the pulmonary arteries).
Depending on whether it is above or below the coarctation arterial Duce then depend on the symptoms and severity of the disease.
Risk factors for aortic coarctation
Risk factors include above all other congenital heart defects occurring either directly to the victim, or his immediate family. It is the following defects.
Bicuspid aortic valve. Aortic valve flap is meant, which is located at the point where the aorta withdraws from the heart (withdrawing from the left ventricle). In most people, it has three lobes.
Stenosis of the aortic valve: in this case meant congenital stenosis, aortic valve stenosis as can be obtained, but the risk factors belong. When this defect is narrowed place from which withdraws aorta from the heart. The heart then has to perform work against greater resistance and gradually increasing his muscle. In the absence of treatment may end in heart failure.
Mitral valve stenosis: Also just innate. The mitral valve is located between the left atrium and the left ventricle and its narrowing results make it more difficult blood flow from atrium to ventricle. The blood is then in the lungs and congestive transposed before heart, i.e. throughout the body, so that there is both to dyspnea and secondly to swelling (by the gravity) of the entire body. Even this defect can lead to heart failure.
Persistent arterial dučej In some cases arterial dučej closes after birth, leading to congestion pulmonary arteries, high blood volume, which are then flows through. Unrecognized defect can have serious consequences.
Ventricular septal defect: Ventricular septum, the muscular and fibrous septum that separates the right and left ventricle. Some neonates in this bulkhead opening through which blood flows from the left ventricle (due to higher pressure in the left ventricle) to the right. This is overloaded both chambers and lungs excessive blood volume. Failure then leads to the development of pulmonary hypertension.
As mentioned above, the risk factor is the disorder called Turner syndrome, in which the aortic coarctation frequent finding (10%). Normally, a person has 46 chromosomes, while the two determine the sex. Men have XY sex chromosomes, females XX.
Turner syndrome is a genetic disease affecting women missing one chromosome X.
Prevention of aortic coarctation
Unfortunately, in case of this disease is no causal prevention. But it is good to advise women who are in their family or partner in a family of proven occurrence of heart defects or Turner syndrome, in order to warn in case of pregnancy your gynecologist. This defect can be detected long before the birth of the child and consider such risks and severity of disability, and to prepare for an immediate solution to the defects after birth.
Signs and symptoms of aortic coarctation
For most affected by the disease symptoms appear shortly after birth, but sometimes the disease is discovered during adolescence or adulthood.
Symptoms of the disease depends on the extent to which the aorta constricted. In cases of severe narrowing, then whether after birth remains arterial dučej open or not.
In cases where the taper is not large, it is the main symptom of high blood pressure in the upper half of the body, which contrasts with the low pressure in the middle bottom. It is the same with the pulse of blood. Upper extremities is palpable very well, but the lower poorly or not at all.
Also included are frequent headaches and nosebleeds caused by high blood pressure. It can appear breathlessness which is more pronounced during exercise. Regularly they are also cold feet, weakness and pain in the muscles of the lower extremities due to bad blood flow.
Gradually, unless a serious disease, arterial collaterals are formed through which oxygenated blood flows from the upper to the lower body. During their formation, the symptoms in the lower limbs to some extent improved.
For severe narrowing of the symptoms appear soon after birth, the baby is pale, much breathless,sweaty and tearful. Moreover, if the narrowing of the gap under arterial Ducey, develops cyanosis(bluing to zfialovění from lack of oxygen), the lower half of the body.
If dučej remains open to the lower half of the body over her a certain amount of oxygenated blood gets and this symptom may not be at all or only slightly expressed.
These cases must be quickly recognized because their oversights can lead quickly to death of the newborn.
Treatment of aortic coarctation
Treatment of this disorder is always surgical. The question is only that, when the operation is performed. In severe narrowing is performed immediately after birth, in the case of minor surgery can be done with the lapse of time and plan so the best time to exercise.
The procedure involves the removal of the tapered section of the aorta and sew unaffected ends to each other. There are several other variations, whose choice depends on the extent and severity of the affliction (alternative is to use stents – springs dilate the narrowing) An advantage is that during this operation can be removed and other heart defects, so it is not necessary to operate on the patient multiple times.
It is also possible to use balloon angioplasty when the femoral artery through the aorta and the balloon is inflated here, which stretches its wall. Performance is often accompanied by implantation of a stent to the affected area, who then holds its diameter and prevents re-narrowing. This method is also chosen in surgery restenosis (re-narrowing).
If there is no surgery immediately after birth, children are often sold drugs, maintaining an open arterial dučej (prostaglandin E). This results in better blood circulation in the lower half of the body until it comes to the operation.
Other drugs have been used those which reduce blood pressure. Patients are administered before surgery. But sometimes you need to continue using them even after the surgery because there is not always complete correction of blood pressure even after successful surgery. This is the case especially for humans, in the coarctation unveiled later in life.
Complications of aortic coarctation
When serious defect are complications related to poor blood flow lower half of the body, which leads to hypoperfusion of vital organs such as the kidneys and liver. This results in severe cases, to their failure with risk of death.
For less serious defects based primarily complications from high blood pressure and it appears often in later life. It is an increased risk of stroke, cerebral aneursmat (aneurysms), left ventricular hypertrophy, which can lead to heart failure.
On the aorta also can create an aneurysm. Furthermore, there is a risk of rupture of the aorta(especially at site bulge) resulting in fatal bleeding mostly ended.
A complicating factor is also the re-narrowing of the aorta after surgery.
Other names: coarctatio aortae, CA
