Everything You Need To Know About Coarctation Of The Aorta Treatment
Aortic coarctation is narrowing of the aorta. It makes the heart to pump harder for blood flow through the aorta. Coarctation of the aorta is generally present at birth (called congenital heart defect). Treatment for aortic coarctation is mostly successful, but the condition would require careful follow-up. On this page, we will explore coarctation of the aorta in detail, such as what is coarctation of the aorta, what are the causes and symptoms of coarctation of the aorta, how to diagnose coarctation of the aorta, what are the treatments for coarctation of the aorta, who are the best doctors for aortic coarctation treatment in India, and which are the top hospitals for coarctation of the aorta treatment in India.
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What is Coarctation of the aorta?
Coarctation of the aorta is a congenital heart defect wherein a baby’s aorta is pinched or narrowed in one place. This condition prevents normal blood flow to their lower body parts. If a baby has aortic coarctation, a part of their aorta is narrow. The coarctation most often occurs in a short piece of the aorta beyond where the arteries to the arms and head start. This is the part of the aorta where another blood vessel known as the ductus arteriosus generally inserts. Coarctation might also happen with some other cardiac defects involving the left part of the heart. The defects generally seen with aortic coarctation are ventricular septal and bicuspid aortic valve defect. Coarctation might also be seen as a part of complex, single ventricle heart defects.
Types of Coarctation of the aorta
Preductal coarctation: The narrowing occurs proximal to the ductus arteriosus. Flow of the blood to the aorta which is distal to the narrowing depends on the ductus arteriosus. Severe coarctation may be life-threatening. Preductal coarctation happens when an intracardiac anomaly during fetal development reduces blood flow through the left side of the heart. This is generally seen in around 5% of infants with Turner syndrome.
Postductal coarctation: The narrowing occurs distal to the insertion of the ductus arteriosus. Even in case of an open ductus arteriosus, flow of the blood to the lower body may be impaired. This type is common in adults. It is linked to notching of the ribs, weak pulses in the lower extremities and hypertension in the upper extremities. Postductal coarctation occurs due to the extension of a muscular artery into an elastic artery during fetal life, where the fibrosis and contraction of the ductus arteriosus upon birth narrows the aortic lumen.
Ductal coarctation: The narrowing happens at the insertion of the ductus arteriosus. This type generally appears when ductus arteriosus closes.
Causes and Symptoms
Causes
- Severe hardening of arteries
- Traumatic injury
- Inflamed arteries
- Recreational drugs
- Diabetes
- Rubella infection while pregnant
Symptoms
- Chest pain, headache
- Difficulty breathing
- Heavy sweating
- Irritability, difficulty feeding
- Pale skin, leg cramps
- High blood pressure
- Muscle weakness
- Nose bleeding
Diagnosis
Below are some tests to diagnose coarctation of the aorta:
Echocardiogram: This is the test used to confirm the diagnosis of aortic coarctation. An echocardiogram can show the location as well as the severity of aortic coarctation. It could also help detect other congenital heart defects like bicuspid aortic valve.
Chest X-ray. A chest X-ray produces images of the lungs and heart. A chest X-ray may show narrowing of the aorta at the place of coarctation or enlarged section of the aorta.
Cardiac magnetic resonance imaging: This test will use magnetic fields and radio waves to produce detailed pictures of the blood vessels and heart. It may reveal the location as well as the severity of the coarctation of aorta, heart defects and damage to other blood vessels. The doctor might use the MRI results to guide treatment.
CT angiogram. A CT angiogram will use a dye and special X-rays to reveal how blood flows via the arteries and veins. The test will also show the location of coarctation of the aorta.
Computerized tomography scan. A CT scan will use a series of X-rays to produce detailed cross-sectional pictures of the body.
Cardiac catheterization. This specific test helps show blockages in heart arteries. A thin flexible tube (or catheter) will be inserted into a blood vessel, and guided to your heart. Dye will flow through the catheter to the heart arteries. The dye will help the arteries show up clearly on X-ray images.
Risk & Complications
Irregular heart rhythms: The most common arrhythmia following surgery is atrial fibrillation, which leads to an increased risk of stroke. However, it is only a temporary problem.
Infections: Another complication of surgery is infection. If infections spread in the body, they may cause sepsis. Sepsis, a life-threatening problem of the immune system, is a medical emergency, and having two or more of its symptoms must be considered dangerous as stroke or a heart attack. Major infections after bypass surgery are rare due to improved surgical care and techniques.
Bleeding: This is a common risk with a major surgery. To avoid this, individuals who take blood thinners need to stop taking them before the surgery.
Confusion or delirium: These cause symptoms such as agitation, memory problems, trouble thinking clearly or someone behaving unusually. Other risks include kidney problems, heart attack and stroke.
Preparation of Treatment
Consider pregnancy carefully: Coarctation of the aorta might increase the risk of aortic dissection, aortic rupture or other complications during pregnancy as well as delivery. Before getting pregnant, talk to the doctor about possible risks and complications. You and your doctor should discuss and plan for special care required during pregnancy. Management of blood pressure during pregnancy is also important.
Do regular exercise: Regular exercise helps reduce blood pressure. Ask your doctor about whether you have any type of activity restrictions. Some physical activities like weightlifting may temporarily increase blood pressure. Your doctor might do an exam to determine whether it is safe to play competitive sports or lift weights.
Prevent heart infections: Bacteria may affect the inner lining of the heart valves, leading to a condition known as endocarditis. In case you have endocarditis or any kind of congenital heart diseases, you should talk to your doctor about any risks and whether you require preventive antibiotics.
Preparing yourself before undergoing coarctation of the aorta surgery is important. It is crucial to consult a dentist before undergoing the surgery because a low grade infection in the mouth may cause infection in the heart at the time of surgery. Preparatory deep breathing exercises will help reduce the overall risk of developing pneumonia during the surgery. The patient should follow a balanced diet before the procedure. Discuss all current medications with the doctor. They may ask to stop or continue the medications.
Treatment Option
Medication: Medications might be prescribed to reduce blood pressure before repair surgery. While repairing aortic coarctation controls blood pressure, many individuals will still need to take blood pressure medications after successful surgery. Children with severe coarctation of the aorta often are prescribed a medication that helps keep the ductus arteriosus open. This allows flow blood around the narrowed part of the aorta until surgery is performed.
Balloon angioplasty: This might be the initial treatment for aortic coarctation. In some cases, it is done when narrowing happens again after coarctation surgery. In balloon angioplasty, the doctor will insert a thin tube into an artery in the groin. An uninflated balloon is positioned in the catheter and then moved in the region of the narrowed aorta.
Bypass graft repair: This type of surgery uses a small tube known as a graft to reroute blood near the narrowed area of aorta.
Patch aortoplasty: The surgeon will cut across the narrowed part of the aorta and attaches a small patch of synthetic material to increase the size of the blood vessel. Patch aortoplasty is often useful if the coarctation involves a long part of the aorta.
Resection with end-to-end anastomosis: This method will involve removing the narrowed part of the aorta and then connecting the two healthy areas of the aorta.
Subclavian flap aortoplasty: A section of blood vessel that carries blood to the left arm might be used to widen the narrowed region of the aorta.
Cost of the treatment
Cost of Coarctation of the aorta treatment
The cost of coarctation of aorta treatment in India is lower than other developed countries across the world. The average cost of coarctation of aorta treatment in India is around $4200 to $7200. The cost of coarctation of aorta treatment in India will depend on several factors like the hospital or clinic where the treatment is being provided, the patient's medical condition and type of treatment required. A large number of international patients travel to India for coarctation of aorta treatment due to affordable treatment cost, world-class hospitals, and highly trained and experienced surgeons.
Recovery
Recovery after Coarctation of the aorta treatment
Recovery after coarctation of the aorta treatment surgery generally takes 2-3 weeks. Measure your weight on a daily basis as there may be a rapid weight gain if the heart is not pumping blood efficiently. You may notice a loss of appetite for food after surgery. You should drink lots of fluid and follow a balanced diet to achieve return to your normal bowel pattern. You need to take all the medications advised by the doctor. Do not change the dosage of medications without the doctor's consent. As you recover from surgery, walking is considered the best form of exercise. Don’t drive until the doctor asks you to do so. Avoid lifting any heavy objects until you recover fully.
Frequently Asked Questions About Coarctation of the Aorta
Patients with coarctation of the aorta have a greater risk of exercise-induced hypertension even in the absence of residual aortic obstruction. Patients with this condition also have worse vascular function indices, and the overall severity of vascular dysfunction is correlated with exercise-induced blood pressure changes.
In the absence of treatment, coarctation of the aorta in babies might cause heart failure or death. Long-term high blood pressure is a common complication of coarctation of the aorta.
Coarctation of the aorta might require open heart surgery or cardiac catheterization, depending on the overall severity of narrowing and on some other factors like your child's age and overall health.
Coarctation of the aorta should be treated quickly as it may lead to high blood pressure and enlarge the heart. It can also lead to rupture of the aorta, which may be fatal.
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