Aortic Coarctation

Signs and Symptoms

Many aortic coarcations, especially mild conditions, may not produce symptoms until later in life. If a baby doesn't experience severe symptoms at birth, aortic coarctation may go unnoticed. Your childs doctor may suspect a problem if he or she hears a distinctive murmur in your childs heart or if your child has high blood pressure in the arms and low pressure in the legs.

Babies born with aortic coarctation often have other heart abnormalities, such as deformed aortic valves, patent ductus arteriosus or ventricular septal defect. Some conditions are so severe at birth that they require immediate treatment.

Symptoms of aortic coarctation may differ for each child. The following are the most common symptoms:

• Elevated blood pressure
• Feeding problems
• Heavy or rapid breathing
• Irritability
• Pale skin
• Poor weight gain
• Sweating

Diagnosis

To diagnose aortic coarctation, your child's doctor will conduct a thorough examination. Tests may be recommended to make a definite diagnosis and rule out other conditions that cause similar symptoms. Tests may include:

• Cardiac catheterization, which involves injecting a dye into the heart to see how the heart and aorta are functioning on a "video" X-ray.
• Chest X-ray to see the heart's size
• Echocardiogram, a test that uses sound waves to create a moving picture of the heart.
• Electrocardiogram (ECG or EKG), a test that records the electrical activity of the heart.
• Magnetic resonance imagining (MRI) or computed tomography (CT) scan may performed to better see the restricted area and surrounding blood vessels

Treatment

In the past, aortic coarctation repair involved heart surgery and required five to seven days in the hospital for recovery. Today, heart specialists correct coarctation in many patients without surgery using a procedure called cardiac catheterization, which involves threading a thin, flexible tube through a blood vessel to insert a specially designed stent or small metal mesh tube.

The catheterization and stent placement is performed in our Cardiac Catheterization Laboratory. The procedure takes about three to four hours. Your child will be admitted to the hospital the morning of the procedure and may return home the following morning.

To perform cardiac catheterization, a tiny incision is made in the groin to insert thin, flexible tubes, called catheters. The catheters are directed through blood vessels to the heart. Catheters can carry very small instruments or repair devices, such as a stent.

The size of the restricted aorta is measured and an appropriately sized stent, or expandable metal tube, is selected. Sometimes, more than one stent is needed for the repair. If the narrowing is too close to the head and neck vessels, stent repair may not be possible. In these cases, surgical repair is necessary and will be scheduled for another time.

The stent placed over a deflated balloon at the catheter's tip. When the balloon reaches the site of the narrowing, it is expanded to widen the artery. The stent is left in place to support the newly widened artery walls and the catheter and balloon are withdrawn.

Complications

Complications during the procedure are unusual and most can be treated immediately. These include allergic reaction to X-ray dye requiring medication, aneurysm or bulge in a blood vessel, blood loss requiring a transfusion and an improper stent position requiring retrieval by catheter or surgery.

There is a small risk of blockage of the groin vessels used for catheterization, which ordinarily responds to medication. Although very rare, serious complications such as a tear in the aorta, requiring surgery or resulting in death, can occur. Complications after the procedure, such as breakage, movement or infection of the stent, are extremely rare.