Learning about the Coarctation of the Aorta

At Genesis Foundation, we care for critically ill children who are diagnosed with Congenital Heart Defects (CHD). Every day, we strive to ensure a healthy life for one more child. Our patrons place faith in us and our belief system, trying to save little hearts. But these little hearts often suffer through severe complications which are unheard of, except in the medical community. This blog will help you understand one such condition, that is the Coarctation of the Aorta.

What is Coarctation of the Aorta?
The aorta is the large blood vessel that branches off your heart and delivers oxygen-rich blood to your body. But when there is a narrowing of the aorta, it is called aortic coarctation or coarctation of the aorta. When this occurs, your heart must pump harder to force blood through the narrowed part of your aorta.

Image Caption: Difference between a normal heart and one with aortic coarctation.

Coarctation of the aorta is generally present at birth (congenital). The condition can range from mild to severe, and might not be detected until adulthood, depending on the narrowing capacity of the aorta.
Coarctation of the aorta often occurs along with other heart defects. While treatment is usually successful, the condition requires careful lifelong follow-up.

Symptoms of Coarctation of the Aorta
Coarctation of the aorta symptoms depend on the severity of the condition. Most people don’t have symptoms. Children with serious aortic narrowing may show signs and symptoms earlier in life, but mild cases with no symptoms often remain undiagnosed until adulthood. Children with aortic coarctation might also show signs or symptoms of other heart defects that they have along with coarctation of the aorta.
The display of symptoms for babies immediately after birth and older children differs. If babies are left untreated, it may lead to heart failure or death. Whereas in older children, the narrowing of aorta may be less severe.

Image Caption: Aortic Coarctation displays varying symptoms in newborns and adult children.

Causes of Coarctation of the Aorta
The exact cause of Coarctation of Aorta is unknown. Mild to severe narrowing can occur in any part of the aorta. The condition generally develops before the birth. But in some rare situations, it can happen later in life too. For example, a traumatic injury may lead to the coarctation of the aorta.

With coarctation of the aorta, the lower left heart chamber (left ventricle) of the heart must work a lot harder to pump blood through the narrowed aorta. This also increases the blood pressure in the left ventricle, sometimes leading to hypertrophy.

Risks & Complications Associated with Coarctation of the Aorta
Coarctation of the aorta often occurs along with other congenital heart defects like Bicuspid Aortic Heart Valve, Patent Ductus Arteriosus, Aortic Valve Stenosis and the like. It has been noticed that it’s more common in males than in females.
However, if this aortic coarctation is left untreated, it can cause multiple complications like narrowing of the aortic valve, high blood pressure, stroke, heart failure, etc.

Diagnosis & Treatment
The age at which Coarctation of Aorta occurs depends on the severity of the obstruction. If it is severe, it is generally diagnosed during infancy. Even with the advanced technologies available, testing for it before birth is not possible yet. Diagnostic tests like echocardiogram (ECHO), electrocardiogram (ECG), chest X ray, CT Scan, MRI, Cardiac Catheterization etc. help in further understanding. Treatments generally include surgery, balloon angioplasty or placement of stent in a Cath lab.

GF Kids who Received Treatment for Coarctation of Aorta

Two-year-old S. Sastika is the second child of Saravanakumar Muthusamy and Sarashwathi who reside in Tiruppur, Tamil Nadu. She has an elder brother who is four years old. Sastika was suffering from a high fever. Later, she was taken to a local hospital where the doctor detected a murmur and suspected a Congenital Heart Defect. Her parents were referred to GKNM Hospital, Coimbatore for further evaluation. Once the ECHO was done and the result showed that she had Coarctation of Aorta. Her parents were counselled for surgery, but her father being a labourer, earned a monthly income of Rs 5,000 and could not afford the total cost of the surgery. With help from Genesis Foundation and Energy Efficient Services Limited, the operation was successful, and she was discharged in a stable condition.

Maheshwaran , is the fifth child of Mahalaksmi and Balraj from Thanjavur district, Tamil Nadu. When he was nine years old, he fainted during the morning prayer in school and was rushed to a government hospital. After the screening, doctors told the parents that Maheshwaran had a hole in his heart that would close on its own with age. However, after a month doctors detected a murmur in his heart and referred the thirteen-year-old for ECHO to Miot Hospital in Chennai. His Bicuspid Aortic Valve was found to be severely narrow. Balraj, his father who worked as a labourer in a furniture shop was making Rs 4000 per month and couldn’t afford the recommended open-heart surgery. With Genesis Foundation’s aid, Maheshwaran was operated upon successfully and discharged with long-term follow-up.

Conclusion
Even after the successful surgeries of aortic coarctation, sometimes there is a long-term complication of developing high blood pressure. Although the blood pressure usually falls, in some cases it may remain high.

Occasionally, the segment of the aorta that has been repaired will become weak and enlarged or even rupture. In some cases, the coarctation can recur, possibly even years after a triumphant treatment. Acknowledging the medical care for critically ill children available in India, it’s possible to have additional surgeries or procedures to correct the re-narrowing or treating other complications..