Coarctation of the aorta

It is a constriction of the aorta located in most cases just below the origin of the left subclavian artery. A constriction at this level obstructs the blood flow to the lower part of the body.

 
  - Fig. 5.4
Coarctation of aorta. The arrow indicate the lesion-.
Superior Vena Cava
Aorta
Pulmonary Artery
Pulmonary Veins Pulmonary Veins
Left Atrium
Right Atrium Left Ventricle
Right Ventricle
Inferior Vena Cava

The blood pressure over the lesion increases and children with coarctation of the aorta have an arterial pressure at superior limbs increased. The pulsation of the upper side of the body are strong whereas those of the lower part are weal or absent.
In some cases, exclusively neonates, there is heart failure. Most of the children have no problem.
Diagnosis of aortic coarctation is made when the physician notes the absence of arterial pulse at the groin. Doppler echography allows the vision of the aortic segment coarctated and an evaluation of blood flow through the constriction.
The surgical treatment can be done using different method; usually the coarctated segment of the aorta is resected and an end-to-end anastomosis is performed. The surgery of the coarctation of the aorta is the oldest heart intervention as it was performed for the first time in 1945. The results are excellent and the children operated can have a normal life. The ideal surgery time is between 1 and 2 years of age. In some cases for the severity of the symptoms the patient must be operated earlier; in 20-30% of these patient the coarctation can formed again during the years. Nowadays, according to the age, the weight of the child, and the anatomy of the arch, recoarctation is treated by percutaneous balloon angioplasty, or, in older children, with the implantation of a covered stent.

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