Coarctation of the aorta in newborns and older children

Coarctation of the aorta in appearance resembles the formation of a constriction on this organ, which visually resembles the shape of an hourglass. This is a dangerous pathology, in case of refusal of treatment, severe complications or fatal outcome are possible.

It is easy to cure it, since after diagnosing it is easy to identify the necessary measures to eliminate the violation.

Contents

  • 1 Description of the disease
    • 1 Description of the disease
    • 2 Causes and risk factors
    • 3 Species, forms, stages
    • 4 Dangers and complications
    • 5 Symptoms
    • 6 Diagnosis
    • 7 Treatment methods
    • 8 Forecasts and prevention measures

Description of the disease


Coarctation of the aorta - partial narrowing of its internal space .This condition leads to hypertension of the vessels of the hands, hypoperfusion of the gastrointestinal tract and legs, a significant increase in the size of the left ventricle.

The number and intensity of symptoms is determined by the size of the remainder of the free inner cavity of the aorta.

If the pathology develops in the early stages, the patient feels an unpleasant feeling in the chest area, headache, general malaise, cooling of the upper and lower extremities. Signs increase with increasing intensity of pathology.

When no treatment measures are taken or the condition of a sick child is initially very severe, is at risk of developing fulminant heart failure, leading to shock. The place of constriction is determined when listening to the chest. The doctor notices a slight noise.

Causes and risk factors

Coarctation of the aorta is manifested due to the formation of pathologies while it is being laid and formed, it occurs in the fetal stage of the fetus .Most often, the most noticeable narrowing is noted in the arterial duct.

Scientists suggest that the process is affected by the change in the location of certain tissues of the duct, as they move directly to the aorta. When closed, they affect the arterial wall, which after a while can provoke a small, and then a significant narrowing.

Genetic conditioning, according to physicians, this pathology only gets in patients with congenital Shereshevsky-Turner syndrome. It differs in the presence of patients only one of the two halves of the X-chromosome with the complete absence of the second.

Species, forms, stages

There are two types of the disease:

  1. Preductal.
  2. Post-product.

Both these types of violations can pass with the functioning of the arterial duct or with its inactivity .

Johnson 1951 and Edwards 1953 distinguish two types of disease:

  1. Coarctation in isolated form.
  2. Coarctation with a normal arterial duct connector.

Pokrovsky identified 3 types of coarctation:

  1. Isolated form.
  2. Coarctation with an open arterial duct.
  3. Co-infection with other hemodynamic disorders that provoke functional pathologies of the cardiovascular system.

Danger and complications

Coarctation of the aorta can cause severe cardiac pathologies and death of the patient, therefore requires immediate medical attention. If proper measures are not taken, there is a risk of such complications:

  1. Stroke.
  2. Hypertension of the patient's arteries.
  3. The lack of the ventricle of the heart located to the left, with aggravation leading to the appearance of cardiac asthma and internal pulmonary edema, with which in childhood can not be handled by every patient.
  4. Hemorrhage in the subarachnoid space.
  5. Destructive phenomena in the area of ​​aneurysm.
  6. Nephroangiosclerosis on the basis of hypertension.
  7. Endocarditis is an infectious nature that is difficult to cure even with the help of potent antibiotics.

Symptoms of

The most dangerous is coagulation of the aorta in newborns and infants ( there is an adult type of disease).It is dangerous for the rapid formation of pulmonary hypertension, which predetermines a sharp deterioration in the patient's condition.

It is possible to clearly identify the site of constriction in the long course of the disease, as the elevated pressure, located in the area of ​​the smallest aortic lumen, is reflected on the physique of the child. For coarctation of the aorta is characterized by the acquisition of the body pseudo-athletic structure , that is, the lower torso is less developed than the shoulders and the upper segment of the chest.

Babies suffer frequent nosebleeds, and also complain of pain in the head.

In some cases, there are changes in the functioning of the coronary arteries of a morphological nature, disorders of the cerebral circulation, including severe cerebral hemorrhage or the surrounding space of , fibroelastosis, a secondary symptom, various pathologies of the left ventricle.

Sometimes a newly born child has already developed a strong constriction of the aorta. In this case, there is the risk of circulatory shock in conjunction with renal insufficiency and acidosis, starting on the basis of metabolic disorders.

General symptoms are confused by parents and inadequately experienced physicians with pathologies of a systemic nature, such as sepsis.

Often narrowing of the internal space of the aorta is expressed minimally, then in the first year of life of the child such a pathology may not have bright symptoms, therefore it goes unnoticed for a long time. If there is a suspicion of the presence of such a disease, the should check the child for the following symptoms:

  1. Pain in the chest.
  2. Frequent headaches.
  3. Impossibility to exercise large physical exertion due to almost instantaneous appearance of lameness( for no additional reason).
  4. Frequent manifestations of weakness, lethargy.

The listed symptoms of gradually progress as the child grows .One of the first characteristic signs manifests increasing hypertension.

If you do not notice the disease on time, you may develop severe complications, such as rupture of an aneurysm, accompanied by a hemorrhage directly into the space around the artery, which can provoke a fatal outcome.

Consultation with a physician is necessary when the first symptoms of aortic coagulation occur. It is advisable to visit the pediatrician , he will give directions for a visit to the cardiologist .With the formation of significant in intensity and specific for this disease symptoms, you can immediately visit a cardiologist.

Diagnostics

To identify the disease use such methods:

  • ECG. The method is especially useful for children who have reached the age of majority. With its help, even small deviations associated with an increase in the size of the left ventricle are detected.
  • Phonocardiography. During the research, vibration and sounds are recorded, which are published during the functioning of the cardiovascular system. If the patient has a pathology, an increase in tone II is observed.
  • Echocardiography. It is possible to call the ultrasound of the heart allegorically. With the correct interpretation, both specific and additional symptoms of pathology are indicated.
  • X-ray. The picture shows the elevation of the upper portion of the heart, the expansion of the upward aorta.
  • Cardiac catheterization. With the help of the study, the pressure in this area is fixed, and later the difference in systolic and arterial blood flow is analyzed. Circumvent the places above and below the area of ​​compression of the main artery.
  • Aortography. Allows to determine the exact rest of the lumen in the artery, the extent of the pathology and the narrowing characteristics, since it is often uneven, but has arbitrary contours.
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Treatment methods

Radical and often necessary for coarctation of the aorta by treatment is an operation. The main indication for the use of this measure is the significant difference in systolic pressure on the lower and upper extremities. The indices should differ by more than 50 mm Hg. .

Immediate operation for infants produces with significant, increasing arterial hypertension and heart decompensation .

Sometimes pathology is diagnosed only after some time after birth. Often the course of the disease is stable. According to the doctors' decision, the operation is performed, but only for 5-6 years after the birth of .

Surgery may be performed at an older age, but in this case there is a risk of achieving only a part of the positive effect, since hypertension is eliminated only at an early age.

Several types of surgery are used when it is necessary to normalize the contours of the body:

  • Plastic aortic surgery with the use of prostheses to replace the vessels .This method is relevant for pathologies in which the artery has a narrowing in the smallest area that does not allow the ends of naturally formed fragments to be joined.
  • Resection of constriction with anastomosis insertion at the end of two healthy sides of the .This method is undertaken when the aperture is narrowed a short distance and with completely healthy other parts of the aorta.
  • Bypass. A vascular prosthesis is made of the material intended for this purpose. The edges of this device are sewn to the tissues at a level below and above the site of constriction. This is necessary for the free movement of blood.
  • Angioplasty and stenting. .It is necessary to perform these procedures in the event that the operation for normalizing the structure of the aorta has already been carried out, but the pathology has been repeated again. A balloon is placed in the cavity of the aorta, through which air is blown into it, artificially expanding the space.
If there is a risk of augmentation of the aortic aperture next time, stents are placed in it, followed by attachment. They help to maintain the necessary size of the aortic cavity.

Learn more about the disease from the video:

Forecasts and prevention measures


The prognosis differs depending on the degree of aortic reduction in a particular child, a normal lifestyle is provided with small manifestations of pathology. The average life expectancy of of such patients is equal to this time in people without similar diseases.

With severe pathology, the patient can live up to 30-35 years, if the necessary operation is not performed. The cause of death is endocarditis of bacterial nature, as well as severe heart failure. Unexpected death of can occur due to a sharp rupture of aortic tissue, an aneurysm or a severe stroke.

Prevention of this pathology in a child is adherence to a healthy lifestyle by his parents. Before conception and during pregnancy, both the father and mother are obliged not to smoke, do not take alcohol and drugs.

Coarctation of the aorta is characterized by specific symptoms that can not be missed to prevent a sharp progression of the disease. Even with normal physical development in children, this disorder can manifest itself and occur in moderate or even severe form. If you notice a disease on time, there is a chance of a complete cure for the disease and a return to normal life.