It's normal to feel scared and shocked when your little one is told by a doctor that they have a congenital heart defect. But don't worry. If you are fully aware of the condition we are going to talk about today, called Coarctation of the Aorta, you can cope with it successfully. Let's take a simple look at what it is, why it happens, and what can be done.
What is Coarctation of the Aorta (CoA)?
Simply put, Coarctation of the Aorta (CoA) is a congenital heart condition. It occurs when a part of the aorta, the main blood vessel that carries oxygenated blood from our heart to the rest of our body, becomes narrowed. The word “coarctation” literally means “narrowing.”
Imagine what would happen if one lane of the road was suddenly closed during a heavy traffic jam on the Colombo-Galle Road? All the vehicles would start moving, and there would be a huge traffic jam. That's what happens when one of the largest blood vessels in our body becomes blocked. The blood would not be able to flow properly.
This blockage usually occurs before the veins that carry blood to the lower parts of the body divide. This causes the blood pressure from the heart to the upper parts (arms, head) to increase, and the pressure from the blood to the lower parts of the body (legs) to decrease. In fact, this big difference that a doctor will see when checking the blood pressure in your baby's arms and legs is one of the main clues to identifying this disease.
What are the symptoms? Is there a difference between babies and older children?
Symptoms vary depending on how severe the blockage is. If the blockage is severe, the baby may start showing symptoms within a week or two of birth. However, if the blockage is very small, symptoms may not appear until late childhood, or at all.
| Age group | Commonly seen symptoms |
|---|---|
| Newborn babies (Infants) |
|
| Children and Adults |
|
Some children may not notice any symptoms. Sometimes, the first time they discover this problem is when the doctor checks their blood pressure at a regular clinic and sees that it is high.
Why is this happening? What are the reasons?
Although the exact cause of this is unknown, doctors believe it has a genetic component . This means that some genetic changes that occur while the baby is developing in the womb may prevent the aorta from forming properly.
One main reason for this is a change in the way a small blood vessel called the ductus arteriosus closes.
Think about it, when the baby is in the mother's womb, the lungs don't work. Then there's a special blood vessel that helps the baby get oxygen. When the baby is born and starts breathing, this vessel is no longer needed, so it closes automatically in a few days. But sometimes when this closes, some of the tissue in it can also be pulled into the aorta, and the aorta can get stuck together.
Additionally, babies with certain genetic conditions, such as Turner syndrome, are at increased risk of developing this CoA condition.
What are the complications that can occur if left untreated?
If this condition is not diagnosed and treated early, various complications can occur over time.
- High blood pressure (Hypertension) throughout the body.
- Excessive thickening of the heart muscle (left ventricular hypertrophy) .
- Fatty deposits in the arteries that supply blood to the heart (coronary artery disease) earlier than normal.
- A balloon-like bulge (aneurysm) in the aorta or a blood vessel in the brain.
- Heart failure is a condition in which the heart is unable to pump enough blood.
The important thing is that many of these complications only occur if the disease is not diagnosed and treated early. Therefore, it is very important to see a doctor as soon as possible.
How do doctors accurately diagnose this disease?
Pediatric cardiologists are usually the ones who diagnose this disease. This is mainly done through a physical examination of the baby.
- Checking the difference in blood pressure in the arms and legs .
- Checking the pulse in the neck and groin.
- A heart murmur is a distinctive sound heard when a stethoscope is placed on the chest and back.
In addition, an Echocardiogram (echo) , a scan of the heart, is performed to confirm the diagnosis and determine the extent of the blockage. Sometimes, CT or MRI scans may also be needed.
Other heart diseases that can occur with this
About 45% to 75% of babies with CoA also have a condition called bicuspid aortic valve . This means that the valve that carries blood from the heart to the aorta has only two cusps instead of three. In addition, conditions such as holes in the heart (atrial septal defect or ventricular septal defect) can also be seen with this condition.
What are the treatment options?
Treatment is determined based on the child's age, the extent of the aortic stenosis, and whether there are other heart diseases.
Surgery
The best treatment for infants and young children is surgery.
- Resection with end-to-end anastomosis: This involves cutting out the small piece of blockage and reconnecting the two healthy parts.
- Resection with extended end-to-end anastomosis: If there is a blockage along the bend of the aorta, this more complex surgery is performed.
Babies who have severe symptoms at birth may need to be given medications such as prostaglandin (PGE-1) to stabilize the baby's condition before surgery.
Cardiac Catheterization
This is a simpler method than surgery. This method is used if the blockage is minor, or if the blockage recurs after surgery.
- Balloon angioplasty: A small balloon-like device is inserted into a blood vessel and inflated to widen the blocked area.
- Balloon angioplasty with stent placement: The blocked area is widened with a balloon, and a small mesh-like tube (stent) is placed inside to prevent the area from becoming blocked again.
What will my child's future be like?
With today's advanced diagnostic methods and treatments, a child with CoA can live a normal, healthy life. While in the past the average life expectancy for these patients was about 35 years, they can now live healthy lives for 60 years or more.
The most important thing is that, even after treatment, you need to go to a cardiologist's clinic for the rest of your life.
Then, Doctor,
- The child's blood pressure is monitored regularly.
- Tests like scans are done to check the functioning of the heart.
- Provides advice on heart-healthy eating patterns and exercise.
- Prescribes medication if necessary.
When you find out that your child has this condition, you may have many questions. You may wonder why this happened. Always remember, this is not your fault. Your doctor and medical team will do everything they can to help you and your child. Don't hesitate to ask them questions and talk about your fears.
Take-Home Message
- Coarctation of the Aorta (CoA) is a congenital heart disease that occurs when a part of the body's main blood vessel becomes blocked.
- Newborn babies may show symptoms such as difficulty feeding, excessive sleepiness, and difficulty breathing.
- A major symptom of this disease is a large difference in blood pressure between the arms and legs.
- This is not your fault. Don't worry, see a doctor.
- This condition can be treated very successfully with surgery and other modern treatments.
- Although the child can live a normal, healthy life after treatment, lifelong visits to medical clinics are mandatory.
Coarctation of the Aorta Sinhala, Coarctation of the Aorta, Congenital heart disease, Baby's heart disease, Pediatric heart disease, High blood pressure, Congenital heart defect Sinhala
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