Coarctation of Aorta (Paed)

7/31/2019 Coarctation of Aorta (Paed)

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COARCTATION OF AORTA


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DEFINITION

Coarctation of the aorta is acongenital (present at birth) heartdefect involving a narrowing of theaorta.

The aorta is the large artery thatcarries oxygen-rich (red) blood fromthe left ventricle to the body.

The narrowed segment calledcoarctation can occur anywhere inthe aorta, but is most likely to

happen in the segment just after the


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This narrowingrestricts theamount ofoxygen-rich(red) bloodthat can travelto the lowerpart of thebody.


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TYPES OF COARCTATION OFAORTA

A) postductal- Adult typecoarctation, aorticis constricted just

distal to theobliterated ductusarteriosus. Itpresents in oldchildren and adultwith hypertensionin upperextremities andlow blood pressure

with weak pulses in


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B) preductal

- Infantile

coarctation, aortais constrictedbetween origin ofleft subclavianartery and ductusarteriosus.

- It presents in

infancy withcongestive heartfailure andcyanosis of lower

extremities.


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Why is coarctation a concern?

Coarctation of the aorta causes several

problems, including the following:

The left ventricle has to work harder to try tomove blood through the narrowing in the aorta.Eventually, the left ventricle is no longer able tohandle the extra workload, and it fails to pumpblood to the body efficiently.

Blood pressure is higher above the narrowing,

and lower below the narrowing. Older childrenmay have headaches from too much pressurein the vessels in the head, or cramps in the legsor abdomen from too little blood flow in thatregion. Also, the kidneys may not make enoughurine since they require a certain amount ofblood flow and a certain blood pressure to


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The walls of the ascending aorta, the aorticarch, or any of the arteries in the head and

arms may become weakened by highpressure. Spontaneous tears in any of thesearteries can occur, which can cause a strokeor uncontrollable bleeding.

There is a higher than average chance ofdeveloping an infection in the valves of theheart known as bacterial endocarditis or aninfection in the aorta itself known as

bacterial endarteritis.

The coronary arteries, which supply oxygen-rich (red) blood to the heart muscle, maynarrow in response to elevated pressure.


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SYMPTOMS Sometimes the narrowing is mild and may not

cause any symptoms. In these patients thecoarctation may be detected due tohypertension (high blood pressure) or presenceof a murmur or absent femoral pulses.

Infants with severe coarctation may developsevere symptoms and heart failure (CHF)including:

Poor weight gain Poor feeding Rapid breathing Excessive sweating Puffy eyes, face or extremities


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Older children and teens that have mildto moderate coarctation may complain

of:

Shortness of breath, especially whenexercising

Leg cramps after exercising or at night Fatigue Frequent nose bleeds Dizziness or fainting Chest pain, especially when exercising Very cold legs and feet Strong, throbbing headache

High blood pressure


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How is coarctation of the aortadiagnosed?

heart murmur- A heart murmur is simply a noise caused by the turbulence

of blood flowing through the obstruction in the coarctation segment of theaorta.

chest X-ray

electrocardiogram (ECG or EKG)- a test that records the electricalactivity of the heart, shows abnormal rhythms (arrhythmias ordysrhythmias), and detects heart muscle damage.

echocardiogram (echo)- a procedure that evaluates the structure andfunction of the heart by using sound waves recorded on an electronicsensor that produce a moving picture of the heart and heart valves. Thevast majority of aortic coarctations are diagnosed by echocardiography.

cardiac catheterization (cath) - a diagnostic procedure that uses

threading a catheter through the arteries and veins of the groin andadvancing this catheter up to the heart. Dye is squirted into the heart andaorta and pictures are taken of the anatomy. Catheterization may also beused to repair the coarctation if the child is big enough.

magnetic resonance imaging (MRI)- a diagnostic procedure that uses acombination of large magnets, radiofrequencies, and a computer to producedetailed images of organs and structures within the body.


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PULMONARY STENOSIS


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DEFINITION

The word stenosis means narrowing of aspecific part. Pulmonary stenosis is the narrowing of

the pulmonary valve or the pulmonary

artery itself distal to the valve.The pulmonary artery carriesdeoxygenated blood from the rightventricle to the lungs.

A pulmonary valve is a flap of tissue thatopens with pressure to allow blood toenter the pulmonary circulation.

Inability of the right ventricle to

evacuate blood to the pulmonary arterywould result to right ventricular


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y s pu monary s enos sa concern?

Mild pulmonary stenosis may not cause any

symptoms. Problems can occur whenpulmonary stenosis is moderate to severe,including the following:

The right ventricle has to work harder to try

to move blood through the tight pulmonaryvalve. Eventually, the right ventricle is nolonger able to handle the extra workload,and it fails to pump forward efficiently.Pressure builds up in the right atrium, and

then in the veins bringing blood back to theright side of the heart. Fluid retention andswelling may occur.

There is a higher than average chance ofdeveloping an infection in the valves of the


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SYMPTOMS

heavy or rapid breathing

shortness of breath

fatigue rapid heart rate

swelling in the feet, ankles, face,

eyelids, and/or abdomen fewer wet diapers or trips to the

bathroom


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DIAGNOSED heart murmur - A heart murmur is simply a noise caused

by the turbulence of blood flowing through the obstruction

from the right ventricle to the pulmonary artery. chest X-ray - a diagnostic test which uses invisible X-

ray beams to produce images of internal tissues, bones,and organs onto film.

electrocardiogram (ECG or EKG) - a test that recordsthe electrical activity of the heart, shows abnormalrhythms (arrhythmias or dysrhythmias), and detects heartmuscle stress.

echocardiogram (echo) - a procedure that evaluatesthe structure and function of the heart by using soundwaves recorded on an electronic sensor that produce a

moving picture of the heart and heart valves. cardiac catheterization - a cardiac catheterization is an

invasive procedure that gives very detailed informationabout the structures inside the heart. Under sedation, asmall, thin, flexible tube (catheter) is inserted into a bloodvessel in the groin, and guided to the inside of the heart.

Blood pressure and oxygen measurements are taken in thefour chambers of the heart, as well as the pulmonary


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Coarctation of Aorta (Paed)