- What is coarctation of the aorta in children
- What triggers / Causes of Coarctation of the aorta in children
- Pathogenesis (what is happening) at the time of Coarctation of the aorta in children
- Symptoms of Coarctation of the aorta in children
- Diagnosis of Coarctation of the aorta in children
- Treatment of Coarctation of the aorta in children
- Prevention of Coarctation of the aorta in children
- Which doctors should be consulted if You have coarctation of the aorta in children
What is coarctation of the aorta in children
Coarctation of the aorta in children is limited narrowing of the aorta, which causes hypertension of blood vessels of the upper extremities, hypoperfusion of abdominal organs and lower extremities, left ventricular hypertrophy. The symptoms depend on how narrowed the lumen. In mild cases can manifest pain in the chest, headache, sure the coldness of the hands and feet, weakness. In the most severe cases, there is a probability of fulminant heart failure and shock. Over the stenosis while listening to fix a soft murmur.
Complications of coarctation of the aorta:
- severe arterial hypertension
- left ventricular heart failure with the development of cardiac asthma and pulmonary edema
- subarachnoid hemorrhage
- breaks extended aneurysm
- hypertensive nephroangiosclerosis
- infective endocarditis (hard to treat with antibiotics)
What triggers / Causes of Coarctation of the aorta in children:
Coarctation of the aorta is caused by a violation of the process of formation of the aorta, when the fetus is still developing in the womb. Coarctation in most cases is at the level of the arterial duct. Assume that some part of the tissues of the duct is moved to the aorta, thereby engaging in the process of its closure and aortic wall, which subsequently leads to its narrowing.
Genetically predisposed to the disease, children with the syndrome Shereshevsky-Turner. It is a chromosomal disorder that is caused by the presence of only one sex X-chromosome and no second.
Pathogenesis (what is happening) at the time of Coarctation of the aorta in children:
When coarctation of the aorta the presence of mechanical obstacles (called the gateway) on the path of blood flow in the aorta leads to the formation of two different modes of circulation. Above the gateway arterial blood pressure is above normal, there is an increase in the vascular bed of the left ventricle due to systolic overload hypertrophies. Below gateway pressure below normal, compensation of blood flow is due to the development of multiple ways to bypass the blood supply. The degree of impairment of the dynamics of blood depends on the length and severity of the gateway and the type of coarctation.
There are adult and children type of coarctation. When adult arteriosus closed. In the vessels of the upper body increased pressure – both systolic and diastolic. Dramatically increases the work of the left ventricle, increasing the mass of circulating blood. In the arteries below the belt pressure is lowered pressure is reduced, which causes the inclusion of the renal mechanism of high blood pressure. Because of this, in the upper body increases the pressure even more.
Children's type is characterized by patent ductus arteriosus. In the vessels of the systemic circulation blood pressure may be raised slightly, and collateral circulation is weak. When postduktalnuyu coarctation of the aorta occurs discharge of blood under high pressure from the aorta through the ductus arteriosus left pulmonary artery, which can sooner lead to the development of pulmonary hypertension. When productalso coarctation of the aorta occurs a discharge of blood from the pulmonary trunk to the descending aorta via the ductus arteriosus. At the children's type of coarctation of the child may occur heart failure at a very early age.
Symptoms of Coarctation of the aorta in children:
As noted above, there are two types of coarctation of the aorta in children:
Child type is considered to be less favourable than an adult, because it is early formed high pulmonary hypertension. Above the constriction increases the pressure, which affects the physique of the baby. The body becomes "athletic" is the shoulder belt is developed more than the lower torso. There are complaints about nosebleeds and headache.
The likely development of morphological changes in the coronary arteries, disorders of cerebral circulation or cerebral hemorrhage, secondary fibroelastosis endo - and myocardium of the left ventricle. If the newborn there is a significant constriction can be circulatory shock with renal failure and metabolic acidosis. The symptoms in such cases similar to those seen in systemic diseases, for example, in sepsis.
If the restriction is poorly expressed, in the first year of life symptom-free. Funds are also nonspecific symptoms of coarctation of the aorta in children:
- pain in the chest area
- claudication during exercise
They can be exacerbated with the growing up of the child. Often hypertension. In rare cases, it may be rupture of an aneurysm of the brain, resulting in subarachnoid or intracranial hemorrhage.
Diagnosis of Coarctation of the aorta in children:
The diagnosis of coarctation of the aorta in children using instrumental methods such:
- radiography of the heart and lungs
- cardiac catheterization
The ECG method, which stands for electrocardiography. ECG in older children shows isolated signs of increased muscle mass of the left ventricle. Phonocardiography is a method of recording vibration and acoustic signals, which make the blood vessels and heart, carrying out its activities. One of the signs of coarctation of the aorta in children determined with the help of this method, it is the strengthening of II tone of the aorta.
Echocardiography – a method which is otherwise called ultrasound of the heart, it gives you the opportunity to fix the narrowing of the aorta in the area of the isthmus. Using this method you identify both direct and indirect signs of aortic coarctation in children. Radiography of the chest to determine that the apex of the heart is elevated, dilated ascending aorta and other signs of the disease under consideration.
Cardiac catheterization allows measurement of the pressure in the aorta and fix the difference of systolic blood pressure above and below by the flow of blood the narrowing of the aorta. Aortography shows the level and the degree of narrowing of the lumen of the aorta.
Treatment of Coarctation of the aorta in children:
When coarctation of the aorta in children treatment may involve surgical intervention. The indication for this method is the difference in systolic pressure measured on the hands and feet, exceeding 50 mm Hg. art For infants indication for surgery will be expressed arterial hypertension and cardiac decompensation.
If the disease is detected for several months after birth, but during favourable, the operation is postponed until the child turns five or six years. Surgery the patient and at an older age, but the results will not be as good because of the possibility of preservation of arterial hypertension.
To date, several methods of surgical treatment of coarctation of the aorta – resection and reconstruction of the aorta:
1. Plastic aorta with the use of vascular prostheses
This method of treatment applies if the aorta is narrowed on a large plot, which is not possible to map the ends of the normal sites.
2. Resection of coarctation of the aorta with the imposition of anastomosis (anastomosis) end to end
This method of topical treatment, if the area is narrowed to a small extent
3. Bypass surgery pathologically narrowed area of the aorta
Of special material manufacture of the vascular prosthesis. Its edges viveurs above and below the constriction site, to create a path for the flow of blood.
4. Aortoplasty with the use of the left subclavian artery of the operated child
5. Balloon angioplasty and stenting of coarctation of the aorta
The method is relevant if the child did the surgery, but was re narrowing of. In the aorta enter the balloon, which is inflated, eliminating the narrowing. In some cases you may need to install stents that support the required diameter of the aorta.
The prognosis of aortic coarctation in children
The prognosis varies depending on the measure of narrowing of the aorta in children. If coarctation of the aorta is negligible, the obstacles to a normal life, the child has not shortens the lifespan – on average it is the same as in people without considering the diagnosis.
If coarctation of the aorta are significant, the duration of life, if not surgery, will be equal to the average of 30 to 35 years. Patients die from bacterial endocarditis, severe heart failure. There may come sudden death due to rupture of the aorta or aneurysm and stroke.
Prevention of aortic Coarctation in children:
Before you conceive a child, the father and mother should abandon these bad habits like alcohol, Smoking and drugs.