Treatment Aortic coarctation abroad

Aortic coarctation is a narrowing of aorta, which is the main and the biggest artery in the human body. It originates close to the left heart ventricle and goes down to the abdomen, where it splits in two. The main purpose of aorta in the human artery system is to distribute the oxygen throughout all parts of the body.

The word coarctation means narrowing. The disease can be only congenital which means that people can not develop aortic coarctation in their lifetime if they did not have a genetic predisposition during the childhood. Aortic coarctation among children may manifest itself in anxiety, coughing, malnutrition, fatigue and dizziness. It occurs with a frequency of almost 6% among children. It is much more common among male population. 

Causes of coarctation

Cardiac medicine presents several theories, which explain the formation of coarctation. It is mainly believed that the main reason for aorta narrowing is the violation of aortic development during the embryogenesis.

Aortic coarctation symptoms

The aortic coarctation is manifested by a number of symptoms and the severity of these symptoms depend on the number of anomalies, which affect inner cardiac and systemic hemodynamical development.

Infants and little children with coarctation of artery may experience the slowing of growth of the bones and weight gain. Predominant symptoms of aortic coarctation for this group of patients include orthopnea, cardiac asthma and pulmonary edema. Orthopnea is a shortness of breath, when a patient can not breath normally. Cardiac asthma usually occurs when a patient experiences the heart failure and it is characterized by constant coughing and sneezing. Pulmonary edema is accumulation of liquid in lungs. Usually almost all patients with aortic coarctation experience some kind of breathing problem.   

At older ages the development of hypertension of the pulmonary artery, which is typical for patients with the case of aortic coarctation.  is characterized by:

  1. dizziness
  2. headache
  3. palpitations
  4. decrease in visual capability
  5. bleeding of the nose
  6. fainting
  7. coughing with blood
  8. numbness
  9. coldness
  10. abdominal pain
  11. intestinal ischemia.

The life expectancy of patients with coarctation is not very high, because the disease is congenital and it progresses with every passing year of the patients. Usually people who have aortic coarctation live until they are about 40 years old. In most cases there is a critical period, which can last up to two years, after which patients die from either heart failure or hemorrhagic stroke.

Diagnosis of aortic coarctation

During the examination of the patient a doctor measures the pulsation of femoral arteries. If the pulsation is too weak or it absent, it might be an indication of a problem with aortic artery. A doctor also determines if there is any decrease in blood pressure, where the aorta divides into two parts. The examinations of the heart as ECG, aortography and chest X-ray are also used if the general examination showed that there was a problem with aorta.

In some cases common diagnostic tests are not enough to determine if there is an aortic coarctation. In such case the doctor may use electrocardiography, which shows ischemic changes. Echocardiography also allows the doctors to visualize the coarctation of the aorta artery and determine the stage and degree of stenosis. Older children and also adults may undergo transesophageal echocardiography, which is not recommended for little infants.

Cardio catheterization can explain why there is hypertension and decreased pressure of oxygen in aorta. Sometimes the reason for the lack of oxygen in the heart may be ascribed to an absolutely different cause which is not connected with aortic coarctation.

Coarctation of artery should be differentiated from other pathological heart diseases, which also are characterized by pulmonary hypertension. Such hypertension may occur to patients who have aortic heart defect or aortitis.

Treatment of aortic coarctation

Aortic coarctation repair may be partially treated by correction of hypertension and heart failure. The only way to eliminate the anatomic defect of the aorta is through aortic coarctation surgery. Cardiac aortic coarctation  surgery should be performed in the early stage of the disease. If it was diagnosed right after the birth of the child, a surgery should be done between the ages of 2.5 to 3 years. If the degree of hypertension is too high, surgery can not be done.

There are following types of aortic coarctation surgery:

Plastic reconstruction of the aorta is used when a doctor resects a considerable part of the aorta.

Resection of aortic coarctation with a prosthesis. During the prosthesis resection a doctor replaces the defect arterial homograft with a special synthetic graft. Before the twentieth century there were no effective ways to treat the aortic coarctation. Around the beginning of the twentieth century a surgeon named Clarence Crafoord invented an operation which helped to dilate the narrowing of the aorta. It was an absolutely innovative surgery which was considered very risky at the time, but now it became very common for the aortic coarctation repair. In modern medicine there is another innovative treatment of aortic coarctation, which is being developed in the best laboratories of the world. Patients who have aortic coarctation are given the long course of oxygen therapy, when they inhale the oxygen for almost 40 weeks. This procedure can also widen the aorta. The outcome of oxygen therapy showed to be particularly good and in a matter of several years it will most likely be even more popular than surgery, as surgery has many complications.

Some postoperative complications may include development of aortic aneurysm, bleeding and ischemia.

Forecast for aortic coarctation

In general aortic coarctation has a very poor prognosis. If there is no timely diagnosis and appropriate cardiac care almost 40% of patients die in the first or the second year of life. Nevertheless, people who have aortic coarctation may survive and have good long-term results if the surgery was performed before the age of 10.

After the aortic coarctation surgery patients need to be under constant care of cardiologist. They are also forbidden to wear weights and to exchange in grueling physical activity. The most important part of the postoperative treatment is the anti-stressful life. Patients should not get angry and avoid situations where the blood tension may significantly increase.

Women who successfully underwent aortic coarctation surgery may get pregnant. The outcome of pregnancy after reconstructive surgery for coarctation of the artery is usually favorable.

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Resection with end-to-end anastomosis
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Alfried Krupp Hospital in Essen-Ruettenscheid

The main treatment areas of the Department of Internal Medicine I, headed by Prof. Dr. med. Thomas Budde, are invasive and non-invasive cardiac diagnostics and therapy of all cardiac diseases.

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HELIOS Cardiosurgery Clinic Karlsruhe

The Department provides treanment for a whole spectrum of adult cardiac surgical diseases, with exception of the heart and lung transplantation.

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