Almost always congenital in nature, aortic coarctation subjects the patient's heart to a greater effort than normal in order to diffuse the blood beyond the narrowing; this effort can have several consequences, including: hypertension in the upper limbs combined with hypotension in the lower limbs, breathing problems, slowing of growth, difficulty in eating, cyanosis and chest pain.
Diagnosis of aortic coarctation is generally based on physical examination, an echocardiogram and a series of in-depth cardiac examinations.
For those suffering from aortic coarctation, there is an option to repair the vascular narrowing by surgery or an operation known as angioplasty with stenting.
Brief review of the aorta
The aorta is the largest and most important artery in the human body.
Originating in the heart (to be precise from the left ventricle of the heart), this fundamental arterial vessel is equipped with numerous ramifications, through which it supplies every district of the human body with oxygenated blood, from the head to the lower limbs, passing through the limbs. upper and trunk.
Analyzing it from the beginning, the aorta can be didactically subdivided into two large consecutive sections: the thoracic aorta, occupying the anatomical portion of the thorax and including the three segments known as the ascending aorta, aortic arch and descending aorta, and the abdominal aorta, located in the anatomical portion of the abdomen.
For the avoidance of doubt, by luminal narrowing we mean a reduction of the vascular lumen or, if you prefer, of the vascular diameter.
What is the scholar of Botallo?
Present only during fetal life, the Botallo duct is the blood vessel that connects the pulmonary artery to the descending aorta and which serves to diffuse oxygenated blood towards the lower parts of the human body (abdominal organs and lower limbs).
The presence of the Botallo duct in the fetus is related to the "impossibility of the baby in the uterus to breathe and use the lungs to oxygenate the blood (at birth, with the disappearance of the arterial duct, the pulmonary artery becomes the" artery that carries oxygen-poor blood to the lungs).
The consequences
Being an obstacle to blood flow, aortic coarctation involves a greater workload for the left ventricle of the heart, when the latter must diffuse the oxygenated blood into the aorta. In fact, in order to carry blood beyond the narrowing of the aorta, the left ventricle of the heart must generate a pressure higher than normal.
The whole situation described above is further complicated when the aortic coarctation is severe: in this circumstance, despite the efforts of the left ventricle of the heart, the oxygenated blood struggles to overcome the aortic narrowing and the blood supply to the lower parts of the human body. it is compromised (remember that the aortic coarctation localizes, at most, at the beginning of the descending aorta, ie the aortic portion that directs oxygenated blood towards the abdomen and lower limbs).
Among the typical consequences of aortic coarctation, the difference in blood pressure that is established between the upper part and the lower part of the body deserves a mention: above, the blood pressure is higher than normal, thanks to the higher pressure work performed. from the heart; inferiorly, on the other hand, it is less than normal, due to the fact that overcoming the aortic narrowing subtracts pressure force from the blood pumped by the heart.
Epidemiology
It is difficult to accurately estimate the incidence of aortic coarctation in the general population, as this aortic defect can go unnoticed even throughout life, due to the possible lack of related symptoms.
Epidemiological studies relating to the spread of aortic coarctation in both sexes have shown that male patients are twice as many as female patients.
Types of aortic coarctation
Depending on the location of the aortic narrowing, doctors distinguish aortic coarctation into three broad categories, which are:
- Pre-ductal aortic coarctation. This category includes all cases of coarctation of the aorta, in which the aortic narrowing is located before the arterial ligament.
- Ductal aortic coarctation. This category includes all cases of coarctation of the aorta, in which the aortic narrowing is located in correspondence with the arterial ligament.
- Post-ductal aortic coarctation. This category includes all cases of aortic coarctation, in which the narrowing of the aorta resides shortly after the arterial ligament.
Curiosity
Pre-ductal aortic coarctation is a congenital defect found in 5% of girls born with Turner syndrome.
The reasons for the association between pre-ductal aortic coarctation and Turner syndrome are unknown.
In an adolescent and at an even older age, however, it can be a reason for:
- Hypertension in the upper limbs and hypotension in the lower limbs;
- Dizziness;
- Dyspnea;
- Syncope or presyncope;
- Chest pain;
- Sense of weakness;
- Leg cramps e intermittent claudication;
- Nosebleed
- Headache.
Severe aortic coarctation: symptoms in the child
In a young child, severe aortic coarctation is always responsible for:
- Major breathing problems;
- Cyanosis;
- Irritability;
- Profuse sweating;
- Severe inability to feed;
- Loss of appetite;
- Drastic slowdown in growth;
- Hypertension in the upper limbs (hypertension in the arms);
- Weak pulse in the lower limbs.
This complex and important symptomatology depends on the extreme workload to which the heart is subjected, in the attempt to pump oxygenated blood, and on the lack of blood perfusion towards the lower extremity of the body.
Complications in mild cases
In later life and in the absence of adequate treatment, mild aortic coarctation can lead to a persistent state of hypertension in the upper parts of the body as well as thickening of the muscular wall of the left ventricle (left ventricular hypertrophy); both of these phenomena are direct effects of the higher pressure work done by the heart, with the intent of spreading oxygenated blood beyond the narrowing of the aorta.
Complications in severe cases
In the absence of adequate therapy, severe aortic coarctation can lead to numerous complications, some with a fatal or highly debilitating outcome.
The complications in question include:
- Heart failure;
- Aortic valve stenosis (aortic stenosis);
- Severe and persistent hypertension in the upper body;
- Stroke;
- Premature coronary artery disease;
- Aortic dissection;
- Formation of an aneurysm of the thoracic aorta;
- Formation of a brain aneurysm;
- Cerebral hemorrhage;
- Renal insufficiency and / or hepatic insufficiency.
Associated conditions
For reasons still unclear, congenital aortic coarctation is often accompanied by congenital heart anomalies; in other words, most individuals who are born with aortic coarctation also have one or more heart defects.
The heart defects in question are:
- The bicuspid aortic valve;
- The patent ductus arteriosus (or patency of the ductus arteriosus);
- The patent foramen ovale;
- Stenosis of the aortic valve;
- The anomaly of the aortic valve which causes the so-called aortic regurgitation;
- Stenosis of the mitral valve;
- The anomaly of the mitral valve which causes the so-called mitral regurgitation.
Clearly, if present, these heart defects associate their symptoms with those of aortic coarctation.
chest x-ray, chest nuclear magnetic resonance, chest CT scan, and cardiac catheterization.
OBJECTIVE EXAMINATION
In a context of aortic coarctation, a careful physical examination must include, in addition to a "careful analysis of the symptoms exhibited by the patient, the measurement of the pulse at the level of the lower limbs, the comparison between the blood pressure at the level of the arm and the blood pressure at the level of the lower limbs, and finally cardiac auscultation.
- Weak pulse in the legs
- Hypertension in the upper limbs;
- Upper body blood pressure higher than lower body blood pressure (ankle / arm index below 0.9);
- Heart murmur (it is the noise emitted by the blood as it passes through the narrowing).
ECHOCARDIOGRAM
The echocardiogram is a diagnostic test which, by means of an ultrasound probe, allows to visualize on a monitor the heart, the blood vessels associated with the heart (including the aorta) and the blood flow inside the heart cavities.
In a context of aortic coarctation, the echocardiogram represents the diagnostic confirmation investigation, as it allows to clearly highlight the presence of a narrowing along the first tracts of the aorta.
It should be added that the echocardiogram allows the identification of those cardiac anomalies mentioned above and often combined with aortic coarctation.
Is there the possibility of prenatal diagnosis?
Unfortunately, there is currently no diagnostic test for prenatal (ie before birth) identification of aortic coarctation.
Diagnosis of asymptomatic cases
In asymptomatic cases, the diagnosis of aortic coarctation often occurs purely by chance, on the occasion of cardiac checks carried out for quite other reasons.
termino-terminal.It consists in the elimination, by resection, of the restricted aorta segment and in the subsequent connection of the two ends resulting from the aforementioned resection (so as to restore continuity to the aortic duct).
Generally, the aforementioned patch is made of synthetic material.
Angioplasty with stenting
Angioplasty is the medical procedure that allows to eliminate or, at least, reduce the narrowing or narrowing of a blood vessel, through the use of a particular catheter.
The stenting, on the other hand, consists in the placement of a metal prosthesis (stent) inside a blood vessel previously occluded and reopened by angioplasty, in order to keep it open over time and avoid second occlusions.
In the presence of aortic coarctation, it is possible to understand "angioplasty with stenting has as its object the segment of the aorta in which the narrowing resides.
Are there any drugs for aortic coarctation?
Before and in some cases even after surgical treatment or angioplasty with stenting, the carrier (or former carrier) of aortic coarctation may need to undergo drug therapy to control hypertension (hypotensive drugs).
Did you know that ...
Unfortunately, for some former aortic coarctation sufferers, hypotensive treatment may take years, if not lifelong.
Tips for the post-treatment phase
Even when the treatment has been 100% efficient, the former carrier of aortic coarctation should:
- Undergo periodic medical checks, in order to monitor the situation;
- Practice physical exercise regularly and according to what are your possibilities;
- Take all possible precautions against endocarditis.
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