What Is Coarctation of the Aorta?

Aortic constriction refers to the narrowing of the aorta and the narrowing of the lumen, resulting in reduced blood flow. Lesions can be very localized or involve long segments. At this time, they are called tubular dysplasia, and they can exist alone or simultaneously. It can occur in the thoracic aorta or in the abdominal aorta, with different symptoms.

Basic Information

English name: coarctation of aorta
Visiting department: Vascular surgery

Common symptoms: Irritability, dyspnea, headache, blurred vision, strong pulse of head and neck blood vessels, etc.
Contagious: no

Causes of aortic constriction

The etiology of aortic constriction is currently unknown, and there are two main theories. One is that aortic constriction is the circular expansion of tissue from the arterial catheter into the aortic wall, so it is believed that contraction and fibrosis when the catheter is closed can spread to the aorta and cause local stenosis. The other is that the aorta originates from abnormal blood flow in the fetus.

Aortic constriction most often occurs at the site where the arterial catheter or arterial ligament connects to the aorta. According to the positional relationship between the narrowed segment and the arterial catheter or arterial ligament, it can be divided into two types: precatheter type and postcatheter type. Precatheter type: This type of constriction is located at the proximal end of an arterial catheter or an arterial ligament, and it is easy to merge with other cardiovascular malformations. It is also called a complex type. Post-catheter type: more common, the constricted segment is located at the distal end of the arterial catheter or arterial ligament, and it is usually a single obstruction, also known as simple type.

Aortic constriction clinical manifestations

The clinical manifestations of aortic constriction depend on the site of the constriction, the severity, the presence or absence of associated deformities, and the age of the patient at the time of consultation.

Anterior narrowing of the catheter is prone to heart malformations. Patients often see a child for congestive heart failure during infancy. If there is an open arterial catheter that sends blood to the thoracic aorta, femoral arterial pulsation may occur. In about half of the cases, the symptoms aggravated when the arterial duct was closed within one month of birth, showing irritability, dyspnea, and so on. There could be systolic murmurs on the left front chest and back.

Children with post-catheter aortic constriction are generally asymptomatic in childhood. Older children and adults often come to the clinic for upper extremity hypertension and hypertension complications. Symptoms increase with age, and they may have headaches, blurred vision, and strong head and neck pulsations. The lower body suffers from cold, fatigue, and even intermittent claudication due to insufficient blood supply.

Aortic constriction

1.X-ray plain film

Small or slightly enlarged heart

2. ECG

May have ventricular hypertrophy.

3. Echocardiography

Transthoracic echocardiography has a better sensitivity for the diagnosis of aortic constriction. Two-dimensional echocardiography of the transsternal fossa. It can show the whole view of the long axis of the aortic arch, and judge the location and length of the aortic constriction.

4.CT and MRI

Using contrast enhancement, continuous scans of the aortic arch can reveal where the aorta has narrowed.

5. Cardiovascular angiography

A typical aortic constriction does not need to be used as a routine examination, but currently aortic angiography is still an intuitive method to observe aortic constriction, showing the constricted area, extent, involved large blood vessels and collateral circulation.

Aortic constriction treatment

Drug treatment

Antihypertensive drugs are mainly used to control hypertension.

2. Interventional Therapy

Including two methods of balloon angioplasty and stent implantation. In general, interventional therapy for aortic constriction is still in the exploration stage.

3. Surgical treatment

In principle, once the aortic constriction is clearly diagnosed, surgery should be performed as soon as possible to relieve the difference in distal and proximal blood pressure of the aortic constriction. Constriction resection and end-to-end anastomosis, suitable for young children with more limited stenosis; aortic constriction angioplasty, including patch molding and vascular graft surgery, is suitable for long constricted sections and resection of the back end Patients with difficulty in end-to-end anastomosis are preferred over 16 years of age; aortic narrowing bypass grafting is suitable for patients with a wide range of constriction and difficult to expose the constricted area, difficulty in resection and re-constriction requiring reoperation.

Aortic constriction prognosis

Patients with this disease have a poor prognosis without surgery and often die of hypertension complications such as heart failure or cerebral hemorrhage at the age of 30.