coarctation of the aorta is a congenital narrowing of the aorta or a full break.The frequency of aortic coarctation is 6,3-15% of all heart defects.The first description of congenital heart disease refers to the 1750 Boys this defect occurs in 3-5 times more often than girls.
ductus arteriosus detected in more than 60% of infants with aortic coarctation.Isolated coarctation of the aorta is typical for older children.Often this defect is combined with a bicuspid aortic valve, the mitral valve deformity.Coarctation of aorta may be associated with the presence in the lumen of the aorta or contraction of the membrane of the vessel.
When coarctation of the aorta in the blood vessels branching from the aorta to the point of its contraction, the pressure is increased (upper limbs, head and neck).The vessels, which extend from the aorta after the place of its contraction, the pressure is reduced (abdominal organs, lower limbs).
manifestations of heart disease are affected by age, anatomical changes taking pla
older children often define long "hypertension of unknown origin", sometimes high blood pressure they found by accident.Complaints in such cases, reduce headaches, repeated nosebleeds.Children are always cold feet, they are prone to "freezing" in the winter, tired quickly under load.On examination, marked with good physical development disproportion of the musculoskeletal system: the muscles of the upper half of the over-developed in the relative underdevelopment of the muscles of the pelvis and lower extremities.Systolic ( "upper") blood pressure on the feet is 50-60 mm Hg.Art.lower than at the hands (normally inverse relation), with normal diastolic ( "lower") blood pressure.This is a major sign of coarctation of the aorta.Less blood pressure in the legs do not determined.In the hands of the blood pressure in the range from 130 to 180 mm Hg.Art.and higher.This high blood pressure can cause sudden bleeding in the brain with the development of hemiparesis.
Additional tests are electrocardiogram, X-ray of the chest.The diagnosis is confirmed by aortography and catheterization of heart cavities, in which the constriction is determined.
The children of the first months and years of life, often severe malformation that creates the need for surgical intervention at an early age.If the defect is not hard for, then in order to avoid a new contraction in place of the correction operation is better to postpone until 6 to 14 years.At this age, even in the absence of complaints and a moderate increase in blood pressure coarctation of the aorta is an indication for surgery.After the operation is stored increased blood pressure, which requires the use of drugs that reduce it.
In order to avoid the development of life-threatening complications of the narrowing of the aorta is subject to surgical treatment.The optimal age for operation from 7 to 10 years, according to some of the other clinics from 7 to 15 years.When the child serious condition operation can be performed in infancy.In this case, the narrowed portion is made of plastic aortic graft child left subclavian artery.At older ages, it may be carried out removing the narrowed area and easy stapling part of the aorta "end to end".Sometimes they use graft.The most dangerous complication of surgery fixes narrowing of the aorta - a violation of the blood supply to the spinal cord.In 0.4% of cases there are persistent paralysis of the lower limbs.The average mortality in this operation, about 9%.The results of operations are good.