Coarctation of the Aorta: Causes and Treatment
Introduction
Coarctation of the aorta is a congenital disease, which, as a rule, is associated with the abnormal development of the right side of the fetal heart during pregnancy. An excessive load is caused by the strong pressure of incoming blood. Genetic predisposition may be one of the risk factors. However, this ailment cannot be predicted, and it can accompany other congenital heart defects. Dijkema et al. (2017) note that predisposition in men is higher than in women. Specific treatment is an imperative condition to avoid death in newborns and prevent the rapid course of the disease in the future.
Clinical Assessment
Based on clinical findings, CA is not the most common form of heart diseases. In the process of assessing various patients’ condition, dyspnea was found to be a frequent symptom associated with the ailment under consideration. Also, high blood pressure and rapid heartbeat are typical phenomena, which, in turn, lead to headaches and recurrent nosebleeds, causing severe discomfort. CA patients experience weakness and fatigue and, as Heck et al. (2018) note, one of the symptoms is the cooling of limbs.
Differential Diagnoses
The aberrant subclavian artery may be a differential diagnosis, but this anomaly occurs in older people and is not typical among pediatric patients (Léauté-Labrèze et al., 2017). The structure of the aorta changes differently compared to the disease under consideration. Right heart enlargement is another form of the abnormal development of the heart muscle; however, this syndrome is a consequence, that is, a secondary pathology but not a congenital one (Sivanandam et al., 2015). As a differential diagnosis, critical aortic stenosis is often mentioned, but this ailment is characterized by peculiar symptoms and manifestations (Léauté-Labrèze et al., 2017).
Diagnostic Studies/Labs
Unlike the classical principles of aortography, transthoracic echocardiography is a more convenient and reliable method of obtaining data on the inclination of a fetus to CA (Sun et al., 2015). Specific technologies make it possible to recognize the ailment as early as possible and to study a neonatal aortic arch comprehensively (Arya et al., 2016). The characteristic properties of these principles of diagnosis are non-invasiveness and relatively cheapness compared to other methods.
Prevention Options
Since CA is a congenital disease, medical professionals cannot give the comprehensive guarantee of safe fetus’s health. Accordingly, almost no significant preventive measures exist in a modern prenatal practice. Among the recommendations that partners receive, the rejection of bad habits (the use of nicotine, alcohol, and drugs) is mandatory as a non-pharmacological option. Scheduled medical examinations are also mandatory for the timely identification of potential problems. Both fathers and mothers should follow the advice of specialists to promote the development of a healthy fetus in the womb.
Treatment Options
Since the drug treatment of CA is ineffective, special medications are prescribed to relieve the symptoms of the disease, for instance, increased blood pressure. The only opportunity for dealing with the disease is surgery, which is usually performed at an early age of patients. In modern practice, the effective methods of aortoplasty are applied, and the defect in question is corrected. In case a corresponding surgery is not performed in timely, the risk of dangerous health outcomes increases, and death is possible. After such an intervention, a patient goes through a rehabilitation period.
Patient and Family Education
Although in addition to surgical interventions, there are no any effective ways of avoiding CA, appropriate educational work should be carried out for pediatric patients and their parents. All family members are to understand the importance of a healthy lifestyle and giving up bad habits. If necessary, psychological support may be required for patients and their parents. Strict adherence to medical prescriptions is an essential condition for reducing risk factors, and regular examinations should be mandatory until an operation is conducted. All stakeholders are to be aware of the categorical ban on self-treatment.
The Best Practices for Optimal Outcomes
Despite the fact that surgical interventions, as a rule, allow eliminating CA, follow-up care is imperative. According to Dijkema et al. (2017), among patients with this diagnosis, life expectancy is reduced, and a high-morbidity risk is common. Therefore, medical consultations and examinations should be regular. Since one of the main symptoms of the disease is high blood pressure, monitoring this indicator is necessary. Also, screening diagnostics may help to identify a newly emerged disease focus and take appropriate measures. Constant medical observation is an important condition for optimal health outcomes.
Regardless of the time of CA identification, that is, whether at the prenatal stage or after childbirth, surgery is the only possible key to positive health outcomes. There may be cases of recurrence of the problem, and the waste of time is unacceptable since with improper medical care, the risk to life is high. Symptoms that occur during CA should be eliminated in order to avoid increased stress on the heart. The application of modern diagnostic methods may help to achieve high precision examinations and, as a result, effective treatment.
Summary
Based on the assessment of the disease under consideration, its consequences, causes, and risk factors, it can be noted that this ailment is the dangerous problem and occurs in pediatric patients due to an anomaly in the process of fetal development. There are differential diagnoses that may have similar symptoms; nevertheless, due to modern high-precision methods for detecting CA, its identification is error-free. Despite the inefficiency of drug treatment, patient and family education should be maintained to increase the awareness of the disease among the population and facilitate patients’ rehabilitation periods.
Questions to Peers
- Are there effective measures for the drug prevention of CA and its consequences?
- Why is follow-up care important for pediatric patients after surgery?
- What types of family and patient education should be promoted?
References
Arya, B., Bhat, A., Vernon, M., Conwell, J., & Lewin, M. (2016). Utility of novel fetal echocardiographic morphometric measures of the aortic arch in the diagnosis of neonatal coarctation of the aorta. Prenatal Diagnosis, 36(2), 127-134. doi:10.1002/pd.4753
Dijkema, E. J., Leiner, T., & Grotenhuis, H. B. (2017). Diagnosis, imaging and clinical management of aortic coarctation. Heart, 103(15), 1148-1155. doi:10.1136/heartjnl-2017-311173
Heck, P. B., von Ohain, J. P., Kaemmerer, H., Ewert, P., & Hager, A. (2018). Quality of life after surgical treatment of coarctation in long-term follow-up (CoAFU): Predictive value of clinical variables. International Journal of Cardiology, 250, 116-119. doi:10.1016/j.ijcard.2017.10.024
Léauté-Labrèze, C., Harper, J. I., & Hoeger, P. H. (2017). Infantile haemangioma. The Lancet, 390(10089), 85-94. doi:10.1016/S0140-6736(16)00645-0
Sivanandam, S., Nyholm, J., Wey, A., & Bass, J. L. (2015). Right ventricular enlargement in utero: Is it coarctation? Pediatric Cardiology, 36(7), 1376-1381. doi:10.1007/s00246-015-1168-7
Sun, Z., Cheng, T. O., Li, L., Zhang, L., Wang, X., Dong, N.,… Xie, M. (2015). Diagnostic value of transthoracic echocardiography in patients with coarctation of aorta: The Chinese experience in 53 patients studied between 2008 and 2012 in one major medical center. PloS One, 10(6), e0127399. doi:10.1371/journal.pone.0127399