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Coarctation of the aorta

Congenital heart defects

What are congenital heart defects?

Congenital malformations of the heart or major blood vessels surrounding the heart, is not uncommon. Many of these will be so small that they will never give any problems. For such a deformity to be called a congenital heart defect, it must be of such a nature or magnitude that it will be able to give importance to quality of life or life expectancy. Congenital heart defects are formed when the heart is formed, that is, in the first part of pregnancy. However, it is not unusual that the error first discovered a few years out in the child's life.

There are a number of different types of heart failure. For most of them will also be the degree or magnitude of the individual errors could vary. Combinations of several types of heart failure also occurs. Congenital heart defects are among the most common "birth defects" and is the most common cause of death due to inborn errors.

How does the heart?

The heart is a muscle that acts as a pump and supply the body with blood. It is divided into four cavities or "chamber". We have two atria and two ventricle, one each on the right and one each on the left side. Atria release blood into the heart chamber, and it is heart chamber which has the main power and pumps blood out to the body (left side) or the pulmonary circulation (right). Between the chambers are valves or flaps. These work in the way that they just do not have the blood through in one direction and prevents blood from flowing back where it came from.

Blood circulation through the body is an endless circle. We can start in the heart's right side, and from there goes to the lungs and the blood is enriched with oxygen. The oxygen rich blood has a clear red color (when bleeding blood will always be red, because the blood when in contact with air) and are now transported back to the heart. The heart's left side (which is the strongest part of the heart muscle) carry the blood through the arteries (arteries) to the body's tissues and organs. Arteries is a common term for the blood vessels that carry oxygen-rich blood out to the body. As oxygen is used up blood becomes darker. The dark bluish blood back then transported to the heart's right side through the veins (of the body's blood vessels that carry oxygen-poor blood back to the heart), and then we are back to the starting point where the cycle continues.

What is coarctation of the aorta?
The aorta is the main artery that runs from the heart and supplies the body with blood. A relatively common congenital malformation of this is a narrowing in the chest portion of the aorta. This leads to more resistance as the heart must pump against, and that the blood does not flow as undisturbed as desired. There are a variety of ways to treat this. The surgeon may remove the narrow section and either replace the removed part with a bit of a different vein from the body, if necessary. with an artificial vein. Is the narrow area short, one can only remove it and sew the two ends together afterwards. In some cases it will be possible to insert a small balloon into the aorta which is inflated in the narrow area and thereby extends this.

What is the cause of congenital heart defects?
The nearly 500 children born with congenital heart defects each year. Only in a small number of these can say with certainty what causes heart disease.

Some diseases of genetic systems (genetic diseases) is linked to heart failure. The most common is Down syndrome . Third of children with Down syndrome have heart defects.

It also seems that the inheritance may play a role. If parents or siblings have heart failure, the risk of having a new child with heart failure increased.

There are also environmental / external factors that can cause heart failure. The most common are some viruses and some drug. Mothers who get rubella in the first part of pregnancy are at increased risk of giving birth to children with heart defects.

Some medicines may increase the risk of developing heart disease if they are taken during pregnancy - especially if taken in the first third of pregnancy. Use of alcohol during pregnancy increases the risk of heart failure. Especially children who are born with so-called "fetal alcohol syndrome" are more likely to have congenital heart defects. Also the use of cocaine during pregnancy increases the risk that the child will be born with malformations of the heart.

Some chronic diseases in the mother increases the risk of heart defects in the baby. This includes diabetes . The risk in diabetics can be reduced and it is negligible if your blood sugar is well controlled before and during pregnancy. Mothers with the rare disease phenylketonuria or Follings disease is likely to have children with heart defects, unless they follow a carefully balanced diet before and during pregnancy.

How will doctors and hospitals investigate child?
Most heart defects detected by routine inspections unless the child has shown no signs of heart disease. It is often detected, a "murmur" when the doctor listens to heart. Children with normal hearts may also have heart murmurs, but it will often be necessary to have further tests to find out if there is something wrong in the heart causing the murmur.

If your child has symptoms of their heart defects may take the form of increased incidence of respiratory infections. In infants, a brand that they have difficulty breathing when they eat, they will often also have lower weight gain than one would expect. Swelling in the legs, abdomen or around the eyes can also occur and is a sign of poor cardiac function.

Some heart defects cause a blue-pale coloring of the skin, a symptom medicine called cyanosis. This detects an often soon after birth, but in some cases it will not appear until later in childhood. The cause of blueing is that blood does not contain enough oxygen. Children with cyanosis become easily tired, short of breath and can faint - especially during exertion. A typical characteristic of children with this type of heart failure is that they are much squatting, as this makes it easier to breathe.

In suspected heart defect baby will be thoroughly examined in hospital. It can be done a lot of research, but ultrasound generally provides the most information. This survey is called echocardiography, and is not dangerous or uncomfortable. It shows us how the heart looks like, and the direction and speed of blood pumped through the heart.

Other studies done in the hospital, blood pressure measurement, measurement of the amount of oxygen in the blood, ECG and a survey called cardiac catheterization.

What is the treatment?
The aim is to detect the condition early so that proper treatment is given and the patient can avoid serious complications in the short and long term. In severe heart failure in infants with coarctation is prompt medical stabilization important in anticipation of surgery. Surgical correction is the most important treatment to ensure good long-term prospects for the patient. In children without symptoms recommended surgical correction planned for 3-5 years of age.

Various surgical methods have been developed. From ancient surgical removal of the involved segment of aorta has been the preferred technique with high success rate. More recently, balloon dilation (blasting of the stricture) and placement of endovascular stent become common to perform - especially in those who are unfit for surgery. Surgery is still considered as the best method of treatment of infants with critical coarctation.

For many years it was believed that the operation was healing and without the need for regular monitoring. Later settlement of patient materials have shown that many patients received long-term complications such as new coarctatio, aortic aneurysm, accelerated atherosclerosis and hypertension.

How is long-term prospects?
For those who survive surgery at a young age, living good prospects.

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