Coarctation (Latin of coarctatio — narrowing) — the most frequent anomaly of development of an aorta representing the narrowing, insignificant on extent, which is located, as a rule, is slightly lower than the place of an otkhozhdeniye of the left subclavial artery.
Depending on localization distinguish preduktalny — narrowing in the field of an isthmus, yukstaduktalny — the localized narrowing in the place of an otkhozhdeniye of an arterial channel, and postduktalny coarctation — narrowing in the field of an aortic arch. The size of coarctation can fluctuate from insignificant narrowing to a phrenic partition with a size of opening of 1 — 1,5 mm.
Clinical picture of coarctation of an aorta
Due to the insufficient blood circulation patients complain of fast fatigue, weakness and cold sense in legs, gastrocnemius muscle pains when walking can be noted. The lower half of a trunk and leg lag behind in development. Arterial hypertension leads to emergence of headaches, a sonitus, heartbeat, an asthma.
At survey the retrosternal pulsation, a visible pulsation of carotid arteries attracts attention. Collateral vessels in shovels, intercostal arteries are palpated. Pulse on beam arteries is fuller, than on femoral. Patognomonichno lowering of arterial pressure standing on 50 mm of mercury. and more in comparison with arterial pressure on hands. Delay of pulse wave on femoral arteries is possible. The percussion sizes of heart are often not changed or slightly expanded to the left.
Cordial tones are increased by Auskultativno, the accent of the II tone in the second mezhreberye to the right of a breast is noted. The systolic noise which is well carried out on vessels of a neck and to interscapular space is determined by the left edge of a breast a rhomboid configuration. Intensity of noise directly correlates with aortostenosis degree.
Patients with coarctation of an aorta are predisposed to an infectious endocarditis. Below the place of narrowing blood clots are quite often formed that can lead to development of a thromboembolism. Approximately in 10% of cases the aorta atherosclerosis prematurity is observed — especially in the place of narrowing, and atherosclerosis of coronary arteries that, on the one hand, causes defect progressing, with another — can serve as the reason of stenocardia and myocardial infarction aged till 30 flyings.
Treatment of patients with aorta coarctation
At considerable degree of coarctation of an aorta operational treatment has to be carried out aged till 1 year. Moderate coarctation also demands operational treatment which is carried out, as a rule, aged 15 years, but even before forming of clinically significant heart failure are more senior. Operation of the choice is baddonny dilatation, is more rare — at extended coarctation existence of calcification, the resection of the narrowed site with its prosthetics is carried out. Contraindications to operation are pulmonary hypertensia and heavy calcification of an aorta.
Conservative treatment of post-operational patients assumes correction of systolic hypertensia, heart failure, prevention of thrombosis of an aorta. Further when maintaining gaky patients the issue of purpose of anti-atherosclerotic therapy for prevention of a possible rekoarktation has to be resolved.