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Coarctation of the aorta

 

 

Coarctation of the aorta – a heart defect in which there is a narrowing of the lumen of the aorta in the region where the registered patent ductus arteriosus.

 

There are two types of aortic coarctation:

1. Congenital type that appears in infancy. It is associated with patent ductus arteriosus, which does not close after birth, with hypoplasia of the aortic arch, as well as with other congenital heart defects.

2. Coarctation aorta which is found in adults – a segmental (local) narrowing of the aorta not associated with heart defects.

 

Prevalence 1: 1600 newborns. The ratio of male: female = 1.5: 1

 

Leading pediatric cardiologists Israel:

Dr. Anat Birk – specialist in pediatric cardiology, Director of Institute for the Heart Study, children hospital Schneider

 

Dr. Elchanan Bruckheimer – an expert in pediatric cardiology, non-invasive surgery, Head of minimally invasive cardiac surgery, children hospital Schneider

 

Dr. Samuel Diamond – Director of the Department of Pediatric Cardiology, Medical Center of Dan Tel Aviv (Ichilov)

 

Dr. Julius Agash – Director of Children’s Cardiology Department, Hospital of Edmond and Lily Safra, Sheba Medical Center, Tel Hashomer

 

Prof. Avraham Lorber – specialist in pediatric cardiology and pediatric cardiology, director of Pediatric Cardiology and Congenital Heart Defects, Rambam Health Care Campus

 

Dr. Avraham Matityahu – specialist in pediatric cardiology, Director, Department of Pediatric Cardiology, Kaplan Medical Center

 

Prof. Azaria Rein – expert in Pediatric Cardiology, Director of Pediatric Cardiology, Hadassah Medical Center

 

Coarctation Causes are multifactorial (including multiple genetic components). There is also a connection with diabetes and high levels of vitamin A. The reason may be congenital heart defects, such as ventricular septal defect (VSD), aortic valve stenosis, transposition of the great vessels (TMS). The reasons are as Turner Syndrome (45, XO), where 35% of newborns suffer aortic coarctation.

 

 

Diagnosis of aortic coarctation

In some cases, the disease is detected by ultrasound in the womb. Sonographic findings indicate asymmetry in the center with the increase and enlargement of the right ventricle and the pulmonary artery. But in most cases it is difficult to diagnose fault in the womb.

 

Signs of heart failure manifest themselves as rapid breathing (tachypnea) and sweating while eating.

 

Imaging techniques of aortic coarctation – ECG, chest X-ray, ECHO (ultrasound of the heart), CT/MRI angiography.

 

 

Treatment of aortic coarctation

After delivery the decision about surgery and terms depends on the severity of aortic coarctation.

 

Blood supply to the lower part of the body depends on ductus arteriosus condition (it usually closes after birth). Without treatment anemia can occur and thus disturb the function of the intestine, kidneys and other organs.

 

To maintain a patent ductus arteriosus, usually experts recommend administration of prostaglandins. Drug therapy may be imposed only experienced pediatric heart surgeon or cardiologist.

 

In cases of cardiac insufficiency and anemia surgical intervention may be appointed.

 

The operation involves removing the affected area and connect the ends (anastomosis) or bypass surgery (removal of the shunt by subclavian flap angioplasty). In some cases, a stent (metal fiber net, the constriction of the aorta extending to the normal state).

 

For children who do not have symptoms surgery may be indicated only from 3-5 years of age.

 

 

Prognosis 

Early diagnosis and treatment as well as the absence of other defects significantly improves the prognosis. Success of the operation coarctation in Israel is more than 90%. Chance of recurrence – 25% within a few months. In the event of a defect, mortality is less than 1%. Typically, other cardiac defects is in 70% of children. The recurrence rate after surgery performed by our surgeons very close to 0%.

 

Without treatment the average age at death of 34 years. 75% die before the age of 46 from heart failure (26%), endocarditis (18%), intracerebral hemorrhage (10%), aortic rupture (21%) and other complications of hypertension, including premature coronary artery disease.

 

 

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