Narrowing of the Aorta
The aorta is the large artery that exits the left side of the heart to take red oxygenated blood to the rest of the body. As it ascends from the heart it arches over the airway to travel down in the back of the left chest to the lower parts of the body. As the aorta arches, it may become narrowed, an abnormality called aortic coarctation. It may become so severely narrowed that there is no blood flow between two segments of the aorta; this is called aortic interruption. Blood flow to the lower part of the body in babies with this abnormality is provided by a ductus arteriosus which is a large artery connecting the lung artery with the aorta. The ductus arteriosus has a muscular type of wall that causes it to close in the first few days of life. There is a medication called prostaglandin that can cause the ductus arteriosus to remain open and provide blood flow to the aorta in babies with severe narrowing of the aorta. This is not a long-term solution however and babies will need surgery.
For localized narrowing of the aorta (aortic coarctation) the repair is done by an operation through the left chest whereby the narrowed section of the aorta is excised and the two ends are joined together with a suture line. The ductus arteriosus is also tied closed. For more extensive narrowing of the aorta and aortic interruption, the surgical repair is done as open heart surgery through the front of the chest using the heart-lung machine to support the circulation while the severely narrowed part of the aorta is excised, the ends are joined back together and the less severely narrowed part of the aorta is patched to enlarge it.
Any child who requires repair of the aorta early in life (eg. coarctation repair) must be monitored with regular follow-up with a cardiologist throughout life. This is because the repaired area can narrow again or, many years later, can become stretched and aneurysmal. These problems do not always cause symptoms and can only be detected by regular ultrasounds (echocardiograms), CT scans or MRIs.