Eight-year-old Rajiv was no different from other kids, except that he got tired easily and could not play football or cricket with his friends. His parents didn’t take much note of this chronic fatigue syndrome, till a routine medical check-up in school revealed a serious problem — his blood pressure was way too high. After conducting a few bedside tests, the alarmed family physician referred the boy to a paediatric cardiologist, who diagnosed the problem as coarctation of aorta (CoA) — a congenital heart disease.
“The aorta is the main blood vessel, carrying oxygen-rich blood to the body from the left lower chamber of our heart. Babies suffering from CoA — a congenital condition — have narrowing of the aorta at some point, which creates high blood pressure in the upper body, forcing the heart to work harder than normal. If the narrowing is severe, very little blood reaches the lower part of the body, resulting in feeble or absent pulse in the groin,” explains Vikas Kohli, director, paediatric cardiology, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS).
Left untreated, the overworked heart is likely to fail at an early age or complications may arise from the persistently high blood pressure. While in severe cases, symptoms surface in the first few months after birth, sometimes a CoA patient goes through 20 years of his/her life without any problems. “This is due to the formation of alternate blood-supply channels,” says Kohli.
Till recently, the narrowed portion of the aorta was either surgically removed and the two ends stitched together or patched with other arteries, like the subclavian artery, to restore normal or near-normal blood flow. But now, like many other congenital lesions, most CoA cases in older children can be successfully treated outside the operation theatre by stenting of coarctation of the aorta, a contemporary process of balloon dilation followed by stent implantation. “This is now the primary treatment for children around seven or older with CoA. It is carried out in a cardiac cath-lab, and the patient is admitted a day prior to the procedure, which usually lasts two to four hours. Very small babies are put to sleep with mild sedatives, while a local anaesthetic is administered to older children,” says Kohli.
A small flexible tube or catheter is inserted in the blood vessel of the groin and taken to the heart. At the tip of the catheter is a deflated balloon. On reaching the site of narrowing, the balloon is gradually inflated and the diameter of the aorta widens. To avoid the wide aortic lumen from recoiling back, a stent — a stainless steel mesh that supports the aorta walls — is implanted in many cases. The child is usually discharged in three to four days.
To cope with the child’s growth, the balloon may have to be dilated once more later, using a simple procedure, says Kohli, who has treated 20 CoA patients at RTIICS in the past 12 months.