The Pediatric Cardiac Surgery Inquest Report



Coarctation of the aorta

In the normal heart, blood flows to the body through the aorta, which connects to the left ventricle and arches over the top of the heart. In coarctation of the aorta, the aorta is pinched (in medical terms, coarcted) at a point somewhere along its length. This pinching restricts blood flow from the heart to the rest of the body. Often, the baby also has other heart defects, such as a narrowing of the aortic arch (in medical terms, transverse aortic arch hypoplasia).

Diagram 2.9 - Coarctation of the Aorta
Diagram 2.9 Coarctation of the aorta
1 - pinched or coarcted aorta
Flow patterns are normal but are reduced below
the coarctation. Blood pressure is increased in
vessels leaving the aorta above the coarctation.
The broken white arrow indicates diminished
blood flow through the aorta.

Usually no symptoms are apparent at birth, but can develop within a week of birth with the closure of the ductus arteriosus. The possible consequences of this condition are poor feeding, an enlarged heart, an enlarged liver and congestive heart failure. Blood pressure also increases above the constriction.

Timing of surgery depends on the degree of coarctation. Surgery may be delayed with mild coarctation (which sometimes is not detected until adolescence). However, if a baby develops congestive heart failure or high blood pressure, early surgery is usually required. A baby with severe coarctation should have early surgery to prevent long-term high blood pressure.

The coarctation can be repaired in a number of ways without opening the heart. The surgeon can remove the narrowed part of the aorta and sew the ends together, thereby creating an anastomosis. (An anastomosis is the surgical formation of a connection between two normally distinct structures.) Alternatively, the surgeon can cut the narrowed section open and sew a patch over the opening.



Current Home - Table of Contents - Chapter 2 - Coarctation of the aorta
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Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown
May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
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