The diagnosis | Aortic isthmus stenosis

The diagnosis

The difference in blood pressure between arms and legs is a clear indication of aortic isthmus stenosis. If the patient reports symptoms such as headaches, throbbing pain, dizziness and weakness in the legs, he should be examined for such vasoconstriction. With the help of an x-ray of the chest it is possible to detect aortic coarctation: The left side of the heart is enlarged and a more pronounced view of the aorta may be seen.

By means of a special ultrasound examination through the esophagus, the heart and the aorta can be closely examined and the narrowing of the aorta can be determined. With a cardiac catheter examination, the location of the narrowing of the vessels can be precisely determined and an attempt at treatment can be made at the same time (see under Treatment). Echocardiography is the examination method of choice for newborns, infants and toddlers.

With the cardiac ultrasound examination one has a certainty of 95% and more to make the diagnosis of aortic isthmus stenosis. In addition, the degree of severity of the stenosis can be determined during the examination and any other malformations of the heart can be detected. In the context of aortic coarctation, a heart murmur can be auscultated with the stethoscope.

Experienced pediatricians and pediatric cardiologists detect a medium-frequency systolic. A systolic is a heart murmur that occurs during the ejection phase (systole) of the cardiac cycle. The systolic can be heard on the left side of the sternum, in the armpit and on the back in case of aortic coarctation.

The Therapy

In order to correct the aortic isthmus stenosis, a surgical procedure is necessary to remove the constriction. After the removal of the vascular constriction, the blood pressure is usually low. A vascular prosthesis can be inserted or the two vascular stumps can be directly connected again.

Particularly in the case of the childhood form of aortic isthmus stenosis, surgery should be performed as early as possible, because the longer the vasculature remains, the more likely it is that the high blood pressure will not recede. An alternative to surgery, especially in adults, is to dilate the narrowing in the vessel with a balloon. This balloon is advanced to the aorta via a catheter, then inflated and pushes the vessel walls outwards. The widening of the vessel by the balloon can also take place if there is a residual narrowing of the vessel after the operation or if the vessel has narrowed again although it was optimally widened by the operation.

The forecast

If a patient with aortic isthmus stenosis is treated late, the main complications are the development of cardiac insufficiency (heart failure) or aortic valve disease or a tear in the aorta. If, on the other hand, surgery is performed early, the risk of secondary diseases of the cardiovascular system can be reduced. Compared to the healthy population, patients with aortic coarctation die more frequently from high blood pressure or other cardiovascular diseases.

Aortic isthmus stenosis (ISTA) is a common heart defect that can be corrected very well by surgery. Interventional procedures with balloon dilatation and stent implantation are also used. Both the surgical and interventional therapy of an ISTA are used as standard and have very good prospects of success.

In some cases, elevated blood pressure levels remain after surgery, which can be treated well with medication. There is still a residual risk for the development of a renewed narrowing in the aortic isthmus area, so that control examinations are necessary. Most children born with aortic isthmus stenosis lead an unrestricted life later. The life expectancy of an aortic coarctation after successful correction of the heart defect is comparable to the life expectancy of the normal population.