American Medical Association Family Medical Guide - American Medical Association [173]
Most older children with coarctation of the aorta do not have any symptoms, but some may have throbbing headaches, cold feet or legs, or leg cramps after exercise. They also have high blood pressure in their upper body, low blood pressure in their lower body, and a weak or absent pulse in the groin area. They may also have a heart murmur.
Diagnosis and Treatment
A doctor often detects coarctation of the aorta during a baby’s first examination by noticing a weak or absent pulse in the groin. Older children with coarctation have high blood pressure in their arms and often a heart murmur. The diagnosis can be confirmed with an ultrasound evaluation of the aorta and heart (echocardiogram; see page 561).
Surgery to correct the narrowing usually is performed shortly after a diagnosis of coarctation of the aorta is made, even in infants. Surgery relieves the symptoms quickly and prevents high blood pressure and heart damage.
Tetralogy of Fallot
Tetralogy of Fallot is a group of several abnormalities that occur together in the heart. These defects include a large hole in the wall (septum) that separates the ventricles (ventricular septal defect; see page 392), a narrowing at or below the pulmonary valve that opens to send blood from the heart to the lungs, a larger-than-normal right ventricle, and an enlarged aorta (the main blood vessel carrying blood from the heart to the rest of the body), which sits abnormally above both the right and left ventricles. These defects can prevent some of the oxygen-depleted blood from reaching the baby’s lungs for a fresh supply of oxygen, causing some oxygen-deficient blood to be pumped out to tissues and preventing the tissues from getting sufficient oxygen.
Symptoms
From birth, or shortly after, the deoxygenated blood gradually turns the baby’s skin blue (cyanosis), especially when he or she is crying or feeding.
Tetralogy of Fallot
In tetralogy of Fallot, four heart abnormalities occur together. One of the defects is a large hole in the wall (septum) separating the right and left ventricles, which allows deoxygenated blood to pass from the right ventricle to the left ventricle and be pumped through the aorta to body tissues without receiving a fresh supply of oxygen from the lungs. Another defect is a narrowing at, or just beneath, the pulmonary valve, which partly blocks the flow of deoxygenated blood into the lungs. In addition, the wall of the right ventricle is more muscular and larger than normal, and the aorta lies directly over the hole in the ventricular septum.
Other symptoms include shortness of breath, rapid breathing, a heart murmur, difficulty feeding, failure to gain weight, and slow growth. Without treatment during infancy, a child may develop thickened, clubbed fingers and toes. After exercise, the child is short of breath and squats in a characteristic position to catch his or her breath.
Diagnosis
Tetralogy of Fallot can often be diagnosed shortly after birth when the doctor notices that the baby has bluish skin and detects a heart murmur during a physical examination. A chest X-ray will show an abnormally shaped heart. The doctor will also order an echocardiogram (see page 561) and an electrocardiogram (see page 559) to identify the abnormalities of tetralogy of Fallot and to rule out other heart defects. The doctor will refer the child to a pediatric cardiologist (a doctor who specializes in treating heart disorders in children) for further evaluation and treatment.
Treatment
A child with tetralogy of Fallot will need to have surgery to correct the defects, usually in the first year of life. Before corrective surgery, the doctor may recommend a temporary solution with a surgical procedure using a special shunt that diverts blood flow to the lungs and relieves the child’s immediate symptoms. But, as heart surgery for infants evolves, more and more children with tetralogy of Fallot are having the defects repaired early in infancy, eliminating