主动脉收缩(CoA)
这是什么??
在这种情况下 主动脉 (the main artery that carries blood from the heart to the body) is narrowed or constricted.
This narrowing affects blood flow where the arteries branch out to carry blood along separate vessels to the upper and lower parts of the body. 辅酶a会导致高血压或心脏损伤.
为CoA患儿的家长提供更多信息
原因是什么??
在大多数儿童中，病因不明. 有些孩子可能会有其他心脏缺陷和缩窄.
它是如何影响心脏的?
血管收缩会阻碍血液从心脏流向身体下部. 血压高于收缩. The blood pressure is much higher than normal in the left pumping chamber (left ventricle) and the heart must work harder to pump blood through the constriction in the 主动脉. 这会导致过度劳累的心肌增厚(肥大)和损伤.
子宫缩窄对我的孩子有什么影响?
Usually no symptoms exist at birth, but they can develop as early as the first week after birth. 婴儿可能会出现充血性心力衰竭或高血压.
If the obstruction is mild, the heart won't be very overworked and symptoms may not occur. In some children and adolescents, coarctation is discovered only after high blood pressure is found.
对于缩窄可以做些什么?
缩窄性梗阻可通过手术或导管术解除.
手术常用于修复缩窄. 外科医生不需要打开心脏来修复缺陷. 有几种方法可以解决这个问题. 一种方法是外科医生切除狭窄的主动脉段. Another option is to sew a patch over the narrowed section using part of the blood vessel to the arm or a graft of synthetic material.
心导管球囊扩张和支架置入也被使用, more commonly in older patients and in patients with recurrent coarctation after surgery. In this case the balloon may stretch the area of narrowing while the stent provides stiff support to prevent the vessel from returning to the smaller size.
An infant with a severe coarctation should have a procedure to relieve the obstruction. 这可以缓解婴儿时期的心力衰竭，防止以后出现问题, 比如成年后因为血管收缩而患上高血压.
我的孩子会做什么活动?
如果缩窄已经修复, 没有重要的梗阻或高血压, 你的孩子在体力活动方面可能不需要任何特别的预防措施, 并且可以在不增加风险的情况下参与正常活动.
一些有梗阻的孩子, 高血压, heart muscle abnormalities or other heart defects may have to limit their physical activity. 咨询一下你孩子的儿科心脏病专家.
我的孩子将来需要什么?
术后前景良好, 但需要儿科心脏病专家的长期随访. 很少，主动脉缩窄可复发. 然后可能需要另一种手术来缓解梗阻. 此外，即使主动脉狭窄已经修复，血压也可能保持在高位.
如何预防心内膜炎呢?
主动脉缩窄的儿童可能有发生心内膜炎的危险. Your child's cardiologist may recommend that your child receive antibiotics before certain dental procedures for a period of time after coarctation repair. 请参阅 心内膜炎 了解更多信息.
更多关于CoA成人的信息
Coarctation of the 主动脉 is a narrowing of the 主动脉 between the upper body branches and the lower body branches. 它通常位于主动脉弓之后的孤立位置. The blockage can increase blood pressure in your arms and head, yet reduce pressure in your legs. Abnormalities of the aortic valve (usually bicuspid; see 主动脉狭窄和不全 节)也可能在场. 有时, the narrowing of the 主动脉 is so severe that there's essentially no connection between the upper and lower portions of the 主动脉 ("Interrupted aortic arch").
原因是什么??
The area where coarctation of the 主动脉 occurs is usually in the same spot where the 开放性动脉导管 关闭. 有时, 在生命的第一周，导管正常闭合期间, 组织会积聚并导致狭窄.
心肌收缩是如何影响心脏的?
主动脉缩窄可引起心脏高血压. This can cause the muscle of the heart's main pumping chamber (left ventricle) to become thick. Eventually, the function of the heart muscle could deteriorate if the condition isn't treated.
缩窄对我有什么影响?
很多人都不知道有问题. 手臂的高血压是典型的. 当出现在年轻人身上时，应立即调查是否有缩窄. 有时成年人也会头痛, 肾脏问题，经常流产, 或者在使用腿部时缺乏能量. However, such symptoms are common in the general population and are usually due to other causes.
如果我的缩窄在童年时就被修复了，我还能指望什么呢?
1985年之前修复的大多数患者都接受了手术. The surgeon had several options depending on the circumstances such as the length and location of the coarctation. Younger adults may have had a repair in the catheterization laboratory (referred to as 介入性或治疗性导尿) where the narrowing was expanded by a balloon inserted through a small hole in your leg. 通常会放置一个金属支架来保持该区域的开放. 如果成人发生进一步的狭窄，这也是一种选择.
如果缩窄仍然存在怎么办? 成年后应该修复吗?
是的, coarctation can be repaired at any age and should be addressed as soon as it's diagnosed depending on the severity of the coarct. Adolescents and adults with coarctation can often be treated by cardiac catheterization.
你可能遇到的问题
高血压是成年人最常见的问题. 即使你的缩窄已经成功修复，它也可能存在. High blood pressure is more common if the coarctation was repaired after five years old. Patients treated in childhood are at risk for redeveloping the coarctation (recoarctation) and may require catheterization. Most patients with recoarctation of the 主动脉 after initial repair usually don't have symptoms, 这就使得医生的定期评估更加重要了. 很多时候，这个区域会缩小到一定程度, 或者主动脉的其他部分可能扩大(动脉瘤)并有破裂的可能. 这些可能需要通过进一步干预来解决. Patients may develop coronary artery disease, leaving them vulnerable to heart attacks. There may even be an increased risk of having an aneurysmal blood vessel in the head.
持续的关心
我将来需要什么?
Everyone with a known coarctation of the 主动脉 should be seen annually by a cardiologist with expertise in caring for adults with congenital heart disease even if the coarctation has been successfully repaired. 应该测量手臂和腿部的血压. 通常建议服用药物, 通常使用-受体阻滞剂(阿替洛尔或美托洛尔)来控制血压. 常规的主动脉显像应通过超声心动图或核磁共振检查. CT扫描也能很好地显示该区域, 但不建议重复常规检查，因为它涉及辐射. You should also consult a cardiologist with expertise in caring for adults with congenital heart disease if you're undergoing any type of non-heart surgery or invasive procedure.
活动
大多数活动可能是安全的，并受到鼓励. 大强度等长运动, 比如力量举重, may be a particular concern especially in patients who have enlargement of the 主动脉 since it raises the blood pressure quickly. 请参阅 身体活动及运动 了解更多信息.
心内膜炎的预防
虽然可能会发生缩窄感染，但可能性不大. 更常见的是，患者可能并发异常主动脉瓣感染. 建议所有患者进行良好的口腔护理.
怀孕
子宫缩窄修复的妇女可以低风险怀孕. The exception is if there's a residual (leftover) narrowing of the 主动脉 or if there's high blood pressure or enlarged areas of the 主动脉. It's best to plan ahead and have a thorough check-up including an imaging study of the 主动脉 to detect these problems before becoming pregnant, 并在受孕前控制问题. 请参阅 怀孕 了解更多信息.
我还需要做手术吗?
The need for surgery or catheterization depends mostly on the level of pressure in your arms and legs when you're resting and, 在某些情况下, 在运动中. If your arm and leg blood pressures are normal and equal, you probably won't need more intervention. If you blood pressure is elevated in your arms and more than 20 mmHg higher than in your legs, 很可能需要进一步的干预. 当问题出现时, 越来越多的机构使用导尿管而不是手术, 哪一个对病人来说更容易.
