Ruby and Mia – Coarctation of the Aorta

Ruby held Mia close in her arms. Her little baby, Mia, was only three weeks old and was extremely ill. She wasn’t feeding well, looked blue and the doctor said they had heard a murmur whilst listening to her heart. Her blood pressure was high and her breathing was too fast. Ruby couldn’t stop crying. The past week had been difficult, and seeing Mia fall ill was heart-breaking.

Ruby placed Mia down into the baby cot on the hospital ward and rubbed her soft cheek. ‘You’ll be fine, my angel, Mummy’s here’, she whispered to her little baby.

Half an hour later, the doctor arrived and greeted Ruby. ‘Ruby, we have some important information for you. We have found out what is wrong with Mia. After listening and investigating at what could be wrong with her heart, we have found the main artery in the heart to be slightly narrow. This artery is called the aorta and it is responsible to transport blood around the body. As it has become narrow, it is harder for the heart to pump and transport blood, thus oxygen, around the body. The medical term for narrowing is called coarcation. Hence, the condition is termed coarctation of the aorta,’ he explained.

‘Oh no!! What will happen now, doctor?’ exclaimed Ruby.

‘The narrowing causes an irregular spread of oxygen and blood to the body and thus causes hypertension in the upper body and hypoperfusion in the lower body. Severe cases present in the neonatal period, as is the case with Mia, but often it may go unnoticed and be diagnosed in childhood and even later. It is a very common condition, affecting 1 in 2500 births and it is more common in Caucasians. It is often also associated with other congenital syndromes, for example, Turner’s syndrome,’ the doctor continued.

‘What tests did you carry out? And what is the cause of this, doctor? Did I do something wrong during pregnancy?’ asked Ruby, whilst stroking Mia’s forehead.

‘We carried out some blood tests, took a few images of her heart using X-ray and Ultrasound and used an ECG to see if her heart was beating normally. This concluded the diagnoses. Usually, this occurs due to a defect in the vessel during development. There are two theories: the ductus tissue theory and the haemodynamic theory. The former involves a muscle growing in a different area to normal causing constriction and narrowing of the aorta and the latter believes reduced blood flow is the cause of underdevelopment of the aorta. It is not your fault, Ruby. Sometimes, congenital developmental problems happen. There’s nothing you could have done. You have always been healthy, and looked after your baby during pregnancy and since birth,’ reassured the doctor.

Ruby shed a tear. ‘Is there anything you can do to fix this, doctor?’

‘As Mia is young, surgery would be the best option. This involves opening the narrowing using balloon angioplasty. In some situations, certain medications, such as beta-blockers, diuretics, ACE inhibitors and prostaglandins, are offered. However, as Mia is young, she will not be in need of this. We shall monitor her closely after her operation. When she is older, she may need medication, but she may also never be in need of it,’ confirmed the doctor. ‘The condition commonly presents in neonates. It is difficult to diagnose it antenatally with ultrasound, but sometimes we can also pick it up. Late presentations are usually asymptomatic, and diagnosis is made when patients come for routine check-ups and we have a listen to their heart. These patients normally complain of headaches, nosebleed and leg cramps on exercise’.

‘Will Mia be okay, doctor?’ queried Ruby.

‘If untreated, the outlook is poor. Be assured Ruby, she is in good hands. We have found it early and we shall use surgery to correct her condition. We will look after her. In the future, she may find it difficult to do vigorous activities, straining exercises and contact sports, but that is easily managed. The complications of surgery do exist, but I can assure you, she will be fine,’ comforted the doctor.

Ruby felt more at ease. Although worried at the idea of surgery, she knew she could trust the doctor. They had done so much for Mia already and Ruby knew they would take good care of her.

‘We will be operating on her this afternoon, Ruby. Is that okay?’ asked the doctor.

‘Yes,’ replied Ruby, as she smiled at him and looked down at Mia. She kissed Mias forehead and continued to comfort her with her touch. ‘You’ll be fine, my angel. You’re mummy’s strong girl aren’t you,’ whispered Ruby, as she put her face close to Mia’s and kisser her forehead once more.

Shrinal Kotecha


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