Coarctation Repair
Coarctation Repair is done to repair the birth defect in which a part of the aorta, the tube that carries oxygen rich blood to the body, is narrower than usual.
Some facts about Coarctation Repair:
- Coarctation of the aorta is a narrowing of the aorta which occurs usually in a short piece of the aorta just beyond where the arteries to the head and arms take off.
- It is called the 'juxtaductal' aorta where Coarctation occurs.
- The ductus arteriosus is a blood vessel that is generally present in a fetus, which has special tissue in its wall that causes it to close in the first hours or days of life
- Coarctation may be caused if ductal tissue is present in extra.
- The aortic arch may also be small in babies with coarctation.
- Coarctation may also happen with other cardiac defects, typically involving the left side of the heart.
- Usually, the defects seen with coarctation are bicuspid aortic valve and ventricular septal defect.
- Coarctation of the aorta can be seen in some patients with genetic disorders, such as Turner's syndrome.
- The left ventricle works harder to create a higher pressure than normal to force blood through the narrow part of the aorta to the lower part of the body when there is a a coarctation.
- The ventricle may not be strong enough to do this extra work when the narrowing is very severe which can lead to congestive heart failure or not enough blood flow to the organs of the body.
Preparation for Coarctation Repair:
- An echocardiography can be done to confirm the diagnosis of coarctation.
- Other cardiac anomalies that may be present can also be evaluated by this.
- A cardiac MRI or CT scan, may be used to look at the coarctation in some cases.
- Food and water the day before surgery will be restricted.
Procedure for Coarctation Repair:
- The goals are to improve ventricular function and restore blood flow to the lower body in a critically ill newborn.
- Prostaglandin (PGE-1), a continuous intravenous medication, is used to open the ductus arteriosus, which allows blood flow to the body beyond the coarctation.
- Other intravenous (IV) medicines may also be needed to help the heart.
- Most of the babies need to be placed on a ventilator before surgery.
- Surgery is done on an urgent basis if the baby has symptoms of a coarctation.
- Resection of the narrowed area with anastomosis, that is reconnection of the two ends to each other is the most common repair for coarctation.
- The resection will be extended towards the arch if there is a longer piece of narrowing.
- The narrowing can be opened with a patch, or a portion of an artery may be used as a flap to expand the area which is called a subclavian flap aortoplasty, in other methods.
- Coarctation repair is typically planned electively in older children as they have minimal symptoms.
- Usually, surgical repair is done with resection of the narrowed piece and end-to-end reconnection.
- Transcatheter therapy is the first-line therapy in older children.
- A balloon or stent can be used in this therapy to dilate the area of narrowing without needing surgery.
