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As an alternative to surgery, some people with coarctation of the aorta may be candidates for a cardiac catheterization procedure which involves placing a device into the area of the coarctation and inflating it to open the narrowed area.
In addition, a small metal tube called a stent may also be placed in the narrowed area after the balloon dilation to keep it open.
Balloon dilation may be an alternative for patients who cannot undergo open-heart surgery due to failing health or other reasons. It may also be suitable for patients whose symptoms are mild to moderate.
Patients meet with members of the specialized team that will be assisting in their care and are encouraged to ask questions about the procedure and anything relating to their experience at Mayo Clinic. They receive instructions on how to prepare for the procedure. Information about eating, drinking and taking medications is explained.
Most patients are admitted to the hospital the morning of the procedure.
The procedure generally takes about four hours. The patient is sedated and a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided to the area of the coarctation.
Once in position, a balloon at the tip of the catheter is inflated. The balloon pushes open and stretches the narrowing, improving blood flow. The balloon is then deflated, and the catheter with balloon is removed from the body.
In some patients, a stent is also placed in the dilated area to hold it open.
The entire procedure is performed under general anesthesia. The dilatation and stent placement is performed with the help of transesophageal echocardiography. In this procedure an ultrasound probe is introduced into the esophagus (the tube that goes from the mouth to the stomach) so that the heart can be viewed more clearly.
Angiograms (pictures taken following dye injection) are performed to determine the size of the defect and its location.
Patients go to a recovery room for several hours and are monitored for vital signs (such as pulse, breathing and blood pressure) and heart sounds. Patients need to lay flat for about six hours after the catheter has been removed from the groin to prevent bleeding.
An electrocardiogram, which records the electrical impulses in the heart, is done. Intravenous fluids are given to help eliminate the X-ray dye. An IV is used to administer blood thinners, and medications that dilate (relax and enlarge) the blood vessels may be given. Pain medication is available and patients are encouraged to take it as needed.
Patients stay overnight in the hospital or go home the same day, depending on the time and length of the surgery, the complexity of the procedure and the general health of the patient.
Determining when it is safe to drive, return to work or resume an exercise program varies with the individual, but is usually within a few days.
Following the procedure, patients will need to be on aspirin or a prescription anticoagulant for approximately six months to keep blood clots from forming on the stent, if one was used, while the body heals over it.
Patients should take an antibiotic before any dental or surgical procedure, because bacteria can enter the bloodstream during these procedures and get into the heart. This could lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis.
Most patients are evaluated at three to six months, and then, for one, two and three years following the procedure.
Cardiac catheterization complications are rare. They include clot formation, bleeding, infection, perforation of the heart or aorta, stroke and arrhythmias.
Complications of balloon dilation and/or intravascular stenting include:
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