Coarctation of the Aorta

Left Thoracotomy for the Repair of Coarctation of the Aorta at Mayo Clinic

Coarctation of the aorta is usually treated by surgical removal of the obstruction. A surgical repair done in childhood may be outgrown and may need to be redone in adulthood.

Before surgery

Mayo Clinic patients who are good candidates for a thoracotomy meet with members of the specialized team that will be assisting in their care. They receive instructions to help prepare for the surgery. Information about eating, drinking and taking medications before the surgery is explained. Patients are encouraged to ask questions about the surgery and anything relating to their experience at Mayo Clinic.

Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery.

During surgery

The time in the operating room varies with the type and severity of the coarctation. Generally, surgery averages four hours, but each person is unique, and it's not unusual for the surgery to range from three to six hours.

Patients are given a mild tranquilizer to help them relax before being taken into the operating room, where they receive a general anesthetic.

If the heart is stopped for the surgery (cardiopulmonary bypass), a heart-lung bypass machine oxygenates the blood and circulates it throughout the body during surgery. An incision is made on the left side of the chest between the ribs and below the armpit to reach the area of the coarctation. The defect is then repaired.

Once the procedure is completed, and the surgical team is satisfied that the heart is beating strongly, the heart-lung machine is disconnected. The incision is then closed (sutured).

Immediately following surgery

When patients awake from the anesthesia, they are generally groggy and somewhat disoriented. The area of the incision may be sore. Pain medication is available and patients are encouraged to take it as needed.

Patients are initially in the cardiac intensive care unit, and then are transferred to a standard hospital unit. Typically, once patients are in standard unit, they are ambulatory (able to walk), while attached to a small heart monitor.

Patients are in the hospital an average of four to five days. Much of that time is spent waiting for the tissue swelling to decrease and to ensure that the defect has been effectively repaired. Blood pressure is closely monitored. While in the hospital, tests are conducted to assess and monitor the patient's condition.

After leaving the hospital

In general, recovery is complete about six to eight weeks after surgery. During that time, patients are usually given aspirin or a prescription anticoagulant to reduce the risk of blood clot formation.

Full energy levels usually start to return in about two to three months. Most patients can expect to feel more tired than usual, and their stamina may not be completely normal. After three to six months, most patients are back to normal.

The decision about when to resume a full work schedule varies with the individual. For patients with physically demanding jobs, the recovery may take longer than three months.

Many patients have benefited from the structured workout of a cardiac rehabilitation program while recovering from surgery. The program starts with a walking schedule for the first six to eight weeks and progresses to more vigorous, supervised training.

Follow-up care

Generally, patients return to their local doctor a week after being discharged from the hospital and are examined to ensure that they are healing properly. Follow-up appointments with the cardiologist take place at six months to one year.

The Mayo Clinic staff works with the patient and the patient's local doctor and cardiologist to assist with a full and smooth recovery following surgery.

Surgery usually relieves the obstruction to the forward flow of blood throughout the body, but often hypertension (high blood pressure) will continue and require ongoing monitoring and treatment.

General narrowing throughout the aorta is often seen in people with a coarctation of the aorta, as is an abnormality in the structure of the arteries. The risk for arterial rupture, dissection (separation of the layers of tissue within the walls of the aorta) and stroke may continue even after a successful surgical repair, so blood pressure control becomes critical in order to reduce this risk.

It is important for those who have had open-heart surgery to tell their doctor and dentist. Patients usually require 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.

Complications

Major complications are rare, and with improvement in technology and surgical techniques, occurrences continue to decrease. However, every thoracotomy entails some risk. Potential complications include infection, bleeding, left lung atelectasis (collapse), stroke or heart attack.