Coarctation of the Aorta

Treatment

Observation and monitoring

For people without symptoms and with mild obstruction related to coarctation, observation and monitoring are reasonable and require regular evaluation by a cardiologist who specializes in congenital diseases. A typical evaluation would include a thorough physical exam, electrocardiogram, chest X-ray, echocardiogram, and an exercise test. A Holter monitor or event recorder may also be used to check for irregular heart rhythms.

Medication

No medications alleviate obstruction of the aorta in coarctation. However, medication is often required and is very important for managing associated hypertension, especially in adults. Antibiotic prophylaxis is also recommended.

Surgery

Coarctation of the aorta is usually treated surgically by removing the area of obstruction. A surgical repair done in childhood may need to be redone in adulthood.

Surgery usually relieves the obstruction to forward blood flow, but often high blood pressure persists and requires ongoing monitoring and treatment.

A surgeon may repair the area of coarctation in several ways:

• The narrowed area of the aorta may be removed and the two ends reconnected, "an end-to-end anastomosis."
• A patch may be added to the aorta to enlarge it, "patch augmentation."
• A bypasslike graft is placed in the area of narrowing, "jump graft."
• The area of coarctation may be removed and replaced, "tube graft."
• Rarely, an ascending-to-descending aortic bypass graft is used to bypass narrowing in the aorta. This allows the surgeon to perform valve replacement simultaneously.

The type of surgery used to repair coarctation of the aorta varies with the individual, depending on many factors, including the patient's overall health and preference; the size, location and severity of the coarctation and the recommendation of the patient's medical team.

Open heart surgery
This type of surgery has been performed for more than 35 years. It utilizes a heart-lung bypass machine that delivers oxygen to the body while the coarctation is repaired. Read more about open-heart surgery.

Left thoracotomy with or without cardiopulmonary bypass
In this surgery, the aortic coarctation is repaired through an incision on the left side of the chest, between the ribs and below the armpit. Some thoracotomies require a heart-lung bypass machine deliver oxygen to the body while the heart is stopped for repair of the coarctation. It may be possible to perform the surgery without using cardiac bypass, depending on the severity of the coarctation and the repair technique used. Read more about left thoracotomy.

Surgery should always be done at a medical center whose specialists are familiar with congenital heart defects and by a cardiac surgeon experienced with the procedure.

Aortic valve repair or replacement is another surgical procedure that may be needed in addition to coarctation repair. See more at heart valve surgery.

Balloon Dilation or Stent Placement (Balloon Angioplasty)

As an alternative to surgery, some people with coarctation of the aorta may be candidates for a cardiac catheterization procedure called balloon dilation or stent placement. This involves inserting a device into the coarctation and inflating it to open the narrowed area.

In addition, a small metal tube called a stent may be placed in the narrowed area after the balloon dilation to keep it open.

Balloon dilation may be an option 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.