Treatment options for coarctation of the aorta depend on your age when you're diagnosed and how narrowed your aorta is. Other heart defects may be repaired at the same time as aortic coarctation. Treatment approaches usually consist of surgery or a procedure called balloon angioplasty.
There are several open-heart surgical techniques to repair aortic coarctation. Your doctor can discuss with you which type is most likely to successfully repair your or your child's condition. The options include:
- Resection with end-to-end anastomosis. This method involves removing the narrowed segment of the aorta (resection) followed by connecting the two ends of the aorta together (anastomosis).
- Patch aortoplasty. Your doctor may treat your coarctation by cutting across the constricted area of the aorta and then attaching a patch of synthetic material to widen the blood vessel. Patch aortoplasty is useful if the coarctation involves a long segment of the aorta.
- Left subclavian flap angioplasty. A portion of the left subclavian artery, the blood vessel that delivers blood to your left arm, may be used to expand the narrowed area of the artery.
- Bypass graft repair. This technique involves bypassing the narrowed area by inserting a plastic tube called a graft between the portions of the aorta.
Balloon angioplasty and stenting
Balloon angioplasty is an option for initially treating aortic coarctation or for treating re-narrowing (re-coarctation) that has occurred after surgery. During this procedure, your doctor inserts a thin flexible tube (catheter) into an artery in your groin and threads it up through your blood vessels to your heart. An uninflated balloon is placed through the opening of the narrowed aorta. When the balloon is inflated, the aorta widens and blood flows more easily. In some cases, a mesh-covered hollow tube called a stent is inserted to keep the narrowed part of the aorta open.
Medication isn't used to repair coarctation of the aorta, but it may be used to control blood pressure before surgery. Although repairing aortic coarctation improves blood pressure, many people will still need to take medication, even after a successful surgery.
Babies with severe coarctation of the aorta may receive a drug called prostaglandin E. This drug helps keep the ductus arteriosus open, providing a bypass for blood flow around the constriction, until the coarctation is repaired.
The most common long-term complication of coarctation of the aorta is high blood pressure. Although your blood pressure usually falls after the aortic coarctation has been repaired, it may still remain higher than normal. Occasionally, the segment of the aorta that has been repaired will become weak and bulge (aortic aneurysm) and may eventually rupture. In some cases, the coarctation will recur, possibly even years after treatment, but it's possible to have additional surgeries or procedures to correct the re-narrowing.
April 20, 2012
- Coarctation of the aorta. American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Coarctation-of-the-Aorta-CoA_UCM_307022_Article.jsp. Accessed Feb. 7, 2012.
- Keane JF, et al, eds. Nadas' Pediatric Cardiology. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-1-4160-2390-6..50001-5&isbn=978-1-4160-2390-6&uniqId=322245209-3. Accessed March 9, 2012.
- Agarwala BN, et al. Clinical manifestations and diagnosis of coarctation of the aorta. http://www.uptodate.com/index. Accessed Feb. 7, 2012.
- Agarwala BN, et al. Management of coarctation of the aorta. http://www.uptodate.com/index. Accessed Feb. 7, 2012.
- Wilson W, et al. Prevention of infective endocarditis: Guidelines from the American Heart Association. Circulation. 2007;116:1736.
- Kenny D, et al. Coarctation of the aorta: From fetal life to adulthood. Cardiology Journal. 2011;18:487.