Treatment

Treatment options for coarctation of the aorta depend on your age at the time of diagnosis and the severity of your condition. Other heart defects might be repaired at the same time as aortic coarctation.

Treatment approaches usually consist of surgery or a procedure called balloon angioplasty or stent placement. A doctor trained in congenital heart conditions will evaluate you and determine the most appropriate treatment for your condition.

Surgery

There are several 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).
  • Subclavian flap aortoplasty. A portion of the blood vessel that delivers blood to your left arm (left subclavian artery), might be used to expand the narrowed area of the aorta.
  • Bypass graft repair. This technique involves bypassing the narrowed area by inserting a plastic tube called a graft between the portions of the aorta.
  • Patch aortoplasty. Your doctor might treat your coarctation by cutting across the narrowed 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.

Balloon angioplasty and stenting

Balloon angioplasty, often with stenting, 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 through your blood vessels to your heart using X-ray imaging.

Your doctor places an uninflated balloon through the opening of the narrowed aorta. When the balloon is inflated, the aorta widens and blood flows more easily. In some cases, your doctor may insert a mesh-covered hollow tube (stent) in the aorta to keep the narrowed part of the aorta open.

Medication

Medication isn't used to repair coarctation of the aorta, but it might be used to control blood pressure before and after stent or surgery. Although repairing aortic coarctation improves blood pressure, many people still need to take blood pressure medication, even after a successful surgery or stenting.

Babies with severe coarctation of the aorta often are given a medication that keeps the ductus arteriosus open. This provides a bypass for blood flow around the constriction until the coarctation is repaired.

After treatment

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 might still remain higher than normal.

Occasionally, the segment of the aorta that has been repaired will become weak and enlarge (aortic aneurysm) and might eventually rupture. In some cases, the coarctation can recur, possibly even years after treatment. It's possible to have additional surgeries or procedures to correct the re-narrowing or treat other complications.

June 15, 2017
References
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