Coarctation of the Aorta
The aorta is the main conduit of blood from the heart to the rest of the body and is thus a very important structure in the human body. A specific of type of blockage of the aorta that babies can be born with is known as coarctation. Coarctation is relatively common and before the advent of successful surgery, the blockage would become more severe and would result in heart failure and death in childhood or young adulthood. Even patients who survived without repair were plagued by high blood pressure and the resulting complications (stroke, aneurysm, etc.).
Thankfully, the vast majority of patients with coarctation can now be treated and live normal lives. Sometimes blood pressure medication is still required after treatment (sometimes even for a lifetime), but the patient can usually be expected to live a full and healthy life if they carefully follow their blood pressure treatments. In many patients in the modern era (usually older children, teenagers and adults), coarctation can be treated without even making an incision. This is called catheter treatment and is done with balloons and stents. Many patients (usually newborns and infants) will still require an incision (the classic “surgical” approach). Thus, it is important for you and your child to be treated at a center with experience in all forms of treatment that can be tailored to the specific coarctation and achieve the best possible result.
Surgery can be complicated; when an incision (surgical approach) is required, there are several different approaches and incisions that can be used depending on the specific anatomy. The majority of patients require an incision on the left side of the chest, known as a thoracotomy. Even after the incision is made, there are many different repair techniques, each with their own pluses and minuses, and your pediatric heart surgeon needs to be familiar and experienced with all the techniques.
Our program has experience making these types of decisions and has been performing the repairs for more than 30 years. From 2009-13 alone, we have repaired 33 patients with isolated coarctation (meaning the coarctation was the only thing done) with a 94 percent success and survival. Coarctation of the aorta can also coexist with more complicated congenital heart defects; thus, during this same time period, many more coarctation type repairs have been done as part of more complicated procedures with similar success (see hypoplastic or interrupted aortic arch). This is important, as it means that our pediatric heart surgeons have developed vast experience treating all forms of this condition.
When patients have had repairs of aortic blockages (which includes coarctation, hypoplastic or interrupted aortic arch either by themselves or as part of larger operations), sometimes they return to us with some recurrent blockage near the repair site. This is relatively common and if detected early, is not usually a cause of life-threatening concern. In the current era, most patients can have this treated without even making an incision using a catheter-based treatment (balloons and stents placed through an IV). In rare cases, redo surgery may need to be discussed as an option and if this is the case, we can discuss the options and results as they pertain to you or your child’s particular condition.