Coarctation of the Aorta

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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Chapter 15 Coarctation of the Aorta

MEDICAL AND SURGICAL MANAGEMENT

Management strategies vary by age of child and severity of the coarctation of the aorta. Neonates with critical coarctation of the aorta require intravenous infusion of prostaglandin E1 to reopen the ductus arteriosus. They may also require stabilization with inotropic agents and respiratory support, and are scheduled for repair when medically stable. Traditionally, defects in children with hypertension who were otherwise asymptomatic were repaired between the age of 3 and 5 years. At present, many centers schedule for repair at presentation to decrease the risk of residual hypertension and postoperative complications.

Repair refers to using one of several methods including resection with end-to-end anastomosis, subclavian flap aortoplasty (ligation and use of the subclavian artery to enlarge the aorta), patch aortoplasty, or conduit insertion. The team selects the method of repair most appropriate for the child’s age and anatomy. The overall mortality rate for repair of isolated coarctation of the aorta is less than 5% and in older children is less than 1%. Balloon dilation is an effective treatment for recurrent coarctation of the aorta and is being used in some institutions to treat native coarctation of the aorta. Finally, stents may be placed in the aorta for mild native or recurrent coarctation of the aorta in older children and adults.