Cardiosurgery: Aortic coarctation — Resection with end-to-end anastomosis. Treatment
Aortic coarctation (AC) is one of the major cardiovascular diseases characterized by segmental narrowing of the aorta with a primary lesion of its upper sections. The overwhelming majority of AC cases has the innate nature, and more than 60% of them are combined with the other abnormalities in structure of the heart and major blood vessels. The disease usually features a grave progression. More than 50% of children born with aortic coarctation have poor prognosis without surgical correction.
Aortic Coarctation Treatment Principles
In rare cases, AC is asymptomatic, does not require special treatment, but the patient should undergo a regular cardiac evaluation, based on results of which the therapeutic and prophylactic treatment with moderate exercises can be recommended.
Conservative therapy does not eliminate the anomaly and is used as a preparation for surgery. The optimal age for surgical correction is considered to be 5 to 7 years old, but upon severe hemodynamic decompensation, the surgery may be indicated at an earlier age, including in the neonatal period.
The surgical correction technique is selected individually, depending on severity of the clinical picture, extent and location of the constriction.
- Aorta plastics is performed when the narrowing captures a small section of aorta. There are several methods of plastic correction, e.g. resection with simple anastomosis, wedge resection, and istmoplasty.
- Resection with prosthetics implies excision of the pathological segment, followed by implantation of a prosthesis made of synthetic or biological material.
- Overlay of bypasses aims at creation of additional paths for blood flow. In this case, the narrowed segment is not removed, but a workaround is created using the patient’s own arteries or synthetic material.
- Balloon dilatation is normally used for recurrent narrowing after surgery. The lumen of the aorta is reduced by means of an inflatable balloon, which is carried out to the aorta through the vessels under the X-ray imaging techniques.
Timely surgical repair of the AC, selection of the optimal operating method and competent determination of indications for surgery allows achieving favorable results with long-term effect in 88-94% patients.Hide