This defect refers to a narrowing of the aorta just beyond the takeoff of the subclavian artery (the artery which supplies blood to the left arm). The diagnosis is generally made after the discovery of elevated blood pressure in the arms and diminished blood pressure or pulses in the lower extremities. A murmur may also be present. Coarctation of the aorta can be associated with other cardiac abnormalities, such as a bicuspid aortic valve, ventricular septal defect, subaortic stenosis or a dilated aorta.
There are several different forms of surgical repair including:
1. excision of the narrowed segment of the aorta with an end-to-end anastomosis,
2. subclavian turndown, in which the left subclavian artery is incorporated into the repair,
3. patch aortoplasty, in which the narrowed segment of aorta is enlarged with a patch
4. use of a bypass graft.
While end-to-end anastomosis is currently the preferred method of repair at our institution, it is important to be familiar with the long term results for the different forms of repair.
Follow up after repair is important to detect any potential late problems such as recurrent narrowing at the site of repair or the development of a localized bulge, or aneurysm, at the repair site.
Recurrent coarctation can be a challenging problem because reoperation is more difficult and surgical options may be more limited. In these cases, an aortic stent may be an alternative to reoperation and is usually effective in eliminating the obstruction.
Patients who underwent repair later in life may have persistent hypertension requiring treatment. Women with coarctation of the aorta require careful evaluation and counseling regarding the risks of pregnancy.
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