Balloon Angioplasty For Coarctation Of The Aorta In Children

WHAT YOU SHOULD KNOW:

• Coarctation (ko-ark-TA-shun) of the aorta is when your child is born with a narrowed area in the aorta. The aorta is the large blood vessel that takes blood away from the heart and out to the body. The narrowed area of the aorta slows blood flow and makes your child's heart work too hard. Coarctation can cause heart failure or a ruptured (burst) aorta. Coarctation may be repaired with surgery or in a cardiac catheterization (kath-ih-ter-ih-ZA-shun) lab ("heart cath lab"). Balloon angioplasty can be done in the heart cath lab to repair a coarctation or recoarctation. A recoarctation happens when the aorta becomes narrow again after it was repaired.
  
  
• Balloon angioplasty (AN-g-o-plas-tee) is a procedure in which catheters (long, thin, bendable tubes) are gently threaded (pushed) into the heart. Your child's caregivers push a catheter with a tiny deflated (not filled up) balloon into the middle of the coarctation. They will inflate (fill up) the balloon to dilate or widen the narrow area. They may inflate and deflate the balloon a few times to make it as wide as possible. Sometimes, caregivers will put in a stent. A stent is a tiny mesh coil that holds the aorta open. Your child may stay overnight in the hospital after the procedure.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

RISKS:

• There are risks in having a balloon angioplasty. Your child could have bleeding, a bruise, and soreness around the place where the catheters went in. The catheters could make a hole in a blood vessel or the heart. Your child could bleed and need a blood transfusion (trans-FEW-shun) or surgery to repair the hole. Your child could get air bubbles or a blood clot. Blood clots may go to your child's lungs or brain and cause a stroke. The clots may go to your child's arm or leg. Clots could stop blood flow to the arm or leg.
  
  
• Your child could get a collapsed lung or an infection. Your child could have an allergic (uh-LER-jik) reaction from the dye used during the test. Your child could have kidney or spinal cord problems. Your child may have high blood pressure after the coarctation is repaired. Caregivers may treat this with medicines. Your child may get an aneurysm (AN-yur-is-m) in the aorta where it was dilated (made wider). An aneurysm is a weak area that can bulge out or break.
  
  
• Your child's aorta could become narrow again. If this happens, it is called recoarctation or restenosis (re-stih-NO-sis). If your child has a recoarctation, he may need another balloon angioplasty or surgery. If caregivers cannot dilate the coarctation with balloon angioplasty, your child may need surgery. If your child does not have a balloon angioplasty, his health condition could get worse. Call your child's caregiver if you are worried or have questions about your child's coarctation, medicine, or balloon angioplasty.

WHILE YOU ARE HERE:

Before Your Child's Angioplasty:

• Informed Consent:
  
  
  • You have the right to understand your child's health problem. You should understand what tests, treatments, or procedures may be done to treat your child's problem. Your child's caregiver should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your child. A consent form is a legal paper that gives a caregiver permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your child's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered. This way you will understand what may happen to your child.
  
  
• Blood Tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. It is tested to see how your child's body is doing before the angioplasty. Your child may need to have blood drawn more than once.
  
  
• Call Button: A call button may be in your child's hospital room. You or your child should use the call button if your child is having problems and a caregiver is needed. You can also use the call button if you or your child have questions for a caregiver. Be sure to keep the call button near you or your child at all times.
  
  
• Chest X-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are handling his heart problem.
  
  
• Gown: A hospital gown is needed so caregivers can easily check and treat your child. Your child's gown should be put on so it opens in the back. Your child may be able to wear regular pajamas or clothes after the angioplasty.
  
  
• Heart Monitor: This is a machine used to see how your child's heart is doing before, during, and after the coarctation repair. 3 or 5 sticky pads are placed on your child's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing well.
  
  
• IV: An IV is a tiny tube placed in your child's vein (blood vessel). Your child's IV may be hooked to a machine that will give your child liquids and medicine. The IV may be put in your child's hand, arm, ankle, or foot. Before putting in the IV, caregivers may put a special numbing cream on your child's skin. This is so your child will feel little or no pain when the IV is put in.
  
  
• Pulse Check: Caregivers will check your child's pulses (heartbeat) in his feet and ankles. The pulse is the feeling under the skin when the heart pushes blood through the arteries (blood vessels). Your child's caregiver may put an "X" over the spots on your child's feet where the pulse is strongest.
  
  
• Pulse Oximeter (oks-IH-mih-ter): This is a machine that tells caregivers how much oxygen is in your child's blood. It will tell caregivers how well your child is doing before, during, and after the coarctation repair. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe.
  
  
• Vital Signs: This may include taking your child's temperature, pulse (heartbeats), respirations (breaths), and blood pressure. Your child's temperature may be taken in the mouth, ear, armpit, or rectum (rear-end). Caregivers may also listen to your child's heart and lungs by using a stethoscope (STETH-o-skop).
  
  
• Transport to the Heart Cath Lab: Your child will be taken on a stretcher or crib to the room where the angioplasty will be done. Your child's caregivers will help your child get comfortable on the bed. A belt may be put over your child's legs for safety. Your child's arms may be tucked at his sides to give caregivers more room to work during the coarctation repair.
  
  
• PreOp Care: This is care your child gets right before surgery. Your child will lie on a hard, movable x-ray bed. There will be large x-ray machines and other equipment in the room. Caregivers will clean the groin or other skin areas with soap. This soap may make your child's skin yellow, but it will be cleaned off later. Sterile (no germs) sheets will be put over your child to keep the area clean. Your child will have tubes put in him and equipment attached to him.
  
  
• Medicines: Your child may get one or more of these medicines before, during, or after the coarctation repair.
  
  
  • Antihistamines (an-te-HISS-ti-meens): This medicine may be given to help decrease itching. This medicine may protect your child from a reaction to the dye.
    
    
  • Anti-Nausea Medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after the angioplasty. Anti-nausea medication will usually be given through an IV or in your child's rectum (rear-end).
    
    
  • Blood Thinner Medicine: This medicine may be given to prevent clots from forming during the angioplasty and coarctation repair.
    
    
  • Heart Medicine: This medicine may be given to make your child's heart beat better or more regularly. It may help your child if he is having blood pressure problems. There are many different kinds of heart medicines. Talk with caregivers to find out what your child's medicine is and why he is taking it.
  
  
• Anesthesia (an-iss-THEE-zuh): This is medicine that makes your child comfortable during the angioplasty. Caregivers may work with you to decide which anesthesia is best for your child. After taking this medicine, your child may feel drowsy, dizzy, or have unclear thinking. Your child may sleep for a few hours after the coarctation repair because of the anesthesia. Your child may get one or more types of anesthesia:
  
  
  • General Anesthesia: This is medicine that puts your child to sleep and makes him comfortable during surgery. It may be given as a liquid or in an IV. It may be given as a gas through a face mask. This medicine may also go through a tube placed in your child's mouth and throat. This tube is called an endotracheal (end-o-TRA-kee-ull) tube or "ET tube".
    
    
  • Local Anesthesia: Caregivers may put a special numbing cream on the places where the catheters may go in. Your child may get a shot of numbing medicine right before the catheter goes in.

During Your Child's Angioplasty:

• Your child will change into a hospital gown. Your child will get medicine to make him relaxed and drowsy. He will be taken on a stretcher to the room where the angioplasty will be done. Your child will get an IV and may get more medicine to make him sleep. Once your child is asleep, catheters will be put into your child's blood vessels, usually in the groin. The groin is the area where the legs and belly join together. The catheters are gently threaded (pushed) into the blood vessels and heart.
  
  
• Caregivers will dilate (widen) the coarctation with a balloon-tipped catheter. Caregivers guide this catheter into the middle of the coarctation. They will inflate (blow up) the balloon-tip until it stretches the coarctation open. They may inflate and deflate the balloon-tip more than once to open up the coarctation as wide as possible.
  
  
• When the angioplasty is finished, the catheters will be removed. Caregivers will put pressure on the area where the catheters came out. This is to stop the bleeding. Sometime, a pressure bag may be put in place to help stop the bleeding. Your child may have stitches to stop the bleeding. It is very important for your child to lie flat. The leg or area that had a catheter in must be kept very flat and still to prevent bleeding.

After Your Child's Angioplasty:

• Aftercare: Your child will be taken to a recovery area. Later, caregivers may take your child to a hospital unit or room. Caregivers will watch your child closely for problems that can happen after an angioplasty. Caregivers will take your child's vital signs every 15 minutes for 1 to 2 hours. The pulses in your child's feet or wrists will also be checked often. Your child's toes or fingers will be checked to see if they are warm. Tell your child's caregiver if your child has any of the following:
  
  
  • Chest pain or discomfort.
    
    
  • Change in color or temperature of your child's arm or leg.
    
    
  • Swelling or bleeding from the area where the catheter was.
    
    
  • Pain, numbness, or tingling in your child's arm or leg.
    
    
  • Pain in your child's back, thigh, or groin.
    
    
  • Nausea. Your child feels sick to his stomach.
    
    
  • Sweating a lot.
  
  
• Activity:
  
  
  • Your child will need to lie flat and still in bed, usually for about 4 hours. Lying flat and still is very important. This helps to prevent bleeding. Your child's caregiver will tell you when it is OK for your child to get out of bed. Help your child to rest or play quietly in bed until the morning after the angioplasty.
    
    
  • Bring favorite books, electronic games, or videotapes that your child enjoys. These may help him to lie still when he is fully awake after the angioplasty.
    
    
  • Do not raise the head or foot of your child's bed without asking a caregiver. Do not remove your child's pressure bag or bandage. Tell your child's caregiver if your child is uncomfortable or tired of lying on his back. Caregivers may have ways to make your child more comfortable.
    
    
  • Help your child or call a caregiver to help the first time your child gets out of bed. Your child may feel weak, dizzy, or sleepy because of the medicine during the angioplasty. Continue to help your child when he gets out of bed to prevent him from falling or hurting himself.
  
  
• Bathroom: Your child may use a bedpan or urinal during the time that he must lie flat. After your child's caregiver says it is OK to get out of bed, you may help your child walk to the bathroom.
  
  
• Eating and drinking: Ask a caregiver before giving your child anything to eat or drink after the angioplasty. Your child may be on a clear liquid diet. Your child may have things like water, apple juice, soup broth, or clear soda pop. If he does not feel sick to his stomach, your child may be able to eat "finger foods". These are foods that can be eaten while your child is lying flat in bed. Help your child to drink as much water as he can. This will help to flush out the dye from your child's body. It will also help keep your child hydrated (keep good body fluid levels).
  
  
• Tests: Your child's caregivers may order tests to see how your child is doing after the angioplasty. They may order blood tests. They may order a chest x-ray and echocardiogram (eh-ko-KAR-d-o-gram) before your child goes home. This is to make sure your child's heart is OK after the coarctation repair.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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