Coarctation Of The Aorta Repair In Children

WHAT YOU SHOULD KNOW:

• Coarctation (ko-ark-TA-shun) of the aorta (a-OR-tuh) is when your child is born with a narrowed area in his aorta. The aorta is the large blood vessel that takes blood away from the heart and out to the body. The narrowed area slows blood flow and makes the heart work too hard. Most children need their coarctation repaired by surgery. During surgery, the narrowed area of the aorta is cut out or patched.
  
  
• With time, new blood vessels can develop and bypass (go around) the narrow area. If your child's coarctation is not repaired, there can be problems even though other blood vessels help to move blood. These problems may include heart failure or a ruptured (burst) aorta. That is why surgery is needed to fix the narrowed area. Some people who have coarctation of the aorta are also born with a patent ductus arteriosus (r-teer-e-O-sus) (PDA). This is an opening between the pulmonary artery and the aorta that should have closed after your child was born. If your child has a PDA, it will also be closed during surgery.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

• Repair of coarctation of the aorta is "closed" heart surgery because the aorta is outside the heart. This lets caregivers do surgery without stopping your child's heart from beating. A heart-lung bypass machine is not needed because your child's heart beats on its own during surgery. This kind of surgery has much less risk to your child than open heart surgery.
  
  
• There are always risks with surgery. Your child may bleed more than usual, get an infection, or have trouble breathing. Without surgery, your child's health problems may get worse such as high blood pressure or heart failure. Infections in the heart muscle or a stroke (blood clot in the brain) may also happen. Caregivers will watch your child closely for these problems. Call your child's caregiver if you are worried or have questions about your child's medicine or care.

WHILE YOU ARE HERE:

Before Surgery:

• Informed Consent:
  
  
  • You have the right to understand your child's health problem. In words you can understand, you should be told what tests, treatments, or procedures may be done to treat your child's coarctation. Your doctor should also tell you about the risks and benefits of each treatment.
    
    
  • You will be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that gives your doctor permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your doctor should tell you 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 so that you understand what may happen.
  
  
• Call Button: A call button will 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.
  
  
• 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 when he feels better.
  
  
• Heart Monitor: This is a machine used to see how your child's heart is handling the coarctation and surgery. 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 tube placed in a vein for giving medicine or liquids. This tube is connected to tubing and liquid.
  
  
• Pulse Oximeter (oks-IH-mih-ter): This is a machine that tells how much oxygen is in your child's blood. A cord with a clip or sticky strip is placed on your child's ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if your child needs more oxygen.
  
  
• Vital Signs: This includes taking your child's temperature, blood pressure, pulse (counting the heartbeat), and respirations (counting your child's breaths). To take your child's blood pressure, a cuff is put on his arm and tightened. The cuff is attached to a machine which will give the blood pressure reading. Caregivers may listen to your child's heart and lungs by using a stethoscope (STETH-uh-skop). Vital signs are taken so caregivers can see how your child is doing before, during, and after surgery.
  
  
• Tests: Your child may need one or more of the following tests before surgery.
  
  
  • Blood Tests: Your child may need blood taken for tests. The blood can be taken from a vein in the hand, arm, the bend in the elbow, or the scalp. It is tested to see how your child is handling the heart problem and if he is ready for surgery. Your child may need to have blood drawn more than once.
    
    
  • Cardiac Catheterization (kath-uh-ter-ih-ZA-shun): This is a test used to see how well your child's heart is working. It is also used to see how well the blood vessels connected to the heart are doing. A special tube is threaded into your child's heart through a blood vessel in his arm, leg or neck. Dye may be given so x-ray pictures of your child's blood vessels show up better. Caregivers may also measure the pressure inside your child's heart.
    
    
  • 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 doing before surgery. The x-ray can also show how large your child's aorta or heart is.
    
    
  • CT Scan:
    
    
    • This may also be called a CAT scan. A special x-ray machine uses a computer to take pictures of your child's body. It may be used to look at bones, muscles, the brain, other organs in the body, or blood vessels. Your child may be given dye before the pictures are taken. The dye is given by mouth, IV, or in the rectum. The dye will help your child's caregiver see the pictures better.
      
      
    • People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your child's caregiver if your child is allergic to shellfish or has other allergies or medical conditions.
    
    
  • Echo:
    
    
    • This test is also called an echocardiogram (eh-ko-KAR-d-o-gram). Sound waves are used to show pictures of the size and shape of your child's heart. An echo can tell how well the heart pumps and how well blood flows through it. It can show heart valve problems and if there is fluid around the heart.
      
      
    • The test is done while your child lies down in a dark, quiet room. Clear gel will be used so the echo probe can be rubbed easily across your child's chest. Using the gel also helps caregivers get a good picture of your child's heart. This gel will be cleaned off after the test.
    
    
  • 12 Lead EKG: This helps caregivers look for problems in different areas of your child's heart. Sticky pads (10) are placed on your child's chest, arms, and legs. Each pad has a wire that is hooked to a machine. This machine prints a paper tracing of your child's heart working. This test takes about 5 to 10 minutes. It is important that your child lie as still as possible during the test. This will help make the best tracing.
    
    
  • MRI: This test is also called magnetic resonance (REH-zuh-nuns) imaging. MRI allows your child's caregivers to see inside your child's body. During the MRI, pictures are taken of your child's heart. Caregivers use these pictures to look at your child's aorta. The MRI also can show if other blood vessels have taken over the work of the aorta.
    
    
  • Transesophageal (trans-e-sof-uh-G-ull) Echocardiogram (eh-ko-KAR-d-o-gram):
    
    
    • This is a test that may also be called tranesophageal echo or "TEE". Sounds waves are used to show pictures of the size and shape of your child's heart. It also looks at how your child's heart moves when it is beating. These pictures are seen on a TV-like screen. The test is done in a quiet room with the lights turned off. A caregiver gives your child anesthesia medicine to make him go to sleep. If your child is older, numbing medicine can be sprayed into your child's throat.
      
      
    • A flexible (bendable) tube is put into your child's throat, and moved close to his heart. A device on the end of the tube sends out sound waves. These sound waves show caregivers your child's heart and aorta. This test can tell how well your child's heart is pumping. A TEE shows how blood flows in and out of the heart. These tests can also show the size of your child's coarctation.
    
    
  • Ultrasound with Color Flow Doppler: This is a painless test using sound waves to look at your child's heart and aorta. Pictures show up on a TV-like screen. Doppler adds color and sound to show blood flow. Your child may need the ultrasound to see how much the blood flow through your child's aorta is obstructed (stopped).
  
  
• Pre-Op Care: Your child may be given medicine right before surgery. This medicine may make your child feel sleepy and more relaxed. Your child will be taken on a cart or crib to the room where surgery will be done. Caregivers will stay with your child all the time and make sure he is warm, safe, and comfortable. Right before surgery, your child may have the following:
  
  
  • Arterial (r-TEER-e-ull) Line: This tube is also called an "art line" or an "A-line". It is placed into an artery, usually in the wrist or groin. The groin is the area where your child's abdomen (belly) meets his upper leg. The art line is attached to tubing with liquid in it. This liquid helps keep the tubing from getting plugged. The tube may be used for measuring your child's blood pressure or for drawing blood.
    
    
  • General Anesthesia (an-iss-THEE-zuh): This medicine 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 facemask. 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".

During Surgery:

• Your child may lie on his back during surgery or may be turned on his side after he goes to sleep. A caregiver will clean your child's chest with soap and water. This soap may make your child's skin yellow, but it will be cleaned off later. Sheets will be put over your child to keep the surgery area clean. An incision (cut) is made between 2 ribs on the left side of your child's chest. If your child also has a PDA, it is repaired first. Suture (thread) is tied around the PDA close to the aorta and at the other end close to the pulmonary artery.
  
  
• The coarctation may be repaired by cutting the narrowed area out and sewing the cut edges together. Caregivers may use stitches to sew a graft (artificial tube) into the place if the narrowed area was long. A flat piece of graft material may be sewn in place to widen the narrowed area instead of using the tube. A piece of another artery (blood vessel) may also be used to patch the narrowed area. The incision in your child's chest will be closed with wire and stitches (thread) or staples.

After Surgery:

Your child is taken to the recovery room or an intensive care unit (ICU). Caregivers will watch him very closely. A bandage will cover your child's stitches or staples. This bandage keeps the area clean and dry to prevent infection (in-FEK-shun). A caregiver may remove the dressing shortly after surgery to check the incision. Do not let your child get out of bed until caregivers say it is OK. You will be allowed to visit your child in the ICU. Check with caregivers to find out what the visiting hours are in your child's ICU.

Activity:

Your child may need to rest after surgery. Once your child feels better, he can start doing all the things he does every day. Talk to caregivers if you have any questions.

Blood Gases:

This test is also called an "ABG". Blood is taken from an artery in your child's wrist, elbow, or groin. The groin is the area where the abdomen (belly) meets the upper leg. It is tested for the amount of oxygen, acids, and carbon dioxide (di-OKS-ide) in your child's blood. ABGs may be done if your child has trouble breathing or other problems caused by the coarctation or surgery.

Chest Tubes:

These are tubes that may be put into your child's chest during surgery. Chest tubes remove air, blood, or fluid from around the lungs. This lets your child's lungs fill back up with air when breathing. The chest tubes are attached to a container with bubbling water. After the chest tubes are removed, your child's lungs should be normal.

Eating after surgery:

• Your child may be able to eat when bowel sounds (stomach growling) are heard. A caregiver will listen for bowel sounds by putting a stethoscope (STETH-uh-skop) on top of your child's belly. A caregiver will then let you know what your child may eat.
  
  
• Ice chips are usually given first. Then liquids like water, broth, apple juice, or clear soda are given. If your child does not have problems after drinking liquids, a caregiver may let your child eat soft foods. Some examples of soft foods are ice cream, applesauce, or pudding. If your child can eat soft food without problems, he may begin eating his usual diet. Ask your child's caregivers if your child is supposed to be on a special diet.

Emotional support:

You may stay with your child for comfort and support. Your child may need to stay in the hospital for more than a day. Ask caregivers if another family member can stay with your child when you cannot be there. Bring in something from home that your child likes, such as a blanket, a favorite toy, or clothing.

Intake and Output (I&O):

• Your child's caregiver may need to know how much fluid your child is getting and liquid he is urinating. Caregivers may also want to know how much your child eats and if he had a bowel movement (BM).
  
  
• You may need to save your child's diapers so a caregiver can measure them. Your child may need to urinate into a container in bed or in the toilet. A caregiver will measure the amount of urine. Do not throw away diapers or flush urine down the toilet before asking your child's caregiver.

Medicines:

• Antibiotics (an-ti-bi-AH-tiks): This medicine may be given to help fight infection caused by a germ called bacteria (bak-TEER-e-uh).
  
  
• Anti-Nausea Medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Pain medicine may upset your child's stomach and make him feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
  
  
• Heart Medicine: This medicine may be given to make your child's heart beat better or more regularly. It may keep your child from having high blood pressure. 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.
  
  
• Pain Medicine: Caregivers may give your child medicine to take away or decrease your child's pain. Tell caregivers if your think your child's pain has not gone away or comes back.