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.

Getting Ready

The Week Before Surgery:

• Do not give your child any aspirin or ibuprofen before surgery. Ask your child's caregiver before giving your child any over-the-counter medicine.
  
  
• Your child may need blood tests before the procedure. Talk to your caregiver about these or other tests you may need. Write down the date, time and location for each test.
  
  
• If caregivers think your child may need a blood transfusion during surgery, ask about donating blood. Your child may be able to donate his own blood before surgery. This is called directed blood donation. This must be done several days before surgery. You may also ask a family member or friend with the same blood type to donate their blood. Talk to your child's caregiver for more information on directed blood donation.

The Night Before Surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The Day of Surgery:

• Write down the date, time, and location of your child's surgery.
  
  
• Ask your child's caregiver before giving your child any medicine on the day of surgery. These medicines include insulin, high blood pressure pills, or heart pills. Bring a list of your child's medicines or the pill bottles with you to the hospital.
  
  
• Bring your child's personal belongings with you to the hospital. These include pajamas and any special toys or blankets. Leave your child's jewelry at home.
  
  
• An anesthesiologist (an-iss-thee-z-ALL-o-jist) may talk to you and your child before your child's surgery. This is the caregiver who gives your child medicine to make him sleepy during surgery.
  
  
• Make sure you have signed an informed consent. You or a close family member may be asked to sign a legal piece of paper (consent form). It gives your child's caregivers permission to do a coarctation of the aorta repair. Be sure all your questions have been answered before you sign the form.

Treatment

What Will Happen:

• Your child may be given medicine that will make him relaxed and drowsy. A caregiver will take your child to the operating room on a wheeled cart or in his crib. Your child will be given general anesthesia to keep him completely asleep. A caregiver will clean your child's chest with soap and water. An incision (cut) will be made between 2 ribs on the left side of your child's chest. If your child also has a PDA, it will be repaired first. Suture (thread) will be 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 will be 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. 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. Do not take your child out of bed or let him get up until caregivers say it is OK.

Waiting Room:

This room is where you and your family can wait during surgery until your child can have visitors. You may also wait here after your child's surgery. Your child's caregiver will find you to let you know how the surgery went. Before the surgery, your child's doctor will tell you how long the operation will take. Sometimes a surgery may last longer than the doctor says. If you or your family leave the hospital, leave a phone number where you can be reached.

Contact a caregiver if

• You cannot get your child to his surgery appointment on time.
  
  
• Your child has a fever. Your child's surgery may need to be done later when he is well.
  
  
• The problems for which your child is having surgery get worse.
  
  
• You have questions or concerns about your child's surgery.