Explain Coarctation of Aorta ?
Coarctation of aorta may be isolated or it may have other co-existing cardiac and vascular lesions. In critically ill neonates with coarctation, IV prostaglandin (PGE 1 at 0.1 mg/Kg/mt) is begun immediately and continued till operation is completed. This leads to re-opening of ductus and reperfusion of lower part of the body and disappearance of metabolic acidosis. When patient's condition is stabilized, operation is undertaken. Neonates and infants who are free of symptoms of heart failure are advised surgery at around 3-6 months. Previously it was though1 that deferring the operation until the child is bigger reduces the chances of re-coarctation. This conclusion is found to be incorrect. Coarctation co-existing with VSD in an infant with heart failure needs surgical connection. Choices available are repair of coarctation alone, coarctation repair with pulmonary artery banding and repair of both through median sternotomy under deep hypothermia and circulatory arrest. In experienced centers, the latter method is the procedure of choice.
Coarctation presenting in an adult should be operated regardless of age. Persistent or recurrent coarctation after previous surgery is best treated by balloon dilatation. Surgery for recoarclation carries slightly higher risk of paraplegia as the collaterals would have disappearance and clamping of aorta for longer period can be dangerous.