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Coarctation of the Aorta Transcatheter Repair

What is coarctation of the aorta transcatheter dilation?

Coarctation of the aorta is an abnormal narrowing of the aorta. The aorta is the large blood vessel that exits the heart and supplies the body with oxygen-rich blood. Transcatheter dilation is a type of procedure that can treat the abnormal narrowing of the aorta without the need for open heart surgery.

The aorta is the large artery connected to the left ventricle of the heart. The left ventricle is one of the heart’s 2 lower chambers. It pumps oxygen-rich blood through the aorta. The aorta branches into smaller blood vessels that lead to parts of the body.

With coarctation of the aorta, the narrowed area is most often between the branches that send blood to the upper body and brain and those that send blood to the lower body. This can cause high blood pressure in the arms and head. And it can cause low blood pressure in the lower parts of the body.

Coarctation of the aorta is most often present from birth. The reason this happens is often not known. In some cases, it occurs along with other heart problems. These include an abnormal aortic valve or a small left ventricle. It can also occur along with Turner syndrome. In rare cases, it can occur later in life due to a health condition, such as Takayasu arteritis.

Transcatheter dilation can help to restore normal blood flow through the aorta. The procedure uses a thin, flexible tube called a catheter. At its tip is an inflatable balloon. The healthcare provider inserts the catheter through a blood vessel in the groin. It’s advanced all the way up into the aorta straddling the narrowed part. Then the balloon is inflated. This stretches the aorta and helps open it up. The blood can then flow freely in the aorta. A mesh tube (stent) may be left in the aorta at the site of the previous narrowing. This is to help keep it open.

Why might I need coarctation of the aorta transcatheter dilation?

Coarctation of the aorta can also lead to very high blood pressure. Over time, this can harm the heart. It can cause it to be thickened (hypertrophied), leading to heart failure. This makes the heart less able to pump blood out to the body. Untreated aortic coarctation can lead to severe health problems. These include coronary heart disease, stroke, and aortic dissection. Because of these risks, healthcare providers advise treating the coarctation as soon as it’s known about. If left untreated, there is a risk of death. Death can be the result of heart failure, aortic rupture, aortic dissection, endocarditis, brain hemorrhage, or heart attack.

Transcatheter dilation is an alternative to open surgery to treat this condition. It is less invasive. It may also lead to a shorter hospital stay and faster recovery time. But surgery may be a better choice in some cases. This may include very young babies. It may also include people who acquired coarctation after birth or have complicated coarctation, or those who need other repairs as well. Talk with your healthcare provider about the risks and benefits of each procedure for you.

What are the risks of coarctation of the aorta transcatheter dilation?

All procedures have risks. The risks of this procedure include:

  • Excessive bleeding

  • Infection

  • Blood clot (which can lead to stroke or other problems)

  • Blockage or other complications to the femoral artery

  • Aortic aneurysm formation

  • Aortic rupture (rare)

  • Return of the coarctation and need for a repeat procedure or surgery

  • Death

Stents can reduce the risk of certain complications. But people who have stents placed have a higher chance of needing follow-up procedures. Talk with your healthcare provider about the risks and benefits of a stent for you.

Your risks may vary based on your overall health, the severity of your coarctation, and other factors. Ask your provider about which risks apply most to you.

How do I get ready for coarctation of the aorta transcatheter dilation?

Talk with your healthcare provider about how to get ready for your procedure.

  • Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines, such as aspirin. It also includes prescription medicines and any vitamins, herbs, supplements, or illegal drugs. You may need to stop taking some medicines ahead of time, such as blood thinners.

  • If you smoke, you’ll need to stop before your procedure. Talk with your healthcare provider if you need help to stop smoking.

  • Follow any directions you are given for not eating or drinking before your procedure.

  • Tell your healthcare provider about any recent changes in your health, such as a fever.

You may need some tests before the procedure, such as:

  • Chest X-ray. This shows the structures in and around the chest.

  • Electrocardiogram. This checks the heart rhythm.

  • Echocardiogram. This is done to see the coarctation, and the heart anatomy and function.

  • MRI or CT angiography. This provides more images of the coarctation.

  • Blood tests. These are done to check your general health.

What happens during coarctation of the aorta transcatheter dilation?

Talk with your healthcare provider about what to expect during your procedure. A typical procedure may go like this:

  • An IV (intravenous) line will be put in your arm or hand before the procedure starts. You’ll be given sedation through the IV line. This will make you relaxed and sleepy during the procedure.

  • Hair in the area of your procedure may be removed. The area may be numbed with local anesthesia.

  • The healthcare provider will make a small cut (incision) in a blood vessel in your groin. They will then insert a long, thin wire into this cut. The wire acts as a guide during the procedure.

  • The provider will then insert a thin, flexible tube (catheter) over the wire. It has a tiny, deflated balloon on the end. The catheter will be threaded through the blood vessel all the way into the aorta. Ongoing X-ray images may be used to show exactly where the catheter is.

  • The balloon will be inflated inside the narrow part of the aorta. This will stretch the area open.

  • A mesh tube (stent) may be left in place in the area. This will help keep the area open.

  • The balloon will be deflated, and the catheter will be removed.

  • The incision site in the groin will be closed and bandaged.

What happens after coarctation of the aorta transcatheter dilation?

After the procedure, you will spend several hours in a recovery room. You may be sleepy and confused when you wake up. Your healthcare team will watch your vital signs. This includes your heart rate and breathing. You’ll be given pain medicine if you need it.

You may need to lie flat without bending your legs for a few hours after the procedure. This is to help prevent bleeding from the incision site. You may be able to go home the same day. Your healthcare provider will tell you more about what to expect.

After you go home, you may need to take medicines to help prevent blood clots. You may need to take them for a short time, or take them for a longer time. You may also need to take antibiotics. Your provider will let you know about any other changes in your medicines. You can take pain medicine at home if you need it. Ask your provider which to take.

You can usually go back to your normal activities when you get home. But don't do any strenuous activities or heavy lifting until your healthcare provider says it's OK. Your provider may give you more instructions.

Your symptoms should get better right after the procedure. Keep all of your follow-up appointments. This will help your healthcare provider keep track of your progress. You may need follow-up tests. These may include an electrocardiogram or an echocardiogram. You will also need lifelong follow-up care with a cardiologist. This is to watch for possible complications from the procedure. Some people will need a repeat transcatheter repair or surgery.

Call your healthcare provider if you have any of the following:

  • Your limb with the puncture gets numb or tingles, or feels cold or turns blue

  • Swelling or pain that gets worse

  • More bruising

  • Fluid leaking from the puncture site

  • Fever

  • Back pain

Follow all of your healthcare provider’s instructions. This includes any advice about medicines, exercise, and wound care.

For several months, you may be at greater risk of infection after some medical or dental procedures. You may need to take antibiotics first. Ask your healthcare provider if this applies to you.

Call 911

Call 911 right away if any of these occur:

  • The puncture site swells up very fast

  • Bleeding from the puncture site does not slow down when you press on it firmly

  • Chest pain or shortness of breath

Next steps

Before you agree to the test or procedure, make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how you will get the results

  • Who to call after the test or procedure if you have questions or problems

  • How much you will have to pay for the test or procedure

Medical Reviewers:

  • Dan Brennan MD
  • Rajadurai Samnishanth
  • Stacey Wojcik MBA BSN RN