Surgical management of Coarctation of the Aorta in the Pediatric Population: A fifteen-year experience

By, Kristi SALIAJ, MD. Prof. Dr. Arben BABOCI, MD. Elvana RISTA, MD. Dr. Sc. Altin VESHTI, MD. Dr. Sc. Saimir KUCI

Introduction

Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), in the pediatric population. It is defined as a hemodynamically significant stenosis of the descending aorta, typically at the site of insertion of ductus arteriosus. It has an estimated incidence of 4-6 cases per 100,000 births, accounting for 5-8% of all congenital heart defects [1-4]. According to The New England Regional Infant Cardiac Program (NERICP), coarctation of the aorta is the fourth most common defect requiring surgery during the first year of life [5]. It can present as an isolated lesion or coexist with other cardiac or extra-cardiac congenital defects. The most common one include bicuspid aortic valve, patent ductus arteriosus, ventricular septal defect, mitral stenosis, berry aneurysms in the circle of Willis [6-8].  Clinical presentation is heterogenous, varying from asymptomatic to congestive heart failure, acute pulmonary edema and cardiogenic shock, depending on the degree of coarctation, the development of collateral circulation and age at presentation [9]. During the neonatal period patients may present with circulatory collapse and pulmonary edema, reduced or absent peripheral pulses, tachypnea, lethargy and progressive metabolic acidosis [9-13]. In early childhood, they present primarily with symptoms of congestive heart failure (CHF) including tachypnea, irritability, sweating, feeding difficulties and failure to thrive [9-13]. In adolescence and adulthood patients may be asymptomatic, presenting with non-specific symptoms including exercise intolerance, fatigue and cramps in the lower limbs, recurrent headaches, epistaxis, vertigo, tinnitus, high blood pressure and difference in blood pressure between arms and legs and reduced or absent peripheral pulses [9-13]. Treatment options for coarctation of the aorta include both surgery and catheter-based procedures. Several surgical techniques have been developed including extended resection with end-to-end anastomosis, prosthetic patch aortoplasty, subclavian patch aortoplasty, interposition grafting and extraanatomic bypass grafting [9-11,13-18]. Catheter-based approaches include balloon angioplasty and stenting. The choice is based on the age at presentation, the type of coarctation and the presence of associated anomalies, as well as other patient specific characteristics [9-11,18-23].

How to cite: Saliaj, K., Baboci, A., Rista, E., Veshti, A., & Kuci, S. (2020). Surgical management of coarctation of the aorta in the pediatric population: A Fifteen-Year experience. Medicus, 4(1), 5–14.

https://doi.org/10.58944/nxdt8964