In the past, coarctation repair always involved heart surgery through an incision in the side of the chest that required five to seven days in the hospital for recovery. Now it is often possible to correct coarctation without surgery in a procedure called a cardiac catheterization.
The heart catheterization consists of placing a long, thin, hollow plastic tube, called a catheter, into the blood vessel in the groin and passing it through vessels into the heart's chambers. The catheter is used to gather blood samples, take pressure measurements and inject dye for X-ray movies. Modern imaging technology allows doctors to see where the catheter is going and how the heart is functioning.
The diameter at the site of aortic narrowing is measured so that the proper size stent, an expandable slotted metal tube, can be selected. Sometimes, more than one stent will be needed for complete repair. If the narrowing is too close to the head and neck vessels, stent repair may not be possible. Surgical repair would then be necessary and would be scheduled for another time.
After an appropriate stent has been selected, it is placed over a deflated balloon at the catheter's tip. When the balloon reaches the site of the narrowing, it is expanded to widen the artery. The stent is left in place to support the newly widened artery walls and the catheter and balloon are withdrawn.
The procedure is safe and effective with immediate complete repair in over 98 percent of patients. Complications during the procedure are rare and almost all can be treated immediately. These include blood loss requiring a transfusion, allergic reaction to X-ray dye requiring medication, aneurysm and improper stent position requiring retrieval by catheter or surgery. There is a small risk of blockage of the groin vessels used for catheterization, which ordinarily responds to medication. Complications after the procedure, such as breakage, movement or infection of the stent, are extremely rare and occur in less than 1 percent of patients. In less than 5 percent of patients, an aneurysm or widening at the stent site may develop.
The catheterization and stent placement take approximately three to four hours. Patients are admitted to the hospital the morning of the procedure and discharged the following morning. Most often, patients are treated with a drug that blocks platelet function, such as clopidigrel, for a period of time after the procedure.
After treatment, follow-up will be necessary for the rest of your life. This will include taking antibiotics before dental or surgical procedures, regular magnetic resonance imaging (MRI) exams and perhaps subsequent surgery. Women should consult with a cardiologist before becoming pregnant to determine any risk factors.
Reviewed by health care specialists at UCSF Medical Center.
Cardiovascular Care and Prevention Center at Mission Bay
535 Mission Bay Blvd. South
San Francisco, CA 94158
Phone: (415) 353-2873
Fax: (415) 353-2528