What other defects may be seen along with CoA ?

Some heart defects are common in association with CoA. These include a Ventricular Septal Defect (VSD) and a bicuspid aortic valve (which is a condition where the aortic valve has only TWO LEAFLETS, instead of the normal three). Dilated portions of arteries - called ANEURYSMS - are more frequent inside the brain in patients with CoA. Other defects may also occur in combination with CoA.

When should Coarctation of the aorta be repaired ?

As in most congenital heart defects, there is no simple answer. There is still a lot of controversy about which patients need intervention, and about what method of treatment is right.
Children with SEVERE CoA need early repair. A severe CoA would be identified by a pressure difference of more than 50 mm.Hg across the area of narrowing (but even this figure is not universally accepted). Milder types of CoA may need individualized assessment. Any patient who has symptoms or complications due to the CoA needs repair.

So which is the ideal age for repair ?

It was previously recommended that CoA be repaired before 10 years of age. The reasons were that:

• The left ventricle is not exposed to a high work-load for too long
• Collaterals do not become too large
• Changes in the kidney do not become permanent, and blood pressure will return to normal after surgery

Recently, with increasing safety of correction in smaller children, there is a trend towards earlier repair. Some suggest that the benefits are maximum when surgery is offered before two years of age. But the last word on this topic has not been said.

What are the methods of treatment available ? Read on .....

 

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