Treatment - Our Patient

Our patient requires elimination of the coarctation. Options exist with regarding methods of treatment, because of the emergence of catheter balloon dilation with stenting as a therapeutic technique for some cardiac and vascular obstructions. Balloon dilation of a previously untreated aortic coarctation has not been uniformly accepted, because of uncertainty that it is equivalent to surgical correction, but may be considered.

There are, furthermore, several methods of surgical repair, including excision of the coarctation segment with end-to-end anastomosis of the aorta, partial excision with patch augmentation and use of the left subclavian artery as a flap over the excised coarctation area. This latter method is often applicable in the infant, but rarely in an older child or adult.

Decision of which technique to employ depends upon age of the patient, precise anatomic relations, experience and preference of the surgeon. The objective of all treatments is total elimination of the obstruction.

Anti renin medication can reduce our patient's blood pressure, but this temporizing therapy is not indicated prior to definitive treatment of his coarctation. Bacterial endocarditis prophylaxis is no longer recommended for unoperated congenital heart defects in the absence of cyanosis or prior endocarditis. Aortic valve replacement is not indicated, as the only hemodynamic abnormality, aortic regurgitation, is mild.