Heart Center: Aortic Stent Placement

Coarctation of the aorta is a narrowing of the aorta, the blood vessel that carries blood to the body. It usually involves an isolated area of the aorta and occurs in five to 8 percent of all patients with congenital heart disease, or 0.04 percent of the general population. The severity is determined by the pressure difference, or gradient, measured between the aorta above and below the narrowing. The greater the pressure difference, the more severe the coarctation. If the pressure difference is greater than 20mmHg, if the patient has congestive heart failure, or if the patient has high blood pressure, intervention is recommended.

In the past, surgeons were asked to repair this defect by cutting out the narrow segment and sewing the aorta back together. Today a non-surgical technique called aortic stent placement can be used to correct the coarctation. A stent is a tube made of stainless steel that looks like chicken wire. The stent is placed over a balloon and enlarged when the balloon is inflated. During the procedure, a catheter with a balloon on the end and a stent mounted on top of the balloon is advanced into the narrowed area through an artery in the leg. Fluoroscopy (X-ray) guides the balloon and stent into the right position.

Once the catheter is in the correct place, the balloon is rapidly inflated and deflated to open the stent and dilate, or open, the narrowed area. When the catheter is removed, the stent remains in the vessel, enlarging the area. Pressures are measured and X-ray pictures are taken of the vessel before and after the procedure. This technique can be performed successfully on patients with or without prior surgery. Intravascular stent placement is performed most often in older patients because smaller children often need to have the stents re-dilated as they grow. After the procedure the patient will be admitted to the hospital for overnight observation and released the next day.

The results for aortic stent placement for coarctation of the aorta vary. Success depends on the type and location of the narrowing. The success rate, as defined by reduction in gradient to less than 20mmHg, has been 100 percent at our hospital. The risk of death is less than 1 percent. The number of stents requiring re-dilation has been small.

A few complications can occur with this procedure, all less than 1 percent. They are femoral artery damage, aortic damage, stent mal-deployment, bleeding, increased X-ray exposure time, stroke, and death. To combat these complications, the balloon size is carefully matched to the aorta size, and heparin, a blood thinner, is given to prevent blood clot formation. Blood is ordered and is available for immediate use in case of bleeding.

Your cardiologist and Dr. Zellers will inform you more fully about this procedure on the morning of your child's catheterization. You will be able to ask questions and will be asked to sign a consent form. Your cardiologist will determine the need for further follow-up, which may include an echocardiogram the day after the procedure.

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