33840 Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis

Name of the Procedure:

Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis.

Summary

Excision of coarctation of the aorta with direct anastomosis is a surgical procedure to remove a narrowed section of the aorta and reconnect the healthy sections directly. It can also address an associated patent ductus arteriosus if present.

Purpose

This procedure corrects a condition known as coarctation of the aorta, which is a narrowing of the aorta that can restrict blood flow. The primary goals are to normalize blood flow, reduce hypertension, and prevent complications like heart failure or aortic rupture.

Indications

• Severe or symptomatic coarctation of the aorta.
• Associated conditions like hypertension or heart failure.
• Diagnosed patent ductus arteriosus that may complicate the condition.
• Evidence of blood flow obstruction affecting overall health.

Preparation

• Pre-operative fasting (usually from midnight before the surgery).
• Adjustments to medications, especially blood thinners.
• Diagnostic tests such as echocardiograms, MRIs, and CT scans to assess aorta condition.
• Preoperative physical examination and blood work.

Procedure Description

1. The patient is administered general anesthesia.
2. A surgical incision is made in the side of the chest to access the aorta.
3. The narrowed section of the aorta is identified and carefully removed.
4. The two healthy ends of the aorta are then sutured together (direct anastomosis).
5. If a patent ductus arteriosus is present, it is either ligated or removed.
6. The incision is closed, and a sterile dressing is applied.

Technology used includes surgical clamps, sutures, and possible vascular grafts depending on the specific case.

Duration

Typically, the procedure takes about 2 to 4 hours.

Setting

The procedure is performed in a hospital, specifically in a surgical operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (if heart-lung bypass machine is required)
• Operating room technician

Risks and Complications

• Bleeding
• Infection
• Re-narrowing of the aorta (re-coarctation)
• Injury to blood vessels or surrounding organs
• Anesthesia-related complications
• Paralysis (rare)

Benefits

• Improved blood flow and reduction of hypertension.
• Enhanced heart function.
• Symptom relief, such as reduced fatigue and improved exercise tolerance.
• Prevention of severe complications like aortic rupture or heart failure.

Recovery

• Hospital stay of about 5 to 7 days.
• Pain management with medications.
• Limited physical activity for several weeks.
• Follow-up appointments to monitor healing and heart function.
• Possible imaging tests to ensure the aorta remains open.

Alternatives

• Balloon angioplasty with or without stenting.
• Endovascular stent graft.
• Medical management with medications (for non-severe cases).

Each alternative has its own benefits and risks, with less invasive procedures generally having faster recovery times but potentially lower efficacy in severe cases.

Patient Experience

During the procedure, the patient will be under general anesthesia and feel no pain. Postoperative discomfort is managed with pain medications. Patients might experience soreness at the incision site and general fatigue as they recover. Regular follow-up is important to monitor progress and address any complications promptly.