Coarctation of the aorta

Nonsurgical treatment approaches

For years, balloon angioplasty and aortic stenting have been reported as nonsurgical interventional approaches for the treatment of COA.3 There has been much debate about the short- and long-term results between nonsurgical and surgical treatment of COA. Due to the risk of aneurysm formation and iliofemoral artery injury after balloon angioplasty, this procedure isnt a first choice for treatment of primary coarctation; surgical repair remains the favorable approach to COA in neonates and children.5,7
Balloon angioplasty for recurrent COA after primary surgical repair is evolving as the preferred treatment modality.3 The scar and fibrosis surrounding the anastomotic site have been hypothesized as protective factors against aortic rupture when undergoing balloon angioplasty.3

After surgical repair of COA, neonates and children should be followed closely by a pediatric cardiologist for reoccurrence of the coarctation and control of systemic hypertension. Long-term cardiology follow-up is essential for patients with COA to detect and prevent future morbidity and mortality.9 OR
REFERENCES 1. May LE. Pediatric Heart Surgery: A Ready Reference for Professionals. Milwaukee, Wis: Maxishare; 2005:32. 2. Park MK. The Pediatric Cardiology Handbook. St Louis, Mo: Mosby; 2003:80-83. 3. Nichols DG, Cameron DE, Greeley WJ, et al. Critical Heart Disease in Infants and Children. Philadelphia, Pa: Mosby; 2006:625-641. 4. Stratakis CA, Rennert OM. Turner syndrome: an update. Endocrinologist. 2005;15(1): 27-36. 5. Karl, TR. Surgery is the best treatment for primary coarctation in the majority of cases. J Cardiovasc Med. 2007; 8(1):50-56. 6. Woods WA, Schutte DA, McCulloch MA. Care of children who have had surgery for congenital heart disease. Am J Emerg Med. 2003; 21(4):318-327. 7. Cowley CG, Orsmond GS, Feola P, et al. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation. 2005;111(25):3453-3456. 8. Polson JW, McCallion N, Waki H, et al. Evidence for cardiovascular autonomic dysfunction in neonates with coarctation of the aorta. Circulation. 2006;113(4):2844-2850. 9. Colonna P, Manfrin M, Cecconi M, et al. Follow-up and physical activity in postoperative congenital heart disease. J Cardiovasc Med. 2007;8(1):83-87.
Sherry Pye is cardiology advanced practice nurse coordinator and pediatric nurse practitioner in the Heart Center, Arkansas Childrens Hospital, Little Rock, Ark. The author has disclosed that she has no financial relationship related to this article.

symptoms of necrotizing enterocolitis such as bloody stools, abdominal distention, and pneumatosis intestinalis on abdominal radiographic films. Other postoperative complications may include transient vocal cord dysfunction due to injury of the laryngeal branch of the vagus nerve, hemidiaphragmatic paralysis due to phrenic nerve injury, paraplegia due to spinal cord ischemia during repair, chylothorax due to thoracic duct injury, and postoperative bleeding.1

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Coarctation of the aorta

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OR Nurse2008 September

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Coarctation of the aorta

ANCC/AACN CONTACT HOURS

GENERAL PURPOSE: To provide the registered professional nurse with an overview of COA. LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to: 1. Discuss the pathophysiology, symptomatolgy, and diagnosis of COA. 2. Describe COA treatment strategies and their potential complications.
1. Which statement about neonatal COA is true? a. Neonatal COA accounts for 20% of congenital heart diseases. b. Theres a male-to-female occurrence ratio of 2:1. c. Neonatal COA is a hereditary heart defect. d. The typical location of the COA is proximal to the origin of the left subclavian artery. 2. A common cardiovascular defect associated with neonatal COA is a. trisomy 13. c. Turners syndrome. b. aortic arch d. ventricular septal defect. hyperplasia. 3. Without treatment, the neonate with a critical COA will most likely progress to a. left ventricular failure. b. right ventricular failure. c. patent ductus arteriosis. d. chromosomal abnormalities. 4. Older children with COA are usually a. hypoperfused below the COA. b. bradycardic. c. hypotensive. d. asymptomatic. 5. Without treatment, the older child with COA is at risk for all except a. stroke. c. ruptured aorta. b. malignant d. paraplegia. systemic hypertension. 6. As the ductus closes, the at-risk symptomatic neonate will demonstrate a. difficulty feeding. c. metabolic alkalosis. b. difficulty urinating. d. diminished brachial pulses. 7. Which study is least useful in diagnosing COA? a. echocardiogram b. complete blood cell count c. chest radiograph d. electrocardiogram 8. Which statement about presenting signs and symptoms of COA is true? a. The degree of coarctation is best determined by chest X-ray. b. Electrocardiogram will show left ventricular hypertrophy. c. Symptoms can mimic newborn sepsis. d. Typical symptoms include bradypnea and cyanosis. 9. The symptom best differentiating COA from other neonatal problems is a. abnormal heart sounds. c. tachycardia. b. absent femoral pulses. d. pulmonary edema. 10. A side effect of prostaglandin E1 therapy is a. apnea. b. closure of the ductus. c. blockage of blood flow below the level of the COA. d. diuresis. 11. A goal for the surgical treatment of neonatal COA is to avoid a. blood transfusion. b. scar formation. c. rib fractures. d. using cardiopulmonary bypass. 12. A common complication of COA repair by flap, anastomosis, or patch is a. anemia. b. recoarctation. c. stroke. d. decreased blood supply to the extremities. 13. Which statement about the left subclavian flap aortoplasty approach is true? a. Its associated with late aneurysm formation. b. It requires cardiopulmonary bypass. c. It uses the neonates own tissue. d. It doesnt disrupt blood flow through the subclavian artery. 14. In the older child, clamping the aorta a. may result in hypertension in the distal aorta. b. may be easier due to the presence of arterial collaterals. c. may increase the risk of paraplegia. d. is no different than in the neonate. 15. Which statement about initial treatment of neonatal COA is true? a. Balloon angioplasty is the preferred treatment. b. Surgical repair remains the favorable approach. c. Aortic stenting has no postoperative complications. d. Surgical and nonsurgical approaches are equally advantageous. 16. Which statement about postoperative systemic hypertension is true? a. It can be controlled by intravenous nitroprusside. b. Its the result of dopamine release. c. A hypertensive state is needed to ensure a good blood supply to the surgical site. d. Uncontrolled hypertension can result in the development of chylothorax. 17. Postcoarctectomy syndrome is best prevented by control of hypertension and a. stimulation of the sympathetic nervous system. b. aggressive intravenous hydration. c. optimal pain control. d. delayed enteral feeding postoperatively. 18. Which of the following isnt a sign or symptom of necrotizing enterocolitis? a. bloody stools b. pneumatosis intestinalis c. hemidiaphragmatic paralysis d. abdominal distention

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