It is a type of disorder that relates to narrowing down of aorta, the large vessel of blood that emerges from the heart and delivers blood rich oxygen to other parts of the body. Due to coarctation, the heart has to pump harder to push blood through the narrow aorta. The coarctation blocks the normal flow of blood to the body. The narrowing down of aorta is usually spotted when the arteries move towards the upper body. If this condition is too severe in nature, sufficient blood may not be able to reach the lower parts of the body. Because of intense pumping, the heart’s wall thickens while the muscles of the heart weaken. If aorta does not widen, the heart might get so weak that it could lead to a heart failure too.
The coarctation of aorta does not occur alone, but is accompanied with some other defects of the heart. It is a congenital defect that is present at the time of birth, but it may not be detected until later in life. Some children might overcome the effects of the disease and grow normally while some others may have to undergo surgeries for repair and take medical treatment to lessen the symptoms and normalise the flow of blood through the body. This defect constitutes 5-8% of the heart defects that are congenital.
The technique involves a full mobilization of the left subclavian artery, which gets extended to the origin of its first branches. The aorta need not be broadly mobilized, & the intercostal arteries are individually controlled with snares. After the proper clamping, the left subclavian artery is detached from the aorta at its origin. It is then opened longitudinally on its posterior aspect. After that, the anterior wall of the aorta is incised, beginning with the opening at the origin of the left subclavian artery as well as extending distally to the descending aorta 12 to 15 mm past the coarctation. The coarctation membrane is then excised, and the ductus is ligated and divided. The opening left subclavian artery, now forming a flap, is pulled down and sutured to the edges of the aorta, widening the coarctation site and also preserving the blood flow to the left arm.
One of the principal advantages of it is that there is less tension on the anastomosis. Moreover, the left subclavian flap approach requires a shorter clamp time as compared to the extended end-to-end anastomosis.
One of its disadvantages is that it requires the division of the left subclavian artery. There is a risk of a remaining subclavian steal; however, it is rare in our experience that this is functionally important during childhood.
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