Aortic coarctation refers to a congenital narrowing of the aorta, usually distal to the origin of the left subclavian artery, opposite the area of the ductus arteriosus at the aortic isthmus.
You should seek medical assistance in case you or your child has the following symptoms or signs:
- Severe chest pain
- Sudden shortness of breath
- Unexplained high blood pressure
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.