Affordable cost Coarctation of the Aorta surgery in India

Affordable cost Coarctation of the Aorta surgery in India.

Coarctation of the Aorta surgery in India – an Overview

Coarctation of the Aorta surgery in India:

Coarctation of Aorta surgery in India is being provided to international as well as Indian patients with best healthcare facilities. The patients are being hospitalized in corporate hospitals which are available in all major metropolitan cities of India having well trained and fully equipped staff present 24*7 at the service of the patients. These hospitals have JCI certified senior and immensely experienced surgeons having abroad expertise in their own specialty.

What is Coarctation of the Aorta?

Coarctation of the aorta (CoA) is a relatively common defect that accounts for 5-8% of all congenital heart defects. Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most commonly bicuspid aortic valve and ventricular septal defect (VSD). The diagnosis of coarctation of the aorta may be missed unless an index of suspicion is maintained, and diagnosis is often delayed until the patient develops congestive heart failure (CHF), which is common in infants, or hypertension, which is common in older children. This article discusses the pathology, pathophysiology, clinical features, noninvasive and invasive evaluation, and therapy in patients with coarctation of the aorta.

Causes:

Numerous theories have been proposed for the etiology of coarctation of the aorta, including postnatal ductal constriction, translocation of ductal tissue onto the aorta, and a theory that alterations in intrauterine blood flow cause altered flow through the aortic arch and result in the substrate for coarctation. Coarctation of the aorta manifests when the ductus closes starting at the pulmonary end, with gradual involution of ductal tissue toward the aorta. Similar to most forms of congenital heart disease (CHD), the etiology of coarctation of the aorta may be explained by multifactorial inheritance hypothesis. The prevalence of coarctation of the aorta in genetic abnormalities such as Turner syndrome (45,X), is as high as 15-20%. Familial patterns of inheritance of coarctation have been reported, as well as for other left heart obstructive lesions. An increase in seasonal occurrence of coarctation of the aorta is reported in September and November.

History

The presentation of patients with coarctation of the aorta (CoA) varies but may be discussed relative to the patients who present early, often with congestive heart failure (CHF), and the patients who present later, most often with hypertension.

Early presentation: The presence of associated defects and aortic arch anomalies, the extent of patency of the ductus arteriosus, the rapidity of the process of closure of the ductus arteriosus, and the level of pulmonary vascular resistance determine the timing of clinical presentation and the severity of symptoms. Young patients may present in the first few weeks of life with poor feeding, tachypnea, and lethargy and progress to overt CHF and shock.20,15 These patients may have appeared well prior to hospital discharge, and deterioration coincides with closure of the patent ductus arteriosus. Presentation may be abrupt and acute with ductal closure. Development of symptoms is often accelerated by the presence of associated major cardiac anomalies, such as ventricular septal defect (VSD). Symptoms may be subtle at first, and patients may make repeated trips to the physician before finally presenting in extremis. Late presentation: Patients often present after the neonatal period with hypertension or a murmur. These patients often have not developed overt CHF because of the presence of arterial collateral vessels. Diagnosis is often made after hypertension is noted as an incidental finding during evaluation of other problems, such as trauma or more routine illness. Other presenting symptoms may include headaches, chest pain, fatigue, or even life-threatening intracranial hemorrhage. True claudication is rare, although an occasional child may experience pain or weakness in the legs. Many patients are asymptomatic except for the incidentally noted hypertension. Frequently, coarctation of the aorta is not recognized by the primary care physician. Palpation of femoral pulses and measurement of blood pressure during routine examination is necessary to avoid a delay in the diagnosis.

Surgical Care

Significant hypertension or congestive heart failure (CHF) is an indication for intervention. Surgical relief of the aortic obstruction and catheter interventional techniques (balloon angioplasty and stents) are available alternatives. Symptomatic neonates and infants should undergo urgent intervention soon after the infant is stabilized. Asymptomatic infants, children, adolescents, and adults should undergo the procedure electively. If neither hypertension nor heart failure is present, elective surgical or balloon therapy in children aged 2-5 years is suggested. Waiting beyond age 5 years for surgery or balloon therapy to relieve aortic obstruction is not advisable because of the evidence of residual hypertension if intervention is performed after age 5 years.

Since the introduction of surgical correction by Crafoord and Nylin (1945) and by Gross and Hufnagel (1945) in the early 1940s, surgical therapy has been the preferred treatment for aortic coarctation. Various surgical techniques have been used to treat patients with coarctation of the aorta, namely, resection and end-to-end anastomosis, patch aortoplasty, left subclavian flap aortoplasty, and tubular bypass grafts. The techniques are occasionally combined or modified to fit the individual patient's anatomy.

For instance, a reverse left subclavian flap aortoplasty may be used, turning the left subclavian artery as a patch back toward the left carotid artery to enlarge an area of transverse arch hypoplasia. In addition, an extended end-to-end repair may be used, in which the segment of descending aorta is beveled and brought up to the underside of the transverse arch to enlarge areas of transverse arch hypoplasia. The exact technique used varies depending on the patient's age at presentation, size, associated abnormalities, and arch anatomy. A surgical approach from a median sternotomy, rather than the classic left lateral thoracotomy, is used commonly in complex arch repairs.

In a review of 1337 patients undergoing repair of coarctation in infancy, the following findings were reported: Subclavian flap aortoplasty was performed in 763 patients (57%). Resection in end-to-end anastomosis was used in 406 patients (30%), and patch aortoplasty was used in 133 patients (9.9%). In addition, 20 patients underwent placement of an interposition graft or bypass graft. In the series, the mortality risk was highest in neonates in whom surgery was performed during the first week of life, whereas only 8 of 279 infants aged 3 months to 1 year who underwent surgery died. Mortality associated with surgery was also higher in smaller infants, particularly in infants who weighed less than 3 kg and infants with associated cardiac anomalies. The presence of a ventricular septal defect (VSD) with or without minor associated anomalies increased the risk of death from 0.9% (no anomalies) to 6.8% (with VSD). Complex associated anomalies, such as a single ventricle or transposition of the great arteries, greatly increased the mortality rate to 16.6%. Similarly, the surgical mortality rate in neonates who required surgery prior to coarctation repair was 45%. Urgent surgery may be required if the patent ductus arteriosus cannot be opened and the patient continues to have poor urine output and acidosis.

Why India:

We always put our “Patients First”. We strive to provide comprehensive, quality and cost-effective healthcare services. A specialist hospital that provides advanced, leading-edge medical care…India’s hospital enables us to be at the forefront of clinical research, and to translate new knowledge into safe, advanced treatment options for our patients. With state-of-the-art facilities and dedicated, well-trained staff. Our medical expertise is internationally recognized for its high standards and medical breakthroughs. Doctors and surgeons undergo rigorous training at established medical institutions, and continually upgrade their knowledge and skills. They are supported by qualified nurses, clinicians and other healthcare professionals. Experience our world class healthcare system in cosmopolitan and culturally vibrant cities of grace.