Cardiovascular Surgery Coarctation Aorta correction

Coarctation of Aorta (Pediatric)

Objective

In case of narrowing of the distal segment of the aortic arch:

•   To open chest  

•   To expose the site of narrowing 

•   Relieving obstruction to blood flow in the descending aorta. 

Position

•   Right lateral position with left arm stretched above the head. 

Anesthesia

General, endotracheal.

Procedure

   1.  Cleaning and draping. 

   2.  Operation for left thoracotomy. 

   3.  BP handle No. 3 with No. 10 skin blade attached to it. 

   4.  Finochietto chest retraction with small sized (No. 2) blades attached to it. 

   5.  Pleural stay - 3-0 on 4-0 atro silk. 

   6.  Straight Mosquito’s clamp to be given for stay suture. 

   7.  Small aortic (angled) clamps to be given. If infant use Castaneda clamps for the aorta.

   8.  Clamps to be placed above and below the coarctation. 

   9.  Operation of coarctation of aorta usually is done by direct end to end anastomosis by resecting the narrow area of the aorta. 

10.  Occasionally a tubular dacron prosthesis or similar graft is required to bridge the gap. 

11.  Pleura to be sutured with 3-0 or 4-0 atro silk loaded on a Sarrot NH. 

12.  Sponge, gauze pieces and instruments count. 

13.  Insertion of chest tube in the pleural cavity. 

14.  Chest closure. 

Instruments

•   Cleaning tray 

•   Cardiac set 

•   Pediatric set 

•   Water seal set 

•   PDA set (above 5 years)

•   Castaneda vascular clamps 

•   Gemini right angle clamp

•   Castroviejo needle holders.

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