Persistent pain in the legs, fatigue, headaches, and dizziness may indicate aortic coarctation., iStockphoto.com | Aynur_sib © iStockphoto.com | Aynur_sib

Medicine and Healthcare

Between Two and 18: Surgery or Catheterization?

New study looks at the best possible therapy for patients with coarctation of the aorta

Scientific name of the study

Arterial Hypertension and its Sequelae After Primary Treatment of Aortic Coarctation by Catheter Intervention versus Surgery: A Nationwide, Multi-Center, Long-term Study.

Aortic coarctation is one of the more common congenital heart defects. Approximately one in 3,000 to 4,000 newborns is affected by the narrowing of the aorta. This heart defect carries life-threatening risks. A narrowed aorta leads to increased blood pressure and strains the left ventricle as it has to work harder to pump oxygen-rich blood through the constriction.

In a newborn, the ductus arteriosus is still open. This is the important connection between the aorta and the pulmonary artery while the baby is in the womb. Shortly after birth, the ductus arteriosus closes on its own. In some children, however, it remains open. This is actually an advantage in cases of an interrupted aortic arch or severe aortic isthmus stenosis (aortic coarctation), as it ensures the supply of blood to the lower half of the body.

Risk to Heart and Brain

If a newborn has a severe constriction of the aorta or an interrupted aortic arch, his or her general condition deteriorates rapidly. Therefore, life-saving surgery is performed as soon as possible. If the stenosis is less severe, the heart defect is often not discovered until the patient is older. Apart from an unusual heart murmur that can be heard with a stethoscope, nothing else is noticeable at first. However, the narrowing of the aorta slowly changes the blood flow in the body. The result is high blood pressure in the upper half of the body, which can have long-term adverse effects on the heart, the blood vessels, and even the brain.

Different Treatment Standards

Today, aortic coarctation can be easily corrected. The goal is to prevent high blood pressure as a long-term complication. For newborns and children up to two years of age, surgery has become the standard of care. After opening the chest, the narrowing of the aorta is removed. Catheter intervention with stent implantation is a proven method for patients 18 years and older. A catheter is inserted and guided into the narrowed area of the aorta. The catheter has a small balloon at its tip that opens only at the narrowed area of the aorta and widens it. In addition, a tiny metal mesh over the balloon, called a stent, is inserted into the widened narrowing. It remains there to keep the aorta wide open.

Ensuring that Treatment is Age Appropriate

It is still unclear which correction method is most beneficial for infants over two years of age and for children and adolescents. That is why we are now investigating it in a nationwide long-term study. We are comparing the long-term outcomes after surgery and after a catheter intervention. We are retrospectively evaluating the course of the disease in participants in the National Registry who underwent one of the two procedures between the ages of two and 18. In this way, we can find out which of the two procedures is better at lowering blood pressure in the long-term and is therefore the more effective therapy.

Better Quality of Life

The results of our study should contribute to new treatment standards. The overall goal is to ensure an age-appropriate and sustainable procedure that is free of complications and thus improves patients' quality of life in the long-term.

This study is funded by the kinderherzen Fördergemeinschaft Deutsche Kinderherzzentren. © Fördergemeinschaft Deutsche Kinderherzzentren e. V.
This study is funded by the kinderherzen Fördergemeinschaft Deutsche Kinderherzzentren.

In charge of the project:

  • Dr. med. Ulrike Bauer, Wolfram Scheible für Nationales Register © Wolfram Scheible für Nationales Register

    Dr. med. Ulrike Bauer

    Ulrike Bauer, born in 1958, is the Scientific Managing Director of the National Register for Congenital Heart Defects and the Competence Network for Congenital Heart Defects. More

    Kompetenznetz Angeborene Herzfehler e. V.
    Network Headquarters

    Augustenburger Platz 1
    13353 Berlin
  • Prof. Dr. med. Fabian Alexander Kari, Éva Gréta Schenkhut © Éva Gréta Schenkhut

    Prof. Dr. med. Fabian Alexander Kari

    Prof. Dr. med. Fabian Kari is a heart surgeon and senior physician at the European Children's Heart Center Munich. More

    Europäisches Kinderherzzentrum München
    Lazarettstr. 36
    80636 München

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