Current management of coarctation of the aorta

Abstract

Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. This condition was once thought to be a relatively simple lesion that would be "cured" upon repair of the narrowing, however, despite relief of the anatomical obstruction the subsequent risk of early morbidity and death persists. This review outlines the optimal management strategy of this disease from neonatal to adult life and provides insights to approach this straightforward but challenging condition.

Figure 1.

Survival curves to 30 years of 588 surgically treated patients (solid line) and the expected survival of an age and sex-matched population based on cohort life tables (dashed line).

Figure 2.

Computed Tomography (CT) reconstruction demonstrating aortic coarctation (arrow).

Figure 3.

Major surgical aortic coarctation repair techniques.

Figure 4.

Stenting of tight native coarctation. Native coarctation with multiple collaterals in A) LAO and B) straight lateral views. C) No residual stenosis following stent implantation.

Figure 5.

A) Aortic angiogram demonstrating large aneurysm at the site of previously repaired coarctation B) Angiogram following successful aneurysm repair using endovascular stent graft.

Figure 6.

Angiogram of a young patient with coarctation and cerebral aneurysm (arrow).