Advances in the Treatment of Neonatal Coarctation of the Aorta

Abstract

Coarctation of the aorta (CoA) is a potentially life-threatening congenital and obstructive anomaly of the distal aortic arch. After constriction of the ductus arteriosus, neonates may develop critical CoA in the isthmus area and present with severe left ventricular dysfunction or even cardiac failure. Low cardiac output and abdominal hypoperfusion (distal to the coarctation) may lead to metabolic derangements and clinical deterioration. Most neonates can be adequately stabilized with critical care support; however, patients who demonstrate treatment-resistant left ventricular dysfunction and end organ damage are often considered too unstable for primary surgical CoA repair. In this particular setting, transcatheter intervention is often regarded as more beneficial than prolonged intensive care. Specialized centers have proposed different approaches to critical CoA treatment. Nevertheless, individual therapy decisions are based on patient condition as well as the experience and expertise of the interdisciplinary team. This article focuses on isolated neonatal CoA (as opposed to CoA in complex congenital heart disease). Advances in neonatal diagnosis, critical care, transcatheter interventions, and surgical techniques have led to lower mortality and reintervention rates and have improved outcomes in neonates with critical CoA. Issues requiring further study include the optimal timing of definitive surgical CoA repair and the question how the severity of aortic obstruction and the choice of surgical technique affect long-term neurologic outcome.