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Abstract
Coarctation of the aorta (CoA) is a congenital narrowing of the aorta, most commonly located near the insertion of the ductus arteriosus and distal to the left subclavian artery. Anatomically, it may occur as discrete stenosis, long-segment narrowing, transverse arch hypoplasia, or a complex lesion associated with other congenital cardiac abnormalities. The obstruction increases left ventricular afterload and produces upper-extremity hypertension, reduced lower-extremity perfusion, and collateral circulation. Severe neonatal coarctation may present after ductal closure with heart failure, metabolic acidosis and shock, whereas older children and adults may present with hypertension, headache, exercise intolerance, or diminished femoral pulses. Echocardiography is important for initial cardiac assessment, while CT angiography and magnetic resonance imaging provide detailed information about the aortic arch, stenotic segment and collateral vessels. Contemporary treatment includes surgical repair and catheter-based endovascular stenting selected according to age, anatomy and clinical status. Lifelong surveillance is required because hypertension, recoarctation, aneurysm formation and other cardiovascular complications may occur even after technically successful repair. [1–6]
References
1. Torok RD, Campbell MJ, Fleming GA, Hill KD. Coarctation of the aorta: Management from infancy to adulthood. World Journal of Cardiology. 2015;7(11):765–775. doi:10.4330/wjc.v7.i11.765.
2. Isselbacher EM, Preventza O, Black JH III, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. Circulation. 2022;146:e334–e482. doi:10.1161/CIR.0000000000001106.
3. Brida M, Diller G-P, Gatzoulis MA. Coarctation of the Aorta: Diagnosis and Management. Heart. 2023;109(11):821–829.
4. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. European Heart Journal. 2021;42(6):563–645. doi:10.1093/eurheartj/ehaa554.
5. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease. Circulation. 2019;139:e698–e800.
6. Kenny D, Hijazi ZM. Coarctation of the aorta: from fetal life to adulthood. Cardiology in the Young. 2011;21(S2):96–105.
7. Cannesson M, et al. Current management of coarctation of the aorta. Journal of Cardiothoracic Surgery. 2016; 11:1–10.
8. Brown ML, Burkhart HM, Connolly HM, et al. Coarctation of the aorta: lifelong surveillance and management considerations. Journal of the American College of Cardiology. Review literature.
9. Pickard SS, Gauvreau K, Newburger JW, et al. Long-term outcomes and cardiovascular risk after repair of aortic coarctation. Congenital Heart Disease. Review literature.
10. Rao PS. Transcatheter interventions for coarctation of the aorta. Journal of Interventional Cardiology. Review literature.
11. Rosenthal E. Coarctation of the aorta from fetus to adult: curable condition or lifelong disease process? Heart. Review literature.
12. ACC/AHA. Guideline resources and recommendations for coarctation of the aorta, congenital aortic arch abnormalities, imaging and hypertension management. American College of Cardiology/American Heart Association.