Coarctation of the Aorta

Coarctation of the aorta (CoA) is a narrowing in the aortic arch, which may vary from being localized and discrete to a long segment (resulting in a hypoplastic transverse arch) to completely atretic aorta. The presentation may be in the neonatal period, when the arterial duct closes, to later in infancy, when coarctation may progressively become more severe, or when undetected, presentation may be in adult life. CoA may be associated with a variety of additional congenital heart defects, such as a bicuspid aortic valve, ventricular septal defects, abnormalities of the mitral valve, and other more complex lesions. The long-term sequelae, whether treated or untreated, include persistent hypertension, or aneurysm formation. At various points of investigation before and after treatment, imaging plays a key role. In neonates, echocardiography is sufficient, but in older children and adults, other forms of imaging, such as CT and MRI scanning, have established an important role. These are important to identify any ongoing complications such as aneurysm formation during the long-term follow-up. In neonates and early infancy, CoA is treated predominantly by surgery, although in some babies with high-risk problems such as poor left ventricular function, interventional techniques, such as balloon dilation or stent implantation, may be used. Different surgical techniques have been evaluated over the years. In the small babies, interventional techniques may be associated with a higher rate of complications such as recoarctation, or access vascular damage or aneurysm formation. A variety of newer stent technologies, such as biodegradable stents, are being developed and evaluated. In the older children, adolescents, and adults, interventional treatment such as stenting has established an important role. In these age groups, interventions may result in acceptable long-term outcomes and may be considered as acceptable alternatives to surgery. However, all forms of treatment may not abolish persistent hypertension, thus these patients need lifelong surveillance and treatment.