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Abstract

Coarctation of the aorta (CoA) is a congenital malformation of the aorta, first described by Morgagni in 1760 [1]. The overall incidence of CoA is 5–8 % of all congenital heart disease, and the condition is 1.7 times more frequent in white males than white females [2]. Aortic coarctation can present as a localised discrete stenosis of the aortic isthmus, but segmental tubular hypoplasia of the aortic arch is also commonly associated. The usual site of CoA is distal to the left subclavian artery.

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Abbreviations

CoA:

Coarctation of the aorta

CT:

Computed tomography

ECG:

Electrocardiography

LV:

Left ventricular

MRI:

Magnetic resonance imaging

References

  1. Perloff JK (1994) The clinical recognition of congenital heart disease, 4th edn. WB Saunders, Philadelphia

    Google Scholar 

  2. Samanek M, Slavik Z, Zborilova B et al (1989) Prevalence, treatment, and outcome of heart disease in live-born children: a prospective analysis of 91,823 live-born children. Pediatr Cardiol 10(4):205–11

    Article  CAS  PubMed  Google Scholar 

  3. Rudolph AM, Spitznas U, Heymann MA (1972) Hemodynamic considerations in development of narrowing of aorta. Am J Cardiol 30:514–25

    Article  CAS  PubMed  Google Scholar 

  4. Russell GA, Berry PJ, Watterson K, Dhasmana JP, Wisheart JD (1991) Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg 102:596–601

    CAS  PubMed  Google Scholar 

  5. Sehested J, Baandrup U, Mikkelsen E (1982) Different reactivity and structure of the pre-stenotic and post-stenotic aorta in human coarctation: implications for baroreceptor function. Circulation 65:1060–5

    Article  CAS  PubMed  Google Scholar 

  6. Xu CP, Zarins CK, Bassiouny HS, Briggs WH, Reardon C, Glagov S (2000) Differential transmural distribution of gene expression for collagen types I and III proximal to aortic coarctation in the rabbit. J Vasc Res 37:170–82

    Article  CAS  PubMed  Google Scholar 

  7. Kaemmerer H (2011) Aortic coarctation and interrupted aortic arch. In: Diagnosis and management of adult congenital heart disease, 2nd edn. Elselvier Saunders, Philadelphia

    Google Scholar 

  8. Rosenthal E (2005) Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart 91:1495–502

    Article  PubMed  PubMed Central  Google Scholar 

  9. Connelly MS, Webb GD, Somerville J et al (1998) Canadian consensus conference on adult congenital heart disease 1996. Can J Cardiol 14:395–452

    CAS  PubMed  Google Scholar 

  10. Curtis SL, Bradley M, Wilde P et al (2012) Results of screening for intracranial aneurysms in patients with coarctation of the aorta. AJNR Am J Neuroradiol 33(6):1182–6

    Article  CAS  PubMed  Google Scholar 

  11. Shepherd B, Abbas A, McParland P et al (2015) MRI in adult patients with aortic coarctation: diagnosis and follow-up. Clin Radiol 70(4):433–45

    Article  CAS  PubMed  Google Scholar 

  12. Erbel Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwo¨ ger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Von Allmen RS, Vrints CJM (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 35:2873–926

    Article  PubMed  Google Scholar 

  13. Baumgartner H, Bonhoeffer P, De Groot N, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJM, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow A, Vouhe PR, Walma E (2010) ESC Guidelines for the management of grown-up congenital heart disease. Eur Heart J 31:2915–57

    Article  PubMed  Google Scholar 

  14. Feltes TF, Bacha E, Beekman RH 3rd et al.; on behalf of the American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, and Council on Cardiovascular Radiology and Intervention (2011) Indications for cardiac catheterization and intervention in paediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 123:2607–2652

    Google Scholar 

  15. Campbell M (1970) Natural history of coarctation of the aorta. Br Heart J 32:633–40

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Warnes CA, Williams RG, Bashore TM et al (2008) ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American heart association Task Force on Practice guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(23):e143–263

    Article  PubMed  Google Scholar 

  17. Canniffe C, Ou P, Walsh K et al (2013) Hypertension after repair of aortic coarctation: a systematic review. Int J Cardiol 167(6):2456–61

    Article  PubMed  Google Scholar 

  18. Crafoord C, Nylin G (1945) Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg 14:347–61

    Google Scholar 

  19. Vossschulte K (1957) Isthmusplastik zur Behandlung der Aortenisthmusstenose. Thoraxchirurgie 4(5):443–50

    CAS  PubMed  Google Scholar 

  20. Backer CL, Paape K, Zales VR, Weigel TJ, Mavroudis C (1995) Coarctation of the aorta. Repair with polytetrafluoroethylene patch aortoplasty. Circulation 92:II132–6

    Article  CAS  PubMed  Google Scholar 

  21. Walhout RJ, Lekkerkerker JC, Oron GH, Hitchcock FJ, Meijboom EJ, Bennink GB (2003) Comparison of polytetrafluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta. J Thorac Cardiovasc Surg 126:521–8

    Article  PubMed  Google Scholar 

  22. Waldhausen JA, Nahrwold DL (1966) Repair of coarctation of the aorta with a subclavian flap. J Thorac Cardiovasc Surg 51(4):532–3

    CAS  PubMed  Google Scholar 

  23. Meier MA, Lucchese FA, Jazbik W, Nesralla IA, Mendonça JT (1986) A new technique for repair of aortic coarctation. Subclavian flap aortoplasty with preservation of arterial blood flow to the left arm. J Thorac Cardiovasc Surg 92(6):1005–12

    CAS  PubMed  Google Scholar 

  24. Adams EE, Davidson WR Jr, Swallow NA et al (2013) Long-term results of the subclavian flap repair for coarctation of the aorta in infants. World J Pediatr Congenit Heart Surg 4(1):13–8

    Article  PubMed  Google Scholar 

  25. Lock JE, Bass JL, Amplatz K, Fuhrman BP, Castaneda-Zuniga W (1983) Balloon dilation angioplasty of aortic coarctations in infants and children. Circulation 68:109–16

    Article  CAS  PubMed  Google Scholar 

  26. Tynan M, Finley JP, Fontes V, Hess J, Kan J (1990) Balloon angioplasty for the treatment of native coarctation: results of Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol 65:790–2

    Article  CAS  PubMed  Google Scholar 

  27. Mendelsohn AM, Lloyd TR, Crowley DC, Sandhu SK, Kocis KC, Beekman RH (1994) Late follow-up of balloon angioplasty in children with a native coarctation of the aorta. Am J Cardiol 74:696–700

    Article  CAS  PubMed  Google Scholar 

  28. Fawzy ME, Fathala A, Osman A, Badr A, Mostafa MA, Mohamed G, Dunn B (2008) Twenty-two years of follow-up results of balloon angioplasty for discreet native coarctation of the aorta in adolescents and adults. Am Heart J 156:910–7

    Article  PubMed  Google Scholar 

  29. O’Laughlin MP, Perry SB, Lock JE, Mullins CE (1991) Use of endovascular stents in congenital heart disease. Circulation 83(6):1923–39

    Article  PubMed  Google Scholar 

  30. Redington AN, Booth P, Shore DF et al (1990) Primary balloon dilatation of coarctation of the aorta in neonates. Br Heart J 64:277–81

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Morrow WR, Palmaz JC, Tio FO, Ehler WJ, VanDellen AF, Mullins CE (1993) Re-expansion of balloon-expandable stents after growth. J Am Coll Cardiol 22(7):2007–13

    Article  CAS  PubMed  Google Scholar 

  32. Holzer R, Qureshi S, Ghasemi A, Vincent J, Sievert H, Gruenstein D, Weber H, Alday L, Peirone A, Zellers T, Cheatham J, Slack M, Rome J (2010) Stenting of aortic coarctation: acute, intermediate, and long-term results of a prospective multi-institutional registry–Congenital Cardiovascular Interventional Study Consortium (CCISC). Catheter Cardiovasc Interv 76:553–63

    Article  PubMed  Google Scholar 

  33. Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R (2015) Intermediate outcomes in the prospective, multicenter coarctation of the aorta stent trial (COAST). Circulation 131:1656–64

    Article  PubMed  Google Scholar 

  34. Cheatham JP (2001) Stenting of coarctation of the aorta. Catheter Cardiovasc Interv 54(1):112–25

    Article  CAS  PubMed  Google Scholar 

  35. Sohrabi B, Jamshidi P, Yaghoubi A, Habibzadeh A, Hashemi- Aghdam Y, Moin A, Kazemi B, Ghaffari S, Abdolahzadeh Baghayi MR, Mahmoody K (2014) Comparison between covered and bare Cheatham-Platinum stents for endovascular treatment of patients with native post-ductal aortic coarctation: immediate and intermediate-term results. JACC Cardiovasc Interv 7:416–23

    Article  PubMed  Google Scholar 

  36. Forbes TJ, Moore P, Pedra CA, Zahn EM, Nykanen D, Amin Z et al (2007) Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta. Catheter Cardiovasc Interv 70(4):569–77

    Article  PubMed  Google Scholar 

  37. Perera AH, Rudarakanchana N, Hamady M, Kashef E, Mireskandari M, Uebing A, Cheshire NJ, Bicknell CD (2014) New-generation stent grafts for endovascular management of thoracic pseudoaneurysms after aortic coarctation repair. J Vasc Surg 60:330–336

    Article  PubMed  Google Scholar 

  38. Brown ML, Burkhart HM, Connolly HM et al (2010) Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation 122(11 Suppl):S81–4

    Article  PubMed  Google Scholar 

  39. Cohen M, Fuster V, Steele PM et al (1989) Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 80(4):840–5

    Article  CAS  PubMed  Google Scholar 

  40. Ungerleider RM, Pasquali SK, Welke KF et al (2013) Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 145(1):150–7 [discussion: 157–8]

    Article  PubMed  Google Scholar 

  41. Choudhary P, Canniffe C, Jackson DJ, Tanous D, Walsh K, Celermajer DS (2015) Late outcomes in adults with coarctation of the aorta. Heart 101(15):1190–5

    Article  CAS  PubMed  Google Scholar 

  42. Warnes CA (2003) Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart 89:965–6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hager A, Kanz S, Kaemmerer H, Schreiber C, Hess J (2007) Coarctation Long-term Assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg 134(3):738–45

    Article  PubMed  Google Scholar 

  44. Johnson D, Perrault H, Vobecky SJ et al (2001) Resetting of the cardiopulmonary baroreflex 10 years after surgical repair of coarctation of the aorta. Heart 85:318–25

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Gardiner HM, Celermajer DS, Sorensen KE et al (1994) Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 89:1745–50

    Article  CAS  PubMed  Google Scholar 

  46. de Divitiis M, Pilla C, Kattenhorn M et al (2001) Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 104(Suppl I):I165–70

    PubMed  Google Scholar 

  47. Guenthard J, Wyler F (1995) Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection. Am J Cardiol 75:814–7

    Article  CAS  PubMed  Google Scholar 

  48. Pfammatter J-P, Berdat P, Carrel T (2004) Impaired poststenotic aortic pulsatility after hemodynamically ideal coarctation repair in children. Pediatr Cardiol 25:495–9

    Article  PubMed  Google Scholar 

  49. Brili S, Dernellis J, Aggeli C et al (1998) Aortic elastic properties in patients with repaired coarctation of aorta. Am J Cardiol 82:1140–3

    Article  CAS  PubMed  Google Scholar 

  50. Carr JA (2006) The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol 47(6):1101–7

    Article  PubMed  Google Scholar 

  51. Forbes TJ, Kim DW, Du W, Turner DR, Holzer R, Amin Z et al (2011) Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am Coll Cardiol 58(25):2664–74

    Article  PubMed  Google Scholar 

  52. Pádua LMS, Garcia LC, Rubira CJ, de Oliveira Carvalho PE (2012) Stent placement versus surgery for coarctation of the thoracic aorta. Cochrane Database Syst Rev (5):CD008204. doi:10.1002/14651858.CD008204.pub2

  53. Nguyen L, Cook SC (2015) Coarctation of the aorta: strategies for improving outcomes. Cardiol Clin 33:521–30

    Article  PubMed  Google Scholar 

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Correspondence to Maria Boutsikou MD, MSc, PhD .

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Boutsikou, M., Uebing, A., Gatzoulis, M.A. (2016). Coarctation of the Aorta. In: Tsioufis, C., Schmieder, R., Mancia, G. (eds) Interventional Therapies for Secondary and Essential Hypertension. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-34141-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-34141-5_4

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