Abstract
Coarctation of the aorta is an important, treatable cause of secondary hypertension. Its prevalence varies from 5% to 8% of all congenital heart defects. This condition is most often detected because of a murmur or hypertension found on routine examination. Delayed or absent femoral pulses and an arm/leg systolic blood pressure difference of 20 mm Hg or more in favor of the arms may be considered as evidence for aortic coarctation. The coarctation may be demonstrated on a suprasternal notch two-dimensional echocardiographic view along with increased Doppler flow velocities across the coarctation site. Cardiac catheterization reveals significant systolic pressure gradient (> 20 mm Hg) across the coarctation and angiography demonstrates the degree and type of aortic narrowing. Aortic obstruction may be relieved by surgery or by transcatheter techniques; the latter include balloon angioplasty and stent implantation. In the past, surgery has been used exclusively, but because of morbidity and complications associated with surgery, catheter techniques are increasingly used in the management of aortic coarctation. Balloon angioplasty in children and stents in adolescents and adults are becoming initial therapeutic options for management of coarctation. Studies evaluating long-term follow-up results of the interventional techniques are needed.
Similar content being viewed by others
References and Recommended Reading
Nadas AS, Fyler DC: Pediatric Cardiology, edn 3. Philadelphia: WB Saunders, 1972:683.
Keith JD, Rowe RD, Vlad P: Heart Disease in Infancy and Childhood, edn 3. New York: Macmillan; 1978:4-6.
Rao PS: Coarctation of the aorta. Semin Nephrol 15:87–105.
Stafford MA, Griffiths SP, Gersony WM: Coarctation of the aorta: a study in delayed detection. Pediatrics 1982, 69:159–163.
Thoele DG, Muster AJ, Paul MH: Recognition of coarctation of the aorta: a continuing challenge for the primary care physician. Am J Dis Child 1987, 141:1201–1204.
Rao PS, Carey P: Doppler ultrasound in the prediction of pressure gradients across aortic coarctation. Am Heart J 1989, 118:229–307.
Liberthson RR, Pennington DG, Jacobs ML, et al.: Coarctation of the aorta: review of 243 patients and clarification of management problems. Am J Cardiol 1979, 43:835–845.
Pinzon JL, Burrows PE, Benson LN, et al.: Repair of coarctation of the aorta in children: postoperative morphology. Radiology 1991, 180:199–203.
Rao PS: Balloon angioplasty of native aortic coarctation. In Transcatheter Therapy in Pediatric Cardiology. Edited by Rao PS. New York: Wiley-Liss; 1993:153-196.
Rao PS: Technique of balloon valvuloplasty/angioplasty. In Transcatheter Therapy in Pediatric Cardiology. Edited by Rao PS. New York: Wiley-Liss; 1993:29-44.
Rao PS: Balloon angioplasty of native aortic coarctation [letter]. J Am Coll Cardiol 1992, 20:756–757.
Lock JE, Bass JL, Amplatz K, et al.: Balloon dilation angioplasty of aortic coarctation in infants and children. Circulation 1983, 68:109-116.
Rao PS: Balloon angioplasty of aortic coarctation: a review. Clin Cardiol 1989, 12:618–628.
Rao PS, Chopra PS: Role of balloon angioplasty in the treatment of aortic coarctation. Ann Thorac Surg 1991, 52:621–631.
Rao PS, Galal O, Smith PA, Wilson AD: Five-to-nine-year followup results of balloon angioplasty of native aortic coarctation in infants and children. J Am Coll Cardiol 1996, 27:462–470. Describes long-term results of balloon angioplasty of AC.
Lababidi Z: Percutaneous balloon coarctation angioplasty: long-term results. J Intervent Cardiol 1992, 5:57–62.
Mendelsohn AM, Lloyd TR, Crowley DC, et al.: Late follow-up of balloon angioplasty in children with a native coarctation of the aorta. Am J Cardiol 1994, 74:696–700.
Fletcher SE, Nihill MR, Grifka RG, et al.: Balloon angioplasty of native coarctation of the aorta: mid-term follow-up and prognostic factors. J Am Coll Cardiol 1995, 25:730–734.
Rao PS: Long-term follow-up results after balloon dilatation of pulmonic stenosis, aortic stenosis and coarctation of the aorta: a review. Progr Cardiovasc Dis 1999, 42:59–74. An excellent review of long-term results of balloon dilatation of congenital stenotic lesions of the heart.
Lababidi Z, Madigan N, Wu J, et al.: Balloon coarctation angioplasty in an adult. Am J Cardiol 1982, 53:350–351.
Attia JM, Lababidi ZA: Early results of balloon angioplasty of native coarctations in young adults. Am J Cardiol 1988, 61:930–931.
Suarez de Lezo J, Sancho M, Pan M, et al.: Angiographic followup after balloon angioplasty for coarctation of the aorta. J Am Coll Cardiol 1989, 13:689–695.
Erbel R, Bednarezyk I, Pop T, et al.: Detection of dissection of the aortic intima and media after angioplasty of coarctation on the aorta. Circulation 1990, 81:805–814.
Tyagi S, Arora R, Kaul VA, et al.: Balloon angioplasty of native aortic coarctation of the aorta in adolescents and young adults. Am Heart J 1992, 123:167–171.
Fawzy ME, Dunn B, Galal O, et al.: Balloon coarctation angioplasty in adolescents and adults: early and intermediate results. Am Heart J 1992, 124:167–171.
Kale P, Lokhandwala YY, Kulkarni HL, et al.: Balloon angioplasty for native aortic coarctation. Indian Heart J 1992, 44:207–211.
Phadke K, Dyet JF, Aber CP, et al.: Balloon angioplasty of adult aortic coarctation. Br Heart J 1993, 69:36–40.
Schrader R, Bussmann WD, Jacobi V, Kadel C: Long-term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients. Cathet Cardiovasc Diagn 1995, 36:220–225.
deGiovanni JV, Lip GY, Osman K, et al.: Percutaneous balloon dilatation of aortic coarctation in adults. Am J Cardiol 1966, 77:435–439.
Koerselman J, de Vries H, Jaarsma W, et al.: Balloon angioplasty of coarctation of the aorta: a safe alternative for surgery in adults: immediate and mid-term results. Cathet Cardiovasc Intervent 2000, 50:28–33.
Paddon AJ, Nicholson AA, Ettles DF, et al.: Long-term followup of percutaneous balloon angioplasty in adult aortic coarctation. Cardiovasc Intervent Radiol 2000, 23:364–367.
Walhout RJ: Lekkerkerker JC, Ernst SM, et al.: Angioplasty of coarctation in different aged patients. Am Heart J 2002, 144:180–186.
Fawzy ME, Awad M, Hassan W, et al.: Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol 2004, 43:1062–1067.
Rao PS, Thapar MK, Kutayli F, et al.: Causes of recoarctation after balloon angioplasty of unoperated aortic coarctation. J Am Coll Cardiol 1989, 13:109–115.
Rao PS: Balloon angioplasty for aortic recoarctation following previous surgery. In Transcatheter Therapy in Pediatric Cardiology. Edited by Rao PS. New York: Wiley-Liss; 1993:197–212.
Siblini G, Rao PS, Nouri S, et al.: Long-term follow-up results of balloon angioplasty of postoperative aortic recoarctation. Am J Cardiol 1998, 81:61–67.
Rao PS, Galal O, Wilson AD: Feasibility and effectiveness of repeat balloon dilatation of restenosed obstructions following previous balloon valvuloplasty/angioplasty. Am Heart J 1996, 132:403–407.
Minich LL, Beekman RH, Rocchini AP, et al. Surgical repair is safe and effective after unsuccessful balloon angioplasty of native coarctation of the aorta. J Am Coll Cardiol 1993, 19:389–383.
Zollikofer CL, Antonucci F, Stuckmann S: Historical overview on the development and characteristics of stents and future outlook. Cardiovasc Intervent Radiol 1992, 15:272–278.
Rao PS: Stents in the treatment of aortic coarctation[bdeditorial]. J Am Coll Cardiol 1997, 30:1853–1855.
Rao PS: Stents in the management of congenital heart disease in the pediatric and adult patients. Indian Heart J 2001, 53:714–730. extensive review of the role of stents in noncoronary vascular stenotic lesions, including AC.
O’Laughlin MP, Perry SB, Lock JE, Mullins CE: Use of endovascular stents in congenital heart disease. Circulation 1991, 83:1923–1939.
Reddington AN, Hayes AM, Ho SY: Transcatheter stent implantation to treat aortic coarctation in infancy. Br Heart J 1993, 69:80–82.
Suarez de Lezo J, Pan M, Romero M et al. Balloon expandable stent repair of severe coarctation of the aorta. Am Heart J 1995, 129:1002–1008.
Rosenthal E, Qureshi SA, Tynan M: Stent implantation for aortic recoarctation. Am Heart J 1995, 129:1220–1221.
Bulbul ZR, Bruckheimer E, Love JC, et al. Implantation of balloon-expandable stents for coarctation of the aorta: implantation data and short-term results. Cathet Cardiovasc Diagn 1996, 39:36–42.
Thanopoulos B, Triposkiadis F, Margetakis A, Mullins CE: Long segment coarctation of the thoracic aorta: treatment with multiple balloon-expandable stent implantation. Am Heart J 1997, 133:470–473.
Ebeid MR, Preita LR, Latson LA: The use of balloon expandable stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 1997, 30:1847–1852.
Suarez de Lezo J, Pan M, Romero M, et al. Immediate and follow-up findings after stent treatment for severe coarctation of the aorta. Am J Cardiol 1999, 83:400–406. excellent original paper examining issues related to follow-up after AC stents
Thanopoulos BD, Hadjinikolaou L, Konstadopoulou GN, et al.: Stent treatment for coarctation of the aorta: intermediate-term follow-up and technical considerations. Heart 2000, 84:65–70.
Magee AG, Brzezinsk-Rajszys G, Qureshi SA, et al. Stent implantation for aortic coarctation and re-coarctation. Heart 1999, 82:600–606.
Marshall AE, Perry SB, Keane JF, et al.: Early results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation. Am Heart J 2000, 139:1054–1060.
Harrison DA, McLaughlin PR, Lazzam C, et al.: Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: 1-year follow-up. Heart 2001, 85:561–566.
Cheatham JP: Stenting of coarctation of the aorta. Cathet Cardiovascu Intervent 2001, 54:112–125.
Ledesma M, Alva C, Gomez FD, et al.:Results of stenting for aortic coarctation. Am J Cardiol 2001, 88:460–462.
Hamdan MA, Maheswari S, Fahey JT, et al.: Endovascular stents for coarctation of the aorta: initial results and intermediateterm follow-up. J Am Coll Cardiol 2001, 38:1518–1523.
Tyagi S, Singh S, Mukhopadhyay S, Kaul UA: Self- and balloonexpandable stent implantation for severe native coarctation of the aorta in adults. Am Heart J 2003, 146:920–928.
Pedra CAC, Fontes VF, Esteves CA, et al.: Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults. Cathet Cardiovascu Intervent 2005, 64:495–506. An original study comparing the results of stents vs balloon angioplasty for coarctation of the aorta.
Rao PS, Balfour IC, Singh GK, et al.: Bridge stents in the management of obstructive vascular lesions in children. Am J Cardiol 2001, 88:699–702.
Rao PS: Newer stents in the management of vascular stenosis in children. In Catheter Based Devices in the Treatment of Noncoronary Cardiovascular Disease in Adults and Children. Edited by Rao PS, Kern MJ. Philadelphia: Lippincott Williams & Wilkins; 2003:369-378.
Coulson JD, Everett AD, Owada CY: Recent technical developments in implantation of stents for congenital and postsurgical cardiovascular anomalies. In Catheter Based Devices in the Treatment of Non-coronary Cardiovascular Disease in Adults and Children. Edited by Rao PS, Kern MJ. Philadelphia: Lippincott William & Wilkins; 2003:285–296.
Kay JD, Al-Khatib Y, O’Laughlin MP, et al.: Congenital coarctation and Takayasu’s arteritis: aortic stenting employing intravascular ultrasound. J Invasive Cardiol 2001, 13:705–707; discussion 707–709.
Duke C, Rosenthal E, Qureshi SA: The efficacy and safety of stent redilatation in congenital heart disease. Heart 2003, 89:905–912.
Zabal C, Attie F, Rosas F, et al.: The adult patient with native coarctation of the aorta: balloon angioplasty or stenting? Heart 2003, 89:3–5.
Macdonald S, Thomas SM, Cleveland TJ, Gaines PA: Angioplasty or stenting in adult coarctation of the aorta? A retrospective single center analysis over a decade. Cardiovasc Intervent Radiol 2003, 26:357–364.
Gunn J, Cleveland T, Gaines P: Covered stent to treat co-existent coarctation and aneurysm of the aorta in a young man. Heart 1999, 82:351–352.
De Giovanni JV: Covered stents in the treatment of aortic coarctation. J Intervent Cardiol 2001, 14:187–190.
Forbes T, Matisoff D, Dysart J, Aggarwal S: Treatment of coexistent coarctation and aneurysm of the aorta with covered stent in a pediatric patient. Pediatr Cardiol 2003, 24:289–291.
Qureshi SA, Zubrzycka M, Brzezinska-Rajszyz G, et al.: Use of covered Cheatham-Platinum stents in aortic coarctation and recoarctation. Cardiol Young 2004, 14:50–54.
Ewert P, Abdul-Khaliq H, Peters B, et al.: Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents. Cathet Cardiovasc Intervent 2004, 63:236–239.
Maron BJ, Humphries JO, Rowe RD, et al.: Prognosis of surgically corrected coarctation of the aorta: a 20-year post-operative appraisal. Circulation 1973, 47:119–126.
Bobby JJ, Emanini JM, Farmer RDT, et al.: Operative survival and 40 year follow-up of surgical repair of aortic coarctation. Br Heart J 1991, 65:271–276.
Campbell M: Natural history or coarctation of the aorta. Br Heart J 1970, 32:633–640.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rao, P.S. Coarctation of the aorta. Curr Cardiol Rep 7, 425–434 (2005). https://doi.org/10.1007/s11886-005-0060-0
Issue Date:
DOI: https://doi.org/10.1007/s11886-005-0060-0