Interventional therapy for coarctation of the aorta

The optimal interventional management of coarctation of the aorta (CoA) remains controversial. Although some are strong advocates for surgery, the timing of operation in elective cases has been a matter of debate. Among those who advocate balloon angioplasty, some recommend dilation only of recurrent CoA. Others recommend dilation of native CoA, but only beyond a certain age. Finally, some are strong proponents of balloon angioplasty, even in the neonatal period, recognizing the need for reintervention (balloon dilation or surgery) in a significant proportion of patients. Recent reports suggest similar or slightly superior acute results of balloon dilation for native compared with recurrent CoA. Balloon-expandable stents are being used increasingly in complex CoAs and in failed dilations. A large multicenter study is required to determine the respective clinical roles of surgery and balloon dilation in the management of CoA.