Coarctation of the Aorta

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]