Abstract
Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6–8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated abnormalities various management options like surgical treatment, transcatheter balloon angioplasty and transcatheter stent implantation are available. There is significant improvement in long-term survival from pre-surgical era to post-surgical era. But, among the postsurgical era patients, the long-term survival has not significantly changed between older and contemporary cohort. Patients with coarctation of aorta need lifelong follow-up event after successful initial intervention.
Highlights
Coarctation of aorta (CoA) can be defined as cardiac abnormality resulting in obstruction to the blood flow in the aorta
When fetus is suspected to have a CoA, serial follow-ups during pregnancy and planned delivery at a tertiary level cardiac center are recommended
Results from the Congenital Cardiovascular Interventional Study Consortium (CCISC) and the Coarctation of Aorta Stent Trial (COAST) trials show that stent patients have lower rate of acute complications compared to surgery and balloon angioplasty cohort [34, 35]
Summary
Coarctation of aorta (CoA) can be defined as cardiac abnormality resulting in obstruction to the blood flow in the aorta. Results from the Congenital Cardiovascular Interventional Study Consortium (CCISC) and the Coarctation of Aorta Stent Trial (COAST) trials show that stent patients have lower rate of acute complications compared to surgery and balloon angioplasty cohort [34, 35] They are more likely to require a planned reintervention for stent dilatation, especially when implanted in younger patient [34]. Forbes et al compared safety and efficacy of surgical and transcatheter treatment options for native coarctation at acute interval and at follow-up for patients between the years 2002 and 2009 from 36 institutions [35] They noted that surgical and stent therapy achieved lower upper-lower extremity blood pressure gradient compared to balloon angioplasty acutely and at short-term follow-up. Despite advances in management techniques and medical management the long-term survival has not significantly changed
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