Native Coarctation Research Articles

Balloon angioplasty for native coarctation in children: one year follow-up results

Balloon angioplasty is an alternative to surgical repair for coarctation of the aorta in children. However, its role in the treatment of neonates and infants younger than 3 months old remains controversial. The purpose of this study was to evaluate the efficacy and safety of balloon angioplasty for native coarctation by comparing children in different age groups. This is a retrospective clinical study including 37 children treated with balloon angioplasty for native coarctation from January 2006 to December 2012. A total of 37 patients consisting of 26 boys and 11 girls underwent the procedure, with median age 10 months (range from 7 days to 6 years) and the mean body weight was 6.3 (2.5-17.0) kg. The indication of the procedure includes discrete native coarctation without aortic arch hypoplasia and a peak-to-peak systolic pressure gradient > 20 mmHg (1 mmHg = 0.133 kPa) across aortic coarctation. During one year follow-up, the approach artery injury, recoarctation and aneurysm formation were particularly assessed. We classified these patients into two groups according to their age. Group A consisted of 25 patients younger than 3 months and Group B of 12 patients older than 3 months. There was no significant difference between the two groups in systolic pressure gradient before balloon angioplasty (P > 0.05). The mean peak systolic gradient decreased from (38 ± 18) mmHg to (12 ± 11) mmHg immediately after angioplasty in group A and from (47 ± 18) to (17 ± 12) mmHg in group B (P = 0.000 for both). Meanwhile, the mean diameter of the coarctation segment increased from (1.8 ± 0.7) to (3.7 ± 1.1) mm after angioplasty in group A and from (2.6 ± 1.5) to (5.5 ± 1.8) mm in group B (both P = 0). The initial successful balloon angioplasty (immediate postangioplasty peak pressure gradient < 20 mmHg) was achieved in all the 37 patients; 32 patients (86.5%) have been followed up for one year. Approach arterial complications occurred in 3 patients (9.4%), all of whom were in Group A (P = 0.537). Two patients had decreased femoral artery pulse and one required surgical repair for a postoperative pseudoaneurysm at left carotid artery. At follow-up, 8 patients (25.0%) developed recoarctation, with 6 cases in Group A and 2 in Group B. There was no significant difference between groups A and B in the recoarctation rate (P = 1.000). Among them, 7 patients underwent repeat balloon angioplasty, and all showed successful relief of coarctation, and one patient required surgical repair. Two patients (2/37, 5.4%) had small aneurysms of the descending aorta immediately after balloon angioplasty, with one patient in each group (12/25 vs.1/12, P = 0.755).Late aneurysm development has not been observed in the 17 patients who have had a follow-up CTA or MRA study. Balloon angioplasty of discrete native coarctation is effective and safe in children both younger and older than 3 months with similar incidence of approach arterial complication, recoarctation and aneurysm formation.

Percutaneous angioplasty used to manage native and recurrent coarctation of the aorta in infants younger than 1 year: immediate and midterm results.

Balloon angioplasty (BAP) used to manage native coarctation of the aorta (CoAo) in infants remains controversial. This study aimed to compare short- and midterm results of BAP between native CoAo (NaCo) and postsurgical recoarctations (ReCo) in infants younger than 1 year. This retrospective study compared the clinical, echocardiographic, hemodynamic, and angiographic data for infants who underwent BAP between July 2003 and September 2012. The 12 NaCo and 13 ReCo patients in this study underwent BAP at 4.61 ± 3.69 and 4.88 ± 3.07 months (p = 0.84) and weighed 5.49 ± 2.57 and 6.10 ± 2.11 kg (p = 0.52), respectively. Their respective heights were 60.58 ± 10.58 and 61.15 ± 6.74 cm (p = 0.87). All the ReCo patients had their initial surgery before the age of 3 months. The minimal CoAo diameter was 2.81 ± 0.96 mm in the NaCo group and 2.86 ± 1.0 mm in the ReCo group (p = 0.90). The relative gradient reduction was 62.79 ± 32.43 % in the NaCo group and 73.37 ± 20.78 % in the ReCo group (p = 0.33). The in situ complication rate (pseudoaneurysm) was 8.33 % in the NaCo group and 7.69 % in the ReCo group (p = 0.74). During the early follow-up evaluation, five NaCo patients (41.66 %) presented with recoarctation requiring BAP reintervention within 1.75 ± 1.41 months (all had their initial BAP before 3 months of age) compared with 1 ReCo patient (7.69 %) (p = 0.165). The mean follow-up period was 3.09 ± 2.69 years for the NaCo patients and 3.6 ± 3.18 years for the ReCo patients (p = 0.69), during which the blood pressure gradient was 12.33 ± 9.67 for the NaCo patients and 7.80 ± 8.78 for the ReCo patients (p = 0.17), with corresponding Doppler peak instantaneous gradients of 21.29 ± 11.19 and 16.20 ± 10.23 (p = 0.24). The resultant diameter ratio between the minimal isthmus diameter and the aortic diameter at the diaphragmatic level was 0.81 ± 0.15 in the NaCo group and 0.85 ± 0.12 in the ReCo group (p = 0.53). The immediate and midterm results of BAP for the NaCo and ReCo infants were comparable. Accordingly, BAP seems to be an acceptable alternative to surgery for infants older than 3 months.

Intravascular stent therapy for coarctation of the aorta.

Intravascular stent therapy is considered a primary therapeutic option for most adults and adolescents with coarctation of the aorta. This review highlights the indications, technical considerations, procedural aspects, and limited long-term outcome data when using this intervention. Stent technology has continued to evolve with potential for further modifications since its inception in the early 1990s. The best therapeutic approach, e.g., stenting versus surgery, in the treatment of native coarctation continues to be debated due to the paucity of long-term clinical and imaging data in both groups.

Comparison Between Covered and Bare Cheatham-Platinum Stents for Endovascular Treatment of Patients With Native Post-Ductal Aortic Coarctation: Immediate and Intermediate-Term Results

This study sought to evaluate the outcomes of endovascular treatment with covered versus bare Cheatham-platinum stents (NuMed, Hopkinton, New York) in coarctation of aorta (CoA) patients. Covered stenting has been newly recognized as a useful therapeutic method for patients with native CoA, but there has been no study comparing the use of covered stents with bare stents for treating CoA. In this randomized clinical trial, 120 patients with a mean age of 23.60 ± 10.99 years (range 12 to 58 years, 79 men), with post-ductal, short-segment, severe native CoA underwent implantation of bare Cheatham-Platinum (bCP) (n = 60) or covered Cheatham-Platinum (cCP) (n = 60) stents. Patients were followed clinically at 1, 3, 6, and 12 months after the stenting and yearly thereafter. During follow-up, multislice computed tomography (64 slices) was scheduled to assess any complications. The procedural success rate was 100% in both groups. Patients were followed for 31.1 ± 19.2months. Although recoarctation was seen only in the bCP group during follow-up, the difference betweengroups did not reach statistical significance (6.7% vs. 0%; p= NS). Two cases of pseudoaneurysm (3.3%) occurred in the cCP group, but none was observed in the bCP group (p= NS). Normotensive statussignificantly increased during follow-up in both groups (from 15% to 73.3% in the bCP group and16.7%to78.3% in the cCP group, p < 0.001 for each group and not significant between groups). Implanting bCP and cCP stents have very high success rates with remarkable hemodynamic effects in severe native CoA patients. Patients undergoing cCP stent implantation experienced a nonsignificantly lower recoarctation rate and a higher occurrence of pseudoaneurysm formation with respect to bCP stenting during follow-up. These findings indicate that CoA stenting isasafe procedure. (Endovascular Stenting With Covered CP Stent Compared With Bare CP Stent forAdultPatients With Coarctation: The Initial and Intermediate-Term Follow-Up Results; IRCT201012045311N1).

From Bare to Covered

Bare stents has become the first line therapy for aortic coarctation. Covered stents has been reported more recently in clinical practice. The present study, reports comparatively 15-year experience of bare and covered stent implantation for aortic coarctation in a single tertiary referral center. From 1997 to 2011, 143 patients with native or postoperative aortic coarctation were treated at our institution. Seventy-one subjects (median age 17 years (range from 4 to 70 years) underwent bare stent implantation (Group 1) while 72 patients (median age of 17.5 years (range from 6 to 68 years) underwent covered stent implantation (Group 2). Success rate in the whole group was 95%. More complex and tighter coarctations were treated using covered stents. Incidence of related-procedure adverse events was higher in Group 1 than in group 2 (21.1% vs. 8.3% P = 0.035). Aortic wall complications occurred in 7% of patients in Group 1 (one death) and 0% in Group 2 (P = 0.028). Subjects in Group 1 had a longer follow-up (median 85 vs. 35 months; P < 0.001). Independent predictors associated with reintervention included the presence of complex lesions (HR: 2.70; CI: 1.15-6.32), balloon diameter used <14 mm (HR: 3.76; CI: 1.48-9.55), and immediate residual gradient >10 mm Hg (HR: 4.30; CI: 1.96-9.47). Both bare and covered stent implantation for aortic coarctation is a safe and efficacious treatment. By using covered stent implantation the spectrum of patients treated has increased with lower rates of acute and late complications.

Renal sympathetic denervation for resistant hypertension in a child after aortic coarctation surgery

Canniffe et al. report that the current prevalence of hypertension lateafter successful coarctation repair is 32.5% (range 25 –68%) [1].Ahigherage at the time of surgery, a longer time of follow up and a better de fini-tion of hypertension are factors that increase the prevalence. There areinsufficient long term data to adequately compare catheter based inter-vention to surgical procedures for native coarctation in terms of the lateprevalence of hypertension. A causative role of the autonomic nervoussystemresultinginarterialhypertensionmaybeoverlooked.Wepresentthe first paediatric patient in whom successful interventional renalsympathetic denervation improved postcoarctation repair hypertension.A 16 yearold boy wasoperated at the age of 13 years. Hypertensionandaorticcoarctationwere firstnoticedduringsurgeryforsportsinjury.Arm/leg pressure gradient was 90 mm HG (194/103 vs 104/69). MRimaging showed severe coarctation and hypoplastic isthmus (Fig. 1).Surgery comprised of proximal descending aorta replacement with an18 mm Dacron tube (Uni-Graft™, B. Braun, Berlin, Germany). Longterm postoperative hypertension with average blood pressures of upto 171/92 mm Hg occurred in circadian monitoring despite fourfoldmedication (Fig. 2). A careful examination of his autonomic nervoussystem showed a highly reduced heart rate variability indicatingsympathetic predominance. Adding carvedilol improved heart rate var-iabilityonly.Maximal Doppler flow was2.8 m/sin the aorticgraft with-outarm/legpressuregradient.Theboysufferedfromchronicfatigueandheadache. He was also found to have an intracranial aneurysm, wasobese (BMI 28.6 kg/m

A Pregnant Patient with Native Aortic Coarctation and Aneurysm

A Pregnant Patient with Native Aortic Coarctation and Aneurysm

Outcomes of Surgical versus Balloon Angioplasty Treatment for Native Coarctation of the Aorta: A Meta-Analysis

Native coarctation of the aorta (COA) accounts for 5-7% of congenital heart disease. Open surgical treatment was the only choice until balloon angioplasty (BA) treatment was introduced as an alternative therapy for COA in the 1980s. BA treatment was thought to be a less invasive and potentially safer technique, and has been used on numerous patients. But as has been reported during the past 30 years, the risk of aneurysm formation and recoarctation existed in either of those 2 procedures. Unfortunately, follow-up for either type of treatment has been limited, making it difficult to draw any meaningful conclusions as to which treatment option is superior. Our objective was to compare results of 2 therapeutic modalities to treat native COA: BA without stent implantation and surgery. We performed a meta-analysis of controlled trials of surgical versus BA treatment for native COA. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and the Chinese Biomedical Database of clinical trials were searched using PubMed and OVID. Controlled trials in which patients with COA were assigned to surgical repair or BA treatment were included. For each outcome, we evaluated the quality of the evidence with reference to the Grading of Recommendations Assessments, Development, and Evaluation criteria. We used RevMan 5.1 software (The Nordic Cochrane Centre, Copenhagen, Denmark) to analyze the data. A literature search yielded 9 comparable studies, for a total of 623 patients, of whom 378 and 245 were assigned to surgery and BA. Meta-analysis of these studies showed no significant difference in postintervention gradient (inverse variance fixed mean difference: 1.44 [95% CI: -1.16 to 4.04]), midterm recoarctation (Mantel-Haenszel [M-H] random odds ratio [OR]: 0.24 [95% CI: 0.04-1.58]), and long-term recoarctation (M-H fixed OR: 0.61 [95% CI: 0.34-1.11]). BA reduces the risk of severe complications (M-H fixed OR: 2.67 [95% CI: 1.37-5.21]; P < 0.001) but increases the risk of short-term recoarctation (M-H fixed OR: 0.25 [95% CI]: 0.12-0.54]; P < 0.001) and aortic aneurysm formation (M-H fixed OR: 0.12 [95% CI]: 0.04-0.34]; P < 0.001). BA provides immediate results comparable to surgery and reduces invasion, but it does not provide better results compared with surgery when considering medium- and long-term complications and even increases the incidence of aneurysm formation.

Balloon Angioplasty of Native Aortic Coarctation Vs. Post Surgical Correction in Infants Under 12-Month-Old at Chu Sainte Justine: Short and Mid-Term Results

Balloon angioplasty (BAP) in native coarctation of the aorta (CoAo) remains controversial especially in infants. This is due in part to the risk of local complications (pseudo-aneurysm, dissection, rupture), to recurrence rate, and to limited comparative studies to surgical approach. The objectives are to compare short-term and mid-term results of BAP in native CoAo (NaCo) vs. post surgical recoarctations (ReCo) in infants < 1 yo.

A Prospective Multicenter Study of Balloon Angioplasty for the Treatment of Native and Recurrent Coarctation of the Aorta

Balloon angioplasty (BA) is an important therapeutic treatment option for coarctation of the aorta. However, previous data regarding efficacy and complications have largely been restricted to relatively small retrospective studies from single centers. The Congenital Cardiovascular Interventional Study Consortium (CCISC) represents a multi-institutional and multi-national effort to prospectively investigate congenital cardiac interventions. A prospective analysis of the efficacy of balloon aortic angioplasty was conducted.

Endovascular management of an acquired aortobronchial fistula following aortic bypass for coarctation

Aortobronchial fistula (ABF) in the setting of aortic coarctation repair is very rare but uniformly fatal if untreated. Endovascular stenting of the descending aorta is now the first-choice approach for ABF presenting with haemoptysis and offers a less-invasive technique with improved outcomes, compared with open repair. We report a case of late ABF occurring following bypass for aortic coarctation. Management focused on two key manoeuvres: use of a covered endovascular stent to occlude the aortic bypass thus controlling the fistula and dilatation and stenting of native coarctation.

Collapse of the advanta V12 large diameter covered stent following implantation for aortic coarctation

We report a case of collapse of the Advanta V12 Large Diameter (LD) covered stent following previous successful implantation for native aortic coarctation. This unreported complication was successfully managed with subsequent stent redilation and implantation of two covered Cheatham-Platinum stents within the collapsed Advanta V12 stent. This case highlights the importance of correct stent apposition to the aortic wall and also raises some concerns regarding the radial strength of the Advanta V12 stent.

Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey

Our aim was to evaluate patients who were treated by percutaneous stent implantation. Patients with aortic coarctation (n = 35) who had been treated with 38 stents - 12 bare and 26 covered - were evaluated. The demographics and procedural and follow-up data were recorded from hospital registers and compared according to patient specifications, for example, weight and coarctation nature. The procedure was successful in all patients. There was a statistically significant difference between the patients with native coarctation (n = 17) and those with recurrent coarctation (n = 18) in terms of pre-procedural blood pressures, systolic gradients, coarctation diameters, and the ratio of the coarctation site diameter to the descending aorta diameter. Although all patients received antihypertensive drugs before the procedure, the drug was discontinued in 26 patients during follow-up (p < 0.001). Stent migration was observed in four patients with recurrent coarctation (11.4%), and peripheral arterial injury was seen in three patients (8.5%). The mean follow-up time was 34 ± 16 months. On average, 21 (6-42) months after the procedure, six patients underwent cardiac catheterisation. At least 2 years after the procedure, tomography was performed in 20 patients (57.2%). Patients who were evaluated by multi-slice computerised tomography revealed no pathologies. There was no statistically significant difference between the five patients weighing less than 20 kg and the other 30 patients in terms of demographic and procedural characteristics, procedure success and complication rates, and follow-up data. Stent implantation for aortic coarctation is a method yielding satisfactory results in reducing coarctation gradients, efficient enlargement of the lesion area, and resolution of hypertension for children, including those weighing less than 20 kg.

Covered stents in the management of native coarctation of the Aorta—Intermediate and long‐term follow‐up

To evaluate the results of covered Cheatham-Platinum stent implantation in the management of native coarctation of the aorta and report intermediate and long-term follow-up. Covered stents are being used increasingly in severe and complex coarctation of the aorta mainly to reduce risk of aortic wall complications. There is, however, limited data on the intermediate and long-term outcome. Fifty-six patients received 59 covered Cheatham-Platinum stents (January 2002-December 2011) at a single center-in 54 patients as primary treatment and in 2 as a rescue. Mean age was 22.25 ± 1.2 (11-56) years and mean weight 58.6 ± 2.1 (32-99) kg. Primary end points were reduction in systolic pressure gradient and an increase in coarctation segment diameter. Changes in antihypertensive medicines and complications were recorded on follow-up. Mean coarctation segment diameter increased from 4.69 ± 0.20 to 15.1 ± 3.2 mm (P < 0.0001). The systolic gradient decreased from mean of 51.4 ± 3.4 to 4.6 ± 0.7 mm Hg (P < 0.0001). There was one death 3 days postprocedure due to cerebral anoxia. There was one dissection diagnosed 24-hr postprocedure. At a mean follow-up of 45.9 ± 3.9 (3-120) months, all stents were patent and in good position on computed tomography. Four (7.1%) patients underwent successful redilation. Antihypertensive medication was decreased or stopped in 37 (66%) patients. Covered Cheetham-Platinum stents may be used effectively as therapy of choice in selected patients with severe coarctation of the aorta. Aortic wall complications occur even with covered stents. Covered stents provide a safe alternative to conventional stenting in the intermediate and long-term and can be redilated safely to keep pace with somatic growth.

Successful management of a proximally migrated stent in a middle-aged woman with unnoticed native aortic coarctation

Endovascular stent placement for adults with a newly diagnosed native discrete post-subclavian aortic coarctation (AC) became widely acceptedas an alternative to surgery,despite thatthe efficacyand long term safety of the technique have not yet been well established [1]. Placement of stent can be technically challenging and has been associated with serious complications, such as acute aortic rupture (rare), aortic dissection, femoral artery trauma, subacute stent thrombosis, recurrent coarctation, and aneurysm formation [2]. There is a paucity of data regarding stent migration, its causes; and its management has not been well defined. Proximal migration of a (covered) stent is a very rare occurrence [3]. To our knowledge, no previous reports of a proximally migrated covered stent and its successful repositioning using a peripheral balloon catheter during transcatheter management of AC in an adult have been published. We report a woman with a native AC whose treatment was complicated by stent migration proximally, which was then successfully repositioned at the expected site by transcatheter technique. A 45-year-old woman was referred for catheterization after her diagnostic work-up for resistant hypertension suggested renal artery stenosis. Her past medical history was notable for a 10-year history of hypertension. She had no other history of cardiovascular disease. She had hadtwo prior pregnancies,with ahistoryof hypertension requiring no drug therapy. Her medical regimen included nebivolol, lercanidipine, irbesartan, hydrochlorothiazide, and atorvastatin at the time of presentation. A thorough physical examination was performed, revealing the blood pressure difference between the right arm and leg of 30 mm Hg in the presence of systemic hypertension, a radial–femoral pulse delay with weak lower limb pulses, and faint mid-systolic murmur over the chest and back. Her electrocardiogram was normal with no evidence of left ventricular hypertrophy or ischemia. Echocardiography demonstrated left atrial dilatation, moderate mitral regurgitation, with an estimated left ventricular ejection fraction of 65%. However, gradient measurement by continuous wave Doppler was not obtainable. No other associated abnormalities were detected.

Transcatheter therapy for aortic coarctation with severe systemic hypertension during pregnancy

Aortic coarctation is an unusual cause of hypertension during pregnancy and its management is not clarified. We report transcatheter balloon dilatation and stenting for native aortic coarctation in a 22-year-old pregnant woman with severe and uncontrolled systemic hypertension. Arterial blood pressure could be successfully controlled with medical treatment during the rest of the pregnancy and the patient underwent uneventful delivery. No adverse events or recoarctation was observed during 24 months clinical follow-up. In conclusion, native aortic coarctation can be successfully treated during pregnancy with transcatheter therapy. More experience is needed to confirm the safety and efficacy of such management.

Native atretic coarctation of the aorta in a 37-year-old hypertensive woman, treated with a low-profile covered stent

We report on a 37-year-old woman with essential systemic hypertension. An MRI was performed because of weak femoral pulses, depicting a severe almost atretic coarctation of the aorta (Fig. 1). Angiography of the proximal distal thoracic aorta was simultaneously performed (Fig. 2a). The transverse arch was narrow (16 mm), as was the diameter of the terminal aortic arch distal to the left subclavian artery (10 mm). Distal of the coarctation the diameter of the descending aorta was 11 mm. A trajectory of 2 mm in length seemed atretic. The atretic segment could be crossed in an antegrade fashion with a straight 0,014 in. coronary wire and balloon pre-dilatation was performed with a 5 mm coronary balloon. Thereafter, a multi-purpose catheter could be advanced retrogradely across the coarctation segment. A 9 French Mullins sheath (Cook) was advanced to the transverse aortic arch. A 41 mm long Advanta V12 premounted covered stent (Atrium, Hudson, USA) on a 12 mm high pressure balloon was implanted. Consecutive angiography revealed complete expansion of the stent up to 12 mm without residual stenosis, and no aneurysm formation (Fig. 2b). Fig. 1 MRI imaging of the left ventricle (LV), ascending aorta (AAo). The left subclavian artery (LSA) is dilated and the descending aorta (DAo) is hypoplastic. The coarctation imposes as atresia. There are numerous collaterals. RV: right ventricle Fig. 2 a Simultaneous angiography of the proximal and distal descending aorta; anterior projection. Atretic coarctation (CoA). Some small collaterals can be seen right of the coarctation. Abbreviations: Cath: catheter, DAo: descending aorta, LSA: left subclavian ... In conclusion, treatment with placement of a low-profile covered stent, using a simultaneous radial and femoral approach and pre-dilatation, delivered an excellent result without complications and a short hospital stay. The patient’s blood pressure returned to normal and her antihypertensive medication could be stopped within 3 weeks after stent implantation. We emphasise that in so-called ‘unexplained’ systemic hypertension, especially in young adults, coarctation of the aorta has to be excluded [1, 2]. When coarctation is confirmed primary stenting is the first choice therapeutic option [3–5].

Endograft Failure in an Adult Patient with Coarctation and Bicuspid Aortic Valve

A 25-year-old man presented with associated bicuspid aortic valve and coarctation of the aorta. Following aortic valve replacement, he underwent endovascular stenting of his native coarctation. We describe early failure of the latter procedure that necessitated definitive surgical correction.

Does thez-Score Value of the Abdominal Aorta Predict Recoarctation in an Infant?

We evaluated left ventricular dimensions and aortic arch z-scores in infants who underwent balloon angioplasty (BAP) or surgery for coarctation of aorta (CoA). We searched for risk factors predicting recoarctation. Between 2007-2011, 27 male and 17 female infants (mean age 2.93 ± 4.78 months, range 2 days-24 months) with CoA were evaluated. Left ventricular dimensions, systolic functions, mitral and aortic annuli, transverse aortic arch, isthmus, coarctation site, and diaphragmatic aorta measurements were done and z-scores were determined before intervention. Six patients underwent primary operation, 38 patients had BAP (86.4%). Associated cardiac pathologies in operated patients were double outlet right ventricle (n = 2), atrioventricular septal defect (n = 1), Ebstein's anomaly (n = 1), arch hypoplasia (n = 2). Twelve patients (27.2%) had simple coarctation. Ventricular septal defect was the most frequent associated cardiac pathology (n = 20, 45.4%). The patients were followed for 10.22 ± 8.21 months. Among 33 primary successful BAP's, 14 had recoarctation (42%). Eleven patients were primarily operated (including 5 with unsuccessful BAP), two had recoarctation (18%). Abdominal and transverse aorta values and z-scores were significantly lower in the recoarctation group (7.15 ± 2.12 mm and 6.07 ± 1.86 mm respectively in the "no-recoarctation group"; vs. 5.53 ± 0.75 mm and 4.94 ± 1.53 mm in the "recoarctation group" P <.05). Abdominal aorta z-score of 0.42 was 88.9% sensitive and 53.8% specific to predict recoarctation (area under ROC curve: 0.618-0.902, P <.05). Although BAP for native coarctation is still a controversial treatment option due to frequent restenosis rates, abdominal aorta z-score of 0.42 could correctly eliminate recoarctation in 89% of these cases. This cutoff value might help us choose patients for primary BAP and decrease the recoarctation rate after BAP.

Challenges in the management of aortic coarctation in the elderly: native coarctation complicated by severe calcification

Although the treatment of aortic coarctation in adults with the use of stents has shown favourable results and reduced complications, there have been few studies involving elderly patients. We highlight the clinical challenges faced in the management of such patients, with attention to severe calcification at the coarctation site. The midterm results were good in our patient, showing an improvement in blood pressure control and maintenance of stent patency.