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World J Cardiol. Nov 26, 2015; 7(11): 765-775
Published online Nov 26, 2015. doi: 10.4330/wjc.v7.i11.765
Coarctation of the aorta: Management from infancy to adulthood
Rachel D Torok, Michael J Campbell, Gregory A Fleming, Kevin D Hill
Rachel D Torok, Michael J Campbell, Gregory A Fleming, Kevin D Hill, Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC 27705, United States
Author contributions: Torok RD, Campbell MJ, Fleming GA and Hill KD contributed to the manuscript literature review, data compilation, and writing.
Conflict-of-interest statement: Fleming GA is the site principal investigator for the Covered Cheatham Platinum Stents for the Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta (COAST II) trial at Duke University Medical Center. There are no other conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kevin D Hill, MD, MSCI, Associate Professor of Pediatrics in the Division of Pediatric Cardiology, Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, 2400 Pratt Street, Room 7582, Box 3850, Durham, NC 27705, United States. kevin.hill@duke.edu
Telephone: +1-919-668466 Fax: +1-919-6687058
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: August 6, 2015
Revised: August 19, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: November 26, 2015
Processing time: 185 Days and 23.6 Hours
Abstract

Coarctation of the aorta is a relatively common form of congenital heart disease, with an estimated incidence of approximately 3 cases per 10000 births. Coarctation is a heterogeneous lesion which may present across all age ranges, with varying clinical symptoms, in isolation, or in association with other cardiac defects. The first surgical repair of aortic coarctation was described in 1944, and since that time, several other surgical techniques have been developed and modified. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Therefore, patients must be followed closely over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects. Considerable effort has been expended investigating the utility and outcomes of various treatment approaches for aortic coarctation, which are heavily influenced by a patient’s anatomy, size, age, and clinical course. Here we review indications for intervention, describe and compare surgical and transcatheter techniques for management of coarctation, and explore the associated outcomes in both children and adults.

Keywords: Coarctation of the aorta; Cardiac surgery; Cardiac catheterization; Balloon angioplasty; Stents

Core tip: This review explores both surgical and transcatheter approaches for the treatment of coarctation of the aorta and examines outcomes of these techniques in children and adults.