Preoperative Physiology, Imaging, and Management of Coarctation of Aorta in Children

Semin Cardiothorac Vasc Anesth. 2019 Dec;23(4):379-386. doi: 10.1177/1089253219873004. Epub 2019 Sep 19.

Abstract

Coarctation of the aorta (CoA) is a narrowing of the proximal thoracic aorta typically located at the junction of the aorta with the ductus arteriosus. While it is a simple lesion to understand, considerable variation exists in the anatomy and pathophysiology, leading to varied clinical presentation, management options, and prognosis. On the one hand critical CoA manifests in the neonatal period as a duct-dependent lesion, while less severe forms of obstruction present later in childhood or adulthood as hypertension or incidentally noted precordial murmurs. While transthoracic echocardiography is usually adequate, older children and adults may need more advanced imaging modalities like computed tomography and magnetic resonance imaging prior to intervention. Depending on the type of lesion, management options currently available include surgery and percutaneous balloon angioplasty and stenting. Even after successful interventions, these patients need life-long surveillance for residual aortic obstruction and systemic hypertension with variable long-term clinical outcomes.

Keywords: coarctation of aorta; congenital heart disease; systemic hypertension.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Angioplasty, Balloon*
  • Aortic Coarctation / diagnostic imaging
  • Aortic Coarctation / therapy*
  • Child
  • Child, Preschool
  • Echocardiography
  • Humans
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging
  • Stents*
  • Tomography, X-Ray Computed