Medscape is available in 5 Language Editions – Choose your Edition here.


Aortic Coarctation Treatment & Management

  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Park W Willis IV, MD  more...
Updated: Mar 27, 2014

Medical Care

See the list below:

  • Severe coarctation of the aorta
    • Neonates with severe coarctation of the aorta should first have their condition stabilized.
    • First, support respiratory collapse with intubation. Second, infuse prostaglandin E1 to open the ductus arteriosus. Third, correct acidosis. Finally, provide inotropic support to improve symptoms of congestive heart failure.
  • Less severe coarctation of the aorta
    • Patients presenting with less severe coarctation of the aorta beyond the neonatal period usually have chronically increased afterload and show signs of congestive heart failure. These patients should be treated with digoxin and diuretics.
    • Attempts should be made to postpone intervention, such as surgery or balloon dilatation, until the patient is hemodynamically stable.

Surgical Care

No single technique is superior to others in minimizing the rate of restenosis. The preferred method depends on anatomy of the lesion and institutional experience.

  • Indication for intervention: At present, 3 specific indications exist for intervention in patients with coarctation of the aorta.
    • Significant coarctation or recoarctation of the aorta with long-standing hypertension with or without symptoms
    • Hemodynamically significant aortic stenosis
    • Female patient contemplating pregnancy
  • Types of surgery
    • In 1944, Blalock and Park performed the first experimental surgical repair of coarctation of the aorta in animals, which involved use of the left common carotid or subclavian artery to bypass the coarctation with end-to-end anastomosis.
    • Resection of the coarctation site and end-to-end anastomosis to repair coarctation was performed first on humans in 1944 by Crafoord, Nylin, Gross, and Hufagel. This is the preferred surgical method even today. In this technique, the aorta is cross-clamped above and below the obstruction, and the discrete narrowing is resected. The advantage of this procedure is that the obstructed site is completely resected. It also avoids the use of prosthetic material and maintains a functioning left subclavian artery. The disadvantages of this procedure involve the sacrifice of spinal and intercostal vessels resulting in paralysis. Also, a high rate of restenosis exists with use of continuous running suture or circumferential fibrosis. This problem is overcome by use of interrupted and absorbable sutures, which allows for improved growth of the anastomotic site.
    • Patch aortoplasty was first performed by Vossschulte in 1961 to repair coarctation of the aorta.[4] This technique involves cutting across the obstruction and augmenting the area with a patch of prosthetic material. The advantages of this procedure include the ability to repair a long segment of coarctation; sparing of the left subclavian, intercostal, and spinal arteries; and preserving native aortic tissue to allow for growth. The disadvantage of this procedure is that it uses prosthetic material, which may gradually result in aneurysm formation.
    • Left subclavian flap angioplasty, introduced in 1966 by Waldhausen and Nahrwold, involves ligating the left subclavian artery and dividing it distally.[5] A longitudinal incision is made from the descending aorta to the coarctation superiorly into the origin of the left subclavian artery. The subclavian artery is turned down and used to enlarge the narrowing. To prevent subclavian steal phenomena, the vertebral artery is ligated. The advantages to this procedure include preservation of native vascular tissue and avoidance of circumferential sutures, which allows for better growth of the involved area. The disadvantage to this procedure is the sacrifice of a major artery to the left arm, resulting in poor growth of that extremity.
    • Bypass graft repair bridges the ascending and descending aorta. The major disadvantage of this procedure is that prosthetic material does not grow as the child grows, and it becomes calcified and narrow with time.

Endovascular Care

Catheter-based intervention is now the preferred therapy for recurrent coarctation when the anatomy permits and necessary skills are available. Its use in native or unoperated coarctation is less well established. Treatment may be with balloon angioplasty alone or with a stent.[6] Outcomes are good in skilled hands, but residual or recurrent coarctation with resultant hypertension and repair site aneurysms can occur. Catheter-based treatment can cause death from aortic rupture and dissection, but mortality compares favorably with surgery if coarctation is recurrent, and perhaps for initial treatment.


Endovascular Versus Surgical Care

The immediate improvement in hypertension and morbidity were similar across all groups. Surgical therapy was associated with a low risk of restenosis and recurrence, whereas endovascular therapy had much higher incidence of restenosis and need for repeat interventions.[7] Endovascular therapy is highly promising in elderly and frail patients with multiple comorbidities who pose a high surgical risk. Overall, long-term outcome of endovascular approaches need to be evaluated.



See Surgical Care.



As with all aortopathies and aortic valve problems, significant and prolonged isometric activities are contraindicated. The risk of dissection, even in repaired coarctation, remains significant and may be increased with isometric activity.

Contributor Information and Disclosures

Sandy N Shah, DO, MBA, FACC, FACP, FACOI Cardiologist

Sandy N Shah, DO, MBA, FACC, FACP, FACOI is a member of the following medical societies: American College of Cardiology, American College of Osteopathic Internists, American College of Physicians, American Osteopathic Association, Society for Cardiovascular Angiography and Interventions, American Society of Nuclear Cardiology, American Medical Association

Disclosure: Nothing to disclose.


Arti N Shah, MD, MS, FACC Assistant Professor of Medicine, Mount Sinai School of Medicine; Director of Electrophysiology, Elmhurst Hospital Center, Queens Hospital Center, Queens Health Network

Arti N Shah, MD, MS, FACC is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, European Society of Cardiology, Heart Rhythm Society, Cardiac Electrophysiology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Frank M Sheridan, MD 

Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Park W Willis IV, MD Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine

Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography

Disclosure: Nothing to disclose.

  1. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation. 2008 Dec 2. 118(23):2395-451. [Medline].

  2. Swartz MF, Atallah-Yunes N, Meagher C, Schiralli MP, Cholette J, Orie J, et al. Surgical Strategy for Aortic Coarctation Repair Resulting in Physiologic Arm and Leg Blood Pressures. Congenit Heart Dis. 2011 Nov 3. [Medline].

  3. Weinstein BM, Stemple DL, Driever W, Fishman MC. Gridlock, a localized heritable vascular patterning defect in the zebrafish. Nat Med. 1995 Nov. 1(11):1143-7. [Medline].

  4. VOSSSCHULTE K. Surgical correction of coarctation of the aorta by an "isthmusplastic" operation. Thorax. 1961 Dec. 16:338-45. [Medline].

  5. Waldhausen JA, Nahrwold DL. Repair of coarctation of the aorta with a subclavian flap. J Thorac Cardiovasc Surg. 1966 Apr. 51(4):532-3. [Medline].

  6. Kenny D, Cao QL, Kavinsky C, Hijazi ZM. Innovative resource utilization to fashion individualized covered stents in the setting of aortic coarctation. Catheter Cardiovasc Interv. 2011 Sep 1. 78(3):413-8. [Medline].

  7. Carr JA. The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol. 2006 Mar 21. 47(6):1101-7. [Medline].

  8. Abbruzzese PA, Aidala E. Aortic coarctation: an overview. J Cardiovasc Med (Hagerstown). 2007 Feb. 8(2):123-8. [Medline].

  9. Attenhofer Jost CH, Schaff HV, Connolly HM. Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease. Mayo Clin Proc. 2002 Jul. 77(7):646-53. [Medline].

  10. Blalock A, Park EA. The Surgical Treatment of Experimental Coarctation (Atresia) of the Aorta. Ann Surg. 1944 Mar. 119(3):445-56. [Medline].

  11. Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, et al. Coarctation of the Aorta: Life-long Surveillance is Mandatory Following Surgical Repair. J Am Coll Cardiol. 2013 Jun 27. [Medline].

  12. Butera G, Piazza L, Chessa M, Negura DG, Rosti L, Abella R, et al. Covered stents in patients with complex aortic coarctations. Am Heart J. 2007 Oct. 154(4):795-800. [Medline].

  13. Cardiac CT & MRI. Available at Accessed: April 11, 2005.

  14. Celermajer DS, Greaves K. Survivors of coarctation repair: fixed but not cured. Heart. 2002 Aug. 88(2):113-4. [Medline].

  15. Connolly HM. Pregnancy in women with coarctation of the thoracic aorta. ACC Curr J Rev. 1997. 55:6-7.

  16. Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg. 1945. 14:347-61.

  17. Fawzy ME, Awad M, Hassan W, et al. Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol. 2004 Mar 17. 43(6):1062-7. [Medline].

  18. Golden AB, Hellenbrand WE. Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv. 2007 Feb 1. 69(2):289-99. [Medline].

  19. Harlan JL, Doty DB, Brandt B 3rd. Coarctation of the aorta in infants. J Thorac Cardiovasc Surg. 1984 Dec. 88(6):1012-9. [Medline].

  20. Hornung TS, Benson LN, McLaughlin PR. Interventions for aortic coarctation. Cardiol Rev. 2002 May-Jun. 10(3):139-48. [Medline].

  21. Karl TR. Surgery is the best treatment for primary coarctation in the majority of cases. J Cardiovasc Med (Hagerstown). 2007 Jan. 8(1):50-6. [Medline].

  22. Konen E, Merchant N, Provost Y, et al. Coarctation of the aorta before and after correction: the role of cardiovascular MRI. AJR Am J Roentgenol. 2004 May. 182(5):1333-9. [Medline].

  23. Konen E, Merchant N, Provost Y, McLaughlin PR, Crossin J, Paul NS. Coarctation of the aorta before and after correction: the role of cardiovascular MRI. AJR Am J Roentgenol. 2004 May. 182(5):1333-9. [Medline].

  24. Miller G. Repair aortic coarctation early and follow for life: 60-year study. Medscape Medical News. Available at Accessed: July 22, 2013.

  25. Perloff JK. The Clinical Recognition of Congenital Heart Disease. 3rd ed. Philadelphia, Pa: WB Saunders and Co; 1987. 125-160.

  26. Ramnarine I. Role of surgery in the management of the adult patient with coarctation of the aorta. Postgrad Med J. 2005 Apr. 81(954):243-7. [Medline].

  27. Rothman A. Coarctation of the aorta: an update. Curr Probl Pediatr. 1998 Feb. 28(2):33-60. [Medline].

  28. Toro-Salazar OH, Steinberger J, Thomas W, et al. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002 Mar 1. 89(5):541-7. [Medline].

  29. Varma C, McLaughlin PR, Hermiller JB, Tavel ME. Coarctation of the aorta in an adult: problems of diagnosis and management. Chest. 2003 May. 123(5):1749-52. [Medline].

  30. von Schulthess GK, Higashino SM, Higgins SS, et al. Coarctation of the aorta: MR imaging. Radiology. 1986 Feb. 158(2):469-74. [Medline].

  31. Webb G. Treatment of coarctation and late complications in the adult. Semin Thorac Cardiovasc Surg. 2005 Summer. 17(2):139-42. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.