Coarctation of the Aorta Clinical Presentation

  • Author: P Syamasundar Rao; Chief Editor: Stuart Berger, MD   more...
 
Updated: Feb 1, 2012
 

History

The presentation of patients with coarctation of the aorta (CoA) varies but may be discussed relative to the patients who present early, often with congestive heart failure (CHF), and the patients who present later, most often with hypertension.

  • Early presentation: The presence of associated defects and aortic arch anomalies, the extent of patency of the ductus arteriosus, the rapidity of the process of closure of the ductus arteriosus, and the level of pulmonary vascular resistance determine the timing of clinical presentation and the severity of symptoms. Young patients may present in the first few weeks of life with poor feeding, tachypnea, and lethargy and progress to overt CHF and shock.[20, 15] These patients may have appeared well prior to hospital discharge, and deterioration coincides with closure of the patent ductus arteriosus. Presentation may be abrupt and acute with ductal closure. Development of symptoms is often accelerated by the presence of associated major cardiac anomalies, such as ventricular septal defect (VSD). Symptoms may be subtle at first, and patients may make repeated trips to the physician before finally presenting in extremis.
  • Late presentation: Patients often present after the neonatal period with hypertension or a murmur. These patients often have not developed overt CHF because of the presence of arterial collateral vessels. Diagnosis is often made after hypertension is noted as an incidental finding during evaluation of other problems, such as trauma or more routine illness. Other presenting symptoms may include headaches, chest pain, fatigue, or even life-threatening intracranial hemorrhage. True claudication is rare, although an occasional child may experience pain or weakness in the legs. Many patients are asymptomatic except for the incidentally noted hypertension. Frequently, coarctation of the aorta is not recognized by the primary care physician.[17, 18, 21] Palpation of femoral pulses and measurement of blood pressure during routine examination is necessary to avoid a delay in the diagnosis.
Next

Physical

As with history, physical examination may conveniently separate patients into 2 groups: those who present early with heart failure and those who present later with hypertension.

  • Early presentation
    • Neonates may be found to have tachypnea, tachycardia, and increased work of breathing and may even be moribund with shock. Keys to the diagnosis include blood pressure (BP) discrepancies between the upper and lower extremities and reduced or absent lower extremity pulses to palpation. However, when the infant is in severe heart failure, all pulses are diminished. Upon treatment for heart failure, prominent brachial pulses with weak or nonpalpable femoral arterial pulses may be discerned. Diminished pulses on examination should never be disregarded, since the digits appreciate the rate of change in BP, which may be diminished in ductally dependent coarctation, although the measured BP may not show discrepancies. In patients with an aberrant origin of the right subclavian artery from the aorta distal to the obstruction, such discrepancies in BP may not be present, although lower extremity pulses are diminished versus the carotid pulses.
    • Differential cyanosis (pink upper extremities with cyanotic lower extremities) may occur when right-to-left shunt across a patent ductus arteriosus provides flow to the lower body. Although often not obvious to the eye, differential cyanosis may be documented based on preductal and postductal pulse oximetry measurements and careful inspection. However, in the presence of lesions with large left-to-right shunt (eg, VSD), pulmonary artery saturations may approximate aortic saturations with less obvious differential oximetric findings. Reversed differential cyanosis (upper body cyanosis with normal lower-body oxygen saturation) may occur with transposition of the great arteries, patent ductus arteriosus, and pulmonary hypertension, resulting in right-to-left ductal shunting.
    • In patients with low cardiac output and ventricular dysfunction, pulses may be diminished diffusely, and BP gradients may seem minimal. Thus, in addition to coarctation, the differential diagnosis of perinatal circulatory insufficiency always includes left ventricular (LV) outflow obstruction, including aortic valve stenosis, subaortic stenosis, and supravalvar aortic stenosis, as well as severe mitral stenosis or insufficiency.
    • The murmur associated with coarctation of the aorta may be nonspecific yet is usually a systolic murmur in the left infraclavicular area and under the left scapula. Additional murmurs that result from the presence of associated abnormalities, such as VSD or aortic valve stenosis, may also be detected. An ejection click may signify the presence of a bicuspid aortic valve, whereas a gallop rhythm may indicate ventricular dysfunction.
  • Late presentation
    • Older infants and children may be referred for evaluation of hypertension or murmur. Hypertension in a fussy infant or a child may be attributed to agitation; thus, comparing BP readings in all the 4 extremities is important. Occasionally, the left arm pressure is lower than the right arm pressure if the origin of the left subclavian artery is involved in the coarctation. Similarly, anomalous origin of the right subclavian artery (below the level of coarctation) may produce decreased or absent right brachial pulse. Careful simultaneous palpation of upper and lower extremity pulses may help confirm suspected coarctation.
    • In older children, adolescents, and adults, coarctation of the aorta is best diagnosed clinically based on simultaneous palpation of femoral and brachial pulses. Blood pressure in both arms and one leg must be determined; a pressure difference of more than 20 mm Hg in favor of the arms may be considered evidence of coarctation of the aorta.
    • A murmur in the left infraclavicular area and under the left scapula may be systolic, but the murmur may also sound continuous in the presence of multiple collateral vessels or, occasionally, severe coarctation. An ejection click may be audible when an associated bicuspid aortic valve and a murmur of aortic stenosis or insufficiency are present. Similarly, a murmur of mitral stenosis or LV outflow tract obstruction may also occur. A gallop rhythm may occur in the presence of a hypertrophic noncompliant LV.
    • Other findings on physical examination may include abnormalities of blood vessels in the retina and a prominent suprasternal notch pulsation. A thrill may be present in the suprasternal notch or on the precordium in the presence of significant aortic valve stenosis. In the rare case of abdominal coarctation, an abdominal bruit may be noted.
Previous
Next

Causes

  • Numerous theories have been proposed for the etiology of coarctation of the aorta, including postnatal ductal constriction,[2, 3] translocation of ductal tissue onto the aorta,[4, 5] and a theory that alterations in intrauterine blood flow cause altered flow through the aortic arch and result in the substrate for coarctation.[2] Coarctation of the aorta manifests when the ductus closes starting at the pulmonary end, with gradual involution of ductal tissue toward the aorta.
  • Similar to most forms of congenital heart disease (CHD), the etiology of coarctation of the aorta may be explained by multifactorial inheritance hypothesis.[22] The prevalence of coarctation of the aorta in genetic abnormalities such as Turner syndrome (45,X), is as high as 15-20%. Familial patterns of inheritance of coarctation have been reported, as well as for other left heart obstructive lesions. An increase in seasonal occurrence of coarctation of the aorta is reported in September and November.
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

P Syamasundar Rao  MD, Professor of Pediatrics, Division of Cardiology, University of Texas Medical School at Houston; Director, Division of Pediatric Cardiology, Children's Memorial Hermann Hospital; Professor of Pediatrics, MD Anderson Cancer Center, University of Texas

P Syamasundar Rao is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, American Pediatric Society, Medical Association of Georgia, Society for Cardiac Angiography and Interventions, Society for Pediatric Research, Southern Society for Pediatric Research, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Paul M Seib, MD  Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Medical Director, Cardiac Catheterization Laboratory, Co-Medical Director, Cardiovascular Intensive Care Unit, Arkansas Children's Hospital

Paul M Seib, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Arkansas Medical Society, International Society for Heart and Lung Transplantation, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Specialty Editor Board

Juan Carlos Alejos, MD  Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, and International Society for Heart and Lung Transplantation

Disclosure: Actelion Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD  Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. Rao PS. Should balloon angioplasty be used instead of surgery for native aortic coarctation?. Br Heart J. Dec 1995;74(6):578-9. [Medline].

  2. Rudolph AM, Heymann MA, Spitznas U. Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol. Oct 1972;30(5):514-25. [Medline].

  3. Talner NS, Berman MA. Postnatal development of obstruction in coarctation of the aorta: role of the ductus arteriosus. Pediatrics. Oct 1975;56(4):562-9. [Medline].

  4. Cassels DE. The Ductus Arteriosus. Springfield, IL,: Charles C. Thomas; 1973:161.

  5. Skoda J. Demonstration eines Falles Ven Obliteration de Aorta. Wochenblatt Zeischrift de kaiserlichen-Konighiche Gesellschaft der Aerttze Zur Wien. 1995;1:710-720.

  6. Goldblatt H, Kahn JR, Hanzal RF. Studies on experimental hypertension. The effect on blood pressure of constriction of the abdominal aorta above and below the site of origin of both renal arteries. J Exper Med. 1939;69:649-674.

  7. Scott HW Jr, Bahnson HT. Evidence for a renal factor in the hypertension of experimental coarctation of the aorta. Surgery. Jul 1951;30(1):206-17. [Medline].

  8. Scott HW Jr, Collins HA, Langa AM, Olsen NS. Additional observations concerning the physiology of the hypertension associated with experimental coarctation of the aorta. Surgery. Sep 1954;36(3):445-59. [Medline].

  9. Alpert BS, Bain HH, Balfe JW, Kidd BS, Olley PM. Role of the renin-angiotensin-aldosterone system in hypertensive children with coarctation of the aorta. Am J Cardiol. Apr 1979;43(4):828-34. [Medline].

  10. Bagby SB. Dissection of pathogenetic factors: I. coarctation hypertension, in Loggie. In: JMH, Horan MJ, Hohn AR, et al Ieds). Proceedings of the NHLBI Workshop on Juvenile Hypertension. Biomedical Informatio Corp. New York, NY: 1984:pp. 253-266.

  11. Gersony WM. Riemenschneider TA (eds). Coarctation of the aorta, in Adams FH, Emmanouildes GC, Moss’ Heart Disease in Infants, Children and Adolescents. Baltimore, MD: Williams & Wilkins; 1989:pp. 243-255.

  12. Cody RJ. Hormonal alterations in heart failure. In: Hosenpud JD, Greenberg BH, eds. Congestive Heart Failure: Pathophysiology, Diagnosis and Comprehensive Approach to Management. 2nd ed. Lippincott Williams & Wilkins: 2000:199-212.

  13. Nadas, AS, Fyler DC. Pediatric Cardiology. 3rd Ed. Philadelphia, PA: Saunders; 1972:p. 683.

  14. Keith JD, Rowe RD, Vlad P. Heart Disease in Infancy and Childhood. 3rd Ed. New York, NY: Macmillan; 1978:pp. 4-6.

  15. Rao PS. Balloon angioplasty of native aortic coarctation. J Am Coll Cardiol. Sep 1992;20(3):750-1. [Medline].

  16. Campbell M. Natural history of coarctation of the aorta. Br Heart J. Sep 1970;32(5):633-40. [Medline].

  17. Strafford MA, Griffiths SP, Gersony WM. Coarctation of the aorta: a study in delayed detection. Pediatrics. Feb 1982;69(2):159-63.

  18. Thoele DG, Muster AJ, Paul MH. Recognition of coarctation of the aorta. A continuing challenge for the primary care physician. Am J Dis Child. Nov 1987;141(11):1201-4. [Medline].

  19. Norton JB Jr. Coarctation of the Aorta. In: Moller JH, ed. Surgery of Congenital Heart Disease: Pediatric Cardiac Care Consortium. Armonk, NY: Futura Publishing Co; 1984-1995.:143-57.

  20. Salahuddin N, Wilson AD, Rao PS. An unusual presentation of coarctation of the aorta in infancy: role of balloon angioplasty in the critically ill infant. Am Heart J. Dec 1991;122(6):1772-5. [Medline].

  21. Ing FF, Starc TJ, Griffiths SP, Gersony WM. Early diagnosis of coarctation of the aorta in children: a continuing dilemma. Pediatrics. Sep 1996;98(3 Pt 1):378-82. [Medline].

  22. Nora JJ. Multifactorial inheritance hypothesis for etiology of congenital heart disease: the genetic-environmental interaction. Circulation. 1968;38:604-17.

  23. Rao PS, Carey P. Doppler ultrasound in the prediction of pressure gradients across aortic coarctation. Am Heart J. Aug 1989;118(2):299-307. [Medline].

  24. Silvilairat S, Cetta F, Biliciler-Denktas G, Ammash NM, Cabalka AK, Hagler DJ. Abdominal aortic pulsed wave Doppler patterns reliably reflect clinical severity in patients with coarctation of the aorta. Congenit Heart Dis. Nov-Dec 2008;3(6):422-30. [Medline].

  25. Mohiaddin RH, Kilner PJ, Rees S, Longmore DB. Magnetic resonance volume flow and jet velocity mapping in aortic coarctation. J Am Coll Cardiol. Nov 1 1993;22(5):1515-21. [Medline].

  26. Pitlick PT, Anthony CL, Moore P, Shifrin RY, Rubin GD. Three-dimensional visualization of recurrent coarctation of the aorta by electron-beam tomography and MRI. Circulation. Jun 15 1999;99(23):3086-7. [Medline].

  27. Rao PS, Chopra PS. Role of balloon angioplasty in the treatment of aortic coarctation. Ann Thorac Surg. Sep 1991;52(3):621-31. [Medline].

  28. Rao PS, Chopra PS, Koscik R, et al. Surgical versus balloon therapy for aortic coarctation in infants < or = 3 months old. J Am Coll Cardiol. May 1994;23(6):1479-83.

  29. [Guideline] Lopez-Sendon J, Swedberg K, McMurray J, et al. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J. Aug 2004;25(15):1341-62. [Medline].

  30. [Best Evidence] Frobel AK, Hulpke-Wette M, Schmidt KG, Läer S. Beta-blockers for congestive heart failure in children. Cochrane Database Syst Rev. Jan 21 2009;CD007037. [Medline].

  31. Liberthson RR, Pennington DG, Jacobs ML, Daggett WM. Coarctation of the aorta: review of 234 patients and clarification of management problems. Am J Cardiol. Apr 1979;43(4):835-40. [Medline].

  32. Lacour-Gayet F, Bruniaux J, Serraf A, Chambran P, Blaysat G, Losay J. Hypoplastic transverse arch and coarctation in neonates. Surgical reconstruction of the aortic arch: a study of sixty-six patients. J Thorac Cardiovasc Surg. Dec 1990;100(6):808-16. [Medline].

  33. Krauser DG, Rutkowski M, Phoon CK. Left ventricular volume after correction of isolated aortic coarctation in neonates. Am J Cardiol. Apr 1 2000;85(7):904-7, A10. [Medline].

  34. Pinzon JL, Burrows PE, Benson LN, Moës CA, Lightfoot NE, Williams WG. Repair of coarctation of the aorta in children: postoperative morphology. Radiology. Jul 1991;180(1):199-203.

  35. Parikh SR, Hurwitz RA, Hubbard JE, Brown JW, King H, Girod DA. Preoperative and postoperative "aneurysm" associated with coarctation of the aorta. J Am Coll Cardiol. May 1991;17(6):1367-72. [Medline].

  36. Parks WJ, Ngo TD, Plauth WH Jr, Bank ER, Sheppard SK, Pettigrew RI. Incidence of aneurysm formation after Dacron patch aortoplasty repair for coarctation of the aorta: long-term results and assessment utilizing magnetic resonance angiography with three-dimensional surface rendering. J Am Coll Cardiol. Jul 1995;26(1):266-71. [Medline].

  37. Chiesa R, Melissano G, Civilini E, Bertoglio L, Setacci F, Baccellieri D. Giant aneurysm 25 years after patch aortoplasty for aortic coarctation. Tex Heart Inst J. 2008;35(2):220-1. [Medline].

  38. Rao PS. Neurologic complications following balloon angioplasty. Pediat Cardiol. 1993;14:63-4.

  39. Mendelsohn AM, Crowley DC, Lindauer A, Beekman RH 3rd. Rapid progression of aortic aneurysms after patch aortoplasty repair of coarctation of the aorta. J Am Coll Cardiol. Aug 1992;20(2):381-5. [Medline].

  40. Crawford FA, Sade RB. Spinal cord injury associated with hyperthermia during aortic coarctation repair. J Thorac Cardiovasc Surg. 1984;87:610-6.

  41. Brewer LA, III, Fosburg RG, Mulder GA, et al. Spinal cord complications following surgery for coarctation of the aorta: a study of 66 cases. J Thorac Cardiovasc Surg. 1992;64:368-80.

  42. Connolly JE. Hume Memorial lecture. Prevention of spinal cord complications in aortic surgery. Am J Surg. Aug 1998;176(2):92-101. [Medline].

  43. Sealy WC, Harris JS, Young WG Jr, Callaway HA Jr. Paradoxical hypertension following resection of coarctation of aorta. Surgery. Jul 1957;42(1):135-47. [Medline].

  44. Ho ECK, Moss AJ. The syndrome of mesenteric arteriitis following surgical repair of aortic coarctation. Pediat. 1972;49:40-5.

  45. Tabbutt S, Nicolson SC, Adamson PC, Zhang X, Hoffman ML, Wells W. The safety, efficacy, and pharmacokinetics of esmolol for blood pressure control immediately after repair of coarctation of the aorta in infants and children: a multicenter, double-blind, randomized trial. J Thorac Cardiovasc Surg. Aug 2008;136(2):321-8. [Medline].

  46. Kittle CF, Schafer PW. Gangrene of the forearm after subclavian arterio-aortostomy for coarctation of the aorta. Thorax. 1953;8:319-22.

  47. Geiss D, Williams WG, Lindsay WK, Rowe RD. Upper extremity gangrene: a complication of subclavian artery division. Ann Thorac Surg. Nov 1980;30(5):487-9. [Medline].

  48. Todd PJ, Dangerfield PH, Hamilton DI, Wilkinson JL. Late effects on the left upper limb of subclavian flap aortoplasty. J Thorac Cardiovasc Surg. May 1983;85(5):678-81. [Medline].

  49. van Son JA, van Asten WN, van Lier HJ, Daniels O, Vincent JG, Skotnicki SH. Detrimental sequelae on the hemodynamics of the upper left limb after subclavian flap angioplasty in infancy. Circulation. Mar 1990;81(3):996-1004. [Medline].

  50. Maddali MM, Menon RG, Valliattu J, Maimouna HA. Left upper limb shortening following reverse flap subclavian artery angioplasty. Asian Cardiovasc Thorac Ann. Aug 2008;16(4):346-7. [Medline].

  51. Rao PS, Galal O, Smith PA, Wilson AD. Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children. J Am Coll Cardiol. Feb 1996;27(2):462-70. [Medline].

  52. Rao PS. Balloon angioplasty for coarctation of the aorta in infancy. J Pediatr. May 1987;110(5):713-8. [Medline].

  53. Rao PS. Current status of balloon angioplasty for neonatal and infant aortic coarctation. Progress Pediat Cardiol. 2001;14:35-44.

  54. Rao PS. Rao PS (ed). Demographic features of tricuspid atresia in Tricuspid Atresia. 2nd Ed. NY, Futura: Mt. Kisco; 1992:pp. 23-37.

  55. Tracy EP, Duncan WJ, Tyrrell MJ, et al. Neurological complications of balloon angioplasty in children. Pediat Cardiol. 1991;12:98-101.

  56. Lock JE, Bass JL, Amplatz K, Fuhrman BP, Castaneda-Zuniga W. Balloon dilation angioplasty of aortic coarctations in infants and children. Circulation. Jul 1983;68(1):109-16. [Medline].

  57. Rao PS, Galal O, Wilson AD. Feasibility and effectiveness of repeated balloon dilatation of restenosed congenital obstructions after previous balloon valvuloplasty/angioplasty. Am Heart J. Aug 1996;132(2 Pt 1):403-7. [Medline].

  58. Rao PS, Wilson AD, Chopra PS. Immediate and follow-up results of balloon angioplasty of postoperative recoarctation in infants and children. Am Heart J. Dec 1990;120(6 Pt 1):1315-20. [Medline].

  59. Tynan M, Finley JP, Fontes V, Hess J, Kan J. Balloon angioplasty for the treatment of native coarctation: results of Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol. Mar 15 1990;65(11):790-2. [Medline].

  60. Rao PS. Should Balloon Angioplasty be Used as a Treatment of Choice for Native Aortic Coarctations?. J Invasive Cardiol. Sep 1996;8(7):301-313. [Medline].

  61. Rao PS. Stents in the management of congenital heart disease in pediatric and adult patients. Indian Heart J. Nov-Dec 2001;53(6):714-30. [Medline].

  62. Rao PS, Jureidini SB, Balfour IC, et al. Severe aortic coarctation in infants less than 3 months: successful palliation by balloon angioplasty. J Intervent Cardiol. 2003;15:203-208.

  63. Lababidi Z. Percutaneous balloon coarctation angioplasty: long-term results. J Interv Cardiol. Mar 1992;5(1):57-62. [Medline].

  64. Rao PS. Long-term follow-up results after balloon dilatation of pulmonic stenosis, aortic stenosis, and coarctation of the aorta: a review. Prog Cardiovasc Dis. Jul-Aug 1999;42(1):59-74. [Medline].

  65. Attia IM, Lababidi ZA. Early results of balloon angioplasty of native aortic coarctation in young adults. Am J Cardiol. Apr 15 1988;61(11):930-1. [Medline].

  66. Rao PS. Coarctation of the aorta. Curr Cardiol Rep. Nov 2005;7(6):425-34. [Medline].

  67. Fawzy ME, Fathala A, Osman A, Badr A, Mostafa MA, Mohamed G. Twenty-two years of follow-up results of balloon angioplasty for discreet native coarctation of the aorta in adolescents and adults. Am Heart J. Nov 2008;156(5):910-7. [Medline].

  68. Shaddy RE, Boucek MM, Sturtevant JE, Ruttenberg HD, Jaffe RB, Tani LY. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation. Mar 1993;87(3):793-9. [Medline].

  69. Shim D, Lloyd TR, Moorehead CP, Bove EL, Mosca RS, Beekman RH 3rd. Comparison of hospital charges for balloon angioplasty and surgical repair in children with native coarctation of the aorta. Am J Cardiol. Apr 15 1997;79(8):1143-6. [Medline].

  70. Marvin WJ, Mahoney LT, Rose EF. Pathologic sequelae of balloon dilation angioplasty of unoperated coarctation of the aorta in children (Abstract). J Am Coll Cardiol. 1986;7:117A.

  71. Cooper RS, Ritter SB, Rothe WB, Chen CK, Griepp R, Golinko RJ. Angioplasty for coarctation of the aorta: long-term results. Circulation. Mar 1987;75(3):600-4. [Medline].

  72. Cowley CG, Orsmond GS, Feola P, McQuillan L, Shaddy RE. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation. Jun 28 2005;111(25):3453-6. [Medline].

  73. Rodes-Cabau J, Miro J, Dancea A, Ibrahim R, Piette E, Lapierre C. Comparison of surgical and transcatheter treatment for native coarctation of the aorta in patients > or = 1 year old. The Quebec Native Coarctation of the Aorta study. Am Heart J. Jul 2007;154(1):186-92. [Medline].

  74. Ebels T, Maruszewski B, Blackstone EH. What is the preferred therapy for patients with aortic coarctation--the standard gamble and decision analysis versus real results?. Cardiol Young. Feb 2008;18(1):18-21. [Medline].

  75. Rao PS. Balloon angioplasty of aortic coarctation: a review. Clin Cardiol. Nov 1989;12(11):618-28. [Medline].

  76. Hager A, Schreiber C, Nutzl S, Hess J. Mortality and restenosis rate of surgical coarctation repair in infancy: a study of 191 patients. Cardiology. 2009;112(1):36-41. [Medline].

  77. Bacha EA. Long-term outcomes after coarctation repair in infancy. Cardiology. 2009;112(1):35. [Medline].

  78. Singer MI, Rowen M, Dorsey TJ. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J. Jan 1982;103(1):131-2. [Medline].

  79. Kan JS, White RI Jr, Mitchell SE, Farmlett EJ, Donahoo JS, Gardner TJ. Treatment of restenosis of coarctation by percutaneous transluminal angioplasty. Circulation. Nov 1983;68(5):1087-94. [Medline].

  80. Hess J, Mooyaart EL, Busch HJ, Bergstra A, Landsman ML. Percutaneous transluminal balloon angioplasty in restenosis of coarctation of the aorta. Br Heart J. May 1986;55(5):459-61. [Medline].

  81. Lorber A, Ettedgui JA, Baker EJ, Jones OD, Reidy J, Tynan M. Balloon aortoplasty for recoarctation following the subclavian flap operation. Int J Cardiol. Jan 1986;10(1):57-63. [Medline].

  82. Saul JP, Keane JF, Fellows KE, Lock JE. Balloon dilation angioplasty of postoperative aortic obstructions. Am J Cardiol. Apr 15 1987;59(9):943-8. [Medline].

  83. Rao PS. Which aortic coarctations should we balloon-dilate?. Am Heart J. Apr 1989;117(4):987-9. [Medline].

  84. Hellenbrand WE, Allen HD, Golinko RJ, Hagler DJ, Lutin W, Kan J. Balloon angioplasty for aortic recoarctation: results of Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol. Mar 15 1990;65(11):793-7. [Medline].

  85. Anjos R, Qureshi SA, Rosenthal E, et al. Determinents of hemodynamic results of balloon dilation of aortic recoarctation. Am J Cardiol. 1992;69:665-71.

  86. Reich O, Tax P, Bartakova H, et al. Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents. Eur Heart J. Aug 2008;29(16):2042-8.

  87. Yetman AT, Nykanen D, McCrindle BW, Sunnegardh J, Adatia I, Freedom RM. Balloon angioplasty of recurrent coarctation: a 12-year review. J Am Coll Cardiol. Sep 1997;30(3):811-6. [Medline].

  88. Minich LL, Beekman RH, Rocchini AP, et al. Surgical repair is safe and effective after unsuccessful balloon angioplasty of native coarctation of the aorta. J Am Coll Cardiol. 1993;19:389-3.

  89. Zollikofer CL, Antonucci F, Stuckmann G, Mattias P, Salomonowitz EK. Historical overview on the development and characteristics of stents and future outlooks. Cardiovasc Intervent Radiol. Sep-Oct 1992;15(5):272-8. [Medline].

  90. Rao PS. Stents in treatment of aortic coarctation. J Am Coll Cardiol. Dec 1997;30(7):1853-5. [Medline].

  91. O'Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation. Jun 1991;83(6):1923-39. [Medline].

  92. Reddington AN, Hayes AM, Ho SY:. Transcatheter stent implantation to treat aortic coarctation in infancy. Br Heart J. 1993;69:80-2.

  93. Suarez de Lezo J, Pan M, et al. Balloon-expandable stent repair of severe coarctation of aorta. Am Heart J. May 1995;129(5):1002-8. [Medline].

  94. Rosenthal E, Qureshi SA, Tynan M. Stent implantation for aortic recoarctation. Am Heart J. Jun 1995;129(6):1220-1. [Medline].

  95. Bulbul ZR, Bruckheimer E, Love JC, Fahey JT, Hellenbrand WE. Implantation of balloon-expandable stents for coarctation of the aorta: implantation data and short-term results. Cathet Cardiovasc Diagn. Sep 1996;39(1):36-42. [Medline].

  96. Chander JS, Wolfe SB, Rao PS. Role of stents in the management of congenital heart disease. J Invasive Cardiol. 1996;8:314-25.

  97. Thanopoulos BV, Triposkiadis F, Margetakis A, Mullins CE. Long segment coarctation of the thoracic aorta: treatment with multiple balloon-expandable stent implantation. Am Heart J. Apr 1997;133(4):470-3. [Medline].

  98. Ebeid MR, Prieto LR, Latson LA. Use of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol. Dec 1997;30(7):1847-52. [Medline].

  99. Suarez de Lezo J, Pan M, Romero M, Medina A, Segura J, Lafuente M. Immediate and follow-up findings after stent treatment for severe coarctation of aorta. Am J Cardiol. Feb 1 1999;83(3):400-6. [Medline].

  100. Thanopoulos BD, Hadjinikolaou L, Konstadopoulou GN, et al. Stent treatment for coarctation of the aorta: intermediate-term follow-up and technical considerations. Heart. 1999;84:65-70.

  101. Magee AG, Brzezinsk-Rajszys G, Qureshi SA, et al. Stent implantation for aortic coarctation and re-coarctation. Heart. 1999;82:600-6.

  102. Marshall AC, Perry SB, Keane JF, Lock JE. Early results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation. Am Heart J. Jun 2000;139(6):1054-60. [Medline].

  103. Harrison DA, McLaughlin PR, Lazzam C, Connelly M, Benson LN. Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up. Heart. May 2001;85(5):561-6. [Medline].

  104. Cheatham JP. Stenting of coarctation of the aorta. Cathet Cardiovascu Intervent. 2001;54:112-25.

  105. Ledesma M, Alva C, Gomez FD, et al. Results of stenting for aortic coarctation. Am J Cardiol. Aug 15 2001;88(4):460-2. [Medline].

  106. Hamdan MA, Maheshwari S, Fahey JT, Hellenbrand WE. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol. Nov 1 2001;38(5):1518-23. [Medline].

  107. Santoro G, Carminati M, Bigazzi MC, Palladino MT, Russo MG, Sarubbi B. Primary stenting of native aortic coarctation. Tex Heart Inst J. 2001;28(3):226-7. [Medline].

  108. Tyagi S, Singh S, Mukhopadhyay S, Kaul UA. Self- and balloon-expandable stent implantation for severe native coarctation of the aorta in adults. Am Heart J. 2003;146:920-8.

  109. Rao PS. Edited by Rao PS, Kern MJ. Newer stents in the management of vascular stenosis in children. In: Catheter Based Devices in the Treatment of Non-coronary Cardiovascular Disease in Adults and Children. Philadelphia, PA: Lippincott, William & Wilkins; 2003:369-378.

  110. Pedra CA, Fontes VF, Esteves CA, Pilla CB, Braga SL, Pedra SR. Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults. Catheter Cardiovasc Interv. Apr 2005;64(4):495-506. [Medline].

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

  112. Holzer RJ, Chisolm JL, Hill SL, Cheatham JP. Stenting complex aortic arch obstructions. Catheter Cardiovasc Interv. Feb 15 2008;71(3):375-82. [Medline].

  113. Rao PS. Current status of balloon angioplasty for neonatal and infant aortic coarctation. Prog Pediatr Cardiol. 2001;14:35-44.

  114. Dehghani P, Collins N, Benson L, Horlick E. Role of routine radial artery access during aortic coarctation interventions. Catheter Cardiovasc Interv. Oct 1 2007;70(4):622-3. [Medline].

  115. Recto MR, Ing FF, Grifka RG, Nihill MR, Mullins CE. A technique to prevent newly implanted stent displacement during subsequent catheter and sheath manipulation. Catheter Cardiovasc Interv. Mar 2000;49(3):297-300. [Medline].

  116. Bonnhoeffer P, Piechaud J, Stumper O, et al. The multi-track angiography catheter: a new tool for complex catheterization in congenital heart disease. Heart. 1996;76:173-7.

  117. Forbes TJ, Moore P, Pedra CA, Zahn EM, Nykanen D, Amin Z. Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta. Catheter Cardiovasc Interv. Oct 1 2007;70(4):569-77. [Medline].

  118. Amirghofran AA, Peiravian F, Borzoee M, Emaminia A, Mollazadeh R. A wandering stent in the ascending aorta. J Cardiovasc Med (Hagerstown). Sep 2008;9(9):969-70. [Medline].

  119. Rohit MK, Garg PK, Talwar K. Stent fracture after stent therapy for aortic coarctation: nightmares in invasive cardiology. Indian Heart J. Jan-Feb 2007;59(1):77-9. [Medline].

  120. Qureshi AM, McElhinney DB, Lock JE, Landzberg MJ, Lang P, Marshall AC. Acute and intermediate outcomes, and evaluation of injury to the aortic wall, as based on 15 years experience of implanting stents to treat aortic coarctation. Cardiol Young. Jun 2007;17(3):307-18. [Medline].

  121. Schaeffler R, Kolax T, Hesse C, Peuster M. Implantation of stents for treatment of recurrent and native coarctation in children weighing less than 20 kilograms. Cardiol Young. Dec 2007;17(6):617-22. [Medline].

  122. Al-Ata J, Arfi AM, Hussain A, Kouatly A, Galal MO. Stent angioplasty: an effective alternative in selected infants with critical native aortic coarctation. Pediatr Cardiol. May-Jun 2007;28(3):183-92. [Medline].

  123. Hijazi ZM, Fahey JT, Kleinman CS, Hellenbrand WE. Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results. Circulation. Sep 1991;84(3):1150-6. [Medline].

  124. Duke C, Rosenthal E, Qureshi SA. The efficacy and safety of stent redilatation in congenital heart disease. Heart. Aug 2003;89(8):905-12. [Medline].

  125. Zabal C, Attie F, Rosas M, Buendia-Hernandez A, Garcia-Montes JA. The adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting?. Heart. Jan 2003;89(1):77-83. [Medline].

  126. Macdonald S, Thomas SM, Cleveland TJ, Gaines PA. Angioplasty or stenting in adult coarctation of the aorta? A retrospective single center analysis over a decade. Cardiovasc Intervent Radiol. Jul-Aug 2003;26(4):357-64. [Medline].

  127. Anagnostopoulos-Tzifa A. Management of aortic coarctation in adults: endovascular versus surgical therapy. Hellenic J Cardiol. Sep-Oct 2007;48(5):290-5. [Medline].

  128. Weber HS, Cyran SE. Endovascular stenting for native coarctation of the aorta is an effective alternative to surgical intervention in older children. Congenit Heart Dis. Jan 2008;3(1):54-9. [Medline].

  129. Gunn J, Cleveland T, Gaines P. Covered stent to treat co-existent coarctation and aneurysm of the aorta in a young man. Heart. Sep 1999;82(3):351. [Medline].

  130. De Giovanni JV. Covered stents in the treatment of aortic coarctation. J Intervent Cardiol. 2001;14:187-90.

  131. Forbes T, Matisoff D, Dysart J, Aggarwal S. Treatment of coexistent coarctation and aneurysm of the aorta with covered stent in a pediatric patient. Pediatr Cardiol. May-Jun 2003;24(3):289-91. [Medline].

  132. Ewert P, Peters B, Nagdyman N, Miera O, Kuhne T, Berger F. Early and mid-term results with the Growth Stent--a possible concept for transcatheter treatment of aortic coarctation from infancy to adulthood by stent implantation?. Catheter Cardiovasc Interv. Jan 1 2008;71(1):120-6. [Medline].

  133. Duggal B, Radhakrishnan S, Mathur A, Khurana P, Shrivastava S. Covered stents deployed for coarctation of aorta with aneurysm. Indian Heart J. Jul-Aug 2005;57(4):346-9. [Medline].

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

  135. Eicken A, Kaemmerer H, Ewert P. Treatment of aortic isthmus atresia with a covered stent. Catheter Cardiovasc Interv. Nov 15 2008;72(6):844-6. [Medline].

  136. Preventza O, Wheatley GH 3rd, Williams J, Ramaiah VG, Rodriguez-Lopez JA, Diethrich EB. Novel endovascular repair of the small thoracic aorta: customizing off-the-shelf endoluminal grafts. J Card Surg. Sep-Oct 2007;22(5):434-5. [Medline].

  137. Collins N, Mahadevan V, Horlick E. Aortic rupture following a covered stent for coarctation: delayed recognition. Catheter Cardiovasc Interv. Oct 2006;68(4):653-5. [Medline].

  138. Butera G, Gaio G, Carminati M. Redilation of e-PTFE covered CP stents. Catheter Cardiovasc Interv. Aug 1 2008;72(2):273-7. [Medline].

  139. Forbes TJ, Kim DW, Du W, et al. Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am Coll Cardiol. Dec 13 2011;58(25):2664-74. [Medline].

  140. Rao PS, Koscik R. Validation of risk factors in predicting recoarctation following initially successful balloon angioplasty of native aortic coarctations. Am Heart J. 1995;130:116-21.

  141. Kaine SF, Smith EO, Mott AR, Mullins CE, Geva T. Quantitative echocardiographic analysis of the aortic arch predicts outcome of balloon angioplasty of native coarctation of the aorta. Circulation. Sep 1 1996;94(5):1056-62. [Medline].

  142. Rao PS, Waterman B. Relation of biophysical response of coarcted aortic segment to balloon dilatation with development of recoarctation following balloon angioplasty of native coarctation. Heart. Apr 1998;79(4):407-11. [Medline].

  143. Isner JM, Donaldson RF, Fulton D, Bhan I, Payne DD, Cleveland RJ. Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites. Circulation. Apr 1987;75(4):689-95. [Medline].

  144. Ho SY, Somerville J, Yip WC, Anderson RH. Transluminal balloon dilation of resected coarcted segments of thoracic aorta: histological study and clinical implications. Int J Cardiol. Apr 1988;19(1):99-105. [Medline].

  145. Elzenga NH, Gittenberger-de Groot AC, Oppenhein-Dekker A. Coarctation and obstructive aortic arch anomalies; their relationship to the ductus arteriosus. Int J Cardiol. 1986;13:289-308.

  146. Russell GA, Berry PJ, Watterson K, Dhasmana JP, Wisheart JD. Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg. Oct 1991;102(4):596-601. [Medline].

  147. Tamai H, Igaki K, Kyo E, Kosuga K, Kawashima A, Matsui S. Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. Circulation. Jul 25 2000;102(4):399-404. [Medline].

  148. Schranz D, Zartner P, Michel-Behnke I, Akinturk H. Bioabsorbable metal stents for percutaneous treatment of critical recoarctation of the aorta in a newborn. Catheter Cardiovasc Interv. May 2006;67(5):671-3. [Medline].

  149. Ewert P, Abdul-Khaliq H, Peters B, Nagdyman N, Schubert S, Lange PE. Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents. Catheter Cardiovasc Interv. Oct 2004;63(2):236-9. [Medline].

  150. Morris CD, Reller MD, Menashe VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA. Feb 25 1998;279(8):599-603. [Medline].

  151. Bobby JJ, Emami JM, Farmer RD, Newman CG. Operative survival and 40 year follow up of surgical repair of aortic coarctation. Br Heart J. May 1991;65(5):271-6. [Medline].

  152. Saidi AS, Bezold LI, Altman CA, Ayres NA, Bricker JT. Outcome of pregnancy following intervention for coarctation of the aorta. Am J Cardiol. Sep 15 1998;82(6):786-8. [Medline].

  153. Crafoord O, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Cardiovasc Surg. 1945;14:347-361.

  154. Dotter CT. Transluminally placed coil spring endarterial grafts. Invest Radiol. 1969;4:654-70.

  155. Gross RE, Hufnagl CA. Coarctation of the aorta: experimental studies regarding its surgical correction. N Engl J Med. 1945;233:287-291.

  156. Haji-Zeinali AM, Ghasemi M. Coarctoplasty with self-expandable stent implantation for treatment of coarctation of aorta in adults. Arch Iran Med. Oct 2006;9(4):348-53. [Medline].

  157. Ho SY, Anderson RH. Coarctation, tubular hypoplasia, and the ductus arteriosus. Histological study of 35 specimens. Br Heart J. Mar 1979;41(3):268-74. [Medline].

  158. Lababidi Z, Madigan N, Wu JR, Murphy TJ. Balloon coarctation angioplasty in an adult. Am J Cardiol. Jan 15 1984;53(2):350-1. [Medline].

  159. McCrindle BW, Jones TK, Morrow WR, Hagler DJ, Lloyd TR, Nouri S. Acute results of balloon angioplasty of native coarctation versus recurrent aortic obstruction are equivalent. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. J Am Coll Cardiol. Dec 1996;28(7):1810-7. [Medline].

  160. Qureshi SA, Zubrzycka M, Brzezinska-Rajszys G, Kosciesza A, Ksiazyk J. Use of covered Cheatham-Platinum stents in aortic coarctation and recoarctation. Cardiol Young. Feb 2004;14(1):50-4. [Medline].

  161. Rao PS. Faculty of 1000 Medicine: Evaluation of Cowley CG et al. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation. 2005; Jun 28;111 (25):3453-6. [Full Text].

  162. Rao PS. Fatal aortic rupture following balloon angioplasty of aortic recoarctation. Br Heart J. 1991;66:406-7.

  163. Rao PS. Pseudoaneurysm following balloon angioplasty of aortic coarctation (Editorial). Am Heart J. 1993;125:1205-6.

  164. Rao PS. Coarctation of the aorta. In: Ram CVS (ed). Secondary Forms of Hypertension, Seminars in Nephrology, Kurtzman NA (ed). 15(2). Philadelphia, PA: W.B. Saunders; 1995:81-105.

  165. Rao PS. Balloon angioplasty of native aortic coarctation. In: Rao PS (ed). Transcatheter Therapy in Pediatric Cardiology. New York, NY: Wiley-Liss; 1993:pp. 153-196.

  166. Rao PS. Transcatheter treatment of pulmonary stenosis and coarctation of the aorta: experience with percutaneous balloon dilatation. Br Heart J. Sep 1986;56(3):250-8. [Medline].

  167. Rao PS, Balfour IC, Singh GK, Jureidini SB, Chen S. Bridge stents in the management of obstructive vascular lesions in children. Am J Cardiol. Sep 15 2001;88(6):699-702. [Medline].

  168. Rao PS, Thapar MK, Kutayli F, Carey P. Causes of recoarctation after balloon angioplasty of unoperated aortic coarctation. J Am Coll Cardiol. Jan 1989;13(1):109-15. [Medline].

  169. Rao PS, Wilson AD, Brazy J. Transumbilical balloon coarctation angioplasty in neonates with critical aortic coarctation. Am Heart J. Dec 1992;124(6):1622-4. [Medline].

  170. Rao PS. Rao PS (ed). Balloon angioplasty for aortic recoarctation following previous surgery in Transcatheter Therapy in Pediatric Cardiology. New York, NY: Wiley-Liss; 1993:pp. 197-212.

  171. Rao PS. Technique of balloon valvuloplasty. In: Rao PS (ed). Transcatheter Therapy in Pediatric Cardiology, Wiley-Liss. New York, NY: 1993:pp 29-44.

  172. Siblini G, Rao PS, Nouri S, Ferdman B, Jureidini SB, Wilson AD. Long-term follow-up results of balloon angioplasty of postoperative aortic recoarctation. Am J Cardiol. Jan 1 1998;81(1):61-7. [Medline].

  173. Sos T, Sniderman KW, Rettek-Sos B, Strupp A, Alonso DR. Percutaneous transluminal dilatation of coarctation of thoracic aorta post mortem. Lancet. Nov 3 1979;2(8149):970-1. [Medline].

  174. Sperling DR, Dorsey TJ, Rowen M, Gazzaniga AB. Percutaneous transluminal angioplasty of congenital coarctation of the aorta. Am J Cardiol. Feb 1983;51(3):562-4. [Medline].

  175. Wong D, Benson LN, Van Arsdell GS, Karamlou T, McCrindle BW. Balloon angioplasty is preferred to surgery for aortic coarctation. Cardiol Young. Feb 2008;18(1):79-88. [Medline].

  176. Zellers TM. Balloon angioplasty for recurrent coarctation of the aorta in patients following staged palliation for hypoplastic left heart syndrome. Am J Cardiol. Jul 15 1999;84(2):231-3, A9. [Medline].

 
Previous
Next
 
Aortic coarctation visualized by aortic angiography.
Aortic coarctation visualized by MR imaging.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.