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Sections Coarctation of the Aorta
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Guidelines
- Medication
- Follow-up
- Questions & Answers
- Media Gallery
- References
Diagnostic Considerations
Important considerations
Do not fail to diagnose coarctation of the aorta (CoA). Hypertensive patients may be treated well into adolescence or adulthood without consideration of the diagnosis of coarctation by physicians. When these patients exhibit complications of coarctation, such as a ruptured cerebral aneurysm, significant repercussions may ensue.
Patients may refuse the administration of blood products and yet need repair. This may be particularly true of infants whose parents refuse the use of blood products. In these patients, consider balloon dilation of a native coarctation to achieve temporary or even permanent relief of obstruction.
Physicians may reduce the risk of paralysis by careful attention to documenting the extent of arterial collateral flow prior to surgical repair in patients with native or recurrent coarctation. Multiple precautionary measures, including Gott shunt, may be used if the status of collateral vessels is uncertain.
Cardiac catheterization, if necessary to document the extent of collateral vessels, allows intraoperative measures to protect the spinal cord and to avoid paralysis.
Special concerns
After successful repair of coarctation of the aorta, pregnancy should be well tolerated. [31] Prenatal care should include careful monitoring of blood pressure (BP), since hypervolemia in pregnancy may contribute to worsening hypertension, especially in patients with some degree of residual obstruction or preexisting hypertension. The presence of other associated lesions, such as aortic valve disease, may further complicate obstetrical management. Anecdotal cases document aortic rupture during pregnancy.
Differential Diagnoses
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Shock
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Trauma with Aortic Dissection
Rao PS. Should balloon angioplasty be used instead of surgery for native aortic coarctation?. Br Heart J. 1995 Dec. 74(6):578-9. [QxMD MEDLINE Link].
Rudolph AM, Heymann MA, Spitznas U. Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol. 1972 Oct. 30(5):514-25. [QxMD MEDLINE Link].
Talner NS, Berman MA. Postnatal development of obstruction in coarctation of the aorta: role of the ductus arteriosus. Pediatrics. 1975 Oct. 56(4):562-9. [QxMD MEDLINE Link].
Cassels DE. The Ductus Arteriosus. Springfield, IL: Charles C. Thomas; 1973. 161.
Skoda J. Demonstration eines Falles Ven Obliteration de Aorta. Wochenblatt Zeischrift de kaiserlichen-Konighiche Gesellschaft der Aerttze Zur Wien. 1995. 1:710-20.
Goldblatt H, Kahn JR, Hanzal RF. Studies on experimental hypertension: IX. The effect on blood pressure of constriction of the abdominal aorta above and below the site of origin of both main renal arteries. J Exp Med. 1939 Apr 30. 69(5):649-74. [QxMD MEDLINE Link].
Scott HW Jr, Bahnson HT. Evidence for a renal factor in the hypertension of experimental coarctation of the aorta. Surgery. 1951 Jul. 30(1):206-17. [QxMD MEDLINE Link].
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. 1954 Sep. 36(3):445-59. [QxMD MEDLINE Link].
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. 1979 Apr. 43(4):828-34. [QxMD MEDLINE Link].
Bagby SB. Dissection of pathogenetic factors: I. Coarctation hypertension. Loggie JMH, Horan MJ, Hohn AR, et al, eds. Proceedings of the NHLBI Workshop on Juvenile Hypertension. New York, NY: Biomedical Information Corp; 1984. 253-66.
Gersony WM. Coarctation of the aorta. Adams FH, Emmanouildes GC, Riemenschneider TA, eds. Moss' Heart Disease in Infants, Children and Adolescents. 4th ed. Baltimore, MD: Williams & Wilkins; 1989. 243-55.
Cody RJ. Hormonal alterations in heart failure. Hosenpud JD, Greenberg BH, eds. Congestive Heart Failure: Pathophysiology, Diagnosis and Comprehensive Approach to Management. 2nd ed. Lippincott Williams & Wilkins: 2000. 199-212.
Nadas, AS, Fyler DC. Pediatric Cardiology. 3rd ed. Philadelphia, PA: Saunders; 1972. 683.
Keith JD, Rowe RD, Vlad P. Heart Disease in Infancy and Childhood. 3rd ed. New York, NY: Macmillan; 1978. 4-6.
Rao PS. Balloon angioplasty of native aortic coarctation. J Am Coll Cardiol. 1992 Sep. 20(3):750-1. [QxMD MEDLINE Link].
Rao PS. Coarctation of the aorta. Ram CVS, ed. Secondary Forms of Hypertension; Seminars in Nephrology, Kurtzman NA, ed. Philadelphia, PA: WB Saunders; 1995. 15(2): 81-105.
Bobby JJ, Emami JM, Farmer RD, Newman CG. Operative survival and 40 year follow up of surgical repair of aortic coarctation. Br Heart J. 1991 May. 65(5):271-6. [QxMD MEDLINE Link].
Oliver JM, Gallego P, Gonzalez AE, et al. Pulmonary hypertension in young adults with repaired coarctation of the aorta: an unrecognised factor associated with premature mortality and heart failure. Int J Cardiol. 2014 Jun 15. 174(2):324-9. [QxMD MEDLINE Link].
Campbell M. Natural history of coarctation of the aorta. Br Heart J. 1970 Sep. 32(5):633-40. [QxMD MEDLINE Link].
Crawford FA, Sade RB. Spinal cord injury associated with hyperthermia during aortic coarctation repair. J Thorac Cardiovasc Surg. 1984. 87:610-6.
Brewer LA 3rd, Fosburg RG, Mulder GA, Verska JJ. Spinal cord complications following surgery for coarctation of the aorta. A study of 66 cases. J Thorac Cardiovasc Surg. 1972 Sep. 64(3):368-81. [QxMD MEDLINE Link].
Sealy WC, Harris JS, Young WG Jr, Callaway HA Jr. Paradoxical hypertension following resection of coarctation of aorta. Surgery. 1957 Jul. 42(1):135-47. [QxMD MEDLINE Link].
Ho EC, Moss AJ. The syndrome of "mesenteric arteritis" following surgical repair of aortic coarctation. Report of nine cases and review of the literature. Pediatrics. 1972 Jan. 49(1):40-5. [QxMD MEDLINE Link].
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. 2008 Aug. 136(2):321-8. [QxMD MEDLINE Link].
Strafford MA, Griffiths SP, Gersony WM. Coarctation of the aorta: a study in delayed detection. Pediatrics. 1982 Feb. 69(2):159-63. [QxMD MEDLINE Link].
Thoele DG, Muster AJ, Paul MH. Recognition of coarctation of the aorta. A continuing challenge for the primary care physician. Am J Dis Child. 1987 Nov. 141(11):1201-4. [QxMD MEDLINE Link].
Norton JB Jr. Coarctation of the aorta. Moller JH, ed. Surgery of Congenital Heart Disease: Pediatric Cardiac Care Consortium. Armonk, NY: Futura Publishing Co; 1984-1995. 143-57.
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. 1991 Dec. 122(6):1772-5. [QxMD MEDLINE Link].
Ing FF, Starc TJ, Griffiths SP, Gersony WM. Early diagnosis of coarctation of the aorta in children: a continuing dilemma. Pediatrics. 1996 Sep. 98(3 Pt 1):378-82. [QxMD MEDLINE Link].
Nora JJ. Multifactorial inheritance hypothesis for the etiology of congenital heart diseases. The genetic-environmental interaction. Circulation. 1968 Sep. 38(3):604-17. [QxMD MEDLINE Link].
Saidi AS, Bezold LI, Altman CA, Ayres NA, Bricker JT. Outcome of pregnancy following intervention for coarctation of the aorta. Am J Cardiol. 1998 Sep 15. 82(6):786-8. [QxMD MEDLINE Link].
Rao PS, Carey P. Doppler ultrasound in the prediction of pressure gradients across aortic coarctation. Am Heart J. 1989 Aug. 118(2):299-307. [QxMD MEDLINE Link].
Silvilairat S, Cetta F, Biliciler-Denktas G, et al. Abdominal aortic pulsed wave Doppler patterns reliably reflect clinical severity in patients with coarctation of the aorta. Congenit Heart Dis. 2008 Nov-Dec. 3(6):422-30. [QxMD MEDLINE Link].
Mohiaddin RH, Kilner PJ, Rees S, Longmore DB. Magnetic resonance volume flow and jet velocity mapping in aortic coarctation. J Am Coll Cardiol. 1993 Nov 1. 22(5):1515-21. [QxMD MEDLINE Link].
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. 1999 Jun 15. 99(23):3086-7. [QxMD MEDLINE Link].
Goubergrits L, Riesenkampff E, Yevtushenko P, et al. MRI-based computational fluid dynamics for diagnosis and treatment prediction: clinical validation study in patients with coarctation of aorta. J Magn Reson Imaging. 2015 Apr. 41(4):909-16. [QxMD MEDLINE Link].
Rao PS, Chopra PS. Role of balloon angioplasty in the treatment of aortic coarctation. Ann Thorac Surg. 1991 Sep. 52(3):621-31. [QxMD MEDLINE Link].
Rao PS, Chopra PS, Koscik R, Smith PA, Wilson AD. Surgical versus balloon therapy for aortic coarctation in infants < or = 3 months old. J Am Coll Cardiol. 1994 May. 23(6):1479-83. [QxMD MEDLINE Link].
[Guideline] Lopez-Sendon J, Swedberg K, McMurray J, et al. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J. 2004 Aug. 25(15):1341-62. [QxMD MEDLINE Link].
Frobel AK, Hulpke-Wette M, Schmidt KG, Laer S. Beta-blockers for congestive heart failure in children. Cochrane Database Syst Rev. 2009 Jan 21. CD007037. [QxMD MEDLINE Link].
Liberthson RR, Pennington DG, Jacobs ML, Daggett WM. Coarctation of the aorta: review of 234 patients and clarification of management problems. Am J Cardiol. 1979 Apr. 43(4):835-40. [QxMD MEDLINE Link].
Lacour-Gayet F, Bruniaux J, Serraf A, et al. Hypoplastic transverse arch and coarctation in neonates. Surgical reconstruction of the aortic arch: a study of sixty-six patients. J Thorac Cardiovasc Surg. 1990 Dec. 100(6):808-16. [QxMD MEDLINE Link].
Krauser DG, Rutkowski M, Phoon CK. Left ventricular volume after correction of isolated aortic coarctation in neonates. Am J Cardiol. 2000 Apr 1. 85(7):904-7, A10. [QxMD MEDLINE Link].
Pinzon JL, Burrows PE, Benson LN, et al. Repair of coarctation of the aorta in children: postoperative morphology. Radiology. 1991 Jul. 180(1):199-203. [QxMD MEDLINE Link].
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. 1991 May. 17(6):1367-72. [QxMD MEDLINE Link].
Parks WJ, Ngo TD, Plauth WH Jr, et al. 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. 1995 Jul. 26(1):266-71. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Rao PS. Neurologic complications following balloon angioplasty. Pediat Cardiol. 1993. 14:63-4.
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. 1992 Aug. 20(2):381-5. [QxMD MEDLINE Link].
Connolly JE. Hume Memorial lecture. Prevention of spinal cord complications in aortic surgery. Am J Surg. 1998 Aug. 176(2):92-101. [QxMD MEDLINE Link].
Kittle CF, Schafer PW. Gangrene of the forearm after subclavian arterioaortostomy for coarctation of the aorta. Thorax. 1953 Dec. 8(4):319-22. [QxMD MEDLINE Link].
Geiss D, Williams WG, Lindsay WK, Rowe RD. Upper extremity gangrene: a complication of subclavian artery division. Ann Thorac Surg. 1980 Nov. 30(5):487-9. [QxMD MEDLINE Link].
Todd PJ, Dangerfield PH, Hamilton DI, Wilkinson JL. Late effects on the left upper limb of subclavian flap aortoplasty. J Thorac Cardiovasc Surg. 1983 May. 85(5):678-81. [QxMD MEDLINE Link].
van Son JA, van Asten WN, van Lier HJ, et al. Detrimental sequelae on the hemodynamics of the upper left limb after subclavian flap angioplasty in infancy. Circulation. 1990 Mar. 81(3):996-1004. [QxMD MEDLINE Link].
Maddali MM, Menon RG, Valliattu J, Maimouna HA. Left upper limb shortening following reverse flap subclavian artery angioplasty. Asian Cardiovasc Thorac Ann. 2008 Aug. 16(4):346-7. [QxMD MEDLINE Link].
Chen SS, Dimopoulos K, Alonso-Gonzalez R, et al. Prevalence and prognostic implication of restenosis or dilatation at the aortic coarctation repair site assessed by cardiovascular MRI in adult patients late after coarctation repair. Int J Cardiol. 2014 May 1. 173(2):209-15. [QxMD MEDLINE Link].
O'Sullivan J. Late hypertension in patients with repaired aortic coarctation. Curr Hypertens Rep. 2014 Mar. 16(3):421. [QxMD MEDLINE Link].
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. 1996 Feb. 27(2):462-70. [QxMD MEDLINE Link].
Rao PS. Balloon angioplasty for coarctation of the aorta in infancy. J Pediatr. 1987 May. 110(5):713-8. [QxMD MEDLINE Link].
Rao PS. Current status of balloon angioplasty for neonatal and infant aortic coarctation. Progress Pediat Cardiol. 2001. 14(1):35-44.
Rao PS. Demographic features of tricuspid atresia. Rao PS, ed. Tricuspid Atresia. 2nd ed. Mount Kisco, NY: Futura; 1992. 23-37.
Treacy EP, Duncan WJ, Tyrrell MJ, Lowry NJ. Neurological complications of balloon angioplasty in children. Pediatr Cardiol. 1991 Apr. 12(2):98-101. [QxMD MEDLINE Link].
Lock JE, Bass JL, Amplatz K, Fuhrman BP, Castaneda-Zuniga W. Balloon dilation angioplasty of aortic coarctations in infants and children. Circulation. 1983 Jul. 68(1):109-16. [QxMD MEDLINE Link].
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. 1996 Aug. 132(2 Pt 1):403-7. [QxMD MEDLINE Link].
Rao PS, Wilson AD, Chopra PS. Immediate and follow-up results of balloon angioplasty of postoperative recoarctation in infants and children. Am Heart J. 1990 Dec. 120(6 Pt 1):1315-20. [QxMD MEDLINE Link].
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. 1990 Mar 15. 65(11):790-2. [QxMD MEDLINE Link].
Rao PS. Should balloon angioplasty be used as a treatment of choice for native aortic coarctations?. J Invasive Cardiol. 1996 Sep. 8(7):301-13. [QxMD MEDLINE Link].
Rao PS. Stents in the management of congenital heart disease in pediatric and adult patients. Indian Heart J. 2001 Nov-Dec. 53(6):714-30. [QxMD MEDLINE Link].
Rao PS, Jureidini SB, Balfour IC, Singh GK, Chen SC. Severe aortic coarctation in infants less than 3 months: successful palliation by balloon angioplasty. J Invasive Cardiol. 2003 Apr. 15(4):202-8. [QxMD MEDLINE Link].
Lababidi Z. Percutaneous balloon coarctation angioplasty: long-term results. J Interv Cardiol. 1992 Mar. 5(1):57-62. [QxMD MEDLINE Link].
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. 1999 Jul-Aug. 42(1):59-74. [QxMD MEDLINE Link].
Attia IM, Lababidi ZA. Early results of balloon angioplasty of native aortic coarctation in young adults. Am J Cardiol. 1988 Apr 15. 61(11):930-1. [QxMD MEDLINE Link].
Rao PS. Coarctation of the aorta. Curr Cardiol Rep. 2005 Nov. 7(6):425-34. [QxMD MEDLINE Link].
Fawzy ME, Fathala A, Osman A, et al. Twenty-two years of follow-up results of balloon angioplasty for discreet native coarctation of the aorta in adolescents and adults. Am Heart J. 2008 Nov. 156(5):910-7. [QxMD MEDLINE Link].
Shaddy RE, Boucek MM, Sturtevant JE, et al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation. 1993 Mar. 87(3):793-9. [QxMD MEDLINE Link].
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. 1997 Apr 15. 79(8):1143-6. [QxMD MEDLINE Link].
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.
Cooper RS, Ritter SB, Rothe WB, Chen CK, Griepp R, Golinko RJ. Angioplasty for coarctation of the aorta: long-term results. Circulation. 1987 Mar. 75(3):600-4. [QxMD MEDLINE Link].
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. 2005 Jun 28. 111(25):3453-6. [QxMD MEDLINE Link].
Rodes-Cabau J, Miro J, Dancea A, et al. 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. 2007 Jul. 154(1):186-92. [QxMD MEDLINE Link].
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. 2008 Feb. 18(1):18-21. [QxMD MEDLINE Link].
Rao PS. Balloon angioplasty of aortic coarctation: a review. Clin Cardiol. 1989 Nov. 12(11):618-28. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Bacha EA. Long-term outcomes after coarctation repair in infancy. Cardiology. 2009. 112(1):35. [QxMD MEDLINE Link].
Singer MI, Rowen M, Dorsey TJ. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J. 1982 Jan. 103(1):131-2. [QxMD MEDLINE Link].
Kan JS, White RI Jr, Mitchell SE, Farmlett EJ, Donahoo JS, Gardner TJ. Treatment of restenosis of coarctation by percutaneous transluminal angioplasty. Circulation. 1983 Nov. 68(5):1087-94. [QxMD MEDLINE Link].
Hess J, Mooyaart EL, Busch HJ, Bergstra A, Landsman ML. Percutaneous transluminal balloon angioplasty in restenosis of coarctation of the aorta. Br Heart J. 1986 May. 55(5):459-61. [QxMD MEDLINE Link].
Lorber A, Ettedgui JA, Baker EJ, Jones OD, Reidy J, Tynan M. Balloon aortoplasty for recoarctation following the subclavian flap operation. Int J Cardiol. 1986 Jan. 10(1):57-63. [QxMD MEDLINE Link].
Saul JP, Keane JF, Fellows KE, Lock JE. Balloon dilation angioplasty of postoperative aortic obstructions. Am J Cardiol. 1987 Apr 15. 59(9):943-8. [QxMD MEDLINE Link].
Rao PS. Which aortic coarctations should we balloon-dilate?. Am Heart J. 1989 Apr. 117(4):987-9. [QxMD MEDLINE Link].
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. 1990 Mar 15. 65(11):793-7. [QxMD MEDLINE Link].
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.
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. 2008 Aug. 29(16):2042-8.
Yetman AT, Nykanen D, McCrindle BW, et al. Balloon angioplasty of recurrent coarctation: a 12-year review. J Am Coll Cardiol. 1997 Sep. 30(3):811-6. [QxMD MEDLINE Link].
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.
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. 1992 Sep-Oct. 15(5):272-8. [QxMD MEDLINE Link].
Rao PS. Stents in treatment of aortic coarctation. J Am Coll Cardiol. 1997 Dec. 30(7):1853-5. [QxMD MEDLINE Link].
O'Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation. 1991 Jun. 83(6):1923-39. [QxMD MEDLINE Link].
Redington AN, Hayes AM, Ho SY. Transcatheter stent implantation to treat aortic coarctation in infancy. Br Heart J. 1993 Jan. 69(1):80-2. [QxMD MEDLINE Link]. [Full Text].
Suarez de Lezo J, Pan M, Romero M, et al. Balloon-expandable stent repair of severe coarctation of aorta. Am Heart J. 1995 May. 129(5):1002-8. [QxMD MEDLINE Link].
Rosenthal E, Qureshi SA, Tynan M. Stent implantation for aortic recoarctation. Am Heart J. 1995 Jun. 129(6):1220-1. [QxMD MEDLINE Link].
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. 1996 Sep. 39(1):36-42. [QxMD MEDLINE Link].
Chandar JS, Wolfe SB, Rao PS. Role of stents in the management of congenital heart defects. J Invasive Cardiol. 1996 Sep. 8(7):314-25. [QxMD MEDLINE Link].
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. 1997 Apr. 133(4):470-3. [QxMD MEDLINE Link].
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. 1997 Dec. 30(7):1847-52. [QxMD MEDLINE Link].
Suarez de Lezo J, Pan M, Romero M, et al. Immediate and follow-up findings after stent treatment for severe coarctation of aorta. Am J Cardiol. 1999 Feb 1. 83(3):400-6. [QxMD MEDLINE Link].
Thanopoulos BD, Hadjinikolaou L, Konstadopoulou GN, Tsaousis GS, Triposkiadis F, Spirou P. Stent treatment for coarctation of the aorta: intermediate term follow up and technical considerations. Heart. 2000 Jul. 84(1):65-70. [QxMD MEDLINE Link]. [Full Text].
Magee AG, Brzezinska-Rajszys G, Qureshi SA, et al. Stent implantation for aortic coarctation and recoarctation. Heart. 1999 Nov. 82(5):600-6. [QxMD MEDLINE Link]. [Full Text].
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. 2000 Jun. 139(6):1054-60. [QxMD MEDLINE Link].
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. 2001 May. 85(5):561-6. [QxMD MEDLINE Link].
Cheatham JP. Stenting of coarctation of the aorta. Catheter Cardiovasc Interv. 2001 Sep. 54(1):112-25. [QxMD MEDLINE Link].
Ledesma M, Alva C, Gomez FD, et al. Results of stenting for aortic coarctation. Am J Cardiol. 2001 Aug 15. 88(4):460-2. [QxMD MEDLINE Link].
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. 2001 Nov 1. 38(5):1518-23. [QxMD MEDLINE Link].
Santoro G, Carminati M, Bigazzi MC, et al. Primary stenting of native aortic coarctation. Tex Heart Inst J. 2001. 28(3):226-7. [QxMD MEDLINE Link].
Tyagi S, Singh S, Mukhopadhyay S, Kaul UA. Self- and balloon-expandable stent implantation for severe native coarctation of aorta in adults. Am Heart J. 2003 Nov. 146(5):920-8. [QxMD MEDLINE Link].
Rao PS. Newer stents in the management of vascular stenosis in children. Rao PS, Kern MJ, eds. Catheter Based Devices in the Treatment of Non-coronary Cardiovascular Disease in Adults and Children. Philadelphia, PA: Lippincott, William & Wilkins; 2003. 369-78.
Pedra CA, Fontes VF, Esteves CA, et al. Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults. Catheter Cardiovasc Interv. 2005 Apr. 64(4):495-506. [QxMD MEDLINE Link].
Golden AB, Hellenbrand WE. Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv. 2007 Feb 1. 69(2):289-99. [QxMD MEDLINE Link].
Holzer RJ, Chisolm JL, Hill SL, Cheatham JP. Stenting complex aortic arch obstructions. Catheter Cardiovasc Interv. 2008 Feb 15. 71(3):375-82. [QxMD MEDLINE Link].
Dehghani P, Collins N, Benson L, Horlick E. Role of routine radial artery access during aortic coarctation interventions. Catheter Cardiovasc Interv. 2007 Oct 1. 70(4):622-3. [QxMD MEDLINE Link].
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. 2000 Mar. 49(3):297-300. [QxMD MEDLINE Link].
Bonhoeffer P, Piechaud JF, Stumper O, et al. The multi-track angiography catheter: a new tool for complex catheterisation in congenital heart disease. Heart. 1996 Aug. 76(2):173-7. [QxMD MEDLINE Link].
Forbes TJ, Moore P, Pedra CA, et al. Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta. Catheter Cardiovasc Interv. 2007 Oct 1. 70(4):569-77. [QxMD MEDLINE Link].
Amirghofran AA, Peiravian F, Borzoee M, Emaminia A, Mollazadeh R. A wandering stent in the ascending aorta. J Cardiovasc Med (Hagerstown). 2008 Sep. 9(9):969-70. [QxMD MEDLINE Link].
Rohit MK, Garg PK, Talwar K. Stent fracture after stent therapy for aortic coarctation: nightmares in invasive cardiology. Indian Heart J. 2007 Jan-Feb. 59(1):77-9. [QxMD MEDLINE Link].
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. 2007 Jun. 17(3):307-18. [QxMD MEDLINE Link].
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. 2007 Dec. 17(6):617-22. [QxMD MEDLINE Link].
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. 2007 May-Jun. 28(3):183-92. [QxMD MEDLINE Link].
Hijazi ZM, Fahey JT, Kleinman CS, Hellenbrand WE. Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results. Circulation. 1991 Sep. 84(3):1150-6. [QxMD MEDLINE Link].
Duke C, Rosenthal E, Qureshi SA. The efficacy and safety of stent redilatation in congenital heart disease. Heart. 2003 Aug. 89(8):905-12. [QxMD MEDLINE Link].
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. 2003 Jan. 89(1):77-83. [QxMD MEDLINE Link].
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. 2003 Jul-Aug. 26(4):357-64. [QxMD MEDLINE Link].
Anagnostopoulos-Tzifa A. Management of aortic coarctation in adults: endovascular versus surgical therapy. Hellenic J Cardiol. 2007 Sep-Oct. 48(5):290-5. [QxMD MEDLINE Link].
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. 2008 Jan. 3(1):54-9. [QxMD MEDLINE Link].
Gunn J, Cleveland T, Gaines P. Covered stent to treat co-existent coarctation and aneurysm of the aorta in a young man. Heart. 1999 Sep. 82(3):351. [QxMD MEDLINE Link].
de Giovanni JV. Covered stents in the treatment of aortic coarctation. J Interv Cardiol. 2001 Apr. 14(2):187-90. [QxMD MEDLINE Link].
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. 2003 May-Jun. 24(3):289-91. [QxMD MEDLINE Link].
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. 2008 Jan 1. 71(1):120-6. [QxMD MEDLINE Link].
Duggal B, Radhakrishnan S, Mathur A, Khurana P, Shrivastava S. Covered stents deployed for coarctation of aorta with aneurysm. Indian Heart J. 2005 Jul-Aug. 57(4):346-9. [QxMD MEDLINE Link].
Butera G, Piazza L, Chessa M, et al. Covered stents in patients with complex aortic coarctations. Am Heart J. 2007 Oct. 154(4):795-800. [QxMD MEDLINE Link].
Eicken A, Kaemmerer H, Ewert P. Treatment of aortic isthmus atresia with a covered stent. Catheter Cardiovasc Interv. 2008 Nov 15. 72(6):844-6. [QxMD MEDLINE Link].
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. 2007 Sep-Oct. 22(5):434-5. [QxMD MEDLINE Link].
Collins N, Mahadevan V, Horlick E. Aortic rupture following a covered stent for coarctation: delayed recognition. Catheter Cardiovasc Interv. 2006 Oct. 68(4):653-5. [QxMD MEDLINE Link].
Butera G, Gaio G, Carminati M. Redilation of e-PTFE covered CP stents. Catheter Cardiovasc Interv. 2008 Aug 1. 72(2):273-7. [QxMD MEDLINE Link].
Sohrabi B, Jamshidi P, Yaghoubi A, et al. Comparison between covered and bare Cheatham-Platinum stents for endovascular treatment of patients with native post-ductal aortic coarctation: immediate and intermediate-term results. JACC Cardiovasc Interv. 2014 Apr. 7(4):416-23. [QxMD MEDLINE Link].
Hayes N, Podnar T, Qureshi S. Collapse of the Advanta V12 Large Diameter covered stent following implantation for aortic coarctation. Catheter Cardiovasc Interv. 2014 Jan 1. 83(1):109-14. [QxMD MEDLINE Link].
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. 2011 Dec 13. 58(25):2664-74. [QxMD MEDLINE Link].
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.
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. 1996 Sep 1. 94(5):1056-62. [QxMD MEDLINE Link].
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. 1998 Apr. 79(4):407-11. [QxMD MEDLINE Link].
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. 1987 Apr. 75(4):689-95. [QxMD MEDLINE Link].
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. 1988 Apr. 19(1):99-105. [QxMD MEDLINE Link].
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.
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. 1991 Oct. 102(4):596-601. [QxMD MEDLINE Link].
Tamai H, Igaki K, Kyo E, et al. Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. Circulation. 2000 Jul 25. 102(4):399-404. [QxMD MEDLINE Link].
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. 2006 May. 67(5):671-3. [QxMD MEDLINE Link].
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. 2004 Oct. 63(2):236-9. [QxMD MEDLINE Link].
Morris CD, Reller MD, Menashe VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA. 1998 Feb 25. 279(8):599-603. [QxMD MEDLINE Link].
Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg. 1945 Oct. 14:347-61.
Dotter CT. Transluminally-placed coilspring endarterial tube grafts. Long-term patency in canine popliteal artery. Invest Radiol. 1969 Sep-Oct. 4(5):329-32. [QxMD MEDLINE Link].
Gross RE, Hufnagel CA. Coarctation of the aorta: experimental studies regarding its surgical correction. N Engl J Med. 1945 Sept 6. 233(10):287-93.
Haji-Zeinali AM, Ghasemi M. Coarctoplasty with self-expandable stent implantation for treatment of coarctation of aorta in adults. Arch Iran Med. 2006 Oct. 9(4):348-53. [QxMD MEDLINE Link].
Ho SY, Anderson RH. Coarctation, tubular hypoplasia, and the ductus arteriosus. Histological study of 35 specimens. Br Heart J. 1979 Mar. 41(3):268-74. [QxMD MEDLINE Link].
Lababidi Z, Madigan N, Wu JR, Murphy TJ. Balloon coarctation angioplasty in an adult. Am J Cardiol. 1984 Jan 15. 53(2):350-1. [QxMD MEDLINE Link].
McCrindle BW, Jones TK, Morrow WR, et al. 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. 1996 Dec. 28(7):1810-7. [QxMD MEDLINE Link].
Qureshi SA, Zubrzycka M, Brzezinska-Rajszys G, Kosciesza A, Ksiazyk J. Use of covered Cheatham-Platinum stents in aortic coarctation and recoarctation. Cardiol Young. 2004 Feb. 14(1):50-4. [QxMD MEDLINE Link].
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].
Rao PS. Fatal aortic rupture during balloon dilatation of recoarctation. Br Heart J. 1991 Nov. 66(5):406-7. [QxMD MEDLINE Link].
Rao PS. Pseudoaneurysm following balloon angioplasty of aortic coarctation (Editorial). Am Heart J. 1993. 125:1205-6.
Rao PS. Balloon angioplasty of native aortic coarctation. Rao PS, ed. Transcatheter Therapy in Pediatric Cardiology. New York, NY: Wiley-Liss; 1993. 153-96.
Rao PS. Transcatheter treatment of pulmonary stenosis and coarctation of the aorta: experience with percutaneous balloon dilatation. Br Heart J. 1986 Sep. 56(3):250-8. [QxMD MEDLINE Link].
Rao PS, Balfour IC, Singh GK, Jureidini SB, Chen S. Bridge stents in the management of obstructive vascular lesions in children. Am J Cardiol. 2001 Sep 15. 88(6):699-702. [QxMD MEDLINE Link].
Rao PS, Thapar MK, Kutayli F, Carey P. Causes of recoarctation after balloon angioplasty of unoperated aortic coarctation. J Am Coll Cardiol. 1989 Jan. 13(1):109-15. [QxMD MEDLINE Link].
Rao PS, Wilson AD, Brazy J. Transumbilical balloon coarctation angioplasty in neonates with critical aortic coarctation. Am Heart J. 1992 Dec. 124(6):1622-4. [QxMD MEDLINE Link].
Rao PS. Balloon angioplasty for aortic recoarctation following previous surgery. Rao PS, ed. Transcatheter Therapy in Pediatric Cardiology. New York, NY: Wiley-Liss; 1993. 197-212.
Rao PS. Technique of balloon valvuloplasty. Rao PS, ed. Transcatheter Therapy in Pediatric Cardiology. New York, NY: Wiley-Liss; 1993. 29-44.
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. 1998 Jan 1. 81(1):61-7. [QxMD MEDLINE Link].
Sos T, Sniderman KW, Rettek-Sos B, Strupp A, Alonso DR. Percutaneous transluminal dilatation of coarctation of thoracic aorta post mortem. Lancet. 1979 Nov 3. 2(8149):970-1. [QxMD MEDLINE Link].
Sperling DR, Dorsey TJ, Rowen M, Gazzaniga AB. Percutaneous transluminal angioplasty of congenital coarctation of the aorta. Am J Cardiol. 1983 Feb. 51(3):562-4. [QxMD MEDLINE Link].
Wan AW, Lee KJ, Benson LN. Infolding of covered stents used for aortic coarctation: report of two cases. Catheter Cardiovasc Interv. 2014 Jan 1. 83(1):104-8. [QxMD MEDLINE Link].
Wong D, Benson LN, Van Arsdell GS, Karamlou T, McCrindle BW. Balloon angioplasty is preferred to surgery for aortic coarctation. Cardiol Young. 2008 Feb. 18(1):79-88. [QxMD MEDLINE Link].
Zellers TM. Balloon angioplasty for recurrent coarctation of the aorta in patients following staged palliation for hypoplastic left heart syndrome. Am J Cardiol. 1999 Jul 15. 84(2):231-3, A9. [QxMD MEDLINE Link].
Kailin JA, Santos AB, Yilmaz Furtun B, Sexson Tejtel SK, Lantin-Hermoso R. Isolated coarctation of the aorta in the fetus: A diagnostic challenge. Echocardiography. 2017 Dec. 34(12):1768-75. [QxMD MEDLINE Link].
Murtuza B, Alsoufi B. Current readings on surgery for the neonate with hypoplastic aortic arch. Semin Thorac Cardiovasc Surg. 2017 Nov 26. [QxMD MEDLINE Link].
[Guideline] 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. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Erbel R, Aboyans V, Boileau C, et al, for the ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014 Nov 1. 35(41):2873-926. [QxMD MEDLINE Link]. [Full Text].
Batlivala SP, Goldstein BH. Current transcatheter approaches for the treatment of aortic coarctation in children and adults. Interv Cardiol Clin. 2019 Jan. 8(1):47-58. [QxMD MEDLINE Link].
Msaad H, Drissa M, Mahfoudhi H, Hakim K, Ouarda F. Particularities of neonatal isthmic aortic coarctation (A Tunisian study). Tunis Med. 2018 Aug - Sep. 96(8-09):514-9. [QxMD MEDLINE Link].
Rajagopalan BK, Jose R, Kader NP, Varma PK. Coarctation of aorta aneurysm with aberrant right subclavian artery and single carotid artery: Surgical and perfusion strategies. J Thorac Cardiovasc Surg. 2018 Sep 28. [QxMD MEDLINE Link].
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Aortic coarctation visualized by aortic angiography.
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Aortic coarctation visualized by MR imaging.
Tables
Syamasundar Rao Patnana, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital
Syamasundar Rao Patnana, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research
Disclosure: Nothing to disclose.
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, Society for Cardiovascular Angiography and Interventions
Disclosure: Nothing to disclose.
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, American Autonomic Society, American Physiological Society
Disclosure: Received research grant from: Lundbeck Pharmaceuticals<br/>Received grant/research funds from Lundbeck Pharmaceuticals for none.
Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine
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, Society for Cardiovascular Angiography and Interventions
Disclosure: Nothing to disclose.
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, International Society for Heart and Lung Transplantation
Disclosure: Received honoraria from Actelion for speaking and teaching.
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Sections Coarctation of the Aorta
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Guidelines
- Medication
- Follow-up
- Questions & Answers
- Media Gallery
- References
