Treatment of Coarctation and Late Complications in the Adult

This article discusses coarctation of the aorta in the adult. Effective treatments for coarctation have come from surgery since 1945 and from interventional cardiology since 1982. Long-term outcome data are available only for surgical approaches. Thirty-year survival rate is 72% to 82%. Complications include recoarctation or residual coarctation, hypertension, aneurysms at the repair site, spinal cord injury. Other sequelae include bicuspid aortic valve disease, ascending aortic aneurysm, premature coronary disease, and infective endocarditis or endarteritis. Interventional catheter therapy 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. Outcomes are good in skilled hands, but residual or recurrent coarctation with resultant hypertension and repair site aneurysms can occur. Catheter treatment can cause death from aortic rupture and dissection, but mortality compares favorably with surgery if coarctation is recurrent, and perhaps for initial treatment.