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Does a stent cure hypertension?
  1. Erwin N Oechslin
  1. Dr E N Oechslin, Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network/Toronto General Hospital, 5 NUW – 519, 585 University Avenue, Toronto, ON M5G 2N2, Canada; erwin.oechslin{at}uhn.on.ca

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Aortic coarctation, first described by Morgagni during an autopsy of a monk in 1760, is characterised by a circumscript narrowing in the region of the ligamentum arteriosum, at the level of the distal aortic arch/descending aorta, just at the origin of the left subclavian artery, in particular when diagnosed in adulthood. The natural history of aortic coarctation was dismal until 1944 when Crafoord and Nylin performed the first resection with end-to-end anastomosis in a human being.1 Natural survival of patients with unoperated aortic coarctation was 35 years on average and mortality at the age of 46 years was 75%. Premature morbidity and death in patient with unrepaired aortic coarctation are common owing to congestive heart failure (25.5%), rupture of the aorta (21%), endocarditis (18%) or intracranial haemorrhage (11.5%).2 This dismal prognosis of unoperated patients reflects the systemic nature of this congenital defect, in particular of the proximal, diseased aorta: cystic changes of the aortic media, bicuspid aortic valve in up to 75% of patients, serial left ventricular inflow and outflow tract obstruction (Shone complex), intracranial aneurysms, systemic hypertension and left ventricular hypertrophy.

The different surgical techniques aim to remove the narrowed segment and to establish unobstructed continuity between the distal aortic arch and the descending aorta in order to relieve arterial hypertension in the upper limbs and to improve blood flow to the lower limbs. Advances in interventional cardiology revolutionised treatment of aortic coarctation: balloon dilatation with or without deployment of a stent has gained popularity and has become the preferred method to treat children and adults with primary coarctation and recoarctation if the morphology is amenable to an interventional approach.3

VASCULAR BIOLOGY AFTER COARCTATION REPAIR

Late sequelae after aortic coarctation repair include recoarctation, …

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