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Treatment options for coarctation of the aorta
  1. Department of Paediatric Cardiology
  2. Yorkshire Heart Centre
  3. E Floor, Jubilee Wing
  4. Leeds General Infirmary
  5. Great George Street
  6. Leeds LS1 3EX, UK
  7. email:

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Surgical treatment for coarctation was introduced over 50 years ago and has steadily been refined, with particular improvements in results over the last 10 years or so. Balloon angioplasty was introduced in the mid 1980s, initially for recoarctation and later for unoperated (“native”) coarctation. In this issue Thanopoulos and his colleagues from Athens report their favourable early experience of stent implantation to treat coarctation or recoarctation in a small group of children and adolescents.1 Many factors should be taken into account when deciding upon the best treatment for a patient with coarctation including age, coarctation morphology, whether previous surgery has been undertaken, and local institutional results of each type of treatment. Unfortunately there are no clinical trials of appropriate size or design upon which to base an objective judgement of the optimum form of treatment, but it is helpful to compare approximately contemporary studies of surgery, balloon angioplasty, and stent implantation.


The major complications of surgery are death, paraplegia caused by perioperative spinal cord ischaemia, recurrent or residual coarctation, and late aneurysm formation at the site of the repair. There are also late complications related to the coarctation itself including hypertension, dissecting, diffuse or false aneurysm of the aorta, stroke, and early coronary artery disease. In a large (571 patients) long term study from the Mayo clinic,2 estimated survival at 10, 20, and 30 years was 91%, 84%, and 76%, respectively. Late deaths were most commonly related to coronary artery disease followed by sudden death, heart failure, stroke, and rupture of aortic aneurysm. Young age at operation favourably influenced outcome, but the risk of late death increased the higher the postoperative resting blood pressure. A similar effect of postoperative hypertension on long term outcome was reported in other studies from the UK3 and from mainland Europe.4 …

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