Korean Circ J.  2019 Apr;49(4):298-313. 10.4070/kcj.2018.0433.

Management of Coarctation of The Aorta in Adult Patients: State of The Art

• Alkashkari W
• Albugami S
• Hijazi ZM

• KMID: 2441133
• DOI: http://doi.org/10.4070/kcj.2018.0433

Abstract

Coarctation of the aorta (CoA) is a common form of congenital heart disease. Adult patients with CoA may be asymptomatic or may present with hypertension. Over the last few years, endovascular management of adult patients with CoA emerged as the preferred strategy. Stent implantation, though technically challenging, offers the best and most lasting therapy. In this paper, we will review technical considerations and outcome of patients undergoing stent implantation for CoA.

Keyword

Stents; Aortic Coarctation; Balloon angioplasty; Cardiac Catheterization

MeSH Terms

Adult*
Angioplasty, Balloon
Aortic Coarctation*
Cardiac Catheterization
Heart Defects, Congenital
Humans
Hypertension
Stents

Figure

• 

  Figure 1 An electrocardiogram of a 45-year old male with coarctation of the aorta. There is evidence of ischemic changes.

• 

  Figure 2 Chest radiograph of a patient with long-standing coarctation of the aorta demonstrating typical findings of coarctation: rib notching (arrows) and ‘3 sign’ beneath the aortic notch.

• 

  Figure 3 (A) A two-dimensional TTE from the suprasternal view demonstrating a discrete narrowing just distal to the take-off of the left subclavian artery (arrow) with continuous high velocity color Doppler signal across the coarctation. (B) Continuous wave Doppler TTE showing continuation of anterograde flow during diastole and peak pressure gradient of 60 mmHg across the coarctation. TTE = transthoracic echocardiography.

• 

  Figure 4 (A) Cardiac magnetic resonance image in sagittal view revealing discrete coarctation of the aorta (arrow). (B) Different view is cardiac magnetic resonance image revealing extensive collaterals.

• 

  Figure 5 (A) Computed tomographic angiogram is revealing coarctation of the aorta just at the origin of the left subclavian artery (arrow). (B) 3D volume rendered reconstruction of the same patient revealing the coarctation (arrow), note the incidental finding of persistent left superior vena cava to left atrium.

• 

  Figure 6 Angiogram in the transverse arch in left anterior oblique 30° (A) and straight lateral 90° (B) in a 28 years female patient with severe coarctation of the aorta, with a gradient of 30 mmHg. (A) The coarctation ridge (arrow). (B) Ductal diverticulum (long arrow) and the coarctation juxta ductal (shorter arrow). Note, there is a pacing catheter in the right ventricle. (C, D) Angiogram via side arm of delivery sheath (covered stent [Bentley 14 mm×39 mm] is uncovered half way). (C) Origin of the left subclavian artery (long arrow) and proximal tip of the stent (short arrow). (E, F) Angiogram via side arm of sheath after uncovering the stent completely. Note, origin of the left subclavian artery (arrow). (G, H) Angiogram via pigtail catheter in transverse arch after complete stent deployment showing good position (arrows) and remodelling of the area of coarctation. Residual gradient was 0 mmHg.

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