Coarctation of the Aorta

Abstract

A coarctation of the aorta is a congenital narrowing of the descending thoracic aorta, usually occurring just distal to the left subclavian artery adjacent to the site of insertion of the arterial duct. Coarctation is often associated with other congenital heart defects, including patent arterial duct, bicuspid aortic valve, ventricular septal defect, and mitral valve abnormalities. This chapter reviews the embryology, anatomy, pathophysiology, natural history, diagnostic techniques, surgical and transcatheter alternatives, postoperative considerations, and complications for coarctation of the aorta. The presentation of patients with coarctation of the aorta occurs in a bimodal distribution. The newborn infant with critical coarctation and arterial duct closure will present in shock. The surgical approach to coarctation in most instances is through a left posterolateral thoracotomy incision entering the thorax through the third or fourth intercostal space. The management of the infant and child with coarctation of the aorta has become fairly standardized.