Coarctation of the aorta

Incidental detection of late presenting co-arctation of the aorta on chest x-ray: the importance of rib notching

A 31-year-old obese male presented to the emergency department with symptoms and signs suggestive of a viral upper respiratory tract illness with a background of low exercise tolerance. Rib notching was identified on plain film chest radiography and subsequent CT of the thorax identified a moderately tight 2-mm juxta-ductal co-arctation of the aorta with multiple enlarged chest wall collaterals. The patient underwent a two-stage percutaneous procedure involving stent insertion and angioplasty up to 16 mm with significant improvement in exercise capacity and a modest reduction in blood pressure.

Coarctation of the aorta. Follow-up of 218 patients operated on after 13 years of age

Twohundred and eighteen patients aged 13 years or more at operation for coarctation of the aorta were selected for a long-term postoperative follow-up study. The mean age of operation was 25,3 years, range 13 to 62 years, and the mean follow-up period was 13 years, range 2 to 28 years. The surgical mortality rate was 1.4%, all 3 patients being in their fourth decade. There were 35 late deaths (16,3%), 26 having cardiovascular disease as the causation; 3 patients developed a dissecting aneurysm of the ascending aorta, and 11 died suddenly of unknown cause. Persisting hypertension was found in approximately one third of the patients. A highly significant correlation was demonstrated between the systolic blood pressures before and after surgery. Aortic valve disease occurred in 31 patients (14,2%). Coarctation of the aorta should be operated on in childhood, and a close postoperative long-term follow-up in all patients is recommended.

Coarctation of the aorta

Coarctation of the aorta is a cause of hypertension that can present dramatically in the severely ill infant or appear incidentally in the asymptomatic young adult. Coarctation is easily detected and there is good evidence that the extremely poor natural history can be altered favorably by surgical correction. The elevated blood pressure can be lowered in the majority of patients, and there is every expectation that the incidence of known complications of coarctation can be decreased. However, in about three fourths of the patients, significant residual cardiovascular defects persist, with their potential for future problems as yet incompletely defined. For this reason, patients who have undergone surgery for coarctation will need to be followed carefully for an indefinite period.

Successful outcome of complications of excision of aortic coarctation

A case is described of a patient who made a complete recovery following unusually serious complications of excision of aortic coarctation. The thoracic aorta was reconstructed successfully using an aortic graft along a course which appears to be short and direct.