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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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REVIEWS  RECENT DEVELOPMENTS IN THE MANAGEMENT OF ADULT COARCTATION


The Journal of Cardiovascular Surgery 2016 August;57(4):557-68

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Modern management of adult coarctation: transcatheter and surgical options

Heiko SCHNEIDER 1, 2, Anselm UEBING 1, 3, Darryl F. SHORE 1, 3

1 Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; 2 Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK; 3 National Heart and Lung Institute, Imperial College, London, UK


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Coarctation of the aorta (CoA), a juxtaductal obstructive lesion in the descending aorta and commonly associated with hypoplasia of the aortic arch occurs in 5-8% of patients with congenital heart disease. Since the initial surgical corrections in the 1950, surgical and transcatheter options have constantly evolved. Nowadays, transcatheter options are widely accepted as the initial treatment of choice in adults presenting with native or recurrent CoA. Surgical techniques are mainly reserved for patients with complex aortic arch anatomy such as extended arch hypoplasia or stenosis or para-CoA aneurysm formation. Extended aneurysms can be covered by conformable stents but stent implantation may require preparative vascular surgery. Complex re-CoA my best be treated by an ascending to descending bypass conduit. The following review aims to describe current endovascular and surgical practice pointing out modern developments and their limitations.

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a.uebing@rbht.nhs.uk