Coarctation of the Aorta

Coarctation of the thoracic aorta in adults: A follow-up study after surgical treatment

“…There are both morphological residual narrowings without any gradient and gradients without proven narrowings at the CoA repair site. That an anastomosis diameter of 25-40 O / o of the distal aorta can be compatible with normal resting blood flow with no gradient has been stated by some authors (91,129). In this study, all such narrowings, as well as some smaller ones, were associated with an intraaortic gradient.…”

“…In one study, a 12 O/o incidence of premature cardiovascular death after 11-25 years is reported (108). In one account of 197 closely monitored patients, seven of the nine postoperative deaths occurring 4 to 18 years postoperatively were ascribed to coexisting aortic valvular disease (91); no manifestations of coronary artery disease were noted. In another series of 190 cases, 11 cardiovascular deaths were reported one to 15.5 years after CoA repair (157).…”

“…According to other workers (152), if an aortogram reveals a residual constriction of the aorta of more than 50 O/o associated with postoperative systolic hypertension during exercise, this is sufficient indication for further surgery. The appearance of the repaired aorta as such in an aortogram is not a reliable guide in evaluation of restenosis, because most repaired aortas show some postoperative narrowing, but usually produce no BP gradient (56,91). Persistent hypertension as such is obviously not a reliable sign of residual obstruction.…”

Coarctation of the aorta

“…While in young adults with pure coarctation most centres report mortality figures up to 5 or 6% (Braimbridge and Yen, 1965;Brom, 1965;Karnell, 1968;Morris et al, 1960;Schuster and Gross, 1962), rates of 1 and 2 % have been reported (Gross, 1953;Sellors and Hobsley, 1963). These figures rise sharply in infancy and in the elderly age groups.…”

“…In the past, the effects of resection of coarctation on blood pressure have been recorded either as a mean fall in measured blood pressure (Karnell, 1968;Taylor and Donald, 1960;Cleland, Counihan, Goodwin, and Steiner, 1956) or as the percentage of individuals falling into arbitrary categories representing 'normal', 'acceptable', and 'high' blood pressures (Gross, 1953;Groves and Effier,, 1960;Shumacker et al, 1968). Sellors and Hobsley (1963) were the first to use age and sex corrections.…”