The treatment of coarctation of the aorta has generated some controversy within medical circles. It can be treated with less invasive, catheter-based treatments or surgery. However, choosing which procedure is appropriate may be complicated.

The catheter-based treatment for coarctation of the aorta is similar to the balloon angioplasty used for coronary artery disease. During this procedure, a catheter tipped with a balloon is threaded into the aorta, usually through the femoral artery in the leg. Once it has reached the narrowed area of the aorta, the balloon is expanded, forcing the vessel to open. Following angioplasty, a stent, or metal, spring-like coil, may be inserted to help keep the aorta open.

Although the initial success rate is about 90 percent, there is considerable risk when the procedure is performed in newborns (between 5 and 25 percent) that the aorta will constrict once again later in life. Therefore, many physicians believe that infants with coarctation of the aorta should be treated with medication until surgery is feasible. Among older children, however, the reclosure rate is somewhat better (about comparable to surgery), making it a more viable option for older children.

The decision and timing of surgery also present challenges. However, if symptoms are present that do not respond to medical treatment, surgery is almost always indicated.  

During the surgical treatment, the narrowed portion of the aorta is removed and the two free ends are sewn back together (surgical anastomosis). If the gap between the two ends is small, it may be bridged with a synthetic graft. Sometimes the gap is patched with a flap of tissue from a nearby blood vessel (often the left subclavian artery). Three to four days of hospitalization is generally required.

Early intervention (before 10 years of age) may improve life expectancy, and almost 70 percent of cases are successfully repaired. A patient’s prognosis after surgery is generally good, but lifetime follow-up and medical management is necessary. For example, patients will need to take antibiotics before any dental, medical or surgical procedure to lower their risk of developing an infection of the aorta or the heart valves (endocarditis). It is also recommended that patients be monitored by a cardiologist to have their blood pressure checked every two years and to make sure the aorta remains unobstructed.

Because it is a congenital (from birth) heart defect, there is no evidence that coarctation of the aorta can be prevented. The long-term effects of surgical repair for many congenital heart conditions are still being studied. However, surgery and a lifetime of follow-up and maintenance offer the hope of a healthy future to more patients than ever before.