title: Isolated aortic coarctation: experience in 100 consecutive patients.
abstract: BACKGROUND
  Coarctation of the aorta (CoA) is a stenosis usually located in the descending aorta. Treatment consists of surgical or percutaneous removal of the obstruction and presents excellent immediate results but significant residual problems often persist.
  
  
  OBJECTIVE
  To describe the presentation, treatment and long-term evolution of a population of 100 unselected consecutive patients with isolated CoA in a single pediatric cardiology center.
  
  
  METHODS
  This was a retrospective study of all patients with isolated CoA treated during4 the last 21 years (1987-2008).
  
  
  RESULTS
  The patients (n=100, 68.3% male) were diagnosed at a median age of 94 days (1 day to 16 years). The clinical presentation differed between patients aged less or more than one year, the former presenting with heart failure and the latter being asymptomatic with evidence of hypertension (88 and 63%, respectively; p < 0.01). Treatment, a median of 8 days after diagnosis, was surgical in 79 cases (20 end-to-end anastomosis, 31 subclavian flap, 28 patch) and percutaneous in the remaining 21 (15 balloon angioplasty, 6 with stenting). The mean age of surgical patients was younger than in those treated percutaneously (3.4 vs. 7.5 years; p < 0.01). Immediate mortality was 2% and occurred in the surgical group. There was no late mortality, in a mean follow-up of 7.2 +/- 5.4 years. Recoarctation occurred in 8 patients (6 surgical, 2 percutaneous). There are 46 patients who currently have hypertension (19 at rest, 27 with effort), their median age at diagnosis being older than the others (23 vs. 995 days; p < 0.01).
  
  
  CONCLUSIONS
  Isolated CoA has an excellent short-term prognosis but a significant incidence of long-term complications, and should thus no longer be seen as a simple obstruction in the descending aorta, but rather as a complex pathology that requires careful follow-up after treatment. Its potentially insidious presentation requires a high level of clinical suspicion, femoral pulse palpation during physical examination of newborns and older children being particularly important. Delay in treatment has an impact on late morbidity and mortality. Taking into account the data currently available on late and immediate results, the final choice of therapeutic technique depends on the patient's age, associated lesions and the experience of the medical-surgical team. Hypertension should be closely monitored in the follow-up of these patients, as well as its risk factors and complications.
authors.affiliation: Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Peres
authors.forename: José Diogo Ferreira
authors.initials: JD
authors.lastname: Martins
authors.forename: Filipa
authors.initials: F
authors.lastname: Paramés
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gil
authors.forename: Carla
authors.initials: C
authors.lastname: Matias
authors.forename: João
authors.initials: J
authors.lastname: Franco
authors.forename: Isabel
authors.initials: I
authors.lastname: Freitas
authors.forename: Conceição
authors.initials: C
authors.lastname: Trigo
authors.forename: José
authors.initials: J
authors.lastname: Fragata
authors.forename: Fátima Ferreira
authors.initials: FF
authors.lastname: Pinto
mesh_terms: D000293:Adolescent; D001017:Aortic Coarctation / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies