Subisthmic Aortic Stenosis and Occlusive Disease

Abstract

Coarctation of the aorta is a remarkably constant congenital lesion involving the distal aortic arch or isthmus. Indeed extensive anatomic studies indicate that the lesion is located at this site in all but 2% of the cases.¹With increasing experience and progressive improvements in the surgical management of isthmic coarctation greater interest has been aroused in the relatively rare and more challenging subisthmic form of aortic stenosis. Although the clinical picture in both of these forms of coarctation is often quite similar, the surgical approach required for each of them may be considerably different. For this reason and in order to provide proper planning of the technical procedure it is important to distinguish between them and to determine before operation the precise location and extent of the occlusive lesion by means of aortography. While routine aortography for all cases of coarctation is not necessary, it is obviously essential in