Coarctation of the Aorta in Infancy

TLDR

The study aimed to differentiate coarctation from tubular hypoplasia using pathologic and angiographic measurements, examine their relationship with congestive heart failure and other cardiac defects, and determine the best treatment for symptomatic infants. The authors reviewed clinical data from 78 infants with coarctation and congestive heart failure within their first six months of life. Three‑quarters of the infants had combined aortic lesions, isolated coarctation was an uncommon cause of congestive heart failure, whereas coarctation with tubular hypoplasia or additional defects frequently led to severe CHF, and surgical treatment proved markedly more effective than medical therapy alone.

Abstract

Material from 78 infants with coarctation and congestive heart failure during the first 6 months of life was reviewed. Three fourths of these infants had combined aortic lesions, that is, coarctation, a narrow constrictive zone of stenosis, and tubular hypoplasia of the transverse arch, a proximal, long, uniformly narrow segment. It was the purpose of this study (1) to distinguish coarctation of the aorta from tubular hypoplasia by using pathologic and angiographic measurements, (2) to assess the relationship of these two entities and additional shunting cardiac defects with the occurrence of congestive heart failure in infancy, and (3) to evaluate the optimal therapeutic approach for symptomatic infants with coarctation. It was found that (1) coarctation of the aorta as an isolated anomaly is a relatively uncommon cause of congestive heart failure in infancy. In contrast, coarctation associated with tubular hypoplasia of the transverse arch or with additional cardiac defects is frequently associated with severe congestive heart failure. It was found also (2) that surgical management is far more successful than medical management alone in symptomatic infants with coarctation of the aorta and associated significant cardiac defects.