How does recoarctation occur following repair of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Residual and recurrent obstructions cannot be easily distinguished, and the term recoarctation may be used to describe both entities. Recoarctation is defined as a peak-to-peak systole pressure gradient in excess of 20 mm Hg with or without angiographically demonstrable narrowing. [82] Recoarctation following both surgical correction and balloon angioplasty has been described.

Recoarctation following surgery does not depend on the type of surgical repair [44, 48] ; it has been observed following resection with end-to-end anastomosis, subclavian flap angioplasty, prosthetic patch repair, subclavian artery turn-down procedure, and interposition tube grafts. The reported incidence of recoarctation has varied depending on the study. The average recoarctations rates were 11-17% in neonates and infants younger than 1 year and 5.6% in children older than 1 year. In a large cohort of patients studied by Pinzon et al (1991), recoarctation occurred in 23%. [44] Recent reports demonstrate similar recoarctation rates. [83, 84] The younger the child at surgery, the higher the chance for recoarctation.

Although no consensus has been reached in regard to the method of intervention (surgery vs balloon angioplasty) for native aortic coarctation, both cardiologists and cardiovascular surgeons generally agree that balloon angioplasty is the treatment of choice for postsurgical aortic coarctations. [48, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94] The immediate and follow-up results of balloon angioplasty for postsurgical recoarctation are essentially similar to those of native coarctations and have been reviewed in detail elsewhere. [71]

Restenosis following balloon angioplasty also appears to be age dependent; the younger the child, the greater the chance for recoarctation. [58] The authors [58, 64] and others [70] recommend repeat balloon dilatations in such cases, whereas others [95] prefer surgical intervention.

The technique of balloon angioplasty for the management of both postsurgical and post–balloon angioplasty recoarctations is similar to that described above for native coarctation. [64]


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