1P-S2-4

TREATMENT OPTIONS IN AORTIC COARCTATION

Michael Tynan MD, FRCP

Emeritus Professor of Paediatric Cardiology, Kings College, London, UK

Since the late 1940s surgical correction has been the recognised treatment for aortic coarctation. Results, in terms of long-term survival have been excellent in older children and adolescents. Problems have been concentrated in those operated on in infancy and adult life. From the mid 1980’s balloon dilation has been employed, initially for the treatment of re-coarctation or persistent coarctation following surgical repair and then as primary treatment of ‘native’ coarctation. Reservations about employing balloon dilation as primary treatment centre on the: risk of aneurysm and a high incidence of restenosis in young infants. Furthermore the balloon dilation of coarctation after surgical treatment is effective in only 75. The risk of aneurysm in children for both ‘native’ coarctation and for recoarctation is in the region of 2-5% and is considered acceptable by many workers, patients and parents. Adverse aortic arch anatomy means that dilation is not generally recommended in neonates. In older patients with recoarctation and ‘native’ coarctation stent implantation has recently proved successful in relieving stenosis.