THE CONTEXT
Coarctation involves narrowing of the aorta; the illustrated CT shows severe narrowing of the proximal descending aorta just beyond the arch.
Untreated disease and timing of correction
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Untreated cases may result in death from left ventricular failure, aortic dissection or cerebral haemorrhage.
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Surgical correction is advisable in all but the mildest cases. Correction sufficiently early in childhood can prevent persistent hypertension.
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Patients repaired in late childhood or adulthood often remain hypertensive or develop recurrent hypertension later.
Recurrent stenosis and associated valve disease
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Stenosis may recur as the child grows. Balloon dilatation and sometimes stenting can be used to manage recurrence; stenting may also be used as primary treatment.
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A coexistent bicuspid aortic valve occurs in over 50% of cases. It may cause progressive aortic stenosis or regurgitation and requires long-term follow-up.
Imaging findings
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The CT example demonstrates severe proximal descending aortic narrowing with collateral circulation and enlarged intercostal arteries.