Coarctation of the aorta: Current surgical management

Progress in the management of coarctation of the aorta over the past 40 years is truly impressive. Nonoperative management of this condition has uniformly met with failure; however, a variety of surgical options is now available for the treatment of children and adults with coarctation. In recent years, significant advances have emerged in the treatment of neonates and infants that have resulted in low operative mortality rates. In addition, our own results with the subclavian flap angioplasty in these young patients indicate that the problem of failure of the repaired area to grow has been all but eliminated. The use of prostaglandin E₁ has dramatically improved our ability to stabilize the decompensated neonate. Repair of coarctation in infancy is not only safe but desirable to minimize the late cardiovascular morbidity and premature death associated with hypertension.