Coarctation of the aorta: natural history and outcome after surgical treatment.
Coarctation of the aorta (Figure 1) accounts for approximately 5% of all congenital heart disease and is found at necropsy in up to 1:1550 patients.1 It is approximately three times more common in males.2 The traditional classification into infantile (preductal) and adult (postductal) types is now regarded as too simplistic, since many patients with preductal lesions do not present until adulthood.3 A spectrum of lesions is now recognized, and it is only those with the most severe obstruction (e.g. aortic arch atresia or interruption) or associated cardiac defects who invariably present in infancy. Most other cases are now identified at routine medical examination. Otherwise, age at presentation is related to the severity rather than the site of obstruction, as a result of cardiac failure or occasionally cerebrovascular accident (CVA), aortic dissection, or endocarditis.



 Figure 1. 
Chest radiograph demonstrating severe rib notching, prominence of the left subclavian artery, and cardiomegaly in an adult with juxtaductal aortic coarctation.



Coarctation of the aorta was not regularly diagnosed clinically until after 1933.4 Details of the natural history of aortic coarctation are therefore incomplete, being largely derived from hospital post-mortem records and selected case series prior to 1945, at which time operative repair was introduced. The first and largest post-mortem series was published by Abbott5 in 1928, who collated findings from all 200 previously documented cases over the age of 2 years, dating from the first report of aortic coarctation by Paris6 in 1791. Reifenstein, Levine and Goss7 subsequently reported 104 further cases from the literature dating from 1928 to 1947. The median age of death for all 304 cases was 31 years, and 76% of deaths were attributed to complications of the aortic coarctation.8 Cardiac failure accounted for 26% of deaths, at a mean age of 37 years. … 

Dr N.P. Jenkins, Department of Cardiology, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT