Preductal coarctation: this occurs in children, with an increased risk in Turner syndrome. The word preductal means that the narrowing is anterior to the ligamentum arteriosum.
Post-ductal coarctation: this is mainly seen in adults.

Signs, symptoms and diagnosis

Arterial hypertension in the left arm with normal to low blood pressure in the right arm is classic. Poor peripheral pulses, especially of right carotid artery and the femoral arteries, may be found in severe cases.

On chest X-ray, resorption of the lower part of the ribs may be seen, due to increased blood flow over the neurovascular bundle that runs there. Coarctation of the aorta can be accurately diagnosed with magnetic resonance angiography or echocardiogram.

Therapy

Therapy is conservative if asymptomatic, but may require surgical resection of the narrow segment if there is arterial hypertension. In some cases angioplasty can be performed to dilate the narrowed artery. If the coarctation is left untreated, arterial hypertension may become permanent due to irreversible changes in some organs (such as the kidney).

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Comparison of helical CT scanning and MRI in the follow-up of adults with coarctation of the aorta
From CHEST, 6/1/05 by Alfred Hager

To the Editor:

Vriend et al (1) outlined in their letter to the editor that the capabilities of MRI are not only limited to a detailed imaging of the entire aorta but also allow functional flow measurements. Therefore, they favor MRI over helical CT scanning in the follow-up of patients with coarctation of the aorta. We totally agree that new functional measurements performed with MRI can contribute to the diagnostic workup of coarctation patients and that it might be even more cost-effective to perform MRI without echocardiography in the regular follow-up. (2) But, at the moment, the availability and experience for MRI in congenital cardiology are very limited to a small number of centers worldwide.

We wanted to point out in our study (3) that both helical CT scanning and MRI are highly useful for the imaging of the thoracic aorta in patients with coarctation, but measurements obtained from different methods in sequential studies should be interpreted with care. The following attributes favor helical CT scanning: better resolution; less investigation time; no disturbance with pacemakers; better compatibility with intensive care monitoring; and, generally, greater availability. Other attributes favor MRI, like the possibility of additional functional studies, the lack of ionizing radiation, and, maybe, the lack of need for contrast media. Therefore, the optimal imaging method should be selected for every individual patient. Shifts between methods should be avoided.

From a scientific point of view, there is no doubt that MRI measurement of collateral flow, (4) the elastic properties of the aorta, (5) flow profiles at different sites of the arterial vessels, and many other functional questions are compelling issues of coarctation research, as coarctation seems to be not only a local defect, but also a systemic vessel disease with alterations in the vessel wall (6-8) and in the vascular response. (9) However, this was not the primary aim of our study.

Alfred Hager, MD

Harald Kaemnaerer, MD, VMD

John Hess, MD

Technische Universitat Munchen

Munchen, Germany

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal. org/misc/reprints.shtml).

Correspondence to: Alfred Hager, MD, Klinik fur Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Lazarettstr 36, D-80636 Munchen, Germany; e-mail: hager@dhm.ndm.de

REFERENCES

(1) Vriend JWJ, Oosterhof T, Mulder BJM. Non-invasive imaging for the (post-operative) assessment of aortic coarctation patients. Chest 2005 (in press)

(2) Therrien J, Thorne SA, Wright A, et al. Repaired coarctation: a "cost-effective" approach to identify complications in adults. J Am Coll Cardiol 2000; 35:997-1002

(3) Hager A, Kaemmerer H, Leppert A, et al. Follow-up of adults with coarctation of the aorta: comparison of helical CT and MRI, and impact on assessing diameter changes. Chest 2004; 126:1169-1176

(4) Steffens JC, Bourne MW, Sakuma H, et al. Quantification of collateral blood flow in coarctation of the aorta by velocity encoded cine magnetic resonance imaging. Circulation 1994; 90:937-943

(5) Rees S, Somerville J, Ward C, et al. Coarctation of the aorta: MR imaging in late postoperative assessment. Radiology 1989; 173:499-502

(6) Isner JM, Donaldson RF, Fulton D, et al. Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites. Circulation 1987; 75:689-695

(7) Connolly HM, Huston J 3rd, Brown RD Jr, et al. Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients. Mayo Clin Proc 2003; 78:1491-1499

(8) Smith Maia MM, Cortes TM, Parga JR, et al. Evolutional aspects of children and adolescents with surgically corrected aortic coarctation: clinical, echocardiographic, and magnetic resonance image analysis of 113 patients. J Thorac Cardiovasc Surg 2004; 127:712-720

(9) Aggoun Y, Sidi D, Bonnet D. Arterial dysfunction after treatment of coarctation of the aorta. Arch Mal Coeur Vaiss 2001; 94:785-789

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