Future Directions in the Management of Aortic Coarctation in Young Patients

The management of COA was by surgical repair since its initial description by Crafoord and Nylin [6] and Gross [7] in mid 1940s. More recently, endovascular therapy either by balloon angioplasty [3,8-10] or intravascular stents [3,11-13] has to a large extent replaced surgery. Surgery in the neonates and young infants, balloon angioplasty in children and stents in adolescents and adults have become standard methods used in the management of COA [3,14-16]. However, recoarctation following both surgery [17-19] and balloon angioplasty [15,20,21] has been observed; the younger the child, the greater is the probability of recoarctation. Presumably because of this recurrence, some groups of cardiologists advocate use of stents even in infants and young children [11,22-28]. However, the stents, which are largely metallic, do not expand as the child grows; this is particularly true in the neonates, infants and young children, as has been articulated elsewhere [29-31] by us and others. While re-dilatation of the stents can be performed, such re-enlargement may not achieve adult size [32]. Therefore, alternative solutions [29,30,33,34] should be sought. Three types of solutions have been considered in the past and include biodegradable stents, growth stents and dilatable stents.