Racial and ethnic (RAE) differences in the presentation and outcomes of coarctation of the aorta (CoA) among adolescents and adults undergoing transcatheter coarctation repair (TCR) remain poorly defined. We retrospectively analyzed patients aged ≥16 years who underwent TCR at US centers participating in the NCDR IMPACT® registry between 2011 and 2023. Among 2267 patients, 70.9% were Non-Hispanic White (NHW), 18.5% Hispanic (H), 7.4% Non-Hispanic Black (NHB), and 3.3% Non-Hispanic Other (NHO), demonstrating underrepresentation of Hispanic and NHB patients. Late CoA presentation occurred in 53.6% of patients and did not differ across RAE groups (p=0.076). Older age was the only independent predictor of late presentation (OR 1.25, 95% CI 1.13-1.40; p<0.001). Late presentation was more frequent in adult-based than pediatric-based hospitals (60.1% vs. 48.6%, p<0.001) but was not associated with center procedural volume. Adverse TCR outcomes occurred in 8.8% of patients and were similar across RAE groups (p=0.392). Higher median household income was independently associated with lower odds of adverse outcomes (OR 0.78, 95% CI 0.62-0.97; p=0.027), while outcomes did not differ by hospital type, TCR volume, or ACHA accreditation status. Sensitivity analyses comparing NHW versus non-NHW patients showed no significant differences in presentation or procedural outcomes, although in-hospital mortality was higher among non-NHW patients (0.6% vs. 0.1%, p=0.012). In conclusion, in this large contemporary registry, RAE was not associated with late presentation or adverse TCR outcomes. Although Hispanic, NHB and NHO patients were underrepresented, TCR was associated with favorable outcomes across groups, supporting its safety and effectiveness while highlighting the need for improved CoA detection and equitable access to specialized congenital heart disease care.

Middle aortic syndrome is a rare cause of renovascular hypertension in infants. We report a 21-month-old boy weighing 11 kg who presented with severe systemic hypertension (205/117 mmHg) and left ventricular (LV) dysfunction due to diffuse hypoplasia of the thoracoabdominal aorta. Echocardiography and computed tomography angiography showed two coarctation segments involving the superior mesenteric and renal arteries without inflammatory signs. After medical stabilization, acute pulmonary edema and cardiogenic shock developed. A hybrid transabdominal approach with sequential covered-stent implantation achieved favorable recovery, with normalization of blood pressure and improvement in LV function.

Coarctation of the aorta (CoA) persisting into adulthood is uncommon and may be complicated by hypertension and aortic pathology. Aortic dissection occurring distal to a coarctation segment in the presence of advanced coronary artery disease (CAD) is not uncommon, but its description in the literature - especially the management - is rarely reported. A 46-year-old male with no prior symptoms or history of comorbid illness presented with acute, tearing chest and back pain. Echocardiography revealed a CoA. Further evaluation with computed tomography angiography demonstrated a Stanford type B aortic dissection distal to the coarcted segment, and coronary angiography showed triple-vessel CAD. He underwent an open surgical repair with resection of the coarctation and Dacron graft replacement, along with triple coronary artery bypass grafting. Recovery was uneventful, and follow-up imaging confirmed durable repair and patent grafts. Vigilance for aortic complications in adults with uncorrected or residual coarctation is essential. Simultaneous repair of coarctation-associated dissection and coronary revascularization is feasible with meticulous planning.

Coarctation of the aorta (CoA) is the 6[th] most common congenital cardiac defect, characterized by a wide spectrum of aortic narrowing that ranges from a discrete constriction to diffuse tubular hypoplasia. This defect leads to obstruction of systemic blood flow and secondary hypertension. Although multiple surgical and endovascular techniques have been developed for the correction of CoA, each procedure has its merit and demerits. Despite their clinical success, these procedures are associated with several limitations. To address some of the documented limitations, we have developed a novel surgical technique specifically designed for pediatric CoA repair. This innovative approach minimizes prosthetic use, preserves native aortic tissue, and allows physiological adaptation with growth. Early clinical experience has demonstrated favorable results. Our innovative methods for the repair of CoA may improve outcomes in children with CoA.

The transition from prenatal to postnatal life involves major changes in cardiac loading conditions, including increased left ventricular preload and afterload, potentially affecting left heart size during the neonatal period. We hypothesized that early postnatal hemodynamic changes would significantly impact left heart size and derived Z-scores. We report serial data from infants with prenatally suspected coarctation of the aorta who underwent coarctation repair. We retrospectively studied 51 infants with a prenatal diagnosis of suspected coarctation of the aorta who underwent repair before 30 days of age. Sequential echocardiography was performed at less than 48 h (US1), 48 h to seven days (US2) and over seven days or last pre-operative scan (US3). Cardiac dimensions were assessed on two-dimensional ultrasound and Z-scores computed. Across US1, US2, and US3 groups, significant median Z-score increases from US1 to US3 were observed for LV length (1.3), AoV (1.0), and DTAA (Distal transverse aortic arch) (0.6). Paired data (US1 vs. US2) showed significant increases in LV length Z-score (0.3), AoV Z-score (0.7), and mitral valve Z-score (1.0). Changes in dimensions and Z-scores inversely correlated with initial Z-scores, meaning infants with the smallest initial left heart dimensions exhibited the largest increases. Infants with prenatally suspected coarctation of the aorta demonstrate postnatal changes in absolute measurements and Z-scores of left heart structures. The infants with the smallest initial size of left heart structures showed the greatest increase in size during the neonatal period.

Thoracic aortic kinking, also known as pseudocoarctation of the aorta, is a rare congenital anomaly characterized by elongation and angulation of the aortic arch without significant luminal narrowing. We report the case of a 67-year-old man admitted for hematemesis and melena. CT pulmonary angiography performed during the diagnostic workup revealed a proximal right pulmonary embolism and an incidental marked angulation of the descending thoracic aorta at the level of the aortic isthmus, without evidence of stenosis or collateral circulation. In the absence of clinical and radiological features of true coarctation, the diagnosis of thoracic aortic kinking was established. Conservative management with clinical and radiological follow-up was adopted. This report highlights the importance of recognizing thoracic aortic kinking as a rare benign anomaly that may mimic true aortic coarctation and emphasizes the role of imaging in establishing the correct diagnosis and avoiding unnecessary intervention.

Prenatal diagnosis of coarctation of the aorta (CoA) remains a challenging diagnosis in fetal cardiology. In rare situations, extrinsic compression of the aorta can produce a pseudocoarctation-like appearance, characterised by elongation and kinking of the aorta. This appearance is rarely recognised prenatally and is not well documented. We report a fetus at 24+4 weeks with ventricular disproportion and arch kinking, initially raising suspicion for CoA. Echocardiography demonstrated preserved haemodynamics and no discrete narrowing, but findings were consistent with extrinsic compression of the descending thoracic aorta by a bony spur from thoracic diastematomyelia. Three-dimensional imaging confirmed vertebral anomalies, kyphoscoliosis and tethered cord. These findings indicated coarctation-like features secondary to skeletal anomalies. The pregnancy was terminated, given the guarded prognosis from extensive spinal dysraphism. This case highlights a possible diagnostic pitfall in fetal echocardiography and underscores the importance of systematic evaluation to distinguish extrinsic mimics from true coarctation.

A 5-month-old infant with critical juxtaductal coarctation (CoA) and an aberrant right subclavian artery (ARSA) underwent successful single-stage repair. Preoperative computed tomography angiography (CTA) confirmed the ARSA originating distal to the coarctation shelf, a critical finding for surgical planning. Through a left thoracotomy, the ARSA was ligated and divided to prevent vascular steal and allow tension-free mobilization. After confirming adequate collateral perfusion to the right arm, an extended end-to-end anastomosis was performed to resect the coarctation. The postoperative course was uncomplicated, with no residual gradient or limb ischemia. This case underscores the importance of preoperative CTA for detecting arch anomalies like ARSA in CoA patients. A tailored approach with initial ARSA division facilitates a successful extended end-to-end repair, ensuring excellent hemodynamic outcomes and preserving upper limb viability.