Cardiac catheterization is not necessary for diagnosis in our patient, because both the bedside findings and laboratory assessment, particularly echocardiographic evaluation, clearly defined his diagnosis. Decision regarding treatment of his coarctation can affect recommendation for catheterization, because of emergence of balloon dilation with stenting as a therapeutic technique for some cardiac and vascular obstructions. Balloon dilation with stenting for initial treatment of a previously untreated aortic coarctation is not uniformly accepted, because of uncertainty that it is equivalent to surgical correction, but it may be considered.
Balloon Dilation with stenting
Cardiac catheterization and balloon dilation with stenting are often recommended in patients who develop recurrent obstruction after initial surgery to relieve the coarctation. Choice of this therapy may depend upon patient age, prior surgical repair technique and precise anatomy of the obstruction site.
Aortic angiogram
This is a still-frame of an angiogram in the aorta in another patient. Labels indicate the ascending aorta, transverse aortic arch, left subclavian artery and descending thoracic aorta. The arrow (>) in frame A indicates the coarctation. Note in frame B the presence of enlarged collateral arteries, (< >) primarily, intercostal arteries. Observe that the direction of flow in these collateral arteries is from the aorta above the coarctation into the aorta below it.
Magnetic resonance imaging
Magnetic resonance imaging is another method that can provide anatomic information regarding coarctation of the aorta. Injection of radiopaque contrast into a peripheral vein, MR angiography, illustrates anatomic details on a par with direct aortography accomplished during catheterization. As with catheterization, however, this procedure is not necessary for routine diagnostic evaluation of coarctation of the aorta, as the bedside findings and echocardiogrpahy suffice.
Magnetic resonance angiogram
This is a still-frame of a magnetic resonance angiogram in a patient with coarctation of the aorta. The arrow points to the coarctation. Note the anatomic details of the arteries. Rapid accumulation of MR images provides a series that simulates a radiographic angiogram.