[Operated and unoperated coarctation of the aorta in the adult].

The common denominator of patients operated for isthmic coarctation of the aorta in childhood who reach adulthood, is the risk of hypertension which is observed in about 70% of cases with its cortege of cerebral and coronary vascular complications or left ventricular hypertrophy, which considerably reduce life expectancy. Systematic follow-up of these patients includes, in addition to clinical and echocardiographic examination, three essential investigations: exercise stress testing, the study of arterial mechanics and angio MRI. Hypertension on exercise is observed in 70% of patients of whom 21% have critical hypertension despite excellent anatomical correction. Vascular study shows changes in arterial eactivity and endothelial function independent of the age at operation: MRI often demonstrates aortic irregularities which partially explain the hypertension. Three therapeutic choices are available: in cases of restenosis, balloon angioplasty with or without stenting gives good results: when hypoplasia of the aorta is observed, a surgical repair is recommended: otherwise, pharmacological treatment with life style adaptation including carefully managed physical exercise is appropriate. Coarctation diagnosed in adulthood is rare but poses special problems. Treatment by angioplasty is possible but is complicated by aneurysms of the isthmus in 20% of cases so that nowadays surgery is the treatment of choice. This is difficult and dangerous because of the collateral circulation, the fragility of the aorta and the risk of medullary ischaemia. Resection-anastomosis is the most effective technique with or without cardiopulmonary bypass, reducing the hypertension in 70% of cases.