Coarctation of aorta continues to be an important acyanotic heart disease . Now , early recognition and intervention is possible with the availability of sophisticated imaging and interventional modalities.
Our understanding of this entity , even though appears complete . . . it is not , especially the complexities of the collateral circulation and the associated malformation.Even in this 21 st century , unexpected circulatory compromise are reported in the postoperative phase from various vascular beds (Spinal, mesentric, limbs etc)
It is also surprising to note , much innocuous entities like ASDs ,VSDs have popular anatomical and functional classification.It is a rare excercise , for cardiology fellows to classify co-arctation of aorta .This , in spite of the fact, we have a meticulous classification suggested by Amato , way back in 1991 published in Annals of thoracic surgery .
Let us be aware of this . . . Click the link below for Amato’s classification
Amato’s surgical classification of coarctation of aorta
Type 1 Primary Aortic Coarctation
Type 2 Coarctation with Isthmus hypoplasia
Type 3 Coarctation with Tubular hypoplasia of distal arch
3A- With VSD
3B-With complex LV outflow lesions
* Ideally we need to include BCAV and status of ductus , suitability of aortic stenting in the classification.
Other old classifications
Bonnet’s classification
Infantile :which later became known as pre-ductal, and adult which later became known as post-ductal . These became obsolete , as we came to know all coarctation or juxta-ductal .(Very difficult to separate into pre or post ductal coarctation by simply looking at it , without knowing the hemodynamics )
* Conte et all ** Backer
1.Isolated coarctation 2.Co- arctation with VSD 3.Co arctation with complex heart anomalies.
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Dr.S.Venkatesan MD 