Coarctation of aorta : A surgical journey

Since my placement as a trainee at Royal Hospital for Children, I became interested in pathophysiology of coarctation of aorta. It may seem a simple pathology which narrow the aortic lumen in distal arch but the story behind this simple pathology is more complex. In fact I was fascinated by the surgical repair techniques and it did not take long after expressing interest to find out “which technique is the best?”, I realised that this has been a historical question at least for the past 50 years. The review of coarctation repair in Scotland and evaluation of outcomes soon became operational while there was no previous such a regional study. Retrieving and reviewing of echocardiography images followed by measuring aortic parameters despite challenges soon became an exciting investigation. The systematic review of the literature was also a fascinating journey through the history where finding an answer for many questions on coarctation of aorta was challenged by a high degree of heterogeneity not only in the study design itself but also in the practice of the individual reporting institution. Apprising historical papers and studies from different part of the world was a rewarding experience; although the result of the search for the best technique was inconclusive. The “Future” Chapter is basically the conclusion of my journey with coarctation of aorta in this thesis. By observing current breakthroughs in technology and evolving computational modelling, the future of coarctation surgery has already been shaped. Maybe we have been looking for an answer for a historical question which probably should been made differently: “which technique is the best for which patient?”