[Aortic coarctation: current solutions for a complex condition].

30 Aortic coarctation is a frequent and serious clinical entity that decreases life expectancy; without treatment it is associated with high morbidity and mortality.1 It has an important impact on the clinical, social and working life of the treated or untreated patient, and requires ongoing follow-up, due the threat of immediate or future complications, such as: aortic rupture, acute stroke, arterial hypertension (AHT), and premature coronary heart disease. The lesion is characterized by thickening of the aortic medial layer with intimal hyperplasia in the posterior wall. Differentiated smooth muscle cells are also found in small numbers and cause a variable blockage to the passage of blood. A large number of pseudocysts are also found on the wall with a high mucin content and without an inflammatory component. It is accompanied by dilatation and poststenotic parietal thickening. The aortic wall presents a variable degree of cystic necrosis of the medial layer that increases with age, until it becomes clearly pathological.2 In the newborn, the region affected also presents intimal thickening and abundant smooth muscle cells, possibly related to its genesis. The anatomy of the lesions is very varied (from just one acute localized coarctation, to more complex lesions with variable hypoplasia of the aortic isthmus and even of the transverse arch) which considerably influences the type of treatment. This should be personalized following a very careful anatomical study. Surgery has changed the natural history of the disease, from the first intervention in 1945 up to extended end-to-end anastomosis representing one of the best current alternatives. Non-surgical treatment began in ED I TO R I A L S