Diagnostic and surgical trends, and epidemiology of coarctation of the aorta in a population-based study.

Birth prevalence, and diagnostic and interventional trends for coarctation of the aorta were analysed in an Island population for patients born between 1925 and 1994. This lesion was diagnosed in 64 live births. A declining trend for age at diagnosis and age at surgery was present for the entire period (P<0.0001), predating the introduction of echocardiography, which caused a further decline. Mode of diagnosis changed from clinically, with or without preoperative catheter confirmation, prior to the mid-1980s, to almost exclusively by echocardiogram. Type of intervention was related to era, with patch aortoplasty and end-to-end resection in the mid 1960s to the mid-1970s changing to subclavian flap aortoplasty in the late 1970s and early 1980s followed by a return to end-to-end resection. The perioperative results showed an increase in mortality associated with a change towards earlier age at surgery. Prior to intervention, all Maltese patients are reviewed by a consultant cardiologist from a tertiary referral centre in the United Kingdom, and intervention is undertaken by a consultant paediatric cardiothoracic surgeon in the same setting. For this reason, these trends may be extrapolated to larger European countries. The birth prevalence of coarctation for all patients born between 1980 and 1994 was 0.32/1000 live births (n = 26), well within the range obtained from a review of previous studies. In conclusion, in Malta, coarctation of the aorta has been diagnosed and treated safely, at progressively younger ages, and this has been attributed to improving medical services over the period under study.