The term coarctation of the aorta (CoA) stands for a narrowing of the thoracic aorta with heterogeneous morphologic phenotypes resulting in different treatment strategies. Its origin remains controversial (hemodynamical versus ductal tissue theory), some types being detected prenatally, while others are diagnosed later in life.

We attempted to establish a classification system based on a 10-year data collection of surgical specimens.

It was a monocentric retrospective study: using precise descriptions of aortic morphology obtained from operative reports (2010–2020) of 181 patients with CoA, we analyzed different characteristics to generate a classification system.

Four types of isthmic CoA were depicted: narrowing (1) associated with aortic hypoplasia (33%), (2) due to a posterior shelf (64%), (3) due to intraluminal membrane (1%) and (4) aortic kinking (2%). Age at surgery ranged from 7 days to 51 years. Prenatal diagnosis rate and associated cardiac anomalies were more frequent in type 1. Distinction of localized (types 2, 3 and 4) and diffuse narrowing (type 1) revealed a significant difference for age at surgery, prenatal diagnosis, and associated anomaly. The presence of a bicuspid aortic valve (48.6%) did not differ according to the types. A left superior vena cava (7.7%) was equally encountered in all the subtypes (Fig. 1).

A new classification system for CoA is presented. According to our data, all the types could be prenatally diagnosed. This classification might be advantageous to better understand pathophysiology of CoA and facilitate scientific communication.