Coarctation of the aorta: Management from infancy to adulthood

Abstract

Coarctation of the aorta is a relatively common form of congenital heart disease, with an estimated incidence of approximately 3 cases per 10000 births. Coarctation is a heterogeneous lesion which may present across all age ranges, with varying clinical symptoms, in isolation, or in association with other cardiac defects. The first surgical repair of aortic coarctation was described in 1944, and since that time, several other surgical techniques have been developed and modified. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Therefore, patients must be followed closely over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects. Considerable effort has been expended investigating the utility and outcomes of various treatment approaches for aortic coarctation, which are heavily influenced by a patient's anatomy, size, age, and clinical course. Here we review indications for intervention, describe and compare surgical and transcatheter techniques for management of coarctation, and explore the associated outcomes in both children and adults.

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…Coarctation of the aorta (CoA) accounts for 5%-7% of all congenital heart disease with an incidence of approximately 3 cases per 10000 births (274). Patients with less severe CoA may not be diagnosed until later in childhood when a murmur is heard or HTN noted.…”

Late Coarctation Presenters Suffer Chronic Hypertension Resisting to Medicine Treatment

“…Stent placement can also be considered for recoarctation in older children and adolescents when the stent can be dilated to near adult size, avoiding the need for multiple redilations [24]. The rate of recoarctation after surgical repair ranges between 3% and 15% in most studies and this is higher BA ranging from 7 to 20% [5,21]. Aneurysms of the ascending aorta or at the site of intervention has been reported to be between 3% and 46% [5].…”

“…For Citation: Petropoulos recurrent CoA in the younger child, it is reasonable to consider initial BA, as aneurysm is less of a long-term concern than with native CoA [24]. BA is variably successful, and surgical reintervention may be required when there is incomplete relief of obstruction [21]. Stent placement can also be considered for recoarctation in older children and adolescents when the stent can be dilated to near adult size, avoiding the need for multiple redilations [24].…”

“…Today, in all age group patients both interventional and surgical options of treatment are offered [5,21]. In patients with a native CoA or re-CoA, a measured peak-to-peak College of Cardiology and the American Heart Association provide some insight, but the level of evidence supporting these recommendations is suboptimal [22].…”

“…Furthermore, HTN is present from the early stages of the disease and is a common pathophysiological mechanism for CHF, accelerating atherosclerosis and as consequence CAD and fi nally provokes morbidity and mortality [5,21,26,28 ].…”