Coarctation of the aorta: Management from infancy to adulthood

Table 2 Executive summary on the diagnosis and treatment of coarctation in children and adults

Diagnosis

Accounts for 5%-7% of congenital heart disease diagnoses

Neonates often present with heart failure, acidosis, and shock with critical coarctation

Less severe coarctation often detected during evaluation for hypertension or murmur in the older child or adult

Diminished or delayed lower extremity pulses and a systolic pressure gradient between the upper and lower extremities are the most useful exam findings

Transthoracic echocardiogram is initial test of choice; CT and MRI useful if echocardiogram inconclusive and for surgical planning

Treatment

Surgical repair

Extended end-to-end anastomosis typically preferred surgical method, as it avoids prosthetic material, allows resection of the coarctation, and has a wider incision that is less prone to restenosis

Surgical repair typically preferred over transcatheter approaches in the infant and young child with native coarctation, patients requiring repair of associated cardiac defects, or in those with complex coarctation anatomy

Balloon angioplasty

Often the preferred intervention for recurrent coarctation

Concern for recoarctation and aneurysm formation in native coarctation

Endovascular stent

Provides structural support and decreased rates of aortic wall injury and aneurysm compared to balloon angioplasty

Covered stents may protect against shear stress and subsequent restenosis, though care must be taken to avoid overlying vital branch vessels

Use of stents in small children controversial due to need for large sheath size and limitations in accommodating for somatic growth

Patient follow-up

Lifelong follow-up with at least annual cardiology visits and repeat imaging every 5 yr to assess coarctation site

High suspicion and aggressive treatment of baseline and exercise- induced hypertension

Future perspectives

Further long-term data analysis needed to determine optimal intervention based on patient anatomy, size, and age

CT: Computed tomography; MRI: Magnetic resonance imaging.