Aortic Coarctation Follow-up
- Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Park W Willis IV, MD more...
Further Outpatient Care
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- According to the Canadian Adult Congenital Heart Association, all patients with coarctation of the aorta need to be monitored by a cardiologist.
- Patients should have at least one MRI or angiogram following repair of the coarctation.
- Close surveillance and aggressive management are necessary for residual hypertension, heart failure or intracardiac disease, associated bicuspid aortic valve, recurrent coarctation of the aorta, or significant arm-leg blood pressure gradient at rest or with exercise.
- Ascending aortic dilation in the presence of a bicuspid aortic valve, new or unusual headache from berry aneurysm formation, late dissection proximal or distal to the repair site, and aneurysm formation at the site of coarctation repair are late sequelae of this disease.
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- Postoperative complications
- Hoarseness due to damage to the recurrent laryngeal nerve as it loops around the patent ductus arteriosus or ligamentum.
- Ipsilateral diaphragmatic paralysis may result from injury to the phrenic nerve.
- Chylothorax can occur due to damage to the thoracic duct that crosses behind the aortic arch and left subclavian artery.
- Serious postoperative hemodynamic collapse may result from hemorrhage due to injury to the chest wall collaterals.
- Rebound and paradoxical hypertension is observed frequently and may be related to the baroreceptor-mediated increase in sympathetic activity and reflex vasospasm in the vascular territory distal to the coarctation.
- Postcoarctectomy syndrome is a unique problem early in the postoperative period. Increases in blood flow and pressure in the mesenteric arteries after repair of coarctation may result in abdominal distention and pain, vomiting, and decreased bowel sounds. This syndrome may be masked because of poorly controlled postoperative hypertension and early enteral feeding. By aggressively controlling postoperative hypertension and delaying enteral feeding for 2 days after surgery, incidence of postcoarctectomy syndrome may be reduced.
- Paralysis of the lower body resulting from spinal cord injury is the most serious complication. Because of complex collateral formation, ischemia of the spinal cord is often difficult to predict and, therefore, may be unavoidable.
- Long-term complications
- Systemic hypertension is the most common long term complication. This may be accentuated by exercise, creating a need to exclude residual or recurrent obstruction.
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- Patients who are not treated for coarctation of the aorta may reach the age of 35 years; fewer than 20% survive to age 50 years. If coarctation is repaired before the age of 14 years, the 20-year survival rate is 91%. If coarctation is repaired after the age of 14 years, the 20-year survival rate is 79%.
- After repair of coarctation of the aorta, 97-98% of patients are NYHA class I. Impaired diastolic left ventricular function and persistent hypertrophy due to increased pressure gradient at the coarctation site during exercise may result in myocardial hypertrophy despite successful hemodynamic results. Overall, left ventricular systolic function is normal or hyperdynamic in these patients.
- Most women reach childbearing age. If maternal coarctation is not repaired, risks to fetus and mother are increased. The maternal mortality rate is approximately 3-8%.
- Despite repair, women have an increased risk of aortic dissection and rupture of cerebral aneurysm in the third trimester and peripartum period due to hemodynamic and hormonal changes.
- All pregnant women with a history of coarctation, either native or repaired, should be considered high risk.
- Significant stenosis—native, residual, or recurrent—is a contraindication to pregnancy.
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- Most adults with coarctation have undergone repair; however, continued education regarding exercise, endocarditis and endarteritis prevention, and pregnancy issues is necessary.
- For the rare adult with uncorrected coarctation, extensive patient education is necessary on issues ranging from pathology and repair to lifestyle modification and follow-up care.
- The medical practitioner must understand that coarctation is a complex lifelong condition that may be repaired but is never truly corrected.
Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation. 2008 Dec 2. 118(23):2395-451. [Medline].
Swartz MF, Atallah-Yunes N, Meagher C, Schiralli MP, Cholette J, Orie J, et al. Surgical Strategy for Aortic Coarctation Repair Resulting in Physiologic Arm and Leg Blood Pressures. Congenit Heart Dis. 2011 Nov 3. [Medline].
Weinstein BM, Stemple DL, Driever W, Fishman MC. Gridlock, a localized heritable vascular patterning defect in the zebrafish. Nat Med. 1995 Nov. 1(11):1143-7. [Medline].
VOSSSCHULTE K. Surgical correction of coarctation of the aorta by an "isthmusplastic" operation. Thorax. 1961 Dec. 16:338-45. [Medline].
Waldhausen JA, Nahrwold DL. Repair of coarctation of the aorta with a subclavian flap. J Thorac Cardiovasc Surg. 1966 Apr. 51(4):532-3. [Medline].
Kenny D, Cao QL, Kavinsky C, Hijazi ZM. Innovative resource utilization to fashion individualized covered stents in the setting of aortic coarctation. Catheter Cardiovasc Interv. 2011 Sep 1. 78(3):413-8. [Medline].
Carr JA. The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol. 2006 Mar 21. 47(6):1101-7. [Medline].
Abbruzzese PA, Aidala E. Aortic coarctation: an overview. J Cardiovasc Med (Hagerstown). 2007 Feb. 8(2):123-8. [Medline].
Attenhofer Jost CH, Schaff HV, Connolly HM. Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease. Mayo Clin Proc. 2002 Jul. 77(7):646-53. [Medline].
Blalock A, Park EA. The Surgical Treatment of Experimental Coarctation (Atresia) of the Aorta. Ann Surg. 1944 Mar. 119(3):445-56. [Medline].
Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, et al. Coarctation of the Aorta: Life-long Surveillance is Mandatory Following Surgical Repair. J Am Coll Cardiol. 2013 Jun 27. [Medline].
Butera G, Piazza L, Chessa M, Negura DG, Rosti L, Abella R, et al. Covered stents in patients with complex aortic coarctations. Am Heart J. 2007 Oct. 154(4):795-800. [Medline].
Cardiac CT & MRI. www.ctcardia.com. Available at www.ctcardiac.com. Accessed: April 11, 2005.
Celermajer DS, Greaves K. Survivors of coarctation repair: fixed but not cured. Heart. 2002 Aug. 88(2):113-4. [Medline].
Connolly HM. Pregnancy in women with coarctation of the thoracic aorta. ACC Curr J Rev. 1997. 55:6-7.
Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg. 1945. 14:347-61.
Fawzy ME, Awad M, Hassan W, et al. Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol. 2004 Mar 17. 43(6):1062-7. [Medline].
Golden AB, Hellenbrand WE. Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv. 2007 Feb 1. 69(2):289-99. [Medline].
Harlan JL, Doty DB, Brandt B 3rd. Coarctation of the aorta in infants. J Thorac Cardiovasc Surg. 1984 Dec. 88(6):1012-9. [Medline].
Hornung TS, Benson LN, McLaughlin PR. Interventions for aortic coarctation. Cardiol Rev. 2002 May-Jun. 10(3):139-48. [Medline].
Karl TR. Surgery is the best treatment for primary coarctation in the majority of cases. J Cardiovasc Med (Hagerstown). 2007 Jan. 8(1):50-6. [Medline].
Konen E, Merchant N, Provost Y, et al. Coarctation of the aorta before and after correction: the role of cardiovascular MRI. AJR Am J Roentgenol. 2004 May. 182(5):1333-9. [Medline].
Konen E, Merchant N, Provost Y, McLaughlin PR, Crossin J, Paul NS. Coarctation of the aorta before and after correction: the role of cardiovascular MRI. AJR Am J Roentgenol. 2004 May. 182(5):1333-9. [Medline].
Miller G. Repair aortic coarctation early and follow for life: 60-year study. Medscape Medical News. Available at http://www.medscape.com/viewarticle/807918. Accessed: July 22, 2013.
Perloff JK. The Clinical Recognition of Congenital Heart Disease. 3rd ed. Philadelphia, Pa: WB Saunders and Co; 1987. 125-160.
Ramnarine I. Role of surgery in the management of the adult patient with coarctation of the aorta. Postgrad Med J. 2005 Apr. 81(954):243-7. [Medline].
Rothman A. Coarctation of the aorta: an update. Curr Probl Pediatr. 1998 Feb. 28(2):33-60. [Medline].
Toro-Salazar OH, Steinberger J, Thomas W, et al. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002 Mar 1. 89(5):541-7. [Medline].
Varma C, McLaughlin PR, Hermiller JB, Tavel ME. Coarctation of the aorta in an adult: problems of diagnosis and management. Chest. 2003 May. 123(5):1749-52. [Medline].
von Schulthess GK, Higashino SM, Higgins SS, et al. Coarctation of the aorta: MR imaging. Radiology. 1986 Feb. 158(2):469-74. [Medline].
Webb G. Treatment of coarctation and late complications in the adult. Semin Thorac Cardiovasc Surg. 2005 Summer. 17(2):139-42. [Medline].