eMedicine Specialties > Cardiology > Congenital Heart Disease in the Adult

Aortic Coarctation: Follow-up

Author: Sandy N Shah, DO, MBA, Private Practice, Houston, Texas
Coauthor(s): Dawn M Calderon, DO, Co-Director of Center for Adults With Congenital Heart Disease, Clinical Associate Professor, Departments of Cardiology and Internal Medicine, Deborah Heart and Lung Center, Robert Wood Johnson School of Medicine
Contributor Information and Disclosures

Updated: Oct 2, 2008

Follow-up

Further Outpatient Care

  • 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.

Complications

  • 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.

Prognosis

  • 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.
  • Pregnancy
    • 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.

Patient Education

  • 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.
 


More on Aortic Coarctation

Overview: Aortic Coarctation
Differential Diagnoses & Workup: Aortic Coarctation
Treatment & Medication: Aortic Coarctation
Follow-up: Aortic Coarctation
References
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References

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Further Reading

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Keywords

aorta coarctation, coarctation of aorta, cardiac lesion, juxtaductal coarctation, preductal coarctation, postductal coarctation, vascular malformation, coarctated aortic segment, infective endarteritis, cystic medial necrosis, coarctation of the aorta, narrowing of the aorta, ductus tissue theory, hemodynamic theory, ventricular septal defect, bicuspid aortic valve, left ventricular outflow obstruction, tubular hypoplasia of the transverse aortic arch, congenital cardiac lesions, XO Turner syndrome, aortic arch hypoplasia, extracardiac vascular anomalies

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Contributor Information and Disclosures

Author

Sandy N Shah, DO, MBA, Private Practice, Houston, Texas
Sandy N Shah, DO, MBA is a member of the following medical societies: American College of Cardiology, American Heart Association, and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Dawn M Calderon, DO, Co-Director of Center for Adults With Congenital Heart Disease, Clinical Associate Professor, Departments of Cardiology and Internal Medicine, Deborah Heart and Lung Center, Robert Wood Johnson School of Medicine
Dawn M Calderon, DO is a member of the following medical societies: American College of Cardiology and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Frank M Sheridan, MD, Cardiology, Providence Everett Medical Center
Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

George A Stouffer III, MD, Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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