Aortic Coarctation Medication
- Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Park W Willis IV, MD more...
No specific medications are used to treat coarctation of the aorta because it is a mechanical obstruction. In the neonate, management of concomitant congestive heart failure may include prostaglandin E1 to maintain patency of the ductus arteriosus. Beyond the neonatal period, management of congestive heart failure may include digoxin and diuretics.
Hypertension should be controlled by beta-blockers, ACE inhibitors, or angiotensin-receptor blockers as first-line medications. The choice of beta-blockers or vasodilators may be influenced in part by the aortic root size, the presence of aortic regurgitation, or both.
This agent promotes vasodilatation by direct effect on the vasculature and smooth muscle of the ductus arteriosus.
Used to maintain patency of ductus arteriosus when cyanotic lesion or interrupted aortic arch presents in newborn. Most effective in premature infants.
These agents increase the contractility of cardiac muscle in a dose-dependent manner (ie, positive inotropic effect).
Cardiac glycoside with direct inotropic effects in addition to indirect effects on cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.
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].