Coarctation of the Aorta Follow-up

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Follow-up

Further Outpatient Care

Focus early outpatient follow-up care on wound healing, resolution of lung atelectasis, and adjustment of antihypertensive medications.

Assess postoperative BP response to exercise prior to discontinuation of antihypertensive therapy.

Many patients may be weaned from antihypertensive therapy over months or years following repair of coarctation. Other patients may require some form of ongoing antihypertensive therapy.

Search for late complications of coarctation repair, including recurrent coarctation and aneurysm formation.

Patients should receive antibiotic prophylaxis before undergoing any bacteremia-producing surgery or procedures, especially in view of reported incidence of bacterial endocarditis during follow-up. [158]

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Further Inpatient Care

Focus postoperative recovery of patients with coarctation of the aorta (CoA) on control of blood pressure (BP), slow advancement of diet, manipulation of antihypertensive medications, progressive ambulation, and pulmonary therapy to improve left lung atelectasis (common after left thoracotomy).

Hospitalization and inpatient care may be required for cardiac catheterizations, catheter interventions, and surgical procedures for treatment of recoarctation or other complications.

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Transfer

If coarctation of the aorta is prenatally diagnosed, the mother should deliver at or near a facility with expertise in caring for an infant with coarctation of the aorta. The facility should also have prostaglandin E1 available.

Infants who present early with severe coarctation of the aorta may require transfer to a facility with pediatric cardiologists and cardiovascular surgeons skilled in the management of coarctation in seriously ill infants.

Consider transfer of older children, adolescents, and adults to a facility with cardiologists and surgeons with experience in the management of coarctation.

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Deterrence/Prevention

Although coarctation of the aorta cannot be prevented, it can be detected early with fetal echocardiography. Although the diagnosis can be difficult to make, echocardiography may be considered in fetuses with unexplained enlargement of the right ventricle, difficult identification of the true aortic arch, identification of an unusual aortic arch contour, or identification of anomalies that may be associated with coarctation of the aorta, such as other forms of left heart obstruction. Fetal echocardiography is indicated during pregnancy in every woman who has previously borne a child with congenital heart disease (CHD), especially left heart obstructive lesions.

Postnatally, early detection of coarctation of the aorta is important to avoid prolonged hypertension or other complications. Careful measurement of BPs and evaluation of lower extremity pulses in newborns and at subsequent healthy child examinations is imperative.

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Patient Education

Educate patients with coarctation of the aorta and their families regarding the need for lifelong follow-up care to detect recurrent coarctation or late complications.

Educate patients regarding a healthy lifestyle by instructing them to avoid smoking and obesity, get plenty of aerobic exercise, control BP appropriately, and reduce other factors that influence cardiovascular disease.

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