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]

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.

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.

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.

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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Media Gallery

Aortic coarctation visualized by aortic angiography.
Aortic coarctation visualized by MR imaging.

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Author

Syamasundar Rao Patnana, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

Syamasundar Rao Patnana, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Paul M Seib, MD Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Medical Director, Cardiac Catheterization Laboratory, Co-Medical Director, Cardiovascular Intensive Care Unit, Arkansas Children's Hospital

Paul M Seib, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Arkansas Medical Society, International Society for Heart and Lung Transplantation, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received research grant from: Lundbeck Pharmaceuticals<br/>Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Juan Carlos Alejos, MD Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, International Society for Heart and Lung Transplantation

Disclosure: Received honoraria from Actelion for speaking and teaching.