Table 2.
Executive summary on the diagnosis and treatment of coarctation in children and adults
| Diagnosis |
| Accounts for 5%-7% of congenital heart disease diagnoses |
| Neonates often present with heart failure, acidosis, and shock with critical coarctation |
| Less severe coarctation often detected during evaluation for hypertension or murmur in the older child or adult |
| Diminished or delayed lower extremity pulses and a systolic pressure gradient between the upper and lower extremities are the most useful exam findings |
| Transthoracic echocardiogram is initial test of choice; CT and MRI useful if echocardiogram inconclusive and for surgical planning |
| Treatment |
| Surgical repair |
| Extended end-to-end anastomosis typically preferred surgical method, as it avoids prosthetic material, allows resection of the coarctation, and has a wider incision that is less prone to restenosis |
| Surgical repair typically preferred over transcatheter approaches in the infant and young child with native coarctation, patients requiring repair of associated cardiac defects, or in those with complex coarctation anatomy |
| Balloon angioplasty |
| Often the preferred intervention for recurrent coarctation |
| Concern for recoarctation and aneurysm formation in native coarctation |
| Endovascular stent |
| Provides structural support and decreased rates of aortic wall injury and aneurysm compared to balloon angioplasty |
| Covered stents may protect against shear stress and subsequent restenosis, though care must be taken to avoid overlying vital branch vessels |
| Use of stents in small children controversial due to need for large sheath size and limitations in accommodating for somatic growth |
| Patient follow-up |
| Lifelong follow-up with at least annual cardiology visits and repeat imaging every 5 yr to assess coarctation site |
| High suspicion and aggressive treatment of baseline and exercise- induced hypertension |
| Future perspectives |
| Further long-term data analysis needed to determine optimal intervention based on patient anatomy, size, and age |
CT: Computed tomography; MRI: Magnetic resonance imaging.