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Primary-care management of patients with coarctation of the aorta*

Published online by Cambridge University Press:  02 February 2017

Jeffrey R. Boris
Jeffrey R. Boris*
Affiliation:
Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: J. R. Boris, MD, Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States of America. Tel: 215 590 3180; Fax: 267 426 5324; E-mail: borisj@email.chop.edu
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Abstract

Coarctation of the aorta is a congenital cardiac defect that results in a variable degree of obstruction to the left side of the heart. It can present with either acute shock in the neonatal period as a critical lesion or it can appear more insidiously with hypertension or other findings later in life. This article summarises aspects of outpatient care of patients with this lesion, including clinical history and physical examination, ancillary testing, and issues associated with long-term follow-up and management. Increasing knowledge and experience with this group of patients have allowed for a higher level of evidence-based care over the long term.

Keywords

AmbulatoryoutpatientCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Special Issue 8: HeartWeek 2016 , December 2016 , pp. 1537 - 1542
Copyright
© Cambridge University Press 2017 

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Footnotes

*

Presented at the Johns Hopkins All Children’s Heart Institute 16th International Symposium on Congenital Heart Disease, Special Focus: Pediatric and Congenital Diseases of the Aorta, Co-Sponsor: The American Association for Thoracic Surgery (AATS), Saint Petersburg, Florida, United States of America, Saturday 13 February, 2016 to Tuesday 16 February, 2016.

References

1. Reller, MD, Strickland, MJ, Riehle-Colarusso, T, et al. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr 2008; 153: 807–813.Google Scholar
2. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (Suppl 4th Report): 555–576.CrossRefGoogle Scholar
3. Eckhauser, A, South, ST, Meyers, L, et al. Turner syndrome in girls presenting with coarctation of the aorta. J Pediatr 2015; 167: 1062–1066.Google Scholar
4. Freylikhman, O, Tatarinova, T, Smolina, N, et al. Variants in the NOTCH1 gene in patients with aortic coarctation. Congenit Heart Dis 2014; 9: 391–396.Google Scholar
5. Kuehl, K, Loffredo, C, Lammer, EJ, et al. Association of congenital cardiovascular malformations with 33 single nucleotide polymorphisms of selected cardiovascular disease-related genes. Birth Defects Res A Clin Mol Teratol 2010; 88: 101–110.Google Scholar
6. Moosmann, J, Uebe, S, Dittrich, S, et al. Novel loci for non-syndromic coarctation of the aorta in sporadic and familial cases. PLoS One 2015; 10: e0126873.Google Scholar
7. Sanchez-Castro, M, Eldjouzi, H, Charpentier, E, et al. Search for rare copy-number variants in congenital heart defects identifies novel candidate genes and a potential role for FOXC1 in patients with coarctation of the aorta. Circ Cardiovasc Genet 2016; 9: 86–94.CrossRefGoogle Scholar
8. Liberthson, RR, Pennington, DG, Jacobs, ML, et al. Coarctation of the aorta: review of 234 patients and clarification of management problems. Am J Cardiol 1979; 43: 835–840.CrossRefGoogle ScholarPubMed
9. Murdison, KA, Baffa, JM, Farrell, PE Jr, et al. Hypoplastic left heart syndrome. Outcome after initial reconstruction and before modified Fontan procedure. Circulation 1990; 82 (Suppl): IV199–IV207.Google Scholar
10. Correia, AS, Gonçalves, A, Paiva, M, et al. Long-term follow-up after aortic coarctation repair: the unsolved issue of exercise-induced hypertension. Rev Port Cardiol 2013; 32: 879–883.Google Scholar
11. Murakami, T, Takeda, A. Enhanced aortic pressure wave reflection in patients after repair of aortic coarctation. Ann Thorac Surg 2005; 80: 995–999.Google Scholar
12. Murakami, T, Takeda, A, Yamazawa, H, et al. Aortic pressure wave reflection in patients after successful aortic arch repair in early infancy. Hypertens Res 2013; 36: 603–607.Google Scholar
13. Ou, P, Celermaier, DS, Joliver, O, et al. Increased central aortic stiffness and left ventricular mass in normotensive young subjects after successful coarctation repair. Am Heart J 2008; 155: 187–193.Google Scholar
14. Ou, P, Celermaier, DS, Mousseaux, E, et al. Vascular remodeling after “successful” repair of coarctation: impact of aortic arch geometry. J Am Coll Cardiol 2007; 49: 883–890.CrossRefGoogle ScholarPubMed
15. Brili, S, Tousoulis, D, Antoniades, C, et al. Effects of ramipril on endothelial function and the expression of proinflammatory cytokines and adhesion molecules in young normotensive subjects with successfully repaired coarctation of aorta. J Am Coll Cardiol 2008; 51: 742–749.Google Scholar
16. Graham, TP Jr, Driscoll, DJ, Gersony, WM, et al. Task Force 2: Congenital Heart Disease. In: 36th Bethesda Conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005; 45: 1326–1333.Google Scholar
17. Curtis, SL, Bradley, M, Wilde, P, et al. Results of screening for intracranial aneurysms in patients with coarctation of the aorta. Am J Neuroradiol 2012; 33: 1182–1186.Google Scholar
18. Connolly, HM, Huston, J 3rd, Brown, RD Jr, et al. Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients. Mayo Clin Proc 2003; 78: 1491–1499.Google Scholar
19. Cook, SC, Hickey, J, Maul, TM, et al. Assessment of the cerebral circulation in adults with coarctation of the aorta. Congenit Heart Dis 2013; 8: 289–295.CrossRefGoogle ScholarPubMed
20. De Divitiis, M, Pilla, C, Kattenhorn, M, et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 2001; 104: I-165–I-170.CrossRefGoogle ScholarPubMed
21. Sable, C, Foster, E, Uzark, K, et al. Best practices in managing transition to adulthood for adolescents with congenital heart disease: the transition process and medical and psychosocial issues: a scientific statement from the American Heart Association. Circulation 2011; 123: 1454–1485.Google Scholar
22. Gurvitz, M, Marelli, A, Mangione-Smith, R, et al. Building quality indicators to improve care for adults with congenital heart disease. J Am Coll Cardiol 2013; 62: 2244–2253.Google Scholar
23. Beauchesne, LM, Connolly, HM, Ammash, NM, et al. Coarctation of the aorta: outcome of pregnancy. J Am Coll Cardiol 2001; 38: 1728–1733.Google Scholar
24. Jimenez-Juan, L, Krieger, EV, Valente, AM, et al. Cardiovascular magnetic resonance imaging predictors of pregnancy outcomes in women with coarctation of the aorta. Eur Heart J Cardiovasc Imaging 2014; 15: 299–306.Google Scholar
25. Krieger, EV, Landzberg, MJ, Economy, ME, et al. Comparison of risk of hypertensive complications of pregnancy among women with versus without coarctation of the aorta. Am J Cardiol 2011; 107: 1529–1534.Google Scholar
26. Crafoord, C, Nylin, G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg 1945; 14: 347–361.Google Scholar