Materiały źródłowe

• #1 Coarctation of the aorta | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/coarctation-of-the-aorta?content_id=CON-20303963

  Treatment for coarctation of the aorta depends on how old the person is when the heart condition is diagnosed. Treatment also depends on how much of the aorta is narrowed. […] Coarctation of the aorta treatment may include: Medicines. A heart procedure. Surgery. […] Medicines for aortic coarctation may include: Blood pressure medicines. Medicines are used to control blood pressure before repair surgery. Although fixing the aorta can improve blood pressure, many people still need blood pressure medicine after the repair surgery. […] Medicine to keep the ductus arteriosus open. Babies are born with a temporary opening called the ductus arteriosus between the aorta and the pulmonary artery. This opening lets some blood go to the lungs. The ductus arteriosus most often closes soon after birth. But medicine can keep it open. Babies with severe coarctation of the aorta often get such medicine until surgery is done to fix the aorta.

• #1 Coarctation of the aorta | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/coarctation-of-the-aorta?content_id=CON-20303963

  Surgery or a heart procedure can be done to repair aortic coarctation. Options include: Balloon angioplasty and stenting. This may be the first treatment for aortic coarctation. Sometimes it’s done if the aorta gets narrow again after coarctation surgery. The treatment helps widen a narrowed artery and improve blood flow. […] During angioplasty, a doctor uses a thin tube called a catheter and a tiny balloon to open a narrowed artery. Usually, a small metal coil called a stent is placed in the artery. The stent keeps the artery open. It also reduces the risk of renarrowing. […] Resection with end-to-end anastomosis. A surgeon removes the narrowed area of the aorta. This is called a resection. The surgeon then connects the two healthy parts of the aorta. This is called anastomosis. […] Subclavian flap aortoplasty. A surgeon takes part of the blood vessel that delivers blood to the left arm, called the left subclavian artery, and uses it to widen the narrowed area of the aorta.

• #1 Coarctation of the aorta | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/coarctation-of-the-aorta?content_id=CON-20303963

  Bypass graft repair. This surgery uses a tube called a graft to create a new path for blood to flow around the narrowed area of the aorta. […] Patch aortoplasty. The surgeon cuts across the narrowed area of the aorta and patches in a piece of material to expand the blood vessel. This treatment is useful if the coarctation involves a long part of the aorta. […] After aortic repair surgery, health checkups are needed for life to keep track of blood pressure and watch for complications.

• #2 Management of adults with coarctation of aorta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7284000/

  Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. […] Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. […] Indications for intervention (surgical or transcatheter intervention) in coarctation of aorta are: (1) Peak to peak coarctation gradient 20 mmHg: This gradient can be measured as a difference between systolic blood pressures from the upper and lower extremities, from catheterization data in which peak pressure distal to the coarctation is subtracted from peak pressure proximal to the coarctation, or with echocardiography.

• #2 Management of adults with coarctation of aorta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7284000/

  Various surgical techniques have been utilized for CoA repair. […] Balloon angioplasty was first described by Singer et al in 1982, and became widely used over the following two decades. […] Stent implantation has become the mainstay of interventional treatment for CoA, with a reduction in clinically significant residual gradient and aortic wall abnormalities when compared with balloon angioplasty alone. […] Stent placement is considered a reasonable treatment option in patients weighing more than 30 kg, as children weighing less than 30 kg may need repeated interventions for stent expansion in the face of growth with the potential injury risk to the femoral arteries during vascular access for stent delivery. […] Studies support the safety and efficacy of stent placement for both native and recurrent coarctation. […] Patients with CoA have a reduced life expectancy and increased risk of morbidity after intervention, despite good long-term survival rates.

• #3 Coarctation of the Aorta > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/coarctation-of-the-aorta

  Treatment includes medications, surgery, balloon angioplasty with stenting. […] Surgery is needed to correct coarctation of the aorta and widen the narrowed section of artery. Patients may also receive medication to manage their symptoms until they undergo surgery. […] The following medications may be prescribed to manage symptoms: Prostaglandin E1, which is typically given to newborns before surgery. It is used to maintain the opening of the ductus arteriosus and, potentially, re-open it if it has already closed, improving blood flow. This medication may also help the narrowed section of artery to relax, also improving blood flow. Beta-blockers to manage high blood pressure. Diuretics to help patients with heart failure. Milrinone, dopamine, or dobutamine, which also help to manage heart failure.

• #3 Coarctation of the Aorta > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/coarctation-of-the-aorta

  The following procedures may be used to treat coarctation of the aorta: Surgery. During this procedure, doctors remove the narrowed segment of aorta and connect the wider ends that remain on either side. They may also use tissue from elsewhere in the body to create a patch that is attached to the aorta to widen the space. Newborns and young children are more likely to have this procedure. Balloon angioplasty with stenting. During this minimally invasive procedure, doctors thread a thin tube through a blood vessel in the groin until it reaches the heart. They insert a deflated balloon through the tubing, then inflate it at the site of the narrowed aorta to widen the space. A mesh stent is implanted to keep the area open. Adults, teens, and older children are more likely to undergo this procedure. This is also typically the preferred procedure for infants who have undergone surgical repair and experienced a re-narrowing of the aorta.

• #4 Coarctation of the Aorta Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/895502-treatment

  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. […] Treatment in patients with congestive heart failure (CHF) includes the use of diuretics and inotropic drugs. […] Prostaglandin E1 (0.05-0.15 mcg/kg/min) is infused intravenously to open the ductus arteriosus.

• #5 Coarctation of the Aorta Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/895502-treatment

  Ventilatory assistance is provided to patients with markedly increased work of breathing. […] Infusion of inotropic drugs (dopamine, dobutamine, epinephrine) is useful when ventricular dysfunction is present, especially with hypotension. […] Patients stabilized by the above interventions are better candidates for surgical or catheter intervention. […] In the presence of associated defects, the significance of coarctation on the clinical course of the patient should be assessed with echo-Doppler and/or catheterization and angiographic studies. […] The goal should be to reduce upper extremity hypertension, but remember that vigorous attempts to achieve normal upper extremity blood pressure (BP) may result in inadequate lower-body perfusion. […] Postoperative hypertension can be treated short-term with vasodilators, such as sodium nitroprusside, and intravenous beta-blockers, such as esmolol.

• #6 Coarctation of the Aorta (CoA)

  https://my.clevelandclinic.org/health/diseases/16876-aortic-coarctation

  Coarctation of the aorta (CoA) is a heart defect some babies are born with. Your child needs surgery or catheterization to repair the problem and prevent complications. […] Treatment depends on your child’s age, the severity of aortic narrowing and any other heart defects they have. Surgery is the gold standard for repairing CoA in babies and young children. Cardiac catheterization (less invasive than surgery) may be appropriate for older children who have mild coarctation. It’s also a treatment for children and adults who have recoarctation. […] The most common repair surgeries for CoA include: Resection with end-to-end anastomosis. If the coarctation is relatively small, the surgeon can remove (resect) the narrowed part of your baby’s aorta and rejoin the two ends. Resection with extended end-to-end anastomosis. When there’s some narrowing of your baby’s aortic arch, the surgeon can remove the narrowed part of their aorta and join the lower part (descending aorta) to an elongated incision in their aortic arch. This is the best option to treat aortic coarctation with associated transverse aortic arch hypoplasia.

• #6 Coarctation of the Aorta (CoA)

  https://my.clevelandclinic.org/health/diseases/16876-aortic-coarctation

  If your child has mild aortic narrowing or narrowing that returns after surgery, their provider may recommend: Balloon angioplasty. A surgeon uses a balloon to widen the narrowed part of your child’s aorta. Balloon angioplasty with stent placement. A surgeon widens your child’s aorta while also placing a tube (stent) to keep it open.

• #7 Current management of coarctation of the aorta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4710863/

  Surgical repair of coarctation was first described in 1944 and since then many modifications have been developed depending on the anatomy. […] Surgery is the preferred treatment of infants with coarctation with an overall survival rate of 98 percent at a median follow-up of 4.8 years of age. […] Early postoperative morbidity includes paradoxical hypertension, left recurrent laryngeal nerve paralysis, phrenic nerve injury and subclavian steal. […] Balloon angioplasty has been an acceptable technique for three decades for the relief of coarctation. […] Stent placement after balloon angioplasty or surgery reduces the complications, improves luminal diameter, results in minimal residual gradient, and sustains hemodynamic benefit. […] Societal guidelines recommend correction of coarctation as early as possible, optimally early in childhood, to reduce the long-term morbidity and improve survival.

• #7 Current management of coarctation of the aorta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4710863/

  For larger patients (weight 25 kg), stenting has become the preferred approach in many centers. […] Long term problems may occur after all forms of treatment. The most important complications are arterial hypertension, recoarctation and aneurysms of the ascending aorta or at the site of intervention. […] Recoarctation is an important cause of morbidity after an initially successful repair. […] Aneurysms of the ascending aorta or in the region of the aortic isthmus are the most dangerous complications because they carry the risk of life-threatening rupture. […] Hypertension is among the factors that contribute to premature death from coronary and cerebrovascular disease following repair of coarctation of the aorta. […] All coarctation patients, whether repaired or not, should be monitored with life-long congenital cardiology follow-up because of the potential long-term complications.

• #7 Current management of coarctation of the aorta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4710863/

  Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. […] This review outlines the optimal management strategy of this disease from neonatal to adult life and provides insights to approach this straightforward but challenging condition. […] The most widely accepted indication for intervention in children and adults is the presence of systemic arterial hypertension, with an upper and lower extremity systolic blood pressure difference 20 mg. […] Correction of coarctation should be performed in infancy or early childhood to prevent the development of chronic systemic hypertension as delayed repair after early childhood does not prevent persistence or late recurrence of systemic hypertension.

• #8 Coarctation of Aorta: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/pediatrics/heart/coarctation-of-aorta/treatment

  Balloon angioplasty and stenting. This is usually the first surgical treatment used. It is also done if narrowing occurs after a previous surgery. A small tube called a catheter is inserted into an artery in the groin. An uninflated balloon is placed in the catheter and is guided by X-rays. Once it reaches the area of the narrowing aorta, the balloon is inflated, allowing the artery to open, and let the blood flow. In addition, a small wire mesh tube called a stent is inserted to keep the artery open and prevent future narrowing. […] Resection with end-to-end anastomosis. This procedure removes the narrowed piece of the aorta and connects the two healthy sections of the aorta. […] Subclavian flap aortoplasty. A section of the blood vessel that transports blood to the left arm may be used to expand the narrowed section of the aorta.

• #9 Coarctation of Aorta: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/pediatrics/heart/coarctation-of-aorta/treatment

  Bypass graft repair. A tube called a graft is used to redirect the blood around the narrowed section of the aorta. […] Patch aortoplasty. An incision is made across the narrowed section of the aorta. Synthetic material is used to widen the blood vessel. This procedure works well when correcting the long part of the aorta. […] Aortic repair surgery is serious and needs to be followed up throughout a persons lifetime. Constant blood pressure monitoring is necessary and following the doctors instructions to avoid complications that can arise.

• #10 Coarctation of the Aorta Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/895502-treatment

  Surgical repair of coarctation of the aorta is accomplished in children and adolescents with generally good results and low mortality. […] Balloon angioplasty may be an effective alternative to surgery for the relief of aortic coarctation. […] Balloon angioplasty is useful in the treatment of extremely ill neonates and infants with severe coarctation; in this subset of patients, the balloon angioplasty has a significant advantage over a surgical approach. […] Most cardiologists and surgeons agree that balloon angioplasty is the treatment of choice for postsurgical recoarctations. […] The following are perceived advantages of stents over balloon angioplasty: The ability to expand tubular long-segment coarctation, hypoplastic isthmus, and the distal transverse aortic arch. […] The ability to increase the coarcted segment diameter independently of the intimal tear.

• #11 Coarctation of the Aorta Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/895502-treatment

  The ability to decrease the probability of restenosis. […] The ability to prevent dissection of the torn intimal flap by facilitating apposition of the intima against the media. […] The ability to prevent aneurysms because of the support of the weakened aortic wall with the stent and neointima. […] Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results. […] The effectiveness of balloon angioplasty appears to be comparable with that of surgery; the mortality rates are similar (and are probably related to the associated cardiac defects, not related to type of intervention performed), and morbidity and complication rates are lower with balloon angioplasty than with surgical therapy.

• #12 Coarctation of the Aorta | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/coarctation

  In a critically ill newborn who comes into the hospital after the ductus arteriosus closes and there is a severe coarctation, the goals are to improve ventricular function and restore blood flow to the lower body. A continuous intravenous medication, prostaglandin (PGE-1), is used to open the ductus arteriosus. This allows blood flow to the body beyond the coarctation. Often other intravenous (IV) medicines may also be needed to help the function of the heart. Many babies need to be placed on a ventilator before surgery. […] If the baby has symptoms of a coarctation, surgery is done on an urgent basis. […] There are a few surgical techniques to repair coarctation. The most common repair involves resection (removal) of the narrowed area with anastomosis (reconnection) of the two ends to each other. Sometimes the removal of tissue must be extended further into the aortic arch if there is a longer piece of narrowing. In another method, the narrowing may be opened with a patch or a portion of an artery may be used as a flap to expand the area (called a subclavian flap aortoplasty).

• #12 Coarctation of the Aorta | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/coarctation

  To repair coarctation surgically, clamps must be placed on the aorta. This will quickly interrupt blood flow to areas supplied by blood vessels from the aorta. Complications of surgery include damage to organs such as the kidneys or the spinal cord, but these are not common in children. […] Because older children may have minimal symptoms, coarctation repair is typically planned electively. Surgical repair is usually done with resection of the narrowed piece and end-to-end reconnection. […] In older children who are closer to adult size, transcatheter therapy is the first-line therapy. It offers the ability to use a balloon or stent to dilate (make the area bigger) the area of narrowing without needing surgery. In children who are still growing, the placement of a stent means that additional catheterization procedures are likely to be needed in the future as the stents cannot grow with them.

• #12 Coarctation of the Aorta | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/coarctation

  Return or re-occurrence of coarctation at the site of surgical or balloon treatment is possible. This may even happen years after surgery. The rate of restenosis is highest among newborns. This happens in 10-20% of patients. The rate of recurrent coarctation after surgical repair decreases in older children. The rate is close to zero by age 3 years. Some patients with recurrent coarctation may need repeat surgery. Most cases can be managed with balloon dilation of the area of narrowing or stenting. […] Another concern after coarctation repair is hypertension (high blood pressure). While this is rarely seen in infants, most older children have unusually high blood pressure right after surgery. This is treated with intravenous medicines while in the hospital. Children will often be sent home with medicine to take by mouth to treat high blood pressure.

• #12 Coarctation of the Aorta | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/coarctation

  Lifelong follow-up with a cardiologist is important for children after coarctation treatment to diagnose late problems of restenosis or high blood pressure. Follow-up visits include a physical exam with blood pressure measurements in both the arms and legs. Periodic echocardiograms are also needed. In older and larger patients, cardiac MRI or CT scans done to get a better look at the repaired aorta. Long-term cardiology follow-up is also important for any additional heart problems.

• #13 Interventional Therapy for Coarctation of the Aorta – Cardiac Interventions Today

  https://citoday.com/articles/2009-nov/1109_08-php

  Balloon angioplasty remains a controversial procedure in neonates and infants with native coarctation of the aorta. Satisfactory results may be achieved in older children and adults, with up to a 7% risk of aneurysms in a recent study. […] Balloon angioplasty is the treatment of choice for recurrent coarctation of the aorta in patients of all age groups. […] Since the 1990s, stent treatment of native or recurrent coarctation of the aorta in children older than 4 years has become the treatment of choice at many institutions. […] Numerous studies have shown the safety and early efficacy of intravascular stent therapy, both acutely and at intermediate follow-up in the treatment of coarctation of the aorta. […] In a multi-institutional retrospective study, intravascular stent placement was successful in 553 of 565 (98%) procedures.

• #14 Coarctation of aorta in adults: a narrative review of surgical and endovascular management – Velayudhan – Journal of Visualized Surgery

  https://jovs.amegroups.org/article/view/48940/html

  Endovascular repair is usually performed under general anaesthesia or heavy sedation because coarctation dilatation can be extremely painful. […] Stent placement: significant stenosis in close proximity to supraortic arch vessels. […] Stent-graft placement: tight stenosis, older patients, and post-stenotic dilatation. […] This approach was introduced by Crafoord and Nylin in 1945. […] The left subclavian artery (LSA) is ligated. […] To reduce the incidence of re-CoA, variety of material has been used to augment the coarcted segment. […] This is the preferred technique for adult patients wherein a vascular graft is sewn onto the aorta bypassing the coarcted segment either as end-to-end or side-to-side depending upon the anatomy. […] CoA repair is usually performed through left thoracotomy.

• #14 Coarctation of aorta in adults: a narrative review of surgical and endovascular management – Velayudhan – Journal of Visualized Surgery

  https://jovs.amegroups.org/article/view/48940/html

  Coarctation of the aorta (CoA) accounts for 58% of all congenital heart diseases. […] The various treatment options include endovascular, surgery and hybrid procedures. […] The endovascular treatment includes simple balloon dilatation, stent placement, and stent-graft placement. […] The surgical techniques include resection and end-to-end anastomosis, subclavian flap repair, prosthetic patch repair and prosthetic interposition tube graft. […] When using CPB for the surgery it can be performed either in normothermic or hypothermic circulatory arrest (HCA) or selective right lung ventilation with partial CPB. […] A multidisciplinary team (consisting of cardiothoracic surgeon, interventional radiologist, cardiologist, and anaesthetist) are required to manage the unique and complex problems that affect these patients.

• #15 Coarctation of the aorta – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coarctation-of-the-aorta/symptoms-causes/syc-20352529

  Coarctation of the aorta often occurs along with other congenital heart defects. Treatment to fix the condition is usually successful. But regular health checkups are needed for life to watch for changes in the heart’s health. […] Prompt treatment is needed to help prevent complications. Without treatment, coarctation of the aorta may lead to: Kidney failure. Heart failure. Death. […] Some people have complications after treatment for coarctation of the aorta. These complications include: Re-narrowing of the aorta, called re-coarctation. Aortic aneurysm or rupture. […] To prevent complications, people with coarctation of the aorta need regular health checkups for life.

• #16 Hypertension and coarctation of the aorta: an inevitable consequence of developmental pathophysiology | Hypertension Research

  https://www.nature.com/articles/hr201122

  Patients with coarctation of the aorta develop early onset hypertension in spite of early effective repair. […] Treatment of choice in infancy is surgical repair with excellent short-to-medium term outcomes. […] In older patients transcatheter management with endovascular stenting is preferable to surgery in many institutions, and provides relief of pressure gradients across the coarctation site. […] Indeed, some reports claim that hypertension is the single most important long-term outcome variable in patients with repaired CoA. […] Although early treatment appears to delay the onset of hypertension, remarkably one third of CoA patients still become hypertensive by adolescence despite early and effective surgical repair. […] This suggests that hypertension may be an inevitable consequence of CoA, even when an effective anatomical repair has been achieved early in life.

• #16 Hypertension and coarctation of the aorta: an inevitable consequence of developmental pathophysiology | Hypertension Research

  https://www.nature.com/articles/hr201122

  Identifying and preventing such maladaptive processes in CoA presents a challenge that if successful, will provide more effective treatment in the future. […] The mainstay of treatment in many units consists of continuation of initial therapy with beta-blockade, and although there is some evidence that this may be effective against mechanisms driving hypertension in the early post-operative phase, there are no published data on its efficacy in older patients with established disease. […] A more important question may be whether we can alter the course of changes in blood pressure with early treatment. […] It is possible that early prophylactic treatment for hypertension with targeted agents may prevent changes that are associated with hypertension from occurring, and thus improve the long-term outlook for these patients.

• #17 Coarctation of the Aorta Surgery | Norton Children’s

  https://nortonchildrens.com/services/cardiology/conditions/treatments/surgical/coarctation-of-the-aorta-surgery/

  Complications from coarctation of the aorta surgery may include: Coarctation reoccurrence: Coarctation (narrowing) may reappear following surgical repair or balloon treatment. This can happen years after surgery. It is more common (about 10% to 20% of patients) when the procedure is done in a newborn. The rate is much lower for older children who have had coarctation repaired. In these cases, balloon dilation or placing a stent can address the issue, instead of having another surgery. High blood pressure is common after treatment. This can be effectively managed with intravenous (IV) medications, and the high blood pressure can get better while the child is in the hospital. The child may need to take oral high blood pressure medications after going home, and that can be addressed at a future outpatient appointment.

• #17 Coarctation of the Aorta Surgery | Norton Children’s

  https://nortonchildrens.com/services/cardiology/conditions/treatments/surgical/coarctation-of-the-aorta-surgery/

  Children treated for coarctation of the aorta will need long-term follow-up with a cardiologist. The cardiologist will look for any issues that can happen later in life, such as renarrowing or high blood pressure. These visits will include a physical exam and blood pressure measurements in the arms and legs.

• #18 Heart team approach for comprehensive management of aortic coarctation in the adult – Hafen- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/16895/html

  We prefer a 0.035 double curved Lunderquist wire (Cook Medical Inc., Bloomington, Indiana, USA) or Amplatz wire for stent or stent graft delivery. […] We feel dilation over time is safer than immediate full expansion in a native primary coarctation to reduce the risk of pseudoaneurysm or rupture. […] Due to potential long-term complications previously discussed, we obtain follow-up imaging, either CTA or MRA, at one month, six months, one year and every five years thereafter regardless of the selected approach. […] Our center has achieved a post-intervention peak-to-peak gradient less than 20 mmHg in all patients undergoing open surgical or endovascular repair of COA.

• #18 Heart team approach for comprehensive management of aortic coarctation in the adult – Hafen- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/16895/html

  The first reports of endovascular interventions appeared in the 1980s with balloon angioplasty; however, due to elastic recoil and intimal hyperplasia, results were mixed. […] With experience and improvement in devices, the majority of COA patients today are treated by endovascular methods. […] We recommend intervention for patients with hypertension and significant native or recurrent COA, defined as meeting at least one of the following criteria: (I) UE to LE mean Doppler systolic gradient or resting peak-to-peak systolic blood pressure gradient 20 mmHg; (II) UE to LE gradient 10 mmHg plus reduced LV systolic function, AI or collateral flow. […] We favor open repair in young, healthy individuals or those with prior endovascular repair with recurrent coarctation deemed to be at low risk for open surgery.

• #18 Heart team approach for comprehensive management of aortic coarctation in the adult – Hafen- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/16895/html

  Procedural success rate was 100%, and there were no 30-day, one-year or five-year mortalities, whether the approach was open or endovascular. […] Our experience suggests that excellent outcomes are obtained by discussing each patient among a multidisciplinary heart team and developing a work-up and treatment protocol to guide selection of interventional modality. […] The goal for management of COA is early identification, early treatment, robust follow-up for post-repair complications, as well as continued hypertension management to mitigate the risks of long-standing, persistent hypertension. […] Open repair of COA through a left thoracotomy was the predominant approach from the first reports in the 1940s until the last few decades. […] Depending on age and anatomy, repair is accomplished by end-to-end anastomosis, graft interposition, excision with patch angioplasty or extra-anatomic bypass.

• #19 Interventional Therapy for Coarctation of the Aorta in Adults – Cardiac Interventions Today

  https://citoday.com/articles/2015-july-aug/interventional-therapy-for-coarctation-of-the-aorta-in-adults

  Short-term follow-up by integrated imaging showed surgery had a high incidence of aortic complications (23%), including moderate to severe reobstruction and aortic aneurysm formation. […] BA is effective for the treatment of native CoA, especially in older children and adults. […] In the CCISC CoA registry, BA clearly is not considered the treatment of choice in adults with native CoA. Of 144 patients undergoing BA for treatment of CoA, only eight adults (6%) underwent BA of their native CoA. […] ST is considered the preferred approach at many centers. Indications for stent placement in native and recurrent CoA are outlined in Table 1. […] In the CCISC experience, ST and surgical treatment of CoA was superior to BA both acutely and at short-term follow-up, although there were no differences between the three groups at intermediate follow-up.

• #19 Interventional Therapy for Coarctation of the Aorta in Adults – Cardiac Interventions Today

  https://citoday.com/articles/2015-july-aug/interventional-therapy-for-coarctation-of-the-aorta-in-adults

  In this high-risk adult group, we recommend aiming for hemodynamic success rather than angiographic resolution of the CoA. […] The prophylactic use of covered stents for CoA would be a safer alternative in older patients. […] Follow-up integrated imaging is essential for any patient undergoing BA, surgical repair, or ST of their native CoA.

• #20 Coarctation: A Review | USC Journal

  https://www.uscjournal.com/articles/coarctation-review?language_content_entity=en

  In the critically ill infant, older child, or adolescent, however, a less invasive method employing transcatheter treatment is often favored. […] Transcatheter treatment of CoA became popular with the advent of balloon angioplasty by Lock et al. in 1983. […] For patients aged 4 years or weighing 15 kg, transcatheter therapy for both native and especially recurrent CoA has become the standard of care in the majority of institutions. […] The goal of using bare metal stents was to avoid dissection, excessive dilation, and elastic recoil of the aorta. […] In a study comparing surgical repair, balloon angioplasty, and stent treatment of native CoA in children, stented patients had significantly lower acute complications compared with those who had undergone surgical or balloon angioplasty repair.

• #20 Coarctation: A Review | USC Journal

  https://www.uscjournal.com/articles/coarctation-review?language_content_entity=en

  To this end, perhaps one of the most important advances in the management of CoA has been the development of covered stent technology. […] Follow-up needs to include thorough evaluation for late complications, including systemic hypertension, coronary artery disease, recurrent obstruction, and aneurysm formation.

• #21 Treatment for coarctation of the aorta: where are we and where do

  https://www.openaccessjournals.com/articles/treatment-for-coarctation-of-the-aorta-where-are-we-and-where-do-we-go-from-here.html

  Interventional treatment, as well as surgical treatment, can only deal with the anatomical coarctation. […] It seems that after coarctation repair, aggressive follow-up, including blood pressure measurements and medical treatment for arterial hypertension is necessary. […] Even the most advanced technology, such as growth stents and absorbable stents, cannot treat the systemic vasculopathy as such, but the anatomical treatment facilitates adequate blood pressure treatment. […] Looking at the arteriopathy, it seems that angiotensin converting enzyme inhibitors should probably be used as first line medication and not b-blockers.

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