Challenges in diagnosis and management of coarctation of the aorta

Abstract

Purpose of reviewCoarctation of the aorta remains a controversial topic with uncertainties in long-term outcomes. Recent findingsRecent advances in fetal imaging including echocardiography and MRI offer novel opportunities for better detection and prediction of the need for neonatal intervention. New imaging techniques are providing novel insights about the impact of arch geometry and size on flow dynamics and pressure gradients. The importance of arch size rather than shape for optimal hemodynamics has been identified. Long-term outcome data suggest a significant increase in mortality risk in coarctation patients beyond the third decade when compared with the general population. Hypertension is highly prevalent not only in adult patients following repair of coarctation but also in normotensive patients presenting with LV diastolic dysfunction and adverse remodelling, indicating that abnormal vascular properties are important. Patients with coarctation undergoing neonatal repair are at risk for adverse neurodevelopmental outcomes and patients could benefit from timely neurocognitive evaluation and intervention.

The Predictive Value of the CSA Index in the Prenatal Diagnosis of Aortic Coarctation in Ultrasound Examination Performed during the Second Trimester

“…The management differs and depends on the severity and clinical status of the patient. Balloon angioplasty, aortic arch stenting or cardiosurgery may be performed, but even if treatment was introduced in time, patients with a neonatal CoA repair are at risk of adverse neurodevelopmental outcomes and these patients could benefit from timely neurocognitive evaluation and intervention [ 7 ].…”

Hemodynamic Melody of Postnatal Cardiac and Pulmonary Development in Children with Congenital Heart Diseases

“…Large VSD and PDA lead to increased pulmonary blood flow, resulting in pulmonary congestion and small vessel remodeling, which in turn cause PH. CHD with a left cardiac defect that causes PH includes mitral or aortic stenosis (MS or AS) and coarctation/interruption of the aortic arch (CAA/IAA) [49,50,52]. CHDs with RVOT obstruction include TOF, isolated pulmonary artery obstruction or embolism, pulmonary artery stenosis (PAS), and pulmonary valve stenosis (PS) [53][54][55][56].…”

“…Hypertension is uncommon in children. CHD with LVOT obstruction includes BAV, CAA/IAA, mitral or aortic stenosis, and hypertrophic cardiomyopathy [49,50,52,57].…”

Antenatal Risk of Coarctation for newborns at Hartford Hospital (ARCH) Pathway: A Predictor of Postnatal Management Strategy

“…A delayed diagnosis of CoA carries risk of reduced systemic blood ow, resulting in heart failure, shock, and possible death due to obstruction of blood ow. Prenatal identi cation of impending coarctation improves neonatal survival, decreases morbidity, and enables parental counseling and delivery planning [7]. Delivery at a tertiary hospital with access to early evaluation and management by pediatric cardiologists can reduce risk of hemodynamic instability, acidosis, or end organ damage due to delay in treatment.…”