Management of adults with coarctation of aorta
Pradyumna Agasthi1, Sai Harika Pujari1, Andrew Tseng2
1Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States.
Insights
Coarctation of the aorta (CoA) is a congenital heart defect causing hypertension. Early diagnosis and treatment are crucial for improving life expectancy and reducing cardiovascular risks in affected individuals.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Vascular Surgery
Background:
- Coarctation of the aorta (CoA) is a common congenital heart defect.
- It often presents with subtle symptoms, making diagnosis challenging.
- Upper extremity hypertension is a key indicator, necessitating lower extremity blood pressure measurement in young hypertensives.
Purpose of the Study:
- To highlight the diagnostic challenges and importance of early detection of CoA.
- To emphasize the long-term cardiovascular risks associated with CoA.
- To discuss current and emerging treatment modalities for CoA.
Main Methods:
- Physical examination focusing on blood pressure differentials between upper and lower extremities.
- Review of long-term data on mortality and cardiovascular complications in CoA patients.
- Evaluation of surgical and endovascular treatment options, including covered stents and stent grafts.
Main Results:
- A significant pressure gradient between arms and legs strongly suggests CoA.
- Patients with CoA face reduced life expectancy and increased cardiovascular risks.
- Persistent hypertension and vascular dysfunction increase coronary disease risk, a major cause of mortality.
Conclusions:
- Early diagnosis and timely intervention are critical for improving outcomes in CoA.
- Both surgical and endovascular approaches are viable treatment options.
- Lifelong monitoring for cardiovascular complications, including coronary disease, is essential post-intervention.
Abstract:
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. 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. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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