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Diagnosis, imaging and clinical management of aortic coarctation
  1. Elles J Dijkema1,
  2. Tim Leiner2,
  3. Heynric B Grotenhuis1
  1. 1 Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, The University of Utrecht, Utrecht, The Netherlands
  2. 2 Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Heynric B Grotenhuis, Pediatric Cardiology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht 3508 AB, The Netherlands; H.B.Grotenhuis{at}umcutrecht.nl

Abstract

Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.

  • DISEASES
  • Congenital heart disease
  • Aortic coarctation
  • CARDIAC PROCEDURES AND THERAPY

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Footnotes

  • Contributors EJD collected data and wrote the manuscript.

    TL reviewed the manuscript and provided images.

    HBG served as scientific advisor and was a large contributor to the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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