How do I follow up a patient who has had correction of aortic coarctation? What should I look for and how should they be managed?

Long term follow up has demonstrated an increased cardiovascular morbidity and mortality following repair of coarctation of the aorta. Repair at an older age has been associated with worse complications. Recoarctation may occur and produces upper body hypertension and pressure overload of the left ventricle. The type of surgical repair does not protect against recoarctation. Hypertension is a common complication affecting 8–20% of patients who have undergone repair of coarctation of the aorta and is associated with increased morbidity and mortality. It is associated with a later age at operation. Indeed, patients who are normotensive at rest may demonstrate an abnormally high increase in systolic blood pressure in response to exercise, probably related to baroreceptor abnormalities and/or reduced arterial compliance. The bicuspid aortic valve is commonly seen in patients with coarctation and may predispose to infective endocarditis, aortic stenosis/regurgitation and to ascending aortic aneurysm. In addition, mitral valve abnormalities have been detected in approximately 20% of patients.

All patients who have undergone repair of aortic coarctation should be followed up on a regular basis with careful monitoring of upper and lower limb blood pressure. Cardiac examination is directed towards palpation of the femoral pulses, monitoring of blood pressure and auscultation. Serial 12-lead ECG will detect the presence of left ventricular hypertrophy and annual transthoracic echocardiography is useful for screening for left ventricular hypertrophy and recurrence of coarctation. A plain chest x-ray picture
may demonstrate mediastinal widening related to aneurysm formation. However, magnetic resonance imaging is the gold standard for non-invasive diagnosis of recoarctation and/or aneurysm formation. Cardiac catheterisation confirms the presence of recoarctation and permits transcatheter balloon dilatation with stenting of the aortic coarctation. This is probably the procedure of choice in suitable lesions because of the small but definite risk of neurological complications associated with surgical correction of coarctation of the aorta. Persisting hypertension should be amenable to medical therapy, e.g. beta blockers providing aortic obstruction has been ruled out. Finally, patients who have had their coarctation repaired are at increased risk from infective endocarditis and antibiotic prophylaxis is recommended.