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Coarctation of aorta

Key sources
The following summarized guidelines for the evaluation and management of coarctation of aorta are prepared by our editorial team based on guidelines from the American Heart Association (AHA/ACC 2022; 2021), the European Society of Cardiology (ESC 2021; 2014), the American Heart Association (AHA 2019), the American College of Preventive Medicine (ACPM/PCNA/ABC/ASPC/ASH/AAPA/AGS/AHA/NMA/ACC/APhA 2018), the European Society for Vascular Surgery (ESVS 2017), the European Society of Endocrinology (ESE/ES 2017), the American Heart Association (AHA/ASA 2015), and the Society for Cardiovascular Angiography and Interventions (SCAI/STS/SVM/AATS/SCA/AHA/ACR/ACC/ASA/SIR 2010).
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Guidelines

1.Screening and diagnosis

indications for screening, hypertension: obtain echocardiography to screen for CoA in patients with hypertension meeting any of the following criteria:
young patient with hypertension (< 30 years of age)
BP higher in upper extremities than in lower extremities
absent femoral pulses
continuous murmur over patient's back, chest, or abdominal bruit
left thoracotomy scar (postoperative)
B
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  • Indications for screening (bicuspid aortic valve)

  • Indications for screening (Turner's syndrome)

2.Diagnostic investigations

Blood pressure measurement: as per ACC 2022 guidelines, measure BP in both arms and one of the lower extremities in patients with CoA.
B

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  • Diagnostic imaging

  • Screening for intracranial aneurysms

3.Medical management

Management of hypertension: initiate guideline-directed medical therapy for the treatment of hypertension in patients with CoA.
B

4.Surgical interventions

Indications for procedural intervention: as per ACC 2022 guidelines, perform endovascular stenting or open surgical repair in patients with significant native or recurrent CoA and hypertension.
B

5.Specific circumstances

Patients with Turner's syndrome: as per ES 2017 guidelines, consider performing elective operations for aneurysm of the aortic root and/or ascending aorta in ≥ 16 years old patients with Turner syndrome with an ascending aortic size index ≥ 2.5 cm/m² with or without associated risk factors for aortic dissection (including bicuspid aortic valve, elongation of the transverse aorta, coarctation of the aorta, and/or hypertension).
C
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