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Coarctation of aorta

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Updated 2024 EACTS/STS guidelines for the management of coarctation of aorta.

Guidelines

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 European Society of Endocrinology (ESE/PES 2024), the Society of Thoracic Surgeons (STS/EACTS 2024), 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 ...
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Screening and diagnosis

indications for screening, hypertension: as per AAPA/ABC/ACC/ACPM/AGS/AHA/APhA/ASH/ASPC/NMA/PCNA 2018 guidelines, 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)

Diagnostic investigations

BP measurement: as per ACC/AHA 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

Medical management

Setting of care: as per EACTS/STS 2024 guidelines, consider referring adult patients with a diagnosis of CoA to a specialized aortic center.
C

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  • Management of hypertension

Surgical interventions

Indications for procedural intervention: as per EACTS/STS 2024 guidelines, treat clinically significant CoA, either primary or recurrent.
B
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Specific circumstances

Patients with Turner's syndrome: as per ESE/PES 2024 guidelines, ensure informed, individualized decision-making about the timing of elective aortic surgery in adult patients with Turner syndrome, taking into account risk factors for aortic dissection, including moderate aortic dilation (aortic height index > 23 mm/m, aortic size index > 2.3 cm/m², or Z > 3.5) with at least one additional risk factor: bicuspid aortic valve, CoA, hypertension, or a rapid increase in aortic diameter (> 3 mm/year). Recognize that dissection risk probably increases if more than one additional risk factor is present. Evaluate for elective aortic surgery in case of severe aortic dilation (aortic height index > 25 mm/m, aortic size index > 2.5 cm/m², or Z > 4) as a single risk factor.
B
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