Critical Care Management of the Adult with Aortic Coarctation
Coarctation of the aorta while usually first recognized and treated in infancy and childhood is one of the more common congenital lesions that may be recognized for the first time in adulthood. For those treated as children, recurrent coarctation of the aorta may be encountered in the adult age group along with other complications of repair including aortic aneurysm. Unrepaired coarctation of the aorta or repaired coarctation with residual stenosis leads to premature atherosclerotic disease of the carotid and coronary arteries and early left ventricular systolic and diastolic dysfunction. Because of these issues, significant coarctation or recoarctation of the aorta presenting in adulthood is treated with surgery or with transcatheter stenting. Aortic aneurysms are usually addressed with transcatheter covered stents. Patients who undergo intervention for coarctation of the aorta are managed in an intensive care unit periprocedurally. Because of the relatively uncommon nature of this disease in the adult population, few ICUs have extensive experience in managing the adult with coarctation of the aorta. A multidisciplinary approach with congenital cardiologists, congenital cardiac surgeons, anesthesiologists, and intensive care physicians usually provides the best care.
KeywordsCoarctation Adult congenital heart disease Intensive care Cardiac intensive care Aneurysm Hypertension End-to-end repair Patch-plasty repair Left subclavian flap repair Interposition graft repair Ascending-descending conduit repair Post-coarctectomy syndrome Balloon dilation Stent Covered stent
- 4.Paris M. Retrecissement considerable de l’aorta pectorale observe a l’Hotel Dieu de Paris. Jour de Chirurgie de Desault. 1791;ii:107.Google Scholar
- 5.Abbott ME. Statistical study and historical retrospect of 200 recorded cases, with autopsy, of stenosis or obliteration of the descending arch in subjects above the age of two years. Am Heart J. 1928;3:392–421. 574–618Google Scholar
- 11.Silversides CK, Kiess M, Beauchesne L, Bradley T, Connelly M, Niwa K, Mulder B, Webb G, Colman J, Therrien J. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: outflow tract obstruction, coarctation of the aorta, tetralogy of fallot, Ebstein anomaly and Marfan’s syndrome. Can J Cardiol. 2010;26(3):e80–97.CrossRefGoogle Scholar
- 15.Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg. 1945;14:347–61.Google Scholar
- 22.Hadley MN, Walters BC, Aarabi B, et al. Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2013;72:1–259.Google Scholar