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Critical Care Management of the Adult with Aortic Coarctation

  • Barry A. Love
Chapter
Part of the Congenital Heart Disease in Adolescents and Adults book series (CHDAA)

Abstract

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.

Keywords

Coarctation 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 

References

  1. 1.
    Bjornard K, Riehle-Colarusso T, Gilboa SM, Correa A. Patterns in the prevalence of congenital heart defects, metropolitan Atlanta, 1978 to 2005. Birth Defects Res Part A: Clin Mol Teratol. 2013;97:87–94.CrossRefGoogle Scholar
  2. 2.
    Becker AE, Becker MJ, Edwards JE. Anomalies associated with coarctation of the aorta. Particular reference to infancy. Circulation. 1970;41:1067–75.CrossRefGoogle Scholar
  3. 3.
    Sybert VP. Cardiovascular malformations and complications in Turner Syndrome. Pediatrics. 1998;101(1):E11.CrossRefGoogle Scholar
  4. 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. 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
  6. 6.
    Reifenstein GH, Levine SA, Gross RE. Coarctation of the aorta: a review of 104 autopsied cases of the “adult-type”, 2 years of age or older. Am Heart J. 1947;33:146–68.CrossRefGoogle Scholar
  7. 7.
    Bambul Heck P, Pabst von Ohain J, Kaemmerer H, et al. Survival and cardiovascular events after coarctation repair in long-term follow-up (COAFU): predictive value of clinical variables. Int J Cardiol. 2017;228:347–51.CrossRefGoogle Scholar
  8. 8.
    Roifman I, Therrien J, Ionescu-Ittu R, Pilote L, Guo L, Kotowycz MA, Martucci G, Marelli AJ. Coarctation of the aorta and coronary artery disease: fact or fiction? Circulation. 2012;126(1):16–21.CrossRefGoogle Scholar
  9. 9.
    Rinnstrom D, Dellborg M, Thilen U, et al. Hypertension in adults with repaired coarctation of the aorta. Am Heart J. 2016;181:10–5.CrossRefGoogle Scholar
  10. 10.
    Warnes CA, Williams RG, Bashore TM, Child JS. ACC/AHA 2008 Guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol. 2008;52:e143–263.CrossRefGoogle Scholar
  11. 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
  12. 12.
    Nielsen JC, Powell AJ, Gavreau K, Marcus EN, Prakash A, Geva T. Magnetic resonance imaging predictors of coarctation severity. Circulation. 2005;111(5):622–8.CrossRefGoogle Scholar
  13. 13.
    Muzzarelli S, Meadows AK, Ordovas KG, et al. Prediction of hemodynamic severity of coarctation by magnetic resonance imaging. Am J Cardiol. 2011;108:1335–40.CrossRefGoogle Scholar
  14. 14.
    Connolly HM, Huston J III, Brown RD Jr, Warnes CA, Ammash NM, Tajik AJ. Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients. Mayo Clin Proc. 2003;78:1491–9.CrossRefGoogle Scholar
  15. 15.
    Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg. 1945;14:347–61.Google Scholar
  16. 16.
    Williams WG, Shindo G, Trusler GA, Dische MR, Olley PM. Results of repair of coarctation of the aorta during infancy. J Thorac Cardiovasc Surg. 1980;79:603–8.PubMedGoogle Scholar
  17. 17.
    Kappetein AP, Zwinderman AH, Bogers AJJC, Rohmer J, Huysmns HA. More than thirty five years of coarctation repair: an unexpected high relapse rate. J Thorac Cardiovasc Surg. 1994;107:87–95.PubMedGoogle Scholar
  18. 18.
    Presbitero P, Demarie D, Villani M, Perinetto EA, Rivera G, Orzan F, Bobbio M, Morea M, Brusca A. Long term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J. 1987;57:462–7.CrossRefGoogle Scholar
  19. 19.
    Sanchez GR, Balsara RK, Dunn JM, Mehta AV, O’Riordan AC. Recurrent obstruction after subclavian flap repair of coarctation of the aorta in infants. J Thorac Cardiovasc Surg. 1986;91:738–46.PubMedGoogle Scholar
  20. 20.
    Cobanoglu A, Teply JF, Grunkeimier GL, Sunderland CO, Starr A. Coarctation of the aorta in patients younger than three months: a critique of the subclavian flap operation. J Thorac Cardiovasc Surg. 1985;89:128–35.PubMedGoogle Scholar
  21. 21.
    Connolly HM, Schaff HV, Izhar U, Dearani JA, Warnes CA, Orszulak TA. Posterior pericardial ascending-to-descending aortic bypass: an alternative surgical approach for complex coarctation of the aorta. Circulation. 2001;104:133–7.CrossRefGoogle Scholar
  22. 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
  23. 23.
    Tawes RL Jr, Bull JC, Roe BB. Hypertension and abdominal pain after resection of aortic coarctation. Ann Surg. 1970;171:409–12.CrossRefGoogle Scholar
  24. 24.
    McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med. 2010;104(1):1–8.CrossRefGoogle Scholar
  25. 25.
    Fox S, Pierce W, Waldhausen JA. Pathogenesis of paradoxical hypertension after coarctation repair. Ann Thorac Surg. 1978;29(2):135–41.CrossRefGoogle Scholar
  26. 26.
    Choy M, Rocchini AP, Beekman RH, Rosenthal A, Dick M, Crowley D, Behrendt D, Snider AR. Paradoxical hypertension after repair of coarctation of the aorta in children: balloon angioplasty versus surgical repair. Circulation. 1987;75:1186–91.CrossRefGoogle Scholar
  27. 27.
    Gidding SS, Rochchini AP, Beekman R, Szpunar CA, Moorehead C, Behrendt D, Rosenthal A. Therapeutic effect of propranolol on paradoxical hypertension after repair of coarctation of the aorta. N Engl J Med. 1985;312(19):1224–8.CrossRefGoogle Scholar
  28. 28.
    Salgado DR, Silva E, Vincent JL. Control of hypertension in the critically ill: a pathophysiological approach. Ann Intensive Care. 2013;3:17.CrossRefGoogle Scholar
  29. 29.
    Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation. 1989;80:840–5.CrossRefGoogle Scholar
  30. 30.
    Brouwer RMHJ, Erasmus ME, Ebels T, Aijgelaar A. Influence of age on survival, late hypertension and recoarctation in elective aortic coarctation repair. J Thorac Cardiovasc Surg. 1994;108:525–31.PubMedGoogle Scholar
  31. 31.
    Chen SS, Dimopoulos K, Alonso-Gonzalez R, et al. Prevalence and prognostic implication of restenosis or dilation at the aortic coarctation repair site assessed by cardiovascular MRI adult patients late after coarctation repair. Int J Cardiol. 2014;173:209–15.CrossRefGoogle Scholar
  32. 32.
    Silka MJ, Hardy BG, Menashe VD, Morris CD. A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol. 1998;32(1):245–51.CrossRefGoogle Scholar
  33. 33.
    Forbes TJ, Kim DW, Wei D, et al. Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta. J Am Coll Cardiol. 2011;58:2664–74.CrossRefGoogle Scholar
  34. 34.
    Hassan W, Awad M, Fawzy ME, et al. Long-term effects of balloon angioplasty on left ventricular hypertrophy in adolescent and adult patients with native coarctation of the aorta. Up to 18 years follow-up results. Catheter Cardiovasc Interv. 2007;70:881–6.CrossRefGoogle Scholar
  35. 35.
    Holzer R, Qureshi S, Ghasemi A, et al. Stenting of aortic coarctation: acute, intermediate and long-term results of a prospective, multiinstitutional registry—Congenital Cardiovascular Interventional Study Consortium (CCISC). Catheter Cardiovasc Interv. 2010;76:553–63.CrossRefGoogle Scholar
  36. 36.
    Meadows J, Minahan M, DB ME, et al. Intermediate outcomes in the prospective, multicenter coarctation of the aorta stents trial (COAST). Circulation. 2015;131(19):1656–64.CrossRefGoogle Scholar
  37. 37.
    Taggart NW, Minahan M, Cabalka AK, et al. Immediate outcomes of covered stent placement for treatment or prevention of aortic wall injury associated with coarctation of the aorta (COAST II). JACC Cardiovasc Interv. 2016;9(5):484–93.CrossRefGoogle Scholar
  38. 38.
    Sohrabi B, Jamshidi P, Yaghoubi A, et al. Comparison between covered and bare Cheatham-Platinum stents for endovascular treatment of patients with native post-ductal aortic coarctation: immediate and intermediate results. JACC Cardiovasc Interv. 2014;4:416–23.CrossRefGoogle Scholar
  39. 39.
    Brown ML, Bukhart HM, Connolly HM, Dearani JA, Hagler DJ, Schaff HV. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation. 2010;122(suppl 1):s81–4.CrossRefGoogle Scholar
  40. 40.
    Swan L, Lupton M, Anthony J, Yentis SM, Steer PJ, Gatzoulis MA. Controversies in pregnancy and congenital heart disease. Congenit Heart Dis. 2006;1(1–2):27–34.CrossRefGoogle Scholar
  41. 41.
    Cripe L, Andelfinger G, Martin LJ, et al. Bicuspid aortic valve is heritable. J Am Coll Cardiol. 2004;44:138–43.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatrics and MedicineIcahn School of Medicine, Mount Sinai Medical CenterNew YorkUSA

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