Aortic coarctation medical therapy

Aortic coarctation Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S.[2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S.[4]

Overview

The treatment choice depends on the patients age of presentation, severity, the location of the coarctation and other associated anomalies. For children who present early, the role of medical management is for stablizing the patient for surgery. However, in older kids and adolescent presenting with hypertension treatment is guided towards correction of hypertension and other associated anomalies. Beta blocker is treatment of choice for both pre and post operative hypertension.

Medical therapy

Early presentation

Treatment in patients with early presentation of coarctation of aorta is supportive, symptomatic and the aim is to stabilize the patient for surgical procedure or catheter intervention.

• Ventilatory support in patients with respiratory distress
• Congestive heart failure - Diuretics, Ionotropes
• Hypotension - Ionotropes
• PgE1 (prostaglandin E1) - Given to keep the ductus arteriosus patent.
• In patients with other associated cardiac defects if the coarctation has a significantly adverse effect on the clinical status, the coarctation should be initially relieved with surgery or balloon angioplasty and the patient reassessed with regard to need for intervention for the associated defects.

Late presentation

Late presenters usually have hypertension. Beta blocker is the treatment of choice for hypertension in these patients both pre and post operatively .

Preoperative

• Beta blockers are the treatment of choice.
• Caution should be taken as too much control of hypertension in upper limb can cause hypotension in lower limbs.
• Surgical treatment of the lesion should not be delayed for the correction of hypertension .

Post-operative

• Immediate post operative hypertension - Use short-term vasodilators for e.g. sodium nitroprusside, or intravenous beta-blockers like esmolol.
• Long-term antihypertensive post surgery
  • Monotherapy with beta-blockers
  • ACE inhibitors or angiotensin II antagonists may be added if hypertension continues with beta-blocker monotherapy.