Aortic coarctation natural history, complications and prognosis
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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
An aortic coarctation is primarily symptomatic enough during childhood to be examined, approximately 80% of cases are diagnosed at this time. The remaining 20% of cases are often less symptomatic, less severe but will ultimately require correction or irreversible organ damage can occur. Common complications, when left untreated, include: rupture, infective endocarditis, congestive heart failure, and calcification of the aorta.
Natural History
In infants with a preductal coarct, the LV output goes to the upper extremities, and the RV output goes to the lower extremities through the patent ductus.
- Childhood:
- 80% of cases are diagnosed in childhood.
- The preductal form is usually discovered in early infancy because it is usually severe.
- Childhood coarctation is associated with a ventricular septal defect (VSD), tubular hypoplasia of the aortic arch, transposition of the great vessels, and mitral valve disease.
- Adolescence:
- When first recognized in adolescents, coarctation of the aorta is generally asymptomatic.
- Adulthood:
- 75% of patients with coarctatin will have hypertension at 30 years of their age.
- If the coarctation is left untreated, arterial hypertension may become permanent due to irreversible changes in some organs (such as the kidney).
Complications
About 50% of patients with coarctation of the aorta die within the first three decades of life, and more than 75% are dead by age 50 due to:
Rupture of the aorta or aortic dissection
- Most frequently in the third or fourth decade.
- Dissections originate either proximally (secondary to hypertension and local stress)or distally (where the jet erodes the intima).
- Ruptures may bleed into the esophagus, and hematemesis or melena may portend disaster.
Infective endocarditis or endarteritis
- Most frequently in the second to fourth decade of life.
Rupture of the circle of Willis
- Most frequently in the second or third decade of life.
- Secondary to the increased incidence of aneurysms in this population and the presence of proximal hypertension.
Congestive Heart Failure
- Common in infants, often occurs with associated abnormalities such as VSD or mitral valve disease.
- In the adult is secondary to hypertension associated with coronary artery disease or aortic valve disease.
Calcification aortic stenosis
- Result of associated bicuspid aortic valve disease that over time becomes calcified.
Premature death occurs due to
- Coronary artery disease
- Heart failure
- Stroke
- Aortic dissection or rupture