Surgical correction of aortic coarctation: what’s next? Long-term patient follow-up

Coarctation of the Aorta (CoA) is a congenital heart defect (CHD) characterized by a narrowing of the thoracic aorta at the level of the isthmus, typically near the insertion of the ductus arteriosus. CoA is among the most common congenital heart defects, with an incidence of 3-4 cases per 10,000 live births, accounting for 8-10% of all CHDs. Clinical manifestations depend on the degree of narrowing, the length of the affected aortic segment, and the timing of ductus arteriosus closure. CoA may present in the neonatal period or later in life. In neonates, the sudden increase in afterload following ductal closure may lead to left ventricular dysfunction and heart failure. In older children and adults, CoA typically presents with hypertension in the upper extremities and may eventually be complicated by early coronary artery disease, aortic aneurysm, and cerebrovascular abnormalities. Over time, collateral circulation may develop via intercostal arteries to bypass the narrowing. The long-term consequences of untreated CoA include aortic aneurysm formation, increased risk of stroke, and lifelong arterial hypertension, underscoring the importance of early diagnosis and timely surgical correction. Current surgical and interventional approaches aim at complete relief of the obstruction. These include balloon angioplasty, endovascular stenting, and surgical repair. The choice of intervention depends on the patient’s anatomy, the degree of narrowing, and age. Aim - to summarize current data, and analyze follow-up protocols for children with repaired CoA to enable timely identification of complications, diagnosis of recoarctation, and referral for reintervention. Patients with repaired CoA require lifelong follow-up and regular echocardiographic monitoring due to potential cardiovascular risks and the possibility of reintervention. Cardiac surgery centers offer different strategies for long-term surveillance in children after CoA repair. This paper presents a unified follow-up protocol proposed by the American College of Cardiology (ACC) in 2023 for children after surgical repair of CoA - both within the first year of life and up to 18 years of age. Each algorithm provides recommendations on visit frequency and the types of necessary examinations. The authors declare no conflict of interest.