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Coarctation of the aorta
Authors:Gordon Mack MD  Grant H. Burch MD  David J. Sahn MD
Affiliation:(1) UHN60, Pediatric Cardiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, 97201-3098 Portland, OR, USA
Abstract:Opinion statement  
–  Balloon angioplasty or early surgical correction is recommended once coarctation of the aorta has been diagnosed. Medical management is not a long-term option.
–  The rate of restenosis is higher in infants and children than in adults, but the incidence of residual or late hypertension increases with age at initial intervention.
–  Current angioplasty and stent placement techniques have reduced the rate of aneurysm formation and expanded the types of complex anatomic configurations amenable to nonsurgical intervention.
–  Patients require long-term follow-up for restenosis and late or residual hypertension.
–  Coarctation treatment is straightforward in patients with simple isolated coarctation. In neonates with associated lesions and diffuse arch hypoplasia, aggressive (albeit higher-risk) arch-enlargement procedures can be done at the time of open-heart correction of intracardiac defects.
–  Changes in aortic compliance, vascular reactivity, and vascular homeostasis mechanisms in patients who have late surgery are associated with a higher incidence of residual hypertension.
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