New Insights and Challenges: Coarctation of the Aorta and Hypertension
A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".
Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 242
Special Issue Editors
Interests: congenital heart disease; cardiac magnetic resonance imaging; 4D flow MRI
Special Issue Information
Dear Colleagues,
Coarctation of the Aorta (CoA) likely forms part of the continuum of congenital left heart obstructions with bicuspid aortic valve at the mild end and hypoplastic left heart syndrome on the severe end. Uncertainty around CoA already starts in fetal life. Missing significant neonatal CoA can be fatal, and much effort has focused on improving antenatal pick-up rate. We cast the diagnostic net wide to maximise antenatal identification of babies at risk, accepting more than 50% false positive cases. Postnatal uncertainty often continues due to diagnostic difficulties prior to duct closure.
Once repaired, residual problems are patch aneurysms as well as re-coarctation and increased vascular stiffness leading to hypertension. Improvement in surgical technique has greatly reduced the use of patches and resulting aneurysms, but even after perfect surgical repair, increased vascular stiffness remains. 50% of patients in their 20s already suffer from hypertension, which increases to >90% by the age of 50 years.
Milder forms of CoA are often diagnosed later in life when hypertension is already manifest and is frequently the main presenting symptom. After treatment with stent placement, aortic stiffness remains abnormal with often residual hypertension.
CoA, once hoped with perfect repair to become a disease treated and cured in childhood, remains a disease with significant long-term morbidity, and significant uncertainty remains. Is there variation in the severity of intrinsic aortopathy? Are some patients at higher risk of early development of hypertension? Is the development of hypertension inevitable? And if it is, when and how do we start treatment to reduce long-term morbidity and optimise life expectancy?
Dr. Malenka M. Bissell
Dr. David Lloyd
Guest Editors
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