Opinion statement
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Balloon angioplasty or early surgical correction is recommended once coarctation of the aorta has been diagnosed. Medical management is not a long-term option.
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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.
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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.
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Patients require long-term follow-up for restenosis and late or residual hypertension.
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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.
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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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Mack, G., Burch, G.H. & Sahn, D.J. Coarctation of the aorta. Curr Treat Options Cardio Med 1, 347–354 (1999). https://doi.org/10.1007/s11936-999-0030-8
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DOI: https://doi.org/10.1007/s11936-999-0030-8