Screening
Routine screening of all neonates with pulse-oximetry is recommended to detect critical congenital heart disease, including critical coarctations.[18][24][25]
All well-child visits should include routine palpation of femoral pulses starting with the first nursery visit. Particular attention should be paid to any difference in caliber or timing of the upper and lower extremity pulses. Infants and children should have noninvasive blood pressure (BP) measurements obtained during this visit. Any question of a differential in the pulses or an elevated upper extremity BP should prompt measurement of BP in all 4 extremities.
In addition to routine postnatal screening, fetal echocardiography is recommended for early detection of congenital heart defects, including aortic coarctation, particularly in fetuses at risk. This screening involves the use of advanced Doppler techniques to evaluate the aortic arch and detect potential abnormalities indicative of coarctation. These techniques are effective in identifying abnormal flow patterns that may suggest aortic narrowing, which can be critically important for timely diagnosis and management. Pregnant women with known risk factors or abnormal findings in routine prenatal ultrasounds should be referred for detailed fetal echocardiographic evaluation. This exam can play a pivotal role in planning for necessary interventions and optimizing neonatal outcomes. It is, however, very important to note that prenatal diagnosis of coarctation can be quite difficult in the setting of the large prenatal ductus arteriosus and can develop postnatally with ductal closure. Thus vigilance remains important postnatally for this lesion even in the setting of an apparently normal fetal echocardiogram.[26]
Adults with a diagnosis of an intracranial berry aneurysm should have their BP measured. If the upper extremity BP is high, measurement should be repeated on a lower extremity, to rule out aortic coarctation.
Routine evaluation for associated intracardiac anomalies should be part of the initial echocardiogram. Patients diagnosed with aortic coarctation should also be screened for intracranial aneurysms, although there are no formal guidelines. Consideration for genetic evaluation is also warranted when there are dysmorphic features, multiple organ abnormalities, or additional intracardiac or vascular abnormalities. If associated with a bicuspid aortic valve, consideration should be given to screening of first-degree relatives.
In the context of ongoing care, it is vital to maintain a proactive approach to cardiovascular health in patients with aortic coarctation, even beyond the initial treatment phase. Regular cardiovascular risk assessments are crucial, particularly in monitoring for potential atherosclerosis, which may develop as a consequence of altered hemodynamics. This emphasizes the need for an integrated care model that includes both adult congenital heart disease specialists and general cardiologists to manage not only the immediate complications but also the long-term cardiovascular risks associated with aortic coarctation.[27]
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