Patient handout

Adult aortic coarctation (native + repaired, chronic ACHD)

PRODUCTION

1. Your condition

This handout is for adult aortic coarctation (native + repaired, chronic achd). Your care team identified this based on: upper-extremity htn with arm-leg bp gradient / radio-femoral delay.

Other reasons your team may use this plan: aortic narrowing on echo/cta/mra (native or re-coarctation); repaired coarctation — surveillance visit; repair-site aneurysm / pseudoaneurysm on imaging.

3. When to call your provider

Contact your care team if any of the following happen:

Dissection / repair-site aneurysm expansion → emergency aortic pathway — 2022 ACC/AHA Aortic
Re-coarctation (recurrent gradient/HTN) → re-intervention — 2018 AHA/ACC ACHD
Uncontrolled HTN despite multi-agent → re-assess obstruction + intensify — 2018 AHA/ACC ACHD

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Peak-to-peak gradient ≥20 mmHg, OR <20 mmHg + significant anatomic narrowing + HTN/LVH/collaterals, OR re-coarctation — stent/surgical intervention — 2018 AHA/ACC ACHD
Persistent/residual or exercise-induced HTN even after successful repair — aggressive lifelong multi-agent control (drives premature CV death) — 2018 AHA/ACC ACHD
Repair-site aneurysm/pseudoaneurysm (esp. post-patch/Dacron) — covered stent or surgery; expansion/rupture = emergency — 2020 ESC ACHD(life-threatening)
Associated bicuspid aortic valve (50–85%) + ascending aortopathy — valve + ascending-aorta surveillance; aortic surgery at ACHD/BAV thresholds — 2022 ACC/AHA Aortic
Coarctation increased intracranial berry-aneurysm prevalence — one-time MRA screen; neurosurgical referral if positive — 2018 AHA/ACC ACHD
Re-coarctation (recurrent gradient/HTN post-repair) — re-intervention (stent preferred in adults) — 2018 AHA/ACC ACHD
Pregnancy with coarctation — HTN + dissection risk (esp. unrepaired/aneurysm); mWHO II–IV by anatomy; avoid ACEi/ARB → labetalol; cardio-obstetric — ESC 2018 Pregnancy

5. Follow-up

Lifelong ACHD; pregnancy + transition planning; CV-prevention (premature CAD/stroke)

6. Sources

Guideline: 2018 AHA/ACC Adult Congenital Heart Disease Guideline (Stout) + 2020 ESC Adult Congenital Heart Disease Guideline (Baumgartner) + 2022 ACC/AHA Aortic Disease Guideline (Isselbacher)