The long-term management of the patient with an aortic coarctation repair.

Several areas of concern arise in the management of the adult patient who has had a surgical repair of an aortic coarctation. The aim is this article is to review these areas and make suggestions regarding current clinical practice. Coarctation of the aorta accounts for 6·8% of congenital heart disease, with an incidence of one in 12 000 live births. Coarctation is a heterogeneous lesion with variability in the degree and site of obstruction, the presence of collaterals, and associated cardiac defects including bicuspid aortic valve, patent ductus arteriosus, or ventricular septal defect. For this reason there is a marked diversity in the timing and nature of clinical presentation. Severe coarctation of the aorta most commonly presents in the neonatal period with cardiac murmurs, diminished femoral pulses and cardiac failure and intervention is often undertaken shortly after detection. In the past, coarctation was considered to be a simple ‘correctable lesion’ and surgery, first performed in 1944, was believed to be curative. In keeping with this belief normotensive patients were often discharged post-operatively with no long-term follow-up.