What are the guideline sources, guidelines and references for Coarctation of aorta ?
Guideline sources The following summarized guidelines for the evaluation and management of coarctation of aorta (CoA) are prepared by our editorial team based on guidelines from the American Heart Association (AHA/ACC 2022; 2021), the European Society of Cardiology (ESC 2021; 2014), the American Heart Association (AHA 2019), the American College of Preventive Medicine (ACPM/PCNA/ABC/ASPC/ASH/AAPA/AGS/AHA/NMA/ACC/APhA 2018), the European Society for Vascular Surgery (ESVS 2017), the European Society of Endocrinology (ESE/ES 2017), the American Heart Association (AHA/ASA 2015), and the Society for Cardiovascular Angiography and Interventions (SCAI/STS/SVM/AATS/SCA/AHA/ACR/ACC/ASA/SIR 2010). 1 2 3 4 5 6 7 8 9 10 Guidelines 1. Screening and diagnosis indications for screening (hypertension): Obtain echocardiography to screen for CoA in patients with hypertension meeting any of the following criteria: young patient with hypertension (< 30 years of age) BP higher in upper extremities than in lower extremities absent femoral pulses https://web.pathway.md/diseases/recPj3P0CccuXQgwL 1/5 6/23/23, 3:25 AM Coarctation of aorta Pathway continuous murmur over patient's back, chest, or abdominal bruit left thoracotomy scar (postoperative). B Indications for screening, bicuspid aortic valve: As per AHA/ACC 2022 guidelines, obtain a TTE to screen for CoA and other associated cardiovascular defects in patients with bicuspid aortic valve. B As per AHA/ACC 2021 guidelines, obtain a TTE to screen for CoA for prediction of clinical outcome in patients with a known bicuspid aortic valve. B As per AHA 2019 guidelines, perform a clinical examination and obtain imaging studies to screen for CoA in adult patients with bicuspid aortic valve. B Indications for screening, Turner's syndrome: As per AHA/ACC 2022 guidelines, obtain a TTE and cardiac MRI at the time of diagnosis to screen for CoA, aortic root and ascending aortic dilation, bicuspid aortic valve, and other congenital heart defects in patients with Turner syndrome. B As per AHA 2019 guidelines, obtain screening for CoA, and enlargement of the ascending aorta, and bicuspid aortic valve in patients with Turner syndrome. B 2. Diagnostic investigations Blood pressure measurement: As per ACC 2022 guidelines, measure BP in both arms and one of the lower extremities in patients with CoA. B As per AHA 2019 guidelines, measure resting BP in upper and lower extremities in all adult patients with CoA. B Show 2 more Diagnostic imaging: As per ACC 2022 guidelines, obtain MRI or CT for initial, surveillance, and follow-up aortic imaging in patients with CoA, including patients treated with surgical or endovascular intervention. B As per AHA 2019 guidelines, obtain cardiac MRI or CT angiography for initial and follow-up aortic imaging in adult patients with CoA, including patients treated with surgical or catheter intervention. B As per ESVS 2017 guidelines, consider obtaining MRA as the imaging technique of choice for anatomical characterization, evaluation for associated cardiovascular abnormalities, and estimation of aortic flow gradients in adult patients with CoA. C Screening for intracranial aneurysms: As per ACC 2022 guidelines, consider obtaining MRI or CT to screen for intracranial aneurysms in adult patients with CoA. C https://web.pathway.md/diseases/recPj3P0CccuXQgwL 2/5 6/23/23, 3:25 AM Coarctation of aorta Pathway As per AHA 2019 guidelines, consider obtaining MRA or CT angiography to screen for intracranial aneurysms in adult patients with CoA. C As per ASA 2015 guidelines, consider obtaining CT angiography or MRA to screen for intracranial aneurysms in patients with CoA. C 3. Medical management Management of hypertension: initiate guideline-directed medical therapy for the treatment of hypertension in patients with CoA. B 4. Surgical interventions Indications for procedural intervention: As per ACC 2022 guidelines, perform endovascular stenting or open surgical repair in patients with significant native or recurrent CoA and hypertension. B As per ESC 2021 guidelines, perform repair of coarctation or re-coarctation (surgically or catheter-based) in patients with hypertension and an increased noninvasive gradient between upper and lower limbs confirmed with invasive measurement (peak-to-peak 20 mmHg) with the preference for catheter treatment (stenting), when technically feasible. B Show 3 more As per AHA 2019 guidelines: Perform surgical repair or catheter-based stenting in adult patients with hypertension and significant native or recurrent CoA. B Consider performing balloon angioplasty in adult patients with native or recurrent CoA when stent placement is not feasible and surgical intervention is not an option. C As per ESVS 2017 guidelines, perform open or endovascular repair in patients with CoA and clinical manifestations resulting from LV dysfunction, severe hypertension, or lower limb ischemia. B Show 2 more As per ESC 2014 guidelines, perform an intervention in all patients with a noninvasive pressure difference > 20 mmHg between upper and lower limbs, regardless of symptoms but with upper limb hypertension (> 140/90 mmHg in adults), abnormal BP response during exercise, or significant LV hypertrophy. B Show 2 more 5. Specific circumstances Patients with Turner's syndrome: As per ES 2017 guidelines, consider performing elective operations for aneurysm of the aortic root and/or ascending aorta in 16 years old patients with Turner syndrome with an ascending https://web.pathway.md/diseases/recPj3P0CccuXQgwL 3/5 6/23/23, 3:25 AM Coarctation of aorta Pathway aortic size index 2.5 cm/m with or without associated risk factors for aortic dissection (including bicuspid aortic valve, elongation of the transverse aorta, coarctation of the aorta, and/or hypertension). C Show 5 more As per AHA 2010 guidelines: Obtain imaging of the heart and aorta for evidence of bicuspid aortic valve, CoA, or dilatation of the ascending thoracic aorta in patients with Turner syndrome. B Consider obtaining imaging of the heart and aorta to help determine the risk of aortic dissection in patients with Turner syndrome with additional risk factors, including bicuspid aortic valve, CoA, and/or hypertension, and in pregnant patients (or attempting pregnancy). C References 1. Eric M Isselbacher, Ourania Preventza, James Hamilton Black rd et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Nov 2. Open 2. V Riambau, D B ckler, J Brunkwall et al. Editor's Choice Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery ESVS . Eur J Vasc Endovasc Surg. 2017 Jan;53 1 4 52. Open 3. Stout KK, Daniels CJ, Aboulhosn JA et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Apr 2;139 14):e698-e800. Open 4. Erbel R, Aboyans V, Boileau C et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology ESC . Eur Heart J. 2014 Nov 1;35 41 2873 926. Open 5. Paul K Whelton, Robert M Carey, Wilbert S Aronow et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71 6):e13-e115. Open 6. Catherine M Otto, Rick A Nishimura, Robert O Bonow et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2021 Aug;162 2):e183-e353. Open 7. Hiratzka LF, Bakris GL, Beckman JA et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010 Apr 6;121 13):e266 369. Open https://web.pathway.md/diseases/recPj3P0CccuXQgwL 4/5 6/23/23, 3:25 AM Coarctation of aorta Pathway 8. Helmut Baumgartner, Julie De Backer, Sonya V Babu-Narayan et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021 Feb 11;42 6 563 645. Open 9. B Gregory Thompson, Robert D Brown Jr, Sepideh Amin-Hanjani et al. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Aug;46 8 2368 400. Open 10. Gravholt CH, Andersen NH, Conway GS et al. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. Eur J Endocrinol. 2017 Sep;177 3 G1 G70. Open https://web.pathway.md/diseases/recPj3P0CccuXQgwL 5/5