"Repaired" aortic coarctation in adults: not a "simple" congenital heart defect.

Long-term follow-up of adult patients after surgical intervention for aortic coarctation has been associated with systemic arterial hypertension, recoarctation, and progressive aortic and/or mitral valve disease from congenital abnormalities (1). Increased morbidity and shortened life span have resulted from aneurysms at the site of previous coarctation repair; aneurysm rupture at the circle of Willis; and premature atherosclerotic coronary artery (1). Paradoxically, cardiologists have often ascribed aortic coarctation as “simple” rather than “complex” congenital heart disease. Nothing could be further from the truth. The complexity of aortic coarctation becomes evident when caring for the adolescent or adult who has had previous surgical or balloon dilation angioplasty “repair.” To reduce the associated morbidity and mortality, Therrien and colleagues (2) explore, in this issue of the Journal, the “most cost-effective” strategy for following adult patients who have undergone surgical and/or catheter intervention for aortic coarctation. In particular, the authors focus on a costeffective strategy based on detection of two specific parameters, recoarctation and/or aneurysm formation. In analysis of sensitivity, specificity and cost, the authors investigated separately, and in combination, factors including symptoms, electrocardiogram, physical examination, chest radiograph, exercise testing, and transthoracic echocardiography. Magnetic resonance imaging (MRI) was used as the “gold standard.” The authors conclude that a clinic visit with MRI was the most “cost-effective” approach to follow this patient group. However, a clinical visit with a screening echocardiogram, and an MRI on patients with positive results, was an acceptable alternative.