What is the medical care in the early presentation of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Note the following:

  • Treatment in patients with congestive heart failure (CHF) includes the use of diuretics and inotropic drugs.

  • Prostaglandin E1 (0.05-0.15 mcg/kg/min) is infused intravenously to open the ductus arteriosus.

  • Ventilatory assistance is provided to patients with markedly increased work of breathing.

  • Infusion of inotropic drugs (dopamine, dobutamine, epinephrine) is useful when ventricular dysfunction is present, especially with hypotension.

  • A Foley catheter is inserted to monitor renal perfusion and urine output.

  • ABGs are tested to monitor acidosis.

  • An umbilical artery catheter may be placed in neonates to assess the response to prostaglandin infusion with regard to improving lower-body blood flow.

  • Patients stabilized by the above interventions are better candidates for surgical or catheter intervention.

  • In the presence of associated defects, the significance of coarctation on the clinical course of the patient should be assessed with echo-Doppler and/or catheterization and angiographic studies. If the coarctation has a significantly adverse effect on the physiology of the associated defects, and consequently the clinical status, the coarctation should be initially relieved with surgery or balloon angioplasty and the patient reassessed with regard to need for intervention for the associated defects. Based on the authors' experience and that of others, the aortic obstruction is usually a major contributing factor for the symptomatology, and relief of the obstruction may postpone or avert the need for additional surgical intervention for the associated cardiac defects. [37, 38]


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