52
Specific Conditions
Table 24. Coarctation of the Aorta: Routine Follow-Up and
Testing Intervals
Type of Follow-Up
or Testing
Physiological
Stage A* (mo)
Physiological
Stage B* (mo)
Physiological
Stage C* (mo)
Physiological
Stage D* (mo)
Outpatient ACHD
cardiologist
24 24
12
6
Electrocardiogram 24 24
12 6
Transthoracic
echocardiogram
†
24 24 12 12
For recommendations on exercise testing, see Section 4.2.6 recommendation #5.
For recommendations about timing of CMR and CT angiography, see Section 4.2.6 supportive
text for recommendations #1 and #2.
Modified with permission from Stout et al. Copyright © 2018 American Heart Association, Inc.
and American College of Cardiolog y Foundation.
* See Section 2.2 for details on the ACHD anatomic and physiological classification system.
ACHD indicates adult congenital heart disease; CMR, cardiovascular magnetic resonance; and
CT, computed tomography.
Table 25. Features Suggestive of Hemodynamic Significance
in Coarctation of the Aorta
Diagnostic Test Index Findings
Upper-to-lower
extremity systolic
blood pressure gradient
Systolic blood pressure >20 mm Hg
Transthoracic
echocardiography
Doppler mean gradient
>20 mm Hg*
†
Corrected COA MIG
gradient
>20 mm Hg*
†
Doppler profile Diastolic tail in the descending
aorta and diastolic forward flow
in abdominal aorta
Cardiac catheterization COA peak-to-peak
gradient
>20 mm Hg*
MRA/CTA Aortic isthmus ratio <0.5–0.7
Angiogram Collateral arteries
* Gradients may be lower in the context of LV dysfunction, severe aortic stenosis, or extensive
collateral arteries. Of the Doppler-derived COA gradients, COA mean gradient provides the
best approximation for catheterization-derived peak-to-peak gradient. Although corrected
and uncorrected maximum instantaneous gradient both have similar correlations with
catheterization-derived peak-to-peak gradient, the threshold to detect peak-to-peak gradient
>20 mm Hg is different for both indices.
†
In repaired aortic coarctation, Doppler gradients may be elevated, even without narrowing,
because of poor arterial compliance and pressure recovery.
COA indicates coarctation of the aorta; CTA, computed tomography angiography; MIG,
maximum instantaneous gradient; and MRA, magnetic resonance angiography.
