Management der Aortenisthmusstenose im Erwachsenenalter: Diagnostik, Prognose und Behandlung

Abstract

The incidence of coarctation ranges between 5-8% in patients with congenital heart disease and in 0.5% in patients with systemic arterial hypertension. Pathomorpho-logically an adult postductal type can be differentiated from infantile preductal type. Other congenital and valvular malformations are often associated with coarctation. The leading clinical symptoms of adult coarctation range from refractory upper body hypertension, accelerated atherosclerotic complications to minor symptoms such cold feet. The mean life expectancy of uncorrected coarctation is on average 33 years with early mortality depending on associated congenital und valvular comorbidities, while late mortality is influenced by atherosclerotic complications. The gold standard for diagnostic imaging of coarctation is contrast-enhanced computed tomography or magnetic resonance imaging. Arterial catheterisation and echocardiography give important additional information for decision-making and therapeutic strategies. Recently, non-surgical interventional repair of coarctation has emerged and become a valid alternative option compared to open surgery as evidenced by the nontraumatic nature of the procedure, by a high procedural success-rate, similar functional results and less neurological complications.