CLINICAL STUDIES
Repaired coarctation: a "cost-effective" approach to identify complications in adults
Judith Therrien, MD, FRCPC*,
Sara A. Thorne, MD, MRCP*,
Andrew Wright, MSc ,
Philip J. Kilner, MD and
Jane Somerville, MD, FRCP, FACC, FESC*
* Jane Somerville Grown Up Congenital Heart Unit, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, Imperial College School of Medicine, Toronto, Ontario, Canada
Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, Imperial College School of Medicine, Toronto, Ontario, Canada
Magnetic Resonance Imaging Unit, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom
Manuscript received January 28, 1999;
revised manuscript received September 10, 1999,
accepted December 7, 1999.
Reprint requests and correspondence: Dr. J. Therrien, Sir MB Davis Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine, Room E206, Montreal, Quebec H3T1E2 Canada
judiththerrian{at}hotmail.com
OBJECTIVES
The study was done to determine the most "cost-effective" approach to follow adults after repair of coarctation of the aorta.
BACKGROUND
Recoarctation and/or aneurysm formation following surgical repair or angioplasty for coarctation of the aorta carry a significant morbidity and mortality. Various screening tests to detect such complications are used, but little is known of their sensitivities and specificities; as a consequence, the most "cost-effective" approach to follow such patients is undefined.
METHODS
Retrospective analysis was done on the sensitivity and specificity of symptomatology, physical examination, electrocardiogram, chest radiograph, exercise testing and transthoracic echocardiography to detect recoarctation and/or aneurysm formation in 84 adult patients following surgical repair or angioplasty of coarctation of the aorta, using magnetic resonance imaging (MRI) as the gold standard test.
RESULTS
Echocardiography had the highest sensitivity in detecting recoarctation (87%) and chest radiograph the highest sensitivity in detecting aneurysm formation (67%). Combined clinical visit and echocardiography had a high sensitivity for diagnosing recoarctation and/or aneurysm formation (97%), but performing a clinical visit and an MRI on every patient without any prior screening test emerged as the most "cost-effective" strategy.
CONCLUSIONS
The most "cost-effective" approach to diagnose complications at the site of repair in patients after surgical repair or balloon angioplasty of coarctation of the aorta appears to be the combination of clinical assessment and MRI scan on every patient. If MRI resources are scant, performing a clinical assessment plus a transthoracic echocardiography and an MRI on patients with positive results is an acceptable alternative.
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Abbreviations and Acronyms
| | ECG | = electrocardiogram/electrocardiographic | | MRI | = magnetic resonance imaging |
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