recoarctation

Recoarctation refers to the re-narrowing of the aorta at or near the site of a prior repair for coarctation of the aorta. It can occur after different types of treatment, including surgical repair or endovascular therapy, and may present months to years after the initial procedure.

The cause is usually related to scar formation and growth of tissue (intimal hyperplasia) at the repaired segment, which can lead to a recurrent obstruction. Risk factors include younger age at initial repair and certain repair techniques. Recoarctation can be more likely to occur in children and may vary in frequency depending on the method used for the initial correction.

Clinical features often include elevated blood pressure in the arms with weaker or delayed pulses in the legs, which may cause leg fatigue or claudication. Some patients are asymptomatic and discovered through routine blood pressure measurements or imaging. Headache, chest discomfort, or signs of heart strain may occur with more significant obstruction.

Diagnosis relies on imaging and hemodynamic assessment. Doppler echocardiography can estimate gradients across the narrowed segment; magnetic resonance angiography or computed tomography angiography provides detailed anatomic visualization. Cardiac catheterization with pressure measurements may be used to quantify the obstruction and plan intervention.

Management depends on severity and symptoms. For mild cases, monitoring and blood pressure control may suffice. Significant obstruction or symptomatic cases typically require reintervention, such as balloon angioplasty with or without stent placement, or surgical repair when endovascular therapy is unsuitable. Lifelong follow-up is recommended due to the possibility of recurrence and other vascular complications.