Repaired coarctation: A "cost-effective" approach to identify complications in adults

OBJECTIVES The study was done to determine the most "cost-effective" approa ch to follow adults after repair of coarctation of the aorta. BACKGROUND Recoarctation and/or aneurysm formation following surgical repai r or angioplasty for coarctation of the aorta carry a significant morbidity and mortality. Various screening tests to detect such complications are us ed, but little is known of their sensitivities and specificities; as a cons equence, the most "cost-effective" approach to follow such patients is unde fined. METHODS Retrospective analysis was done on the sensitivity and specificity of symptomatology, physical examination, electrocardiogram, chest radiograp h, exercise testing and transthoracic echocardiography to detect recoarctat ion and/or aneurysm formation in 84 adult patients following surgical repai r or angioplasty of coarctation of the aorta, using magnetic resonance imag ing (MRI) as the gold standard test. RESULTS Echocardiography had the highest sensitivity in detecting recoarcta tion (87%) and chest radiograph the highest sensitivity in detecting aneury sm 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 MRT on every patient without any pri or 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 angioplast y of coarctation of the aorta appears to be the combination of clinical ass essment and MRI scan on every patient. If MRT resources are scant, performi ng a clinical assessment plus a transthoracic echocardiography and an MRT o n patients with positive results is an acceptable alternative. (C) 2000 by the American College of Cardiology.