title: Repaired coarctation: a "cost-effective" approach to identify complications in adults.
abstract: OBJECTIVE
  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.
authors.affiliation: Jane Somerville Grown Up Congenital Heart Unit, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom. judiththerrian@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Therrien
authors.forename: S A
authors.initials: SA
authors.lastname: Thorne
authors.forename: A
authors.initials: A
authors.lastname: Wright
authors.forename: P J
authors.initials: PJ
authors.lastname: Kilner
authors.forename: J
authors.initials: J
authors.lastname: Somerville
mesh_terms: D000293:Adolescent; D000328:Adult; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000191:economics / Q000601:surgery; D001017:Aortic Coarctation / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation