CARDIOVASCULAR MANIFESTATIONS OF COARCTATION OF THE AORTA

Abstract

Introduction: Coarctation of the aorta, a congenital condition characterized by narrowing of the aorta, is a complex cardiovascular anomaly. This anatomical alteration significantly impacts hemodynamics, generating a pressure gradient between the upper and lower circulation. The consequences of this hemodynamic alteration are diverse and manifest mainly in the cardiovascular system. The clinical manifestations of coarctation of the aorta are variable and depend on the extent of aortic obstruction, the patient's age, and the presence of other associated cardiac malformations. Objective: To identify and synthesize the available scientific evidence on the cardiovascular manifestations of coarctation of the aorta, focusing on the last 10 years, in order to contribute to a better understanding of the pathophysiology and clinical implications of this condition. Methodology: A systematic review of the literature was performed, following the principles of the PRISMA statement. The PubMed, SciELO and Web of Science databases were searched using the following descriptors: "coarctation of the aorta", "cardiovascular manifestations", "hypertension", "heart failure" and "vascular complications". The selection of studies included original articles published in the last 10 years, in Portuguese or English, that addressed the cardiovascular manifestations of coarctation of the aorta in humans. The following inclusion criteria were established: observational studies (cohorts, case-controls) and systematic reviews; patients of all ages with a confirmed diagnosis of coarctation of the aorta; and articles that evaluated at least one cardiovascular manifestation. The exclusion criteria were: experimental studies in animals, narrative reviews and articles that did not address cardiovascular manifestations. Results: The literature search resulted in a large number of articles, from which those that met the inclusion and exclusion criteria were selected. The results of the review demonstrated that the most frequent cardiovascular manifestations of coarctation of the aorta include arterial hypertension in the upper limbs, weakness of the femoral pulses, heart murmurs and electrocardiographic alterations. Arterial hypertension, resulting from increased systemic vascular resistance, is one of the main complications of coarctation of the aorta and can lead to the development of heart failure, aortic aneurysm and stroke. In addition, coarctation of the aorta may be associated with other cardiac anomalies, such as aortic stenosis and ventricular septal defect, which can aggravate the clinical picture. Conclusion: Coarctation of the aorta is a complex condition that manifests itself by several cardiovascular alterations. Early diagnosis and appropriate treatment are essential to prevent complications and improve the quality of life of patients. Arterial hypertension is the main cardiovascular manifestation of coarctation of the aorta and requires rigorous monitoring. The present study demonstrates the importance of a systematic review of the literature to update knowledge about the cardiovascular manifestations of coarctation of the aorta and to guide clinical practice.