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repair, how to evaluate a repair long after it's been done, and the important things to keep in mind.",{"id":215,"name":216},1,"Course previews",[218,228,233,238],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},185,{"platform":223,"name":212,"url":224,"size":225},"YouTube","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=bC26hc_zndw",{"width":226,"height":227},200,113,{"type":229,"data":230},"free_text",{"readDurationInSeconds":231,"text":232},16,"\u003Cp> \u003Cstyle type=\"text\u002Fcss\">\u003C!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--> \u003C\u002Fstyle> Stenting is the preferred form of repairing a coarctation, but not every situation is suited to this procedure. There are three possible outcomes after a coarctation repair—and only one of these is a good one! In this video, from our Echo Masterclass: Adult Congenital Heart Disease course, you'll learn about what can go wrong after a coarctation repair, how to evaluate a repair long after it's been done, and the important things to keep in mind.\u003C\u002Fp>",{"type":229,"data":234},{"readDurationInSeconds":235,"title":236,"text":237},19.2,"Join our Echo Masterclass: Adult Congenital Heart Disease course today!","\u003Cp>Flustered at the thought of performing an adult congenital echo? Don’t be! In our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fecho-masterclass-adult-congenital-heart-disease\">Echo Masterclass: Adult Congenital Heart Disease\u003C\u002Fa> course, you’ll learn about the lesions associated with common types of defects, as well as the common surgical repair complications. Explore the hemodynamics of intracardiac defects, master key assessment strategies (such as the sequential segmental approach), and know what to leave out of the echo report.\u003C\u002Fp>\u003Cp>Get a \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister\">FREE TRIAL ACCOUNT\u003C\u002Fa> and start Chapter 1 now! \u003C\u002Fp>",{"type":229,"data":239},{"readDurationInSeconds":240,"title":241,"text":242},108.53333333333333,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-92a49567-7fff-1962-1900-e77ae9225334\">[00:00:00] \u003C\u002Fb>We've already learned how to diagnose coarctation of the aorta, so now let's talk about how it is repaired. Let's start with this aortic arch with a tight coarctation. It causes pressure to build up in the brain and the heart and results in reduced blood flow down to the gut and the legs. That's not good so how do we fix this problem? Here's a real case of a patient with a very narrow coarctation. It's a pretty discrete or focal narrowing, so it can be opened up with a stent. This particular patient\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-92a49567-7fff-1962-1900-e77ae9225334\">[00:00:30] \u003C\u002Fb>had a pretty nice result from the coarctation stenting and done with minimal invasion through the groin which means no scars. Stenting is currently the preferred form of repair of coarctation but not every case is well suited for this type of procedure. Coarctations can occur at the top of the arch or involve the head and neck vessels and this makes stenting very difficult so surgery is required. It might even involve repairing the head and neck vessels themselves. There have been a lot of different approaches to surgery in the past. So if you're scanning a patient with a repaired coarctation,\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-92a49567-7fff-1962-1900-e77ae9225334\">[00:01:00]\u003C\u002Fb> it's good to know what type of repair they've had. For most of the repairs, though, the features to watch out for are similar. There are really three things that can happen. The first and best result is that everything works amazingly well, the repair holds and there's no concern. The second is that despite having a repair, sometimes there can be scar lines or the material shrinks or the coarctation just narrows up again in the adjacent tissue. So renarrowing is definitely something to watch out for. Assess this in the same way as the original coarctation. And the third thing that can happen\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-92a49567-7fff-1962-1900-e77ae9225334\">[00:01:30] \u003C\u002Fb>is just the opposite. The tissue abnormality within the aortic wall can go the other way and turn into an aneurysm. Let's have a look at a real case. Here's a 45-year-old male patient with the previous coarctation repair. He presented with ongoing hypotension. As often happens, the area of repair is fairly unclear in the suprasternal view. The color certainly doesn't look [inaudible 00:01:51]. Maybe everything's okay. The Doppler tells us that there is no significant gradient but look at diastole. Let's check out the abdominal aortic Doppler flow.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-92a49567-7fff-1962-1900-e77ae9225334\">[00:02:00] \u003C\u002Fb>Interestingly, the Doppler from the abdominal aorta looks pretty normal. The systolic flow drops back to the baseline before continuing throughout diastole. That's a normal flow profile. So what could be causing diastolic flow in the aortic arch but not in the abdominal aorta? Well, this might explain it. This is the aortic arch enhanced with ultrasound contrast. It shows a huge aneurism at the repair site. Magnetic Resonance Imaging shows it beautifully. So the diastolic flow on the Doppler trace\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-92a49567-7fff-1962-1900-e77ae9225334\">[00:02:30] \u003C\u002Fb>was blood swirling around within the circular aneurysm. Coarctations can be repaired but shouldn't be forgotten. The various types of repairs work really well in the majority of patients but complications are well described. \u003C\u002Fp>",{"courses":244,"showAwardsBelow":48},[245],{"id":246,"isFreeCmeCourse":247,"title":248,"type":249,"specialization":250,"teachers":252,"cmeCredits":254,"teacherIllustration":255,"backgroundImage":256,"relativeUrl":257,"lastChanged":258,"created":259,"description":260,"relativeURL":257,"meta":261},6085,false,"Echo Masterclass: Adult Congenital Heart Disease","course",[251],"Ultrasound",[253],"Cathy West, M.Sc FASE",4,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ef6-225d-4e3e-85fd-d9fb56d621df","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ef6-fa12-46f3-aba5-e25a0fc8c8bf","\u002Fcourses\u002Fecho-masterclass-adult-congenital-heart-disease","1767452488","1550522966","Flustered at the thought of performing an adult congenital echo? 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Currently she works as a cardiac scientist at Royal Brisbane and Women's Hospital in Brisbane Australia.","\u002Fteachers\u002Fcathy-west-msc-fase",[251],154,"3m",[276,302,321],{"id":277,"title":278,"text":279,"image":280,"author":288,"path":296,"readDuration":297,"readDurationFormatted":274,"internal":298},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. 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Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":307,"title":282,"size":308,"location":310},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":309,"height":309},600,{"bucket":286,"key":311},"\u002F2026-04\u002FC121_magazine image.png",{"id":289,"title":290,"relativeURL":291,"image":292,"professionLong":293,"profession":313,"weight":254},{"name":295},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":318,"updated":319,"published":320},1777403036,1777572381,1777412421,{"id":322,"title":323,"text":324,"image":325,"author":330,"path":339,"readDuration":340,"readDurationFormatted":341,"internal":342},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":326,"title":282,"size":327,"location":328},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":309,"height":309},{"bucket":286,"key":329},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":331,"title":332,"relativeURL":333,"image":334,"professionLong":335,"profession":336,"weight":338},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":337},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":343,"updated":344,"published":345},1776705362,1776710540,1776710541,{"seo":347,"og":349},{"title":348,"description":213},"Evaluating coarctation repairs | Medmastery",{"title":348,"description":213,"image":350},{"alt":282,"title":282,"size":351,"location":354},{"width":352,"height":353},1188,688,{"bucket":286,"key":355},"\u002Fmigrated-images\u002FScreen Shot 2019-04-29 at 12.16.06 pm.png",{"id":357,"created":358,"updated":359,"published":358},300,1558351164,1655189586]