This causes ostial stenosis with restriction in diastolic filling of the coronary arteries; the left coronary is most frequently involved. TEE with Doppler can be used in the assessment of proximal coronary patency and to search for flow turbulence. CMR can also be used in assessing the coronary ostia. Electrocardiographic-gated CT coronary angiog- raphy or invasive selective coronary angiography provides excellent visualization of the coronary ar- terial anatomy. 3. Supravalvular aortic stenosis is usually a progres- sive problem with a progressive increase in LV systolic pressure resulting in exertional symptoms and, if the stenosis is severe, eventual decreases in LV systolic function. 4. Impaired coronary perfusion may occur because of varying degrees of aortic valve leaflet adhesion to the narrowed sinotubular junction with restric- tion in diastolic filling of the coronary arteries; the left coronary is most frequently involved. Surgical coronary revascularization is recommended for patients with symptoms of coronary ischemia. 4.2.6. Coarctation of the Aorta Recommendations for Coarctation of the Aorta Referenced studies that support recommendations are summarized in Online Data Supplement 38. COR LOE Recommendations Diagnostic I B-NR Initial and follow-up aortic imaging using CMR or CTA is recommended in adults with coarctation of the aorta, including those who have had surgical or catheter I C-EO Resting blood pressure should be measured in upper and lower extremities in all adults with coarctation of the aorta. 