Elsevier

American Heart Journal

Volume 201, July 2018, Pages 49-53
American Heart Journal

Clinical Investigation
Arterioventricular interaction after coarctation repair

https://doi.org/10.1016/j.ahj.2018.04.004Get rights and content

Abstract

Background

Hypertension is common in patients with coarctation of the aorta (CoA), even after successful repair. Increased aortic stiffness has been implicated in the pathology of CoA-associated hypertension. This study aimed to investigate aortic vascular function and its relationship with hypertension in well-repaired CoA-patients at long-term follow-up. Furthermore, we assessed the additive effect of hypertension to adverse arterioventricular coupling associated with increased aortic stiffness.

Methods

Twenty-two CoA-patients (age 30 ± 10.6 years) with successful surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) between 3 months and 16 years of age with a follow-up of >10 years and 22 healthy controls underwent cardiac magnetic resonance imaging (CMR), at mean follow-up of 29.3 years, to study aortic pulse wave velocity (PWV), aortic distensibility, global left ventricular (LV) function, LV dimensions, and LV myocardial deformation.

Results

CoA-patients had significantly increased aortic arch PWV (5.6 ± 1.9 m/s vs. 4.5 ± 1.0 m/s, P = .02) and decreased distensibility (4.5 ± 1.8 × 10–3 mmHg−1 vs. 5.8 ± 1.8 × 10–3 mmHg−1, P = .04) compared to controls. Significant differences in aortic arch PWV were found between hypertensive patients, normotensive patients and controls (6.1 ± 1.8 m/s vs. 4.9 ± 1.9 m/s and 4.5 ± 1.0 m/s, respectively, P = .03). Aortic arch PWV and distensibility were correlated with systolic blood pressure (R = 0.37 and R = −0.37, respectively, P = .03 for both). Global LV function, LV mass, LV dimensions and myocardial deformation were similar in CoA-patients when compared to controls.

Conclusions

Central aortic stiffness is significantly increased in well-repaired CoA-patients long-term after repair, and is associated with hypertension. Global LV function, myocardial deformation indices and LV dimensions are however preserved.

Section snippets

Study population

Patients treated with surgery or balloon angioplasty (BA) between 3 months and 16 years of age between 1969 and 2004 with a follow-up of at least 10 years were included in this study. Patients who had their primary CoA procedure before the age of 3 months were excluded from this study, as overall these patients had more severe CoA with varying degrees of LV dysfunction prior to repair. Patients with isthmus hypoplasia, aortic arch hypoplasia and/or severe associated heart defects (e.g.,

Study population

The study population consisted of 22 CoA-patients and 22 controls. Baseline characteristics of the study population are presented in Table I. Primary treatment of CoA-patients was performed with BA (10 patients) or surgery with end-to-end anastomosis (12 patients) at a mean age of 5.9 years (range 0.4–14.4 years). Mean follow-up at time of investigation was 23.9 years (range 10.8–42.2 years). Surgical patients were significantly older than BA patients (35 ± 9.5 versus 22 ± 6.7 years, P = .001),

Discussion

Increased aortic stiffness has been implicated in the development of hypertension in CoA-patients, even after anatomically successful repair.17., 18., 19., 20., 21., 22. Impaired aortic distensibility may also lead to increased LV afterload and adverse arterioventricular coupling.4., 6. The impact of increased aortic stiffness on LV function and the potential additive role of hypertension is however unclear in CoA-patients after anatomically satisfying repair. The purpose of this study was to

Conclusion

The data presented in this study highlight the growing understanding that although CoA may be repaired to anatomical satisfaction, patients are not ‘cured’ and demonstrate increased aortic stiffness proximal to the CoA repair-site, even if they are normotensive.4., 5. At long-term follow-up even well-repaired CoA-patients show increased PWV and decreased distensibility in the pre-coarctation aorta, associated with systemic hypertension. Despite these vascular pathologies, LV function was

Acknowledgements

This study was funded by a grant from the “Stichting Hartekind”; grand number: 2012.001.

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  • Cited by (0)

    Funding: This study was funded by a grant from the “Stichting Hartekind”.

    Conflicts of interest: None.

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