Long-term observation of adults after successful repair of aortic coarctation

Abstract

Introduction: Despite successful repair of aortic coarctation, cardiovascular complications occur. Aim: To analyse type and frequency of late complications and their impact on exercise capacity in adults after aortic coarctation repair. Material and methods: Fifty-eight adults after aortic coarctation repair, 36 male, median age 27.46 ±10.57, were compared to 30 healthy volunteers. Physical examination, transthoracic echocardiography, carotid intima-media thickness measurement, cardiopulmonary exercise test and 24-hour ambulatory blood pressure monitoring were performed. Results: The main complications were: arterial hypertension 48.3%, myocardial hypertrophy in echocardiography 29.34%, recoarctation 25.86%, aortic dilation 13.79% and coronary artery disease 6.89%. Exercise tolerance was reduced in the cardiopulmonary exercise test. The VO 2 /kg peak was lower, 29.01 ±8.79 vs. 49.16 ±7.38 ml/kg/min, p < 0.001, VE/VCO 2 peak higher 28.18 ±4.69 vs. 26.78 ±3.13, p = 0.017. The peak heart rate was reduced, 157.28 ±22.22 vs. 177.93 ±23.08 bpm, p < 0.001, peak systolic blood pressure was higher, 174.79 ±17.62 vs. 153.33 ±4.79 mm Hg, p < 0.001. Systolic blood pressure in 24-hour ambulatory monitoring correlated with left ventricle mass index, r = 0.29, p = 0.025, wall thickness, r = 0.31, p = 0.039. Age at operation was related to left ventricle wall thickness, r = 0.27, p = 0.041, and carotid intima-media thickness, r = 0.26, p = 0.046. There was no association of any cardio-pulmonary parameters with time from surgery, type of operation or echocardiography results. Conclusions: Adults after aortic coarctation repair suffer from arterial hypertension, recurrent aortic stenosis, aortic aneurysms, and coronary artery disease. Reduced exercise capacity in cardio-pulmonary exercise test is related to hypertensive reaction and chronotropic incompetence.

Hypertension after coarctation repair—a systematic review

“…The remaining full texts were requested via our library, but only 4 published in English were used. After consulting the full content of these 356 articles, only 17 fulfilled the inclusion criteria as set out above (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) (Table 1).…”

Infants With Congenital Heart Disease at Risk of Early Atherosclerotic Disease

“…In the past 2 decades, studies on neonates with repaired coarctation measuring aortic wall stiffness and distensibility found impaired elastic properties of the ascending aorta, supporting the assumption that coarctation was not only a localized aortic isthmus abnormality but also a systemic vascular disease of the precoarctation aorta. 10 , 11 Although some earlier studies found the incidence of hypertension was higher in late coarctation repair, 12 recent studies show a strong association between coarctation and risk of hypertension and coronary artery disease 13 and that elastic properties of the ascending aorta were abnormal even in newborns who underwent early repair, suggesting that this increased risk was related to the abnormal prestenotic aortic vascular bed. 10 , 11 …”

Anatomical/Physiological Correlates of Functional Capacity in Adults With Repaired and Nonsevere Coarctation of the Aorta

“…Notably, these trials do not provide data regarding how exercise capacity is related to relative severity of coarctation, whether anatomical or CoA gradient-based. Rog et al 16 compared patients with prior CoA repair to healthy controls using echocardiography and CPET and found that patients with prior CoA repair had significantly greater peak gradient of the coarctation and significantly lower exercise capacity, but did not find any associations between echocardiographic and CPET parameters. Similarly, 2 studies by Trojnarska et al 17 , 18 demonstrated that patients with prior surgically repaired CoA with recurrent coarctation had similar exercise tolerance to controls and that exercise capacity did not relate to whether patients had severe or nonsevere recoarctation, with severity defined by a mean coarctation gradient at rest >25 mm Hg by echocardiography.…”