Neurohormonal activity and vascular properties late after aortic coarctation repair

Endothelial function in contemporary patients with repaired coarctation of aorta

“…In the light of our results, it appears that other mechanisms of hypertension in the absence of re-coarctation must also be considered: increased stiffness of the aorta and the carotid arteries have been demonstrated by several studies 23 24. Aortic coarctation patients have been found to have histological changes of the aortic wall including fibrosis, cystic media necrosis and fragmentation of elastic fibres 28.…”

“…The findings of persistent impaired endothelial function proximally, but not distally, to the former coarctation site,19 23 as well as association of endothelial dysfunction with age at repair,21 suggest that the former pressure gradient across the coarctation may be a mechanism inducing structural and functional changes including endothelial dysfunction. Proinflammatory cytokines and soluble adhesion molecules associated with endothelial function have been found to be increased even in normotensive patients3 24 and point towards an ongoing endothelial injury. However, a number of investigators have recently reported preserved endothelium-dependent vascular reactivity in contemporary patients after coarctation repair4 5 25 and have found serum markers of endothelial dysfunction (Endothelin-1) not to be significantly elevated compared with controls 24…”

“…Proinflammatory cytokines and soluble adhesion molecules associated with endothelial function have been found to be increased even in normotensive patients3 24 and point towards an ongoing endothelial injury. However, a number of investigators have recently reported preserved endothelium-dependent vascular reactivity in contemporary patients after coarctation repair4 5 25 and have found serum markers of endothelial dysfunction (Endothelin-1) not to be significantly elevated compared with controls 24…”

Is the medical treatment for arterial hypertension after primary aortic coarctation repair related to age at surgery? A retrospective cohort study

“…It seems that the longer the coarctation is left unoperated, the more re-modelling takes place and is likely to be less reversible. [12][13][14][15][16][17][18] We hypothesised that the more unwell patients with longer post-operative intensive care stays and needing inotropes would be more likely to develop future hypertension and re-coarctation. We also thought an antenatal diagnosis of coarctation and the use of cardiopulmonary bypass may have had a protective effect on future hypertension or re-coarctation, as those diagnosed antenatally would be less likely to have presented later and unwell, and cardiopulmonary bypass is associated with more extensive resection of coarctation tissue and more extensive aortic arch reconstruction, thereby reducing the substrate for re-coarctation in the future.…”

Rationale and design of long-term outcomes and vascular evaluation after successful coarctation of the aorta treatment study

“…Successfully treated CoA patients have stiffer large arteries[ 16 17 18 19 20 21 ] and compromised vascular reactivity in small arteries,[ 8 10 22 23 24 25 26 ] their arterial pressure waveform is altered,[ 9 10 23 27 28 ] have imbalances in vascular function biomarkers,[ 24 25 27 29 30 ] and increased left ventricular (LV) mass. [ 8 9 19 20 21 26 31 32 ] Vascular dysfunction is associated with older age at treatment,[ 2 19 22 29 31 33 ] but early treatment does not guarantee normal vascular function.…”