Serial assessment of arterial structure and function in patients with coarctation of the aorta undergoing stenting

Abstract

Stenting for CoA has become an acceptable treatment modality in the last 20 years. However little is known about arterial changes after this procedure. To assess arterial structure and function including peripheral reactivity and stiffness and intima-media thickness (IMT) pre and post stenting for coarctation of the aorta (CoA). Twenty-one patients [median age: 15 years (8-39)] were studied at baseline, 1 day, 6 months and 1 year after stenting. Twenty-one healthy subjects (1:1 matched) were used as controls. Left ventricular (LV) mass, ejection fraction, flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of left brachial artery, common carotid (CC) and right subclavian artery (RSCA) IMT and pulse wave velocity (PWV) were assessed by echocardiography and vascular ultrasound. CoA patients had higher LV indexed mass (p < 0.0001), impaired FMD (p < 0.0001) and NMD (p < 0.0001), increased PWV (p < 0.0001), carotid and RSCA IMT (both p < 0.0001). All procedures were successful and resulted in significant gradient reduction (p < 0.001). One year after stenting there was improvement in LV function (p = 0.034) and although there was significant reduction of LV mass (103.29 ± 24.77 vs. 74.39 ± 22.07 g/m(2), p < 0.0001) values did not normalize. There was no significant change in FMD, NMD, PWV and CC or RSCA IMT. In patients with CoA, arterial reactivity is impaired and LV mass, arterial stiffness and thickness are increased. Although stenting is successful to relieve the obstruction resulting in better LV function and mass reduction, arterial structure and function remains abnormal after 1 year of follow-up.

Arterial Stiffness in Congenital Heart Disease

“…Elevated arterial stiffness relative to controls, particularly in the ascending aorta and carotid artery, has been widely reported in infants, children, adolescents and adults following CoA repair (Figure 3) [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46], as well as increased carotid arterial intima-media thickness [38,40,45,46]. Furthermore, a similar degree of increased arterial stiffness was evident both pre and postoperatively in the ascending aorta of neonates, suggesting that changes in arterial properties were present from early life [30].…”

Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls?

“…20,38 Most of the studies, evaluating pulse wave velocity in patients with coarctation of the aorta, have a heterogenous study population in terms of age including both adults and paediatric age groups. 9,27,[39][40][41] The studies which include only children and adolescents are scarce. 5,42 In general, these studies have shown increased pulse wave velocity (m/s) in the precoarctation aorta after successful repair of the coarctation compared to controls.…”

Myocardial strain pattern progress in patients with Coarctation of the Aorta undergoing aortic stenting

“…Late cardiovascular events in more than one third of patients after CoA repair have been described since the 1980s, 3,4 and this highlights the fact that morbidity in this cohort is still concerning. Arterial stiffness is a well‐known risk factor for cardiovascular events and mortality 38 ; it was prevalent in the CoA territory, and it remains so after stenting 39 . Li et al demonstrated a clear relationship between arterial stiffness and LV systolic deformation in patients after CoA treatment 15 .…”