Surgical correction of coarctation of the aorta

Bergdahl, L; Björk, V. O.; Jonasson, Rune

doi:10.1016/s0022-5223(19)37537-3

Cited by 37 publications

(6 citation statements)

References 6 publications

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“…Almost half were hypertensive on late follow-up ( Figure 3) in contrast to the low frequency reported for those operated on under 13 years of age. 24 ' 25 This phenomenon has been recognized previously. 513 ' 26 The hypertension is probably not related to recoarctation, since none of our adults required reoperation for this reason.…”

Section: Survival Of Patients With Coarct Repairsupporting

confidence: 56%

Long-term follow-up of aortic coarctation in infants, children and adults

et al. 1993

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We have studied 140 patients undergoing corrective surgery for aortic coarctation between 1952 and 1972, following them for a mean period of 23 years. Of the patients, 19 underwent surgery in infancy (age range 15 days to 190 days, mean 84 days), 52 during childhood, with a mean age of 11.8 years (range 1 years), and 69 as adults (age range 18−50 years, mean 30.5 years). All infants were symptomatic at presentation and fared poorly because of associated cardiac lesions. Their operative mortality was 11%, and mortality prior to discharge from hospital was 21%. Of the survivors, 38% required surgery for recurrent coarctation. There were three late deaths. Of the survivors, 90% were asymptomatic at long-term follow-up. Only six children (11%) were symptomatic at presentation. There was no operative or early postoperative mortality, and only three late deaths (6%). Of the 49 survivors, 96% were asymptomatic, and only six required antihypertensive medication. The recoarctation rate was 9% (four patients). In the group undergoing surgery as adults, 42% were symptomatic at presentation with 90% being hypertensive. There were two postoperative deaths and a late mortality of 22%, which was mainly related to the cardiovascular complications. None of the adults had suffered recoarctation, but 48% remained hypertensive. Our study confirms that the prognosis of patients with aortic coarctation presenting in infancy is related to presence of associated cardiac anomalies and operative complications. The prognosis in older patients, and particularly adults, is related to residual hypertension and resultant cardiovascular disease. Surgical correction reduces symptoms and improves life expectancy, regardless of the age at operation, with the best overall prognosis being obtained for those undergoing surgery as children.

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Section: Survival Of Patients With Coarct Repairsupporting

confidence: 56%

Long-term follow-up of aortic coarctation in infants, children and adults

et al. 1993

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“…In this study, we have demonstrated that the risk of medical treatment for arterial hypertension was 4.5 times and 10.5 times higher if primary surgical repair was performed during infancy and childhood, respectively, compared with surgery in the neonatal period. Several studies have demonstrated that older age at coarctation surgery conveys an increased risk of future hypertension, 4 , 5 , 8 – 11 and our results are in keeping with this. Previous studies, however, had a much wider age range of study participants, including adults undergoing their first coarctation surgery.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2017

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“…However, hypertension is common even in the presence of a good repair [3, 5, 10] and associated with autonomic imbalance [10]. Age at the time of the original CoA repair has been shown to contribute to subsequent risk of hypertension [11]. However, a high prevalence of hypertension has been subsequently demonstrated in children aged 7–16 years who were treated for CoA at a median age of 0.2 years and without residual significant arch obstruction [7].…”

Section: Introductionmentioning

confidence: 99%

Repaired coarctation of the aorta, persistent arterial hypertension and the selfish brain

Rodrigues

Jaring

Werndle

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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BackgroundIt has been estimated that 20–30% of repaired aortic coarctation (CoA) patients develop hypertension, with significant cardiovascular morbidity and mortality. Vertebral artery hypoplasia (VAH) with an incomplete posterior circle of Willis (ipCoW; VAH + ipCoW) is associated with increased cerebrovascular resistance before the onset of increased sympathetic nerve activity in borderline hypertensive humans, suggesting brainstem hypoperfusion may evoke hypertension to maintain cerebral blood flow: the “selfish brain” hypothesis. We now assess the “selfish brain” in hypertension post-CoA repair.MethodsTime-of-flight cardiovascular magnetic resonance angiography from 127 repaired CoA patients (34 ± 14 years, 61% male, systolic blood pressure (SBP) 138 ± 19 mmHg, diastolic blood pressure (DBP) 76 ± 11 mmHg) was compared with 33 normotensive controls (42 ± 14 years, 48% male, SBP 124 ± 10 mmHg, DBP 76 ± 8 mmHg). VAH was defined as < 2 mm and ipCoW as hypoplasia of one or both posterior communicating arteries.ResultsVAH + ipCoW was more prevalent in repaired CoA than controls (odds ratio: 5.8 [1.6–20.8], p = 0.007), after controlling for age, sex and body mass index (BMI). VAH + ipCoW was an independent predictor of hypertension (odds ratio: 2.5 [1.2–5.2], p = 0.017), after controlling for age, gender and BMI. Repaired CoA subjects with VAH + ipCoW were more likely to have difficult to treat hypertension (odds ratio: 3.3 [1.01–10.7], p = 0.049). Neither age at time of CoA repair nor any specific repair type were significant predictors of VAH + ipCoW in univariate regression analysis.ConclusionsVAH + ipCoW predicts arterial hypertension and difficult to treat hypertension in repaired CoA. It is unrelated to age at time of repair or repair type. CoA appears to be a marker of wider congenital cerebrovascular problems. Understanding the “selfish brain” in post-CoA repair may help guide management.Journal subject codesHigh Blood Pressure; Hypertension; Magnetic Resonance Imaging (MRI); Cardiovascular Surgery; Cerebrovascular Malformations.

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Surgical correction of coarctation of the aorta

Cited by 37 publications

References 6 publications

Long-term follow-up of aortic coarctation in infants, children and adults

Long-term follow-up of aortic coarctation in infants, children and adults

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

Repaired coarctation of the aorta, persistent arterial hypertension and the selfish brain

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