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Late follow-up after resection of aortic coarctation
1University Hospital Leiden, Dept. of Thoracic Surgery, The Netherlands.
Insights
Long-term follow-up of aortic coarctation repair in 30 young patients revealed significant restenosis in most. Exercise tolerance was not linked to restenosis, but valve abnormalities were common.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Aortic coarctation is a congenital heart defect requiring surgical repair.
- Early surgical intervention aims to improve long-term outcomes.
- Long-term surveillance is crucial to monitor for complications like restenosis and valve issues.
Purpose of the Study:
- To evaluate long-term outcomes after surgical repair of aortic coarctation in patients operated on before 3 years of age.
- To assess the prevalence of restenosis and associated hemodynamic changes.
- To identify any undiagnosed cardiac abnormalities and their correlation with exercise tolerance.
Main Methods:
- Retrospective study of 30 patients who underwent aortic coarctation repair with end-to-end anastomosis.
- Mean follow-up of 22 years (range 15-34 years).
- Assessment included magnetic resonance imaging (MRI), digital subtraction angiography (DSA), and bicycle exercise testing.
Main Results:
- Twenty-three out of 30 patients (76.7%) showed some degree of restenosis on MRI/DSA.
- Eighteen of these 23 patients (78.3%) exhibited a post-exercise blood pressure gradient.
- Eleven patients (36.7%) had undiagnosed aortic or mitral valve abnormalities; exercise tolerance did not correlate with restenosis.
Conclusions:
- Surgical repair of aortic coarctation in young children is associated with a high rate of long-term restenosis.
- Restenosis and associated hypertension may not directly impact exercise tolerance.
- Routine long-term monitoring is essential for detecting restenosis and previously undiagnosed valve abnormalities.
Abstract:
Out of 121 patients who underwent resection of aortic coarctation followed by end-to-end anastomoses at an age of less than 3 years at the time of surgery, 30 patients were studied. The mean duration of follow-up was 22 years, ranging from 15 to 34 years. Eight of the patients were younger than 26 weeks at the time of operation. All 30 patients underwent magnetic resonance imaging (MRI), digital subtraction angiography (DSA), and bicycle exercise testing. MRI and DSA showed some degree of stenosis in 23 patients. Eighteen of these 23 patients showed a post-exercise blood pressure gradient between right arm and leg. Hypertension, if found, did not correlate with age at the time of operation. Eleven patients showed aortic or mitral valve abnormality not diagnosed at the time of repair of the coarctation. Exercise tolerance did not correlate with the presence of restenosis.