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Arterioventricular interaction after coarctation repair.

Elles J Dijkema1, Martijn G Slieker2, Tim Leiner3

  • 1Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands.

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Summary
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Hypertension is common after coarctation of the aorta (CoA) repair due to increased aortic stiffness. This study found preserved left ventricular function despite this stiffness in repaired CoA patients.

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Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Vascular Biology

Background:

  • Hypertension frequently occurs in patients with coarctation of the aorta (CoA), persisting even after successful surgical repair.
  • Increased aortic stiffness is a suspected factor in CoA-associated hypertension.
  • This study investigates aortic vascular function and its link to hypertension in long-term follow-up patients with repaired CoA.

Purpose of the Study:

  • To assess aortic vascular function in patients with repaired coarctation of the aorta (CoA) during long-term follow-up.
  • To determine the relationship between aortic stiffness and hypertension in these patients.
  • To evaluate the impact of hypertension on arterioventricular coupling in the context of aortic stiffness.

Main Methods:

  • Cardiac magnetic resonance imaging (CMR) was used to examine 22 patients with repaired CoA and 22 healthy controls.
  • Measurements included aortic pulse wave velocity (PWV), aortic distensibility, global left ventricular (LV) function, LV dimensions, and LV myocardial deformation.
  • Patients underwent repair via surgery (n=12) or balloon angioplasty (n=10) between 3 months and 16 years of age, with follow-up exceeding 10 years.

Main Results:

  • Repaired CoA patients exhibited significantly higher aortic arch PWV and lower aortic distensibility compared to controls.
  • Hypertensive CoA patients showed significantly increased aortic arch PWV compared to normotensive CoA patients and controls.
  • Aortic arch PWV and distensibility were correlated with systolic blood pressure, while global LV function and myocardial deformation remained preserved.

Conclusions:

  • Central aortic stiffness is notably increased in well-repaired CoA patients long-term post-intervention.
  • This increased aortic stiffness is significantly associated with the presence of hypertension.
  • Despite aortic stiffness and hypertension, global left ventricular function, myocardial deformation, and dimensions are preserved in these patients.