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[Hypertensive retinopathy in patients with aortic coarctation]
T Vicente Vera1, J M Gual Juliá, M C Castañón Romo
1Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Insights
Hypertensive retinopathy affects 54% of patients with coarctation of the aorta. High systolic blood pressure, older age, and cardiomegaly are key determinants of retinal vascular damage.
Area of Science:
- Cardiology
- Ophthalmology
- Vascular Biology
Context:
- Coarctation of the aorta is a congenital heart defect often associated with hypertension.
- Hypertensive retinopathy is a known complication of systemic hypertension.
Purpose:
- To determine the incidence and risk factors for hypertensive retinopathy in patients with coarctation of the aorta.
- To evaluate the impact of surgical correction on blood pressure and retinal vascular changes.
Summary:
- Fifty patients with coarctation of the aorta were analyzed for retinal vascular changes using the Puig-Solanes classification.
- Hypertensive retinopathy was observed in 54% of patients, with no cases of papilledema.
- Systolic arterial pressure >150 mm Hg, age >15 years, and cardiomegaly were significantly associated with retinal lesions.
- Surgical correction normalized blood pressure in 98% of patients within one year.
- Retinal vascular damage in coarctation of the aorta appears similar to other forms of systemic hypertension and is linked to the severity and duration of hypertension.
Impact:
- Highlights the prevalence of hypertensive retinopathy in coarctation of the aorta, emphasizing the need for regular ophthalmologic screening.
- Identifies key clinical predictors of retinal vascular damage, aiding in risk stratification and management.
- Demonstrates the effectiveness of surgical intervention in controlling blood pressure and potentially preventing further retinal complications.
Abstract:
In order to assess the incidence and the determinants of hypertensive vascular changes in the retina of patients with coarctation of the aorta, fifty (37 male and 13 female) were analyzed. The mean age of the group was 18.7 +/- 10.3 years. No one had evidence of nephropathy. Different degrees of hypertensive retinopathy (Puig-Solanes classification) were observed in 54%. Of the patients, no one had papilledema. Retinal vascular damage was not related to either age or sex. The group of patients with retinal vascular lesions had a mean level of systolic arterial pressure higher than the group with normal retinas. Multivariant statistical analysis of the results permitted the identification of systolic arterial pressure higher than 150 mm Hg, age greater than 15 years and cardiomegaly as the three variables more frequently associated with retinal vascular lesions. Surgical correction of the aortic malformation resulted in normalization of both systolic and diastolic arterial pressures in 98% of the total number of patients as determined one year postoperatively. It is concluded that, in coarctation of the aorta, vascular damage of the retina appears to have an incidence that is similar to that observed in patients with other forms of systemic arterial hypertension. The development of these retinal lesions in patients with coarctation of the aorta would seem to be determined by the severity and duration of the hypertensive process.