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Cuff pressures and Doppler gradients after coarctectomy. A long-term follow-up
Insights
Adults operated on for coarctation of the aorta as children may experience hypertension due to residual obstruction. This study found a correlation between blood pressure and obstruction, suggesting mechanical issues persist post-surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hypertension Research
Background:
- Coarctation of the aorta is a congenital heart defect requiring surgical repair.
- Long-term outcomes, including hypertension, after childhood repair are not fully understood.
- Resection and end-to-end anastomosis is a common surgical technique for coarctation.
Purpose of the Study:
- To investigate the relationship between residual mechanical obstruction and postoperative hypertension in adults treated for coarctation of the aorta in childhood.
- To assess blood pressure and pressure gradients in patients following surgical repair.
- To determine the cause of persistent hypertension in this patient cohort.
Main Methods:
- Study included 46 adult patients who underwent resection and end-to-end anastomosis for coarctation of the aorta during childhood (ages 7-13).
- Follow-up occurred between ages 18-28.
- Measurements included resting and exercise arm/thigh cuff pressures and systolic gradients estimated by continuous wave Doppler.
Main Results:
- 26% of patients had a resting systolic blood pressure of 150 mmHg or higher.
- Resting cuff pressure correlated well with arm-leg gradients (at rest and during exercise) and Doppler gradients.
- Doppler-derived gradients slightly underestimated invasive measurements.
Conclusions:
- Postoperative hypertension in adults treated for coarctation of the aorta appears to be linked to residual mechanical obstruction.
- Blood pressure measurements and gradient estimations are valuable tools for assessing long-term outcomes.
- Further investigation into managing residual obstruction is warranted.
Abstract:
Fourty-six adult patients operated on as children with resection and end to end anastomosis because of coarctation of the aorta were studied. The age at operation was 7 to 13 years (mean age 10 years) and at follow-up 18 to 28 years (mean age 21 years). Arm and thigh cuff pressure was measured at rest, during and immediately after submaximal exercise. The systolic gradients were also estimated using continuous wave Doppler. Systolic blood pressure at rest was 150 mmHg or more in 12 patients (26%). The cuff pressure at rest correlated well with arm-leg gradients at rest and at work, and also with the Doppler gradients at rest. Doppler gradients slightly underestimated invasively measured gradients. The results imply that postoperative hypertension was explained by residual mechanical obstruction.