TY - JOUR

T1 - High long-term morbidity in repaired aortic coarctation

T2 - weak association with residual arch obstruction

AU - Pedersen, Thais A L

AU - Munk, Kim

AU - Andersen, Niels H

AU - Lundorf, Erik

AU - Pedersen, Erling B

AU - Hjortdal, Vibeke E

AU - Emmertsen, Kristian

N1 - © 2011 Wiley Periodicals, Inc.

PY - 2011/10/21

Y1 - 2011/10/21

N2 - OBJECTIVE: The objective of this study was to assess late morbidity after repair of aortic coarctation and its association with residual aortic arch obstruction.DESIGN AND SETTING: This is an observational cohort study of 133 patients who underwent surgical repair during 1965-1985. Echocardiography, bicycle exercise testing, 24-hour ambulatory blood pressure monitoring, and magnetic resonance imaging/computerized tomography scan of the thoracic aorta were performed. The setting of this study was a tertiary referral center.PATIENTS: Among 156 survivors, 133 (84 men) accepted study participation. Median age (range) was 10 (0.1-40) years at repair and 44 (26-74) years at follow-up.OUTCOME MEASURES: Outcome measures used are prevalence of previous cardiovascular reinterventions, current cardiac and valvular function, exercise capacity, blood pressure levels at rest and during exercise, and presence of recurrent or residual aortic arch obstruction and/or aortic aneurysms.RESULTS: Thirty-five had undergone cardiovascular reinterventions. Sixteen had an aortic and three had a mitral valve prosthesis; 117 had a native aortic valve that was bicuspid in 63 and dysfunctional in 45. Ejection fraction was below 50% in 16. On exercise, performance was reduced in 37 and hypertension was induced in 47. Fifty-eight had elevated blood pressures and further 17 received antihypertensives. The ascending aorta was aneurysmal in 28 and the distal arch in five. The presence of a bicuspid aortic valve was significantly associated with valve regurgitation and ascending aortic ectasia. Fifty-eight of 121 patients had minimal aortic arch diameters between 46% and 79% of the diaphragmatic aortic diameter, indicating moderate/mild recoarctation. This was associated with elevated blood pressures and use of antihypertensive medication, but not with hypertension in unmedicated patients or with echocardiographic or exercise parameters. Only five patients had normal study findings, were normotensive, and without reinterventions after coarctation repair.CONCLUSIONS: Cure by repair of aortic coarctation is rare; heart diseases, aortopathy, and hypertension are common. Morbidity is only weakly associated with mild/moderate recoarctation.

AB - OBJECTIVE: The objective of this study was to assess late morbidity after repair of aortic coarctation and its association with residual aortic arch obstruction.DESIGN AND SETTING: This is an observational cohort study of 133 patients who underwent surgical repair during 1965-1985. Echocardiography, bicycle exercise testing, 24-hour ambulatory blood pressure monitoring, and magnetic resonance imaging/computerized tomography scan of the thoracic aorta were performed. The setting of this study was a tertiary referral center.PATIENTS: Among 156 survivors, 133 (84 men) accepted study participation. Median age (range) was 10 (0.1-40) years at repair and 44 (26-74) years at follow-up.OUTCOME MEASURES: Outcome measures used are prevalence of previous cardiovascular reinterventions, current cardiac and valvular function, exercise capacity, blood pressure levels at rest and during exercise, and presence of recurrent or residual aortic arch obstruction and/or aortic aneurysms.RESULTS: Thirty-five had undergone cardiovascular reinterventions. Sixteen had an aortic and three had a mitral valve prosthesis; 117 had a native aortic valve that was bicuspid in 63 and dysfunctional in 45. Ejection fraction was below 50% in 16. On exercise, performance was reduced in 37 and hypertension was induced in 47. Fifty-eight had elevated blood pressures and further 17 received antihypertensives. The ascending aorta was aneurysmal in 28 and the distal arch in five. The presence of a bicuspid aortic valve was significantly associated with valve regurgitation and ascending aortic ectasia. Fifty-eight of 121 patients had minimal aortic arch diameters between 46% and 79% of the diaphragmatic aortic diameter, indicating moderate/mild recoarctation. This was associated with elevated blood pressures and use of antihypertensive medication, but not with hypertension in unmedicated patients or with echocardiographic or exercise parameters. Only five patients had normal study findings, were normotensive, and without reinterventions after coarctation repair.CONCLUSIONS: Cure by repair of aortic coarctation is rare; heart diseases, aortopathy, and hypertension are common. Morbidity is only weakly associated with mild/moderate recoarctation.

KW - Adolescent

KW - Adult

KW - Aged

KW - Antihypertensive Agents/therapeutic use

KW - Aorta, Thoracic/diagnostic imaging

KW - Aortic Coarctation/complications

KW - Aortic Diseases/diagnosis

KW - Aortography/methods

KW - Blood Pressure

KW - Blood Pressure Monitoring, Ambulatory

KW - Cardiac Surgical Procedures/adverse effects

KW - Chi-Square Distribution

KW - Child

KW - Child, Preschool

KW - Denmark/epidemiology

KW - Exercise Test

KW - Exercise Tolerance

KW - Female

KW - Heart Diseases/epidemiology

KW - Humans

KW - Hypertension/epidemiology

KW - Infant

KW - Logistic Models

KW - Magnetic Resonance Angiography

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Reoperation

KW - Risk Assessment

KW - Risk Factors

KW - Time Factors

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

KW - Ultrasonography

KW - Young Adult

U2 - 10.1111/j.1747-0803.2011.00575.x

DO - 10.1111/j.1747-0803.2011.00575.x

M3 - Journal article

C2 - 22011266

VL - 6

SP - 573

EP - 582

JO - Congenital Heart Disease

JF - Congenital Heart Disease

SN - 1747-079X

IS - 6

ER -