High long-term morbidity in repaired aortic coarctation: weak association with residual arch obstruction
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High long-term morbidity in repaired aortic coarctation : weak association with residual arch obstruction. / Pedersen, Thais A L; Munk, Kim; Andersen, Niels H; Lundorf, Erik; Pedersen, Erling B; Hjortdal, Vibeke E; Emmertsen, Kristian.
In: Congenital Heart Disease, Vol. 6, No. 6, 21.10.2011, p. 573-82.Research output: Contribution to journal › Journal article › Research › peer-review
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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 -
ID: 242711783