Abstract
Long-term observation of adults after successful repair of aortic coarctation
- Cardiological Outpatient Clinic, Department of Cardiovascular Diseases, John Paul II Hospital, Krakow, Poland
- Department of Pediatric Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Krakow, Poland
- Pediatric Heart Surgery Department and General Pediatric Surgery Department, Medical University of Warsaw, Warsaw, Poland
Introduction
Despite successful repair of aortic coarctation, cardiovascular complications occur.
Aim
To analyse type and frequency of late complications and their impact on exercise capacity in adults after aortic coarctation repair.
Material and methods
Fifty-eight adults after aortic coarctation repair, 36 male, median age 27.46 ±10.57, were compared to 30 healthy volunteers. Physical examination, transthoracic echocardiography, carotid intima-media thickness measurement, cardiopulmonary exercise test and 24-hour ambulatory blood pressure monitoring were performed.
Results
The main complications were: arterial hypertension 48.3%, myocardial hypertrophy in echocardiography 29.34%, recoarctation 25.86%, aortic dilation 13.79% and coronary artery disease 6.89%. Exercise tolerance was reduced in the cardiopulmonary exercise test. The VO2/kg peak was lower, 29.01 ±8.79 vs. 49.16 ±7.38 ml/kg/min, p < 0.001, VE/VCO2 peak higher 28.18 ±4.69 vs. 26.78 ±3.13, p = 0.017. The peak heart rate was reduced, 157.28 ±22.22 vs. 177.93 ±23.08 bpm, p < 0.001, peak systolic blood pressure was higher, 174.79 ±17.62 vs. 153.33 ±4.79 mm Hg, p < 0.001. Systolic blood pressure in 24-hour ambulatory monitoring correlated with left ventricle mass index, r = 0.29, p = 0.025, wall thickness, r = 0.31, p = 0.039. Age at operation was related to left ventricle wall thickness, r = 0.27, p = 0.041, and carotid intima-media thickness, r = 0.26, p = 0.046. There was no association of any cardio-pulmonary parameters with time from surgery, type of operation or echocardiography results.
Conclusions
Adults after aortic coarctation repair suffer from arterial hypertension, recurrent aortic stenosis, aortic aneurysms, and coronary artery disease. Reduced exercise capacity in cardio-pulmonary exercise test is related to hypertensive reaction and chronotropic incompetence.
Keywords
atherosclerosis risk factors, coarctation of aorta, exercise capacity, cardio-pulmonary exercise test, long-term complications in coarctation of the aorta
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