Blood pressure, left ventricular mass and function in adult patients after successful repair of coarctation of the aorta

Abstract

Background: In spite of surgical correction, arterial hypertension may persist in a significant proportion of patients with aortic coarctation.

Aim: To asses arterial blood pressure (BP) and left ventricular (LV) mass and function in adult patients who underwent surgical repair of aortic coarctation.

Methods: The study group consisted of 56 patients (27 females, 29 males, mean age 31.2+/-10 years), who underwent surgery due to aortic coarctation at the mean age of 11.53+/-8 years. The control group consisted of 61 healthy subjects. The following parameters were analysed: BP values, end-diastolic interventricular septum (IVS) and posterior wall (PW) thickness, end-diastolic LV diameter, residual stenosis of descending aorta, LV ejection fraction, LV mass (LVM), LVM index (LVMI) and parameters of diastolic LV function.

Results: Hypertension was diagnosed in 55% of patients, particularly in those who underwent surgery in more advanced age. In 21 patients the residual pressure gradient through the descendent aorta exceeded 20 mmHg; 14 of them had hypertension. Echocardiography showed significantly higher values of PW thickness in patients than in controls, and significantly higher values of PW, IVS, LVM and LVMI in patients with rather than without hypertension. The most pronounced differences in these parameters were noted between controls and patients with hypertension. In patients with residual trans-aortic gradient, all the above mentioned parameters were similar to those obtained in patients without the gradient or controls. Also, both systolic and diastolic LV function were similar in patients and controls, in patients with or without hypertension, and in patients with or without residual aortic gradient. In the whole study group, a positive linear correlation between age at surgery and BP values was found (p=0.01) whereas no such correlation was found between BP and time which elapsed after surgery. There was a significant negative correlation between E/A and age at surgery (p=0.004) and a positive correlation between time from surgery and IVRT (p=0.025). IVRT positively correlated with BP (p=0.024). BP values correlated positively with PW (p=0.024) and IVS (p=0.04). Among patients with hypertension, a significant positive correlation between age at surgery and LVM (p=0.034) as well as LVMI (p=0.013) was noted. Diastolic LV function in the subgroup of patients with hypertension was characterised by a negative correlation between age at surgery and E/A (p=0.001) and a positive correlation between time from surgery, BP values and IVRT (p=0.045 and p=0.024, respectively). In patients without hypertension no significant correlation between the analysed parameters was found.

Conclusions: 1. Hypertension is present in more than half of adult patients after surgical repair of aortic coarctation, is more frequent in patients who underwent surgery at a more advanced age, and in the majority of patients is not associated with the presence of residual trans-aortic gradient. 2. LV thickness, mass and index increase due to hypertension, regardless of the presence of gradient. 3. LV diastolic parameters are similar to those in healthy subjects, however, they become impaired as the time from surgery increases, particularly in patients who underwent repair at an advanced age and who have hypertension.