Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation.

AIMS: The significance of mild residual descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation.

METHODS AND RESULTS: In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient > or =30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio <0.7. Thirty-four patients (32%) had a significant residual aortic narrowing and were excluded from the analysis. Of the remaining 73 patients (43 male) with no or only mild residual descending aortic narrowing, median age was 29.8 years (range 17.1-52.5 years), mean age at repair 8.1 years (range 0.02-37.3 years), mean arm/leg gradient 2+/-12 mmHg, and mean common carotid intima-media thickness 0.612+/-0.118 mm. Thirty-three (45%) of these patients had hypertension. In multivariable regression analysis the site of repair/diaphragmatic aorta ratio was a strong and independent predictor of mean daytime systolic blood pressure (P<0.001) and common carotid intima-media thickness (P=0.027).

CONCLUSION: Mild residual descending aortic narrowing in post-coarctectomy patients is independently associated with mean daytime blood pressure and carotid intima-media thickness. Our data suggest that a threshold for re-intervention of residual aortic narrowing lower than posed in current guidelines may be desirable to improve long-term outcome in these patients. However, further research on such aggressive interventional approaches is needed.