Details

Autor(en) / Beteiligte

• Lee, Melissa G.Y., MBBS, BMedSci
• Allen, Sarah L., MD, BBiomed
• Kawasaki, Ryo, MD, PhD
• Kotevski, Aneta, BMedSci, PhD
• Koleff, Jane, DipMedLabSc
• Kowalski, Remi, MBBS
• Cheung, Michael M.H., MBChB
• Konstantinov, Igor E., MD, PhD
• Brizard, Christian P., MD
• d’Udekem, Yves, MD, PhD

Titel

High Prevalence of Hypertension and End-Organ Damage Late After Coarctation Repair in Normal Arches

Ist Teil von

• The Annals of thoracic surgery, 2015-08, Vol.100 (2), p.647-653

Ort / Verlag

Netherlands: Elsevier Inc

Erscheinungsjahr

2015

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Background To (1) determine the prevalence of hypertension late after coarctation repair in patients with normal-sized transverse arches, and (2) evaluate the potential for end-organ damage related to hypertension after coarctation repair. There are no studies specifically investigating end-organ damage and hypertension after coarctation repair using noninvasive techniques. Methods Eighty-two patients aged 10 years or greater with a coarctation repair and a normal-sized arch operated on between 1978 and 2010, underwent a transthoracic echocardiogram, 24-hour blood pressure (BP) monitoring, and retinal imaging. Median age at repair was 1 year (interquartile range, 0 to 6); 45% (37 of 82) were operated in the first year of life. Results After a follow-up of 24 ± 7 years, 27% (22 of 82) and 50% (41 of 82) suffered resting hypertension and resting prehypertension, respectively. On 24-hour BP monitoring, 61% (49 of 80) and 21% (17 of 80) suffered hypertension and prehypertension, respectively. Arch reobstruction (echo gradient > 25 mm Hg) was present in only 15% (12 of 82), and in only 15% (7 of 47) with 24-hour hypertension. Resting hypertension was associated with a smaller central retinal artery equivalent (average width of arterioles) and central retinal vein equivalent (average width of venules) ( p  = 0.0006 and p  = 0.003, respectively). Left ventricular hypertrophy on echocardiography was present in 63% (31 of 49) with 24-hour hypertension compared with only 42% (13 of 31) with normal 24-hour BP ( p  = 0.06). Conclusions There is a high rate of hypertension late after coarctation repair, even in patients with unobstructed arches. The presence of retinal imaging abnormalities and left ventricular hypertrophy signals the presence of end-organ damage in this young adult population. Regular follow-up with 24-hour BP monitoring is warranted.