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Cardiovascular changes in children with coarctation of the aorta treated by endovascular stenting

Abstract

The aim of this study was to investigate the echocardiographic, biochemical short- and mid-term effects of the stenting procedure on left ventricular function, aortic stiffness, elasticity and systemic hypertension in children with coarctation of the aorta (CoA). Fifteen patients with native or recurrent CoA and 30 healthy controls who were sex and age matched were included in the study. The blood pressure values, echocardiographic measurements, elastic functions of ascending aorta and serum N-Terminal ProBNP (NT-ProBNP) levels were recorded prospectively before and at the first and sixth month after stenting. The mean arterial pressure recorded before stenting was 134.4±16.3 mm Hg; at the sixth month it was 115.5±9.5 mm Hg and in the control group it was 107.3±9.4 mm Hg. Although blood pressure levels were lower compared with the pre-stenting measurements (P<0.05), they were still significantly higher compared with the control group (P<0.05). Although a significant reduction was detected in the LVMIz at the end of the sixth month (50.4±14.3 g m−2.7) compared with the baseline (66.6±17.9 g m−2.7; P<0.05), it was still higher compared with the control group (35.7±6.2 g m−2.7; P<0.05). The baseline aortic elasticity (6.4±3.4 cm2 dyn−1 10−6) was lower compared with the control group (10.0±1.7 cm2 dyn−1 10−6; P<0.05), and prestenting aortic stiffness was higher than that of the control group (5.6±1.6 dyn−1 10−6; 2.5±0.45 dyn−1 10−6; P<0.05). A statistically significant negative correlation was detected between the pressure gradient at the lesion site and aortic elasticity (r: −0.53, P: 0.04). Although resolution of the coarctation by endovascular stenting led to a reduction in the arteriopathy that had already begun before treatment, it was demonstrated that these children did not completely return to normal.

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References

  1. O’Sullivan JJ, Derrick G, Darnell R . Prevalence of hypertension after early repair of coarctation of the aorta: a cohort study using casual and 24 h blood pressure management. Heart 2002; 88: 163–166.

    Article  Google Scholar 

  2. Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC . Coarctation of the aorta: long term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.

    Article  CAS  Google Scholar 

  3. Presbitero P, Demarie D, Villani M, Perinetto EA, Riva G, Orzan F et al. Long term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 1987; 57: 462–467.

    Article  CAS  Google Scholar 

  4. Burchell Hb, Clagett OT, Hines EA Jr, Wood EH, Wright JL . Hemodynamic and clinical appraisal of coarctation four to seven years after resection and end-to-end anastomosis of the aorta. Circulation 1956; 14: 806–814.

    Article  CAS  Google Scholar 

  5. Donner R, Black I, Spann JF, Corin WJ, Hess OM, Bourgeois M . Left ventricular wall stress and function in childhood coarctation of the aorta. J Am Coll Cardiol 1985; 5: 1161–1167.

    Article  CAS  Google Scholar 

  6. Litwin M, Niemirska A . Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol 2009; 24: 707–719.

    Article  Google Scholar 

  7. Hunt PJ, Richards AM, Nicholls MG, Yandle TG, Doughty RN, Espiner EA . Immunoreactive aminoterminal pro-brain natriuretic peptide (NT-pro BNP) a new marker of cardiac impairment. Clin Endocrinol 1997; 350: 1347–1351.

    Google Scholar 

  8. Sutovsky I, Katoh T, Ohno T, Honma H, Takayama H, Takano T . Relationship between natriuretic peptide, myocardial wall stres and ventricular arrhytmia severity. Jpn Heart J 2004; 45: 771–777.

    Article  CAS  Google Scholar 

  9. Iso T, Arai M, Wada A, Kogure K, Suzuki T, Nagai R . Humoral factors produced by pressure overload enhance cardiac hypertrophy and natriuretic peptide expression. Am J Physiol 1997; 273: 113–118.

    Google Scholar 

  10. Holzer R, Qureshi S, Ghasemi A, Vincent J, Sievert H, Gruenstein D et al. Stenting of aortic coarctation: acute, intermediate and long-term results of a prospective multi-institutional registry Congenital Cardiovasculer Stud Consortium (CCISC). Catheter Cardiovasc Interv 2010; 76: 553–563.

    Article  Google Scholar 

  11. Eidem BW, Tei C, O’Leary PW, Cetta F, Seward JB . Nongeometric quantitative assessment of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly. J Am Soc Echocardiogr 1998; 11: 849–856.

    Article  CAS  Google Scholar 

  12. Devereux RB, Reichek N . Echocardiographic determination of left ventricular mass in man: Anatomic validation of the method. Circulation 1997; 55: 613–618.

    Article  Google Scholar 

  13. De Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O et al. Left ventricular mass and body size in normotensive children and adults: Assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251–1260.

    Article  CAS  Google Scholar 

  14. Vogt M, Kühn A, Baumgartner D, Busch R, Kostolny M, Hess J . Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries? Circulation 2005; 111: 3269–3273 11.

    Article  Google Scholar 

  15. Ikonomidis I, Lekakis J, Stamatelopoulos K, Markomihelakis N, Kaklamanis PG, Mavrikakis M . Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet's disease. J AmColl Cardiol 2004; 43: 1075–1081.

    Article  Google Scholar 

  16. Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC . Coarctation of aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.

    Article  CAS  Google Scholar 

  17. Beekman RH . Coarctation of the aorta. Allen HG, Gutgessell HP, Clark EB, Driscoll DJ (eds). Moss and Adams’ Heart Disease in Infants, Children, and Adolescents Including the Fetus and Young Adults 6th edn. Lippincott Williams and Wilkins: Philadelphia, PA, USA, 2001 pp 988–1010.

    Google Scholar 

  18. Rosenthal E . Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart 2005; 91: 1495–1502.

    Article  Google Scholar 

  19. Erdoğan HB, Ardal H, Ömeroğlu SN, Mansuroğlu D, Polat A, İzgi A et al. Aort koarktasyonu cerrahi tedavisi. Yirmi yıllık deneyim. Türk Göğüs Kalp Damar Cer Derg 2006; 14: 2117–2121.

    Google Scholar 

  20. Brouwer RMHJ, Erasmus ME, Ebels T, Eijgelaar A . Influence of age on survival, late hypertension, and recoarctation in elective aortic coarctation repair. J Thorac Cardiovasc Surg 1994; 108: 525–531.

    CAS  PubMed  Google Scholar 

  21. De Divitiis M, Pilla C, Kattenhorn M, Donald A, Zadinello M, Wallace S et al. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol 2003; 41: 2259–2266.

    Article  Google Scholar 

  22. Leandro J, Smallhorn JF, Benson L, Musewe N, Balfe JW, Dyck JD et al. Ambulatory blood pressure monitoring and left ventricular mass and function after successful surgical repair of coarctation of the aorta. J Am Coll Cardiol 1992; 20: 197–204.

    Article  CAS  Google Scholar 

  23. Maron BJ, O’Neal HJ, Rowe RD, Mellits ED . Prognosis of surgically corrected coarctation of the aorta: a 20 year postoperative appraisal. Circulation 1973; 47: 119–126.

    Article  CAS  Google Scholar 

  24. Leskinen M, Reiniela A, Tarkka M, Uhari M . Reversibility of hypertensive vascular changes after coarctation repair in dogs. Pediatr Res 1992; 31: 297–299.

    Article  CAS  Google Scholar 

  25. Graham TP Jr, Lewis BW, Jarmakani MM, Canent RV Jr, Capp MP . Left heart volume and mass quantification in children with left ventricular pressure overload. Circulation 1970; 41: 203–212.

    Article  Google Scholar 

  26. Roberts WC . Frequency of systemic hypertension in various cardiovascular diseases. Am J Cardiol 1987; 60: 1E–8E.

    Article  CAS  Google Scholar 

  27. Falk E . Cardiac causes of death in hypertension. Scand J Clin Lab Invest 1989; 49: 33–41.

    Article  Google Scholar 

  28. Pfammater JP, Ziemer G, Kaulitz R, Heinemann MK, Luhmer I, Kallfelz HC . Isolated aortic coarctation in neonates and infants: results of resection and end-to-end anastomosis. Ann Thoracic Surg 1996; 62: 778–783.

    Article  Google Scholar 

  29. Moskowitz WB, Schieken RM, Mosteller Mi Bossano R . Altered systolic and diastolic function in children after successful repair of coarctation of the aorta. Am Heart J 1990; 120: 103–109.

    Article  CAS  Google Scholar 

  30. Lacombe F, Dart A, Dewar E, Cameron J, Laufer E . Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992; 13: 1040–1045.

    Article  CAS  Google Scholar 

  31. Lam YY, Kaya MG, Li W, Gatzoulis MA, Henein MY . Effect of chronic afterload increase on left ventricular myocardial function in patients with congenital left-sided obstructive lesions. Am J Cardiol 2007; 99: 1582–1587.

    Article  Google Scholar 

  32. Berger R, Huelsman M, Strecker K, Bojic A, Moser P, Stanek B et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation 2002; 105: 2392–2397.

    Article  Google Scholar 

  33. Talwar S, Siebenhofer A, Williams B, Ng L . Influence of hypertension, left ventricular hypertophy, and left ventricular systolic dysfunction on plasma N terminal proBNP. Heart 2000; 83: 278–28.

    Article  CAS  Google Scholar 

  34. Tavli V, Saritas T, Guven B, Okur F, Saylan BC, Tavli T et al. Myocardial performance after successful intervention for native aortic coarctation. Cardiol Young 2010; 20: 33–38.

    Article  Google Scholar 

  35. Daly C, Fox K, Henein M . Natriuretic peptides in the diagnosis of heart disease-first amongst equals? Int J Cardiol 2002; 84: 107–111.

    Article  CAS  Google Scholar 

Download references

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Correspondence to A Ozyurt.

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Sezer, S., Narin, N., Ozyurt, A. et al. Cardiovascular changes in children with coarctation of the aorta treated by endovascular stenting. J Hum Hypertens 28, 372–377 (2014). https://doi.org/10.1038/jhh.2013.119

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