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Multi-centre cross-sectional study on vascular remodelling in children following successful coarctation correction

Abstract

Coarctation of the aorta is an arteriopathy with life-long sequelae, with remarkably increased cardiovascular events in young adults even after successful repair and despite blood pressure status. There are data on arterial remodelling in adults after coarctation correction, however, these data are scarce in childhood. Thus, the aim of this cross-sectional study was to evaluate changes in arterial wall function and morphology in children following successful coarctation repair and to compare these changes among patients with different blood pressure status and coarctation correction modes. Blood pressure status, echocardiographic parameters, arterial wall structure and stiffness, endothelial function and central blood pressure measurements were evaluated in 110 children aged 6–18 years following successful coarctation repair with right arm blood pressure not exceeding leg blood pressure by ≥20 mmHg. The prevalence of arterial hypertension was 50%. The mean carotid intima-media thickness SDS was 3.1 ± 1.5 and above 1.65 SDS in 91 of 110 patients. Increased right carotid intima-media thickness was associated with left ventricular hypertrophy, office blood pressure difference between leg and right arm, recoarctation in the past and interventional coarctation correction. Increased local common carotid artery stiffness was associated with increased pulse pressure and central systolic blood pressure. Potentially decreased endothelial function was related to a slight increase of peak and mean systolic gradient in the descending aorta. After successful coarctation repair and with a low blood pressure gradient, children still have a high prevalence of arterial hypertension and significant arterial remodelling, indicating accelerated biological age and advanced arteriosclerosis.

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Fig. 1: Enrolment of patients.
Fig. 2: Comparison of right cIMT SDS means between patients who did not have recoarctation and patients who were treated for recoarctation in the past.
Fig. 3: Comparison of right cIMT SDS means between patients in whom CoA was corrected by balloon angioplasty, surgery and stenting.
Fig. 4: Median of peak systolic gradient in descending aorta among normal and decreased FMD groups.

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Acknowledgements

This project was supported by the Association for European Paediatric and Congenital Cardiology, junior member research grant.

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SS—conceived and designed the analysis, collected the data, performed the analysis, wrote the paper. RS—discussed the results and contributed to the final manuscript. IL—discussed the results and contributed to the final manuscript. PS—contributed data and analysis tools. AR—contributed data and analysis tools. GBR—discussed the results and contributed to the final manuscript. ŁO—contributed data and analysis tools. AJ—contributed to conceiving and designing the analysis, discussed the results and contributed to the final manuscript. ML—contributed to conceiving and designing the analysis, discussed the results and contributed to the final manuscript.

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Correspondence to Skaiste Sendzikaite.

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Sendzikaite, S., Sudikiene, R., Lubaua, I. et al. Multi-centre cross-sectional study on vascular remodelling in children following successful coarctation correction. J Hum Hypertens 36, 819–825 (2022). https://doi.org/10.1038/s41371-021-00585-6

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