Elsevier

American Heart Journal

Volume 151, Issue 1, January 2006, Pages 242-247
American Heart Journal

Clinical Investigation
Vascular and Congenital Heart Disease
Increased carotid and femoral intima-media thickness in patients after repair of aortic coarctation: Influence of early repair

https://doi.org/10.1016/j.ahj.2005.02.013Get rights and content

Background

In patients, after repair of aortic coarctation, abnormal function of the proximal precoarctation arterial conduits has been demonstrated, but data on arterial wall structure of proximal and distal arteries in patients are scarce. The aim of our study is to compare intima-media thickness (IMT) of the carotid and femoral arteries in controls and patients after coarctation repair and to identify independent predictors of carotid and femoral IMT.

Methods

A total of 137 patients after repair of aortic coarctation (89 male, median age 29.7 years, range 17-74 years, and median age at repair 6.3 years, range 0.01-46 years) and 46 age-matched controls underwent ambulatory blood pressure monitoring and B-mode ultrasound of the carotid and femoral arteries.

Results

Twenty (15%) of the 137 patients were operated on before the age of 1 year (“early repair”). The patients with an early repair were younger compared to the controls and compared with the patients with a late repair (24.5 [10.5] vs 31.6 [8.4] years, P = .005, and vs 32.1 [10.5] years, P < .001, respectively). Eighty patients (59%) had hypertension on the basis of the results of the ambulatory blood pressure monitoring (mean daytime blood pressure ≥ 135/85 mm Hg). The prevalence of hypertension was not significantly different between patients with an early or late repair. Although patients with an early repair were younger, both carotid and femoral IMT were increased in these patients compared to controls (common carotid artery 0.57 [0.11] vs 0.49 [0.07] mm, P < .001; common femoral artery 0.48 [0.10] vs 0.44 [0.05] mm, P = .033). In multivariable regression analyses, age at repair was only an independent predictor of femoral and not of carotid IMT.

Conclusions

Patients, after repair of aortic coarctation, have increased carotid and femoral IMT despite normal ambulatory blood pressures and successful previous repair. Early repair seems to preserve postcoarctation arterial wall structure, but seems to have only limited effect on precoarctation vessel walls, which supports the theory of a developmental defect of the proximal aorta and its branches.

Section snippets

Study design

From 2001 until 2002, all 137 consecutive adult postcoarctectomy patients (89 male) from the outpatient clinic of our tertiary referral institution and 46 age-matched, normotensive, healthy volunteers were enrolled in this observational study. The institutional review committee approved the protocol and an informed consent was obtained from all participants. In all patients, significant residual aortic stenosis or recoarctation had been ruled out by magnetic resonance imaging within 2 years

Patient population

Median age of the 137 patients after repair of aortic coarctation (89 male) was 29.7 years (range 17.1-74.3 years). Median age at repair was 6.3 years (range 0.01-45.7 years). Twenty patients (15%) were operated on before the age of 1 year (“early repair”). Nine of these patients had neonatal repair (before the age of 1 month). Table I shows the clinical characteristics in patients with early or late repair and controls. Seventy-three percent of the patients had resection and end-to-end

Discussion

Our study demonstrates for the first time that both carotid and femoral IMT are increased in young patients after successful repair of aortic coarctation compared to controls. The differences in carotid IMT are prominent, even in patients with early repair. In contrast to earlier assumptions, postcoarctation arterial wall structure is not normal; femoral IMT is increased even in patients with early aortic coarctation repair. Age at repair was shown an independent predictor of femoral IMT but

References (25)

  • H.M. Gardiner et al.

    Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood

    Circulation

    (1994)
  • M. De Divitiis et al.

    Vascular dysfunction after repair of coarctation of the aorta. Impact of early surgery

    Circulation

    (2001)
  • Cited by (43)

    • Arterial Stiffness in Congenital Heart Disease

      2021, Heart Lung and Circulation
    View all citing articles on Scopus
    View full text