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Coarctation of the aorta (CoA) has long term sequelae of systemic hypertension, premature cardiovascular disease and death. We sought to determine possible risk factors for such outcomes in the recent era of CoA management.
Performed by retrospective chart review of patients with isolated CoA (other hemodynamically significant lesions excluded) who had surgical or catheterization (cath) procedure from 1998-2010, with viewable diagnostic echocardiogram, and minimum 1 yr post-procedural follow up.
Median age at diagnosis of CoA for the 83 subjects was 0.03 yr (−0.4-29.0) with follow-up of 9.7 yr (1.1-31.0). Median age of initial procedure was 0.04 yr (0.0-16.9, surgical n=66) compared to 12.5 yr (0.1-29.3, cath n=17). At last follow up, median upper to lower extremity BP gradient was −3 (−30 to 38), Doppler uncorrected gradient was 20 (0-37), and cath peak-peak gradient was 4 mm Hg (0-35, n=28). Hypertension (HTN), pre-HTN, or HTN on exercise stress test was present in 25% at median 9.4 yr (5.5-29.0) and was associated with older age of diagnosis (7.1 vs. 0.02 yrs, p <0.001), first procedure ≥6 mos vs. <6 mos of age (27.6% vs. 7.4%, p=0.02), elevated blood pressure (BP) percentile at diagnosis (95±13 vs. 82±20, p=0.002), and increased left ventricular (LV) mass z-score at diagnosis (2.6±1.3 vs. 0.7±2.0, p=0.002). Median cath measured LV end diastolic pressure (n=30) was 12 mm Hg (6-19) at a median age of 11.4 yr (0.1-30.3). Increased LV end diastolic pressure was not related to LV systolic dysfunction, HTN, or age at first procedure. LV mass z-score >2 was present in 7 of 75 patients (9%) at last follow up (median 0.29, range −2.08 to 2.67). A single procedure was performed in 70%, 2 in 24%, and 3 in 6%. Re-intervention was less common with lower initial BP gradient (35±17 vs. 44 ± 16, p=0.05) and was not related to size at initial procedure or arch measurements. Though not statistically significant, fewer re-interventions occurred if age at initial procedure <6 mos vs. ≥6 mos (25.9 vs. 37.9%, p=0.32).
At mid-term follow up of current CoA management, HTN and diastolic dysfunction are common and may contribute to early morbidity and mortality associated with CoA.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Aortic Disease
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1246-118
- 2013 American College of Cardiology Foundation