European Heart Journal Advance Access originally published online on November 30, 2004
European Heart Journal 2005 26(1):84-90; doi:10.1093/eurheartj/ehi004
Clinical research
Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation
1Department of Cardiology, Room B2-240, Academic Medical Centre, Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
2Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands
3Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
Received May 18, 2004; revised September 10, 2004; accepted September 16, 2004 * Corresponding author. Tel: +31 20 56 69 111; fax: +31 20 69 14 940. E-mail address: b.j.mulder{at}amc.uva.nl
See page 8 for the editorial comment on this article (doi:10.1093/eurheartj/ehi006)
Aims The significance of mild residual descending aortic narrowing in post-coarctectomy patients is not known. The aim of our study was to investigate the influence of mild residual descending aortic narrowing on blood pressure and vascular damage in patients after repair of aortic coarctation.
Methods and results In 107 consecutive post-coarctectomy patients, magnetic resonance imaging, ambulatory blood pressure monitoring, and B-mode ultrasound of the carotid arteries were performed. A significant residual aortic narrowing was defined as: (i) a resting blood pressure gradient 
30 mmHg with hypertension or exercise-induced hypertension (European Society of Cardiology guidelines); and/or (ii) a site of repair/diaphragmatic aorta ratio <0.7. Thirty-four patients (32%) had a significant residual aortic narrowing and were excluded from the analysis. Of the remaining 73 patients (43 male) with no or only mild residual descending aortic narrowing, median age was 29.8 years (range 17.1–52.5 years), mean age at repair 8.1 years (range 0.02–37.3 years), mean arm/leg gradient 2±12 mmHg, and mean common carotid intima--media thickness 0.612±0.118 mm. Thirty-three (45%) of these patients had hypertension. In multivariable regression analysis the site of repair/diaphragmatic aorta ratio was a strong and independent predictor of mean daytime systolic blood pressure (P<0.001) and common carotid intima--media thickness (P=0.027).
Conclusion Mild residual descending aortic narrowing in post-coarctectomy patients is independently associated with mean daytime blood pressure and carotid intima--media thickness. Our data suggest that a threshold for re-intervention of residual aortic narrowing lower than posed in current guidelines may be desirable to improve long-term outcome in these patients. However, further research on such aggressive interventional approaches is needed.
Key Words: Coarctation • Hypertension • Restenosis • Risk factors • Intima-media thickness
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