European Heart Journal Advance Access originally published online on December 16, 2004
European Heart Journal 2005 26(6):617-622; doi:10.1093/eurheartj/ehi037
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Predicting the risk of early atherosclerotic disease development in children after repair of aortic coarctation
1Department of Pediatric Cardiology, University of Rostock, Germany
2Department of Cardiac Surgery, University of Rostock, Germany
3Department of Medical Informatics and Biometry, University of Rostock, Germany
4Department of Laboratory Medicine, University of Rostock, Germany
Received 23 February 2004; revised 18 September 2004; accepted 1 October 2004; online publish-ahead-of-print 16 December 2004.
* Corresponding author: Universitäts- Kinder- und Jugendklinik Rostock, Rembrandtstraße 16-17, 18055 Rostock, Germany. Tel: +49 381 4947211; fax: +49 381 7202. E-mail address: andreas-alexander.meyer{at}medizin.uni-rostock.de
Aims Increased cardiovascular morbidity is manifested a long time after the repair of aortic coarctation (CoA). By way of impaired flow-mediated vasodilation (FMD) and increased intima media thickness (IMT), surrogate parameters of atherosclerosis, cardiovascular risk factors (RFs) can be correlated with early vascular wall changes in children. This study investigated whether changes in arterial wall function and morphology are detectable in children after coarctation repair.
Methods and results We examined 28 children after successful repair of CoA vs. 30 control subjects. All children underwent identical screening, with a broad RF profile and FMD/IMT measurements. CoA-children presented significantly (P<0.001) impaired FMD (4.87±2.6 vs. 10.2±3.1%) and higher IMT values (P<0.001) than the controls (0.48±0.08 vs. 0.38±0.05 mm). The blood pressure during rest and exercise and the left ventricular mass were significantly elevated, but no additional RF could be identified in CoA-children. Only a remaining pressure gradient related significantly to FMD.
Conclusion This study documents early vascular wall changes in children after successful coarctation repair. Arterial hypertension and a resting pressure gradient are the major contributing factors to early atherosclerotic development and should be primary targets for therapy. Vascular status should be monitored regularly by FMD and IMT.
Key Words: Atherosclerosis • Paediatrics • Aortic coarctation • Risk factors
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