European Heart Journal Advance Access originally published online on January 24, 2006
European Heart Journal 2006 27(9):1100-1105; doi:10.1093/eurheartj/ehi748
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The fate of systemic blood pressure in patients after effectively stented coarctation
1 Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität, Lazarettstr. 36, D-80636 Munich, Germany
2 Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
3 Department of Pediatric Cardiology, Universitätsklinikum Ulm, Ulm, Germany
4 Department of Medical Statistics and Epidemiology, Technische Universität, München, Germany
Received 18 July 2005; revised 16 December 2005; accepted 5 January 2006; online publish-ahead-of-print 24 January 2006.
* Corresponding author. Tel: +49 89 1218 3011; fax: +49 89 1218 3013. E-mail address: eicken{at}dhm.mhn.de
Aims The current study was designed to assess midterm results of stent implantation into the aorta for native and recurrent coarctation (CoA) in children and young adults.
Methods and results Forty-three patients (native CoA, 8; female, 12) were treated with stent implantation at a median age of 16.8 years (range 7.9–44.8 years). Only stents dilatable to an adult size aorta were implanted. All but two patients with functionally univentricular hearts had arterial hypertension. Exercise tests, 24-h blood pressure, clinical examination, echocardiography, and elective catheterization were used to assess follow-up. The narrowed segment was widened significantly from a median of 8 to 12.4 mm (P<0.0005). The peak-to-peak gradient between the ascending and the descending aorta was lowered significantly from a median of 22 mmHg to 1 mmHg (P<0.0005). No major complications occurred. The systolic blood pressure at the right arm was lowered significantly (P<0.0005) from 144 mmHg before stent implantation to 128 mmHg at the last visit. At a median follow-up of 30 months (3–72 months), 68% of all patients were classified to be normotensive.
Conclusion Stent implantation for selected patients with recurrent and native CoA is safe and may effectively reduce the blood pressure gradient across the CoA site. We suggest using only stents dilatable to an adult size aorta. However, arterial hypertension persists in a significant number of the patients. Impaired elastic properties of the aorta may be the cause for this finding.
Key Words: Native and recurrent coarctation • Stent • Blood pressure
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