Carotid and femoral B-mode ultrasound intima-media thickness measurements in adult post-coarctectomy patients.
OBJECTIVE
Cardiovascular and cerebrovascular morbidity and mortality in adult post-coarctectomy patients is increased even after successful surgical repair of the aorta. B-mode ultrasound intima-media thickness (IMT), a validated marker for atherosclerosis and vascular disease risk, was used to measure pre-coarctatial carotid and post-coarctatial femoral arterial wall changes in these patients.


METHODS
Measurements were done in 131 patients (mean age 31.6 y [SD 11.3 y]; 78 were normotensive, 53 were hypertensive) and in 26 controls (30.9 y [SD 9.4 y]).


RESULTS
Age, serum lipids and smoking history were similar in patients and controls. Overall, IMT in patients and controls were similar (0.59 mm [SD 0.14 mm] and 0.59 mm [SD 0.08 mm]. In patients, carotid IMT was increased (0.67 mm [SD 0.12 mm] vs 0.61 mm [SD 0.08 mm] in controls: p=0.01); femoral IMT was decreased (0.48 mm [SD 0.09 mm] vs 0.57 mm [SD 0.07 mm]: p=0.001). In normotensive patients carotid IMT was not increased (0.64 mm [SD 0.12 mm] vs 0.61 mm [SD 0.08 mm]: p=0.2), but patients showed a higher SD. Carotid IMT in hypertensive patients was increased (0.72 mm [SD 0.12 mm] vs 0.64 mm [SD 0.11 mm] in normotensive patients: p<0.001). The femoral IMT in normo- and hypertensives patients were similar (0.48 mm [SD 0.09 mm] and 0.49 mm [SD 0.10 mm]: p=0.12). Carotid IMT in patients with aortic coarction and age at surgery were associated (r=0.36, p<0.0001), where femoral IMT is not.


CONCLUSIONS
Early peripheral arterial wall damage is prominent in hypertensive post-coarctatial patients and is limited to pre-coarctatial conduits. The decreased femoral IMT in all patients may indicate a relatively low post-coarctatial blood pressure if pressure control is guided according to pre-coarctatial RR. Pre-coarctatial arterial wall change is less apparent in post-coarctectomy patients who have a controlled blood pressure and who had early surgical repair.
Vriend
J J W
JJ
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
De Groot
E
E
Kastelein
J J P
JJ
Mulder
B J M
BJ
D000328:Adult; D001017:Aortic Coarctation / Q000601:surgery*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D017539:Tunica Intima / Q000000981:diagnostic imaging* / Q000473:pathology*; D017540:Tunica Media / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography