Predicting the risk of early atherosclerotic disease development in children after repair of aortic coarctation.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Meyer
A A
AA
Department of Pediatric Cardiology, University of Rostock, Germany. andreas.alexander.meyer@medizin.uni-rostock.de
Joharchi
M S
MS
Kundt
G
G
Schuff-Werner
P
P
Steinhoff
G
G
Kienast
W
W
D000293:Adolescent; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001916:Brachial Artery / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D002648:Child; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D012039:Regional Blood Flow; D012086:Reoperation; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D014664:Vasodilation