The fate of systemic blood pressure in patients after effectively stented coarctation.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Eicken
Andreas
A
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität, Germany. eicken@dhm.mhn.de
Pensl
Ulrike
U
Sebening
Walter
W
Hager
Alfred
A
Genz
Thomas
T
Schreiber
Christian
C
Lang
Dieter
D
Kaemmerer
Harald
H
Busch
Raymonde
R
Hess
John
J
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon; D001017:Aortic Coarctation / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002648:Child; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008134:Long-Term Care; D008297:Male; D018709:Statistics, Nonparametric; D015607:Stents