title: Vascular remodeling in adults after coarctation repair: impact of descending aorta stenosis and age at surgery.
abstract: BACKGROUND
  Patients after successful repair of coarctation of aorta (CoAo) are at risk of hypertension at rest and associated end-organ damage. The aim of the study was to assess arterial stiffness and function in adults after coarctation repair in relation to descending aorta (AoD) residual coarctation and patient's age at operation.
  
  
  METHODS
  85 patients after CoAo repair (53 males) aged 34.6 ± 10.3 years; median age at operation 0.9 ± 8.2 years. The control group-30 individuals (18 males) at mean age 33.6 ± 8.2 years. The following central parameters: augmentation pressure (AP) and augmentation index (AI) as well as peripheral vascular parameters: flow-mediated dilatation (FMD), nitroglycerin-mediated vasodilatation (NMD), intima-media thickness (IMT) and pulse wave velocity (PWV) were measured.
  
  
  RESULTS
  47 CoAo-repaired patients were normotensive, and compared to control, they presented higher values of central parameters AP (7.3 ± 4.6 vs. 4.4 ± 3.6 mmHg; p = 0.002) and AI (18.6 ± 10.4 vs. 13.5 ± 4.3%; p = 0.03); as well as the increased PWV (6.8 ± 1.2 vs. 5.4 ± 0.9 m/s; p = 0.003), while IMT was comparable (0.53 ± 0.01 vs. 0.51 ± 0.01 mm; p = 0.06). The vasodilatation was impaired in the normotensive patients: FMD (4.8 ± 2.8 vs. 8.5 ± 2.3%; p = 0.00003) and NMD (11.3 ± 4.6 vs. 19.8 ± 7.2%; p = 0.00001). The comparison of recoarctation (46, 54%) to non-recoarctation (39, 46%) patients did not reveal any significant differences in resting systolic and diastolic pressures, as well as the values of AI and the peripheral vascular parameters; the value of AP was higher in the recoarctation patients (10.5 ± 6.9 vs. 7.5 ± 4.1; p = 0.02) and correlated positively with the gradient across AoD (r = 0.295, p = 0.01). There was no significant linear correlation between age at the time of surgery and any of peripheral arterial parameters.
  
  
  CONCLUSIONS
  Residual stenosis in AoD does not affect the arterial vasodilatation nor stiffness in patients after CoAo repair. Early operation has no impact on peripheral vascular remodeling or central pressure which supports the claim that coarctation of the aorta is a systemic vascular disorder which leads to progressive vascular and end-organ damage despite early correction.
authors.affiliation: 1st Department of Cardiology, Poznań University of Medical Sciences, Poland, ul. Długa 1/2, 61-848, Poznań, Poland. olgatroj@wp.pl
authors.forename: Olga
authors.initials: O
authors.lastname: Trojnarska
authors.forename: Ludwina
authors.initials: L
authors.lastname: Szczepaniak-Chicheł
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Mizia-Stec
authors.forename: Marcin
authors.initials: M
authors.lastname: Gabriel
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Bartczak
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gąsior
authors.forename: Lucyna
authors.initials: L
authors.lastname: Kramer
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tykarski
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001017:Aortic Coarctation / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003187:Compliance; D003251:Constriction, Pathologic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000503:physiopathology*; D011044:Poland; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014664:Vasodilation; D055815:Young Adult