title: Augmentation of central arterial pressure in adult patients after coarctation repair.
abstract: OBJECTIVE
  Arterial hypertension and its complications are associated with an increased morbidity and mortality in patients after aortic coarctation (CoA) repair. It is debatable whether early surgery can prevent it. Residual stenosis of descending aorta (AoD) and stiffness in the precoarctation region supposedly lead to hypertension. The aim of this study was to evaluate aortic pulse-wave parameters in adult patients after CoA repair and to determine the influence of residual stenosis and age at operation on their values.
  
  
  METHODS
  Eighty-five patients underwent CoA repair (53 males; aged 34.6±10.3 years, age at operation: 10.9±8.2 years). The control group consisted of 30 individuals (18 males; aged 33.6±8.2 years). Augmentation pressure (AP), augmentation index (AI), aortic pulse pressure (APP), and pulse-wave velocity (PWV) were measured with applanation tonometry method.
  
  
  RESULTS
  Normotensive patients after CoA repair (47/55%) had higher values of AP (7.3±4.6 vs. 4.4±3.6 mmHg; P=0.002), AI (18.6±10.4 vs. 13.5±4.3%; P=0.03), APP (39.6±8.8 vs. 35.1±9.8; P=0.00001), and PWV (6.8±1.2 vs. 5.4±0.9 m/s; P=0.003) than controls. Forty-six patients presented signs of recoarctation. No significant differences in the systolic blood pressure and diastolic blood pressure, AI and PWV were found between AoD(+) and AoD(-) but AoD(+) had significantly higher APP (46.7±13.8 vs. 38.3±6.9; P=0.001) and AP (10.5±6.9 vs. 7.5±4.1; P=0.02). Significant correlations were found between current age and APP, AP, and AI. No significant correlations were found between central parameters and the age at operation.
  
  
  CONCLUSIONS
  Normotensive patients after CoA repair have elevated central parameters, related to the residual AoD gradient, regardless of the age at operation. Even early repair cannot prevent progressive vascular impairment in CoA.
authors.affiliation: First Department of Cardiology, Department of Hypertensiology, Angiology and Internal Medicine, University of Medical Sciences in Poznań, ul. Długa 1/2, Poznań, Poland. szczepaniak-chichel@o2.pl
authors.forename: Ludwina
authors.initials: L
authors.lastname: Szczepaniak-Chicheł
authors.forename: Olga
authors.initials: O
authors.lastname: Trojnarska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Mizia-Stec
authors.forename: Marcin
authors.initials: M
authors.lastname: Gabriel
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gasior
authors.forename: Lucyna
authors.initials: L
authors.lastname: Kramer
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tykarski
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000503:physiopathology; D001017:Aortic Coarctation / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000503:physiopathology* / Q000628:therapy*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged