Cor Vasa 2002, 43(4):169-174
What is the status of patients operated on for coarctation of the aorta 33 years ago?
- 1 Interní klinika 2. lékařské fakulty Univerzity Karlovy
- 2 Dětské Kardiocentrum
- 3 Klinika zobrazovacích metod, Fakultní nemocnice v Motole, Praha, Česká republika
Aim:
To evaluate the clinical status of patients at a long interval from surgery for coarctation of the aorta.
Group:
Out of 75 patients having surgery for coarctation of the aorta, who were evaluated at the Department of Internal Medicine of Motol University Hospital in the late 1970s, 49 patients (65%) were re-assessed after an interval of 21 years. Twenty-six patients did not present for the follow-up assessment; death certificates were provided for 7 (9%) of these patients. The re-assessed patients included 33 men (67%) and 16 women, with a mean age of 44 ± 8.3 years; interval from surgery 33 ± 8 years.
Method of assessment:
All patients had physical and echocardiographic examination. Exercise testing was performed in 38 patients. The pressure gradient between the right upper and lower limbs using a cuff at rest and during exercise and, also, the flow rate in the descending aorta we measured at rest and immediately after exercise using continuous Doppler echocardiography. Magnetic resonance imaging was performed in 17 patients; 12 patients were assessed using catheterization.
Results:
A total of 88% of patients were in NYHA Class I and II while 12% of patients were in NYHA Class III. Resting systolic or diastolic hypertension was present in 53% of patients; in addition to these, a hypertensive response to exercise was seen in another 22% of patients. The sensitivity and specificity of resting systolic hypertension > 140 mm Hg for the detection of recoarctation were 91.6% and 64.8%. Recoarctation was present in 24% of patients. Bicuspid aortic valve was diagnosed in 59%, significant aortic or mitral valve disease indicated for surgery in 16%. Ascending or descending aorta dilatation ł 40 mm was present in 12% of patients. An associated congenital heart defect was present in 7 patients (14%), Turner's syndrome was diagnosed in 3 patients (6%). Anginal complaints associated with a normal coronary angiographic finding were reported by 6 patients (12%).
Conclusion:
Patients at a long-term interval from surgery for coarctation of the aorta are mostly in a good clinical condition, in NYHA Class I to II; however, with a high incidence of residual findings (resistant arterial hypertension, re-coarctation, valve disease, associated congenital defects, aortic aneurysms). Many of these findings may not be made until many years after surgery, and may be amendable to conservative or surgical treatment. As a result, patients after surgery for coarctation of the aorta cannot be regarded as cured individuals; by contrast, they require life-long management by a cardiologist.
Keywords: Coarctation of the aorta; Echocardiography; Hypertension; Recoarctation; Bicuspid aortic valve
Published: April 1, 2002 Show citation