Long‐term results (up to 18 years) of balloon angioplasty on systemic hypertension in adolescent and adult patients with coarctation of the aorta

Abstract

SummaryBackground: Little is known regarding the long-term follow-up results of balloon angioplasty (BA) for patients with aortic coarctation (AC) on systemic hypertension.Hypothesis: To define the long-term effect of BA of AC on systemic hypertension in adolescent and adult patients.Methods: Follow-up data of 53 patients (36 male), mean age 24 ± 9 years, undergoing BA for discrete AC at median interval of 11.8 years (range, 4-18 years), including cardiac catheterization, magnetic resonance imaging (MRI), and echocardiography. Patients were divided into two groups at 1 year after BA on the basis of absence (group A: 40 patients) or presence (group B: 11 patients) of persistent hypertension and need for medication.Results: Fifty-one patients had baseline hypertension, BA produced an immediate reduction in peak AC gradient from 66 ± 23 mmHg to 10.8 ± 7 mmHg (p < 0.0001). The immediate systolic blood pressure (SBP)

Coarctation of the aorta – clinical picture and terapeutical options

“…Początkowo jej zastosowanie budziło kontrowersje ze względu na ryzyko wystą-pienia powikłania -powstania tętniaka aorty [5]. U starszych dzieci ze zlokalizowaną postacią CoA w wielu ośrodkach BAP jest obecnie uważana za metodę leczenia z wyboru zlokalizowanych postaci CoA lub ReCoA, jednak w niektórych ośrodkach nadal preferowane jest leczenie kardiochirurgiczne [6,7]. W nielicznych przypadkach rów-nież po BAP może dojść do ponownego zwężenia, zwłasz-cza w tzw.…”

“…Hassan i wsp. zalecają, aby w sytuacji gdy podczas testu wysiłko-wego pacjent osiąga ciśnienie wyższe niż 200 mm Hg, włączać leczenie hipotensyjne, nawet gdy ciśnienie spoczynkowe jest prawidłowe [6]. Wskazują na to również obserwacje Trojnarskiej i wsp.…”

Endovascular Management of Coarctation of the Aorta

“…14,33,72 Rates of recurrent coarctation appear to decrease with age at intervention, 43 especially if the stenosis is discrete, and recent results cite an incidence of 0 to 15% in adults. 58,73,89,102,145 The use of angioplasty in recurrent coarctation appears to yield much better results, even in the very young, 142 particularly if the lesion is discrete, 65 and is viewed by many as the optimal management in this circumstance, 97,101,142 because the risks of repeat surgery are generally greater than the initial intervention.…”

“…114 In the intermediate term, 50 to 75% of patients will be able to discontinue pharmacotherapy or at least benefit from an improvement in blood pressure control, possibly allowing a reduction in their medica-tion. 58,73,87,89,102,109,113,114,145,148 The outcome of later follow-up is awaited.…”