Abstract 19988: Long Term Evaluation of Stent Implantation in Arch Coarctation- What have we Achieved?
Introduction: Stent implantation is a recognized treatment strategy for coarctation. However, the general arterial nature of lesion suggests that resolution of stenosis may not be a curative event. Aims. To assess the long term impact of stent implantation for arch coarctation (CoA) during childhood on blood pressure (BP) homeostasis.
Method: 109 patients who had stent implantation during childhood to address recurrent or native CoA were identified. 31 patients (native CoA, 20; recurrent coarctation, 11) were prospectively recruited and studied by echocardiography; vascular ultrasound; ambulatory blood pressure monitoring (ABPM) and exercise testing (ET). Median age was 13.1 yrs (range 4.5 to 17.8 yrs). Median time from stent implantation was 6 yrs (range 0.2 to 14.1 yrs). All had haemodynamically successful treatment by stent implantation (residual invasive gradient median = 1 mmHg; range 0 to 14).
Results: ABPM revealed that 45.2% (n=14) of the cohort were hypertensive with a median average BP percentile of 84.5% (range 6 to 99%), despite a median resting arm to leg blood pressure gradient of only 1 mmHg (range 0 to 34 mm Hg). An exaggerated ET BP response was noted in 80% of the patients. The presence of ABPM hypertension was independent of the resting arm to leg BP gradient or exercise hypertension. Diurnal variation of BP was maintained in all but 6 patients. Left ventricular (LV) hypertrophy was seen in 36% (median LV mass = 88.6 g/m2 (range 54.9 to 147.5 6 g/m2)) and correlated with the mean ABPM systolic percentile (r=0.51;p<0.05). There was a correlation between resting arm to leg BP gradient and the resting ECHO Doppler gradient (r=.44; P<0.05); LV mass and peak ET BP (r=.51; p<0.05); and between ECHO gradient and ABPM percentiles (r=.51; p<0.05).
Conclusion: Satisfacory anatomical and haemodynamic results in the cath lab do not constitute long-term control of BP in patients with recurrent or native coarctation of the aorta. Even in the absence of a significant resting arm to leg or ECHO Doppler gradient; the proportion of patients with hypertension on the basis of ABPM or exercise testing criteria is significantly higher than expected. Whether resting hypertension will evolve in this cohort and the impact of pharmacological intervention requires further study.
- © 2010 by American Heart Association, Inc.