Abstract 18359: Long Term Follow-up of Aortic Coarctation Repair Using Leg-arm Blood Pressure Difference to Assess Hemodynamic Profiles
Introduction: Patients with successfully repaired coarctation (CoA) need long term follow up due to the risk of abnormal arterial elasticity and complications of hypertension. We hypothesize that even subtle hemodynamic abnormalities are marked by lack of a blood pressure standing wave effect to the lower extremities (arm ≥ leg systolic BP: ARM Group) and is associated with elevated aortic flow velocities, increased left ventricular posterior wall thickness (LVPWd), higher arm BP and a greater requirement for interventions compared to subjects with the normal standing wave effect (leg > arm SBP: LEG Group).
Methods: CoAs repaired between 1990 and 2008 with at least two documented right arm and leg SBPs at clinic visits along with M-mode, 2D and Doppler echocardiography were selected. The largest recorded peak instantaneous (PeakV) and mean velocities (MeanV) in the descending aorta were reviewed, as were measures of the proximal transverse arch (TA) and LVPWd. Measurements were indexed by Z-score. Patient records were also reviewed for reintervention and antihypertensive medical therapy.
Results: Eighty patients met our criteria with 29 ARM (median age 12 years) and 51 LEG (median 13 years) Group members. Compared to LEG, ARM had significantly increased arm SBP Z-score (p <0.001), PeakV (p <10-4), MeanV (p <10-6), and LVPWd (p <0.01) (Figure). There was no difference in arm diastolic BP (p =0.7) or TA diameter (p =0.3). Even without overt markers such as hypertension or medication, otherwise healthy ARM subjects were still found to have the same relationships. Furthermore, 11/29 (38%) ARM compared to 39/51 (76%) LEG were normotensive with no previous intervention and no BP medicine (Fisher’s p <0.001).
Conclusions: Higher leg SBP after CoA repair is a marker for salutary hemodynamic and echo parameters as well as freedom from interventions post repair. Follow-up tailored by recognizing good outcome in LEG Group could be accomplished with less expense and obtrusive testing.
Author Disclosures: D.F. Labuz: None. J.A. Berry: None. L.A. Pyles: None.
- © 2015 by American Heart Association, Inc.