Assessment of vascular phenotype using a novel very high resolution ultrasound technique in adolescents after aortic coarctation repair and/or stent implantation: relationship to central haemodynamics and left ventricular mass.

Objectives The objective was to determine the severity of residual cardiovascular abnormalities in youths after coarctation of the aorta (CoA) repair and their relation to regional blood pressure (BP). Design Prospective cross-sectional study in tertiary health care setting Methods Thirty-six CoAs (age 16±1 years; neonatal surgery only: n=16; surgery and/or stent implantation: n=20) and 37 age-matched controls were examined by very-high resolution ultrasound, echocardiography and applanation tonometry. Results CoA was associated with increased right arm systolic BP (p<0.001), intima-media thickness (IMT) in the common carotid (p<0.001), right brachial (p<0.05) and radial (p<0.05) arteries and ascending aortic stiffness (p<0.05). Carotid IMT correlated positively with age at first intervention (r=0.36, p<0.05). With left subclavian flap type repair, left arm systolic BP (p<0.001) and left brachial (p<0.001), radial (p<0.001) and ulnar (p<0.05) arterial IMTs were all reduced. When adjusted for BP, body mass index, age and gender, only carotid IMT (p<0.001) and LV-mass (p=0.013) of stented patients, as well as left arm arterial IMTs (p<0.01) in subclavian flap type repair patients remained different from controls. The significant associations of stented patients disappeared after adjustment for later patient age at intervention (median 8.7 vs 0.03 years, p<0.001). Residual arm-leg BP gradients correlated positively with carotid and brachial IMT. Conclusion CoA repair in early childhood is associated with increased preductal arterial IMT, LV mass and ascending aortic stiffness in adolescents. The more pronounced cardiovascular abnormalities after CoA stent implantation are likely related to the older patient age at the time of intervention [ABSTRACT FROM AUTHOR]