Evidence of vascular dysfunction in young patients with successfully repaired coarctation of aorta
Introduction
Adult patients even after successful coarctation repair (SCR) suffer from relapse of hypertension and their life expectancy is shorter than normal, because of premature coronary and cerebrovascular events [1], [2], [3]. In addition, it has been shown that aortic elastic properties in patients with coarctation of the aorta are reduced before as well as after surgery because remodeling alterations may exist for unknown period of time [4], [5], [6], [7]. These alterations may be the cause of morbidity and mortality that occur during follow up in this category of patients. The post-repair functional and mechanical properties of conduit arteries and the underlying inflammatory process in these patients are not well studied.
In the present study we compared endothelial function in the forearm circulation as well as mechanical properties and intima/media thickness (IMT) in the carotid and femoral arteries, between normotensive patients with SCR and healthy individuals. We also examined whether inflammatory markers such as C-reactive protein (CRP), fibrinogen, interleukins 1b (IL-1b) and 6 (IL-6), and the soluble forms of adhesion molecules such as E-selectin, vascular cell adhesion molecule (sVCAM-1) and intercellular adhesion molecule (sICAM-1), play a role in these patients.
Section snippets
Patients
Sixteen normotensive patients aged 29.9 ± 2.2 years old, 12.2 ± 02.9 years after SCR were randomly selected from out database and 16 age- and sex-matched controls were also recruited. After the initial recruitment one patient refused to participate and she was excluded from the study (Table 1). To avoid any non-specific effects of hypertension on the examined parameters, patients with arterial blood pressure at the right arm <140/90 mmHg were excluded from the study. Furthermore, all patients had
Results
There were no significant differences in demographic characteristics and serum lipid levels between patients and controls. There was no significant difference in systolic blood pressure between patients and controls, although patients had significantly lower diastolic blood pressure and higher pulse pressure (Table 1).
Although forearm blood flow and NTG were not significantly different between the two groups, forearm vasodilatory response to reactive hyperemia was significantly lower in
Discussion
The results of the present study indicate that adult patients after SCR have impaired endothelial function in the forearm circulation, increased intima/media thickness, decreased distensibility in the carotid arteries and increased levels of proinflammatory cytokines and adhesion molecules than healthy controls. These results may partly explain the high incidence of coronary artery disease in patients with repaired coarctation.
Conclusions
Adult patients after SCR have abnormal structural and functional properties of the upper part of their body vasculature, increased levels of proinflammatory cytokines and adhesion molecules. These results provide evidence that the alterations in mechanical properties of carotid arteries as well as the generalized endothelial dysfunction and increased inflammatory process observed in patients with coarctation of the aorta are permanent, many years after surgical repair, and may partly explain
References (37)
- et al.
Non-invasive long term follow-up after coarctation repair
Ann Thorac Surg
(1993) - et al.
Aortic elastic properties in patients with repaired coarctation of aorta
Am J Cardiol
(1998) - et al.
Increased stiffness and persistent narrowing of the aorta after successful coarctation of the aorta: relationship to left ventricular mass and blood pressure at rest and with exercise
Am Heart J
(1992) - et al.
Effect of the angiotensin-converting enzyme inhibitor imidapril on reactive hyperemia in patients with essential hypertension: relationship between treatment periods and resistance artery endothelial function
J Am Coll Cardiol
(2001) - et al.
Relationship between the angiotensin-converting enzyme genotype and the forearm vasodilator response to estrogen replacement therapy in postmenopausal women
J Am Coll Cardiol
(2001) - et al.
Endothelial dysfunction in human disease
J Mol Cell Cardiol
(1999) - et al.
Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis
Lancet
(1992) - et al.
Altered baroreceptorfunction in children with systolic hypertension after coarctation repair
Am J Cardiol
(1983) Paradoxical hypertension after repair of coarctation of the aorta: a review of its causes
Ann Thorac Surg
(1990)- et al.
Long-term follow-up of patients after coarctation of the aorta repair
Am J Cardiol
(2002)