The Medium-Term Effects of Treatment for Mild Aortic Recoarctation

OBJECTIVE: To assess medium-term effects of treatment for mild to moderate recoarctation in an adult population.

DESIGN: We identified all patients who had coarctation repair between 1965 and 1985 in our institution. They were all (n = 156) invited to a thorough outpatient examination, which was accepted by 133. Eleven (median age 36 [28-53] years) were identified with isolated mild to moderate recoarctation and received reintervention. They comprise the patient population of the current study. We performed bicycle exercise testing, transthoracic echocardiography, magnetic resonance imaging, and 24-hour blood pressure monitoring before and 14 to 29 months after reintervention.

RESULTS: Compared to the values before reintervention, 24-hour blood pressures were reduced, but only significantly so for nighttime values. On echocardiography, wall thickness was reduced (1.2 ± 0.3 vs 1.1 ± 0.2, P > .05), and maximum flow velocity in the distal aortic arch decreased (2.8 ± 0.5 m/s vs 2.1 ± 0.4 m/s, P < .05). The invasive coarctation gradient was significantly reduced (15 ± 7 mm Hg vs 5 ± 9 mm Hg, P < .05), and the diameter at the coarctation site was increased (11 ± 3 mm vs 15 ± 3 mm, P < .05). Maximum achieved workload increased (182 ± 51 W vs 205 ± 65 W, P < .05). Cardiac symptoms were overall reduced.

CONCLUSION: Reintervention was overall beneficial in increasing exercise capacity and reducing symptoms in the medium term, but the effects on established myocardial hypertrophy and blood pressures were less profound. Larger studies are needed in order to establish the definite role of reintervention for patients with milder recoarctation.