Endovascular treatment of aortic coarctation: Long-term effects on hypertension

Abstract

Introduction Endovascular management of aortic coarctation (CoA) is safe but few data are available concerning the long-term cure of hypertension. Aim of this study was to evaluate immediate and long-term clinical and haemodynamic outcome in a consecutive series of adolescent and adult patients with CoA submitted to endovascular treatment. Methods A total of 21 adolescent and adult patients underwent successful transcatheter intervention of CoA. Follow-up comprised cardiological examination with special attention to blood pressure (BP), echocardiogram, 24/h ambulatory blood pressure monitoring (ABP), exercise test and spiral computed tomography. Results Pre-intervention CoA diameter and degree of stenosis were 4.8 ± 2.1 mm and 73.7 ± 9.8%, respectively, and 14.8 ± 3.0 mm and 13.5 ± 6.5% post-intervention ( p < 0.001). Systolic arterial hypertension persisted in 2 patients at rest (9.5%). Mean number of antihypertensive medications per patient was 1.5 ± 1.1 and 0.5 ± 0.9 at 1 year after treatment ( p < 0.05). At ABP 3 patients (14%) were hypertensive. The Doppler gradient across the coarctation site decreased from 58.8 ± 16.9 to 10.5 ± 4.9 mmHg ( p < 0.001) as well as left ventricular mass (199 ± 14.6 and 189.3 ± 9.1; p < 0.001). Overall, 18 patients (86%) underwent a treadmill exercise test and 4 patients (22%), normotensive at rest, showed a pathological blood pressure response. Overall, 7/21 patients (33%) showed persistent hypertension. Conclusion Endovascular treatment of native or recurrent CoA in adolescent and adult patients is safe but 33% of patients showed persistent hypertension. Meticulous clinical follow-up is mandatory, including an exercise test in order to monitor eventual blood pressure increase and to assess effort tolerance.