Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Am J Cardiol. 2010 Mar 1;105(5):740-4. doi: 10.1016/j.amjcard.2009.10.070.
Patients after coarctation repair still have an increased risk of cardiovascular or cerebrovascular events. This has been explained by the persisting hypertension and alterations in the peripheral vessels. However, involvement of the central vessels such as the retinal arteries is virtually unknown. A total of 34 patients after coarctation repair (22 men and 12 women; 23 to 58 years old, age range 0 to 32 years at surgical repair) and 34 nonhypertensive controls underwent structural and functional retinal vessel analysis. Using structural analysis, the vessel diameters were measured. Using functional analysis, the endothelium-dependent vessel dilation in response to flicker light stimulation was assessed. In the patients after coarctation repair, the retinal arteriolar diameter was significantly reduced compared to that of the controls (median 182 mum, first to third quartile 171 to 197; vs 197 microm, first to third quartile 193 to 206; p <0.001). These findings were independent of the peripheral blood pressure and age at intervention. No differences were found for venules. The functional analysis findings were not different between the patients and controls (maximum dilation 3.5%, first to third quartile 2.1% to 4.5% vs 3.6%, first to third quartile 2.2% to 4.3%; p = 0.81), indicating preserved autoregulative mechanisms. In conclusion, the retinal artery diameter is reduced in patients after coarctation repair, independent of their current blood pressure level and age at intervention. As a structural marker of chronic vessel damage associated with past, current, or future hypertension, retinal arteriolar narrowing has been linked to stroke incidence. These results indicate an involvement of cerebral microcirculation in aortic coarctation, despite timely repair, and might contribute to explain the increased rate of cerebrovascular events in such patients.
主动脉缩窄修复术后的患者仍存在心血管或脑血管事件的风险增加。这可以用持续的高血压和外周血管改变来解释。然而，中央血管如视网膜动脉的受累实际上是未知的。总共 34 例主动脉缩窄修复术后的患者（22 名男性和 12 名女性；23 至 58 岁，手术修复时年龄范围为 0 至 32 岁）和 34 名非高血压对照者接受了视网膜血管结构和功能分析。通过结构分析测量了血管直径。通过功能分析评估了对闪烁光刺激的血管舒张反应。在主动脉缩窄修复术后的患者中，视网膜小动脉直径明显小于对照组（中位数 182µm，第一至第三四分位数 171 至 197；vs 197µm，第一至第三四分位数 193 至 206；p<0.001）。这些发现与外周血压和干预时的年龄无关。小静脉无差异。患者和对照组之间的功能分析结果无差异（最大扩张率 3.5%，第一至第三四分位数 2.1%至 4.5%vs 3.6%，第一至第三四分位数 2.2%至 4.3%；p=0.81），表明自动调节机制得到保留。总之，主动脉缩窄修复术后患者的视网膜动脉直径减小，与他们目前的血压水平和干预时的年龄无关。作为与过去、现在或未来高血压相关的慢性血管损伤的结构标志物，视网膜小动脉狭窄与中风发病率有关。这些结果表明，尽管及时修复，但主动脉缩窄会影响大脑微循环，并可能有助于解释此类患者中脑血管事件发生率的增加。
