成人缩窄修复术后的血管重构：降主动脉狭窄和手术年龄的影响。
Vascular remodeling in adults after coarctation repair: impact of descending aorta stenosis and age at surgery.
机构信息
1st Department of Cardiology, Poznań University of Medical Sciences, Poland, ul. Długa 1/2, 61-848, Poznań, Poland.
出版信息
Clin Res Cardiol. 2011 May;100(5):447-55. doi: 10.1007/s00392-010-0263-2. Epub 2010 Dec 16.
BACKGROUND
Patients after successful repair of coarctation of aorta (CoAo) are at risk of hypertension at rest and associated end-organ damage. The aim of the study was to assess arterial stiffness and function in adults after coarctation repair in relation to descending aorta (AoD) residual coarctation and patient's age at operation.
METHODS
85 patients after CoAo repair (53 males) aged 34.6 ± 10.3 years; median age at operation 0.9 ± 8.2 years. The control group-30 individuals (18 males) at mean age 33.6 ± 8.2 years. The following central parameters: augmentation pressure (AP) and augmentation index (AI) as well as peripheral vascular parameters: flow-mediated dilatation (FMD), nitroglycerin-mediated vasodilatation (NMD), intima-media thickness (IMT) and pulse wave velocity (PWV) were measured.
RESULTS
47 CoAo-repaired patients were normotensive, and compared to control, they presented higher values of central parameters AP (7.3 ± 4.6 vs. 4.4 ± 3.6 mmHg; p = 0.002) and AI (18.6 ± 10.4 vs. 13.5 ± 4.3%; p = 0.03); as well as the increased PWV (6.8 ± 1.2 vs. 5.4 ± 0.9 m/s; p = 0.003), while IMT was comparable (0.53 ± 0.01 vs. 0.51 ± 0.01 mm; p = 0.06). The vasodilatation was impaired in the normotensive patients: FMD (4.8 ± 2.8 vs. 8.5 ± 2.3%; p = 0.00003) and NMD (11.3 ± 4.6 vs. 19.8 ± 7.2%; p = 0.00001). The comparison of recoarctation (46, 54%) to non-recoarctation (39, 46%) patients did not reveal any significant differences in resting systolic and diastolic pressures, as well as the values of AI and the peripheral vascular parameters; the value of AP was higher in the recoarctation patients (10.5 ± 6.9 vs. 7.5 ± 4.1; p = 0.02) and correlated positively with the gradient across AoD (r = 0.295, p = 0.01). There was no significant linear correlation between age at the time of surgery and any of peripheral arterial parameters.
CONCLUSIONS
Residual stenosis in AoD does not affect the arterial vasodilatation nor stiffness in patients after CoAo repair. Early operation has no impact on peripheral vascular remodeling or central pressure which supports the claim that coarctation of the aorta is a systemic vascular disorder which leads to progressive vascular and end-organ damage despite early correction.
背景
成功修复主动脉缩窄（CoAo）的患者在休息时存在高血压风险，并伴有相关的靶器官损害。本研究旨在评估 CoAo 修复后成年人的动脉僵硬度和功能与降主动脉（AoD）残余缩窄以及患者手术时的年龄之间的关系。
方法
85 例 CoAo 修复后的患者（53 名男性），年龄 34.6±10.3 岁；中位手术年龄为 0.9±8.2 岁。对照组为 30 名个体（18 名男性），平均年龄为 33.6±8.2 岁。测量以下中心参数：增强压（AP）和增强指数（AI）以及外周血管参数：血流介导的扩张（FMD）、硝酸甘油介导的血管扩张（NMD）、内膜-中层厚度（IMT）和脉搏波速度（PWV）。
结果
47 例 CoAo 修复后的患者血压正常，与对照组相比，他们的中心参数 AP（7.3±4.6 与 4.4±3.6mmHg；p=0.002）和 AI（18.6±10.4 与 13.5±4.3%；p=0.03）更高，以及 PWV 增加（6.8±1.2 与 5.4±0.9m/s；p=0.003），而 IMT 相似（0.53±0.01 与 0.51±0.01mm；p=0.06）。在血压正常的患者中，血管舒张功能受损：FMD（4.8±2.8 与 8.5±2.3%；p=0.00003）和 NMD（11.3±4.6 与 19.8±7.2%；p=0.00001）。对再狭窄（46%，54%）和非再狭窄（39%，46%）患者进行比较，发现静息收缩压和舒张压以及 AI 和外周血管参数均无显著差异；再狭窄患者的 AP 值较高（10.5±6.9 与 7.5±4.1；p=0.02），与 AoD 跨壁梯度呈正相关（r=0.295，p=0.01）。手术时的年龄与任何外周动脉参数之间均无显著线性相关性。
结论
AoD 残余狭窄不影响 CoAo 修复后患者的动脉舒张功能或僵硬度。早期手术对外周血管重塑或中心压力没有影响，这支持了主动脉缩窄是一种系统性血管疾病的观点，尽管早期矫正，但仍会导致进行性血管和靶器官损害。
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