Department of Cardiovascular Surgery, Shahid Gangalal National Heart Center, Kathmandu, Nepal.
Department of Cardiovascular and Thoracic Surgery, Nepal Mediciti, Lalitpur, Nepal.
Eur J Cardiothorac Surg. 2019 Feb 1;55(2):323-330. doi: 10.1093/ejcts/ezy228.
Coarctation of the aorta is known to present with hypertension in older patients; we reviewed our experience and assessed the outcome of hypertension following surgical correction.
From April 2004 to date, 43 patients above the age of 12 underwent coarctation of the aorta repair. The mean age was 20.4 + 9.7 years (maximum 56 years); 21 (48.8%) were older than 18 years and 28 (65.1%) were men. Thirty (69.8%) patients had hypertension. Fourteen (32.6%) had a bicuspid aortic valve; 11 (25.6%) had patent ductus arteriosus; 6 (14%) had myxomatous mitral valve; 4 (9.3%) had ascending aortic aneurysms; and 2 (4.7%) had descending aneurysms.
Surgical correction included resection and interposition of a tube graft in 31 (72.1%), an end-to-end anastomosis in 6 (14%) and patch aortoplasty in 3 (7%). Three (7%) patients required an extra-anatomical bypass: 1 had a long segment coarctation of the aorta, and 2 had a Bentall procedure with an ascending-to-descending aortic bypass. Staged procedures were done for concomitant disease in 4 (9.3%). There was 1 death: a 56-year-old woman died of refractory ventricular fibrillation during surgery. Thirty (69.8%) patients were discharged with antihypertensive medication. At a follow-up of 2.8 ± 2.2 years (maximum 9.2 years), the number of hypertensive patients decreased (17/36; 47.2%) (P = 0.042). Univariable predictors for persistence of hypertension revealed the use of an interpositional tube graft for repair (odds ratio 13.855, confidence interval 0.000-0.001; P = 0.001) as an indicator, whereas there were no independent predictors for persistence of hypertension.
Surgical intervention is warranted irrespective of age and helps correct and control hypertension better; however, significant numbers of patients still require antihypertensive medication and regular monitoring. Intervention using an interposition tube graft may affect the prevalence of hypertension.
已知主动脉缩窄可导致老年患者出现高血压；我们回顾了我们的经验，并评估了手术矫正后高血压的结局。
自 2004 年 4 月至今，共有 43 名年龄在 12 岁以上的患者接受了主动脉缩窄修复术。平均年龄为 20.4±9.7 岁（最大 56 岁）；21 名（48.8%）年龄超过 18 岁，28 名（65.1%）为男性。30 名（69.8%）患者有高血压。14 名（32.6%）患者有二叶主动脉瓣；11 名（25.6%）患者有动脉导管未闭；6 名（14%）患者有黏液样二尖瓣；4 名（9.3%）患者有升主动脉瘤；2 名（4.7%）患者有降主动脉瘤。
手术矫正包括 31 名患者（72.1%）行切除和间置管型移植物、6 名患者（14%）行端端吻合术和 3 名患者（7%）行补片主动脉成形术。3 名（7%）患者需要行额外的解剖旁路：1 名患者有长段主动脉缩窄，2 名患者行 Bentall 手术伴升主动脉至降主动脉旁路。4 名（9.3%）患者因合并疾病而行分期手术。有 1 例死亡：1 例 56 岁女性在手术中死于难治性心室颤动。30 名（69.8%）患者出院时服用降压药。在 2.8±2.2 年（最长 9.2 年）的随访中，高血压患者数量减少（17/36；47.2%）（P=0.042）。单变量预测因素显示，使用间置管型移植物修复（比值比 13.855，置信区间 0.000-0.001；P=0.001）是高血压持续存在的指标，而高血压持续存在无独立预测因素。
无论年龄大小，手术干预都是必要的，有助于更好地纠正和控制高血压；然而，仍有相当数量的患者需要服用降压药并定期监测。使用间置管型移植物的干预可能会影响高血压的患病率。
