Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, Institute for Treatment and Research, Rome, Italy.
Eur J Cardiothorac Surg. 2019 Mar 1;55(3):559-563. doi: 10.1093/ejcts/ezy257.
This study was designed to evaluate the difference in the prevalence of long-term arterial hypertension among patients with corrected aortic coarctation according to the existence of associated cardiac congenital lesions.
We identified 235 patients who had undergone surgery for aortic coarctation and classified them into 2 groups: patients with isolated coarctation of the aorta (CoA) and patients with aortic coarctation associated with complex congenital heart disease. Data were retrospectively analysed.
There were 148 subjects with isolated CoA and 87 with complex CoA (CoA-c). Patients were defined as hypertensive if they required antihypertensive treatment and/or when blood pressure was above 95th percentile. Patients with isolated aortic coarctation were significantly younger than patients with CoA-c (P < 0.001) and a markedly higher prevalence of arterial hypertension (44% vs 24%) was documented in the isolated coarctation group. The difference in the prevalence of hypertension in the 2 groups was still significant after correcting for differences in age (P < 0.001), confirming that the prevalence of arterial hypertension in patients with CoA-c was half of that of patients with isolated CoA.
We conclude that complex congenital heart disease in patients who have undergone surgical correction for aortic coarctation results in a significantly lower prevalence of late-onset hypertension. Reduced systemic flow and pressure before surgery in patients with CoA-c might be associated with a lower rate of arterial hypertension.
本研究旨在评估经手术矫正的主动脉缩窄患者中，合并心脏先天性病变与不合并心脏先天性病变的患者长期发生动脉高血压的患病率是否存在差异。
我们纳入了 235 例曾接受过主动脉缩窄手术的患者，并将其分为两组：单纯主动脉缩窄（CoA）患者和主动脉缩窄合并复杂先天性心脏病（CoA-c）患者。对这些数据进行了回顾性分析。
148 例患者为单纯 CoA，87 例患者为复杂 CoA-c。如果患者需要降压治疗和/或血压高于第 95 百分位，则定义为高血压患者。单纯主动脉缩窄患者明显比 CoA-c 患者年龄更小（P < 0.001），且单纯主动脉缩窄组的动脉高血压患病率显著更高（44% vs 24%）。校正年龄差异后，两组间高血压患病率的差异仍然显著（P < 0.001），证实 CoA-c 患者的动脉高血压患病率是单纯 CoA 患者的一半。
我们的结论是，接受主动脉缩窄手术矫正的患者合并复杂先天性心脏病会显著降低迟发性高血压的患病率。CoA-c 患者在手术前的体循环流量和压力降低可能与较低的动脉高血压发生率相关。
