Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
Clinic for Paediatric Cardiology and Cardiac Surgery, Children's Clinical University Hospital, Stradins University, Riga, Latvia.
J Hum Hypertens. 2022 Sep;36(9):819-825. doi: 10.1038/s41371-021-00585-6. Epub 2021 Aug 3.
Coarctation of the aorta is an arteriopathy with life-long sequelae, with remarkably increased cardiovascular events in young adults even after successful repair and despite blood pressure status. There are data on arterial remodelling in adults after coarctation correction, however, these data are scarce in childhood. Thus, the aim of this cross-sectional study was to evaluate changes in arterial wall function and morphology in children following successful coarctation repair and to compare these changes among patients with different blood pressure status and coarctation correction modes. Blood pressure status, echocardiographic parameters, arterial wall structure and stiffness, endothelial function and central blood pressure measurements were evaluated in 110 children aged 6-18 years following successful coarctation repair with right arm blood pressure not exceeding leg blood pressure by ≥20 mmHg. The prevalence of arterial hypertension was 50%. The mean carotid intima-media thickness SDS was 3.1 ± 1.5 and above 1.65 SDS in 91 of 110 patients. Increased right carotid intima-media thickness was associated with left ventricular hypertrophy, office blood pressure difference between leg and right arm, recoarctation in the past and interventional coarctation correction. Increased local common carotid artery stiffness was associated with increased pulse pressure and central systolic blood pressure. Potentially decreased endothelial function was related to a slight increase of peak and mean systolic gradient in the descending aorta. After successful coarctation repair and with a low blood pressure gradient, children still have a high prevalence of arterial hypertension and significant arterial remodelling, indicating accelerated biological age and advanced arteriosclerosis.
主动脉缩窄是一种终身性的血管疾病，即使在成功修复后，年轻人的心血管事件发生率仍然很高，尽管血压状况正常。虽然有关于成人主动脉缩窄矫正后动脉重塑的数据，但在儿童中这些数据却很少。因此，本横断面研究的目的是评估成功修复主动脉缩窄后儿童的动脉壁功能和形态的变化，并比较不同血压状况和主动脉缩窄矫正方式的患者之间的这些变化。在 110 名年龄在 6 至 18 岁之间的成功修复主动脉缩窄的儿童中评估了血压状况、超声心动图参数、动脉壁结构和僵硬度、内皮功能和中心血压测量值，右臂血压不超过腿部血压 20mmHg。动脉高血压的患病率为 50%。110 名患者中有 91 名的颈动脉内膜中层厚度 SDS 平均值为 3.1±1.5，超过 1.65 SDS。右侧颈动脉内膜中层厚度增加与左心室肥厚、腿部和右臂之间的诊室血压差异、过去的再狭窄以及介入性主动脉缩窄矫正有关。局部颈总动脉僵硬度增加与脉压和中心收缩压增加有关。内皮功能可能下降与降主动脉收缩期峰值和平均梯度略有增加有关。成功修复主动脉缩窄后，即使血压梯度较低，儿童仍存在较高的高血压患病率和明显的动脉重塑，表明其生物学年龄加速和动脉粥样硬化进展。
