Çetiner Nilüfer, Erolu Elif, Baran Him Neslihan, Şaylan Çevik Berna, Akalın Figen
Department of Pediatric Cardiology, Koç University, Faculty of Medicine, İstanbul, Turkey.
Department of Pediatric Cardiology, Koşuyolu Highly Specialized Training and Research Hospital, İstanbul, Turkey.
Turk Arch Pediatr. 2022 Mar;57(2):193-199. doi: 10.5152/TurkArchPediatr.2022.21236.
We investigated arterial functions by measuring carotid-intima-media thickness, flow-mediated dilatation of the brachial artery, and distensibility and stiffness of the abdominal aorta as early indicators of cardiovascular risk in children followed up after coarctation repair.
Twenty patients with successful repair of coarctation and 27 healthy children were investigated. Two-dimensional echocardiographic images, and carotid and brachial ultrasound studies were performed.
The ages of the study group ranged from 5.3 to 22 years, and those of the control group from 7 to 17 years. The age at time of surgery was between 0.23 and 257 months. Average follow-up duration after repair was between 11 and 257 months. The stiffness index of the abdominal aorta was significantly higher in patients with coarctation repair than controls (mean = 0.625 ± 0.41, mean = 0.11 ± 0.73; P = .007). Flow-mediated dilatation of the brachial artery in the first minute decreased significantly among the patients (mean = 4.5 ± 2.7, mean = 6.9 ± 4.5; P = .005). Age of the patients had a negative correlation with distensibility of the abdominal aorta (r = -0.572; P = .008) and a positive correlation with stiffness of abdominal aorta (r = 0.566, P = .009).
This study suggested that vascular wall changes in children and adolescents can be seen even after successful coarctation repair and may progress toward overt atherosclerosis at older ages.
我们通过测量颈动脉内膜中层厚度、肱动脉血流介导的扩张以及腹主动脉的扩张性和僵硬度，来研究动脉功能，将其作为缩窄修复术后随访儿童心血管风险的早期指标。
对20例缩窄修复成功的患者和27名健康儿童进行了研究。进行了二维超声心动图成像以及颈动脉和肱动脉超声检查。
研究组年龄范围为5.3至22岁，对照组年龄范围为7至17岁。手术时年龄在0.23至257个月之间。修复后的平均随访时间在11至257个月之间。缩窄修复患者腹主动脉的僵硬度指数显著高于对照组（均值 = 0.625 ± 0.41，均值 = 0.11 ± 0.73；P = 0.007）。患者中肱动脉在第一分钟的血流介导的扩张显著降低（均值 = 4.5 ± 2.7，均值 = 6.9 ± 4.5；P = 0.005）。患者年龄与腹主动脉扩张性呈负相关（r = -0.572；P = 0.008），与腹主动脉僵硬度呈正相关（r = 0.566，P = 0.009）。
本研究表明，即使缩窄修复成功，儿童和青少年的血管壁变化仍可见，且在老年时可能会发展为明显的动脉粥样硬化。
