Baelen Robbe, Fordel Nerea, Coomans Ilse, De Wolf Daniel, Vandekerckhove Kristof, Martens Thomas, François Katrien, Bové Thierry
Department of Pediatric Cardiology, University Hospital of Gent, Ghent, Belgium.
Department of Cardiac Surgery, University Hospital of Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Pediatr Cardiol. 2025 Jan 18. doi: 10.1007/s00246-025-03777-w.
Restenosis occurs commonly after aortic coarctation (CoA) repair, usually requiring treatment by balloon dilation. Its effect on physical exercise performance is not documented. A retrospective analysis of exercise testing and echocardiographic assessment was performed in children after CoA repair. A group without restenosis (= group 1) and a group with recoarctation, treated by single balloon dilation (= group 2) were compared by matching for age and gender at a 2:1 ratio. Group 1 included 40 children and group 2 comprised 21 children, with mean age of 12.3 ± 2.3y and 11.9 ± 2.9y (p = 0.536) at evaluation. Group 2 children were younger at CoA repair (group 1: median 32.0d (11.0-188.0)-group 2: 9.0d (5.5-19.0), p = 0.011). Arterial hypertension was frequently noticed (group 1: 23(57.5%)-group 2: 7(33.3%), p = 0.106). Echocardiography revealed comparable cardiac function properties, showing more left ventricular (LV) hypertrophy in all CoA patients compared to their peers (Posterior wall thickness z-value: 1.03 ± 1.65, p < 0.001)). Exercise results were generally comparable, despite small differences in favor of group 1 (predicted % peak VO = group 1: 95.2 ± 21.4%-group 2: 82.3 ± 10.5%, p = 0.024; peak VO/kg = group 1: 38.9 ± 9.5 ml/min/kg-group 2: 33.8 ± 6.9 ml/min/kg, p = 0.034; VO/WR slope = group 1: 12.6 ± 2.0 ml/min/watt-group 2: 11.3 ± 1.7 ml/min/watt, p = 0.018). Compared to uncomplicated coarctation patients, children developing a surgical restenosis after CoA repair, and treated effectively by balloon dilation, had lower-but still acceptable-oxygen uptake during exercise. As intrinsic cardiovascular function characteristics were similar, further study to evaluate the impact of non-disease-specific factors is mandatory.
主动脉缩窄（CoA）修复术后常发生再狭窄，通常需要通过球囊扩张进行治疗。其对体育锻炼表现的影响尚无文献记载。对CoA修复术后儿童进行了运动测试和超声心动图评估的回顾性分析。将无再狭窄的一组（=第1组）和经单次球囊扩张治疗的再缩窄一组（=第2组）按年龄和性别以2:1的比例进行匹配比较。第1组包括40名儿童，第2组包括21名儿童，评估时的平均年龄分别为12.3±2.3岁和11.9±2.9岁（p = 0.536）。第2组儿童在CoA修复时年龄较小（第1组：中位数32.0天（11.0 - 188.0）-第2组：9.0天（5.5 - 19.0），p = 0.011）。经常发现动脉高血压（第1组：23例（57.5%）-第2组：7例（33.3%），p = 0.106）。超声心动图显示心脏功能特性相当，与同龄人相比，所有CoA患者的左心室（LV）肥厚更明显（后壁厚度z值：1.03±1.65，p < 0.001）。尽管存在有利于第1组的微小差异，但运动结果总体相当（预测%峰值VO =第1组：95.2±21.4%-第2组：82.3±10.5%，p = 0.024；峰值VO/kg =第1组：38.9±9.5 ml/min/kg-第2组：33.8±6.9 ml/min/kg，p = 0.034；VO/WR斜率 =第1组：12.6±2.0 ml/min/瓦特-第2组：11.3±1.7 ml/min/瓦特，p = 0.018）。与无并发症的缩窄患者相比，CoA修复术后发生手术再狭窄并通过球囊扩张有效治疗的儿童在运动期间的摄氧量较低，但仍可接受。由于内在心血管功能特征相似，必须进一步研究以评估非疾病特异性因素的影响。
