Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-03T08:20:58.676Z Has data issue: false hasContentIssue false
  • English
  • Français

Mid-term effects of implanting stents for relief of aortic recoarctation on systemic hypertension, carotid mechanical properties, intimal medial thickness and reflection of the pulse wave

Published online by Cambridge University Press:  03 May 2005

Gabriella Agnoletti ,
Caroline Bonnet ,
Damien Bonnet ,
Daniel Sidi  and
Yacine Aggoun
Gabriella Agnoletti
Affiliation:
Service de Cardiologie Pédiatrique, Necker-Enfants Malades, Paris, France
Caroline Bonnet
Affiliation:
Service de Cardiologie Pédiatrique, Necker-Enfants Malades, Paris, France
Damien Bonnet
Affiliation:
Service de Cardiologie Pédiatrique, Necker-Enfants Malades, Paris, France
Daniel Sidi
Affiliation:
Service de Cardiologie Pédiatrique, Necker-Enfants Malades, Paris, France
Yacine Aggoun
Affiliation:
Unité de Cardiologie Pédiatrique, Hôpital Cantonal, Genève, Switzerland
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: Primary implantation of stents is an accepted technique for treating aortic recoarctation, albeit that the effects of stenting on pressure profiles, carotid mechanical properties, intimal medial thickness, and reflection of the pulse wave have not been systematically investigated. Methods: Over the period from 1 January, 1999, to 31 December, 2002, we implanted stents to relieve aortic recoarctation in 15 patients, with a median age of 17 years, and a range from 7 to 29 years, with a median weight of 56 kilograms, ranging from 20 to 96 kilograms. Indications were a gradient of 20 millimetres of mercury or more measured in all, systemic hypertension at rest in 8, and systemic hypertension at exercise in all. Of the patients, 5 were receiving anti-hypertensive treatment. Before implantation of the stents, and after a mean follow-up of 22 months, all patients underwent an exercise test, vascular echography, and examination of the common carotid artery so as to determine its cross sectional compliance and distensibility, and the augmentation index. Results: The stents were implanted successfully in all patients. The mean gradient was reduced from 27 to 4 millimetres of mercury (p < 0.001). Systolic blood pressure at rest diminished from 140 to 131 millimetres of mercury (p = 0.04), while hypertension at rest regressed in 4 patients. Systolic blood pressure at exercise diminished from 245 to 222 millimetres of mercury (p = 0.018), and hypertension at exercise regressed in 1 patient. Anti-hypertensive treatment is still required for 4 patients. A correlation was found between systolic blood pressure at rest and initial peak-to-peak gradient (r = 0.8), and between initial gradient and percentage reduction of systolic blood pressure at rest at follow-up (r = −0.73). Compliance and distensibility of the common carotid artery were not significantly modified, albeit that the intimal medial thickness diminished from 0.64 to 0.57 millimetres (p = 0.04), and the augmentation index decreased from 5 to −1 (p = 0.012). Conclusions: Primary implantation of stents is effective in mid-term repair of aortic recoarctation. Although there is an improvement in systemic hypertension, the tensional profile and vascular sonography are not normalized. At long term follow-up, the suppression of an early reflection site of the pulse wave could decrease the wall stress of the great elastic vessels, reducing the thickness of the arterial walls.

Keywords

Aortic coarctationballoon dilatationstentexercise test
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 3 , June 2005 , pp. 245 - 250
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Morrow WR, Smith VC, Ehler WJ, VanDellen AF, Mullins CE. Balloon angioplasty with stent implantation in experimental coarctation of the aorta. Circulation 1994; 89: 2677–2683.Google Scholar
Hamdan MA, Maheshwari S, Fahey JT, Hellenbrand WE. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 2001; 38: 1518–1523.Google Scholar
Zabal C, Attie F, Buendia-Hernandez A, Garcia-Montes JA. The adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting? Heart 2003; 89: 77–83.Google Scholar
Ince H, Petzsch M, Rehders T, Kische S, Korber T, Weber F. Percutaneous endovascular repair of aneurysm after previous coarctation surgery. Circulation 2003; 108: 2967–2970.Google Scholar
Ebeid MR, Prieto LR, Latson LA. Use of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 1997; 5: 1847–1852.Google Scholar
Thanopoulos BD, Hadjinikolaou L, Konstadopoulou GN, Tsaousis G, Triposkiadis F, Spirou P. Stent treatment for coarctation of the aorta: intermediate term follow-up and technical considerations. Heart 2000; 84: 65–70.Google Scholar
Harrison DA, McLaughlin PR, Lazzam C, Connelly M, Benson LN. Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow-up. Heart 2001; 85: 561–566.Google Scholar
Magee AG, Brzezinska-Rajszys G, Qureshi SA, Rosenthal E, Zubrzycka M, Ksiazyk J. Stent implantation for aortic coarctation and recoarctation. Heart 1999; 82: 600–606.Google Scholar
Bruce R. Exercise testing in patients with coronary artery disease. Ann Clin Res 1971; 3: 323–332.Google Scholar
Aggoun Y, Bonnet D, Sidi D, Girardet JP, Brucker E, Polak M. Arterial mechanical changes in children with familial hypercholesterolemia. Arterioscler Thromb Vasc Biol 2000; 20: 2070–2075.Google Scholar
Bulbul ZR, Bruckheimer E, Love JC, Fahey JT, Hellenbrand WE. Implantation of balloon-expandable stents for coarctation of the aorta: implantation data and short term results. Cathet Cardiovasc Diagn 1996; 39: 36–42.Google Scholar
Kappetein AP, Zwinderman AH, Bogers AJ, Rohmer J, Huysmans H. More than thirty-five years of coarctation repair. An unexpected high relapse rate. J Thorac Cardiovasc Surg 1994; 107: 87–95.Google Scholar
Korkola SJ, Tchervenkov CI, Shum-Tim D, Roy N. Aortic rupture after stenting of a native coarctation in an adult. Ann Thorac Surg 2002; 74: 936.Google Scholar
Saliba Z, Aggoun Y, Iserin L, et al. Balloon angioplasty with stent implantation in recoarctation of the aorta: an attractive alternative. Arch Mal Coeur Vaiss 2001; 94: 427–432.Google Scholar
Bouchart F, Dubar A, Tabley A, Litzler PY, Haas-Hubscher C, Redonnet M. Coarctation of the aorta in adults: surgical results and long-term follow-up. Ann Thorac Surg 2000; 70: 1483–1488.Google Scholar
Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpente B, Moller JH. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol 2002; 89: 541–547.Google Scholar
Brouwer RM, Erasmus ME, Ebels T, Eijgelaar A. Influence of age on survival, late hypertension, and recoarctation in elective aortic coarctation repair. J Thorac Cardiovasc Surg 1994; 108: 525–531.Google Scholar
Swan L, Goyal S, Hsta C, Hechter S, Webb G, Gatzoulis MA. Exercise systolic blood pressure are of questionable value in the assessment of the adult with a previous coarctation repair. Heart 2003; 89: 189–192.Google Scholar
Sigurdardottir LY, Helgason H. Exercise-induced hypertension after corrective surgery for coarctation of the aorta. Pediatr Cardiol 1996; 17: 301–307.Google Scholar
Weber HS, Cyran SE, Grzeszczak M, Myers JL, Gleason MM, Bayle BG. Discrepancies in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 1993; 21: 1002–1007.Google Scholar