Surgical correction of aortic coarctation: does it always satisfy expectations?

Objective: To evaluate post-operative elastic properties of the aorta and prevalence of arterial hypertension and left ventricular (LV) hypertrophy in infants who underwent surgery for aortic coarctation during the first 2 months of their lives. Methods: Main group (n=32) consisted of patients who underwent surgery for isolated aortic coarctation (extended anastomosis and classic end-to-end anastomosis technique). Control group (n=19) included healthy children. Echocardiography was done in all patients upon admission, immediately after surgery, before discharge, and 1 year after surgery. We also evaluated the elastic properties of the aorta such as distensibility (D) and the aortic wall stiffness index (SI). Results: Patients with aortic coarctation, who underwent surgery during the first 2 months after birth, had different aortic elastic properties compared with those in healthy children. We found that the elastic properties remained decreased in the long-term follow-up period. One year after surgery, despite the absence of the signs of re-coarctation in the main group, the mean pressure gradient (according to echocardiography) was 16.4+9.6 and 29.1% of patients still required antihypertensive medications; LV hypertrophy was documented in 45.8% of patients. Conclusion: Among patients, who underwent surgery for aortic coarctation during the first 2 months of life, 30% had arterial hypertension and 50% had LV hypertrophy one year after surgery. These results were independent from the correction method of aortic coarctation. The study showed that anatomically radical operation was not physiologically and functionally radical in one third of our patients.