Cardiovascular Outcome after Repair of Aortic Coarctation

Abstract

Although coarctation of the aorta (CoA) is recognized and treated for several decades, long-term morbidity is still a prevalent issue in the CoA population and many pathophysiological questions remain regarding the embryological development and long-term outcome. This thesis assesses long-term outcome after native repair of CoA and provides an insight into diagnosis, treatment and long-term complications after CoA repair. Furthermore, the underlying pathology of the observed complications is assessed by use of cardiac magnetic resonance (CMR) imaging, cardiopulmonary exercise testing (CPET) and peripheral vascular resistance (PVR) assessment. Over the past decades several treatment techniques have been developed and revised and endovascular treatment (balloon angioplasty and stent placement) has been introduced as a less invasive alternative to surgery. As balloon angioplasty without stent placement provides a higher risk of reintervention, this treatment is not recommended as primary therapy for native CoA in children. Despite adequate repair of the coarctation, one third of patients require reintervention in long-term follow-up and more than half of the patients develop hypertension. Increased central and peripheral vascular stiffness is seen in CoA patients late after successful repair and play an important role in development of hypertension. These late vascular abnormalities suggest that CoA is a manifestation of extensive arterial vasculopathy rather than just a localized narrowing of the aorta. Furthermore, exercise induced hypertension is a prevalent issue and can precede systemic hypertension. Therefore, regular follow-up with adequate imaging of the heart and aorta and cardiopulmonary exercise testing is important.