Specialist Registrar Children's Health Ireland at Crumlin Dublin, Dublin, Ireland
Background: Systemic arterial hypertension is a well-recognised and common adverse effect following successful aortic coarctation repair. Significant long-term morbidity associated with unrecognised or untreated hypertension includes stroke and ischaemic heart disease in adulthood. Age at initial repair has been associated with the development of hypertension and therefore early repair in infancy is favoured if possible. There is a paucity of research pertaining to long term blood pressure monitoring in this cohort. Objective: To describe the monitoring of blood pressure, quantify blood pressure centiles and corresponding LV dimensions in a national cohort of children with isolated aortic coarctation intervention. Design/Methods: A retrospective analysis was carried out that included all children diagnosed with aortic coarctation (in the absence of associated complex congenital heart disease) over a 6-year period from 2015-2021. Data was collected pertaining to diagnosis, age at intervention, blood pressure assessment and blood pressure values at outpatient follow up, as well as left ventricle dimension parameters. Results: During the study period, 229 aortic arch repairs were carried out. Patients with associated complex congenital cardiac lesions, late diagnoses, or those who were discharged to a different cardiology service were excluded. 89 patients were therefore included in this analysis. The average age at repair was 29.5 days. Coarctation repair with end-to-end anastomosis was carried out in 78 (87.6%) cases. 18 patients (20.2%) were discharged from hospital on an anti-hypertensive agent and the average length of therapy was 1.68 years.
At most recent follow up review, only 72% of this cohort had a blood pressure recorded. 21% (N=13) of these patients had a blood pressure that was >95th centile. Two of these patients were on anti-hypertensive agents at the time of follow up with an average gradient of 11.98 mmHg in the descending aorta.
We were unable to demonstrate a significant relationship between age at repair and systolic blood pressure centile (SBPC) or SBPC and IVSd/LVPWd z scores using ANOVA analysis.
Conclusion(s): A significant proportion of children post coarctation repair demonstrated elevated blood pressures. Further work to better recognise, monitor and treat this cohort is needed so as to minimise long term morbidity.
