Arterial hypertension and organo-vascular pathological changes as late complications after coarctation of the aorta repair

Abstract

Surgical treatment of one of the most often found congenital heart diseases - coarctation of the aorta is possible since over half of the century and more and more patients are the subject to such invasive management. However, such procedure does not lead to complete recovery due to the fact that surgery on the main artery always leaves some residual narrowing and in some cases may be the cause of its aneurismatic dilatation. What is more, bicuspid aortic valve often coexisting with coarctation of the aorta is the subject of inevitable degeneration.
Results from the recent studies prove that coarctation of the aorta is not only the problem of simple mechanic obstruction for the blood flow in the descending aorta but a more generalized vascular disease. On this account, even after so called "successful" correction of the coarctation, the consistent progression of the disease is observed with development of consequent target organ complications arising mainly from following arterial hypertension and early atherosclerotic changes. As a result the span of life of such patients is significantly shorter than in the general population.
Pathogenesis of arterial hypertension in the analyzed population is still not fully understood.
Currently there are two main theories concerning this subject: mechanistic, explaining the development and progression of the disease by obstruction of the descending aorta and decreased compliance of the precoarctation region of the main artery, and neurohormonal one, assuming changed reactivity of baroreceptors and referring to Goldblatt phenomenon - hyperreactivity of the rennin-angiotensin-aldosteron system as a result of relative kidneys’ hypoperfusion.
Up to the date we have no unequivocal recommendations concerning pharmacological management of arterial hypertension in this group of patients, but it is obvious and unquestionable that subjects after surgical correction of the aortic coarctation should be under constant and close supervision of cardiologists specialized and experienced in management of congenital heart diseases. Systematic clinical monitoring of such patients is indicated as some of them may require re-operation in the future. Ongoing development of surgical techniques and widening the knowledge on late complications gradually improves the clinical outcome of those patients.
Arterial Hypertension 2010, vol. 14, no 6, pages 480-489