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Arterial hypertension and organo-vascular pathological changes as late complications after coarctation of the aorta repair
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Abstract
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
Abstract
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
Keywords
coarctation of the aorta; arterial hypertension; long-term follow-up; treatment
Title
Arterial hypertension and organo-vascular pathological changes as late complications after coarctation of the aorta repair
Journal
Issue
Article type
Review paper
Pages
480-489
Published online
2011-01-14
Page views
803
Article views/downloads
3540
Bibliographic record
Nadciśnienie tętnicze 2010;14(6):480-489.
Keywords
coarctation of the aorta
arterial hypertension
long-term follow-up
treatment
Authors
Olga Trojnarska
Ludwina Szczepaniak-Chicheł
Aleksandra Ciepłucha
Katarzyna Pawlaczyk-Gabriel