G001: Increased pulse pressure in repaired aortic coarctation is not related to residual pressure gradient

Abstract

Background:

Increased pulse pressure (PP) is being recognised as a new risk factor related to vessel stiffness. In successfully operated on coarctation of the aorta (CoA) an arm-leg residual systolic pressure gradient (SRGr), related to localised fibrotic scar in the previous coarctation site is usually present, even with no clinical significance. We hypothesise that a certain kind of vessel stiffness should remain in all that proximal upper aortic segment, and that the residual gradient should be an expression of it. Our aim was to search in successfully CoA operated adolescents patients, the presence of an eventual pulse pressure abnormality and to verify any relationship with the SRGr.

Material and methods:

Twenty three adolescents (mean age = 15,3) operated on for CoA more than 5 and less than 16 years ago showing normal blood pressure values and a SRGr between 4 and 17 mmHg (mean = 8) were submitted to 24 hours ambulatory blood pressure monitoring (spacelabs 90207) in a standard manner. Pulse pressure values were automatically derived from 24 hours systolic and diastolic measurements. A control group of 18 age matched normotensive adolescents (N) were submitted to identical protocol.

Results:

We find highly significant pulse pressure increase in the CoA group, although when searching for a linear correlation between the increased value and the SRGr within this group a r = 0.36 was obtained (Table).

	CoA	N	P
PP (mmHg)	57.783 ± 11.144	46.222 ± 2.647	< 0.0001

Conclusions:

Increased pulse pressure indicating a vascular risk is present in adolescents who suffered from previous CoA, despite actual normal blood pressure. Other cause than the localised vessel stiffness, that we presume to exist surrounding the previous CoA site, must be searched for, in order to prevent cardiovascular events in this young population.

Aortic coarctation, pulse pressure, gradient