ADULT CONGENITAL DISEASE
Risk factors for aortic complications in adults with coarctation of the aorta
Jose Maria Oliver, MD*,*,
Pastora Gallego, MD ,
Ana Gonzalez, MD*,
Angel Aroca, MD*,
Monserrat Bret, MD and
Jose Maria Mesa, MD*
* Adult Congenital Heart Disease Unit, Radiology Department, La Paz University Hospital, Madrid, Spain
Radiology Department, La Paz University Hospital, Madrid, Spain
Virgen Macarena University Hospital, Sevilla, Spain
Manuscript received February 8, 2004;
revised manuscript received May 6, 2004,
accepted July 5, 2004.
* Reprint requests and correspondence: Dr. Jose Maria Oliver, Unidad Médico-Quirúrgica de Cardiología, Hospital Universitario La Paz, Castellana 261, Madrid 28046 (Email: pepeoliver{at}jet.es).
OBJECTIVES: We sought to determine the prevalence and predisposing condition for aortic wall complications in adults with either repaired or non-repaired coarctation of the aorta.
BACKGROUND: Aortic wall complications may develop in adults with coarctation of the aorta, despite successful surgical repair in childhood.
METHODS: A total of 235 adults with coarctation (mean age 27 ± 13 years) were retrospectively reviewed. Treatment had been performed by surgery in 181 patients (group I) or by balloon angioplasty or stenting in 28 patients (group II). No previous intervention had been carried out in 26 patients with mild coarctation at diagnosis (group III).
RESULTS: Forty-four aortic wall complications were found in 37 patients (16%). There were no differences among the three groups with respect to total complications (15%, 18%, and 15%, respectively), ascending aortic aneurysms (9%, 11%, and 12%), or descending aortic aneurysms (4% in all three groups). Multivariate analysis did not show a significant relationship between previous repair, type of repair, age at repair, residual Doppler pressure gradient, or systemic hypertension and the occurrence of aortic complications. Only aging (risk ratio [RR] 1.4 per decade of age, 95% confidence interval [CI] 1.1 to 1.8, p = 0.002) and bicuspid aortic valve (RR 3.2, 95% CI 1.3 to 7.5, p = 0.005) were significantly related to these complications.
CONCLUSIONS: Aortic wall complications are frequent in adults with coarctation of the aorta beyond that attributable to associated hemodynamic derangement or previous repair. The only independent risk factors appear to be advanced age and bicuspid aortic valve.
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Abbreviations and Acronyms
| | BAV = bicuspid aortic valve | | CI = confidence interval | | RR = risk ratio | | TAV = tricuspid aortic valve |
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