Follow up of IMT in post-coarctectomy patients

Coarctation of the aorta is typically a discrete narrowing of the thoracic
aorta just distal to the left subclavian artery. Coarctation of the aorta is a
common malformation, accounting for 6 to 8 percent of all congenital heart
defects.
Although the blood pressure typically falls after successful repair,
persistent or recurrent hypertension and disproportionate systolic hypertension
with exercise are not uncommon. Normotensive patients, especially those
repaired at an older age, often have an exaggerated rise in systolic pressure
in response to exercise. The factors responsible for the persistent risk of
hypertension after coarctation repair are not well understood.
Studies have shown decreased survival rates in post-coarctectomy
patients1. The most common cause of this premature death was coronary artery
disease, followed by sudden death, heart failure, cerebrovascular accident and
ruptured aortic aneurysm.
Intima-media thickness (IMT) is nowadays considered a validated and
reproducible endpoint for atherosclerosis2. A study in 137 post-coarctectomy
patients, median age 29,7 years, performed in the Academical Medical Centre
Amsterdam, VU medical centre Amsterdam and University Medical Centre Leiden in
2001-2002, showed an increased IMT in this group of patients3.
In the healthy population, annual progression of IMT is ranging from
0.0085 * 0.0195 mm4, depending on race, gender and arterial wall segment.
Though we know post-coarctectomy patients suffer from accelerated
atherosclerosis, little is known about progression of IMT in these patients.
Analysing progression of IMT might give more insight in the pathofysiology of
the accelerated atherosclerosis in this group of patients.

to evaluate progression of IMT in post-coarctectomy patients in 7 years follow
up.

observational follow up study

all investigations, blood analysis excepted, are non-invasive and free of risk.
The burden for the patients mainly consists of the time that is consumed by the
investigations, namely: history taking + physical examination (15 min);
Quality-of-Life score (15 min); laboratory tests (lipids, glucose, renal
function, liver function, CPK); EKG (10 min); ambulatory blood pressure
measurement (10min/24h); exercise testing; echocardiogram (30 min); IMT
measurement (1/2 hour); MRI (1/2 hour); Pulse wave analysis (1/2 hour)