Coarctation of the Aorta: Long Term Outcomes and Comorbidities
This is a case-control study design. For study cases, we will identify all subjects 5 years of age or older with coarctation of the aorta that are status post surgical or transcatheter repair who are currently under the care of the Cardiology clinic at Children's Medical Center. Subjects will be recruited from both the investigators' patients and patients of other CMC Cardiologist. information regarding type of repair, age at repair and associated anomalies will be obtained from existing charts prior to enrollment. We plan to evaluate the adequacy of their repair utilizing standard methods (4 extremity blood pressure measurements, echocardiography). if clinically they have evidence of an adequate repair (non-invasive blood pressure gradient from right arm to lower extremity difference of [Less Than] 20 mmHg between the systolic pressures) they will be deemed suitable candidates for enrollment. once enrolled, the patients will undergo the following evaluations, which are standard of care for routine follow-up: clinical examination, echocardiography to evaluate left ventricular size and function as well as patency of the aortic arch in addition to the previously performed 4 extremity blood pressures. For the purposes of this study, they will undergo an exercise stress tests to determine the incidence of persistent and/or exercise induced hypertension (defined as systolic blood pressure in the right arm of [Greater Than]200 mmHg at peak exercise) and 24-hour ambulatory blood pressure monitoring. additionally, we will perform carotid iMT measurements and flow mediated vasodilation studies to identify abnormalities of the arterial bed at the time of their echocardiogram. We plan to consent 60 subjects, allowing for a combined attrition rate and screen failure rate of 15%, with a goal of 50 enrolled subjects. We plan to have ~50% of patients with presence of a bicuspid aortic valve without stenosis. our goal for complete enrollment is 24 months.
Control patients will be recruited from the outpatient cardiology clinic who present with innocent cardiac murmurs, non-cardiac chest pain or other symptoms in which no organic cardiac disease is found. The control group will have the same exams performed except the exercise stress test. We plan to consent 50 age and sex matched controls.
Case study group:
1) between 5 and 30 years old
2) diagnosis of coarctation of the aorta that has been repaired
3) Possible additional diagnosis of bicuspid aortic valve without stenosis.
Control Group: No organic cardiac disease, age and sex matched to the cases.