Renal vascular function in aorta coarctation

  • Dr Benedetta Leonardi, Department of Cardiology, Bambino Gesu’ Hospital, Rome, Italy
  • Dr Tom Gentles, Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
  • Dr Mauro Colajacomo, Department of Radiology, Bambino Gesu’ Hospital, Rome, Italy
  • Dr Lidia Monti, Department of Radiology, Bambino Gesu’ Hospital, Rome, Italy
  • Dr Andrea Magistrelli, Department of Radiology, Bambino Gesu’ Hospital, Rome, Italy
  • Dr Fabrizio Gimigliano, Department of Cardiology, Bambino Gesu’ Hospital, Rome, Italy
  • Dr Ugo Giordano, Cardiorespiratory and Sports Medicine Unit- Dept of Pediatrics, Bambino Gesu’ Hospital, Rome, Italy
  • Dr Stephen Sanders, Department of Cardiology, Bambino Gesu’ Hospital, Rome, Italy

    • Background: Despite operative repair, subjects with coarctation of the aorta have a high risk of abnormal systemic vascular characteristics and late hypertension. The effect of these pathological changes on the left ventricle has been well described, but their impact on other organs less well defined.
    Objective: Our aim was to assess renal vascular function in patients late after coarctation repair.
    Methods: 16 patients, age 21±7 years, underwent a renal artery duplex ultrasound. The resistance index (RI) was measured (max systolic velocity-diastolic velocity/systolic velocity). Results were correlated with MRI parameters including LV size and mass.
    Results: RI was abnormal in 2 patients and borderline abnormal in another (19%). They had long standing arch obstruction (>10 years) that had been repaired in the last 1 to 3 years. Two of the three required treatment with antihypertensive agents and had abnormal with night time hypertension on 24 hour monitor and excessive BP response to exercise. An abnormal exercise BP response was present in 2/2 (100%) of those with an abnormal RI who had exercise tests, compared to 4 of 10 (40%) of those with a normal RI (p=0.12). Those with an abnormal RI tended to have greater LV mass (82 vs. 64g/m2, p=0.10), and a larger LV (94 vs. 80ml/m2, p = 0.17) assessed by MRI.
    Conclusions: There is a risk of renal vascular dysfunction late after coarctation repair. This may be particularly so when repair is delayed with persistent hypertension, and/or an abnormal blood pressure response to exercise.