NONINVASIVE LONG-TERM FOLLOW-UP AFTER COARCTATION REPAIR

Thirty patients operated on for aortic coarctation while less than 3 y ears of age underwent magnetic resonance imaging, digital subtraction angiography, and bicycle exercise testing 14 to 33 years (mean, 22 yea rs) after operation. Diameters of the aorta at the site of the anastom osis, of the distal arch, and of the aorta at the level of the diaphra gm were measured in the images. Blood pressures were obtained from the right arm and leg before and after exercise. Patients were divided in to three groups according to blood pressure data: group I, resting gra dient less than 30 mm Hg and exercise gradient less than 50 mm Hg; gro up II, resting gradient less than 30 mm Hg and exercise gradient great er than 50 mm Hg; and group III, resting gradient 30 mm Hg or greater. A control group underwent the same test. The frequency of hypertensiv e patients was greater in groups II (58%) and III (100%) than in group I (20%). The anastomosis/descending aorta ratio seen in digital subtr action angiograms was smaller in group II and III patients. Exercise b lood pressure gradient correlated significantly (r = -0.48; p = 0.009) with anastomosis/descending aorta ratio in digital subtraction angiog rams but not in magnetic resonance images. Twenty of 30 patients (67%) had a significant anatomic narrowing at the site of the anastomosis. Blood pressure data correlated with diameters measured in digital subt raction angiograms but not with diameters measured in magnetic resonan ce images.