Predictors and Effects of Persistent Hypertension after Successful Treatment of Coarctation of the Aorta

Background:Coarctation of the aorta is a congenital heart disease that sometimes remains clinically silent until adulthood,usually presenting with arterial hypertension.It is well known that after coarctation treatment,many patients remain hypertensive despite successful repair.In this study we approached the predictors and effects of residual hypertension after successful coarctation therapy.Methods:It was a cross sectional observational study involving 50 patients who underwent Coarctation repair/angioplasty in Ain Shams university hospitals.We divided the patients into two groups(hypertensive and normotensive)and we studied their demographic data(e.g.,age,gender,age at first repair,follow up period,etc.)to conclude the possible predictors of persistent hypertension in such cases.We also performed full echocardiographic assessment including 3D speckle tracking echocardiography to detect subtle changes in left ventricular systolic functions.Results:Hypertensive patients had significantly higher BMI(29.1 kg/m^(2))as compared to normotensives(24 kg/m^(2)),p<0.0001.Age at first CoA intervention was significantly higher in hypertensive patients.Hypertensive patients had significantly lower 3D left ventricular strain measures(Global area strain,global circumferential strain and global longitudinal strain).The incidence of bicuspid aortic valve was significantly higher in the hypertensive group,yet it was not an independent predictor of persistent hypertension.Conclusions:The predictors for residual hypertension post successful CoA repair were late intervention and higher BMI.Bicuspid aortic valve was more common in the hypertensive group.Regarding the effects of such disease domain,treated CoA patients with persistent hypertension tended to have higher LV mass index and lower values of LV deformation.

The Glenn Shunt Revisited, A Single Center Registry in Ain Shams University Cardiology Department

Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are performed at an older age than that recommended by the literature.So,we aim to assess post bidirectional Glenn shunt patients to detect the presence of any complications and to evaluate their functional capacity.Methods:This was a descriptive study that included all patients who underwent a bidirectional Glenn shunt and were referred for follow up in Ain shams university hospitals.History taking including NYHA class and physical activity,clinical examination,six-minutes-walk test,laboratory investigations,full echocardiographic assessment were done for all patients.Some patients needed invasive cardiac catheterization.Results:Our registry included 178 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from January 2019 till July 2020.The mean age of the registry was 18.7±8.26 years(range between 5 and 37 years),85 males(48%)and 93 females(52%).Regarding the basic anatomy,double outlet right ventricle with hypoplastic left ventricle was the commonest.Furthermore,our descriptive study confirmed many characteristic similarities between our patients and patients in developing countries.Our patients underwent bidirectional Glenn shunt at a median age of 6 years which is considered a relatively old age but similar to other studies that have been made in developing countries like Pakistan,India and Iran.There is a significant delay in the operation in Egyptian patients due to lack of patients’awareness,few numbers of primary health care facilities and high economic burden.Conclusion:Although the presence of slight systemic desaturation,our study demonstrated a satisfactory functional capacity among our patients;thus,bidirectional Glenn can be considered an acceptable definite univentricular repair in patients with late presentation.