Congenital heart disease
Structural Alterations of Retinal Arterioles in Adults Late After Repair of Aortic Isthmic Coarctation

https://doi.org/10.1016/j.amjcard.2009.10.070Get rights and content

Patients after coarctation repair still have an increased risk of cardiovascular or cerebrovascular events. This has been explained by the persisting hypertension and alterations in the peripheral vessels. However, involvement of the central vessels such as the retinal arteries is virtually unknown. A total of 34 patients after coarctation repair (22 men and 12 women; 23 to 58 years old, age range 0 to 32 years at surgical repair) and 34 nonhypertensive controls underwent structural and functional retinal vessel analysis. Using structural analysis, the vessel diameters were measured. Using functional analysis, the endothelium-dependent vessel dilation in response to flicker light stimulation was assessed. In the patients after coarctation repair, the retinal arteriolar diameter was significantly reduced compared to that of the controls (median 182 μm, first to third quartile 171 to 197; vs 197 μm, first to third quartile 193 to 206; p <0.001). These findings were independent of the peripheral blood pressure and age at intervention. No differences were found for venules. The functional analysis findings were not different between the patients and controls (maximum dilation 3.5%, first to third quartile 2.1% to 4.5% vs 3.6%, first to third quartile 2.2% to 4.3%; p = 0.81), indicating preserved autoregulative mechanisms. In conclusion, the retinal artery diameter is reduced in patients after coarctation repair, independent of their current blood pressure level and age at intervention. As a structural marker of chronic vessel damage associated with past, current, or future hypertension, retinal arteriolar narrowing has been linked to stroke incidence. These results indicate an involvement of cerebral microcirculation in aortic coarctation, despite timely repair, and might contribute to explain the increased rate of cerebrovascular events in such patients.

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Methods

We included 34 patients (22 men and 12 women, mean age 38 ± 10 years, range 23 to 58) with successfully repaired aortic coarctation and without recoarctation, as defined by a peak pressure gradient of >20 mm Hg between the upper and lower extremities. None of these patients had additional congenital or acquired heart disease. The patients were selected sequentially during their annual coarctation follow-up examination. The mean age at intervention was 11 ± 9 years (range 0 to 32). The

Results

We found a significant reduction of the AVR in patients after coarctation repair compared to the healthy controls (median 0.80, first to third quartile 0.75 to 0.86 vs median 0.89, first to third quartile 0.84 to 0.90; p <0.001; Figure 1). To determine whether this alteration was caused by smaller arteries or, instead, by larger veins, we analyzed both the summarized arteriolar and venular diameters expressed as the CRAEs or CRVEs. Only the arterioles showed a significant reduction between the

Discussion

The main finding of our study was of a significant reduction of retinal arteriolar diameter that occurs independently of the current blood pressure level and also independently of the age at intervention. In contrast, no difference was found in endothelial function as measured by dynamic vessel analysis. Also, no changes in either structural or functional parameters were found in the retinal venules.

Very few studies have evaluated the function and morphology of the retinal vessels in

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    The Retinal Vessel Analyzing System used in the present study was provided by Imedos (Jena, Germany) for research purposes without any financial associations.

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