IJCS | Volume 33, Nº1, January / February 2019

4 result, although resection of the coarcted segment may prevent patients from dying by age of 30, even after this procedure, subjects remain at higher risk of hypertension and premature cardiovascular death. 5,6 This challenging phenomenon has led to an intense search for predictors of worse prognosis in repaired patients. In this direction, some have claimed that late repair is among themain risk factor for all-causemortality in subjects undergoing resection of aorta coarctation. 7 Importantly, late correction frequently occurs as a result of an underdiagnosis rate of over 62%, placing CoA as the most frequently misdiagnosed critical congenital heart disease. 8 Besides, recoarctation occurs in one-third of patients, leading to a regression of the benefits of first surgical correction and, often, requiring reintervention. This complication demands a life-long surveillance by regular echocardiography in repaired patients. 5 Finally, hypertension stands as themain complication in repaired subjects, hence representing a known risk factor for cardiovascular disease from an early age, with important long-term repercussions on mortality. 9-11 In this study, we retrospectively analyzed data of patients operated for CoA at a tertiary care hospital. The main goals of this study were: (i) to register the frequency of common clinical signs at diagnosis; (ii) to describe the course of echocardiographic parameters before and during the follow-up of coartectomized subjects; (iii) to analyze the clinical prognosis of patients according to baseline characteristics, occurrence of recoarctation and associated malformations. A total of 417 patient-years follow-up was studied, revealing hypothesis-generating results. Materials and methods Study population Data were collected from medical records of patients operated for native coarctation of the aorta between June 1996 and November 2016 at the University of Campinas General Hospital (HC-UNICAMP), a tertiary care hospital in Brazil. The last visit to outpatient clinic occurred in November 2016. We compared clinical and echocardiographic data collected at the time of diagnosis and at the last outpatient clinic visit (in November 2016). Diagnosis of coarctation of the aorta was defined as a peak aortic gradient greater than 20 mmHg with compatible clinical history. Clinical variables Clinicalvariablesincludedage,gender,antihypertensive medications and symptoms. Hypertension was defined as the use of antihypertensive drugs. Symptoms were classified according to the New York Heart Association (NYHA) criteria, and all other variables obtained from medical records. During follow-up, recoarctation was defined as a peak descending aorta gradient (DAG) greater than 20mmHg after successful surgical correction at baseline. Echocardiographic Echocardiographic measurements were obtained by trained cardiologists using Vivid S6 (GE Vingmed Ultrasound, Horten, Norway) and EchoPAC version 8.0 (GE Healthcare). The following parameters were considered: left ventricular (LV) end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), posterior wall diastolic thickness (PW), aortic root diameter (ARD), peakDAG, left atrial diameter (LAD) and LVmass (LVM). All variables, except for DAG and ejection fraction (EF), were indexed by body surface calculated by DuBois formula. LV hypertrophy was defined as LVmass values above the 95th percentile for respective age and gender, according to validated guidelines. 12 For comparative purposes, we considered the first echocardiographic test performed before surgical correction as “baseline”, and the last echocardiographic examination after surgery as the “last” examination. Operative technique Medical registries including operative notes, data on perioperative hemodynamics and complications of all patients operated at our hospital were collected for analysis. In our study, all patients have undergone coartectomy by posterolateral thoracotomy and an end- to-end anastomosis as previously described. 13 Briefly, in this procedure, a left posterolateral thoracotomy is completed with sparing of the serratus anterior muscle in the third to fourth intercostal space. Then, the lung is retracted inferiorly andmedially, exposing the aortawhich is further mobilized. Then, a proximal clamp is placed at the base of the left subclavian artery or proximal to the carotid bifurcation, and a distal clamp is placed below the second intercostal space. Finally, the narrowed segment is resected, and an end-to-end anastomosis performed. Barreto et al. Follow-up of surgically corrected coarctation of the aorta Int J Cardiovasc Sci. 2020;33(1):3-11 Original Article