IJCS | Volume 33, Nº1, January / February 2019

6 Table 3 - Baseline echocardiographic variables Findings Peak aortic gradient, mmHg 55 ± 3.2 (20 to 103) Left ventricular hypertrophy, % 19/25 (76) Bicuspid aortic valve, % 19/58 (32.8) Persistent arterial duct, % 18/58 (31) Interventricular communication% 11/58 (19) Patent foramen ovale, % 9/58 (15.5) Mitral valve insufficiency, % 8/58 (13.8) Interatrial communication, % 7/58 (12.1) Aortic valve insufficiency, % 7/58 (12.1) Pulmonary artery hypertension, % 7/58 (12.1) Tricuspid valve insufficiency, % 6/58 (10.3) Aortic stenosis, % 3/58 (5.2) Data expressed as mean ± SE (range) or n/total (%) Table 2 - Number of antihypertensive medications Baseline (n = 46) Last exam Control a (n = 34) Recoarctation b (n = 14) Bicuspid aortic valve c (n = 16) 0 19 (41.3) 21 (61.8) 3 (21.4)* 7 (43.8) # 1 15 (32.6) 8 (23.5) 6 (42.9) 6 (37.5) 2 5 (10.9) 3 (8.8) 3 (21.4) 2 (12.5) 3 7 (15.2) 2 (5.9) 2 (14.3) 1 (6.3) Values are n (%). *p = 0.011 compared with control; chi-square test; #p = 0.53 compared with control; chi-square test; a Patients without bicuspid aortic valve (BAV) at diagnosis and without recoarctation in the last echocardiographic test; b absence of BAV at diagnosis, and presence of recoarctation in the last echocardiographic test; c BAV at diagnosis, and absence of recoarctation in the last echocardiographic test; NYHA: New York Heart Association classification for heart failure symptoms; BAV: bicuspid aortic valve. three patients had chylothorax, with no other surgical complications being reported. Among those who did not have recoarctation during follow-up, surgical correction greatly decreased peak DAG (54 vs 13 mmHg; p < 0.001) and symptoms (60 vs 4.5%; p < 0.001), but not hypertension (58 vs 38%; p = 0.17) (Figure 1). Besides, a significant reduction in LVM, LVEDD, LVESD, PW, ARD and LADwas observed in these patients when compared to baseline values (Figure 2 and Table 4). Importantly, during follow-up, 16 (27.6%) patients had recoarctation (Figure 3). The mean follow-up period before detection of recoarctation was 5.6 years, and half of the cases occurred after 3.6 years of follow-up. Last recoarctation event was identified after 15 years of follow-up. Overall, patients with recoarctation were more likely to be symptomatic (4.5 vs 64%; p < 0.001) and hypertensive (38 vs 78%; p = 0.011) when compared to those without recoarctation (Table 5). In addition, compared to baseline, there was no significant change in peak gradient or in LVM (Table 5). Noteworthy, patients with BAV at diagnosis had comparable results with controls during follow-up. Also, age at surgery and gender did not affect the outcomes (data not shown). Discussion In this case series, we evaluated data from 72 patients operated for coarctation of the aorta and followed for up to 20 years in tertiary hospital in Brazil. Our main objectives were to identify the most frequent clinical findings that could benefit from early diagnosis, to describe the course of echocardiographic measures following surgical correction, and to detect the occurrence of recoarctation and its impact on prognosis. Our main findings were the following: (i) heart murmur is present in most patients; (ii) in addition to peak DAG, LV mass and diameters also decreased after surgical correction; (iii) recoarctation is a late finding in operated subjects and significantly impacts prognosis. Barreto et al. Follow-up of surgically corrected coarctation of the aorta Int J Cardiovasc Sci. 2020;33(1):3-11 Original Article