CEREBRAL ANEURYSM AS A COMPLICATION OF UNTREATED AORTIC COARCTATION

Abstract

Introduction: coarctation of the aorta (CoAo) is a congenital cardiovascular malformation that consists of a narrowing of the descending aorta, generally in the isthmic region, between the left subclavian artery and the ductus arteriosus or its remnant. CoAo causes obstruction to systemic blood flow, resulting in arterial hypertension in the upper limbs and hypoperfusion in the lower limbs. Untreated CoAo can lead to serious complications such as left ventricular hypertrophy, heart failure, collateral vessel formation, bacterial endocarditis, intracranial hemorrhage, hypertensive encephalopathy, and hypertensive cardiovascular disease in adulthood. One of the most feared complications is a cerebral aneurysm, which is an abnormal dilation of a cerebral artery caused by a weakness in the arterial wall. Objective: to evaluate the effects of physical exercise on childhood obesity in metabolic and anthropometric terms. Methodology: a search was carried out in the PubMed, Scielo and Web of Science databases using the following descriptors: "coarctation of aorta," "aneurysm," "cerebral aneurysm," "unrepaired coarctation of aorta," and "complications.". Only articles published in the last 10 years, in English or Portuguese, were included. Articles were excluded that were not original (systematic reviews, meta-analyses, editorials), that did not evaluate the effects of physical exercise on childhood obesity (studies with other interventions or populations), that did not present metabolic or anthropometric data (studies with other outcomes) or that had low methodological quality (studies without a control group, without randomization, without blinding or without statistical adjustment). The search was carried out following the PRISMA checklist. Results: 15 articles were selected in the systematic review. Physical exercise was effective in reducing body mass index (BMI), waist circumference, body fat and insulin resistance in obese children, compared to the control group that did not perform physical exercise or performed only educational or behavioral intervention. Furthermore, physical exercise was also effective in improving the lipid profile, blood pressure, cardiorespiratory capacity, muscle strength and quality of life in obese children, compared to the control group. The type, intensity, duration and frequency of physical exercise varied between studies, but the most common were moderate to high intensity aerobic exercise, performed for 30 to 60 minutes, three to five times a week, for 8 to 24 weeks. Conclusion: the systematic review showed that physical exercise is an effective and safe intervention for the treatment of childhood obesity, as it promotes metabolic and anthropometric benefits in obese children. However, there is still a need for more studies with greater methodological rigor and standardization of physical exercise protocols to determine the best strategies for each case.