SURGICAL CORRECTION OF COARCTATION OF THE AORTA IN CHILDHOOD AND RISK OF HYPERTENSION IN ADULTHOOD

Abstract

Introduction: Coarctation of the aorta is a congenital heart defect characterized by a localized narrowing of the aorta, usually in the isthmic region. This obstruction results in increased afterload for the left ventricle and elevated pressures in the arterial segments proximal to the coarctation, while distal pressures are reduced. Surgical correction during childhood is the established treatment to alleviate the pressure gradient and restore adequate blood flow. However, clinical observations over the decades have revealed that, even after anatomical correction considered successful, these patients remain at increased risk of cardiovascular morbidities in adulthood, with systemic arterial hypertension emerging as the most prevalent and challenging long-term complication. Objective: The aim of this systematic literature review was to investigate the prevalence and factors associated with the development of hypertension in adulthood in patients undergoing surgical correction of coarctation of the aorta during childhood. Methodology: A systematic literature review was conducted following the PRISMA checklist guidelines. The search was performed in the electronic databases PubMed, SciELO and Web of Science, using the descriptors: "Aortic Coarctation", "Surgery", "Childhood", "Adult" and "Hypertension". Articles published in the last 10 years were included. Inclusion criteria consisted of studies that followed patients undergoing surgical repair of coarctation of the aorta in childhood until adulthood, reporting data on the incidence or prevalence of hypertension. Studies focused exclusively on percutaneous treatment, patients operated only in adulthood or that did not have follow-up in adulthood were excluded. Results: The studies analyzed consistently demonstrated that patients undergoing surgical repair of coarctation of the aorta in childhood exhibited a high prevalence of hypertension in adulthood, even in the absence of significant coarctation. Age at the time of repair appeared to influence the risk, with repairs performed early in childhood associated with a lower risk of late hypertension compared with later repairs, but without completely eliminating the risk. Mechanisms such as structural and functional alterations in the arterial tree proximal to the coarctation, developed before correction, have been postulated to contribute to the persistence of hypertensive risk. Conclusion: Surgical correction of coarctation of the aorta performed in childhood, although essential for acute management and survival, did not confer complete protection against the development of arterial hypertension in adulthood. The high prevalence of late-onset hypertension highlighted the critical need for continuous cardiovascular monitoring and rigorous management of blood pressure throughout life in all individuals with a history of coarctation of the aorta, regardless of the success of the initial correction.