Coarctation of the Aorta. postoperative hypertension noted beyond the 10th postoperative yr: -- alive and well and normotensive 70% at 10 yrs 65% at 15 yrs 20% at 25 yrs. arm leg gradient with exercise average is 80 mm Hg. SUDDEN DEATH in YOUNG ATHLETES.
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-- alive and well and normotensive
70% at 10 yrs
65% at 15 yrs
20% at 25 yrs.
SUDDEN DEATH in YOUNG ATHLETES
Maron, et al, Circ 1980
Causes of Sudden Death
Unequivocal CV dis.
No CV disease
Probable CV Disease
(no fiber disarray)
Increased risk of sudden death ass. with: documented v. tach, family hx. of sudden death, young age of onset of symptoms.
Sudden death not related to presence or degree of outflow gradient.
HAS BEEN SHOWN TO DECREASE RISK OF SUDDEN DEATH.
a. sudden death reported with SVT,long QT, SSS.
b. exercise syncope most common presentation.
focused hx of syncope, chest pain, or seizures in patient- always ask about sudden death in family members
focused PE looking for path. murmur, gallop, or S4, obvious ectopy
RESIDUAE & SEQUELAE of CONGENITAL HEART SURGERY
It ain’t over, til it’s over
Mustard or Senning
-- Late developement of stenosis/insuf-
Associated with calcific changes
-- infective endocarditis
-- intracranial aneurysms
-- late aortic dissection
-- intramural coronary artery disease
-- 38% incidence of aneurysms
-- incidence of aneurysms unknown
native vs recoarc. For recoarctation,
balloon is procedure of choice
30-40% have recurrent gradient when surgery done at less than 1yr.
--10-20% have resting hypertension
This is directly related to age at surgery.Exercise testing will provock gradient.