Background: Coarctation of the aorta (CoA) is a congenital heart disease which represents a narrowing of the proximal descending aorta, hence increasing pressure afterload to the left ventricle (LV). Conventional treatment of native CoA is surgical repair, however potential recurrence or other related complications e.g. aortic rupture, heart failure and cerebrovascular events are common. Thus, lifelong follow-up of these patients is required. Echocardiography is the most patient’s friendly method to evaluate CoA and in particular its effect on LV function. Moreover, the novel speckle tracking echocardiography (STE) is an important method to assess subclinical LV dysfunction, a technique that promises better evaluation of LV function in these patients. The aims of this thesis were to review the literature on LV function in children with CoA using myocardial deformation imaging technologies, hence, to better understand the current knowledge and vagueness of the scientific evidence. We also aimed to study the effect of early CoA repair on the structure and function of LV and ascending aorta. In addition, we wished to establish in a meta-analysis format normal values of speckle tracking derived strain and strain rate values. Methods: Study 1. We have systematically searched the PubMed, and studies that fulfilled the inclusion criteria were critically analyzed and presented on a narrative form. Study 2 and 3. In addition to conventional echocardiographic measures of LV and ascending aorta, we measured longitudinal strain and strain rate of the LV using a vendor independent software, TomTec. We have also measured the aorto-septal angle (AoSA). Data was compared with normal healthy controls. Study 4. Electronic databases were systematically searched and suitable studies were meta analyzed using Comprehensive meta-analysis version 3 software. Results: Study 1. In 7/4945 included articles, 123 and 76 patients with congenital aortic stenosis (CAS) and CoA were reported, respectively. Normal conventional LV function, with subclinical myocardial dysfunction were reported in all studies before intervention. After intervention, a consistent improvement of myocardial deformation parameters was documented, even though not reaching normal values. Study 2. In 21 patients with CoA, LV function significantly improved after intervention (p <0.001), however normal values were not reached even at medium-term follow-up (p = 0.002). Medium-term longitudinal strain correlated with pre intervention LV ejection faction (EF) (r = 0.58, p = 0.006). Medium-term subnormal values were more frequently associated with Bicuspid aortic valve (BAV) (33.3% vs. 66.6%; p <0.05). Study 3. AoSA was abnormally wide before intervention, in particular at peak ejection in the descending aorta (p <0.0001), and correlated with CoA pressure gradient. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters. Study 4. In a meta-analysis of 28/282 studies including 1192 subjects, strain and strain rate values were established. Longitudinal strain normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95 % CI, -20.0 to -21.0). Normal mean values of circumferential strain varied from -10.5 to -27.0 (mean, -22.06; 95 % CI, -21.5 to -22.5). Radial strain normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95 % CI, 43.0 to 47.8). Meta-regression showed LV end-diastolic diameter as a significant determinant of variation of longitudinal strain. Longitudinal systolic strain rate was significantly determined by age and radial strain was influenced by the type of vendor used. Conclusion: The systematic review showed subclinical LV dysfunction in children with CoA before and after correction. However, since most of the patients were operated at an older age and had preserved LV EF, the effect of early intervention on LV function was only speculated. Our children with CoA who were operated at an earlier age showed LV subclinical dysfunction even at medium- term after intervention while the AoSA returned to normal shortly after intervention. Lower longitudinal strain values were found in patients with LV dysfunction (LV EF <50%) before intervention and BAV. Finally, normal range values for strain and strain rate have been established and seem to be influenced by patients’ age, LV end-diastolic diameter and vendor used.

Background Coarctation of the aorta (CoA) constitutes 5-8 % of all congenital heart disease (CHD) and is associated with long-term complications such as hypertension (HTN) and left ventricular hypertrophy (LVH). Factors associated with HTN, LVH, and diffuse myocardial fibrosis, are not yet fully explored in this population. Methods Papers I-III: The Swedish national register of congenital heart disease (SWEDCON) was used to identify adult patients with repaired CoA. Paper IV: Data on 2,424 adult patients with CHD was extracted from SWEDCON and compared to controls (n = 4,605) regarding height, weight and body mass index (BMI). Paper V: Adults with CoA (n = 21, age 28.5 (19.1-65.1) years, 33.3 % female) referred for CMR were investigated with T1 mapping to determine left ventricular extracellular volume fraction (ECV). Results Papers I-II: Out of 653 patients, 344 (52.7 %) had HTN. In a multivariable model, age (years) (OR 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68) and BMI (kg/m2) (OR 1.09, CI 1.03-1.16) were associated with having HTN, and so was systolic arm-leg blood pressure (BP) gradient where an association was found at the ranges (10, 20] mmHg (OR 3.58, CI 1.70-7.55) and > 20 mmHg (OR 11.38, CI 4.03-32.11), in comparison to the range [0, 10] mmHg. When investigating 243 patients with diagnosed HTN, 127 (52.3 %) had elevated BP (≥ 140/90 mmHg). Age (years) (OR 1.03, CI 1.01-1.06) was associated with elevated BP, and so was systolic arm-leg BP gradient in the ranges (10, 20] mmHg (OR 4.92, CI 1.76-13.79), and > 20 mmHg (OR 9.93, CI 2.99-33.02), in comparison to the reference interval [0, 10] mmHg. Patients with elevated BP had more classes of anti-hypertensive medication classes prescribed (1.9 vs 1.5, p = 0.003). Paper III: Out of 506 patients, 114 (22.5 %) were found to have LVH. Systolic BP (mmHg) (OR 1.02, CI 1.01-1.04), aortic valve disease, (OR 2.17, CI 1.33–3.53), age (years) (OR 1.03, CI 1.01–1.05), and HTN (OR 3.02, CI 1.81-5.02), were associated with LVH, while sex (female) (OR 0.41, CI 0.24-0.72) was negatively associated with LVH. Paper IV: There was no difference in height, weight, or BMI between patients with CoA (n = 414) and the reference population. Paper V: In the population of 21 patients, an increased left ventricular myocardial ECV was found in 6 cases (28.6 %). Of the patients with increased ECV, 5/6 (83.3 %) were female (p = 0.002). Patients with increased ECV did not otherwise differ from the rest of the study population. iv Conclusions In adults with repaired CoA, HTN and LVH were common, and many patients with HTN had elevated BP despite treatment. The potentially modifiable factors BMI and systolic arm-leg BP gradient were associated with HTN, and the gradient was also associated with elevated BP among patients with diagnosed HTN. The gradient’s significance remained even within what the current guidelines consider acceptable ranges. Potentially modifiable factors associated with LVH were systolic BP and aortic valve disease. We found no general difference in height, weight, or BMI between patients with CoA and the reference population. While LVH was more common among men, increased myocardial ECV was more common among women.

A expectativa de vida após correção cirúrgica da coarctação da aorta (CoAo) permanece menor que a da população geral, sendo que a maioria das mortes tardias se deve a complicações cardiovasculares, tais como: recoarctação, hipertensão arterial sistêmica (HAS), doença coronária, insuficiência cardíaca, acidente vascular cerebral (AVC) e morte súbita. Já se demonstrou que pacientes com CoAo têm estrutura e função arterial anormais, o que pode persistir mesmo após correção cirúrgica e ser responsável pela morbi-mortalidade tardias. Há pouca informação na literatura em relação ao possível remodelamento arterial após aortoplastia. O objetivo primário desse estudo foi avaliar os efeitos imediatos e após 1 ano da aortoplastia com implante de stent na reatividade e rigidez arteriais, e na espessura do complexo médiointimal (EMI). O objetivo secundário foi correlacionar os achados evolutivos da reatividade, rigidez e espessura médiointimal arteriais entre si. Vinte e um pacientes com idade mediana de 15 anos (8-39 anos) foram estudados antes da aortoplastia e após a intervenção (1 dia, 6 meses e 1 ano). A dilatação fluxo-mediada (DFM), a dilatação induzida por nitrato na artéria braquial esquerda, a velocidade da onda de pulso (VOP) carotídea, e a EMI carotídea e na artéria subclávia direita foram estudadas por meio do ultrassom. Antes do tratamento percutâneo, os pacientes apresentaram dilatação fluxo-mediada (DFM) (3,50 ± 2,01% vs 17,50 ± 3,20%, p<0,0001) e dilatação induzida por nitrato (12,51±3,66% vs 28,44 ± 6,85%, p<0,0001) prejudicadas, VOP aumentada (5,40 ± 0,79 m/s vs 4,32 ± 0,54 m/s, p<0,0001) e EMI em carótidas (0,59 ± 0,09 mm vs 0,49 ± 0,04mm, p<0,0001) e artéria subclávia direita aumentadas (1,20 ± 0,25mm vs 0,69 ± 0,16 mm, p<0,0001). Um ano após aortoplastia, não houve melhora significativa na DFM (3,61±1,86%), dilatação induzida por nitrato (12,80±3,53%), rigidez arterial (5,25 ± 0,77 m/s), EMI carotídea (0,59 ± 0,11 mm) ou EMI da artéria subclávia direita (1,21 ± 0,28 mm). Não houve correlação linear entre rigidez arterial, EMI e DFM. Pacientes submetidos à aortoplastia com balão e implante de stent não apresentaram melhora da reatividade arterial, rigidez arterial e EMI. Não houve correlação da rigidez arterial, EMI e DFM entre si. / Life expectancy after surgical repair of aortic coarctation (CoA) remains lower than general population and the majority of late deaths are due to cardiovascular complications, such as recoarctation, systemic arterial hypertension (SAH), coronary artery disease, heart failure, stroke and sudden death. It has been shown that patients with CoA have abnormal arterial structure and function, which may persist even after surgery and may be responsible for late morbidity and mortality. There is little information regarding arterial remodeling after angioplasty. The primary objective of this study was to evaluate immediate and one year results after aortic stenting on arterial reactivity and stiffness and intima-media thickness (IMT). The secondary objective was to correlate arterial reactivity, arterial stiffness and IMT. Twenty-one patients with a median age of 15 years (8-39 years) were studied before and after aortic stenting (1 day, 6 months and 1 year). The flow-mediated dilation (FMD) and nitrate-mediated dilation in left brachial artery, pulse wave velocity (PWV), carotid IMT and right subclavian artery IMT were studied by ultrasound. Before the percutaneous treatment, the patients had impaired FMD (3.50 ± 2.01% vs. 17.50 ± 3.20%, p<0.0001) and nitrate-mediated dilation (12.51 ± 3.66% vs. 28.44 ± 6.85%, p<0.0001), increased PWV (5.40 ± 0.79m/s vs. 4.32 ± 0.54m/s, p<0.0001), increased both carotid IMT (0.59 ± 0.09mm vs. 0.49 ± 0,04mm, p<0.0001) and right subclavian artery IMT (1.20 ± 0.25mm vs. 0.69 ± 0 16mm p <0.0001). One year after angioplasty, there was no significant improvement in FMD (3.61 ± 1.86%), nitrate-mediated dilation (12.80 ± 3.53%), arterial stiffness (5.25 ± 0.77 m/s), carotid IMT (0.59 ± 0.11mm) or right subclavian artery IMT (1.21 ± 0.28 mm). There was no linear correlation between arterial stiffness, IMT and FMD. Patients undergoing balloon angioplasty and stenting showed no improvement in arterial reactivity, arterial stiffness and IMT. There was no correlation among arterial stiffness, IMT and FMD.

Dans cette thèse nous traitons de la simulation d'interaction fluide- structure (FSI) dans les problèmes en hémodynamique, en mettant l'accent sur l'assimilation de données et sur la simulation dans les conditions physiologiques. La première partie présente et analyse un schéma de couplage semi-implicite des équations de Navier-Stokes (NSE) et d'un modèle de conditions aux limites réduit, lorsque les NSE sont résolues avec une méthode de projection. Cela permet de simuler des problèmes de mécanique de fluides et de FSI de fac ̧on plus robuste, c'est à dire en évitant les possibles instabilités associées à des cas-tests réalistes. La deuxième partie est consacrée à l'assimilation des données avec des méthodes séquentielles en FSI. Nous présentons d'abord une étude sur l'application d'un fil- tre de Kalman réduit pour l'estimation efficace des paramètres physiques d'intérêt, comme la distribution de la rigidité de la paroi de l'artère et la résistance proximale dans le fluide, à partir des mesures de deplacement à l'interface fluide-structure. Ensuite, nous analysons certains observateurs de Luenberger utilisés pour la mé- canique des solides en FSI, dans le but de construire des estimateurs d'état efficaces pour des problèmes FSI de grande taille. Dans la troisième et dernière partie, nous appliquons les méthodologies mention- nées ci-dessus aux problèmes physiques réels. Tout d'abord, la rigidité de la paroi est estimée (pour des modèles solides linéaires et non linéaires) à partir de données provenant d'un tube de silicone simulant une aorte. Pour finir, nous analysons une aorte réelle avec une coarctation réparée, nous testons les techniques d'estimation avec des données synthétiques et nous montrons quelques résultats obtenues à partir de données issues du patient.

A expectativa de vida após correção cirúrgica da coarctação da aorta (CoAo) permanece menor que a da população geral, sendo que a maioria das mortes tardias se deve a complicações cardiovasculares, tais como: recoarctação, hipertensão arterial sistêmica (HAS), doença coronária, insuficiência cardíaca, acidente vascular cerebral (AVC) e morte súbita. Já se demonstrou que pacientes com CoAo têm estrutura e função arterial anormais, o que pode persistir mesmo após correção cirúrgica e ser responsável pela morbi-mortalidade tardias. Há pouca informação na literatura em relação ao possível remodelamento arterial após aortoplastia. O objetivo primário desse estudo foi avaliar os efeitos imediatos e após 1 ano da aortoplastia com implante de stent na reatividade e rigidez arteriais, e na espessura do complexo médiointimal (EMI). O objetivo secundário foi correlacionar os achados evolutivos da reatividade, rigidez e espessura médiointimal arteriais entre si. Vinte e um pacientes com idade mediana de 15 anos (8-39 anos) foram estudados antes da aortoplastia e após a intervenção (1 dia, 6 meses e 1 ano). A dilatação fluxo-mediada (DFM), a dilatação induzida por nitrato na artéria braquial esquerda, a velocidade da onda de pulso (VOP) carotídea, e a EMI carotídea e na artéria subclávia direita foram estudadas por meio do ultrassom. Antes do tratamento percutâneo, os pacientes apresentaram dilatação fluxo-mediada (DFM) (3,50 ± 2,01% vs 17,50 ± 3,20%, p<0,0001) e dilatação induzida por nitrato (12,51±3,66% vs 28,44 ± 6,85%, p<0,0001) prejudicadas, VOP aumentada (5,40 ± 0,79 m/s vs 4,32 ± 0,54 m/s, p<0,0001) e EMI em carótidas (0,59 ± 0,09 mm vs 0,49 ± 0,04mm, p<0,0001) e artéria subclávia direita aumentadas (1,20 ± 0,25mm vs 0,69 ± 0,16 mm, p<0,0001). Um ano após aortoplastia, não houve melhora significativa na DFM (3,61±1,86%), dilatação induzida por nitrato (12,80±3,53%), rigidez arterial (5,25 ± 0,77 m/s), EMI carotídea (0,59 ± 0,11 mm) ou EMI da artéria subclávia direita (1,21 ± 0,28 mm). Não houve correlação linear entre rigidez arterial, EMI e DFM. Pacientes submetidos à aortoplastia com balão e implante de stent não apresentaram melhora da reatividade arterial, rigidez arterial e EMI. Não houve correlação da rigidez arterial, EMI e DFM entre si. / Life expectancy after surgical repair of aortic coarctation (CoA) remains lower than general population and the majority of late deaths are due to cardiovascular complications, such as recoarctation, systemic arterial hypertension (SAH), coronary artery disease, heart failure, stroke and sudden death. It has been shown that patients with CoA have abnormal arterial structure and function, which may persist even after surgery and may be responsible for late morbidity and mortality. There is little information regarding arterial remodeling after angioplasty. The primary objective of this study was to evaluate immediate and one year results after aortic stenting on arterial reactivity and stiffness and intima-media thickness (IMT). The secondary objective was to correlate arterial reactivity, arterial stiffness and IMT. Twenty-one patients with a median age of 15 years (8-39 years) were studied before and after aortic stenting (1 day, 6 months and 1 year). The flow-mediated dilation (FMD) and nitrate-mediated dilation in left brachial artery, pulse wave velocity (PWV), carotid IMT and right subclavian artery IMT were studied by ultrasound. Before the percutaneous treatment, the patients had impaired FMD (3.50 ± 2.01% vs. 17.50 ± 3.20%, p<0.0001) and nitrate-mediated dilation (12.51 ± 3.66% vs. 28.44 ± 6.85%, p<0.0001), increased PWV (5.40 ± 0.79m/s vs. 4.32 ± 0.54m/s, p<0.0001), increased both carotid IMT (0.59 ± 0.09mm vs. 0.49 ± 0,04mm, p<0.0001) and right subclavian artery IMT (1.20 ± 0.25mm vs. 0.69 ± 0 16mm p <0.0001). One year after angioplasty, there was no significant improvement in FMD (3.61 ± 1.86%), nitrate-mediated dilation (12.80 ± 3.53%), arterial stiffness (5.25 ± 0.77 m/s), carotid IMT (0.59 ± 0.11mm) or right subclavian artery IMT (1.21 ± 0.28 mm). There was no linear correlation between arterial stiffness, IMT and FMD. Patients undergoing balloon angioplasty and stenting showed no improvement in arterial reactivity, arterial stiffness and IMT. There was no correlation among arterial stiffness, IMT and FMD.

Currarino-Silverman syndrome is a rare disorder characterized by premature fusion of manubrio-sternal joint and the sternal segments, resulting in a high carinate chest deformity; it is frequently associated with congenital heart disease. Among the various heart lesions reported in this syndrome, mitral valve disease and coarctation of the aorta have not yet been described (to our knowledge). Our report consists of five children with this syndrome, four of whom had mitral valve disease, with an associated coarctation of the aorta in one patient. The fifth patient had an innocent heart murmur.

Mais informações são necessárias para definir se o tratamento percutâneo da coartação da aorta com stents é superior à angioplastia com cateter-balão. De julho de 2000 a maio de 2003, 21 adolescentes e adultos com coartação da aorta focal e média de idade de 24 anos (DP 11 anos) foram submetidos, consecutivamente, a implante de stents (grupo 1). Os resultados foram comparados com os obtidos em um grupo histórico de 15 pacientes com média de idade de 18 anos (DP 10 anos) (p = 0,103) submetidos a angioplastia (grupo 2) nos últimos 18 anos. Após o procedimento, a redução do gradiente sistólico foi maior (99% [DP 2%] versus 87% [DP 17%]; p = 0,015), o gradiente residual foi menor (0,4 mmHg [DP 1,4 mmHg] versus 5,9 mmHg [DP 7,9 mmHg]; p = 0,019), o ganho no local da coartação foi maior (333% [DP 172%] \"versus\" 190% [DP 104%]; p = 0,007) e o diâmetro da coartação foi maior (16,9 mm [DP 2,9 mm] versus 12,9 mm [DP 3,2 mm]; p < 0,001) no grupo 1. Alterações da parede da aorta, incluindo dissecções, abaulamentos e aneurismas, foram observadas em oito pacientes do grupo 2 (53%) e em um do grupo 1 (7%) (p < 0,001). Não houve complicações maiores. Cateterismo (n = 33) ou ressonância magnética (n = 2) de controle foram realizados em seguimento mediano de um ano para o grupo 1 e um ano e meio para o grupo 2 (p = 0,005). A redução do gradiente sistólico persistiu em ambos os grupos; entretanto, gradientes tardios mais altos foram observados no grupo 2 (mediana de 0 mmHg para o grupo 1 versus 3 mmHg para o grupo 2; p = 0,014). Não houve perdas no diâmetro da coartação no grupo 1 e houve ganho tardio no grupo 2 (16,7 mm [DP 2,9 mm] versus 14,6 mm [DP 3,9 mm]; p = 0,075). No grupo 1, dois pacientes necessitaram de novo implante de stent em decorrência da formação de aneurisma ou fratura da malha do stent. No grupo 2, as anormalidades da parede aórtica não progrediram e um paciente necessitou de redilatação em decorrência da recoartação. A pressão arterial sistêmica foi semelhante em ambos os grupos durante o seguimento (sistólica: 126 mmHg [DP 12 mmHg] no grupo 1 versus 120 mmHg [DP 15 mmHg] no grupo 2; diastólica: 81 mmHg [DP 11 mmHg] no grupo 1 versus 80 mmHg [DP 10 mmHg] no grupo 2; p = 0,149 e p = 0,975, respectivamente). Apesar de os desfechos clínicos terem sido satisfatórios e similares com ambas as técnicas, o uso de stents propiciou resultados mais previsíveis e uniformes para alívio da estenose, minimizando também o risco de desenvolvimento de alterações da parede da aorta. / More information is needed to define whether stenting is superior to balloon angioplasty for coarctation of the aorta. From July/2000 to May/2003, 21 adolescents and adults with discrete coarctation underwent consecutive stent implantation at a mean age of 24 years (SD 11 years) (group 1). The results were compared to those achieved by balloon angioplasty performed in the last 18 years in a historical group of 15 patients at a mean age of 18 years (SD 10 years) (p = 0.103) (group 2). After the procedure, systolic gradient reduction was higher (99% [SD 2%] vs. 87% [SD 17%]; p = 0.015), residual gradients lower (0.4 mmHg [SD 1.4 mmHg] vs. 5.9 mmHg [SD 7.9 mmHg); p = 0.019), gain at the coarctation site higher (333% [SD 172%] vs. 190% [SD 104%]; p = 0.007) and coarctation diameter larger (16.9 mm [SD 2.9 mm] vs.12.9 mm [SD 3.2 mm]; p < 0.001) in group 1. Aortic wall abnormalities, including dissections, bulges and aneurysms, were observed in eight patients in group 2 (53%) and in one in group 1 (7%) (p < 0.001). There was no major complication. Repeat catheterization (n = 33) or magnetic resonance imaging (n = 2) was performed at a median follow-up of 1.0 year for group 1 and 1.5 year for group 2 (p = 0.005). Gradient reduction persisted in both groups, although higher late gradients were observed in group 2 (median of 0 mmHg for group 1 vs. 3 mmHg for group 2; p = 0.014). There was no late loss in the coarctation diameter in group 1 and there was a late gain in group 2 (16.7 mm [SD 2.9 mm] for group 1 vs. 14.6 mm [SD 3.9 mm] for group 2; p = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in group 1. Aortic wall abnormalities did not progress and one patient required redilation due to recoarctation in group 2. Blood pressure was similar in both groups at follow-up (systolic: 126 mmHg [SD 12 mmHg] in group 1 vs. 120 mmHg [SD 15 mmHg] in group 2; diastolic: 81 mmHg [SD 11 mmHg] in group 1 vs. 80 mmHg [SD 10 mmHg] in group 2; p = 0.149 and p = 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, the use of stents yielded more predictable and uniform results for stenosis relief, also minimizing the risk of developing aortic wall abnormalities.

Mais informações são necessárias para definir se o tratamento percutâneo da coartação da aorta com stents é superior à angioplastia com cateter-balão. De julho de 2000 a maio de 2003, 21 adolescentes e adultos com coartação da aorta focal e média de idade de 24 anos (DP 11 anos) foram submetidos, consecutivamente, a implante de stents (grupo 1). Os resultados foram comparados com os obtidos em um grupo histórico de 15 pacientes com média de idade de 18 anos (DP 10 anos) (p = 0,103) submetidos a angioplastia (grupo 2) nos últimos 18 anos. Após o procedimento, a redução do gradiente sistólico foi maior (99% [DP 2%] versus 87% [DP 17%]; p = 0,015), o gradiente residual foi menor (0,4 mmHg [DP 1,4 mmHg] versus 5,9 mmHg [DP 7,9 mmHg]; p = 0,019), o ganho no local da coartação foi maior (333% [DP 172%] \"versus\" 190% [DP 104%]; p = 0,007) e o diâmetro da coartação foi maior (16,9 mm [DP 2,9 mm] versus 12,9 mm [DP 3,2 mm]; p < 0,001) no grupo 1. Alterações da parede da aorta, incluindo dissecções, abaulamentos e aneurismas, foram observadas em oito pacientes do grupo 2 (53%) e em um do grupo 1 (7%) (p < 0,001). Não houve complicações maiores. Cateterismo (n = 33) ou ressonância magnética (n = 2) de controle foram realizados em seguimento mediano de um ano para o grupo 1 e um ano e meio para o grupo 2 (p = 0,005). A redução do gradiente sistólico persistiu em ambos os grupos; entretanto, gradientes tardios mais altos foram observados no grupo 2 (mediana de 0 mmHg para o grupo 1 versus 3 mmHg para o grupo 2; p = 0,014). Não houve perdas no diâmetro da coartação no grupo 1 e houve ganho tardio no grupo 2 (16,7 mm [DP 2,9 mm] versus 14,6 mm [DP 3,9 mm]; p = 0,075). No grupo 1, dois pacientes necessitaram de novo implante de stent em decorrência da formação de aneurisma ou fratura da malha do stent. No grupo 2, as anormalidades da parede aórtica não progrediram e um paciente necessitou de redilatação em decorrência da recoartação. A pressão arterial sistêmica foi semelhante em ambos os grupos durante o seguimento (sistólica: 126 mmHg [DP 12 mmHg] no grupo 1 versus 120 mmHg [DP 15 mmHg] no grupo 2; diastólica: 81 mmHg [DP 11 mmHg] no grupo 1 versus 80 mmHg [DP 10 mmHg] no grupo 2; p = 0,149 e p = 0,975, respectivamente). Apesar de os desfechos clínicos terem sido satisfatórios e similares com ambas as técnicas, o uso de stents propiciou resultados mais previsíveis e uniformes para alívio da estenose, minimizando também o risco de desenvolvimento de alterações da parede da aorta. / More information is needed to define whether stenting is superior to balloon angioplasty for coarctation of the aorta. From July/2000 to May/2003, 21 adolescents and adults with discrete coarctation underwent consecutive stent implantation at a mean age of 24 years (SD 11 years) (group 1). The results were compared to those achieved by balloon angioplasty performed in the last 18 years in a historical group of 15 patients at a mean age of 18 years (SD 10 years) (p = 0.103) (group 2). After the procedure, systolic gradient reduction was higher (99% [SD 2%] vs. 87% [SD 17%]; p = 0.015), residual gradients lower (0.4 mmHg [SD 1.4 mmHg] vs. 5.9 mmHg [SD 7.9 mmHg); p = 0.019), gain at the coarctation site higher (333% [SD 172%] vs. 190% [SD 104%]; p = 0.007) and coarctation diameter larger (16.9 mm [SD 2.9 mm] vs.12.9 mm [SD 3.2 mm]; p < 0.001) in group 1. Aortic wall abnormalities, including dissections, bulges and aneurysms, were observed in eight patients in group 2 (53%) and in one in group 1 (7%) (p < 0.001). There was no major complication. Repeat catheterization (n = 33) or magnetic resonance imaging (n = 2) was performed at a median follow-up of 1.0 year for group 1 and 1.5 year for group 2 (p = 0.005). Gradient reduction persisted in both groups, although higher late gradients were observed in group 2 (median of 0 mmHg for group 1 vs. 3 mmHg for group 2; p = 0.014). There was no late loss in the coarctation diameter in group 1 and there was a late gain in group 2 (16.7 mm [SD 2.9 mm] for group 1 vs. 14.6 mm [SD 3.9 mm] for group 2; p = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in group 1. Aortic wall abnormalities did not progress and one patient required redilation due to recoarctation in group 2. Blood pressure was similar in both groups at follow-up (systolic: 126 mmHg [SD 12 mmHg] in group 1 vs. 120 mmHg [SD 15 mmHg] in group 2; diastolic: 81 mmHg [SD 11 mmHg] in group 1 vs. 80 mmHg [SD 10 mmHg] in group 2; p = 0.149 and p = 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, the use of stents yielded more predictable and uniform results for stenosis relief, also minimizing the risk of developing aortic wall abnormalities.