الفهرس 
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Abstract
Coarctation of the aorta represents more than a simple obstructive lesion, as there is often evidence of hypertension and vascular dysfunction despite successful repair at an early age.
Patients who underwent a coarctation repair are at risk of developing hypertension at a young age, but the mechanism leading to hypertension and its true prevalence are still unclear.
The vast majority of studies reporting prevalence of hypertension after aortic coarctation repair have been retrospective reviews reporting the prevalence of hypertension on the basis of casual blood pressure measurement in outpatient clinics .It has now been demonstrated that the gold standard examination for detecting hypertension is 24-hour blood pressure monitoring, because it is more closely related to end-organ damage than screening with casual blood pressure monitoring.
The goal of this study is to assess the prevalence of systemic hypertension in those undergoing early successful repair of aortic coarctation(within the first two years of life) as compared with those undergoing late successful repair of aortic coarctation(after the first two years of life), including both catheter-based and surgical intervention using twenty-four hour ambulatory blood pressure monitoring.
Patients were divided into two groups:
group Ι: Included 15 patients who underwent early successful management of aortic coarctation (within the first two years of life), either catheter-based or surgical intervention.
group ΙΙ: Included 15 patients who underwent late successful management of aortic coarctation (after the first two years of life), either catheter-based or surgical intervention.
Patients have undergone full history taking, general and local cardiac examination and casual resting blood pressure measurement.
Patients underwent full echocardiographic study included peak instantaneous pressure doppler gradient through the coarctation repair, diameters of ascending aorta, aortic arch, coarctation segment and descending aorta at the diaphragm.
Lastly Patients underwent twenty four-hour ambulatory blood pressure monitoring.
13 patients of the study population underwent surgical repair while 17 patients underwent percutaneous intervention .
As regard number of interventions,22 patients underwent single intervention while 7 patients underwent two interventions and one patient underwent three interventions .
Follow up duration from first intervention to study ranged from 3 months to 19 years with a mean duration of 6.5 years.
Two patients were hypertensive in group Ι while 5 patients were hypertensive in group ΙΙ by office blood pressure measurement while Three patients were hypertensive in group Ι and 8 patients were hypertensive in group ΙΙ by ambulatory blood pressure monitoring
Although hypertension had higher incidence in group ΙΙ than group Ι by office and ambulatory blood pressure monitoring but statistically insignificant.
The study found that the 11 hypertensive patients by ambulatory blood pressure monitoring had increased BP load while only 5 of the 11 hypertensive patients had increased mean 24 hours BP measurements and 6 patients had normal 24 hours BP measurements. So it was concluded that blood pressure load on ABPM may therefore be a more relevant clinical parameter than the
standard mean BP calculation.
The study revealed that 3 patients in group Ι: 2 nondippers and one reverse dipper and similarly 3 patients were nondippers in group ΙΙ by ambulatory blood pressure monitoring.
The study found that sensitivity and specificity of office blood pressure for detecting Increased ambulatory blood pressure is 45 % and 89 % respectively.
As regard recurrent coarctation, The study found that 5 patients had recurrent coarctation and one patient had residual coarctation ( PG through descending aorta > 30 mmhg). Also two patients found to have hypoplastic aortic arch (z score < ─2) and one patient had aneurysm of ascending aorta.
The study concluded that early intervention of coarctation of the aorta during infancy decreases the risk of late systemic hypertension and further studies are needed to evaluate increased risk of recoarctation after early intervention of coarctation of the aorta.
The study also concluded that Office blood pressure leads to underdetection of systemic hypertension and home and ambulatory blood pressure monitoring are superior to office blood pressure in detection of systemic hypertension and follow up of drug efficacy.
The study also concluded that ABPM is recommended for detection of hypertension after aortic coarctation repair and time interval for applying ABPM should be individualized according to age and risk for hypertension.