Myocardial performance after successful intervention for native aortic coarctation

Abstract

Coarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood.

Endothelin-1 activation in pediatric patients undergoing surgical coarctation of the aorta repair

“…This pattern is contrasted with more modest ET-1 level before surgery in older children and no significant post-operative change. Taking all patients together, our population also shows higher levels of ET-1 concentration than previously reported normal controls[ 11 ]. Similar changes in ET-1 level surrounding anatomic correction of a congenital heart lesion have not previously been described.…”

“…Clinical data in human subjects, however, are quite limited. While ET-1 concentration is increased compared to controls at late follow-up after coarctation repair[ 11 ], the clinical implications of this finding are yet to be evaluated. Further, no prior study has assessed either ET-1 concentration or its association with cardiovascular pathology at the time of initial surgery for CoA.…”

Clinical utility of B‐type natriuretic peptide (NP) in pediatric cardiac surgery – a systematic review

“…Another paper published after our original search, fulfilled our inclusion criteria . From these 39 papers , we excluded a further nineteen papers which looked at long‐term postoperative outcome as these studies did not evaluate NP levels during the immediate postoperative period but rather at the time of follow‐up . This systematic review therefore includes 20 peer‐reviewed papers (Figure ).…”

Circulating biomarkers of left ventricular hypertrophy in pediatric coarctation of the aorta

“…In coarctation of the aorta, Tavli et al demonstrated an association between ET-1 concentration and persistent LV hypertrophy at a mean of 58 months after coarctectomy. 17 Previous studies in adult subjects with heart failure due to reduced ejection fraction, ST-elevation myocardial infarction, and hypertension have each also shown an association between blood ET-1 concentration and clinical worsening. [18][19][20] Higher ET-1 concentration was additionally linked to larger shunt volume in preoperative pediatric subjects with left-to-right shunts.…”