Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-03T05:43:58.933Z Has data issue: false hasContentIssue false
  • English
  • Français

Left ventricular mechanics after early successful repair of aortic coarctation

Published online by Cambridge University Press:  19 August 2008

Giuseppe Pacileo ,
Carlo Pisacane ,
Giovanna M. Russo ,
Roberto M. Di Donato ,
Carlo Vosa  and
Raffaele Calabrò
Giuseppe Pacileo
Affiliation:
From Pediatric Cardiology and Pediatric Cardiac Surgery, University of Naples, Monaldi Hospital, Naples and Pediatric Cardiothoracic Surgery, Children's Hospital, Newark
Carlo Pisacane
Affiliation:
From Pediatric Cardiology and Pediatric Cardiac Surgery, University of Naples, Monaldi Hospital, Naples and Pediatric Cardiothoracic Surgery, Children's Hospital, Newark
Giovanna M. Russo
Affiliation:
From Pediatric Cardiology and Pediatric Cardiac Surgery, University of Naples, Monaldi Hospital, Naples and Pediatric Cardiothoracic Surgery, Children's Hospital, Newark
Roberto M. Di Donato
Affiliation:
From Pediatric Cardiology and Pediatric Cardiac Surgery, University of Naples, Monaldi Hospital, Naples and Pediatric Cardiothoracic Surgery, Children's Hospital, Newark
Carlo Vosa
Affiliation:
From Pediatric Cardiology and Pediatric Cardiac Surgery, University of Naples, Monaldi Hospital, Naples and Pediatric Cardiothoracic Surgery, Children's Hospital, Newark
Raffaele Calabrò*
Affiliation:
From Pediatric Cardiology and Pediatric Cardiac Surgery, University of Naples, Monaldi Hospital, Naples and Pediatric Cardiothoracic Surgery, Children's Hospital, Newark
*
Dr. Raffaele Calabrò, Via Bracco 71, 80100 Naples, Italy. Fax. 081-7062355.
Get access Rights & Permissions [Opens in a new window]

Summary

A successful aortic coarctectomy performed beyond early infancy is followed, even in the long term, by persistence of left ventricular hypertrophy and by diastolic dysfunction, although systolic function is often increased. In this study we investigated whether earlier coarctectomy provides better preservation of left ventricular function. Experimental studies on the myocardial response to pressure overload show that neonates and young infants develop a functionally advantageous combination of myocytic hyperplasia (together with mild hypertrophy) and increased angiogenesis. Older patients, in contrast, generate myocytic hypertrophy in isolation, setting the scene for ventricular dysfunction. Cross-sectional echo-Doppler evaluation of left ventricular size, shape, mass and systolic and diastolic function was made in 13 patients a mean of 44±36 months (range 11 days-10 years) after successful coarctectomy in the first year of life. They were compared to 11 age, body surface area and gender-matched control subjects. In all patients, left ventricular mass normalized for body surface area was significantly greater than in the control group (66.2±12.3 vs 43±l2 p=0.0001). There was no correlation between left ventricular mass normalized for body surface area and age at operation, follow-up duration, degree of residual isthmic gradient, peak systolic wall stress, systolic blood pressure or left ventricular shape. No significant differences were noted between the two groups in regard to transverse diameter of the aortic arch, left ventricular afterload (meridional end-systolic wall stress), volume and shape (both in systole and diastole), systolic performance (fractional shortening and ejection fraction) and contractility (rate-corrected velocity of fiber shortening to meridional end-systolic wall stress relationship). Furthermore, no significant differences were found with respect to indices of mitral (including peak filling rate normalized to mitral stroke volume) and pulmonary venous flow, suggesting normal diastolic function. Repair of aortic coarctation in the first year of life promotes a more complete recovery of left ventricular function (particularly diastolic) than that reported after coarctectomy at older age, despite persistence of moderate ventricular hypertrophy.

Keywords

Left ventricular functionaortic coarctation repairechocardiography
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 5 , Issue 4 , October 1995 , pp. 310 - 318
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bunnell, IL, Ikkos, D, Rudhe, UG, Swan, HJC. Left heart volumes in coarctation of the aorta. Am Heart J 1961; 61: 165–172.CrossRefGoogle ScholarPubMed
2. Donner, R, Black, I, Spann, JF, Carabello, BA. Left ventricular wall stress and function in childhood coarctation of the aorta. J Am Coll Cardiol 1985; 5: 1161–1167.CrossRefGoogle ScholarPubMed
3. Carpenter, MA, Dammann, JF, Watson, DD, Jedeikin, R, Tompkins, DG, Beller, GA. Left ventricular hyperkinesia at rest and during exercise in normotensive patients 2 to 27 years after coarctation repair. J Am Coll Cardiol 1985; 6: 879–886.CrossRefGoogle ScholarPubMed
4. Kimball, BP, Shurvell, BL, Houle, S, Fulop, JC, Rakowski, H, McLaughlin, PR. Persistent ventricular adaptations in postoperative coarctation of the aorta. J Am Coll Cardiol 1986; 8: 172–178.CrossRefGoogle ScholarPubMed
5. Moskowitz, WB, Schieken, RM, Mosteller, M, Bossano, R. Altered systolic and diastolic function in children after successful repair of coarctation of the aorta. Am Heart J 1990; 120: 103–109.CrossRefGoogle ScholarPubMed
6. Ong, CM, Canter, CE, Gutierrez, FR, Sekarski, DR, Goldring, DR. Increased stiffness and persistent narrowing of the aorta after successful repair of coarctation of the aorta: relationship to left ventricular mass and blood pressure at rest and with exercise. Am Heart J 1992; 123: 1594–1600.CrossRefGoogle ScholarPubMed
7. Pelech, AN, Kartodihardjo, W, Balfe, JA, Balfe, JW, Olley, BM, Leenen, FHH. Exercise in children before and after coarctectomy: hemodynamic, echocardiographic, and biochemical assessment. Am Heart J 1986; 112: 1263–1270.CrossRefGoogle ScholarPubMed
8. Leandro, J, Smallhorn, JF, Benson, L, Musewe, N, Balfe, JW, Dyck, JD, West, L, Freedom, R. Ambulatory blood pressure monitoring and left ventricular mass and function after successful surgical repair of coarctation of the aorta. J Am Coll Cardiol 1992; 20: 197–204.CrossRefGoogle ScholarPubMed
9. Krogmann, ON, Rammos, S, Jakob, M, Corin, WJ, Hess, OM, Bourgeois, M. Left ventricular diastolic dysfunction late after coarctation repair in childhood: influence of left ventricular hypertrophy. J Am Coll Cardiol 1993; 21: 1454–1460.CrossRefGoogle ScholarPubMed
10. Cohen, M, Fuster, V, Steele, P, Driscoll, D, McGoon, D. Coarctation of the aorta: long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.CrossRefGoogle ScholarPubMed
11. Maron, BJ, O'Neal, Humphries J, Rowe, RD, Mellits, ED. Prognosis of surgically corrected coarctation of the aorta. A 20- year postoperative assessment. Circulation 1973; 47: 119–126.CrossRefGoogle Scholar
12. Clarkson, PM, Nicholson, MR, Barrat-Boyes, BG, Neutze, GM, Whitlock, RM. Results after repair of coarctation of the aorta beyond infancy: a 10 to 28 year follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 1481–1488.CrossRefGoogle ScholarPubMed
13. Di Donato, RM, Fujii, AM, Jonas, RA, Castaneda, AR. Age-dependent ventricular response to pressure overload. Considerations for the arterial switch operation. J Thorac Cardiovasc Surg 1992; 104: 713–722.CrossRefGoogle ScholarPubMed
14. Rakusan, K, Flanagan, MF, Geva, T, Southern, J, Van Praagh, R. Morphometry of human coronary capillaries during normal growth and the effect of age in left ventricular pressure-overload hypertrophy. Circulation 1992; 86: 38–46.CrossRefGoogle ScholarPubMed
15. Horan, MJ, Folkner, B, Kimm, SYS, Loggie, JMH, Prineas, RJ, Rosner, B, Hutchinson, J, Lauer, R, Mueller, S, Riopel, DA, Sinaiko, A, Weidman, WH, Berenson, G, Fixler, D, Schachter, J. Report of the Second Task Force on Blood Pressure Control in Children—1987. Pediatrics 1987; 79: 1–25.Google Scholar
16. Michaelson, M, Sunnegardh, J, Hallberg, M, Aberg, T. Cuff pressure and Doppler gradients after coarctectomy: a long-term follow-up. Acta Paediatric Scand(Suppl) 1986; 329: 94–97.CrossRefGoogle Scholar
17. Snider, AR, Serwer, GA. Echocardiography in Pediatric Heart Disease. Year Book Medical Publishers, Chicago, 1990, pp 118–119.Google Scholar
18. Colan, SD, Borow, KM, Neumann, A. Left ventricular end-systolic wall stress–velocity of fiber shortening relation: a load independent index of myocardial contractility. J Am Coll Cardiol 1984; 4: 715–724.CrossRefGoogle ScholarPubMed
19. Sahn, DJ, DeMaria, A, Kisslo, J, Weymann, A. The Committee on M-mode Standardization of American Society of Echocardiography. Recommendations regarding quantitation in M-mode echocardiography: result of a survey of echocardiographic measurements Circulation 1978; 58: 1072–1083.CrossRefGoogle Scholar
20. Teichholz, LE, Kreulen, T, Herman, MV, Gorlin, R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 1976; 37: 7–11.CrossRefGoogle ScholarPubMed
21. Kronik, G, Slany, J, Mosslacher, H. Comparative value of eight M-mode echocardiographic formulas for determining left ventricular stroke volume: a comparative study with thermodilution and left ventricular single-plane cineangiography. Circulation 1979; 60: 1308–1316.CrossRefGoogle ScholarPubMed
22. Grossman, W, Jones, D, McLaurin, LP. Wall stress and pattern of hypertrophy in the human left ventricle. J Clin Invest 1975; 56: 56–64.CrossRefGoogle ScholarPubMed
23. Devereux, RB, Alonso, DR, Lutas, EM, Gottlieb, GJ, Campo, E, Sachs, I, Reicheck, N. Echocardiographic assessment of left ventricular hypertrophy to necropsy findings. Am J Cardiol 1986; 57: 450–458.CrossRefGoogle ScholarPubMed
24. Daniels, R, Meyer, RA, Liaug, Y, Bove, KE. Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults. J Am Coll Cardiol 1988; 12: 703–708.CrossRefGoogle ScholarPubMed
25. Gaasch, WH. Left ventricular radius to wall thickness ratio. Am J Cardiol 1979; 43: 1189–1194.CrossRefGoogle ScholarPubMed
26. Borow, KM, Lang, RM, Neumann, A, Caroll, JD, Rajfer, SI. Physiologic mechanisms governing hemodynamic responses to positive inotropic therapy in patients with dilated cardio-myopathy. Circulation 1988; 77: 625–637.CrossRefGoogle Scholar
27. Bazett, HC. An analysis of the time relations of electrocardiograms. Heart 1920; 7: 353–370.Google Scholar
28. Kimball, TR, Daniels, SR, Khoury, P, Meyer, RA. Age-related variation in contractility estimate in patients <20 years of age. Am J Cardiol 1991; 68: 1383–1387.CrossRefGoogle ScholarPubMed
29. Bowman, LK, Lee, FA, Jaffe, CC, Mattera, J, Wackers, FJTh, Zaret, BL. Peak filling rate normalized to mitral stroke volume: a new Doppler echocardiographic filling index validated by radionuclide angiographic techniques. J Am Coll Cardiol 1988; 12: 937–943.CrossRefGoogle ScholarPubMed
30. Masuyama, T, Lee, JM, Tamai, M, Tanouchi, J, Kitabatake, A, Kamada, T. Pulmonary venous flow velocity pattern as assessed with transthoracic pulsed Doppler echocardiography in subjects without cardiac disease. Am J Cardiol 1991; 67: 1396–1404.CrossRefGoogle ScholarPubMed
31. Hood, WP, Rackley, CE, Rolett, EL. Wall stress in the normal and hypertrophied human ventricle. Am J Cardiol 1968; 22: 550–558.CrossRefGoogle Scholar
32. Borow, KM, Colan, SD, Naumann, A. Altered left ventricular mechanics in patients with valvular aortic stenosis and coarctation of the aorta: effects on systolic performance and late outcome. Circulation 1985; 72: 515–522.CrossRefGoogle ScholarPubMed
33. Colan, SD, Sanders, SP, Borow, KM. Physiologic hypertrophy: effects on left ventricular systolic mechanics in athletes. J Am Coll Cardiol 1987; 9: 776–783.CrossRefGoogle ScholarPubMed
34. Colan, SD. Noninvasive assessment of myocardial mechanics—a review of analysis of stress-shortening and stress-velocity. Cardiol Young 1992; 2: 1–13.CrossRefGoogle Scholar
35. Balderston, SM, Daberkow, E, Clarke, DR,Wolfe, RR. Maximal voluntary exercise variables in children with postoperative coarctation of the aorta. J Am Coll Cardiol 1992; 19:154–158.CrossRefGoogle ScholarPubMed
36. Brown, AL. Morphologic factors in cardiac hypertrophy. In: Alpert, NR (ed). Cardiac Hypertrophy. Academic Press, New York, 1971, pp 11–18.Google Scholar
37. Limas, CJ. Myocardial nuclear protein kinases during postnatal development. Am J Physiol 1978; 234: H338–H355.Google Scholar
38. Dowel, RT, McManus, RE III. Pressure-induced cardiac enlargement in neonatal and adult rats. Left ventricular functional characteristics and evidence of cardiac muscle cell proliferation in the neonate. Circ Res 1978; 42: 303–310.CrossRefGoogle Scholar
39. Dorn, GW II, Donner, R, Assey, ME, Spann, JF Jr, Wiles, HB, Carabello, BA. Alterations in left ventricular geometry, wall stress, and ejection performance after correction of congenital aortic stenosis. Circulation 1988; 78: 1358–1364.CrossRefGoogle ScholarPubMed
40. Monrad, ES, Hess, OM, Murakami, T, Nonogi, H, Corin, WJ, Krayenbuehl, HP. Time course of regression of left ventricular hypertrophy after aortic valve replacement. Circulation 1988; 77: 1345–1349.CrossRefGoogle ScholarPubMed
41. Sluysmans, T, Sanders, SP, van der, Velde M, Matitiau, A, Parness, IA, Spevak, PJ, Mayer, JE, Colan, SD. Natural history and patterns of recovery of contractile function in single left ventricle after Fontan operation. Circulation 1992; 86: 1753–1761.CrossRefGoogle ScholarPubMed
42. Gould, KL, Lipscomb, K, Hamilton, GW, Kennedy, JW. Relation of left ventricular shape, function, and wall stress in man. Am J Cardiol 1974; 34: 627–633.CrossRefGoogle ScholarPubMed
43. Johnson, MC, Gutierrez, FR, Sekarski, DR, Ong, CM, Canter, CE. Comparison of ventricular mass and function in early versus late repair of coarctation of the aorta. Am J Cardiol 1994;73:698–701.CrossRefGoogle ScholarPubMed
44. Leskinen, M, Uhari, M, Tarkka, M, Kettunen, R. Left ventricular function in dogs 1 year after coarctectomy. Pediatr Cardiol 1991; 12: 150–154.CrossRefGoogle ScholarPubMed
45. Harrison, MR, Clifton, GD, Pennell, AT, De Maria, AN. Effect of heart rate on left ventricular diastolic transmitral flow velocity patterns assessed by Doppler echocardiography in normal subjects. Am J Cardiol 1991; 67: 622–627.CrossRefGoogle ScholarPubMed
46. Choong, CY, Abascal, VM, Thomas, JD, Guerrero, JL, McGlew, S, Weyman, AE. Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. Circulation 1988; 78: 672–683.CrossRefGoogle ScholarPubMed
47. Stoddard, MF, Pearson, AC, Kern, MJ, Ratclifft, J, Mrosek, DG, Labowitz, AJ. Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation 1989; 79: 1226–1236.CrossRefGoogle ScholarPubMed
48. Mild, S, Murakami, T, Iwase, T, Tomita, T, Nakamura, Y, Kawai, C. Doppler echocardiographic transmitral peak early velocity does not directly reflect hemodynamic changes in humans: importance of normalization to mitral stroke volume. J Am Coll Cardiol 1991; 17: 1507–1516.Google Scholar
49. Minich, LL, Snider, AR, Meliones, JN. Doppler evaluation of normalized peak filling in normal children and children with left ventricular outflow obstruction. J Am Soc Echocardiogr 1992; 5: 598–602.CrossRefGoogle ScholarPubMed
50. Klein, AL, Tajik, AG. Doppler assessment of pulmonary venous flow in healthy subjects and in patients with heart disease. J Am Soc Echocardiogr 1991; 4: 379–392.CrossRefGoogle ScholarPubMed
51. Smith, VE, Schulman, P, Karimeddini, MK, White, WB, Meeran, MK, Katz, AM. Rapid ventricular filling in left ventricular hypertrophy: II pathologic hypertrophy. J Am Coll Cardiol 1985; 5: 869–874.CrossRefGoogle ScholarPubMed
52. Granger, CB, Karimeddini, MK, Smith, VE, Shapiro, HR, Katz, AM, Riba, AL. Rapid ventricular filling in left ventricular hypertrophy: I physiologic hypertrophy. J Am Coll Cardiol 1985; 5: 862–868.CrossRefGoogle ScholarPubMed
53. Weber, HS, Cyran, SE, Grzeszczak, M, Myers, JL, Gleason, MM, Baylen, BG. Discrepancies in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 1993; 21: 1002–1007.CrossRefGoogle ScholarPubMed
54. Sehested, J, Baandrup, U, Mikkelsen, E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Implications for baroreceptor function. Circulation 1982; 65: 1060–1065.CrossRefGoogle ScholarPubMed