Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-24T19:03:23.132Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors affecting left ventricular remodelling and mechanics in the long-term follow-up after successful repair of aortic coarctation

Published online by Cambridge University Press:  22 April 2005

Roberto Crepaz ,
Roberto Cemin ,
Cristina Romeo ,
Edoardo Bonsante ,
Lino Gentili ,
Diego Trevisan ,
Walter Pitscheider  and
Giovanni Stellin
Roberto Crepaz
Affiliation:
Department of Cardiology, S. Maurizio Regional Hospital of Bolzano, Italy
Roberto Cemin
Affiliation:
Department of Cardiology, S. Maurizio Regional Hospital of Bolzano, Italy
Cristina Romeo
Affiliation:
Department of Cardiology, S. Maurizio Regional Hospital of Bolzano, Italy
Edoardo Bonsante
Affiliation:
Department of Cardiology, S. Maurizio Regional Hospital of Bolzano, Italy
Lino Gentili
Affiliation:
Department of Paediatrics, S. Maurizio Regional Hospital of Bolzano, Italy
Diego Trevisan
Affiliation:
Department of Statistics, S. Maurizio Regional Hospital of Bolzano, Italy
Walter Pitscheider
Affiliation:
Department of Cardiology, S. Maurizio Regional Hospital of Bolzano, Italy
Giovanni Stellin
Affiliation:
Department of Paediatric Cardiac Surgery, University of Padova, Italy
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims: To identify factors predisposing to abnormal left ventricular geometry and mechanics in 52 patients after successful repair of aortic coarctation. Methods and results: We evaluated left ventricular remodelling, systolic midwall mechanics, and isthmic gradient by echo-Doppler, systemic blood pressure at rest/exercise and by ambulatory blood pressure monitoring, and the aortic arch by magnetic resonance imaging. Echocardiographic findings were compared with those of 142 controls. The patients with aortic coarctation showed an increased indexed left ventricular end-diastolic volume, increased mass index, increased ratio of mass to volume and systolic chamber function. The contractility, estimated at midwall level, was increased in 21 percent of the patients. In 26 (50 percent) of the patients, we found abnormal left ventricular geometry, with 9 percent showing concentric remodelling, 33 percent eccentric hypertrophy, and 8 percent concentric hypertrophy. These patients were found to be older, underwent a later surgical repair, and to have higher systolic blood pressures at rest and exercise as well as during ambulatory monitoring. The relative mural thickness and mass index of the left ventricle showed a significant correlation with different variables on uni- and multivariate analysis. Age and diastolic blood pressure at rest are the only factors associated with abnormal left ventricular remodelling. Conclusions: Patients who have undergone a seemingly successful surgical repair of aortic coarctation may have persistently abnormal geometry with a hyperdynamic state of the left ventricle. This is more frequent in older patients, and in those with higher diastolic blood pressures.

Keywords

Grown-up congenital heart diseaseadults with congenital heart diseaseleft ventricular midwall function
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 2 , March 2005 , pp. 160 - 167
Copyright
© 2005 Cambridge University Press

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

Moskowitz WB, Schieken RM, Mosteller M, Bossano R. Altered systolic and diastolic function in children after successful repair of the aorta. Am Heart J 1990; 120: 103–109.Google Scholar
Carpenter MA, Dammann JF, Watson DD, et al. Left ventricular hyperkinesias at rest and during exercise in normotensive patients 2 to 27 years after coarctation repair. J Am Coll Cardiol 1985; 6: 879–886.Google Scholar
Leandro J, Smallhorn JF, Benson L, et al. 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.Google Scholar
Kimball BP, Shurvell BL, Houle S, et al. Persistent ventricular adaptation in postoperative coarctation of the aorta. J Am Coll Cardiol 1986; 8: 172–178.Google Scholar
Presbitero P, Demarie D, Villani M, et al. Long term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 1987; 57: 462–467.Google Scholar
Clarkson PM, Nicholson MR, Barrat-Boyes BG, Neutze JM, Whitlock RM. Results after repair of coarctation of the aorta beyond infancy: 10 to 28 year follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 1481–1488.Google Scholar
Pacileo G, Pisacane C, Russo MG, et al. Left ventricular remodelling and mechanics after successful repair of aortic coarctation. Am J Cardiol 2001; 87: 748–752.Google Scholar
Daniels SR, Loggie JMH, Khoury P, Kimball TR. Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 1998; 97: 1907–1911.Google Scholar
Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodelling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550–1558.Google Scholar
Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbility and mortality in men and women with essential hypertension. Ann Intern Med 1991; 114: 345–352.Google Scholar
Verdecchia P, Schillaci G, Borgioni C, et al. Adverse prognostic significance of concentric remodelling of the left ventricle in hypertensive patients with normal left ventricular mass. J Am Coll Cardiol 1995; 25: 871–878.Google Scholar
Second Task Force on Blood Pressure Control in Children: Report of the Second Task Force on Blood Pressure Control in Children – 1987. Paediatrics 1987; 79: 1–25.
Sahn DJ, DeMaria A, Kisslo J, Weyman A. The committee on M-Mode Standardization of the American Society for Echocardiography. Recommendations regarding quantitations in M-Mode echocardiography; results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–1083.Google Scholar
Iwahara M, Benson LN, Freedom RM. Noninvasive estimation of end-systolic aortic pressure in children. Echocardiography 1991; 8: 559–562.Google Scholar
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.Google Scholar
Deveroux RB, Alonso DR, Lutas A, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.Google Scholar
Daniels SR, Meyer RA, Liang Y, Bove KE. Echocardiographically determined left ventricular mass index in normal children adolescents and young adults. J Am Coll Cardiol 1988; 12: 703–708.Google Scholar
De Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251–1260.Google Scholar
Shimizu G, Zile MR, Blaunstein AS, Gaash WH. Left ventricular chamber filling and midwall fibre lengthening in patients with left ventricular hypertrophy: overestimation of fibre velocity by conventional midwall measurements. Circulation 1985; 71: 266–272.Google Scholar
Gentles TL, Sanders SP, Colan SD. Misrepresentation of left ventricular contractile function by endocardial indexes: clinical implications after coarctation repair. Am Heart J 2000; 140: 585–595.Google Scholar
Gaash WH, Zile MR, Hoshino PK, Apstein CS, Blaunstein AS. Stress-shortening relations and myocardial blood flow in compensated and failing canine hearts with pressure-overload hypertrophy. Circulation 1989; 79: 872–883.Google Scholar
De Simone G, Devereux RB, Roman MJ, et al. Assessment of left ventricular function by midwall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol 1994; 23: 1444–1451.Google Scholar
Colan SD. Noninvasive assessment of myocardial mechanics; a review of analysis of stress-shortening and stress-velocity. Cardiol Young 1992; 2: 1–13.Google Scholar
Stern HC, Locher D, Wallnoefer K. Noninvasive assessment of coarctation of the aorta: comparison measurements by two-dimensional echocardiography, magnetic resonance and angiography. Ped Cardiol 1991; 12: 1–5.Google Scholar
James F, Blomqvist CG, Freed MD, et al. Standard for exercise testing in paediatric age group. American Heart association Council on Cardiovascular Disease in the Young. Circulation 1982; 66: 1377A–1397A.Google Scholar
Aldousany AW, DiSessa TG, Alpert BS, Birnbaum SE, Willey ES. Significance of the Doppler-derived gradient across a residual coarctation. Ped Cardiol 1990; 11: 8–14.Google Scholar
Ernst ME, Bergus GR. Noninvasive 24-hour ambulatory blood pressure monitoring. Overview of technology and clinical applications. Pharmacotherapy 2002; 5: 597–612.Google Scholar
Zak R. Cell proliferation during cardiac growth. Am J Cardiol 1973; 31: 211–219.Google Scholar
Pacileo G, Pisacane C, Russo MG, Di Donato RM, Vosa C, Calabrò R. Left ventricular mechanics after early successful repair of aortic coarctation. Cardiol Young 1995; 5: 310–318.Google Scholar
Krogman ON, Kramer HH, Rammos S, Heush A, Bourgeois M. Non-invasive evaluation of left ventricular systolic function late after coarctation repair: influence of early vs late surgery. Eur Heart J 1993; 14: 764–769.Google Scholar
Kimball BP, Shurvell BL, Houle S, Fulop JG, Rakowsky H, McLaughlin PR. Persistent ventricular adaptation in postoperative coarctation of the aorta. J Am Coll Cardiol 1986; 8: 172–178.Google Scholar
Balderston SM, Dakerkow 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.Google Scholar
Beekman RH, Rocchini AP, Behrendt DN, et al. Longterm outcome after reapair of coarctation in infancy: subclavian angioplasty does not reduce the need for reoperation. J Am Coll Cardiol 1986; 8: 1406–1411.Google Scholar
Brili S, Dernellis J, Aggeli C, et al. Aortic elastic properties in patients with repaired coarctation of aorta. Am J Cardiol 1998; 82: 1140–1143.Google Scholar
Gidding SS, Rocchini AP, Moorehead C, Schork MA, Rosenthal A. Increased forearm vascular reactivity in patients with hypertension after repair of coarctation. Circulation 1985; 71: 495–499.Google Scholar
Guenthard J, Wyler F. Doppler echocardiography during exercise to predict residual narrowing of the aorta after coarctation resection. Ped Cardiol 1996; 17: 370–374.Google Scholar
Weber HS, Cyran SE, Grzeszczak M, Meyers JL, Gleason NM, Baylon BG. Discrepanciens in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 1993; 21: 1002–1007.Google Scholar
Cyran SE, Grzeszczak M, Kaufman K, et al. Aortic recoarctation at rest versus exercise in children evaluated by stress-Doppler after good repair. Am J Cardiol 1993; 71: 963–970.Google Scholar