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Left ventricular remodeling and mechanics after successful repair of aortic coarctation
G Pacileo1, C Pisacane, M G Russo
1Pediatric Cardiology, 2nd University, A.O. Monaldi, Naples, Italy. gpacile@tin.it
Insights
Normotensive patients after aortic coarctation repair often show abnormal left ventricular (LV) geometry and hyperdynamic function, even years post-surgery. Factors predicting these persistent changes remain elusive in this cohort.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Aortic coarctation repair is crucial for long-term cardiovascular health.
- Persistent left ventricular (LV) abnormalities can occur post-repair, impacting patient outcomes.
- Understanding LV remodeling and mechanics is vital for managing patients after aortic coarctation surgery.
Purpose of the Study:
- To evaluate left ventricular (LV) remodeling and mechanics in normotensive patients post-aortic coarctation repair.
- To identify factors associated with persistent LV abnormalities after surgical correction.
- To assess LV geometry and contractility using advanced echocardiography and MRI.
Main Methods:
- Studied 40 normotensive patients with successful aortic coarctation repair using echo-Doppler and MRI.
- Assessed LV geometry (mass/height^2.7, relative wall thickness) and mechanics (Z-scores).
- Quantified aortic narrowing via MRI and analyzed potential predictors of LV remodeling.
Main Results:
- 60% of patients had normal LV geometry; 40% exhibited abnormal geometry (remodeling or eccentric hypertrophy).
- LV contractility was elevated in 70% (endocardial) and 37.5% (midwall) assessments.
- No significant independent predictors for abnormal LV remodeling were identified.
Conclusions:
- Normotensive patients post-aortic coarctation repair can exhibit LV hyperdynamic states and varied LV geometry.
- Late surgical repair may be associated with a higher incidence of hyperdynamic LV states.
- Further research is needed to elucidate predictors of persistent LV abnormalities and optimize long-term management.
Abstract:
Forty normotensive patients (mean age 12.3 +/- 6.5 years) followed up after a successful repair of aortic coarctation (mean age at coarctectomy 5.1 +/- 4.8 yrs) were studied by echo-Doppler to (1) evaluate left ventricular (LV) remodeling and endocardial and midwall mechanics, and (2) identify factors that might predispose to persistent abnormalities. Sex- and age-specific cutoff levels for LV mass/height2.7 and relative wall thickness were defined to assess LV geometry. To adjust for age-and growth-related changes in ventricular mechanics, all echocardiographic variables were expressed as a Z-score relative to the normal distribution. In addition, the smallest diameter of the aorta was assessed by magnetic resonance imaging and calculated as percent narrowing compared with the diameter of the aorta at the diaphragmatic level. In the study group, 24 of 40 patients (60%) had normal LV geometry. Among the 16 patients (40%) with abnormal LV geometry, 5 (12.5%) had a pattern of concentric remodeling and 11 (27.5%) an eccentric hypertrophy. LV hypertrophy was marked (LV mass index >51 g/m2.7) in 5 of these patients. No patient had a pattern of concentric hypertrophy. LV contractility was increased (Z-score >95th percentile) in 28 patients (70%) as assessed using the endocardial stress-velocity index. In contrast, LV contractility assessed using midwall stress-velocity index remained elevated (Z-score >95th percentile) in 15 patients (37.5%). The stepwise multiple logistic regression analysis was not able to detect any significant independent predictor of abnormal LV remodeling, including sex, age at surgical repair, length of postoperative follow-up, heart rate, body mass index, systolic and diastolic blood pressure, and smallest diameter of the aorta, as well as indexes of LV geometry (shape, mass, volume, mass/ volume ratio) and function (preload, afterload, pump function, and myocardial contractility). Thus, normotensive patients after surgical repair of aortic coarctation may be in an LV hyperdynamic cardiovascular state (more frequent in those who have undergone late repair) and have multiple patterns of LV geometry.