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Enhanced characterization of ventricular performance after coarctation repair in neonates and young children

Liselotte M Klitsie1, Arno A W Roest, Irene M Kuipers

  • 1Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

The Annals of Thoracic Surgery
|June 29, 2013
PubMed

Insights

Neonatal coarctation repair patients show persistent left ventricular systolic impairment one year post-surgery compared to non-neonatal patients. Diastolic function remains impaired in both groups after coarctation repair.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Echocardiography

Background:

  • Coarctation of the aorta repair involves distinct patient subgroups: neonates with critical coarctation and older children.
  • A hypothesis suggests that neonatal repair leads to more persistent postoperative ventricular dysfunction.

Purpose of the Study:

  • To compare biventricular performance after coarctation repair in neonatal versus non-neonatal patients.
  • To assess the long-term impact of coarctation repair timing on ventricular function.

Main Methods:

  • Prospective study of pediatric patients (0-17 years) undergoing coarctation repair, categorized as neonatal (<1 month) or non-neonatal.
  • Echocardiographic assessment of left (LV) and right ventricular (RV) performance, including fractional shortening, peak systolic (S') and early diastolic (E') tissue Doppler velocities, and E/E' ratio.
  • Measurements were taken preoperatively, at discharge, and 1 year postoperatively, with age-matched controls for comparison.

Main Results:

  • Left ventricular (LV) performance improved in both neonatal and non-neonatal groups within the first year post-coarctation repair.
  • One year post-surgery, neonatal patients had significantly lower LV systolic velocity (S') compared to controls, unlike non-neonatal patients.
  • LV diastolic performance remained impaired in both neonatal and non-neonatal patients one year after coarctation repair compared to controls.

Conclusions:

  • Left ventricular diastolic function does not normalize within one year following coarctation repair in either neonatal or non-neonatal patients.
  • Neonatal coarctation repair is associated with more persistent impairment of left ventricular systolic function compared to repair in older children.
Abstract

Keywords:
20EE'FSLVLVIDdLVIDsLVMILeft ventricle internal diameter at end-diastoleLeft ventricle internal diameter at end-systoleRVS'SDTDIV(max)aortic peak instantaneous velocity at the previous coarctation siteearly diastolic tissue Doppler imaging velocityfractional shorteningindexed left ventricular massleft ventriclepeak early wave Doppler flow velocityright ventriclestandard deviationsystolic tissue Doppler imaging velocitytissue Doppler imaging

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