Coarctation repair normalizes left ventricular function and aorto-septal angle in neonates
Haki Jashari1, Katarina Lannering2, Mats Mellander2
1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Insights
Coarctation of the aorta (CoA) causes a wider aorto-septal angle (AoSA) and impacts left ventricular (LV) function. Surgical repair normalizes AoSA and improves LV function and deformation.
Area of Science:
- Pediatric Cardiology
- Cardiac Imaging
- Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) increases left ventricular (LV) afterload, affecting LV and ascending aortic function.
- The aorto-septal angle (AoSA) is a potential indicator of these hemodynamic changes.
Purpose of the Study:
- To investigate the effect of CoA on LV function and AoSA before and after surgical repair.
- To correlate AoSA with LV function and deformation parameters.
Main Methods:
- Retrospective study of 21 patients with surgically repaired CoA.
- AoSA measurement at three cardiac cycle time points before and after intervention.
- Assessment of LV structure, function, global longitudinal strain, and strain rate using STE.
Main Results:
- AoSA was significantly wider in neonates with CoA, particularly at peak ejection, correlating with CoA pressure gradient.
- Post-intervention, AoSA normalized and correlated with improved LV cavity function and global deformation.
Conclusions:
- Abnormally wide AoSA in neonates with CoA is linked to obstruction severity, LV dysfunction, and impaired LV global deformation.
- AoSA normalization after repair indicates improved LV mechanics.
Background And Aims:
Patients with coarctation of the aorta (CoA) have increased left ventricular (LV) afterload that has been shown to impact the LV and ascending aortic function. We aimed to examine the effect of coarctation on LV function and aorto-septal angle (AoSA) before and after surgical repair.
Methods:
We retrospectively studied 21 patients with surgically repaired CoA at a median age of 9 (2-53) days at three time points: (1) just before intervention, (2) at short-term follow-up, and (3) at medium-term follow-up after intervention. AoSA was measured from the parasternal long axis view, at three time points during the cardiac cycle: (1) end diastole, (2) beginning of systole, and (3) at peak ejection in the descending aorta. In addition to conventional LV structure and function, global longitudinal strain, and strain rate were measured using STE technique and Tomtec software. Three groups of age matched healthy children served as controls at each time point.
Results:
AoSA was significantly wider before intervention, in particular at peak ejection in the descending aorta (144° ± 6.4° vs. 136° ± 4.1°; P < .0001), and correlated with CoA pressure gradient. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters.
Conclusions:
AoSA is abnormally wide in neonates with CoA and is associated with severity of obstruction, LV dysfunction and compromised LV global deformation.
