Impaired left atrial function in adults and adolescents with corrected aortic coarctation

Area of Science:

• Cardiology
• Medical Imaging
• Pediatric Cardiology

Background:

• Aortic coarctation (CoA) repair is a common surgical intervention.
• Long-term effects of CoA repair on cardiac function, particularly left atrial (LA) function, require further investigation.
• Understanding LA function post-repair is crucial for managing patient outcomes.

Purpose of the Study:

• To evaluate left atrial (LA) function using 2D strain analysis in patients after aortic coarctation (CoA) repair.
• To explore the relationship between LA function and patient characteristics, including aortic arch anatomy.
• To identify the prevalence of LA dysfunction (LAD) and its clinical implications post-CoA repair.

Main Methods:

• Two-dimensional (2D) strain imaging was employed to assess LA and left ventricular (LV) functions in 56 CoA repair patients and 56 controls.
• Key metrics included peak-positive LA strain, diastolic LA strains, and LV global strains (longitudinal and circumferential).
• LA dysfunction (LAD) was defined based on established criteria for peak-positive LA strain.

Main Results:

• Patients with repaired CoA exhibited significantly lower peak-positive LA strain, diastolic LA strains, and LV-GLS compared to controls.
• 41% of CoA patients presented with LAD (peak-positive LA strain < 25%).
• Non-congruent aortic arch anatomy in post-end-to-end anastomosis/subclavian flap repair patients was associated with lower peak-positive LA strain.

Conclusions:

• Left atrial dysfunction (LAD) is prevalent in patients long after aortic coarctation repair.
• Postoperative aortic arch anatomy may be a significant factor influencing LA strain.
• LAD in CoA patients is linked to a higher incidence of ischemic stroke and atrial arrhythmia.