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Left ventricular diastolic dysfunction late after coarctation repair in childhood: influence of left ventricular
O N Krogmann1, S Rammos, M Jakob
1Department of Pediatric Cardiology, Heinrich-Heine University, Düsseldorf, Germany.
Insights
Late after aortic coarctation repair, systolic function remains normal. However, diastolic dysfunction, indicated by an upward shift in the diastolic pressure-volume curve, may persist and is linked to left ventricular hypertrophy.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Coarctation of the aorta repair can lead to persistent hypertension and left ventricular hypertrophy.
- These conditions may negatively impact left ventricular function post-surgery.
Purpose of the Study:
- To evaluate left ventricular systolic and diastolic function in patients long after successful childhood aortic coarctation repair.
- To investigate the effects of residual hypertension and hypertrophy on cardiac function.
Main Methods:
- Biplane angiography and high-fidelity pressure measurements were performed in 12 post-coarctation repair patients (3-12 years post-op).
- Hemodynamic data were collected at rest and during nitroprusside infusion.
- Patient data were compared to 12 healthy control subjects.
Main Results:
- Systolic left ventricular function was preserved in all patients.
- Patients exhibited significantly higher left ventricular muscle mass, right atrial pressure, and left ventricular end-diastolic pressure compared to controls.
- An upward shift in the diastolic pressure-volume curve was observed, which nitroprusside administration reversed.
Conclusions:
- Successful aortic coarctation repair preserves systolic left ventricular function.
- Diastolic dysfunction, characterized by an altered diastolic pressure-volume relationship, can be present late after repair.
- This diastolic abnormality is likely attributable to residual left ventricular hypertrophy and is reversible with vasodilators.
Objectives:
Left ventricular systolic and diastolic function were evaluated late after successful operation for aortic coarctation in childhood.
Background:
Persistent arterial hypertension and left ventricular hypertrophy after coarctation repair might impair left ventricular function.
Methods:
Biplane angiography and simultaneous high fidelity pressure measurements were performed in 12 patients 3 to 12 years postoperatively (residual pressure gradient 4 mm Hg). Eight patients were normotensive and four had borderline hypertension. Data at rest and after nitroprusside infusion (1.7 micrograms/kg per min) were evaluated and compared with data from 12 control subjects.
Results:
Systolic left ventricular function (ejection fraction-end-systolic wall stress relation) was normal in all patients. However, left ventricular muscle mass (113 vs. 86 g/m2), right atrial pressure (5.2 vs. 1.9 mm Hg) and left ventricular end-diastolic pressure (16 vs. 11 mm Hg) were significantly higher in patients than in control subjects. There was a linear relation between muscle mass and left ventricular end-diastolic (r = 0.66, p < 0.001) or right atrial (r = 0.60, p < 0.01) pressure. Left ventricular relaxation and myocardial stiffness were normal. However, there was an upward shift of the diastolic pressure-volume curve when compared with control values, but this shift was reversed by the administration of nitroprusside.
Conclusions:
Systolic function is normal late after coarctation repair. However, diastolic function can be abnormal with an upward shift of the diastolic pressure-volume curve that is reversed by nitroprusside administration and is probably due to residual left ventricular hypertrophy.