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Doppler echocardiography during exercise to predict residual narrowing of the aorta after coarctation resection
1Department of Cardiology, University Children's Hospital of Basel, Römergasse 8, Postfach, CH-4005 Basel, Switzerland.
Insights
Exercise Doppler echocardiography can identify significant residual narrowing after coarctation repair. A systolic half-time over 110 ms and diastolic gradient over 17 mmHg during exercise accurately predict >30% isthmic narrowing.
Area of Science:
- Cardiovascular Medicine
- Noninvasive Diagnostic Techniques
- Pediatric Cardiology
Background:
- Coarctation of the aorta (CoA) repair can lead to residual obstructions.
- Long-term surveillance is crucial for patients post-CoA resection.
- Noninvasive methods are needed to assess anastomotic site patency.
Purpose of the Study:
- To evaluate Doppler echocardiography during exercise for detecting residual coarctation.
- To correlate Doppler-derived parameters with the degree of anastomotic narrowing.
- To establish noninvasive criteria for identifying significant residual coarctation.
Main Methods:
- 36 patients underwent blood pressure measurement and Doppler echocardiography at rest and during exercise, 17 years post-coarctation resection.
- Doppler systolic and diastolic gradients and half-times were analyzed during exercise.
- Results were compared with magnetic resonance imaging (MRI) measurements of anastomotic narrowing.
Main Results:
- Exercise Doppler parameters were correlated with the degree of residual isthmic narrowing.
- A systolic half-time >110 ms and a diastolic gradient >/=17 mmHg during exercise predicted >30% narrowing.
- This noninvasive method demonstrated high predictive value for significant residual coarctation.
Conclusions:
- Exercise Doppler echocardiography is a valuable noninvasive tool for assessing residual coarctation.
- Specific Doppler criteria can identify patients requiring further imaging evaluation.
- Early detection of residual narrowing can guide decisions regarding surgical reintervention.
Abstract:
Blood pressure measurements and Doppler echocardiography at rest and during exercise were performed in 36 patients at an average 17 years after coarctation resection. Interest focused on the study of Doppler systolic and diastolic gradients and half-times during exercise. Blood pressure gradients and Doppler values were compared with the degree of narrowing at the site of the anastomosis measured by magnetic resonance imaging. A systolic half-time of >110 ms together with a diastolic gradient of >/=17 mmHg on exercise Doppler sonography predicted a residual isthmic narrowing of >30%. We propose the use of this noninvasive method for identifying patients with narrowing of >30% at the site of the anastomosis after coarctation resection. In these cases evaluation by an imaging technique is necessary to confirm the need for surgery.