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Echocardiographic evaluation of systolic and diastolic function in postoperative coarctation patients
L Y Sigurdardóttir1, H Helgason
1University of Iceland, Medical School, Reykjavik, Iceland.
Insights
Postoperative coarctation patients show left ventricular hypertrophy and hyperdynamic circulation. Increased flow velocities suggest outflow obstruction, indicating potential residual coarctation or diastolic dysfunction.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Postoperative coarctation (CoA) patients often exhibit persistent myocardial dysfunction.
- Understanding cardiac function in these patients is crucial for long-term outcomes.
Purpose of the Study:
- To investigate left ventricular (LV) size, mass, systolic and diastolic function, and outflow tract velocities in "healthy" postoperative CoA patients.
- To identify echocardiographic markers of persistent cardiac abnormalities.
Main Methods:
- M-mode echocardiography and Doppler ultrasonography were used.
- 28 postoperative CoA patients (5-21 years) and 28 controls were studied.
- Evaluated LV dimensions, mass, systolic function, diastolic parameters, and blood flow velocities.
Main Results:
- Patients had higher early (E) and late (A) diastolic transmitral velocities.
- Increased left atrial diameter, LV wall thickness, end-diastolic diameter, and LV mass were observed.
- Higher stroke volume, cardiac output, and cardiac index indicated a hyperdynamic circulation.
- Elevated LV outflow tract and aortic blood flow velocities suggested obstruction.
Conclusions:
- Postoperative CoA patients exhibit LV hypertrophy and hyperdynamic circulation.
- Increased A wave velocity is a sensitive marker for diastolic abnormality associated with LV hypertrophy.
- Elevated outflow velocities may indicate residual obstruction or increased flow in the descending aorta.
Abstract:
Postoperative coarctation (CoA) patients are often found to have signs of persistent myocardial dysfunction. M-mode echocardiography was performed to study left ventricular (LV) size, mass, and systolic function and Doppler ultrasonography to study LV filling and flow velocity in the LV outflow tract and aorta in 28 "healthy" postoperative CoA patients (5-21 years) and 28 age- and sex-matched controls. The early (E) and late (A) diastolic transmitral velocities were significantly higher in the patient group than in the controls (p < 0.05). Other diastolic parameters (isovolumic relaxation time, E/A ratio, and deceleration time of the early diastolic velocity) were similar in the two groups (p = NS). The left atrial diameter, LV wall average, end-diastolic diameter of the LV and LV mass were higher in the patients than controls (p < 0.05). The patients also had a higher stroke volume, cardiac output, and cardiac index than the controls (p < 0.01). The fractional shortening was similar in the two groups (p = NS). Blood flow velocities in both the LV outflow tract and aorta were higher in the patients than the controls (p < 0.0002). We found LV hypertrophy with signs of a hyperdynamic circulation (increased cardiac index and stroke volume) in our patients. An increase in A is associated with LV hypertrophy and seems to be a sensitive marker of diastolic abnormality. The rise in E is paradoxical but has been seen in other studies. The increased blood flow velocity in the LV outflow tract suggests obstruction to LV outflow and increased flow in the descending aorta is due to residual coarctation.