Effect of Endovascular Stenting of Aortic Coarctation on Biventricular Function in Adults

Overview

Journal Heart

Date 2007 Jun 19

PMID 17575331

Citations 1

Authors

Yat-Yin Lam

Mehmet G Kaya

Wei Li

Vaikom S Mahadevan

Arif A Khan

Michael Y Henein

Michael Mullen

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the effect of endovascular stenting of aortic coarctation on biventricular function in adults during intermediate-term follow-up.

Methods: 21 patients (age 34 (10) years) were studied prospectively before and 14 (2) months after coarctation stenting from year 2002 to 2005. Biventricular function and blood pressure measurements were made. The post-stenting results were compared with pre-stenting values (group 1), with 22 age- and sex-matched post-surgical repair patients (group 2) and 30 normal controls (group 3).

Results: The peak systolic gradient across the coarctation site fell (55 (15) mm Hg to 18 (8) mm Hg, p<0.001). Systolic, mean blood pressure and left ventricular (LV) mass dropped after stenting (p<0.05 for all). LV long-axis function improved at intermediate-term follow-up (tissue Doppler imaging lateral and septal systolic and diastolic velocities and E/Em ratios: LSm, 6.5 (1.4) cm/s to 7.9 (1.7) cm/s; SSm, 5.8 (1.2) cm/s to 7.3 (1.6) cm/s; LEm, 8.1 (1.3) to 9.4 (2.3) cm/s; SEm, 6.7 (1.5) cm/s to 7.8 (1.9) cm/s; LE/Em, 11.2 (2.7) to 9.8 (2.8); SE/Em, 14.8 (5.3) to 11.8 (3.9); p<0.05 for all). No significant difference in LV ejection fraction, conventional LV diastolic measurements (E, A, E/A ratio, IVRT and DT) was found after stenting. No significant deterioration of right ventricular function was seen in stented patients. Both post-stenting and post-surgical repair patients had poorer LV long-axis function than controls (p<0.01 for all).

Conclusions: Endovascular stenting of aortic coarctation resulted in medium-term LV mass regression and long-axis function improvement that may provide insight into long-term outcome of the stented patients. The results support aortic stenting in patients with anatomically suitable defects, given the additional benefit of avoiding cardiopulmonary bypass. The clinical significance of subclinical myocardial dysfunction in patients with stented or repaired coarctation warrants further studies.

Citing Articles

Assessment of left ventricular diastolic function in children after successful repair of aortic coarctation.

Florianczyk T, Werner B Clin Res Cardiol. 2011; 100(6):493-9.

PMID: 21193915 PMC: 3100502. DOI: 10.1007/s00392-010-0272-1.

References

Warnes C . The adult with congenital heart disease: born to be bad?. J Am Coll Cardiol. 2005; 46(1):1-8. DOI: 10.1016/j.jacc.2005.02.083. View

Dokainish H, Abbey H, Gin K, Ramanathan K, Lee P, Jue J . Usefulness of tissue Doppler imaging in the diagnosis and prognosis of acute right ventricular infarction with inferior wall acute left ventricular infarction. Am J Cardiol. 2005; 95(9):1039-42. DOI: 10.1016/j.amjcard.2004.12.056. View

Heymans S, Schroen B, Vermeersch P, Milting H, Gao F, Kassner A . Increased cardiac expression of tissue inhibitor of metalloproteinase-1 and tissue inhibitor of metalloproteinase-2 is related to cardiac fibrosis and dysfunction in the chronic pressure-overloaded human heart. Circulation. 2005; 112(8):1136-44. DOI: 10.1161/CIRCULATIONAHA.104.516963. View

Murakami T, Takeda A . Enhanced aortic pressure wave reflection in patients after repair of aortic coarctation. Ann Thorac Surg. 2005; 80(3):995-9. DOI: 10.1016/j.athoracsur.2005.03.055. View

Vriend J, Engelfriet P, de Groot E, Elsen B, Kastelein J, Mulder B . Age at repair and left ventricular mass in patients after repair of aortic coarctation. J Thorac Cardiovasc Surg. 2005; 130(3):896-7. DOI: 10.1016/j.jtcvs.2005.03.026. View

Tan J, Babu-Narayan S, Henein M, Mullen M, Li W . Doppler echocardiographic profile and indexes in the evaluation of aortic coarctation in patients before and after stenting. J Am Coll Cardiol. 2005; 46(6):1045-53. DOI: 10.1016/j.jacc.2005.05.076. View

Mahadevan V, Vondermuhll I, Mullen M . Endovascular aortic coarctation stenting in adolescents and adults: angiographic and hemodynamic outcomes. Catheter Cardiovasc Interv. 2006; 67(2):268-75. DOI: 10.1002/ccd.20585. View

Carr J . The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol. 2006; 47(6):1101-7. DOI: 10.1016/j.jacc.2005.10.063. View

Lam Y, Kaya M, Goktekin O, Gatzoulis M, Henein M, Li W . "Isolated" diastolic dysfunction in left ventricular outflow tract obstruction. Am J Cardiol. 2006; 98(4):509-14. DOI: 10.1016/j.amjcard.2006.02.059. View

10.

Carr-White G, Kon M, Koh T, Glennan S, Ferdinand F, de Souza A . Right ventricular function after pulmonary autograft replacement of the aortic valve. Circulation. 1999; 100(19 Suppl):II36-41. DOI: 10.1161/01.cir.100.suppl_2.ii-36. View

11.

Marshall A, Perry S, Keane J, Lock J . Early results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation. Am Heart J. 2000; 139(6):1054-60. DOI: 10.1067/mhj.2000.106616. View

12.

Meluzin J, Spinarova L, Bakala J, Toman J, Krejci J, Hude P . Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J. 2001; 22(4):340-8. DOI: 10.1053/euhj.2000.2296. View

13.

Harrison D, McLaughlin P, Lazzam C, Connelly M, Benson L . Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up. Heart. 2001; 85(5):561-6. PMC: 1729735. DOI: 10.1136/heart.85.5.561. View

14.

Toro-Salazar O, Steinberger J, Thomas W, Rocchini A, Carpenter B, Moller J . Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002; 89(5):541-7. DOI: 10.1016/s0002-9149(01)02293-7. View

15.

Dhillon R, Josen M, Henein M, Redington A . Transcatheter closure of atrial septal defect preserves right ventricular function. Heart. 2002; 87(5):461-5. PMC: 1767091. DOI: 10.1136/heart.87.5.461. View

16.

Duncan A, Francis D, Henein M, Gibson D . Limitation of cardiac output by total isovolumic time during pharmacologic stress in patients with dilated cardiomyopathy: activation-mediated effects of left bundle branch block and coronary artery disease. J Am Coll Cardiol. 2003; 41(1):121-8. DOI: 10.1016/s0735-1097(02)02665-7. View

17.

de Divitiis M, Pilla C, Kattenhorn M, Donald A, Zadinello M, Wallace S . Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol. 2003; 41(12):2259-65. DOI: 10.1016/s0735-1097(03)00480-7. View

18.

Fawzy M, Awad M, Hassan W, Al Kadhi Y, Shoukri M, Fadley F . Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol. 2004; 43(6):1062-7. DOI: 10.1016/j.jacc.2003.10.040. View

19.

Sharma U, Barenbrug P, Pokharel S, Dassen W, Pinto Y, Maessen J . Systematic review of the outcome of aortic valve replacement in patients with aortic stenosis. Ann Thorac Surg. 2004; 78(1):90-5. DOI: 10.1016/j.athoracsur.2004.02.020. View

20.

Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T . Tissue Doppler imaging in patients with moderate to severe aortic valve stenosis: clinical usefulness and diagnostic accuracy. Am Heart J. 2004; 148(4):696-702. DOI: 10.1016/j.ahj.2004.03.049. View