Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries?
BACKGROUND
Despite successful surgical correction, morbidity of patients with coarctation of the aorta is increased. It is well known that these patients have impaired elastic properties of the prestenotic arteries. To find out whether these abnormalities are primarily present or develop later, we studied 17 newborns before and early after surgical repair.


RESULTS
Aortic wall stiffness index and distensibility were calculated using ascending and abdominal aortic diameters determined by M-mode echocardiography and noninvasive estimation of aortic pulse pressure in the right arm and leg. Seventeen patients with aortic coarctation (mean age, 20+/-26 days) were compared with 17 normal neonates (mean age, 13+/-7 days) preoperatively and postoperatively (10+/-6 days after surgery). Ascending aortic distensibility in patients was significantly reduced preoperatively (79+/-58 versus 105+/-36; P=0.03) and postoperatively (65+/-24 versus 105+/-36; P<0.005). Preoperative and postoperative ascending aortic stiffness index was higher in patients (preoperative, 5.2+/-4.4 versus 2.7+/-0.9; P=0.04; postoperative, 4.0+/-1.6 versus 2.7+/-0.9; P<0.005). Elastic properties of the descending aorta did not differ preoperatively or postoperatively compared with those in normal subjects.


CONCLUSIONS
Elastic properties of the prestenotic aorta of patients with coarctation seem to be impaired primarily, even in neonates, and remain unchanged early after successful operation. Surgical correction does not resolve inborn pathology of the prestenotic aortic vascular bed.
Vogt
Manfred
M
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
Kühn
Andreas
A
Baumgartner
Daniela
D
Baumgartner
Christian
C
Busch
Raymonde
R
Kostolny
Martin
M
Hess
John
J
D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001017:Aortic Coarctation / Q000601:surgery*; D001021:Aortic Valve; D001157:Arterial Occlusive Diseases / Q000503:physiopathology*; D001794:Blood Pressure; D016022:Case-Control Studies; D003251:Constriction, Pathologic / Q000503:physiopathology; D004452:Echocardiography; D004548:Elasticity; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D016896:Treatment Outcome; D014655:Vascular Resistance