title: Effect of endovascular stenting of aortic coarctation on biventricular function in adults.
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.
authors.affiliation: Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. homalam@hotmail.com
authors.forename: Yat-Yin
authors.initials: YY
authors.lastname: Lam
authors.forename: Mehmet G
authors.initials: MG
authors.lastname: Kaya
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Vaikom S
authors.initials: VS
authors.lastname: Mahadevan
authors.forename: Arif A
authors.initials: AA
authors.lastname: Khan
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
mesh_terms: D000328:Adult; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right