title: Assessment of ascending aorta distensibility after successful coarctation repair by strain Doppler echocardiography.
abstract: BACKGROUND
  Increased arterial stiffness may participate in the genesis of hypertension and increase of left ventricular (LV) mass after surgical correction of coarctation of the aorta. The purpose of the current study was to assess the aortic elastic properties using Doppler tissue imaging and strain rate imaging in patients after coarctoplasty.
  
  
  METHODS
  Echocardiography with Doppler tissue/strain rate imaging capabilities was performed in 26 adult normotensive patients who had successful repair of coarctation of the aorta in infancy and in 24 control subjects. Transesophageal aortic transverse sections were imaged at the level of the proximal and distal segments to the repair site. Doppler tissue imaging wall velocities during systole (S(w)), early relaxation (E(w)), and atrial systole (A(w)) and peak systolic strain (ps epsilon) were measured in both groups. Transthoracic ascending aorta (AAo) measurements were also obtained.
  
  
  RESULTS
  In the patients with coarctoplasty, S(w) velocities and ps epsilon were significantly decreased in the proximal segments compared with control subjects. Both peak systolic blood pressure after exercise (P < .001) and pulse pressure after exercise (P < .001) were directly related to AAo wall strain. LV annular early diastolic velocity was significantly reduced compared with control subjects in patients with decreased AAo wall strain and exercise-induced hypertension (P < .001) and related to AAo wall velocity (P < .005) and strain (P < .001). In multiple linear regression analysis, only weight, study group, and AAo wall strain were correlated to LV mass index.
  
  
  CONCLUSIONS
  Patients with coarctation of the aorta have reduced proximal aortic wall velocities and strain and increased stiffness even after successful repair. This amplifies stress-induced hypertension and increases LV burden.
authors.affiliation: Cardiac Department, Sapienza University, Rome, Italy. vitar@tiscali.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitarelli
authors.forename: Ysabel
authors.initials: Y
authors.lastname: Conde
authors.forename: Ester
authors.initials: E
authors.lastname: Cimino
authors.forename: Simona
authors.initials: S
authors.lastname: D'Orazio
authors.forename: Simona
authors.initials: S
authors.lastname: Stellato
authors.forename: Daniela
authors.initials: D
authors.lastname: Battaglia
authors.forename: Viviana
authors.initials: V
authors.lastname: Padella
authors.forename: Fiorella
authors.initials: F
authors.lastname: Caranci
authors.forename: Giovanna
authors.initials: G
authors.lastname: Continanza
authors.forename: Olga
authors.initials: O
authors.lastname: Dettori
authors.forename: Lidia
authors.initials: L
authors.lastname: Capotosto
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001017:Aortic Coarctation / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D004548:Elasticity; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology