Assessment of ascending aorta distensibility after successful coarctation repair by strain Doppler echocardiography.
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.
Vitarelli
Antonio
A
Cardiac Department, Sapienza University, Rome, Italy. vitar@tiscali.it
Conde
Ysabel
Y
Cimino
Ester
E
D'Orazio
Simona
S
Stellato
Simona
S
Battaglia
Daniela
D
Padella
Viviana
V
Caranci
Fiorella
F
Continanza
Giovanna
G
Dettori
Olga
O
Capotosto
Lidia
L
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