title: Is torsion a suitable echocardiographic parameter to detect acute changes in left ventricular afterload in children?
abstract: BACKGROUND
  Congenital heart defects such as coarctation or valvular aortic stenosis are followed by changes in left ventricular myocardial deformation mechanics induced by pressure overload.
  
  
  METHODS
  Echocardiography was performed in 37 patients (aged 0-27 years, 15 female) with coarctation (27) or valvular aortic stenosis (10) before and after interventional catheterization and compared with 37 body surface area/age-matched healthy children. Deformation was calculated by 2-dimensional strain speckle tracking.
  
  
  RESULTS
  Stress gradients under provocation with orciprenaline in coarctation decreased from 51.8 +/- 20.0 mm Hg to 6.0 +/- 12.0 mm Hg (P < .0001), and resting gradients in aortic stenoses decreased from 57.5 +/- 18.8 mm Hg to 25.5 +/- 14.0 mm Hg (P < .0001) after intervention. Patients had an increased maximal torsion (tor(max): 16.7 +/- 6.7 deg vs 11.0 +/- 4.7 deg (controls; P < .0001), which decreased significantly after therapy (11.8 +/- 4.9 deg, P < .0001).
  
  
  CONCLUSIONS
  Compensatory elevation of left ventricular tor(max) in children with moderate left ventricular pressure load changes rapidly after successful interventional treatment. tor(max) may be a valuable tool to assess cardiac unloading or indicate the need for interventional treatment.
authors: Center of Congenital Heart Disease, Heart and Diabetes Center Northrhine-Westfalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany. tlaser@hdz-nrw.de
authors: Kai Thorsten
authors: KT
authors: Laser
authors: Nikolaus Alexander
authors: NA
authors: Haas
authors: Nadine
authors: N
authors: Jansen
authors: Rainer
authors: R
authors: Schäffler
authors: Jorge Roberto
authors: JR
authors: Palacios Argueta
authors: Armin
authors: A
authors: Zittermann
authors: Brigitte
authors: B
authors: Peters
authors: Hermann
authors: H
authors: Körperich
authors: Deniz
authors: D
authors: Kececioglu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014102:Torsion Abnormality / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D055815:Young Adult