title: Left ventricular response to pressure afterload in children: aortic stenosis and coarctation: a systematic review of the current evidence.
abstract: Congenital aortic stenosis (CAS) and Coarctation of Aorta (CoA) represent two forms of pressure afterload that affect the left ventricle (LV), hence require regular echocardiographic monitoring. Subclinical dysfunction of the LV exists even in asymptomatic patients with preserved left ventricular ejection fraction (EF), implying low sensitivity of EF in predicting optimum time for intervention. In this article we review patterns of LV myocardial deformation before and after correction of CAS and CoA in infants, children and adolescents, showing their important role in monitoring the course of LV dysfunction. A systematic search using PubMed was performed and suitable studies are presented on a narrative form. Normal EF and/or fractional shortening (FS), with subclinical myocardial dysfunction are reported in all studies before intervention. The short-term results, after intervention, were related to the type of procedure, with no improvement or further deterioration related to surgery but immediate improvement after balloon intervention. Long term follow-up showed further improvement but still subnormal function. Thus correction of CAS and CoA before irreversible LV dysfunction is vital, and requires longitudinal studies in order to identify the most accurate parameter for function prognostication. Until then, conventional echocardiographic parameters together with myocardial velocities and deformation parameters should continue to provide follow-up reproducible measures of ventricular function.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Sweden.
authors.forename: Haki
authors.initials: H
authors.lastname: Jashari
authors.affiliation: Department of Clinical Sciences, Umeå University, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rydberg
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Sweden.
authors.forename: Pranvera
authors.initials: P
authors.lastname: Ibrahimi
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Sweden.
authors.forename: Gani
authors.initials: G
authors.lastname: Bajraktari
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Sweden. Electronic address: Michael.henein@medicin.umu.se.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
mesh_terms: D000293:Adolescent; D001017:Aortic Coarctation / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Coarctation of aorta; Congenital aortic stenosis; Left ventricle; Myocardial deformation imaging