Left Ventricular Function in Children After Successful Repair of Aortic Coarctation

Balderrabano-Saucedo, Norma; Vizcaíno-Alarcón, Alfredo; Cruz, Lorenzo Reyes-de la; Espinosa-Islas, Gonzalo; Arévalo-Salas, Alexis; Segura-Stanford, Begoña

doi:10.1016/s1885-5857(09)60026-8

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…The myocardial performance index, also known as the Tei index 15 , has been the subject of interest since its inception in 1995. One study of 40 normotensive children who had undergone repair of aortic coarctation revealed an abnormal myocardial performance index in almost half the patients, 24 a finding again endorsed by our experience. The index is a valid echocardiographic parameter owing to its ability to assess overall left ventricular performance.…”

Section: Discussionsupporting

confidence: 79%

Myocardial performance after successful intervention for native aortic coarctation

et al. 2010

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Coarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood.

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Section: Discussionsupporting

confidence: 79%

Myocardial performance after successful intervention for native aortic coarctation

et al. 2010

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“…However, in contrast to other studies, readmissions and cost of medical care between discharge after surgery and 1-year follow-up was similar between the groups, as was the number of echocardiograms, suggesting that serial echocardiograms were performed less frequently after recovery of LV EF. Our data support prior studies suggesting that most infants recover LV function, and that advanced heart failure therapies, such as mechanical circulatory support, are rarely used [14][15][16].…”

Section: Discussionsupporting

confidence: 88%

Implications of Left Ventricular Dysfunction at Presentation for Infants with Coarctation of the Aorta

et al. 2020

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Infants with aortic coarctation may present with left ventricular (LV) dysfunction which may complicate the postoperative course and lead to increased healthcare costs. We aimed to define the prevalence of moderate to severe left ventricular (LV) systolic dysfunction, evaluate time to recovery, and compare health care costs. Single-center retrospective cohort study at a tertiary care hospital was conducted. Infants < 6 months old at diagnosis with aortic coarctation were identified using surgical codes for coarctation repair between January 2010 and May 2018. Moderate to severe dysfunction was defined as ejection fraction (EF) < 40%. Of 160 infants studied, 18 (11%) had moderate to severe LV dysfunction at presentation. Compared to those with better LV function, infants with moderate to severe LV dysfunction were older at presentation (12 vs. 6 days, p = 0.004), had more postoperative cardiac intensive care unit (ICU) days (5 vs. 3, p < 0.001), and more ventilator days (3.5 vs. 1, p < 0.001). The median time to normal LV EF (≥ 55%) was 6 days postoperatively (range 1-230 days). Infants presenting with moderate to severe LV dysfunction had higher index hospitalization costs ($90,560 vs. $59,968, p = 0.02), but no difference in cost of medical follow-up for the first year following discharge ($3,078 vs. $2,568, p = 0.46). In the current era, > 10% of infants with coarctation present with moderate to severe LV dysfunction that typically recovers. Those with moderate to severe dysfunction had longer duration of mechanical ventilation and postoperative cardiac ICU stays, likely driving higher costs of index hospitalization.

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“…Systolic RV function then improved prior to hospital discharge, possibly due to decreased LV and left atrial pressure, more favorable interventricular interaction and normalized pulmonary artery pressure (RV afterload). 4 The discrepancy between our results and aforementioned studies 8 , 9 , 10 , 11 , 12 , 13 , 14 suggests that early intervention (transcatheter or surgery) and the absence of other congenital heart defects might improve outcomes in neonatal CoA.…”

Section: Discussioncontrasting

confidence: 80%

“…Previous studies have described persistently impaired LV function after repair of CoA in neonates 7 , 8 and non-neonatal patients. 9 , 10 , 11 , 12 , 13 In this study, biventricular recovery of the systolic function occurred in both interventional and surgical CoA patients. All conventional echocardiographic variables related to systolic LV function significantly improved in the interventional cohort, and normalized in most patients prior to hospital discharge.…”

Section: Discussionmentioning

confidence: 54%

Recovery of Biventricular Function After Catheter Intervention or Surgery for Neonatal Coarctation of the Aorta

et al. 2023

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Left Ventricular Function in Children After Successful Repair of Aortic Coarctation

Cited by 4 publications

References 21 publications

Myocardial performance after successful intervention for native aortic coarctation

Myocardial performance after successful intervention for native aortic coarctation

Implications of Left Ventricular Dysfunction at Presentation for Infants with Coarctation of the Aorta

Recovery of Biventricular Function After Catheter Intervention or Surgery for Neonatal Coarctation of the Aorta

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