732-5 Coarctation of the Aorta: Risk for Developing Late Left Sided Obstructive Lesions

Abstract

Patients (pts) presenting with aortic coarctation (COA) can subsequently develop left sided obstruction at other sites. We sought, retrospectively, to identify morphologic predictors for the development of late obstruction. Pts diagnosed with COA before age 3 months (from 1988—1992) were included (N = 101). Pts with aortic stenosis, mitral stenosis, subaortic stenosis or complex heart disease on initial presentation were excluded. A VSD was present in 53%, an LSVC in 18% and a bicuspid aortic valve in 59% (53%—intercoronary cusp fusion and 6%—right/non-coronary cusp fusion). At the initial study, left ventricular volume tended to be larger than normal while other left sided structures were smaller. The probability of freedom from new left sided lesions was 81% at 1 yr, 74% at 3 yrs and 70% at 5yrs. Mitral stenosis developed in 11 pts. Multivariate analysis revealed that these pts had smaller mitral valve annulus diameter (MV) (p = 0.027), higher mean transmitral gradients (p = 0.043) and longer intervalvular fibrosa (p = 0.017). Ten pts developed aortic stenosis. They had smaller MV (p = 0.006), higher initial aortic valve velocities (p = 0.007), and were more likely to have fusion of the right/non-coronary cusp (p = 0.001). Eight pts developed subaortic stenosis. They had smaller MV (p = 0.027) and longer intervalvular fibrosa (p = 0.025). Risk factors for the development of any stenosis were: small MV (p < 0.001). presence of a VSD (p = 0.004), initial aortic valve gradient > 14 mmHg (p = 0.01), right/non-coronary cusp fusion (p = 0.022) and longer intervalvular fibrosa (p = 0.008). Measurements-1 st study Mean Z-score Mitral valve diameter –0.70 Aortic valve diameter –092 Distal transverse arch –2.6 Isthmus diameter –3.9 End systolic volume +0.76 End diastolic volume +0.73 Late left sided stenoses are common in isolated neonatal COA and often develop by 1 yr of age. Echocardiography can identify patients at increased risk for these progressive lesions.