Altered systolic and diastolic function in children after “successful” repair of coarctation of the aorta

Abstract

We investigated whether left ventricular (LV) structural or functional abnormalities persist in children on long-term follow-up after successful correction of coarctation of the aorta. Two-dimensional directed M-mode and Doppler echocardiographic examinations were performed on 11 such subjects and 22 age-matched control subjects. Digitized tracings were made from M-mode recordings of the LV and Doppler mitral valve inflow recordings to measure septal, posterior wall, and LV dimensions, LV mass, shortening fraction, peak shortening and lengthening velocities, diastolic filling time, peak E velocity, peak A velocity, and velocity time integrals. Despite group similarities in age, body size, and systolic blood pressure, greater fractional shortening ( p = 0.0001), indexed peak shortening velocity ( p < 0.001), and greater LV mass index ( p < 0.05) were seen in the coarctation group in the face of lower LV wall stress ( p = 0.0001). LV mass index correlated with the resting arm-leg gradient, which ranged from −4 to +10 mm Hg. The coarctation group had decreased early filling ( p < 0.006) with compensatory increased late diastolic filling ( p < 0.05). Diastolic filling abnormalities were prominent in the older coarctation subjects and were related to both systolic blood pressure ( p < 0.001) and LV mass index ( p < 0.01). Despite apparently successful repair of coarctation of the aorta, persistent alterations in both systolic and diastolic LV function and LV mass are present in children at long-term follow-up, which are related to the resting arm-leg gradient. We speculate that these small measured arm-leg gradients represent persistent alterations in flow, which may result in LV hypertrophy and hyperkinesia.