Enhanced Aortic Pressure Wave Reflection in Patients After Repair of Aortic Coarctation

Abstract

Despite the relative successes in cardiac surgical repair, early onset of heart disease (hypertension, myocardial infarction, cardiac failure, and sudden death) is a common late complication in patients who have undergone repair of occlusive aortic vessels. Many hypotheses for the cause of this complication have been proposed, but these mechanisms are still controversial. We enrolled 20 patients who had undergone arch repair for coarctation or interruption of the aortic arch. We analyzed the ascending and descending aortic pressure waveforms using a pressure sensor mounted catheter during mid-term or long-term follow-up cardiac catheterization. We compared the pressure waveforms with those of age-matched control subjects who had never undergone aortic arch surgery. In patients after an arch repair, the inflection time was short (0.095 +/- 0.024 vs 0.19 +/- 0.05 s; p < 0.0001) and the augmentation index increased (27.5 +/- 15.4 vs -3.47 +/- 8.8 %; p < 0.0001). Moreover, they demonstrated high systolic blood pressure (105.2 +/- 12.2 vs 94.7 +/- 11.7 mm Hg; p = 0.0018) and a greater range in pulse pressure variation (40.4 +/- 7.2 vs 32.7 +/- 5.3 mm Hg; p = 0.0004). Our results show the early return of the pressure wave reflection and augmented ascending aortic pressure wave in patients after repair of the aortic arch. The elevated ventricular afterload resulting from the enhanced pressure wave reflection may contribute to subsequent late cardiovascular complications (hypertension, myocardial infarction, cardiac failure, and sudden death) in patients after repair of the aortic defects.