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Peripheral vascular disease
Effect of endovascular stenting of aortic coarctation on biventricular function in adults
  1. Yat-Yin Lam1,
  2. Mehmet G Kaya2,
  3. Wei Li3,
  4. Vaikom S Mahadevan2,
  5. Arif A Khan2,
  6. Michael Y Henein4,
  7. Michael Mullen2
  1. 1
    Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
  2. 2
    Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
  3. 3
    Department of Echocardiography, Royal Brompton Hospital, London, UK
  4. 4
    Department of Cardiology, West Middlesex University Hospital, London, UK
  1. Dr Y-Y Lam, Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK; homalam{at}hotmail.com

Abstract

Objective: To investigate the effect of endovascular stenting of aortic coarctation on biventricular function in adults during intermediate-term follow-up.

Methods: 21 patients (age 34 (10) years) were studied prospectively before and 14 (2) months after coarctation stenting from year 2002 to 2005. Biventricular function and blood pressure measurements were made. The post-stenting results were compared with pre-stenting values (group 1), with 22 age- and sex-matched post-surgical repair patients (group 2) and 30 normal controls (group 3).

Results: The peak systolic gradient across the coarctation site fell (55 (15) mm Hg to 18 (8) mm Hg, p<0.001). Systolic, mean blood pressure and left ventricular (LV) mass dropped after stenting (p<0.05 for all). LV long-axis function improved at intermediate-term follow-up (tissue Doppler imaging lateral and septal systolic and diastolic velocities and E/Em ratios: LSm, 6.5 (1.4) cm/s to 7.9 (1.7) cm/s; SSm, 5.8 (1.2) cm/s to 7.3 (1.6) cm/s; LEm, 8.1 (1.3) to 9.4 (2.3) cm/s; SEm, 6.7 (1.5) cm/s to 7.8 (1.9) cm/s; LE/Em, 11.2 (2.7) to 9.8 (2.8); SE/Em, 14.8 (5.3) to 11.8 (3.9); p<0.05 for all). No significant difference in LV ejection fraction, conventional LV diastolic measurements (E, A, E/A ratio, IVRT and DT) was found after stenting. No significant deterioration of right ventricular function was seen in stented patients. Both post-stenting and post-surgical repair patients had poorer LV long-axis function than controls (p<0.01 for all).

Conclusions: Endovascular stenting of aortic coarctation resulted in medium-term LV mass regression and long-axis function improvement that may provide insight into long-term outcome of the stented patients. The results support aortic stenting in patients with anatomically suitable defects, given the additional benefit of avoiding cardiopulmonary bypass. The clinical significance of subclinical myocardial dysfunction in patients with stented or repaired coarctation warrants further studies.

  • aortic coarctation
  • endovascular stenting
  • LV mass
  • long-axis function

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Footnotes

  • Funding: Dr Yat-Yin Lam was supported by Hong Kong Hospital Authority.

  • Conflict of interest: None.

  • Abbreviations:
    LV
    left ventricular
    RV
    right ventricular
    SPG
    systolic pressure gradient
    TDI
    tissue Doppler imaging
    tIVT
    total isovolumic time

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