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Effect of Endovascular Stenting of Aortic Coarctation on Biventricular Function in Adults
  1. Yat-yin Lam (homalam{at}hotmail.com)
  1. The Chinese University of Hong Kong, Hong Kong
    1. Mehmet G Kaya
    1. Royal Bromptom Hospital, United Kingdom
      1. Wei Li
      1. Imperial College, United Kingdom
        1. Vaikom S Mahadevan
        1. Royal Brompton Hospital, United Kingdom
          1. Arif A Khan
          1. Royal Brompton Hospital, United Kingdom
            1. Michael Y Henein
            1. Royal Brompton Hospital, United Kingdom
              1. Michael Mullen
              1. Royal Brompton Hospital, United Kingdom

                Abstract

                Aim We sought to investigate the effect of endovascular stenting of aortic coarctation on biventricular function in adults during intermediate term follow-up.

                Methods We prospectively studied 21 patients (age 34iÓ10 years) before and 14iÓ2 months after coarctation stenting from year 2002-2005. Measurements of biventricular function and blood pressures 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 coarctation site fell (55iÓ15mmHg to 18iÓ8mmHg, p<0.001). Systolic, mean BP and LV mass dropped after stenting (p<0.05 for all). LV long axis function improved at intermediate term follow-up (TDI lateral and septal systolic and diastolic velocities and E/Em ratios: LSm, 6.5iÓ1.4cm/s to 7.9iÓ1.7cm/s; SSm, 5.8iÓ1.2cm/s to 7.3iÓ1.6cm/s; LEm 8.1iÓ1.3 to 9.4iÓ2.3; SEm 6.7iÓ1.5cm/s to 7.8iÓ1.9cm/s; LE/Em: 11.2iÓ2.7 to 9.8iÓ2.8; SE/Em: 14.8iÓ5.3 to 11.8iÓ3.9, p<0.05 for all). No significant difference in LVEF, conventional LV diastolic measurements (E, A, E/A ratio, IVRT and DT) was found after stenting. No significant deterioration of RV function was observed in stented patients. Both post-stenting and post-surgical repair patients had poorer LV long axis function compared to 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. We support aortic stenting in anatomically suitable defects given additional benefit of avoiding cardiopulmonary bypass. The clinical significance of subclinical myocardial dysfunction in patients with stented or repaired coarctation warrants further studies.

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