Assessment of vascular phenotype using a novel very high resolution ultrasound technique in adolescents after aortic coarctation repair and/or stent implantation: relationship to central haemodynamics and left ventricular mass
- Taisto Sarkola1,2,
- Andrew N Redington1,3,
- Cameron Slorach1,
- Wei Hui1,
- Timothy Bradley1,
- Edgar Jaeggi1,3
- 1Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- 2Children's Hospital, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
- 3Research Institute, Physiology & Experimental Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Correspondence to Professor Edgar Jaeggi, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada;
Contributors Dr Jaeggi, Redington and Sarkola designed the study. Dr Sarkola conducted the study under the supervision of Dr Jaeggi. Mr Slorach, Mr Hui, and Dr Bradley participated with technical assistance. Dr Sarkola did the data analysis and wrote the manuscript draft.
- Accepted 26 July 2011
- Published Online First 13 September 2011
Objectives The objective was to determine the severity of residual cardiovascular abnormalities in youths after coarctation of the aorta (CoA) repair and their relation to regional blood pressure (BP).
Design Prospective cross-sectional study in tertiary health care setting.
Methods Thirty-six CoAs (age 16±1 years; neonatal surgery only: n=16; surgery and/or stent implantation: n=20) and 37 age-matched controls were examined by very-high resolution ultrasound, echocardiography and applanation tonometry.
Results CoA was associated with increased right arm systolic BP (p<0.001), intima-media thickness (IMT) in the common carotid (p<0.001), right brachial (p<0.05) and radial (p<0.05) arteries and ascending aortic stiffness (p<0.05). Carotid IMT correlated positively with age at first intervention (r=0.36, p<0.05). With left subclavian flap type repair, left arm systolic BP (p<0.001) and left brachial (p<0.001), radial (p<0.001) and ulnar (p<0.05) arterial IMTs were all reduced. When adjusted for BP, body mass index, age and gender, only carotid IMT (p<0.001) and LV-mass (p=0.013) of stented patients, as well as left arm arterial IMTs (p<0.01) in subclavian flap type repair patients remained different from controls. The significant associations of stented patients disappeared after adjustment for later patient age at intervention (median 8.7 vs 0.03 years, p<0.001). Residual arm-leg BP gradients correlated positively with carotid and brachial IMT.
Conclusion CoA repair in early childhood is associated with increased preductal arterial IMT, LV mass and ascending aortic stiffness in adolescents. The more pronounced cardiovascular abnormalities after CoA stent implantation are likely related to the older patient age at the time of intervention.
Funding The study was supported by grants from the Sigrid Juselius Foundation, the Instrumentarium Foundation, Societatis Medicorum Fennicae, the Finnish Cultural Foundation, the Finnish Foundation for Cardiovascular Research and the Stockmann Foundation. The 25 MHz and 35 MHz probes were loaned to the investigators by VisualsonicsR (Toronto, Canada). The company had no other role in the study.
Competing interests None to declare.
Patient consent Obtained.
Ethics approval Ethics approval was obtained from SickKids REB, Toronto.
Provenance and peer review Not commissioned; externally peer reviewed.