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Myocardial performance after successful intervention for native aortic coarctation

Published online by Cambridge University Press:  13 January 2010

Vedide Tavli ,
Turkay Saritas ,
Baris Guven ,
Faik Okur ,
Berna Cevik Saylan ,
Talat Tavli ,
Bekir Sami Uyanik ,
Zeki Ari  and
Banu İsbilen
Vedide Tavli
Affiliation:
Izmir Dr Behcet Uz Children’s Hospital, Pediatric Cardiology, Izmir, Turkey
Turkay Saritas
Affiliation:
Siyami Ersek Hospital, Paediatric Cardiology, Istanbul, Turkey
Baris Guven*
Affiliation:
Izmir Dr Behcet Uz Children’s Hospital, Pediatric Cardiology, Izmir, Turkey
Faik Okur
Affiliation:
Sifa Medical Center, Cardiothoracic Surgery, Izmir, Turkey
Berna Cevik Saylan
Affiliation:
Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Pediatric Cardiology, Ankara, Turkey
Talat Tavli
Affiliation:
Celal Bayar University, Cardiology, Manisa, Turkey
Bekir Sami Uyanik
Affiliation:
Celal Bayar University Hospital, Biochemistry, Manisa, Turkey
Zeki Ari
Affiliation:
Celal Bayar University Hospital, Biochemistry, Manisa, Turkey
Banu İsbilen
Affiliation:
Celal Bayar University Hospital, Biochemistry, Manisa, Turkey
*
Correspondence to: Baris Guven MD, Izmir Dr Behcet Uz Children’s Hospital, Pediatric Cardiology, Izmir, Turkey 1417 Street Alsancak/Izmir Zip code: 35210. Tel: +90 2324895656-2210; Fax: +90 2324892315; E-mail: drbarisguven@yahoo.com
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Abstract

Coarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood.

Keywords

Balloon dilationendothelin-1B-type natriuretic peptide
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 1 , February 2010 , pp. 33 - 38
Copyright
Copyright © Cambridge University Press 2010

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References

1.O’Sullivan, JJ, Derrick, G, Darnell, R. Prevalence of hypertension after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure management. Heart 2002; 88: 163–166.CrossRefGoogle Scholar
2.Cohen, M, Fuster, V, Steele, PM, et al. Coarctation of the aorta: long term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.CrossRefGoogle ScholarPubMed
3.Yanagisawa, M, Kurihara, H, Kimura, S, et al. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature 1988; 332 (6163): 411–415.Google Scholar
4.Ekblad, H, Arjamaa, O, Vuolteenaho, O, Kapa, P, Kero, P. Plasma endothelin-1 concentration at different ages during infancy and childhood. Acta Pediatr 1993; 82: 302–303.CrossRefGoogle ScholarPubMed
5.Horigome, H, Miyauchi, T, Takahashi- Igari, M, et al. Increased plasma endothelin-1 following percutaneus balloon dilatation of aortic coarctation in children. Eur J Pediatr 2003; 167: 543–544.CrossRefGoogle Scholar
6.Yousufuddin, M, Henein, MY, Flather, M, Wang, D, et al. Incremental importance of peak plasma levels of endothelin-1and natriuretic peptides in chronic heart failure. J Cardiovasc Pharmacol 2001; 38: 468–473.CrossRefGoogle Scholar
7.Donner, R, Black, I, Spann, JF, Carabello, BA. Left ventricular wall stress and function in childhood coarctation of the aorta. J Am Coll Cardiol 1985; 5: 1161–1167.CrossRefGoogle ScholarPubMed
8.Iso, T, Arai, M, Wada, A, Kogure, K, Suzuli, T, Nagai, R. Humoral factors produced by pressure overload enhance cardiac hypertrophy and natriuretic peptide expression. Am J Physiol 1997; 273: 113–118.Google ScholarPubMed
9.Hunt, PJ, Richards, AM, Nicholls, MG, et al. Immunoreactive aminoterminal pro-brain natriuretic peptide (NT-pro BNP) a new marker of cardiac impairment. Clin Endocrinol 1997; 350: 1347–1351.Google Scholar
10.Sutovsky, I, Katoh, T, Ohno, T, et al. Relationship between natriuretic peptide, myocardial wall stres and ventricular arrhytmia severity. Jpn Heart J 2004; 45: 771–777.CrossRefGoogle Scholar
11.Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics 1996; 98 (4 Pt 1): 649–658.Google Scholar
12.Devereux, RB, Alonso, DR, Lutas, EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.CrossRefGoogle ScholarPubMed
13.Daniels, R, Meyer, RA, Liaug, Y, Bove, KE. Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults. J Am Coll Cardiol 1988; 12: 703–708.CrossRefGoogle ScholarPubMed
14.Bahler, RC, Vrobel, TR, Martin, P. The relation of heart rate and shortening fraction to echocardiographic indexes of LV function in normal subjects. J Am Coll Cardiol 1983; 2: 926–933.CrossRefGoogle Scholar
15.Tei, C, Ling, LH, Hodge, DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357–366.Google ScholarPubMed
16.Brouwer, RMHJ, Erasmus, ME, Ebels, T, et al. Influence of age on survival, late hypertension, and recoarctation in elective aortic coarctation repair. J Thorac Cardiovasc Surg 1994; 108: 525–531.CrossRefGoogle ScholarPubMed
17.Maron, BJ, O’Neal, HJ, Rowe, RD, Mellitis, ED. Prognosis of surgically corrected coarctation of the aorta: a 20 year postoperative appraisal. Circulation 1973; 47: 119–126.CrossRefGoogle ScholarPubMed
18.Pfammater, JP, Ziemer, G, Kaulitz, R, et al. Isolated aortic coarctation in neonates and infants: results of resection and end-to-end anastomosis. Ann Thoracic Surg 1996; 62: 778–783.CrossRefGoogle Scholar
19.Moskowitz, WB, Schieken, RM, Mosteller Mi Bossano, R. Altered systolic and diastolic function in children after successful repair of coarctation of the aorta. Am Heart J 1990; 120: 103–109.CrossRefGoogle ScholarPubMed
20.Inoue, I, Massie, b, Loge, D, et al. Abnormal left ventricular filling: early finding in mild to moderate systemic hypertension. Am J Cardiol 1984; 53: 120–126.CrossRefGoogle Scholar
21.Phillips, R, Coplan, N, Krakoff, L, et al. Doppler echocardiographic analysis of left ventricular filling in treated hypertensive patients. J Am Coll Cardiol 1987; 9: 317–322.CrossRefGoogle ScholarPubMed
22.Stoddard, MF, Pearson, AC, Kern, MJ, Ratcliff, J, et al. Left ventricular diastolic function: comparison pulsed Doppler echocardiographic and hemodynamic indexes in subjects with and without coronary heart disease. J Am Coll Cardiol 1989; 13: 327–336.CrossRefGoogle Scholar
23.Leandro, J, Smallhorn, JF, Benson, L, et al. Ambulatory blood pressure monitoring and left ventricular mass and function after succesful surgical repair of coarctation of the aorta. J Am Coll Cardiol 1992; 20: 197–204.CrossRefGoogle Scholar
24.Balderraibano-Saucedo, NA, Vizcaíno-Alarcon, A, Reyes-de la Cruz, L, et al. Left ventricular function in children after successful repair of aortic coarctation. Rev Esp Cardiol 2008; 61 (11): 1126–1133.Google Scholar
25.Lubien, E, DeMaria, A, Krishnaswamy, P, et al. Utility of B natriuretic peptide (BNP) in diagnosing diastolic dysfunction. Circulation 2002; 105: 595–601.Google Scholar
26.Berger, R, Huelsman, M, Strecker, K, et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation 2002; 105: 2392–2397.CrossRefGoogle ScholarPubMed
27.Sirvio, ML, Uhlenius, N, Stewen, P, Metsarinne, K, Fyhrquist, F. The effect of aortic coarctation on expression of endothelin-1and endothelin receptor in heart and lungs. Blood press 1995; 4: 320–323.CrossRefGoogle Scholar
28.Yousufuddin, M, Henein, MY, Flather, M, Wang, D, et al. Incremental importance of peak plasma lavels of endothelin-1and natriuretic peptides in chronic heart failure. J Cardiovasc Pharmacol 2001; 38 (3): 468–473.CrossRefGoogle Scholar