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(Circulation. 2005;111:3269-3273.)
© 2005 American Heart Association, Inc.

Pediatric Cardiology

Impaired Elastic Properties of the Ascending Aorta in Newborns Before and Early After Successful Coarctation Repair

Proof of a Systemic Vascular Disease of the Prestenotic Arteries?

Manfred Vogt, MD^*; Andreas Kühn, MD^*; Daniela Baumgartner, MD; Christian Baumgartner, PhD; Raymonde Busch, MS; Martin Kostolny, MD; John Hess, MD

From the Department of Pediatric Cardiology and Congenital Heart Disease (M.V., A.K., J.H.) and the Department of Cardiovascular Surgery (M.K.), Deutsches Herzzentrum München, Technische Universität, Munich, Germany; Clinical Division of Pediatric Cardiology (D.B.), Clinical Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria; Research Group for Biomedical Data Mining (C.B.), University for Health Sciences, Medical Informatics and Technology, Hall, Austria; Institut für Medizinische Statistik und Epidemiologie (R.B.), Klinikum rechts der Isar, Technische Universität, Munich, Germany.

Correspondence to Dr Andreas Kühn, Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Lazarettstr 36, 80636 München, Germany. E-mail kuehn{at}dhm.mhn.de

Received December 15, 2004; revision received February 10, 2005; accepted March 3, 2005.

Background— Despite successful surgical correction, morbidity of patients with coarctation of the aorta is increased. It is well known that these patients have impaired elastic properties of the prestenotic arteries. To find out whether these abnormalities are primarily present or develop later, we studied 17 newborns before and early after surgical repair.

Methods and Results— Aortic wall stiffness index and distensibility were calculated using ascending and abdominal aortic diameters determined by M-mode echocardiography and noninvasive estimation of aortic pulse pressure in the right arm and leg. Seventeen patients with aortic coarctation (mean age, 20±26 days) were compared with 17 normal neonates (mean age, 13±7 days) preoperatively and postoperatively (10±6 days after surgery). Ascending aortic distensibility in patients was significantly reduced preoperatively (79±58 versus 105±36; P=0.03) and postoperatively (65±24 versus 105±36; P<0.005). Preoperative and postoperative ascending aortic stiffness index was higher in patients (preoperative, 5.2±4.4 versus 2.7±0.9; P=0.04; postoperative, 4.0±1.6 versus 2.7±0.9; P<0.005). Elastic properties of the descending aorta did not differ preoperatively or postoperatively compared with those in normal subjects.

Conclusions— Elastic properties of the prestenotic aorta of patients with coarctation seem to be impaired primarily, even in neonates, and remain unchanged early after successful operation. Surgical correction does not resolve inborn pathology of the prestenotic aortic vascular bed.

Key Words: coarctation • elasticity • pediatrics • ultrasonics

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