Published Online
on June 13, 2005

A more recent version of this article appeared on June 21, 2005

This Article Full Text (PDF) All Versions of this Article: 111/24/3269    most recent CIRCULATIONAHA.104.529792v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vogt, M. Articles by Hess, J. Search for Related Content PubMed PubMed Citation Articles by Vogt, M. Articles by Hess, J. Related Collections Peripheral vascular disease Echocardiography

Submitted on December 15, 2004
Revised on February 10, 2005
Accepted on March 3, 2005

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, and 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.

^* To whom correspondence should be addressed. E-mail: kuehn{at}dhm.mhn.de.

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

This article has been cited by other articles:

				Y-Y Lam, M J Mullen, M G Kaya, M A Gatzoulis, W Li, and M Y Henein Left ventricular long axis dysfunction in adults with "corrected" aortic coarctation is related to an older age at intervention and increased aortic stiffness Heart, May 1, 2009; 95(9): 733 - 739. [Abstract] [Full Text] [PDF]

				A. T. Yetman and T. Graham The dilated aorta in patients with congenital cardiac defects. J. Am. Coll. Cardiol., February 10, 2009; 53(6): 461 - 467. [Abstract] [Full Text] [PDF]

				C. Schreiber and A. Hager eComment: Surgical treatment of coarctation in adult patients yields better long-term results with regard to hypertension but carries a substantial risk Interactive CardioVascular and Thoracic Surgery, January 1, 2009; 8(1): 127 - 128. [Full Text] [PDF]

				S. Tabbutt, S. C. Nicolson, T. E. Dominguez, W. Wells, C. L. Backer, J. S. Tweddell, P. Bokesch, and M. Schreiner Perioperative course in 118 infants and children undergoing coarctation repair via a thoracotomy: A prospective, multicenter experience. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1229 - 1236. [Abstract] [Full Text] [PDF]

				H. Senzaki, Y. Iwamoto, H. Ishido, S. Masutani, M. Taketazu, T. Kobayashi, T. Katogi, and S. Kyo Ventricular-Vascular Stiffening in Patients With Repaired Coarctation of Aorta: Integrated Pathophysiology of Hypertension Circulation, September 30, 2008; 118(14_suppl_1): S191 - S198. [Abstract] [Full Text] [PDF]

				S. Tabbutt, S. C. Nicolson, P. C. Adamson, X. Zhang, M. L. Hoffman, W. Wells, C. L. Backer, F. X. McGowan, J. S. Tweddell, P. Bokesch, et al. The safety, efficacy, and pharmacokinetics of esmolol for blood pressure control immediately after repair of coarctation of the aorta in infants and children: a multicenter, double-blind, randomized trial. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 321 - 328. [Abstract] [Full Text] [PDF]

				A. Hager and J. Hess Reply to the editor. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1406 - 1406. [Full Text] [PDF]

				P. Ou, D. S. Celermajer, O. Raisky, O. Jolivet, F. Buyens, A. Herment, D. Sidi, D. Bonnet, and E. Mousseaux Angular (Gothic) aortic arch leads to enhanced systolic wave reflection, central aortic stiffness, and increased left ventricular mass late after aortic coarctation repair: Evaluation with magnetic resonance flow mapping J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 62 - 68. [Abstract] [Full Text] [PDF]

				A. Hager, S. Kanz, H. Kaemmerer, C. Schreiber, and J. Hess Coarctation Long-term Assessment (COALA): Significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 738 - 745. [Abstract] [Full Text] [PDF]

				D. Baumgartner, C. Baumgartner, E. Schermer, G. Engl, U. Schweigmann, G. Matyas, B. Steinmann, and J. I. Stein Different patterns of aortic wall elasticity in patients with Marfan syndrome: A noninvasive follow-up study J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 811 - 819. [Abstract] [Full Text] [PDF]

				A. Kuhn and M. Vogt Ascending Aortic Distensibility is Impaired Before and After Surgical "Repair" of Coarctation Ann. Thorac. Surg., June 1, 2006; 81(6): 2341 - 2341. [Full Text] [PDF]

				T. Murakami Reply Ann. Thorac. Surg., June 1, 2006; 81(6): 2341 - 2342. [Full Text] [PDF]

				A. Eicken, U. Pensl, W. Sebening, A. Hager, T. Genz, C. Schreiber, D. Lang, H. Kaemmerer, R. Busch, and J. Hess The fate of systemic blood pressure in patients after effectively stented coarctation Eur. Heart J., May 1, 2006; 27(9): 1100 - 1105. [Abstract] [Full Text] [PDF]