Assessment of aortic elastic properties by transesophageal strain echocardiography after repair of coarctation of the aorta.

Background: Increased arterial stiffness may participate in the genesis of hypertension and persistent increases in left ventricular mass after surgical correction of coarctation of the aorta (CoA). The purpose of the present study was to assess the aortic elastic properties using tissue Doppler imaging (TDI) and strain echocardiography in patients (pts) after coartectomy. Methods: Transesophageal echocardiography with TDI and strain capabilities (Toshiba corp, Tokyo, Japan) was performed in 10 pts aged 12-39 years who had repair of CoA and residual aortic narrowing <30% and who were not hypertensive at rest. 11 age- and sex-matched subjects with no signs of heart disease were selected as normal controls (CTR). Aortic transverse sections were measured at the level of the proximal, distal and coarctation segments. Transverse aortic stiffness was measured by the elastic modulus (Ep) and stiffness index beta () using previously reported formulas. TDI wall velocities during systole (Sw), early relaxation (Ew) and atrial systole (Aw) were measured in transverse views in both groups. Using dedicated software peak systolic strain (ps ) was measured from the resultant deformation curves in the same views. Results: In the coartectomy pts there was a significant increase of Ep (47.66.5 vs 21.82.9 kPa, p<0.001) and  (4.112.51 vs 2.280.65, p<0.005) at the level of the proximal and coarctation segments compared with CTR. At the same level Sw velocities were significantly decreased compared with CTR (4.10.8cm/sec vs 6.90.9cm/sec, p<0.001). There was a significant decrease of ps  in the coartectomy pts compared with CTR in the proximal and coarctation segments (71.4% vs 232.5%, p<0.0001). Univariate correlations in the coartectomy group showed significant relationships of  and Sw velocities (r=-0.66, p<0.01) and  and ps  (r=-0.78, p<0.001) Conclusion: Thus, pts with CoA have increased proximal aortic stiffness and reduced wall velocities and wall strain even after successful repair.