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32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Persistent subclinical myocardial dysfunction after aortic coarctation correction
Session:
Posters 4 - Écran 10 - Miocárdio e Pericárdio
Speaker:
Helena Filipa Marinho Nascimento Guedes
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.6 Congenital Heart Disease – Clinical
Session Type:
Posters
FP Number:
---
Authors:
Helena M. Nascimento; Marta Braga; Vânia Ribeiro; Carla De Sousa; Filipe Macedo; Cristina Cruz; Maria Júlia Maciel Barbosa
Abstract
<p>Background: Aortic coarctation (CoA) adult population is growing, because of major improvements in both diagnostic and therapeutic approaches. However, even after a successful repair, hypertension and left ventricular (LV) myocardial dysfunction may still occur. The aim of our study was to assess the role of 2-D speckle tracking echocardiography (STE) in the early detection of subclinical myocardial dysfunction in patients with CoA repaired. <br /> <br /> Material and methods: This study was based on a retrospective analysis of adult patients (pts) with the diagnosis of repaired CoA, followed-up in a Grown-up Congenital Heart Disease Centre. Patients with significant concomitant lesions (except for bicuspid aortic valve without stenosis) and clinical LV systolic dysfunction were ruled out. Epidemiologic and clinical data were collected and inserted in a registry base. Transthoracic echocardiograms were reviewed in order to assess global longitudinal strain (GLS) using 2-D STE (Echopac Software, GE). The data were compared with those obtained from 14 healthy subjects (7 male; median age 31 years-old, interquartile range: 25-50). <br /> <br /> Results: From the twenty-one pts with repaired CoA studied, 12 were women and median age was 35 years-old (interquartile range: 31-40). Bicuspid aortic valve was present in 5 patients (23.8%). Surgical repair was performed in 16 pts (76.2%): resection with subclavian artery flap aortoplasty (7); head-to-head anastomosis (1) and woven Dacron patch (1). Median age at correction was 6 years-old (interquartile range: 3-21). The remaining 5 pts (23.8%) were submitted to percutaneous intervention. Twelve of these patients were controlled hypertensive (57.1%). All pts were in sinus rhythm and LV hypertrophy was observed in 2 (9.5%). Comparing to the healthy controls, CoA pts group presented superior LV wall thickness (ventricular septum: 8.9±1.4 vs. 7.6±1.7mm, p=0.033; posterior wall: 8.5±1.7 vs. 7.3±1.2, p=0.026). Regarding the diastolic function parameters the E/e’ is significantly higher in the CoA pts (7.9±1.8 vs. 5.5±1.4, p=0.04). Despite the absence of differences in LV ejection fraction, CoA pts presented a significantly reduced LV GLS (-16.2±4.2 vs. -18.6±1.7, p=0.043). There was no significant correlation between LV GLS and current systolic blood pressure or age of CoA repair. <br /> <br /> Conclusion: In spite of a low percentage of LV hypertrophy, significant reduction of GLS was found, consistent with persistent subclinical myocardial dysfunction even long after correction of the defect. Although the significant prevalence of hypertension in these pts, this factor did not appear to play a significant role.</p>
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