Left ventricular longitudinal strain in newborns with aortic coarctation before and after surgical correction
Abstract
Echocardiographic analysis of longitudinal mechanics of the left ventricle in newborns with
coarctation of aorta can help in the detection of subclinical systolic dysfunction.
Aim. Evaluation of left ventricular longitudinal mechanics in newborns with coarctation of aorta
before and after surgical correction during a year of observation.
Material and methods. We examined 48 children with coarctation of the aorta at the age
of 15.2±6 days, with a body mass of 3.108±0.37 kg. Conventional echocardiography was performed
with the study of longitudinal mechanics using Vector Velocity Imaging (Syngo VVI, Siemens)
before the operation, in 7 days and in 12 months after surgery. To compare the longitudinal
strain, 30 healthy newborns were examined. A surgical correction was performed for all patients
with coarctation of the aorta during the first 24 hours of hospitalization.
Results. There were no mortality during follow-up. Functional class of heart failure have decreased.
Ejection fraction of the left ventricle increased (from 52±8.6% to 66.4±5.4%, p=0.0001). Strain and strain
rate were reduced in children with coarctation of the aorta in comparison with healthy newborns (-8.9±3%
vs -18.6±1.8%, p=0.00000, strain rate -0.51±0.1 s-1 vs -0.8±0.14 s-1, p=0.0000, respectively). A year
later, the parameters of longitudinal mechanics increased (strain from -8.9±3% to -11.5±4.4%,
p=0.00004, strain rate from -0.51±0.1s-1 to -0.62±0.08 s-1, p=0.0000), but theу did not reach the
level of normal values determined in healthy children of this age. We found correlations between
strain and strain rate with aortic diameter in the coarctation zone (RS=-0.5, p=0.01, RS=-0.42,
p=0.003, respectively) and longitudinal strain with the distal segment of the aortic arch (RS=-0.43,
p=0.002), longitudinal strain and left ventricular mass index (RS=0.62, p=0.0001).
Conclusions. The longitudinal mechanics of the left ventricle is lower in newborns with aortic
coarctation, it does not measure up the normative values after surgery. The remaining disturbances
of longitudinal strain of the left ventricle can be a potential substrate for the left ventricular
dysfunction in long term postoperative period, demanding long dynamic monitoring.
Keywords:aortic coarctation, longitudinal strain, strain rate
Clin. Experiment. Surg. Petrovsky J. 2017; 5 (4): 43–50.
DOI: 10.24411/2308-1198-2017-00006
Received: 01.06.2017. Accepted: 10.10.2017.
References
1. Padua L.M., Garcia L.C., Rubira C.J., de Oliveira Carvalho P.E.
Stent placement versus surgery for coarctation of the thoracic aorta.
Cochrane Database Syst Rev. 2012; 5: CD008204.
2. Neonatology: national guide. In: N. Volodin (ed.). Moscow,
2009: 848 p. (in Russian)
3. Price J.F. Heart failure in congenital heart disease. In:
E. Shaddy (ed.). London: Springer-Verlag, 2011. doi: 10.1007/
978-1-84996-480-7_2.
4. Boriskov M.V., Petrakovskii P.Yu., Serov T.V. Coarctation
of the aorta in newborns Current state of the problem.
Innovatsionnaya meditsina Kubani [Innovative Medicine of the
Kuban’]. 2016; (3): 66–70. (in Russian)
5. Sinelnikov Yu.S., Humpback Yu.N., Humpback A.V., et al. Sur-
gical correction of coarctation with hypoplasia of the distal aortic
arch in newborns. Patologiya krovoobrashcheniya i kardiokhirurgiya
[Pathology of Circulation and Cardiac Surgery]. 2011; (3): 9–12.
(in Russian)
6. Jashari H., Lannering K., Ibrahimi P., et al. Persistent reduced
myocardial deformation in neonates after CoA repair. Int J Cardiol.
2016; 221: 886–91.
7. Pettersen M.D., Du W., Skeens M., et al. Regression equations
for calculation of Z scores of cardiac structures in large cohort
of healthy infants, children, and adolescents: an echocardiographics
study. J Am Echocardiogr. 2008; 21 (8): 922–34.
8. Ungerleider R., Pasquali S., Welke K.F., et al. Contemporary
patterns of surgery and outcomes for aortic coarctation: an analysis
of the society of thoracic surgeons congenital heart surgery
database. J Thorac Cardiovasc Surg. 2013; 1: 1–20.
9. Kappetein A., Zwinderman A., Bogers A., et al. More than
thirty-five years of coarctation repair. J Thorac Cardiovasc Surg.
1994; 107 (1): 87–95.
10. Klitsie L.M., Roest A., Kuipers I.M., et al. Enhanced
characterization of ventricular performance after coarctation repair
in neonates and young children. Ann Thorac Surg. 2013; 96 (2):
629–36.
11. Lang R.M., Badano L.P., Mor-Avi V., et al. Recommendations
for cardiac chamber quantification by echocardiography in adults:
an Update from the American Society of Echocardiography and
the European Association of Cardiovascular Imaging. J Am Soc
Echocardiogr. 2015; 28: 1–39.
12. LopesL.,ColanS.D.,FrommeltP.C.,etal.Recommendationsfor
quantification methods during the performance of a pediatric echocar-
diogram: a Report from the Pediatric Measurements Writing Group of the
American Society of Echocardiography Pediatric and Congenital Heart
Disease Council. J Am Soc Echocardiogr. 2010; 23: 465–95.
13. Voigt J.U., Pedrizzetti G., Lysyansky P., et al. Definitions
for a common standard for 2D speckle tracking echocardiography:
consensus document of the EACVI/ASE/Industry Task Force to
standardize deformation imaging. Eur Heart J Cardiovasc Imaging.
2015; 16: 1–11.
14. Breatnach C.R., Levy P.T., James A.T., et al. Novel
echocardiography methods in the functional assessment of the
newborn heart. Neonatology. 2016; 110: 248–60.
15. JashariН.,RydbergА.,IbrahimiР.,etal.Normalrangesofleft
ventricular strain in children: a meta-analysis. Cardiovasc Ultrasound.
2015; 13: 37. URL: http://dx.doi.org/10.1186/s12947-015-0029-0.
16. Jashari H., Rydberg A., Ibrahimi P., et al. Left ventricular
response to pressure afterload in children: aortic stenosis and
coarctation: a systematic review of the current evidence. Int
J Cardiol. 2015; 178: 203–9.
17. Dijkema E.J., Leiner T., Grotenhuis H.B. Diagnosis, imaging
and clinical management of aortic coarctation. Heart. 2017 Apr 4.
pii: heartjnl-2017-311173. doi: 10.1136/heartjnl-2017-311173.
18. Iwano H., Pu M., Upadhya B., et al. Delay of left ventricular
longitudinal expansion with diastolic dysfunction: impact on load
dependence of e' and longitudinal strain rate. Physiol Rep 2014; 2
(7): e12082.
19. Lombardi K.C., Northrup V., McNamara R.L., et al. Aortic
stiffness and left ventricular diastolic function in children following
early repair of aortic coarctation. Am J Cardiol. 2013; 112: 1828–33.