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Ann Thorac Surg 2005;80:999-1000
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Invited commentary

Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322

(Email: kkanter{at}emory.edu).

This paper by Murakami and Takeda [1] carefully looks at aortic pressure waveforms in 20 children on average nine years after repair of aortic coarctation or interrupted aortic arch, and compares them with age-matched "normal" control patients. They found an abnormal ascending aortic pressure tracing with a shortened inflection time, a higher systolic blood pressure with a wider pulse pressure, and an increased augmentation index. The authors speculate that this abnormality is related to decreased distensibility of the reconstructed portion of the repaired aorta creating a mismatch in impedance. This reconstructed portion, therefore, generates a reflection wave traveling backward along the ascending aorta accounting for these abnormal findings. In a child with a normal aorta, this reflection wave is usually generated at the iliac bifurcation.

There is also evidence that the aorta proximal to the coarctation or arch repair is intrinsically abnormal with decreased distensibility, which increases the pressure wave consequently increasing the afterload of the heart. Long term, of course, this translates into increased risk for cardiovascular disease, a known complication of patients after coarctation repair.

One can argue that this study is somewhat flawed because 5 of the 20 patients had undergone balloon angioplasty for residual arch gradients and two others had residual gradients at catheterization, meaning that only 13 of the 20 patients had a "perfect" coarctation repair. However, if these findings that the aortic pressure wave is inherently abnormal after coarctation or arch repair hold true, then we need to rethink our feeling that we have "cured" these children, even those who are repaired in infancy. Yet another congenital heart problem that we previously thought in the past to have cured, in fact, we have only achieved palliation.

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1. Murakami T, Takeda A. Enhanced aortic pressure wave reflection in patients after repair of aortic coarctation Ann Thorac Surg 2005;80:995-1000.[Abstract/Free Full Text]

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				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]

This Article Full Text (PDF) 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 Add to Personal Folders Download to citation manager Author home page(s): Kirk Kanter Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kanter, K. Search for Related Content PubMed PubMed Citation Articles by Kanter, K. Related Collections Congenital - acyanotic