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Ann Thorac Surg 2006;81:2341
© 2006 The Society of Thoracic Surgeons

Correspondence

Ascending Aortic Distensibility is Impaired Before and After Surgical "Repair" of Coarctation

Andreas Kühn, MD, Manfred Vogt, MD

Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University, Lazarettstr 36, Munich, D-80636 Germany

(Email: drvogt{at}dhm.mhn.de).

To the Editor:

We read with interest the article of Murakami and Takeda [1]. They enrolled 20 patients after successful repair of coarctation and compared their data with that of 20 patients with other cardiac disease. They tested the hypothesis that after reconstruction of the aortic arch pressure wave reflection in the ascending and descending aorta is enhanced due to the surgical procedure and may contribute to late vascular complications. Unfortunately, they do not preserve any data with the same method in the same patients before the surgical intervention.

In our opinion the authors cannot answer the question with their experimental methods. The only message their data provide is that pulse wave reflection in patients after coarctation repair is enhanced compared with patients with no coarctation repair. Their hypothesis remains highly speculative because it not known whether these abnormalities are present before surgery. They cannot determine why the pulse wave reflection is impaired nor can they determine the clinical significance of their findings in patients.

In our opinion pulse wave curves are formed by two components: (1) the active power of the pumping ventricle, and (2) the forces formed by the wall of the vessel through which blood is pumped. The second component can be measured nicely and noninvasively by echo M-mode, and aortic distensibility can be calculated as described in the literature [2].

With this method we examined 17 newborns before and 10 days after successful surgical repair of coarctation [3]. In contrast to Murakami and Takeda [1], we have preoperative and postoperative data of both aortic distensibility and an index of wall stiffness for our patients. We show that before any surgical intervention in newborns, not only the ascending aortic distensibility is impaired, but also the wall stiffness index is elevated whereas the descending aortic wall distensibility and wall stiffness are normal.

We conclude that significant changes in ascending aortic wall motion may be primarily inherent early after birth in coarctation patients. Kanter [4] may be right in believing that surgical intervention in coarctation patients does not cure, but palliates the patients. Enhanced pulse wave reflection is a secondary phenomenon, which is influenced by a primarily altered ascending aortic wall.


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 References
 

  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]
  2. Baumgartner D, Baumgartner Ch, Matyas G, et al. Diagnostic power of aortic elastic properties in young patients with Marfan syndrome J Thorac Cardiovasc Surg 2005;129:730-739.[Abstract/Free Full Text]
  3. Vogt M, Kühn A, Baumgartner D, et al. Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair Circulation 2005;111:3269-3273.[Abstract/Free Full Text]
  4. Kanter K. Invited commentary Ann Thorac Surg 2005;80:999-1000.[Free Full Text]

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Tomoaki Murakami
Ann. Thorac. Surg. 2006 81: 2341-2342. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., June 1, 2006; 81(6): 2341 - 2342.
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