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Ann Thorac Surg 2006;81:2341-2342
© 2006 The Society of Thoracic Surgeons

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Correspondence

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Department of Pediatrics, Hokkaido University, Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, 060-8638 Japan,

(Email: murat{at}med.hokudai.ac.jp).

To the Editor:

We thank Drs Kühn and Vogt [1] for their comments concerning our article [2].

The analysis of aortic pressure waveforms in patients with aortic coarctation before surgical intervention has already been covered by several textbooks [3]. These sources mention that the pressure waveforms recorded in the ascending aorta of patients with aortic coarctation can be explained on the basis of an early return of wave reflection. Our report demonstrated that the early return of pressure wave reflection persisted after surgery. In other words, the surgical treatment in our case could only improve the conduit function of the aorta in patients with aortic coarctation.

For the pressure-generated wave reflection, the pressure waveforms during the pullback of the catheter from the ascending to the descending aorta suggested that these wave reflections occurred at the reconstructed site. This is reasonable because wave reflections arise from any discontinuity in the elastic properties in any wall along the arterial tree in which there is a change or impedance mismatch. Moreover, many hypertension reports have demonstrated the importance of enhanced pressure wave reflection in cardiovascular diseases [4, 5].

Our report stated that the enhanced aortic pressure wave reflection, which could cause later cardiovascular disease, persisted even after surgery in patients with aortic coarctation. This may damage the left ventricle and the arterial system in the upper half of the body. Although Vogt and Kühn's [6] report ignored the importance of "central" aortic pressure [7], we do not deny the possibility that the distensibility of the ascending aortic wall is the primary damage. However that hypothesis cannot explain the pressure waveforms in patients after aortic arch repair observed in our report.

	References

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1. Kühn A, Vogt M. Ascending aortic distensibility is impaired before and after surgical "repair" of coarctation Ann Thorac Surg 2006;81:2341.[Free Full Text]
2. 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]
3. Nichols WW, O'Rourke MF. McDonald's blood flow in arteries4th ed. London: Arnold; 1998.
4. Hayashi T, Nakayama Y, Tsumura K, et al. Reflection in the arterial system and the risk of coronary heart disease Am J Hypertens 2002;15:405-409.[Medline]
5. Mitchell GF, Parise H, Benjamin EJ, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and womenthe Framingham Heart Study. Hypertension 2004;43:1239-1245.[Abstract/Free Full Text]
6. 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]
7. Murakami T, Nakazawa M, Momma K, Imai Y. Impaired distensibility of neoaorta after arterial switch procedure Ann Thorac Surg 2000;70:1907-1910.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Murakami, T. Search for Related Content PubMed Articles by Murakami, T. Related Collections Congenital - acyanotic Related Article