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CARDIAC ULTRASOUND

Doppler Echocardiographic Profile and Indexes in the Evaluation of Aortic Coarctation in Patients Before and After Stenting

Ju-Le Tan, MBBS, MRCP^_*,, Sonya V. Babu-Narayan, MBBS, MRCP^_*, Michael Y. Henein, MD, PhD, Michael Mullen, MD, MRCP^_* and Wei Li, MD, PhD^_*,,_*

^_* Adult Congenital Heart Disease Unit, Royal Brompton Hospital, London, United Kingdom
Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
National Heart Center, Singapore General Hospital, Singapore

Manuscript received February 1, 2005; revised manuscript received May 17, 2005, accepted May 31, 2005.

^_* Reprint requests and correspondence: Dr. Wei Li, Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom (Email: w.li{at}rbht.nhs.uk).

OBJECTIVES: We sought to assess the effect of successful stenting on the Doppler profile of aortic coarctation and to identify echocardiographic indexes that could be used for follow-up of such patients.

BACKGROUND: Doppler echocardiography demonstrates characteristic flow patterns in significant aortic coarctation.

METHODS: We undertook retrospective echocardiographic analyses before and at six to nine months after coarctation stenting in consecutive patients from 2002 to 2003. Peak systolic pressure gradient (SPG), diastolic velocity (DV), end-diastolic tail velocity (EDTV), systolic velocity half-time index (SVHTi) and diastolic velocity half-time index (DVHTi), and systolic pressure half-time index (SPHTi) and diastolic pressure half-time index (DPHTi) were measured. The severity of aortic coarctation was compared with cardiovascular magnetic resonance (CMR) imaging using the coarctation index (CoAi).

RESULTS: The patient cohort was divided into two groups: group 1 (13 patients; age 30 ± 8 years), which consisted of patients with significant aortic coarctation treated with stenting, and group 2 (11 patients; age 39 ± 16 years), which consisted of patients with previous surgical repair of aortic coarctation without evidence of re-coarctation. After stenting, there was significant reduction in SPG (p = 0.001), DV (p = 0.001), EDTV (p = 0.005), DVHTi (p = 0.001), and DPHTi (p = 0.001) values. In the patient group as a whole, there was a significant correlation between SPG and DV (r = 0.86; p < 0.001), EDTV (r = 0.80; p < 0.001), DVHTi (r = 0.56; p < 0.001), and DPHTi (r = 0.50; p = 0.002). In addition, DV >193 cm/s (100% sensitivity, 100% specificity) and diastolic/systolic velocity ratio >0.53 (100% sensitivity, 96% specificity) had high predictive values for severe aortic coarctation (CoAi <0.25).

CONCLUSIONS: After stenting, peak SPG, DV, and pressure half-time indexes (i.e., DVHTi and DPHTi) decreased significantly. These findings can confidently be used in the follow-up of coarctation patients after stenting, particularly in those with limited two-dimensional images.

Abbreviations and Acronyms   CMR = cardiovascular magnetic resonance   CoAi = coarctation index   DPHTi = diastolic pressure half-time index   DT = diastolic tail   DV = diastolic velocity   DVHTi = diastolic velocity half-time index   EDTV = end-diastolic tail velocity   SPG = systolic pressure gradient   SPHTi = systolic pressure half-time index   SV = systolic velocity   SVHTi = systolic velocity half-time index

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