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Purpose: Bicuspid aortic valve (BAV) is associated with proximal aortic dilatation (AD). Using a multimodality approach, the aims were: a) to study the flow in proximal aorta; b) to assess the relationship between aortic wall shear stress and dilatation; c) to study the aortic valve shear stress.
Methods: A computational model of patient-specific aortas with different BAV phenotypes was built. A computed model of BAV, aortic valve shear stress, proximal aorta flow, aortic wall shear stress was built. The shape and BAV orifice was built using transthoracic echocardiographic images from parasternal long and short axis views. The BAV leaflets were built in a peak systolic configuration using SOLIDWORKS®. Peak radial strain was evaluated at annulus level in a transthoracic parasternal short axis view. Transvavular flow velocity was measured by continuous Doppler echocardiography in 5 chambers apical view. The aortic lumen was reconstructed from thoracic computed tomographic images and the aortic wall was virtually created using computational algorithms.
Results: In a BAV with two cusps without a raphe the flow in proximal aorta was turbulent and directed to the aortic wall immediately after sinotubular junction. The flow presented an elevated velocity (m/s) in the aortic root and proximal aorta, reaching the aorta wall (fig A). The flow’s impact in aorta generated an area of higher wall displacement (mm) and wall shear stress (dyn/ cm2), resulting in consequent AD (fig B-C). Maximum kinetic energy (1.06 J) was achieved immediately after the valve and in the flow that impacted in aortic wall (fig D). Maximum viscous dissipation (2.07e7 s^-2) and maximum energy loss (3.76e6 s^-2) were also coincident with the area of flow impact in aortic wall. The reconstruction of BAV and the determination of valvular shear stress showed a higher stress in valvular leaflets tip. The area of greatest wall shear stress corresponded to the area of the lowest peak radial strain in echocardiography (fig. I and J).
In the patient with right and left cusps fusion the AD was more distal in ascending aorta. The flow velocity was higher in transvalvular zone and in area of impact on the aortic wall (fig E), generated AD and higher wall displacement (fig F), wall shear stress (fig G), kinetic energy (fig H), maximum viscous dissipation and maximum energy loss. The shear stress was uniform in valvular leaflets tip, in line with similar peak radial strain around the valve (fig K-M).
Conclusion: The turbulence and high velocity of blood flow in BAV generated a higher displacement and wall shear stress leading to AD. The highest hemodynamic stress areas in BAV corresponded to areas with the worst peak radial strain. This multimodality and non-invasive approach can be relevant in clinical practise to study the impact of the transvalvular flow in the aortic wall and valvular leaflets in BAV patients. We intend to analyse other types of BAV to continue this preliminary study.
Abstract 538 Figure.
Abstract 538 Figure.
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Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and may significantly affect aortic diameter. Various types of BAV morphology can differently affect the aortic dilatation.
Aim: To evaluate the impact of the two most common BAV morphology patterns (right-left vs right-noncoronary fusion) on the diameter of aorta at the level of sinuses of Valsalva (SVD) and the ascending aorta (AAD). We also have performed a meta-regression analysis to assess the impact of gender, aortic stenosis (AS), aortic regurgitation (AR) and age on the observed effect in selected studies.
Methods: The PubMed databases was searched up to 31 December 2016 to identify studies on the morphology of BAV and aortic diameters. Inclusion criteria were: the data on indexed (to the body size area) and/or non-indexed SVD and/or AAD and the morphology pattern of BAV, defined as right-left cusp fusion (RL) or right-noncoronary cusp fusion (RN). The additional characteristics of included studies (gender [% of male], AS [% of patients with moderate or severe AS], AR [% of patients with moderate or severe AR] and mean age) were collected to perform a meta-regression analysis. A random effect model was applied. To evaluate the individual impact of each study on the overall effect size, sensitivity analysis was conducted using the "leave-one-out" approach, by estimating the weighted mean difference in the absence of each single study. Two independent reviewers extracted the data.
Results: We included 13 studies on AAD with 2322 patients (pts) with indexed, and 14 studies with 2941 pts with non-indexed diameter. Similarly, 7 studies with 1271 pts with indexed, and 16 studies with 3454 pts with non-indexed SVD. There was no difference between RL and RN group in AAD - mean difference (MD) in indexed AAD: - 0.12 mm/m2 (95% CI: -0.85 to 0.61 mm/m2, p=0.75); MD in non-indexed AA: 0.03 mm (95% CI –1.09 to 1.15 mm, p=0.96). Differently, the RL BAV morphology was associated with significantly larger SVD than RN phenotype - MD in indexed diameter: 1.63 mm/m2 (95% CI 0.70 to 2.56 mm/m2, p<0.001); MD in non-indexed diameter: 2.03 mm (95% CI 0.98 to 3.09 mm, p<0.001). Multivariate meta-regression analysis showed that only AS significantly reduced the observed difference in non-indexed SVD between RL and RN patterns (β=-0.02; 95% CI: -0.10 to -0.01; p=0.027), whereas gender, AS, AR and age had no influence on differences in AAD between RL and RN BAV phenotype. The "leave-one-out" analysis revealed no potential study selection bias.
Conclusions: BAV phenotype significantly affects the aortic diameter at the level of sinuses of Valsalva. In right and left cusp fusion of BAV the aortic diameter at the level of sinuses of Valsalva is larger than in right and non-coronary cusp fusion. As presented in performed meta-regression the observed differences decrease with increasing degree of aortic stenosis, but are unrelated to age, gender or presence of aortic regurgitation.
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On behalf of: HoloViz
Funding Acknowledgements: South Eastern Regional Health Authorities, Norway. Digilab, Sopra Steria.
Background/Introduction: Complex congenital heart defects, such as double outlet right ventricle, pose great challenges in surgical decision making and custom made solutions are often necessary. 3D printed heart models have come into use in both surgical and interventional planning, providing real three dimensional experience.
Purpose: Proof of concept study for a clinical workflow to visualize 3D heart models of congenital heart defects in a wearable shared hologram solution providing mixed reality.
Methods: Heart models from patients with different lesions were made by semi-automated segmentation of CT or MRI data by similar methods as for 3D printing. These files were converted to .ply files and shown as holograms in a lens that integrates the model into the real surroundings. The holograms could be studied by several viewers simultaneously. Tools for rotating and cutting the holograms were developed and applied.
Results: Three segmented heart models (table) from CT and MRI datasets were easily represented and studied as holograms with acceptable resolution and image quality. Structures that are critical for surgical decision making could be studied, such as ventricular septal defect in relation to great arteries. Holograms provide true 3D experience and may be a time-saving and material-cost-free alternative to 3D printed heart models for some applications in congenital heart disease.
Conclusion: High quality segmented cardiac CT and MRI holograms could be presented in this wearable hologram solution, to show intracardiac anatomy in complex congenital heart defects. Validation studies and clinical trials to evaluate the value of such holograms as preoperative and intraoperative tools are needed. Further development of virtual surgical tools is expected.
Hologram Cases
| Case no and age | diagnosis | surgical plan | image data |
|---|---|---|---|
| 1. 8 years | DORV, TGA, Subpulmonary VSD | Arterial switch operation + LV to neo-aorta rerouting | 1,5T MRI. 1,2 mm slices. Pixel spacing 1,2/1,2mm |
| 2. 15 years | Left atrial isomerism, ccTGA, PA, VSD, MAPCA, Small morphological LV. | Atrial rerouting, LV to PA conduit. VSD closure +/- Glenn shunt. | 1,5T MRI. 1,5mm slices. Pixel spacing 0,74/0,74 mm |
| 3. 1 year | TGA, VSD, subPS, vPS | Nikaidoh procedure w/LeCompte manoeuvre | Contrast CTA. 0,5 mm slices. Pixel spacing 0,282/0,282 mm |
| Case no and age | diagnosis | surgical plan | image data |
|---|---|---|---|
| 1. 8 years | DORV, TGA, Subpulmonary VSD | Arterial switch operation + LV to neo-aorta rerouting | 1,5T MRI. 1,2 mm slices. Pixel spacing 1,2/1,2mm |
| 2. 15 years | Left atrial isomerism, ccTGA, PA, VSD, MAPCA, Small morphological LV. | Atrial rerouting, LV to PA conduit. VSD closure +/- Glenn shunt. | 1,5T MRI. 1,5mm slices. Pixel spacing 0,74/0,74 mm |
| 3. 1 year | TGA, VSD, subPS, vPS | Nikaidoh procedure w/LeCompte manoeuvre | Contrast CTA. 0,5 mm slices. Pixel spacing 0,282/0,282 mm |
First three cases presented at surgical conference with CT/MRI based holograms
Hologram Cases
| Case no and age | diagnosis | surgical plan | image data |
|---|---|---|---|
| 1. 8 years | DORV, TGA, Subpulmonary VSD | Arterial switch operation + LV to neo-aorta rerouting | 1,5T MRI. 1,2 mm slices. Pixel spacing 1,2/1,2mm |
| 2. 15 years | Left atrial isomerism, ccTGA, PA, VSD, MAPCA, Small morphological LV. | Atrial rerouting, LV to PA conduit. VSD closure +/- Glenn shunt. | 1,5T MRI. 1,5mm slices. Pixel spacing 0,74/0,74 mm |
| 3. 1 year | TGA, VSD, subPS, vPS | Nikaidoh procedure w/LeCompte manoeuvre | Contrast CTA. 0,5 mm slices. Pixel spacing 0,282/0,282 mm |
| Case no and age | diagnosis | surgical plan | image data |
|---|---|---|---|
| 1. 8 years | DORV, TGA, Subpulmonary VSD | Arterial switch operation + LV to neo-aorta rerouting | 1,5T MRI. 1,2 mm slices. Pixel spacing 1,2/1,2mm |
| 2. 15 years | Left atrial isomerism, ccTGA, PA, VSD, MAPCA, Small morphological LV. | Atrial rerouting, LV to PA conduit. VSD closure +/- Glenn shunt. | 1,5T MRI. 1,5mm slices. Pixel spacing 0,74/0,74 mm |
| 3. 1 year | TGA, VSD, subPS, vPS | Nikaidoh procedure w/LeCompte manoeuvre | Contrast CTA. 0,5 mm slices. Pixel spacing 0,282/0,282 mm |
First three cases presented at surgical conference with CT/MRI based holograms
Abstract 540 Figure. Planning surgery with shared hologram
Abstract 540 Figure. Planning surgery with shared hologram
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Funding Acknowledgements: ESC training grant
Background: Despite a growing population of women of childbearing age with repaired tetralogy of Fallot (rToF), few data inform counselling with regards to potential effects of pregnancy on clinical status and ventricular remodelling. Echocardiography measurement of global longitudinal strain and strain rate is considered sensitive to changes in ventricular performance.
Purpose: Our aim was to investigate the effects of pregnancy on the clinical status and cardiac haemodynamics in a group of rToF patients using echocardiography, including 2D strain imaging.
Methods: Women with rToF who had at least one successful pregnancy in the period from 2008 to 2015 were retrospectively reviewed. Only those who had pre- and post- pregnancy echocardiographic and clinical data were included in the study. Changes in NYHA class, QRS duration and echocardiographic parameters of severity of pulmonary (PR) and tricuspid regurgitation, right ventricular (RV) outflow tract obstruction, RV and left ventricular (LV) size and function, including global longitudinal strain and strain rate were analysed.
Results: Overall, 18 women with rToF (mean age at delivery 29.7±4.3 years) and 24 pregnancies were included. After pregnancy (12.7±7.7 months) there was significant prolongation of QRS duration (139.5±17.2 vs 144.9±17.3ms, p<0.001) but no change in NYHA class. Echocardiography showed a significant increase in PR severity grade (1.42±1.1 vs 1.67±1.0, p=0,031), RV systolic area index (RVSAi) (7.6±1.3 vs 8.8±1.7cm2/m2, p=0.015), tricuspid annular plane systolic excursion (TAPSE) (15.3±3.4 vs 16.7±3.4mm, p=0.024) and RV global longitudinal strain (GLS) (-15.4±2.6 vs -16.7±4.0%, p=0.042). The increase in RV diastolic area index (RVDAi) was statistically not significant (14.4±2.7 vs 16.1±2.6cm2/m2, p=0.053) and there was no change in other parameters, including RV global longitudinal strain rate (GLSR). After delivery, severity of PR correlated with RVDAi (p=0.001, r=0.651), RVSAi (p<0.001, r=0.713), TAPSE (p<0.001, r=0.685) and RV GLS(p=0.050, r=0.405) but not with RV GLSR.
Conclusion: In women with rToF, significant QRS prolongation, worsening PR and RV dilatation were observed post pregnancy, without deterioration in functional class. Increase in TAPSE and RV GLS, which are load dependant parameters of systolic function, may be potentially related to increase in PR severity. Larger studies with case controls are necessary to assess whether pregnancy itself impacts on all these changes or these are purely reflecting the ‘natural’ course of the condition.
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Funding Acknowledgements: The authors have no competing of interest to disclose
Background: In adult patients with Fontan circulation, exercise performance is reduced and has prognostic impact. Skeletal, pulmonary and cardiac factors contribute to a progressive decline in exercise capacity. We have recently shown that chronotropic incompetence, increased pulmonary vascular resistance as well as the lack of adequate preload may limit exercise performance in Fontan patients. However, cardiac intrinsic mechanisms involved in this exercise limitation have not been identified yet.
Objectives: To evaluate the relationship between single ventricle function and exercise capacity in adult patients with Fontan circulation.
Methods: Patients with Fontan circulation who underwent 2-dimensional echocardiography with speckle tracking analysis and cardiopulmonary exercise testing (CPET) were included. We analyzed the associations between echocardiographic parameters and exercise capacity measurements evaluated with CPET.
Results: 30 patients with Fontan circulation were retrospectively studied, 25 (83%) patients had adequate ventricular echo images allowing strain measurements. The ventricle longitudinal peak systolic strain was significantly correlated with exercise peak VO2 (R=0,62; p<0.01) and percentage of predicted peak VO2 (R=0,47; p=0,01). There was no significant correlation between ventricular ejection fraction and exercise measurements. Finally a significant correlation between percentage of predicted peak VO2 and E/A (R=-0.43;p=0,03) suggested a role of diastolic dysfunction in exercise limitation.
Conclusion: In Fontan patients, decrease in global longitudinal strain and diastolic dysfunction of the single ventricle are significantly associated with exercise limitation. These parameters could have a prognostic value in Fontan circulation and could be useful non invasive, easily measurable tools able to identify patients at risk for failing Fontan, who deserve closer follow-up.
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Background/Introduction: Aortic root dilatation (ARD) is a frequent finding in patients after surgical repair of tetralogy of Fallot (TOF). ARD may lead to serious complications such as aortic regurgitation (AR), aneurysm formation and even aortic dissection or rupture.
Purpose: The aim of this study is to assess the degree of ARD and rate of progression during follow-up of TOF patients, and to define risk factors associated with the development of ARD and AR in pediatric TOF patients.
Methods: In this single-center longitudinal study we retrospectively identified 768 patients with TOF. Of them there were 592 subjects (77%) with standard TOF, 41 subjects (5.3%) with double outlet right ventricle (DORV), and 135 subjects (17.6%) with pulmonary atresia (PA). Mean age at repair was 12.1±20.9 months. A total of 462 patients had an echocardiography follow-up >2 years (mean follow-up time of 6.3±2.2 years, total follow-up of 2.841 subjects-years). We reviewed all echocardiographic studies for degree of AR and aortic root dimensions, adjusted for body surface and expressed as z-scores. Measurements were compared with 304 control subjects.
Results: Among TOF patients, aortic dimensions were enlarged at baseline and during follow-up. At the pre-operative neonatal echocardiogram, the aortic valve diameter Z score was 3.6±2.9. The mean Z score of the aortic valve diameter at the first post-op echo was 3.3±2.7. Similar results were observed for sinus of Valsalva and ascending aorta. The mean of the maximum aortic valve diameter Z score reached during follow-up was 4.3±2.7, and was associated with type of TOF (standard TOF < TOF/DORV < TOF/PA; p<.0001).
Overall, there was no progression of ARD during follow-op. The mean rate of Z score change during follow-up was -0.11 Z score unit per year [95%CI -0.14: -0.07], indicating a slightly decreasing Z score during follow-up. A rapid increase of Z score was observed in <1% of patients. Larger Z score tended to be observed early during follow-up, rather than later. The rate of Z score change was associated with the maximal Z score reached during follow-up but the correlation was poor and the sensitivity to detect ARD was very low. During follow-up of the entire TOF group of 768 patients, 3 patients developed moderate or severe AR and 2 patients required aortic surgery. No mortality was associated with aortic related sequelae.
Conclusions: This study shows that ARD is a frequent finding in repaired TOF, although dilated aortic root dimensions remain stable and even show a very mild regression in the vast majority of TOF patients. Aortic-related complications were very rare. Progressive ARD is difficult to predict and therefore meticulous follow-up of the aortic root remains warranted after repair in TOF patients.
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Background: Bicuspid aortic valve (BAV) is the most common cause of isolated valvular aortic stenosis (AS) in adults and the most common cause of isolated aortic insufficiency (AI).The changes in hemodynamics, as well as changes in the aortic media during pregnancy, put the women with BAV and significant AS and/or dilated aortic roots at risk for complications during this period.
Material and Methods: 97 patients with BAV, aged 18-42, mean 25.6±4.3 years, were observed during pregnancy and after delivery. Among them, 57 patients had aortic stenosis (SA): 23 mild AS (AVA 1.6-2.0 cm²), 34 moderate to severe AS (AVA 0.5-1.5 cm²) and 40 patients aortic insufficiency (AI): 23 mild and 17 moderate to severe. Medical history; physical examination, NYHA class assessment, ECG and echocardiography were performed during each trimester (TR) of pregnancy and 8-12 weeks after delivery. Results: All pregnants with mild AS remained in NYHA functional class I, there was no deterioration of clinical status. Echocardiographic monitoring: LVEDD, LVESD, EDV, ESV, SV, CO, RV, LA, LV mass, peak and mean aortic gradients increased significantly between consecutive TR and decreased after delivery. Patients with moderate to severe AS in the I TR remained in NYHA class I-II, in 7 patients clinical deterioration was observed within III TR. Echocardiography revealed the maximum pressure gradient ranging from 55 to 152 mmHg, which was greater by 19 to 42 mmHg comparing to the post-delivery values (p<0.001). Echocardiographic monitoring revealed no significant increase of LVEDD, EDV, CO, SV between II and III TR. In the group of AI patients in III TR of pregnancy a clinical deterioration was observed in 5 patients with severe AI, enlarged LV and decreased LV systolic function (EF ≤ 50%). In echocardiography the significant increase of LVEDD, LVESD, EDV, ESV, CO, RV, LA was notified during pregnancy, there were no statistical differences of SV values between II and III TR. A significant increase of EF and FS postpartum comparing to pregnancy period was noted.
In the observed group of patients with BAV the ascending aorta diameters (range: 28-44 mm) didn’t change during pregnancy, there was no pregnancy-associated dissection. Delivery: All patients with mild AS delivered vaginally. Nineteen women with severe AS delivered by cesarean section, the remaining vaginally. All patients delivered healthy babies with normal birth-weight. Eight patients with AI delivered by cesarean section due to obstetric indications, the remaining vaginally.
Conclusions: Among the patients with BAV, patients with mild AS tolerate well the increased cardiovascular demand of pregnancy. In patients with severe AS pregnancy intensifies the hemodynamic disorders. Volume overload of pregnancy is well tolerated in patients with mild and moderate AI. Our findings suggest that complication risk increases with severe AI, LV enlargement, impaired systolic function and/or the enlargement of ascending aorta.
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Background: Pulmonary valve regurgitation (PR) and related right ventricular (RV) dilatation are frequent sequelae after surgical repair for Tetralogy of Fallot (TOF). Timing of pulmonary valve replacement is still subject of debate and little is known about the rate of progression of RV dilatation. We sought to analyze the natural course of RV dilatation using serial magnetic resonance (CMR) data.
Methods: This retrospective multicentric case control study included all TOF patients with significant PR and RV dilatation, who underwent serial CMR scans between 2002 and 2016 without any intervention between CMR exams. RV volumes and degree of PR were quantified in both centers using the same CMR technique. Clinical and volumetric CMR data were analyzed regarding progression of ventricular dilation and related potential risk factors.
Results: 86 consecutive patients (81 TOF, 3 DORV, 2 PA/VSD) underwent at least 2 (range 2-6) CMR examinations. Median age at first CMR was 13.7 yrs (range 1.4 – 45 yrs), time interval to last CMR was 3.4 yrs (6 months-12.2 yrs).
In the overall group no significant change was observed between first and last CMR for RV end-diastolic volume (RVEDV 151±32 vs 155±34 ml/m2), RV end-systolic volumes (RVESV 78±29 vs 80±28 ml/m2) and RV function (EF 49±8% vs 49±8%).
Progression of dilatation, defined as an increase >20ml/m2, occurred in 21 patients (24%). In this group RVEDV increased from 152±33 ml/m2 to 182±32 ml/m2 (p<0.001); RVESV changed from 85±39 ml/m2 to 98±29 ml/m2 (p<0.0012); ejection fraction did not deteriorate significantly (48±10% vs 47±7%). Presence of a transannular patch, initial RV volume and age at repair were not predictive for progressive RV dilatation. In contrast longer time interval between repair and first CMR (p 0.03) was predictive for progressive RV dilatation.
Conclusion: During a follow-up of 3.4 yrs, only 24% of all TOF patients with PR experience significant RV dilatation.
Time since surgical repair was the only factor predictive for progression of dilatation.
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Background: As surgical techniques have improved more children born with congenital heart disease are surviving into adulthood. As these patients age they are developing new complications; one of the most common is the development of pulmonary regurgitation, which is often well tolerated initially but has long term adverse effects including poor exercise capacity, progressive right ventricular remodelling, tachyarrhythmias, congestive cardiac failure and sudden cardiac death. To avoid this pulmonary valve replacement (PVR) is undertaken.
Purpose: We sought to assess the performance of pulmonary valve replacements over time, aiming to identify any patients who suffer early valve dysfunction.
Methods: 241 patients who had undergone PVR between 2001 and 2016 were identified. Serial echocardiogram reports were evaluated to assess PVR durability. Early valve dysfunction was defined as: 1) PVR with evidence of significant pulmonary stenosis (peak velocity ≥ 3.2m/s); 2) PVR with evidence of significant pulmonary regurgitation (> mild pulmonary regurgitation); 3) Re-intervention upon the PVR either with a percutaneous valve or a redo valve replacement.
Results: 54% of the patients were male with a mean age at PVR of 32.6±12.1yrs. 66% of patients had a primary diagnosis of Tetralogy of Fallot. The mean period of follow up was 8.2 ± 3.8 years. The mean age of patients at the time of the last follow up was 40.7±12.7 yrs. Over the course of follow up 12 patients developed significant pulmonary stenosis and 26 developed more than mild pulmonary regurgitation. In 6 of these cases there was mixed pulmonary stenosis and regurgitation. In total 32 (13.3%) of participants had evidence of early valvular dysfunction. The results for the degree of pulmonary stenosis and pulmonary regurgitation are shown in Figure A & B below. Of these 32 patients, 3 required redo pulmonary valve replacement, 2 of these for pulmonary stenosis and the other 1 for pulmonary regurgitation in the context of recent infective endocarditis. Freedom from redo surgical or trans-catheter PVR at 5 years was 100%. The three patients who required redo surgery required this at 6, 9 and 12 years. No cases of valve thrombosis were noted during the follow up interval.
Conclusions: This study has found that the majority of patients have a well-functioning pulmonary valve replacement. However there are a small group of patients whose PVR appears to deteriorate earlier. In this cohort 32 participants, 13.3% of the study population showed evidence of early valve dysfunction. In total three participants, 1.2% of the study cohort required further pulmonary valve implantation due to prosthesis failure. Future work will aim to identify risk factors for early valve dysfunction so that echocardiographic resources can be focused upon these patients, whilst patients at lower risk of valve dysfunction may have a less intense follow up regime.
Abstract 546 Figure.
Abstract 546 Figure.
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Background: Life expectancy is still reduced in aortic coarctation (AoC) patients despite a successful repair because of late arterial hypertension and atherosclerosis. Exercise-induced arterial hypertension (EIAH) is well known to be responsible of myocardial hypertrophy, and poor prognosis. EIAH is also common in AoC patients, although its clinical significance is still unclear.
Aim: To assess the prevalence of EIAH among AoC normotensive young patients successfully treated and to evaluate the impact of EIAH on left ventricular (LV) geometry and function.
Methods: We studied 64 AoC patients (mean age 15±6 years, male 58%) who underwent successful coarctation repair > 12 months before the study. All had to be normotensive at office evaluation and able to perform exercise test on the bicycle. All patients underwent standard echo evaluation and speckle tracking analysis before the exercise test. According to exercise test our sample was divided in real normotensive patients (Group RN, n=20) and EIAH patients (Group EIAH, n=44).
Results: The two groups were comparable for age and sex. There was an increased pressure gradient in the aortic arch (14.9 mm Hg±4 vs 11.4 mm Hg±4.5, P<0.05), increased LV mass (49 g m(-2.7)±12 vs 36 g m(-2.7)±9, P<0.05), in EIAH AoC patients. Regional longitudinal deformation properties of the basal septal segment (-18.6%±4.4 vs -20%±5, P<0.01) and LV twist values (14°±1.6 vs 11.8°±2.4, P<0.0001) were reduced in the EIAH group.
Conclusions: There is a high prevalence of EIAH in young patients with repaired AoC, which is associated with abnormal LV structure and function. Clinicians should consider exercise test in apparently normotensive patients followed up for AoC repair.
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