diastolic retraction velocity and time to peak systolic (TAo). Strain, distensibility and stiffness index of the aortic root were determined noninvasively. Results: We ...
Congenital heart disease: aortic disease
an event. Kaplan-Meier analysis demonstrated that aortic tortuosity of ≥ 2.0 is a predictor of cardiovascular events in MFS (Log Rank test: p < 0.01). Conclusion: Increased aortic tortuosity predicts cardiovascular events in Marfan syndrome.
P2116 | BEDSIDE Aortic tissue Doppler imaging after tetralogy of Fallot repair: beyond aortic diameters C. Cruz 1 , T. Pinho 1 , A. Lebreiro 1 , C.C. Dias 2 , J. Silva Cardoso 1 , M. Julia Maciel 1 . 1 Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; 2 University of Porto, Faculty of Medicine, Department of Health Information and Decision Sciences, Porto, Portugal Purpose: Structural abnormalities of the aortic wall have been described in tetralogy of Fallot (ToF) and could be responsible for aortic stiffening leading to aortic dilatation. We aimed to study if aortic root stiffness indices assessed by tissue Doppler imaging (TDI) could be related to the aortic diameter late after ToF repair. Methods: We included adult (≥ 18 years) patients (pts) with surgically repaired ToF followed at a terciary care center from January till December 2012. We defined two groups based on the Cornell data-based z-score formulae for twodimensional transthoracic echocardiographic diameter of the aortic root at the level of the sinuses of Valsalva (AoZ), in parasternal long-axis view: group 1 with Ao dil (AoZ > 2) and group 2 - without Ao dil (AoZ ≤ 2). Aortic root M-mode systolic and diastolic diameters and TDI variables were measured, including systolic maximum anterior wall expansion velocity (SAo), early (EAo) and late (AAo) diastolic retraction velocity and time to peak systolic (TAo). Strain, distensibility and stiffness index of the aortic root were determined noninvasively. Results: We included 43 pts (mean age 32±11 years; 58% female); mean followup time since ToF repair was 22±8 years. In 21 pts (49%) an aortopulmonary (AP) shunt was done prior to complete repair, with a median interval of 3 years. In 15 pts complete repair used a transannular patch. In 10 pts (23%) we identified Ao dil (mean age 32±11 years; 5 males). Only 1 pt had moderate aortic regurgitation. Both group 1 and 2 were similar concerning age, gender, body surface area, age at ToF repair and follow up time after repair. Also, no differences could be found in systemic blood pressure, pulse pressure, and TDI variables. There was a trend to a positive correlation between the aortic root z-score and the aortic stiffness index, whereas a trend to a negative correlation was found for the aortic strain and distensibility. The aortic stiffness index was significantly increased in group 1 (14.8±6.3 vs 8.5±6.8, p=0.019) and in univariate and multivariate analysis, the aortic stiffness index was an independent predictor of aortic dilatation (odds ratio 1.30, 95% confidence interval 1.02-1.65, p=0.033). Conclusions: TDI can assess the aortic elastic properties noninvasively in this subset of pts and the aortic stiffness index may be a predictor of aortic dilatation late after ToF repair.
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not been sufficiently followed up. Thus, great efforts should be done to performed follow up programs for these high risk patients.
P2118 | BENCH Restricted blood flow in the abdominal aorta at rest and exercise in patients after coarctation aortae repair despite correction H.A.C.M. De Bruin-Bon, P. Luijendijk, B.J.M. Mulder, R.B.A. Brink Van Den, B.J. Bouma. Academic medical center, Amsterdam, Netherlands Purpose: Anatomic measurements and blood pressure differences in rest are currently used to determine whether patients after aortic repair for coarctation have a recoarctation or not. Whether flow patterns in the abdominal aorta at rest and during exercise are of additional value in determining functional restriction of the former coarctation side is unknown. Therefore, we investigated Doppler flow patterns in the abdominal aorta compared these with normal volunteers. Methods: We included random patients after aortic coarctation repair without significant re-coarctation on MRI, or uncontrolled hypertension. All patients underwent a rest echocardiography and a bicycle exercise test with echocardiographic examination limited to 70% of the predicted heart rate. Echocardiography was performed according to international recommendations. The systolic diastolic ratio (S/D) was measured in the abdominal aorta. The pulse delay was the difference of the time measured from R-wave until peak velocity in the left ventricular outflow tract and the abdominal aorta. Ten random healthy volunteered controls underwent the similar protocol. Results: Twenty adult patients were included (10 males, mean age 38 years±5) and 10 healthy controls (4 males, mean age 41 years± 10). The maximum flow velocity in the descending aorta was significantly higher than in healthy volunteers. The S/D ratio at rest was similar for both patient groups, but differed significantly at exercise. The pulse delay was significantly larger in coarctation patients than in controls. All parameters indicate a abnormal arterial systemic flow pattern below the coarctation site.
RR Heart rate Max flow ao desc S/D ratio Pulse delay
CoA rest
CoA exercise
Control rest
Control exercise
122/72 69 2,1 4,2 54†
– 121 2,7* 2,9** 62‡
123/75 70 1,1 4,3 31†
– 122 1,3* 3,7** 28‡
*, **, † , ‡ All P2) and group 2 - without Ao dil (AoZ ≤ 2). We reviewed patients (pts) demographic, echocardiographic and surgical data. Exclusion criteria were: associated heart disease congenital or acquired, genetic syndromes, unrepaired ToF and pregnancy. Results: We included 127 consecutive pts from March 2011 till December 2012 (mean age 30±9 years; 48% female); 115 pts were asymptomatic; mean followup time since ToF repair was 23±7 years. In 58 pts (46%) an aortopulmonary (AP) shunt was done prior to complete repair, with a median interval of 3 years. In 50 pts complete repair used a transannular patch. A right aortic arch was found in 29 pts. In 112 pts left ventricle end-diastolic volume (LVEDV) could be assessed by echocardiography. In 37 pts (29%) we identified Ao dil (mean age 32±11 years; 62% male). Neither gender, age, body surface area, right aortic arch nor previous AP shunt could differenciate between group 1 and 2. In pts with Ao dil a transannular patch was used more often for ToF repair (p=0.026), with longer time interval between AP shunt and ToF surgical repair (p=0.018). Also, a higher LVEDV (101±26 vs 83±22 mL; p
