Moderated Posters session * Congenital heart disease: 12/12/2013, 14:00-18:00 * Location: Moderated Poster area

Background: Surgical correction of aortic coarctation (CoAo) has been successfully performed for over half of the century but life expectancy of these patients remains reduced due to increased aortic stiffness leading to adverse left ventricular remodeling and end-organ damage. The role of tissue doppler imaging (TDI), in particular assessment of long axis dysfunction (LAD) defined as septal mitral annulus pulsed-wave early diastolic velocity E’≤8cm/s, in the evaluation of left ventricle diastolic dysfunction has been proved. Aim of the study: was to evaluate left ventricle diastolic function in relation to pre-coarctation aortic stiffness and arterial elastic properties and to determine relationship between left ventricle diastolic dysfunction and clinical findings in adult patients after aortic coarctation repair. Methods: Eighty-two subjects after CoAo repair (53 males) aged 33 (18-60 years) operated on at the age of 9 (1-44years) and 20 controls (8 males) aged 30 (21-46 years) were enrolled in the study. Detailed echocardiographic examination with evaluation of mitral inflow and TDI parameters (E’, A’, S’ from septal and lateral mitral annulus) was performed. Following vascular parameters were determined: central: augmentation pressure (AP), augmentation index (AI) as well as peripheral: pulse wave velocity (PVW), flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD) and intima-media thickness (IMT). Results: LAD was observed in 27 (32,9%) patients. They were older (p=0,0007), also older at the time of surgery (p=0,01) compared to non-LAD patients. The groups did not differ in respect to presence of arterial hypertension (AH), bicuspid aortic valve (BAV) or significant gradient through descending aorta (AoD+). Analysis of vascular and echocardiographic parameters revealed increased AP (p=0,005), AI (p=0,01) and IMT (p=0,001) as well as larger left atria (LA) (p=0,0001) and thicker left ventricle walls (interventricular septum, p=0,004; posterior wall, p=0,02) in the LAD patients in comparison to non-LAD group. Univariate logistic regression analysis proved increased IMT (p=0,001), AP (p=0,007), AI (p=0,01) as well as older age (p=0,002) and older age at surgery (p=0,008) to increase LAD probability. Conclusions: Left ventricle diastolic function is reduced in patients after CoAo repair. Increased pre-coarctation aortic stiffness and loss of arterial elastic properties as well as patient’s age and older age at surgery impair left ventricle diastolic function.