Right Ventricular Function and Right Ventricular-Vascular Coupling Assessment After Coarctation Repair in Adults

Surgical and interventional treatment for coarctation of the aorta currently results in excellent survival during childhood adolescence.1Oster M.E. McCracken C. Kiener A. et al.Long-term patients with repaired infancy (from Pediatric Cardiac Care Consortium).Am J Cardiol. 2019; 124: 795-802Abstract Full Text PDF PubMed Scopus (12) Google Scholar However, long-term outcomes adult treated are still guarded studies showing an increase mortality beyond third decade life.2Lee M.G.Y. Babu-Narayan S.V. Kempny cardiovascular burden survivors aorta.Heart. 105: 1190-1196PubMed Associated bicuspid aortic valve disease, which is present approximately 50% population, also significantly increases likelihood needing cardiac reinterventions without however affecting survival.3Lim M.S. Cordina R. Kotchetkova I. Celermajer D.S. Late complication rates after repair or a valve.Heart. 2022; 108: 855-859Crossref (1) One most common problems development left ventricular (LV) diastolic dysfunction, from arterial hypertension increased LV afterload related to vascular stiffness left-sided ventriculoarterial coupling.4Egbe A.C. Miranda W.R. Connolly H.M. Increased prevalence dysfunction adults aorta.Int Cardiol Heart Vasc. 2020; 28100530PubMed Scholar,5Egbe Reddy Y.N.V. Obokata M. Borlaug B.A. Doppler-Derived Arterial Load Indices Better Reflect Left Ventricular Afterload Than Systolic Blood Pressure Coarctation Aorta.Circ Cardiovasc Imaging. 13e009672Google Elevated atrial pressures can result group 2 pulmonary hypertension, negatively impact right (RV) function. The importance developing heart disease was demonstrated previous work by Egbe al.6Egbe Jain C.C. Right aorta: prognostic implications.Circ 2021; 14: 1100-1108Crossref (10) In their earlier study looking at function, research developed hemodynamic score (RHHS) that based on echocardiographic assessment 7 different parameters: (RA) volume, RA pressure, reservoir strain, RV global longitudinal end-diastolic area, systolic tricuspid regurgitation severity. Every unit this RHHS associated 64% risk events follow-up. This suggested impacts important clinical follow-up repair. Based these data, should be component problem it not easy clinically implement as requires measurements, some them being part routine scanning protocols, needs further validation. current study, Ahmed al.7Ahmed Karnakoti S. Obosied O. al.Prognostic Role Tricuspid Annular Plane Excursion/Right Ratio Aorta.Can Ped Cong Disease. 2013; 2: 167-173Google look right-sided ventricular-vascular coupling using annular plane excursion (TAPSE)/RV pressure (RVSP) index It retrospective single-centre cohort including 661 patients. they found TAPSE/RVSP <0.43 mm/mm Hg could used detecting predicted They claim help identify dysfunction. Individually, indices decrease TAPSE RVSP both known predictors secondary disease. has been shown reasonable noninvasive predictor invasively end-systolic elastance/arterial elastance uncoupling occurring when <0.31.8Tello K. Wan J. Dalmer al.Validation excursion/systolic artery ratio ventricular-arterial severe hypertension.Circ 12e009047Google Uncoupling indicates point where does longer compensate afterload. Using simple only routinely parameters seems easier compared 7-parameter scoring system. Its predictive value validation looked into its potential use predicting “new-onset dysfunction,” defined free-wall strain (RVFWS) ≥−24% presence estimation >5 mm Hg, pedal edema, initiation loop diuretics. authors did overall whether performs well outcomes. mainly purpose receiver operating characteristic analysis cutoff RVFWS defining choice motivated, Morris al.9Morris D.A. Krisper Nakatani al.Normal range usefulness detect subtle abnormalities failure: multicentre study.Eur 2017; 18: 212-223Crossref (112) lowest expected healthy control data −19% RVFWS, indicating having may have within normal range. As this, considered high certainly before implemented. interesting note invasive much lower (<0.31) one proposed thus suggest caution until validated against better outcome data. interaction between function explored. What becomes obvious published need assessed detail following includes size Future focus integrating all easily higher biventricular There subgroup who circulation ventricle. filling compromised since fetal life we know smaller fill well, resulting relative underdevelopment structures, mitral outflow tract.10Lloyd D.F.A. van Poppel M.P.M. Pushparajah al.Analysis 3-dimensional arch anatomy, flow, postnatal cases suspected magnetic resonance imaging.Circ 14e012411Crossref (21) Reduced flow speculated main causes underdevelopment. Repairing birth generally good growth preserved but there subset persistent underlying become more aging, life. Thus, hypothesized features and, combined other factors such stiffness, explain why so vulnerable failure. treatments aim identification early design slow down progression toward Longitudinal needed, methods imperfect detection changes, especially younger reported manuscript adheres relevant ethical guidelines. No funding received study.