Doppler Echocardiographic Evaluation of Patients after Aortic Coarctation Repair

Objective- We aimed to evaluate the accuracy of Doppler echocardiography indices in patients with significant recoarctation of the aorta (ReCoA). Methods- Thirty-nine consecutive patients (11 females) post-surgical repair of aortic coarctation were included in the study. All the patients underwent complete Doppler echocardiography and clinical evaluation and peak systolic instantaneous pressure gradient (PPG), mean pressure gradient, velocity time integral (VTI) in the descending thoracic aorta, acceleration time (AT), ejection time (ET), and AT/ET of the coarctation repair site were measured. All the patients underwent CT angiography; and in case of significant ReCoA, cardiac catheterization was done. Results- Measured values of ET, AT, AT/ET, and VTI at the repair site and VTI in the descending thoracic aorta were significantly greater in the patients with ReCoA. The average difference between the echocardiographic and angiographic systolic PPG was 16 mmHg. The presence of Doppler PPG greater than 35 mmHg, VTI in the descending thoracic aorta more than 40cm, and AT at the repair site of more than 135 msec had high sensitivity and specificity for the diagnosis of significant ReCoA. Five (0.42) patients with recoarctation had significant hypertension; compared to 7 (0.26) patients without recoarctation (P-value =0.32). Conclusion- After coarctation repair, Doppler PPG should be interpreted with caution but considering other Doppler indices, Doppler echocardiography is a practical and accurate screening method for an evaluation of significant ReCoA, with a low threshold for invasive of aorta investigation if the Doppler PPG in the descending aorta exceeds 35mmHg (Iranian Heart Journal 2009; 10 (2):25-30).