CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
AFRICA
483
Doppler echocardiographic indices in aortic coarctation:
a comparison of profiles before and after stenting
SHOKOUFEH HAJSADEGHI, SEYED-MOHAMMAD FERESHTEHNEJAD, MAHSHID OJAGHI,
HOSSEIN ALI BASSIRI, MOHAMMAD REZA KERAMATI, MITRA CHITSAZAN, SAEID GHOLAMI
Abstract
Background:
Diagnosis of aortic coarctation is important as
it is a difficult condition to evaluate, especially in adults. A
Doppler echocardiographic index could provide a simple tool
to evaluate coarctation.This study was performed to compare
Doppler echocardiographic profiles before and after stenting
and to assess the diagnostic value of a complete list of echo-
cardiographic indices for detecting aortic coarctation.
Methods:
This prospective study was conducted on 23 patients
with a diagnosis of aortic coarctation based on angiogra-
phy. Echocardiographic assessment was done twice for all
patients before and after stenting. Each time, two-dimension-
al and Doppler echocardiographic imaging modalities were
performed and complete lists of indices were recorded for
each case. After comparing the values of indices before and
after stenting, diagnostic values of each index were calculated
in order to diagnose significant coarctation.
Results: Twenty-three patients, including 16 males and seven
females with a mean age of 26.14
±
10.17
years, were enrolled
in this study. Except for the mean velocity and mean pres-
sure gradient of the abdominal aorta, the values of the other
indices of the abdominal/descending aorta showed enough
change after stenting to indicate significant diagnostic accu-
racy for detecting aortic coarctation. The velocity–time inte-
gral and the pressure half-time were among the indices with
the highest accuracy rates for this purpose (all
p
<
0.001).
Conclusion:
Post-stenting echocardiographic profiles could
provide a reliable reference value of the normal aortic
haemodynamics as a unique identification of each patient
and it is presumed that these indices could be used as reliable
indicators of response to treatment.
Keywords:
aortic coarctation, Doppler echocardiography, index,
diagnostic values
Submitted 2/10/11, accepted 11/5/12
Cardiovasc J Afr
2012;
23
: 483–490
DOI: 10.5830/CVJA-2012-044
As one of the most common congenital heart defects,
1
aortic
coarctation has a wide morphological spectrum that varies from
transverse arch and isthmal hypoplasia, which are seen most
commonly in new-born babies, to discrete stenosis or membrane-
like obstructions, which are typically observed in older patients.
2
Aortic coarctation presenting during adult life most frequently
represents cases either of re-coarctation following previous
transcatheter or surgical therapy, or missed cases of native
coarctation.
3
Nowadays, percutaneous stenting is an accepted form
of treatment for isolated coarctation of the aorta.
4
Balloon-
expandable endovascular stents have been used in various
locations since the 1980s.
5-15
Stents support the integrity of
the vessel wall after balloon dilation by opposing the recoil of
the elastic vascular stenosis and re-adhering the torn intima
to the media. This minimises the extension of wall tears and
subsequent dissection or aneurysm formation.
7,11,13,15,16
Moreover,
stents provide a homogenous framework for smooth endothelial
growth along the aortic wall that reduces the risk of thrombosis,
neo-intimal hyperplasia and subsequent restenosis.
5
Diagnosis and evaluation of coarctation is of great importance,
not only before stenting but also after implantation, in order to
assess the occurrence of restenosis. With regard to evaluation
of aortic coarctation, cardiovascular magnetic resonance
(
CMR) imaging is the procedure of choice.
17
However, its
use may be limited because of lack of availability or clinical
contraindications.
On one hand, due to the wide availability, in the presence
of clinical suspicion of aortic coarctation, echocardiography
is the only available bedside diagnostic tool. It is also used in
the initial assessment and follow up after the intervention of
patients with coarctation. On the other hand, two-dimensional
and colour Doppler echocardiographic techniques including
analysis of pulse-wave and continuous-wave Doppler across
the coarctation site and at the abdominal aorta are also used
for the indirect evaluation of coarctation.
4
Therefore a Doppler
echocardiographic index, independent of cardiac function or
other lesions and based on two-dimensional measurements of the
Department of Cardiology, Rasoul-e-Akram Hospital, Tehran
University of Medical Sciences (TUMS), Tehran, Iran
SHOKOUFEH HAJSADEGHI, MD
Firoozgar Clinical Research Development Center (FCRDC),
Firoozgar Hospital, Tehran University of Medical Sciences
(
TUMS), Tehran, Iran
SEYED-MOHAMMAD FERESHTEHNEJAD, MD, MPH,
Department of Echocardiography and Cardiology, Shaheed
Rajaie Cardiovascular Medical and Research Centre, Tehran
University of Medical Sciences (TUMS), Tehran, Iran
MAHSHID OJAGHI, MD
HOSSEIN ALI BASSIRI, MD
Department of Surgery, Firoozgar Hospital, Tehran
University of Medical Sciences (TUMS), Tehran, Iran
MOHAMMAD REZA KERAMATI, MD
Medical Students’ Cardiology Research Centre, Shaheed
Rajaie Cardiovascular Medical and Research Centre, Tehran
University of Medical Sciences (TUMS), Tehran, Iran
MITRA CHITSAZAN, MD
Medical Students’ Research Committee (MSRC), Tehran
University of Medical Sciences (TUMS), and Rasoul-e-
Akram Hospital, Tehran, Iran
SAEID GHOLAMI, MD
