Left ventricular wall stress and function in childhood coarctation of the aorta

Unlike most adults with compensated pressure overload of the left ventricle, children with moderate to severe aortic stenosis exhibit pronounced left ventricular muscle hypertrophy, enhanced ejection performance and diminished wall stress. To determine whether these findings are present in other forms of left ventricular pressure overload in children, left ventricular mechanics were studied by catheterization in 14 children with coarctation of the aorta (average peak gradient 39 ± 17 mm Hg) and in 10 normal children. Ejection fraction and mean velocity of circumferential fiber shortening in the coarctation group (0.74 ± 0.09 and 1.71 ± 0.43 circumferences/s, respectively) were significantly higher than in normal subjects (0.65 ± 0.05 and 1.27 ± 0.26 circumferences/s, respectively) (p = 0.008), but the ranges for both groups overlapped. End-systolic stress in children with coarctation (77 ± 20 dynes · 103/cm2) was less than in normal children (121 ± 24 dynes · 103/cm2) (p < 0.001), again with overlap of the ranges for both groups.The ratio of end-systolic stress to end-systolic volume index, an estimate of contractile function, was similar in both groups. Relations between severity of obstruction (left ventricular peak systolic pressure, coarctation gradient) and end-systolic stress and between stress and ejection performance were present within the coarctation group. Comparison of these data with those found in children with moderate to severe aortic stenosis shows a similar but less pronounced response to pressure overload due to coarctation of the aorta