Endothelin-1 activation in pediatric patients undergoing surgical coarctation of the aorta repair

AIM To determine endothelin-1（ET-1）concentration before and after surgical coarctectomy and evaluate its association with left ventricular geometric change.METHODSA prospective,cohort study of 24 patients aged 2 d to 10years with coarctation of the aorta undergoing surgical repair.A sub-cohort of patients with age<1 mo was classified as“neonates”.Echocardiograms were performed just prior to surgery and in the immediate post-op period to assess left ventricle mass index and relative wall thickness（RWT）.Plasma ET-1 levels were assessed at both time points.Association between ET-1 levels and ventricular remodeling was assessed.RESULTSPatients<1 year demonstrated higher pre-op ET-1 than post-op（2.8 pg/m L vs 1.9 pg/m L,P=0.02）.Conversely,patients>1 year had no change in ET-1 concentration before and after surgery（1.1 vs 1.4,NS）.Pre-op,patients<1 year demonstrated significantly higher ET-1 than older children（2.8 vs 1.1,P=0.001）.Post-op there was no difference between the age groups（1.9 vs 1.4,NS）.Neither RWT nor left ventricle mass index（LVMI）varied from pre-op to post-op.The subset of neonates showed a strong positive correlation between pre-op ET-1 and RWT（r=0.92,P=0.001）.Patients with ET-1>2 pg/m L preop demonstrated higher LVMI(65.7 g/m2.7 vs 38.5 g/m2.7,P=0.004)and a trend towards higher RWT（45%vs39%,P=0.07）prior to repair than those with lower ET-1concentration.CONCLUSIONET-1 concentration is significantly variable in the perioperative period surrounding coarctectomy.Older children and infants have different responses to surgical repair suggesting different mechanisms of activation.