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Retinal vascular patterns after operative repair of aortic isthmic coarctation
Kamran Shamsa1, Joseph K Perloff, Eric Lee
1Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA.
Insights
Retinal arteriolar tortuosity is a unique finding in patients with coarctation of the aorta, persisting even after surgical repair. This study highlights its prevalence and persistence in adult congenital heart disease patients.
Area of Science:
- Ophthalmology
- Cardiology
- Vascular Biology
Background:
- Coarctation of the aorta (CoA) is a congenital narrowing of the aortic isthmus.
- Associated retinal arteriolar abnormalities are distinctive but understudied.
- Adult congenital heart disease centers manage patients with repaired CoA.
Purpose of the Study:
- To investigate the prevalence and characteristics of retinal vascular abnormalities in adults with repaired coarctation of the aorta.
- To determine if these abnormalities persist long after surgical correction and blood pressure normalization.
Main Methods:
- Ophthalmic examinations were performed on 10 adult patients (mean age 35 years) with a history of repaired coarctation of the aorta.
- Methods included visual acuity, tonometry, slit lamp examination, and dilated funduscopy with digital photography.
- Patients were studied at least 3 years post-repair, with no significant residual coarctation gradients.
Main Results:
- Mild to severe retinal arteriolar tortuosity was observed in 70% of patients.
- Retinal venule tortuosity was also identified in 40% of subjects.
- Intraocular pressure and slit lamp findings were normal; hypertensive retinopathy was absent.
Conclusions:
- Unique retinal arteriolar tortuosity associated with coarctation of the aorta persists long-term after surgical repair.
- These retinal vascular changes are prevalent in adults with a history of coarctation.
- A previously unrecognized venular tortuosity was also noted, though less common.
Abstract:
The retinal arteriolar abnormality that accompanies aortic isthmic coarctation is as distinctive as it is unique but has thus far been virtually ignored. Accordingly, 10 patients (4 men and 6 women) were recruited for a study from the Ahmanson/UCLA Adult Congenital Heart Disease Center Outpatient Clinic. Patient age at enrollment was 35 + or - 4 years (range 25 to 66). The inclusion criterion was postoperative coarctation of the aortic isthmus, simple or complex. Coarctation gradients were absent, mild, or moderate, as determined by standard echocardiographic criteria. Ophthalmic investigations were done > or = 3 years after the last coarctation repair and included visual acuity, intraocular tonometry, slit lamp examination, and dilated funduscopic examination that used either a standard fundus camera or wide-field digital photography. The intraocular pressure and slit lamp examination findings were within normal limits. The retinal vascular patterns were bilaterally similar in all but 2 patients, in whom the left eye was significantly more affected than the right. Mild to severe retinal arteriolar tortuosity was present in 70% of our subjects, 4 of whom also had tortuosity of the retinal venules. Hypertensive retinopathy was absent. In conclusion, the unique retinal arteriolar tortuosity that accompanies coarctation of the aorta persists long after ideal surgical repair and normalization of systemic blood pressure. These retinal patterns were present in 70% of our patients, differing only by degree. A hitherto unrecognized tortuosity of venules was identified but to a lesser extent.
