Aortic valve dysfunction and aortic dilation in adults with coarctation of the aorta
Mathieu Clair1, Susan M Fernandes, Paul Khairy
1Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.
Insights
Adults with coarctation of the aorta (CoA) rarely need aortic valve intervention in early adulthood. However, aortic dilation is common, particularly in patients with bicuspid aortic valve (BAV).
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Aortic Diseases
Background:
- Aortic valve dysfunction and dilation are uncommon in pediatric patients with coarctation of the aorta (CoA).
- Adults with CoA may experience disease progression over time.
Purpose of the Study:
- To determine the prevalence of aortic valve dysfunction and dilation in adults with CoA.
- To assess the incidence of aortic valve and ascending aortic interventions in this population.
Main Methods:
- Retrospective review of adult patients with CoA (repaired or unrepaired) between 2004 and 2010.
- Analysis of aortic valve function, aortic dimensions, and interventions at last follow-up.
Main Results:
- 216 adults with CoA were identified; 65.7% had bicuspid aortic valve (BAV).
- Moderate/severe aortic stenosis (3.2%) and regurgitation (3.7%) were uncommon.
- Aortic root (28.0%) and ascending aorta (41.6%) dilation were prevalent, especially in BAV patients (19.5% vs. 0%).
- Aortic valve intervention (5.6%) and aortic root/ascending aorta replacement (3.2%) were infrequent.
Conclusions:
- Significant aortic valve dysfunction and interventions are uncommon in early adulthood for CoA patients.
- Aortic dilation, particularly of the ascending aorta, is prevalent in adults with CoA, especially those with BAV.
Objectives:
To determine the prevalence of aortic valve dysfunction, aortic dilation, and aortic valve and ascending aortic intervention in adults with coarctation of the aorta (CoA).
Background:
Aortic valve dysfunction and aortic dilation are rare among children and adolescents with CoA. With longer follow-up, adults may be more likely to have progressive disease.
Methods:
We retrospectively reviewed all adults with CoA, repaired or unrepaired, seen at our center between 2004 and 2010.
Results:
Two hundred sixteen adults (56.0% male) with CoA were identified. Median age at last evaluation was 28.3 (range 18.0 to 75.3) years. Bicuspid aortic valve (BAV) was present in 65.7%. At last follow-up, 3.2% had moderate or severe aortic stenosis, and 3.7% had moderate or severe aortic regurgitation. Dilation of the aortic root or ascending aorta was present in 28.0% and 41.6% of patients, respectively. Moderate or severe aortic root or ascending aortic dilation (z-score > 4) was present in 8.2% and 13.7%, respectively. Patients with BAV were more likely to have moderate or severe ascending aortic dilation compared with those without BAV (19.5% vs. 0%; P < 0.001). Age was associated with ascending aortic dilation (P = 0.04). At most recent follow-up, 5.6% had undergone aortic valve intervention, and 3.2% had aortic root or ascending aortic replacement.
Conclusion:
In adults with CoA, significant aortic valve dysfunction and interventions during early adulthood were uncommon. However, aortic dilation was prevalent, especially of the ascending aorta, in patients with BAV.
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:15Aortic Regurgitation I: Introduction
01:25Aortic Regurgitation III: Medical Management
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:30Aneurysm I: Introduction
01:30Cardiomyopathy II: Dilated Cardiomyopathy