Aortic Coarctation a Systemic Vessel Disease-Insights from Magnetic Resonance Imaging
Joachim G Eichhorn1, Sebastian Ley2, Florian Kropp3
1Children's Hospital, Klinikum Leverkusen, Leverkusen, Germany.
Insights
Aortic coarctation (CoA) repair doesn't always resolve hypertension. Reduced aortic compliance, a systemic vascular issue, is linked to hypertension in CoA patients, regardless of restenosis or repair type.
Area of Science:
- Cardiovascular Research
- Medical Imaging
- Vascular Biology
Background:
- Hypertension persists post-aortic coarctation (CoA) repair, leading to premature morbidity and mortality.
- Mechanisms underlying post-CoA repair hypertension remain unclear.
- This study investigates aortic elastic properties and morphology in relation to CoA repair outcomes.
Purpose of the Study:
- To evaluate elastic wall properties and aortic morphology after CoA repair.
- To correlate these findings with restenosis severity, hypertension, aortic arch geometry, pressure gradients, and surgical procedure details.
- To understand the underlying mechanisms of persistent hypertension in CoA patients.
Main Methods:
- Magnetic Resonance Imaging (MRI) including contrast-enhanced MR angiography and CINE MRI.
- Assessment of 89 CoA patients and 20 controls (age range 17-20 years).
- Calculation of aortic compliance (C) by measuring relative changes in aortic cross-sectional areas at the diaphragm level.
Main Results:
- 54% of CoA patients exhibited hypertension, with over half showing no significant stenosis (≥30%).
- Aortic compliance (C) was significantly lower in CoA patients compared to controls (3.30 vs. 4.67 x 10^-5 Pa^-1 m^-2, p=0.024).
- Lower compliance correlated with hypertension (r=0.671, p<0.01) and specific aortic arch geometries, independent of repair type or restenosis.
Conclusions:
- Decreased aortic compliance is a key factor in post-CoA repair hypertension, suggesting a systemic vascular anomaly.
- Hypertension in CoA patients is often present without significant restenosis.
- Aortic compliance assessment is crucial for tailoring treatment strategies in CoA patients with hypertension or restenosis.
Background:
Even after successful aortic coarctation (CoA) repair, hypertension causes premature morbidity and mortality. The mechanisms are not clear. The aim was to evaluate elastic wall properties and aortic morphology and to correlate these results with severity of restenosis, hypertension, aortic arch geometry, noninvasive pressure gradients, and time and kind of surgical procedure.
Methods:
Eighty-nine patients (17 ± 6.3 years) and 20 controls (18 ± 4.9 years) were examined using magnetic resonance imaging (MRI). In addition to contrast-enhanced MR angiography and flow measurements, CINE MRI was performed to assess the relative change of aortic cross-sectional areas at diaphragm level to calculate aortic compliance (C).
Results:
Fifty-four percent of all patients showed hypertension (> 95th percentile), but more than half of them had no significant stenosis (defined as ≥30%). C was lower in CoA than in controls (3.30 ± 2.43 vs. 4.67 ± 2.21 [10-5 Pa-1 m-2]; p = 0.024). Significant differences in compliance were found between hyper- and normotensive patients (2.61 ± 1.60 vs. 4.11 ± 2.95; p = 0.01), and gothic and Romanesque arch geometry (2.64 ± 1.58 vs. 3.78 ± 2.81; p = 0.027). There was a good correlation between C and hypertension (r = 0.671; p < 0.01), but no correlation between C (and hypertension) and time or kind of repair, restenosis, or pressure gradients.
Conclusion:
The decreased compliance, a high rate of hypertension without restenosis, and independency of time and kind of repair confirm the hypothesis that CoA may not be limited to isthmus region but rather be a widespread (systemic) vascular anomaly at least in some of the CoA patients. Therefore, aortic compliance should be assessed in these patients to individually tailor treatment of CoA patients with restenosis and/or hypertension.
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