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Repaired coarctation of the aorta, persistent arterial hypertension and the selfish brain

Jonathan C L Rodrigues1,2,3, Matthew F R Jaring4, Melissa C Werndle4

  • 1Department of Cardiovascular Magnetic Resonance, Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. j.rodrigues1@nhs.net.

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance
|November 10, 2019
PubMed

Insights

Vertebral artery hypoplasia with an incomplete posterior circle of Willis (VAH+ipCoW) is more common in patients after aortic coarctation repair and predicts hypertension. This finding may help manage cardiovascular risks in these patients.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Radiology

Background:

  • Aortic coarctation (CoA) repair is associated with a 20-30% incidence of hypertension.
  • The "selfish brain" hypothesis suggests that brain hypoperfusion may lead to hypertension.
  • Vertebral artery hypoplasia (VAH) with an incomplete posterior circle of Willis (ipCoW) may contribute to brain hypoperfusion.

Purpose of the Study:

  • To investigate the association between VAH+ipCoW and hypertension in patients who underwent aortic coarctation repair.
  • To determine if VAH+ipCoW is an independent predictor of hypertension post-CoA repair.

Main Methods:

  • 127 repaired CoA patients and 33 controls underwent time-of-flight cardiovascular magnetic resonance angiography.
  • VAH was defined as vertebral artery diameter < 2 mm; ipCoW involved hypoplasia of posterior communicating arteries.
  • Statistical analysis controlled for age, sex, and body mass index.

Main Results:

  • VAH+ipCoW was significantly more prevalent in repaired CoA patients compared to controls (OR: 5.8).
  • VAH+ipCoW independently predicted hypertension in repaired CoA patients (OR: 2.5).
  • Repaired CoA patients with VAH+ipCoW were more likely to have difficult-to-treat hypertension (OR: 3.3).

Conclusions:

  • VAH+ipCoW is a significant predictor of arterial hypertension and difficult-to-treat hypertension in repaired CoA patients.
  • The presence of VAH+ipCoW is independent of age at repair or repair type.
  • CoA may be associated with broader congenital cerebrovascular issues, necessitating consideration of the "selfish brain" mechanism in management.
Abstract

Keywords:
Circle of WillisCoarctationHypertensionVertebral artery

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