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Aorta size mismatch predicts decreased exercise capacity in patients with successfully repaired coarctation of the

Jason G Mandell1, Yue-Hin Loke1, Paige N Mass2

  • 1Division of Cardiology, Children's National Hospital, Washington, DC.

The Journal of Thoracic and Cardiovascular Surgery
|November 2, 2020
PubMed

Insights

Aorta size mismatch after coarctation of the aorta (CoA) repair is linked to reduced exercise capacity. This study used 3D models to show how geometry impacts blood flow and patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomedical Engineering

Background:

  • Coarctation of the aorta (CoA) repair often results in decreased exercise capacity, even without residual stenosis.
  • The underlying hemodynamic mechanisms for this reduced exercise capacity remain unclear.

Purpose of the Study:

  • To correlate aortic arch geometry with exercise capacity in patients with successfully repaired CoA.
  • To elucidate hemodynamic changes using 3D-printed aorta models in a mock circulatory flow loop.

Main Methods:

  • Retrospective review of patients with CoA repair, including cardiac MRI and exercise stress tests.
  • 3D printing of patient aortas for flow loop simulations to measure flow and pressure.
  • Correlation of aortic dimensions and flow parameters with peak oxygen consumption (VO2 max).

Main Results:

  • Aorta diameter and descending aorta flow positively correlated with VO2 max.
  • The ratio of ascending to descending aorta diameter negatively correlated with VO2 max.
  • Flow loop simulations indicated that the ratio of exercise to rest flow in the descending aorta negatively correlated with VO2 max.

Conclusions:

  • Aorta size mismatch (ascending to descending aorta diameter ratio) is a novel predictor of exercise capacity in repaired CoA.
  • Increased vascular resistance and altered flow distribution likely explain the link between size mismatch and reduced exercise capacity.
  • Aorta size mismatch and descending aorta flow warrant further clinical investigation in repaired CoA patients.
Abstract

Keywords:
cardiac magnetic resonancecoarctation of the aortaexercisemock circulatory flow loop

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