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Published on: August 30, 2022
Intraventricular haemodynamic changes caused by increased left ventricular afterload in re-coarctation of aorta: a
Yuki Shibagaki1, Hideharu Oka1, Kouichi Nakau1
1Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan.
Insights
Re-coarctation of the aorta can lead to serious complications. Four-dimensional flow MRI revealed improved aortic helical flow and left ventricular hemodynamics after balloon dilatation treatment for aortic re-coarctation.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Interventional Cardiology
Background:
- Long-term re-coarctation of the aorta increases left ventricular (LV) afterload, potentially causing aortic dilatation, hypertension, and cardiac dysfunction.
- Assessing LV function changes under increased afterload is challenging when LV contractility is preserved.
- Re-coarctation of the aorta presents a significant clinical challenge, necessitating advanced imaging techniques for accurate assessment.
Background:
Long-term re-coarctation of the aorta can cause aortic dilatation, hypertension, and cardiac dysfunction due to increased left ventricular (LV) afterload. It is difficult to detect changes in LV function due to increased afterload if the contractile force of the left ventricle is maintained. Herein, we have reported a case of re-coarctation of the aorta, for which four-dimensional (4D) flow magnetic resonance imaging (MRI) scan was obtained both before and after balloon dilatation for aortic re-coarctation. Ultimately, improvement in aortic helical flow and LV haemodynamics was observed.
Case Summary:
A 29-year-old female was diagnosed with coarctation of the aorta and a bicuspid aortic valve after birth and underwent surgery at 1 month. At 8 years of age, she underwent balloon dilatation for re-coarctation. At the age of 28 years, she was diagnosed with re-coarctation triggered by hypertension. She underwent balloon dilatation as her cardiac catheterization revealed a systolic pressure gradient of 40 mmHg. Pretreatment 4D flow MRI demonstrated helical flow in the ascending aorta and descending thoracic aorta and LV blood flow analysis revealed a decrease in LV kinetic energy during systole; these improved after treatment.
Discussion:
The use of helical flow evaluation by 4D flow MRI for aortic re-coarctation is well known in clinical practice. However, our report is the first to evaluate intraventricular blood flow before and after the re-coarctation treatment. The MRI evaluation demonstrated that the helical flow and LV blood flow distribution improved after re-coarctation treatment due to the reduction of afterload.
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