Aortic Valve Dysfunction and Aortic Dilation in Adults with Coarctation of the Aorta

Clair, Mathieu; Fernandes, Susan M.; Khairy, Paul; Krieger, Eric V.; Opotowsky, Alexander R.; Singh, Michael; Colan, Steven D.; Meijboom, Erik J.; Landzberg, Michael J.

doi:10.1111/chd.12109

Cited by 16 publications

(17 citation statements)

References 49 publications

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“…Patients with CoA were classified into two groups based on the severity of coarctation: mild group (CDR > 50%) and severe group (CDR < 50%) [ 2 ]. Given the growth-related changes, aortic diameter was standardized as z-score, the ratio of the aortic diameters over the square root of body surface area (BSA) [ 12 ]. Aortic dilation was considered if the z-score > 2 (Fig.…”

Section: Methodsmentioning

confidence: 99%

Predictors of aortic dilation in patients with coarctation of the aorta: evaluation with dual-source computed tomography

Zhao

Shi

Yang

et al. 2018

BMC Cardiovasc Disord

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BackgroundCoarctation of aorta (CoA) may progressively develop aortic dilation at other site of the aorta and can lead to fatal aortic diseases. We aimed to evaluate the occurrence of aortic dilation and related predictors in patients with CoA using dual-source computed tomography (DSCT).MethodsFifty-three patients with CoA identified by DSCT were retrospectively reviewed. Aortic diameters were measured at six different levels and standardized as z-scores based on the square root of body surface area. Coarctation site–diaphragm ratio (CDR) was used to describe the degree of narrowing. A total of 26 patients were included in mild group (CDR > 50%) and 27 in severe group (CDR < 50%) according to the severity of coarctation. Student’s t-test and Spearman correlation coefficients, univariate and multivariable logistic regression analyses were used to assess the risk factors including age, degree of narrowing and other malformations for aortic dilation.ResultsSevere group had significantly larger z-scores of ascending aorta (2.41 ± 0.39 vs. 2.10 ± 0.57, p < 0.05) and post-coarctation aorta (2.17 ± 0.48 vs. 1.68 ± 0.43, p < 0.001) compared with mild group. Degree of coarctation was associated with the z-scores of the ascending aorta (r = − 0.356, p < 0.05) and post-coarctation aorta (r = − 0.414, p < 0.05). Collateral circulation was related to the z-scores of ascending aorta (r = 0.375, p < 0.05). Increased severity of coarctation was independent predictor of ascending (odds ratio 7.46; 95% CI 1.19–46.76; p < 0.05) and post-coarctation aortic dilation(odds ratio 8.42; 95% CI 1.84–38.56; p < 0.05).ConclusionsAscending and post-coarctation aortic diameters or dilations were both associated with the degree of coarctation. By comprehensively evaluating the aortic diameters and associated malformations including collateral circulation, DSCT can aid in stratification of risk for aortic dilation in patients with CoA.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0863-8) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Predictors of aortic dilation in patients with coarctation of the aorta: evaluation with dual-source computed tomography

Zhao

Shi

Yang

et al. 2018

BMC Cardiovasc Disord

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“…1,2 The recommended size threshold for ascending aortic replacement is either 4.5 cm in patients undergoing concurrent aortic valve replacement or 5 cm otherwise. 1,2 The recommended size threshold for ascending aortic replacement is either 4.5 cm in patients undergoing concurrent aortic valve replacement or 5 cm otherwise.…”

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confidence: 99%

Systolic Flow Displacement Correlates With Future Ascending Aortic Growth in Patients With Bicuspid Aortic Valves Undergoing Magnetic Resonance Surveillance

Burris¹,

Sigovan²,

Knauer³

et al. 2014

Investigative Radiology

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Systolic flow displacement calculated from conventional 2D PC-MRI in the ascending aorta correlates with future aortic growth in patients undergoing routine surveillance imaging for BAV. With a cutoff valve of 0.2, flow displacement may be used to identify a subset of patients likely to have elevated growth rates and may better risk-stratify patients with BAV for aortic disease progression than vessel diameter alone.

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“…We did not reveal any association between ascending aorta diameter and type of aortic coarctation surgery. Data from the literature [42][43][44] show that aneurysms are more common after patch aortoplasty technique and transcatheter interventions, particularly balloon angioplasty without stent implantation.…”

Section: Discussionmentioning

confidence: 99%

Long-term observation of adults after successful repair of aortic coarctation

Róg¹,

Okólska²,

Weryński³

et al. 2019

pwki

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Introduction: Despite successful repair of aortic coarctation, cardiovascular complications occur. Aim: To analyse type and frequency of late complications and their impact on exercise capacity in adults after aortic coarctation repair. Material and methods: Fifty-eight adults after aortic coarctation repair, 36 male, median age 27.46 ±10.57, were compared to 30 healthy volunteers. Physical examination, transthoracic echocardiography, carotid intima-media thickness measurement, cardiopulmonary exercise test and 24-hour ambulatory blood pressure monitoring were performed. Results: The main complications were: arterial hypertension 48.3%, myocardial hypertrophy in echocardiography 29.34%, recoarctation 25.86%, aortic dilation 13.79% and coronary artery disease 6.89%. Exercise tolerance was reduced in the cardiopulmonary exercise test. The VO 2 /kg peak was lower, 29.01 ±8.79 vs. 49.16 ±7.38 ml/kg/min, p < 0.001, VE/VCO 2 peak higher 28.18 ±4.69 vs. 26.78 ±3.13, p = 0.017. The peak heart rate was reduced, 157.28 ±22.22 vs. 177.93 ±23.08 bpm, p < 0.001, peak systolic blood pressure was higher, 174.79 ±17.62 vs. 153.33 ±4.79 mm Hg, p < 0.001. Systolic blood pressure in 24-hour ambulatory monitoring correlated with left ventricle mass index, r = 0.29, p = 0.025, wall thickness, r = 0.31, p = 0.039. Age at operation was related to left ventricle wall thickness, r = 0.27, p = 0.041, and carotid intima-media thickness, r = 0.26, p = 0.046. There was no association of any cardio-pulmonary parameters with time from surgery, type of operation or echocardiography results. Conclusions: Adults after aortic coarctation repair suffer from arterial hypertension, recurrent aortic stenosis, aortic aneurysms, and coronary artery disease. Reduced exercise capacity in cardio-pulmonary exercise test is related to hypertensive reaction and chronotropic incompetence.

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Aortic Valve Dysfunction and Aortic Dilation in Adults with Coarctation of the Aorta

Abstract: 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.

Cited by 16 publications

References 49 publications

Predictors of aortic dilation in patients with coarctation of the aorta: evaluation with dual-source computed tomography

Predictors of aortic dilation in patients with coarctation of the aorta: evaluation with dual-source computed tomography

Systolic Flow Displacement Correlates With Future Ascending Aortic Growth in Patients With Bicuspid Aortic Valves Undergoing Magnetic Resonance Surveillance

Long-term observation of adults after successful repair of aortic coarctation

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