Magnetic Resonance Imaging Predictors of Coarctation Severity

Abstract

Background-MRI is increasingly used for anatomic assessment of aortic coarctation (CoA), but its ability to predict the transcatheter pressure gradient, considered the reference standard for hemodynamic severity, has not been studied in detail. This study evaluated the ability of MRI to distinguish between mild versus moderate and severe CoA as determined by cardiac catheterization. Methods and Results-The clinical, MRI, and catheterization data of 31 subjects referred for assessment of native or recurrent CoA were reviewed retrospectively. Patients were divided into 2 groups on the basis of peak coarctation gradient by catheterization: Ͻ20 mm Hg (nϭ12) and Ն20 mm Hg (nϭ19). Patients with cardiac index Ͻ2.2 L · min

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…The aortic gradient may be directly measured by catheterisation, or indirectly estimated using Doppler echocardiography or cardiovascular MR. 263 While TTE is usually diagnostic in children, it is often inconclusive in adults. However, TOE is the method of choice to evaluate cardiac sequelae such as ventricular hypertrophy and left ventricular dysfunction, and association with congenital cardiac abnormalities.…”

Imaging congenital heart disease in adults

“…A functionally bicuspid aortic valve is present in at least 50% of cases, and is more prone to progressive stenosis and/or to regurgitation than a normal valve. Echocardiography from a suprasternal window can usually provide a Doppler trace of jet flow through the residual coarctation, enabling an assessment of the presence or absence of diastolic prolongation of forward flow (a ''diastolic tail''), which can be a telling sign of significant obstruction [27]. However, two-dimensional echo rarely provides full visualisation of the repaired region in adults.…”

Morphometric Analysis of Aortic Coarctation Determination of the Target Vessel Diameter Required to Relieve the Pressure Gradient

“…Nielsen et al reported that the narrowest aortic CSA indexed to the BSA using magnetic resonance imaging is a more reliable marker for detecting significant CoA (pressure gradients >20 mmHg). 2 In this report, an indexed CSA <56 mm 2 /m 2 is the cut-off point to predict a coarctation pressure gradient >20 mmHg. Rammos et al reported that the normal indexed CSA at the level of the isthmus is 158±36 mm 2 /m 2 .…”

“…A number of methods and indices have been used to assess the severity of CoA. [1][2][3][4] Angiographic measurement of the diameter of the narrowest aortic segment indexed to that of the DAo at the diaphragm is still widely used for evaluation of the severity of CoA. 1 Table 1.…”