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

Abstract

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.

Morphometric evaluation of aortic coarctation and collateral circulation using computed tomography in the adult population

“…This is contrary to the study by Zhao et al. (17), which documented concomitant aortic dilatation and collateral circulation in patients with severe aortic coarctation. This discrepancy may result from a well-developed compensatory mechanism in our group of participants with significant aortic stenosis, including smooth muscle proliferation and increased aortic wall thickness (23).…”

“…The CT-based study by Zhao et al. (17) involved a larger population; however, in contrast to our study, they did not perform an evaluation of clinical symptoms. Another limitation was unsuccessful contact with 2 (6%) patients during the follow-up, which meant that we could not evaluate the clinical symptoms in those individuals.…”

“…(17), the mean age of patients with significant aortic stenosis was lower, at just over 20 years. Another explanation for this discrepancy could be that they included only patients with native CoA (17), while in our study, 30% of patients underwent prior intervention for coarctation. Among this group, the majority had mild coarctation stenosis at the time of CT examination.…”

“…Zhao et al. (17) performed a CT-based study of CoA morphometry and predictors of aortic dilatation. However, this study concentrated on the aorta without detailed evaluation of the clinical background.…”

Determinants of aortic growth rate in patients with bicuspid aortic valve by cardiovascular magnetic resonance

“…BAV is often concomitant with aortic coarctation (CoA)12 and aortic wall complications are frequent in adults with CoA,13 whereas those with progressive course of the disease may also develop aortic dilation and be at risk of aneurysm and aortic dissection. Recent studies have shown that ascending and post-CoA aortic diameters or dilations are linked to the degree of CoA severity14 and that, in a CoA population, patients with BAV were more likely to have moderate or severe ascending aorta (AAo) dilation compared with those with a trileaflet valve 15. While BAV-aortopathy is likely a reflection of BAV morphotype rather than CoA or its physiological effects,16 questions remain about changes in aortic growth in BAV+CoA patients compared with isolated BAV.…”