Screening for Aortic Aneurysm After Treatment of Coarctation

Abstract

Isolated coarctation of the aorta (CoA) occurs in 6-8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for CoA during the study period. Three hundred and ninety-nine patients had at least one AAI. Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting aneurysms was 24 %. The prevalence of aneurysms was significantly greater in the catheterization group (p < 0.05) compared with the surgery group. Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures. Aortic aneurysms continue to be an important complication after CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of aneurysms after CoA repair. Because the time to aneurysm diagnosis was shorter and the risk greater in the catheterization group (particularly for patients requiring more than one procedure), surveillance with cardiac MRI or CT should begin earlier in these patients.

Thoracic aorta 3D hemodynamics in pediatric and young adult patients with bicuspid aortic valve

“…This finding is potentially important because this hemodynamic alteration could result in subsequent aortopathy at sights of elevated WSS. 37,38 While we noted reduced mean WSS sys in patients with unrepaired coarctation, the conclusions we can draw are limited by the small number of patients (n = 3) that made up this group. Moreover, this cohort tended to be younger and have reduced BSA.…”

Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation

“…In the CCISC report, it was noted that the incidence of AWI decreased over the study period, 10 and in the study by Hoffman et al, 22 the authors reported a higher incidence of follow-up aneurysms in patients who were initially treated beyond 1 year of age and those who had ≥3 CoA procedures. There is a suggestion in the literature that late aneurysm formation may be more common after treatment of native than recurrent CoA.…”

“…22 Isolated bicuspid AOV, occurring in 1% to 2% of the population, is identified in 9% to 24% of cases of aortic dissection, with most showing some degree of CMN in addition to underlying hypertension. The association between CoA, bicuspid AOV, and CMN suggests an interaction among these factors or a unifying arteriopathy, which could predispose to AWI.…”

“…Among patients treated with balloon expandable covered stents, acute aneurysms have been reported in <1%. 2,[9][10][11]22,37,52,68,85,86,[92][93][94][97][98][99][100][101][102] In 5 studies of BMS treatment for CoA that included a total of 119 patients, there were no reported aortic aneurysms or dissections, 85,[103][104][105][106][107] and some early studies did not mention assessment for AWI. 92 In series that reported ≥1 cases with AWI, 55 out of a total of 3541 procedures (1.6%) reportedly experienced acute AWI, and new AWI were noted on follow-up in 108 patients (3%), as detailed in Table 2.…”

“…Echocardiography is inadequate for detection of aneurysms after CoA repair, with a sensitivity of 24%. 22 MRI is the gold standard for evaluating AWI after surgical repair or BA. 34 Although MRI has historically been limited in patients with stents because of magnetic susceptibility and metallic stent artifact, with new sequences and MRI compatible stents it is becoming a feasible and attractive alternative in many patients.…”