Aortic elasticity after aortic coarctation relief: comparison of surgical and interventional therapy by cardiovascular magnetic resonance imaging

Theresa Pieper,Inga Voges,Bettina Reich,Joachim Kreuder,Kerstin Gummel,Helge Hudel,Heiner Latus,Dietmar Schranz

doi:10.1186/s12872-019-01270-w

Abstract

BackgroundPatients after aortic coarctation (CoA) repair show impaired aortic bioelasticity and altered left ventricular (LV) mechanics, predisposing diastolic dysfunction. Our purpose was to assess aortic bioelasticity and LV properties in CoA patients who underwent endovascular stenting or surgery using cardiovascular magnetic resonance (CMR) imaging.MethodsFifty CoA patients (20.5 ± 9.5 years) were examined by 3-Tesla CMR. Eighteen patients had previous stent implantation and 32 had surgical repair. We performed volumetric analysis of both ventricles (LV, RV) and left atrium (LA) to measure biventricular volumes, ejection fractions, left atrial (LA) volumes, and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir). Aortic distensibility and pulse wave velocity (PWV) were assessed. Native T1 mapping was applied to examine LV tissue properties. In twelve patients post-contrast T1 mapping was performed.ResultsLV, RV and LA parameters did not differ between the surgical and stent group. There was also no significant difference for aortic distensibility, PWV and T1 relaxation times. Aortic root distensibility correlated negatively with age, BMI, BSA and weight (p < 0.001). Native T1 values correlated negatively with age, weight, BSA and BMI (p < 0.001). Lower post-contrast T1 values were associated with lower aortic arch distensibility and higher aortic arch PWV (p < 0.001).ConclusionsCoA patients after surgery or stent implantation did not show significant difference of aortic elasticity. Thus, presumably other factors like intrinsic aortic abnormalities might have a greater impact on aortic elasticity than the approach of repair. Interestingly, our data suggest that native T1 values are influenced by demographic characteristics.

Highlights

Patients after aortic coarctation (CoA) repair show impaired aortic bioelasticity and altered left ventricular (LV) mechanics, predisposing diastolic dysfunction
Babu-Narayan et al has shown improved aortic distensibility after stenting [10]. Another recent study found no difference in aortic stiffness and endothelial function between CoA patients who were treated with surgery, balloon dilation, or stent implantation [11]
There were no significant differences in thoracic aortic distensibility as well as aortic arch and descending aorta (DAo) pulse wave velocity (PWV) between the two study groups (Table 2)

Summary

Introduction

Patients after aortic coarctation (CoA) repair show impaired aortic bioelasticity and altered left ventricular (LV) mechanics, predisposing diastolic dysfunction. More recent reports show, that patients after CoA repair are still at risk for long-term complications, in addition to the aforementioned, in particular increased aortic stiffness and left ventricular (LV) diastolic dysfunction [6,7,8]. These studies mainly included patients after surgical treatment. Babu-Narayan et al has shown improved aortic distensibility after stenting [10] Another recent study found no difference in aortic stiffness and endothelial function between CoA patients who were treated with surgery, balloon dilation, or stent implantation [11]

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Discussion

Conclusion