History Of Aortic Coarctation Research Articles

Advanced echocardiographic function analysis in adolescents and young adults with corrected and residual coartation of the aorta

Abstract Funding Acknowledgements Type of funding sources: None. Introduction This study aimed to assess systolic and diastolic heart function changes in patients with history of aortic coarctation using advanced echocardiographic imaging. Additionally, we sought to analyse which severity factors influenced these changes. Methods We performed a complete echocardiographic evaluation, with advanced functional analysis, including myocardial work analysis, to a random sample of 53 patients (age 12 to 40 years). These had a previous history of coarctation of the aorta (CoAo), which was either corrected (aortic transisthmic Doppler gradient (Dgrad) ≤20mmHg) or presented a significant residual gradient (Dgrad >20mmHg). A control group of healthy individuals, matched for age, sex and BMI, was subjected to the same evaluation. Selected dependent variables were: E/A, E’, E/E’, atrial strain parameters, biplane ejection fraction, ventricular global longitudinal strain, and global myocardial work (GMW). One-way ANOVA with appropriate post-hoc tests was done to compare the distribution of dependent variables among controls (n = 31), patients with corrected coartation (cCOAO) (n = 36), and patients with residual coartation (rCOAO) (n = 17). Multivariable linear regression was used to evaluate the association, in the 53 patients, between the dependent variables and parameters of CoAo severity: systolic blood pressure (SBP), left ventricular indexed mass (LVmass), Dgrad, and the ratio of the narrowest diameter of the aortic arch to the aorta at the diaphragm level (Aoratio). Statistical significance was established as p < 0.05. Results Patients with either cCOAO or rCOAO had lower E’ (p < 0.001), higher E/E’ (p < 0.001), lower atrial reservoir (p < 0.001) and conduit (p < 0.001) strain, when compared with controls (table 1). Patients with rCOAO had higher GMW when compared with either cCOAO or controls (p = 0.002). Multivariable regression analysis showed that both lower atrial reservoir and conduit strain were associated with a narrower aortic arch (lower Aoratio (p = 0.002 and p = 0.011, respectively); higher E/E’ with higher LVmass (p = 0.030); higher GMW with higher LVmass (p = 0.027) and Dgrad (p = 0.035). Patients subsequently submitted to an intervention for coartation treatment (n = 8) had lower atrial conduit (p = 0.007) and higher GMW (p = 0.015) when compared to all other patients (n = 45). Conclusion: Myocardial work emerged as a particularly useful tool as it was both significantly different between CoAo groups, and significantly higher in more severe patients, driven by the LV mass and residual gradient. This analysis may have a role in these patients’ clinical decision-making. Abstract Table 1

Assessment of cerebral blood flow in adult patients with aortic coarctation.

Survival into adult life in patients with aortic coarctation is typical following surgical and catheter-based techniques to relieve obstruction. Late sequelae are recognised, including stroke, hypertension, and intracerebral aneurysm formation, with the underlying mechanisms being unclear. We hypothesised that patients with a history of aortic coarctation may have abnormalities of cerebral blood flow compared with controls. Patients with a history of aortic coarctation underwent assessment of cerebral vascular function. Vascular responsiveness of intracranial vessels to hypercapnia and degree of cerebral artery stiffness using Doppler-derived pulsatility indices were used. Response to photic stimuli was used to assess neurovascular coupling, which reflects endothelial function in response to neuronal activation. Patient results were compared with age- and sex-matched controls. A total of 13 adult patients (males=10; 77%) along with 13 controls underwent evaluation. The mean age was 36.1±3.7 years in the patient group. Patients with a background of aortic coarctation were noted to have increased pulse pressure on blood pressure assessment at baseline with increased intracranial artery stiffness compared with controls. Patients with a history of aortic coarctation had less reactive cerebral vasculature to hypercapnic stimuli and impaired neurovascular coupling compared with controls. Adult patients with aortic coarctation had increased intracranial artery stiffness compared with controls, in addition to cerebral vasculature showing less responsiveness to hypercapnic and photic stimuli. Further studies are required to assess the aetiology and consequences of these documented abnormalities in cerebral blood flow in terms of stroke risk, cerebral aneurysm formation, and cognitive dysfunction.

PS 08-69 INTRACRANIAL VESSEL STIFFNESS IN POST-REPAIR PATIENTS WITH AORTIC COARCTATION

Objective: Coarctation of the aorta (CoA) is one of the most common congenital cardiovascular anomalies and is associated with reduced life expectancy due to sources of morbidity, including intracerebral aneurysm formation, despite improved postoperative outcomes. We hypothesised that patients with a history of aortic coarctation may have abnormalities of cerebral blood flow compared with controls. Design and Method: Thirteen adult patients (77% males, mean age of 36.1 ± 3.7 years), 12 of which had undergone previous surgical repair to relieve obstruction, and 13 age-gender matched controls (mean age 38.8 ± 3.9 years) underwent assessments of blood pressure, arterial compliance and cerebrovascular function. Transcranial Doppler ultrasound was used to assess basal mean blood flow velocity in the middle and posterior cerebral arteries (MCA and PCA respectively) and stiffness of cerebral vessels, as determined by pulsatility and resistive indices. Cerebrovascular responsiveness (CVR) to a 3-min hypercapnic challenge (95% O2/5% CO2) in the MCA was recorded the peak velocity achieved during hypercapnia expressed as a percent change from the basal velocity. Results: Both groups were normotensive. However, pulse pressure was 17% higher in the patient group (P = 0.013) compared with the controls despite similar systemic blood pressure and arterial compliance in both groups. In both the MCA and PCA, the patient group exhibited significantly increased stiffness of the intracranial vessels (16–30% greater pulsatility in the MCA and 16–37% greater in the PCA). Additionally, CVR to hypercapnia was 35% lower in the patient group. Conclusions: It appears that in normotensive repaired CoA patients, intracranial arteries are stiffer and cerebral vasodilator function is compromised. Further investigation is warranted to assess whether these abnormalities might predispose patients to stroke or cerebral aneurysm formation.

4-Dimensional Magnetic Resonance Imaging of the Levoatriocardinal Vein

![Figure][1] [![Graphic][3] ][3] A 9-year-old girl with a history of aortic coarctation, large ventricular septal defect (VSD), patent ductus arteriosus, and bicuspid aortic valve had previously undergone neonatal coarctation repair with ductal ligation followed by VSD closure at 4

Accessory Mitral Valve Associated With Coarctation of the Aorta and Bicuspid Aortic Valve Without Left Ventricular Outflow Tract Obstruction

ACCESSORY MITRAL VALVE (AMV) is a rare congenital cardiac anomaly that most frequently presents as heart failure secondary to left ventricular outflow tract (LVOT) obstruction. AMV is diagnosed most commonly in youth; however, much less frequently, it may present in the older population. It almost always occurs in concert with other congenital cardiac anomalies. An uncommon presentation of AMV without LVOT obstruction in an elderly patient with a history of aortic coarctation and congenital biscuspid aortic valve is described.

Aortic Dimensions in Girls and Young Women with Turner Syndrome: A Magnetic Resonance Imaging Study

This study aimed to determine the dimensions of the thoracic aorta and the predictors of aortic dimensions in girls and young women with Turner syndrome (TS). A cross-sectional study was performed at a secondary care center. The study compared 41 TS patients with 50 healthy age-matched control subjects. The mean age of the patients was 17 +/- 3.3 years. Magnetic resonance imaging was performed for all the patients. The thoracic aortic diameters of the patients were measured at nine positions. Adjustment for body surface area (BSA) was performed. The outcome for the patients was measured in terms of absolute and BSA-adjusted aortic dilation. In TS, both the absolute and the BSA-adjusted mean aortic diameters were smaller than or comparable with those of the control subjects. However, individual aortic dilation at one to four positions was found in four TS patients according to the uncorrected data and in five TS patients after BSA-adjustment. The aortic diameters correlated with height, weight, body mass index (BMI), and BSA at all positions (R = 0.34-0.60; all p < 0.04). The diameters of the aortic arch and the descending aorta correlated with a history of aortic coarctation (R = 0.35-0.52; p < 0.03). The presence of bicuspid aortic valves correlated at the descending part of the aorta (R = 0.38; p < 0.03). The mean thoracic aortic dimensions were not enlarged in girls or young TS patients. The BSA predicted aortic size at all positions. The prevalence of aortic dilation and aneurysm was lower in this population of girls and younger women with TS than in older TS populations.

Repaired Coarctation of the Aorta Imaged by 64-Detector Computed Tomography

![Figure][1] A 35-year-old man with a history of aortic coarctation (CoA) repair during childhood presented with the complaint of atypical chest pain. During childhood, he had undergone CoA repair with the placement of a conduit from the aortic arch just distal to the left subclavian artery (