Abnormalities of Aortic Arch Shape, Central Aortic Flow Dynamics, and Distensibility Predispose to Hypertension After Successful Repair of Aortic Coarctation

Donazzan, Luca; Crepaz, Robert; Stuefer, Josef; Stellin, Giovanni

doi:10.1177/2150135114551028

Cited by 25 publications

(24 citation statements)

References 34 publications

(51 reference statements)

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“…An elevated pulse pressure is typical in elderly hypertensive patients and is due to a major vascular stiffness. As further confirmation of a prehypertensive state, subjects with a gothic arch shape show a higher day and night-time systolic blood pressure and a higher number of blood pressure measurements above the normal values for age 13 .…”

mentioning

confidence: 88%

“…According to published data 3,5,6,13 , a decreased ascending aorta distensibility coupled with an increased loss of systolic wave amplitude across the arch was reported in patients with a gothic shape after AoCo repair. The triangular-shaped morphology of the gothic arch could simply reflect the systolic wave inducing an early remodeling of the aortic wall.…”

mentioning

confidence: 99%

“…The gothic shape of the aortic arch, the reduced ascending aorta distensibility and the loss of systolic wave amplitude across the aortic arch, measured by MRI, correlate with systolic blood pressure and pulse pressure on ambulatory monitoring in a group of patients after successful AoCo repair 13 . An elevated pulse pressure is typical in elderly hypertensive patients and is due to a major vascular stiffness.…”

mentioning

confidence: 99%

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Abnormalities of aortic arch shape after successful repair of aortic coarctation and systemic arterial hypertension

Crepaz¹

2018

J Pediatrics & Pediatr Med

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After successful repair of aortic coarctation (AoCo), many patients remain at risk for cardiovascular problems and major adverse prognostic factors have been identified [1][2][3][4] . After AoCo repair, different pathogenic mechanisms leading to persistent systemic arterial hypertension have been identified, including mild residual arch stenosis, increased aortic wall stiffness, hyperactivity of reninangiotensin system, impairment of the baroreflex system and peripheral vascular reactivity 4 .An abnormal aortic arch shape has been associated with rest or exercise-induced arterial hypertension in the long-term follow-up of patients after repair of AoCo, without any residual arch obstruction 3,5 . Native aortic arch morphology, age at repair and surgical approach were all identified as possible causes for a persistent postoperative abnormal arch shape; however all these findings are still debated. An abnormal arch shape with either gothic or crenel morphology after surgical repair leads to an abnormal central aortic flow dynamic and increased aortic wall stiffness 6 , which can both contribute to the development of systemic arterial hypertension in the long-term 7,8 (see Figure 1 and Figure 2).

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confidence: 99%

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Abnormalities of aortic arch shape after successful repair of aortic coarctation and systemic arterial hypertension

Crepaz¹

2018

J Pediatrics & Pediatr Med

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“…28,33 In addition, advanced age and postoperative hypertension have been implicated in the development of AWI. 26,30 Association with bicuspid AOV or CMN should also support aggressive control of postoperative hypertension, along with more frequent monitoring, although these factors have not specifically been associated with a higher risk of adverse aortic outcomes.…”

Section: Frequency and Risk Factors For Awi After Surgical Coa Repairmentioning

confidence: 99%

“…[24][25][26] The underlying pathophysiology includes residual CoA, increased aortic stiffness, hyperactivity of the renin-angiotensin system, impaired baroreflexes, peripheral vascular dysfunction, and abnormal arch geometry. 25,26 In addition, older age at the time of CoA surgery has been associated with a higher incidence of late hypertension. 27 In turn, hypertension has been identified as one of the major contributing factors in the development of AWI and resulting mortality both in native and postoperative CoA.…”

Section: Systemic Hypertensionmentioning

confidence: 99%

Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation

Tretter

Jones

McElhinney

2015

Circ: Cardiovascular Interventions

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Abstract-Aortic wall complications can occur in unrepaired aortic coarctation (CoA) and after surgical repair or endovascular treatment. This review summarizes the available literature and current understanding of aortic wall injury (AWI) surrounding the management of CoA, focusing specifically on acute and follow-up AWI after endovascular treatment.There have been 23 reported cases of aortic rupture after endovascular treatment for CoA, including angioplasty alone, bare metal stenting, and primary covered stent therapy. Even if these published cases represent only a minority of ruptures that have actually occurred, the incidence is substantially <1%. The incidence of acute aneurysm formation was 0% to 13% after angioplasty, 0% to 5% after bare metal stent placement, and <1% after covered stent placement. The reported incidence and natural history of both acute and new AWI during follow-up after endovascular therapy for CoA varies considerably, likely secondary to ascertainment and reporting biases and inconsistent definitions. Although important AWI after endovascular treatment of CoA seems to be declining in frequency with increasing experience and improving technology, it remains one of the most important potential adverse outcomes. Long-term surveillance for new AWI and monitoring of existing AWI is mandatory, with institution of appropriate treatment when necessary. A central research focus in this population should be determination of the appropriate treatment for both native and recurrent CoA across various ages with regard to limiting recurrent CoA and preventing associated aortic wall complications, in addition to determining the appropriate treatment of various AWI. Consistent definitions and reporting are necessary to truly understand the incidence of, risk factors for, and measures protective against AWI after angioplasty or stent implantation for CoA. Contemporary Reviews in Interventional CardiologyA ortic wall complications can occur in both unrepaired aortic coarctation (CoA) and after surgical repair or endovascular treatment. In this review, we summarize the literature on and current understanding of aortic wall injury (AWI) surrounding the management of CoA, focusing specifically on endovascular treatment. Before reviewing AWI related to balloon angioplasty (BA) and stent therapy, it is important to set the context by providing an overview of historical, anatomic, and physiological factors that may be related to aortic wall complications in CoA patients, as well as a brief discussion of AWI in patients with surgically repaired CoA.

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Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain

et al. 2016

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Abnormalities of Aortic Arch Shape, Central Aortic Flow Dynamics, and Distensibility Predispose to Hypertension After Successful Repair of Aortic Coarctation

Cited by 25 publications

References 34 publications

Abnormalities of aortic arch shape after successful repair of aortic coarctation and systemic arterial hypertension

Abnormalities of aortic arch shape after successful repair of aortic coarctation and systemic arterial hypertension

Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation

Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain

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