Impact of different coarctation therapies on aortic stiffness: phase-contrast MRI study

Abstract

Coarctation of the aorta has been associated with increased thoracic aortic stiffness in adolescents and young adults. However, the effects of different therapeutic strategies on aortic stiffness in a young population is unknown. This study aimed to non-invasively assess aortic stiffness between different repair or intervention strategies in patients with coarctation of the aorta. Forty-nine coarctation patients who underwent either surgery (n = 26), balloon angioplasty (n = 14), or stent implantation (n = 12), and 26 age- and size-matched normotensive healthy controls underwent evaluation of thoracic aortic stiffness and flow hemodynamics via phase-contrast cardiac magnetic resonance. In children who had undergone surgical repair or balloon angioplasty, ascending aortic stiffness was increased when measured via pulse wave velocity (PWV) when compared to normal controls (all P < 0.05). Furthermore, ascending aortic distensibility and relative area change (RAC) was significantly lower in surgically and balloon treated groups (both P < 0.01). Stiffness (PWV), distensibility, and RAC in the ascending aorta were not statistically different between stented patients and controls. The ascending aorta of children following surgical repair or balloon angioplasty demonstrated signs of elevated stiffness, whereas those treated by stent implantation showed no difference in stiffness markers when compared to normal controls.

Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls?

“…9,27,[39][40][41] The studies which include only children and adolescents are scarce. 5,42 In general, these studies have shown increased pulse wave velocity (m/s) in the precoarctation aorta after successful repair of the coarctation compared to controls. The studies evaluating subgroups have shown that hypertensive patients had higher pulse wave velocity compared to normotensive ones, as expected.…”

Acute and medium term results of balloon expandable stent placement in the transverse arch—a multicenter pediatric interventional cardiology early career society study

“…In a study of hemodynamic modeling of arch flow after surgical reconstruction, Olivieri et al observed that all post‐surgical arches had higher flow disturbances and peak wall shear stresses compared with the native arch configurations, with the gothic arch associated with a higher late morbidity (hypertension and early cardiovascular disease) than other arch shapes 34 . Placing of a rigid stent may have cyclic mechanical effects on arterial hemodynamics that are not well understood but may be important 35 . There has been some discussion regarding the abnormal development of aortic arch, which may alter catecholamine traffic at the cardiac sympathetic nerve terminals affecting the baroreflex‐mediated balance of sympathetic nerve regulation 36 …”

“…34 Placing of a rigid stent may have cyclic mechanical effects on arterial hemodynamics that are not well understood but may be important. 35 There has been some discussion regarding the abnormal development of aortic arch, which may alter catecholamine traffic at the cardiac sympathetic nerve terminals affecting the baroreflexmediated balance of sympathetic nerve regulation. 36…”

Pros, cons and future perspectives – three questions on three dimensional guidance for cardiac catheterization in congenital heart disease

“…We know that abnormal flow patterns affect vessel endothelium in a negative way leading to inflammation. I wonder if we can start to prove that intervention A is better than intervention B not just because it's anatomically better but because it's functionally or physiologically better and if we can get flow patterns from 3DRA that are meaningful I think that's going to be a huge advantage [57]. I think it's a great tool but I'm unsure, in a very positive way, where this is going to end up but I think it's going to be a great story because the technology is already developing rapidly.…”