Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study

Ghorbani, Niky; Muthurangu, Vivek; Khushnood, Abbas; Goubergrits, Leonid; Nordmeyer, Sarah; Fernandes, João Filipe; Lee, Chong-Bin; Runte, Kilian; Roth, Sophie; Schubert, Stephan; Kelle, Sebastian; Berger, Felix; Küehne, Titus; Kelm, Marcus

doi:10.1136/bmjopen-2019-034853

Cited by 5 publications

(4 citation statements)

References 34 publications

(37 reference statements)

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“…In this study, 19 patients had isolated CoA, and 178 children had CoA combined with other congenital cardiovascular malformations, consistent with the previous data ( 13 , 22 ). In the literature, bicuspid aortic valve is the most associated abnormality that affects ≤75% of all CoA cases ( 23 ). However, our results suggested that PDA was the most frequent cardiovascular lesion associated with CoA.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study

Gong¹,

Zhang²,

Feng³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundCoarctation of the aorta (CoA) is a common congenital cardiovascular malformation, and improvements in the diagnostic process for surgical decision-making are important. We sought to compare the diagnostic accuracy of transthoracic echocardiography (TTE) with computed tomographic angiography (CTA) to diagnose CoA.MethodsWe retrospectively reviewed 197 cases of CoA diagnosed by TTE and CTA and confirmed at surgery from July 2009 to August 2019.ResultsThe surgical findings confirmed that 19 patients (9.6%) had isolated CoA and 178 (90.4%) had CoA combined with other congenital cardiovascular malformations. The diagnostic accuracy of CoA by CTA was significantly higher than that of TTE (χ2 = 6.52, p = 0.01). In contrast, the diagnostic accuracy of TTE for associated cardiovascular malformations of CoA was significantly higher than that of CTA (χ2 = 15.36, p < 0.0001). Infants and young children had more preductal type of CoA, and PDA was the most frequent cardiovascular lesion associated with CoA. The pressure gradient was significantly decreased after the first operation, similar at 6 months, 1 year, and 3 years follow-ups by TTE.ConclusionsCTA is more accurate as a clinical tool for diagnosing CoA; however, TTE with color Doppler can better identify associated congenital cardiovascular malformations. Therefore, combining TTE and CTA would benefit clinical evaluation and management in patients suspected of CoA. TTE was valuable for post-operation follow-up and clinical management.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study

Gong¹,

Zhang²,

Feng³

et al. 2023

Front. Cardiovasc. Med.

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“…It is likely that a coexistence of these pathogenetic mechanism in patients with both COA and BAV is responsible for the higher aortic stiffness seen in this group. In a smaller group of COA patients, Ghorbani et al also recently reported that BAV was associated with lower AAO distensibility [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of aortic stiffness and hypertension in repaired coarctation patients with a bicuspid versus a tricuspid aortic valve

Saengsin

Prakash

2023

Journal of Cardiovascular Magnetic Resonance

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Background Coarctation of the aorta (COA) is associated with reduced aortic distensibility and systemic hypertension (HTN). 60–85% of COA patients have a bicuspid aortic valve (BAV). It is not known if the presence of a BAV accentuates the aortopathy and HTN in CoA patients. We examined whether patients with COA and a BAV had lower aortic distensibility by CMR, and a higher prevalence of systemic HTN compared with COA patients with a tricuspid aortic valve (TAV). Methods In successfully repaired COA patients excluding those with residual COA, ascending aorta (AAO) and descending aorta (DAO) distensibility was calculated by CMR. HTN was assessed using standard pediatric and adult criteria. Results Among 215 COA patients (median age 25.3 years), 67% had a BAV, and 33% had a TAV. Median AAO distensibility z-score was lower in the BAV group (− 1.2 versus − 0.7; p = 0.014) but DAO distensibility was similar in BAV and TAV patients. HTN prevalence was similar in BAV (32%) and TAV groups (36%, p = 0.56). On multivariable analysis controlling for confounders, HTN was not associated with BAV but was associated with male gender (p = 0.003) and older age at follow-up (p = 0.004). Conclusions In young adults with treated COA, those with a BAV had stiffer AAO compared to those with a TAV, but DAO stiffness was similar. HTN was not related to BAV. These results suggest that although the presence of a BAV in COA exacerbates the AAO aortopathy, it does not exacerbate the more generalized vascular dysfunction and associated HTN.

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“…Persistent hypertension is common in patients with CoA, both preoperatively and postoperatively. Ghorbani et al found that, in young patients with coarctation, distensibility impairments of the aorta were predominantly associated with arterial hypertension ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Aortic Elasticity and Cardiac Function in Fetuses With Aortic Coarctation

Zhou

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThe purpose of the study was to observe the elasticity of the ascending aorta (AAo) in normal fetuses and fetuses with coarctation of the aorta (CoA) by M-mode echocardiography.MethodsThis was a prospective clinical study performed on 16 fetuses with CoA and 48 gestational-age matched normal fetuses. The minimum internal diameter in the diastolic phase (Dmin) and the maximum internal diameter in the systolic phase (Dmax) of the AAo were measured by M-mode echocardiography. The aortic strain was calculated using the formula 100 × (Dmax−Dmin)/Dmin). Doppler echocardiography was performed to measure the cardiac function parameters. Correlations between aortic strain and cardiac function were assessed in fetuses with CoA.ResultsThe aortic strain of the ascending aorta in the fetuses with CoA was significantly lower than that in normal fetuses (18.12 ± 4.88% vs. 25.22 ± 4.92%, p < 0.01). The fetuses with CoA showed significantly higher combined cardiac output than the controls (471.89 ± 93.98 vs. 411.57 ± 46.35 ml/min/kg, p < 0.05). Compared with the normal group, the early diastolic velocities (E') and peak systolic velocities (S') of the left side were obviously decreased in the CoA group (p < 0.05), while the left early diastolic velocity ratio (E/E') was significantly increased in the fetuses with CoA (p < 0.01). For the fetuses with CoA, the aortic strain of the AAo was correlated with the left E/E' and S' (r = −0.522 and 0.504, respectively, P < 0.05).ConclusionsThe aortic strain of the ascending aorta was significantly decreased in fetuses with CoA in middle-late gestation. The impaired strain of the ascending aorta was correlated with the left ventricle function in the fetuses with CoA. These findings imply that the abnormalities of the intrinsic aortic wall of CoA might develop early in utero.

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Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study

Cited by 5 publications

References 34 publications

Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study

Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study

Comparison of aortic stiffness and hypertension in repaired coarctation patients with a bicuspid versus a tricuspid aortic valve

Aortic Elasticity and Cardiac Function in Fetuses With Aortic Coarctation

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