Impaired Elastic Properties of the Ascending Aorta in Newborns Before and Early After Successful Coarctation Repair

Abstract

Background-Despite successful surgical correction, morbidity of patients with coarctation of the aorta is increased. It is well known that these patients have impaired elastic properties of the prestenotic arteries. To find out whether these abnormalities are primarily present or develop later, we studied 17 newborns before and early after surgical repair. Methods and Results-Aortic wall stiffness index and distensibility were calculated using ascending and abdominal aortic diameters determined by M-mode echocardiography and noninvasive estimation of aortic pulse pressure in the right arm and leg.

Hypertension and coarctation of the aorta: an inevitable consequence of developmental pathophysiology

“…Previously reported data have suggested increased aortic stiffness 17 and alteration in autonomic cardiac balance 18 in pre-operative neonates with CoA, suggesting an early maladaptive response to mechanisms responsible for longer term blood pressure control (discussed below). With this in mind, we measured non-invasive indices of autonomic balance, large artery stiffness and cardiac output in an 8-month-old male with native CoA and his monozygotic twin.…”

“…17,18 The genetic homogeneity in this case is interesting and provides a unique opportunity to assess variances in arterial compliance, BRS and cardiac autonomic balance between twin infants, and postulates on how this may affect longer term control of blood pressure.…”

“…34 As previously mentioned, similar studies have been carried out in neonates looking at aortic compliance in order to examine the effects of CoA on fetal and early neonatal arterial stiffness. Vogt et al 17 measured local arterial stiffness indices and distensibility in the ascending and descending aortas of pre-and post-operative CoA neonates, and compared these values to matched controls. The authors demonstrated significantly reduced distensibility and increased stiffness indices in the ascending aortas of the pre-and post operative group, when compared with controls.…”

Differential impact of local stiffening and narrowing on hemodynamics in repaired aortic coarctation: an FSI study

“…Patients with (repaired) aortic coarctation might have intrinsic structural defects in extracellular matrix proteins due to genetic defects [42], and their aorta has been subjected to growth and remodeling [16,23] with adaptions in shape and material properties. In particular for the case of aortic coarctation, wall thickening is often observed along with a decrease in compliance of the proximal aorta due to prolonged hypertension [8,27].…”

Coarctation of the Aorta in the Adult

“…(2,5) These wall abnormalities result in an increased stiffness of the aorta (6,7) and of the carotid arteries, (8) in a blunted baroreceptor refl ex, (9) in an increased brachial pulse wave velocity (10) and may be related to late aneurysm formation or aortic dissection.…”