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Zhu W, Xia Z, Zhou C, Wan J, Wang J, Li Y, Zhang J, Henein M, Fang F, Zhang G. Prognostic implications of residual mild coarctation gradient after interventional repair. J Clin Hypertens (Greenwich) 2024. [PMID: 39073270 DOI: 10.1111/jch.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
There is limited data on the prognostic implications of residual mild coarctation (RMC) in patients with repaired native coarctation of the aorta (CoA). To explore the association of RMC with mid-term comorbidities in post-interventional patients, and the predictive value of the residual pressure gradient. The authors retrospectively analyzed 79 native CoA patients who received successful intervention at our hospital between October 2010 and June 2023. The outcomes of the study were late arterial hypertension (either raised blood pressure or commencement of hypotensive medications) only in normotensive patients at early follow-up and the composite mid-term comorbidities including new-onset aortic injury, re-stenosis, and re-intervention. At a median follow-up of 60 months, late hypertension and mid-term comorbidities occurred in 16 (28.1%) and nine (11.4%) patients, respectively. Multivariate Cox proportional hazard regression analysis identified invasive peak systolic CoA pressure gradient (PSPG) as the best independent predictor of both outcomes. The maximally selected rank statistics indicated 10 mm Hg as the best PSPG cut-off value for predicting late hypertension. Compared to patients with PSPG < 11 mm Hg, the cumulative event rates of both outcomes were higher in those with PSPG ≥ 11 mm Hg (log-rank test, p < .001 for both endpoints). PSPG ≥ 11 mm Hg was proved to be the independent predictor of late hypertension with a significantly increased risk. In patients with non-surgical CoA repair, the post-interventional RMC and PSPG ≥11 mm Hg are important predictors of clinical comorbidities at mid-term follow-up.
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Affiliation(s)
- Wenhao Zhu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhiyuan Xia
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Congcong Zhou
- School of Global Public Health, New York University, New York, New York, USA
| | - Junyi Wan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyu Wang
- Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yihang Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingnan Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Michael Henein
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Fang Fang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gejun Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Guo M, Li B, Peng Q, Yao R, Wu Y, Ma P, Du C, Liu H, Shu Z, Qin S, Yang X, Yu W. Co-exposure to particulate matter and humidity increases blood pressure in hypertensive mice via the TRPV4-cPLA 2-COX2 pathway. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 255:114800. [PMID: 36933481 DOI: 10.1016/j.ecoenv.2023.114800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/16/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
Epidemiological studies have demonstrated that particulate matter (PM) can induce or exacerbate hypertension. High relative humidity has been associated with elevated blood pressure in certain regions. However, the coupling effect of humidity and PM on elevated blood pressure and the underlying mechanisms remain unknown. Herein, we aimed to explore the effects of exposure to PM and/or high relative humidity on hypertension, as well as elucidate underlying mechanisms. Male C57/BL6 mice were intraperitoneally administered NG-nitro-L-arginine methyl ester (L-NAME) to establish a hypertensive mouse model. The hypertensive mice were exposed to PM (0.15 mg/kg/day) and/or different relative humidities (45/90%) for eight weeks. Histopathological changes, systolic blood pressure (SBP), endothelial-derived contracting factors (thromboxane B2 [TXB2], Prostaglandin F2α [PGF2α], endothelin-1 [ET-1], and angiotensin II [Ang II]), and relaxing factors (prostaglandin I2 [PGI2] and nitric oxide [NO]) were measured to assess the effects of PM exposure and humidity on hypertension in mice. Levels of transient receptor potential vanilloid 4 (TRPV4), cytosolic phospholipase A2 (cPLA2), and cyclooxygenase 2 (COX2) were measured to explore their potential mechanisms. Herein, exposure to 90% relative humidity or PM alone had a slight but insignificant effect on hypertension. However, pathological changes and elevated blood pressure were markedly exacerbated following exposure to PM and 90% relative humidity. Levels of PGF2α, TXB2, and ET-1 were significantly increased, whereas the PGI2 level was substantially decreased. HC-067047-mediated blockade of TRPV4 suppressed TRPV4, cPLA2, and COX2 expression and effectively alleviated the increased blood pressure induced by exposure to PM and 90% relative humidity. These results indicate that 90% relative humidity and PM can activate the TRPV4-cPLA2-COX2 ion channel in the aorta, altering the endothelial-derived contracting and relaxing factors and enhancing blood pressure in hypertensive mice.
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Affiliation(s)
- Miao Guo
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China
| | - Baizhan Li
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China
| | - Qi Peng
- Xianning Engineering Research Center for Healthy Environment, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Runming Yao
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China
| | - Yang Wu
- Xianning Engineering Research Center for Healthy Environment, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Ping Ma
- Xianning Engineering Research Center for Healthy Environment, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Chenqiu Du
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China
| | - Hong Liu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China
| | - Ziyu Shu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China
| | - Shuo Qin
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China
| | - Xu Yang
- Xianning Engineering Research Center for Healthy Environment, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Wei Yu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing 400045, China.
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Eriksson P, Pihkala J, Jensen AS, Dohlen G, Liuba P, Wahlander H, Sjoberg G, Hlebowicz J, Furenas E, Leirgul E, Settergren M, Vithessonthi K, Nielsen NE, Christersson C, Sondergaard L, Sinisalo J, Nielsen-Kudsk JE, Dellborg M, Larsen SH. Transcatheter Intervention for Coarctation of the Aorta: A Nordic Population-Based Registry With Long-Term Follow-Up. JACC Cardiovasc Interv 2023; 16:444-453. [PMID: 36858664 DOI: 10.1016/j.jcin.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Coarctation of the aorta (CoA), a congenital narrowing of the proximal descending thoracic aorta, is a relatively common form of congenital heart disease. Untreated significant CoA has a major impact on morbidity and mortality. In the past 3 decades, transcatheter intervention (TCI) for CoA has evolved as an alternative to surgery. OBJECTIVES The authors report on all TCIs for CoA performed from 2000 to 2016 in 4 countries covering 25 million inhabitants, with a mean follow-up duration of 6.9 years. METHODS During the study period, 683 interventions were performed on 542 patients. RESULTS The procedural success rate was 88%, with 9% considered partly successful. Complications at the intervention site occurred in 3.5% of interventions and at the access site in 3.5%. There was no in-hospital mortality. During follow-up, TCI for CoA reduced the presence of hypertension significantly from 73% to 34%, but despite this, many patients remained hypertensive and in need of continuous antihypertensive treatment. Moreover, 8% to 9% of patients needed aortic and/or aortic valve surgery during follow-up. CONCLUSIONS TCI for CoA can be performed with a low risk for complications. Lifetime follow-up after TCI for CoA seems warranted.
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Affiliation(s)
- Peter Eriksson
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Jaana Pihkala
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu)
| | - Annette S Jensen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaute Dohlen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Hakan Wahlander
- University of Gothenburg, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gunnar Sjoberg
- Astrid Lindgren Children's Hospital and Department of Children's and Women's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Furenas
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital and Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Lars Sondergaard
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Juha Sinisalo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu)
| | | | - Mikael Dellborg
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Signe H Larsen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark
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Xiao HJ, Zhan AL, Huang QW, Huang RG, Lin WH. Evaluation of the aorta in infants with simple or complex coarctation of the aorta using CT angiography. Front Cardiovasc Med 2023; 9:1034334. [PMID: 36698954 PMCID: PMC9868234 DOI: 10.3389/fcvm.2022.1034334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To assess aortic dilatation and determine its related factors in infants with coarctation of the aorta (CoA) by using computed tomography angiography (CTA). Methods The clinical data of 55 infantile patients with CoA diagnosed by CTA were analyzed retrospectively. Aortic diameters were measured at six different levels and standardized as Z scores based on the square root of body surface area. The results of simple and complex CoA were compared. Univariate and multivariate logistic regression were used to analyze the effects of sex, age, hypertension, degree of coarctation, CoA type, bicuspid aortic valve (BAV), and other factors related to aortic dilatation. Results In total, 52 infant patients with CoA were analyzed, including 22 cases of simple CoA and 30 cases of complex CoA. The ascending aorta of the infants in the simple CoA group and the complex CoA group were dilated to different degrees, but the difference was not statistically significant (50.00% vs. 73.33%, P = 0.084, and 2.05 ± 0.40 vs. 2.22 ± 0.43 P = 0.143). The infants in the complex CoA group had more aortic arch hypoplasia than those in the simple CoA group (33.33% vs. 9.09%, P = 0.042). Compared to the ventricular septal defect (VSD) group, the Z score of the ascending aorta in the CoA group was significantly higher than that in the VSD group (P = 0.023 and P = 0.000). A logistic retrospective analysis found that an increased degree of coarctation (CDR value) was an independent predictor of ascending aortic dilatation (adjusted OR = 0.002; P = 0.034). Conclusion Infants with simple or complex CoA are at risk of ascending aortic dilatation, and the factors of ascending aortic dilatation depend on the degree of coarctation. The risk of aortic dilatation in infants with CoA can be identified by CTA.
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Sendzikaite S, Sudikiene R, Lubaua I, Silis P, Rybak A, Brzezinska-Rajszys G, Obrycki Ł, Litwin M, Jankauskiene A. Antihypertensive therapy of late arterial hypertension in children following successful coarctation correction. J Hypertens 2022; 40:2476-2485. [PMID: 36129116 DOI: 10.1097/hjh.0000000000003282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUNG Late arterial hypertension (AH) is the most significant complication of coarctation of the aorta (CoA). Only a few clinical studies described antihypertensive treatment of late AH following successful CoA repair. The primary objective of this multicentre cross-sectional study was to describe real-life antihypertensive therapy for late AH in children after hemodynamically successful CoA repair. The secondary objective was to describe antihypertensive therapy used within different haemodynamic phenotypes of AH. METHOD Blood pressure status, echocardiographic parameters and central blood pressure measurements were evaluated in 110 children aged 6-18 years following successful CoA repair with right arm blood pressure not exceeding leg blood pressure by at least 20 mmHg. RESULTS AH was found in 62 (56%) patients including 47 who were already treated and 15 with new diagnosed AH of whom seven presented with masked hypertension. Among treated patients, 10 presented with masked hypertension. The dominant phenotype of AH among patients with uncontrolled AH was isolated systolic hypertension (32 patients out of 37; 87.5%). AH was controlled in 53% of treated patients. Fifty-three percent of hypertensive patients had elevated central SBP and 39% had left ventricular hypertrophy with various left ventricle geometry patterns, 23% of them had both. β-adrenergic receptor blockers were the most used antihypertensive drugs followed by angiotensin-converting enzyme inhibitors with doses within the lower recommended range. CONCLUSION High prevalence of uncontrolled AH despite successful CoA repair and use of relatively low doses of antihypertensive drugs indicates the need of close blood pressure monitoring and more intensive and combined antihypertensive therapy.
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Affiliation(s)
- Skaiste Sendzikaite
- Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania
| | - Rita Sudikiene
- Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania
| | - Inguna Lubaua
- Clinic for Paediatric Cardiology and Cardiac Surgery, Children's Clinical University Hospital, Stradins University, Riga, Latvia
| | - Pauls Silis
- Clinic for Paediatric Cardiology and Cardiac Surgery, Children's Clinical University Hospital, Stradins University, Riga, Latvia
| | | | | | - Łukasz Obrycki
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mieczysław Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Augustina Jankauskiene
- Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania
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Ylinen MK, Pihkala JI, Salminen JT, Sarkola T. Predictors of blood pressure and hypertension long-term after treatment of isolated coarctation of the aorta in children—a population-based study. Interact Cardiovasc Thorac Surg 2022; 35:6659103. [PMID: 35944231 PMCID: PMC9380783 DOI: 10.1093/icvts/ivac212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to assess predictors of BP and hypertension and relations between BP and LV mass in a population-based retrospective study of repaired isolated coarctation of aorta.
METHODS
We collected follow-up data until 2018 of 284/304 (93%) patients with coarctation treated by surgery (n = 235) or balloon angioplasty/stent (n = 37/12) in our unit 2000–2012. Systolic hypertension was defined as systolic BP (SBP) z-score ≥+2 standard deviation (SD) or regular use of BP medication. LV hypertrophy was defined as LV mass z-score ≥+2 SD or LV mass index g/m2.7 ≥95th percentile.
RESULTS
The median (25–75th percentiles) follow-up time and age at follow-up were 9.7 years (6.9–13.2) and 11.8 years (7.9–16.0), respectively. Age at first procedure (P = 0.011) and systolic arm-leg-gradient (P = 0.007) were positively and transverse arch (P = 0.007) and isthmus diameter (P = 0.001) z-scores at follow-up were negatively associated with SBP z-score adjusted for age at follow-up and need for reintervention for coarctation. Systolic hypertension was present in 53/284 (18.7%) and related with increasing age at first procedure (median 33.2 vs 0.6 months; P < 0.001) and arm-leg-gradient at follow-up (mean ± SD, −0.3 ± 14.6 vs −6.4 ± 11.6 mmHg; P = 0.047) adjusted for reintervention for coarctation and age at follow-up. LV hypertrophy was present in 20/227 (9.3%) and related with SBP z-score.
CONCLUSIONS
Higher SBP and hypertension in repaired coarctation of aorta are related with increasing age at first procedure and arm-leg-gradient at follow-up. Transverse arch and isthmus diameters at follow-up are inversely related with SBP.
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Affiliation(s)
- Mari K Ylinen
- Department of Pediatric Cardiology, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Jaana I Pihkala
- Department of Pediatric Cardiology, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Jukka T Salminen
- Department of Pediatric Surgery, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Taisto Sarkola
- Department of Pediatric Cardiology, New Children’s hospital, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
- Minerva Foundation Institute for Medical Research , Helsinki, Finland
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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8
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/12/2022] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A. Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.)
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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9
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Bhatt AB, Lantin-Hermoso MR, Daniels CJ, Jaquiss R, Landis BJ, Marino BS, Rathod RH, Vincent RN, Keller BB, Villafane J. Isolated Coarctation of the Aorta: Current Concepts and Perspectives. Front Cardiovasc Med 2022; 9:817866. [PMID: 35694677 PMCID: PMC9174545 DOI: 10.3389/fcvm.2022.817866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Current management of isolated CoA, localized narrowing of the aortic arch in the absence of other congenital heart disease, is a success story with improved prenatal diagnosis, high survival and improved understanding of long-term complication. Isolated CoA has heterogenous presentations, complex etiologic mechanisms, and progressive pathophysiologic changes that influence outcome. End-to-end or extended end-to-end anastomosis are the favored surgical approaches for isolated CoA in infants and transcatheter intervention is favored for children and adults. Primary stent placement is the procedure of choice in larger children and adults. Most adults with treated isolated CoA thrive, have normal daily activities, and undergo successful childbirth. Fetal echocardiography is the cornerstone of prenatal counseling and genetic testing is recommended. Advanced 3D imaging identifies aortic complications and myocardial dysfunction and guides individualized therapies including re-intervention. Adult CHD program enrollment is recommended. Longer follow-up data are needed to determine the frequency and severity of aneurysm formation, myocardial dysfunction, and whether childhood lifestyle modifications reduce late-onset complications.
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Affiliation(s)
- Ami B. Bhatt
- Departments of Internal Medicine and Pediatrics and Division of Cardiology, Harvard Medical School, Boston, MA, United States
| | - Maria R. Lantin-Hermoso
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Curt J. Daniels
- Departments of Pediatrics and Internal Medicine, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Jaquiss
- Department of Cardiovascular and Thoracic Surgery and Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin John Landis
- Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, United States
| | - Rahul H. Rathod
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert N. Vincent
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Bradley B. Keller
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Juan Villafane
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
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10
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Mayoral I, Bevilacqua E, Gómez G, Hmadcha A, González-Loscertales I, Reina E, Sotelo J, Domínguez A, Pérez-Alcántara P, Smani Y, González-Puertas P, Mendez A, Uribe S, Smani T, Ordoñez A, Valverde I. Tissue engineered in-vitro vascular patch fabrication using hybrid 3D printing and electrospinning. Mater Today Bio 2022; 14:100252. [PMID: 35509864 PMCID: PMC9059085 DOI: 10.1016/j.mtbio.2022.100252] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
Three-dimensional (3D) engineered cardiovascular tissues have shown great promise to replace damaged structures. Specifically, tissue engineering vascular grafts (TEVG) have the potential to replace biological and synthetic grafts. We aimed to design an in-vitro patient-specific patch based on a hybrid 3D print combined with vascular smooth muscle cells (VSMC) differentiation. Based on the medical images of a 2 months-old girl with aortic arch hypoplasia and using computational modelling, we evaluated the most hemodynamically efficient aortic patch surgical repair. Using the designed 3D patch geometry, the scaffold was printed using a hybrid fused deposition modelling (FDM) and electrospinning techniques. The scaffold was seeded with multipotent mesenchymal stem cells (MSC) for later maturation to derived VSMC (dVSMC). The graft showed adequate resistance to physiological aortic pressure (burst pressure 101 ± 15 mmHg) and a porosity gradient ranging from 80 to 10 μm allowing cells to infiltrate through the entire thickness of the patch. The bio-scaffolds showed good cell viability at days 4 and 12 and adequate functional vasoactive response to endothelin-1. In summary, we have shown that our method of generating patient-specific patch shows adequate hemodynamic profile, mechanical properties, dVSMC infiltration, viability and functionality. This innovative 3D biotechnology has the potential for broad application in regenerative medicine and potentially in heart disease prevention.
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Key Words
- 3D printing
- Electrospinning
- Endothelin Receptor A, ETA
- Endothelin Receptor B, ETB
- Mesenchymal stem cells
- Reverse Transcription, Rt
- Three-dimensional, 3D
- Tissue engineering
- Vascular graft
- anti-alpha-smooth muscle actin, α-SMA
- anti-cluster of differentiation 31, CD31
- anti-fibroblast specific protein 1, FSP1
- anti-smooth muscle protein 22, SM-22
- bone morphogenetic protein, BMP4
- computation fluid dynamic, CFD
- computed tomography, CT
- derived VSMC, dVSMC
- endothelin-1, ET-1
- extracellular matrix, ECM
- fused deposition modelling, FDM
- mesenchymal stem cells, MSC
- platelet-derived growth factor composed by two beta chains, PDGF-BB
- room temperature, RT
- tissue engineering vascular grafts, TEVG
- transforming growth factor beta 1, TGFβ-1
- vascular smooth muscle cells, VSMC
- wall shear stress, WSS
- western blotting, WB
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Affiliation(s)
- Isabel Mayoral
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Elisa Bevilacqua
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Gorka Gómez
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Abdelkrim Hmadcha
- Advanced Therapies and Regenerative Medicine Research Group.General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain
| | - Ignacio González-Loscertales
- Department Mechanical, Thermal and Fluids Engineering, School of Engineering, University of Málaga, Málaga, Spain
| | - Esther Reina
- Department of Mechanical and Manufacturing Engineering, University of Seville, Seville, Spain
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, and Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Pedro Pérez-Alcántara
- Department of Mechanical and Manufacturing Engineering, University of Seville, Seville, Spain
| | - Younes Smani
- Department of Molecular Biology and Biochemical Engineering, Andalusian Center of Developmental Biology, CSIC, University of Pablo de Olavide, Seville, Spain
| | | | - Ana Mendez
- Pediatric Cardiology Unit, Hospital Virgen Del Rocio, Seville, Spain
| | - Sergio Uribe
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, and Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tarik Smani
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
- Department of Medical Physiology and Biophysics, School of Medicine, University of Seville, Seville, Spain
| | - Antonio Ordoñez
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Israel Valverde
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
- Pediatric Cardiology Unit, Hospital Virgen Del Rocio, Seville, Spain
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Pharmacology, Pediatric and Radiology, School of Medicine, University of Seville, Seville, Spain
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11
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Outcome and Impact of Associated Left-Sided Cardiac Lesions in Coarctation of the Aorta Diagnosed During Fetal Life. Am J Cardiol 2022; 166:114-121. [PMID: 34952671 DOI: 10.1016/j.amjcard.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
Abstract
Significant effort has been put into the optimization of the antenatal diagnosis of coarctation of the aorta (CoA). However, although left-sided cardiac lesions are known to cluster, the necessity to intervene postnatally for other left-sided cardiac lesions has not been reported in a cohort of fetuses with suspected CoA. We report a study of all 89 fetuses with antenatally suspected and postnatally confirmed diagnosis of CoA who underwent CoA repair as the primary procedure at a single tertiary congenital heart disease center over 10 years (January 1, 2010, to December 31, 2019). Almost 1 in 5 patients (18%) had to undergo surgery and/or transcatheter intervention on additional left-sided cardiac lesions (14%) and/or reintervention on the aortic arch (12%) during follow-up to median age of 2.85 years. Freedom from intervention at 5 years was 78% (95% confidence interval [CI] 67 to 88%) if reintervention on CoA was excluded, and 72% (95% CI 60 to 82%) if this was included. Five-year survival was 95% (95% CI 90 to 100%). Furthermore, 20% of affected infants had genetic (10%) and/or extracardiac (16%) abnormalities. Our study highlights the need for comprehensive antenatal counseling, including the prognosis of primary repair of CoA and the potential development of additional left-sided cardiac lesions, which may be difficult to diagnose prenatally even in expert hands or impossible to diagnose because of the physiology of the fetal circulation.
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12
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Bilitardo IO, Watashi DM, Sene DR, Teixeira GS. Posterior Reversible Encephalopathy Syndrome Associated With Coarctation of the Aorta. Cureus 2021; 13:e17456. [PMID: 34462714 PMCID: PMC8389859 DOI: 10.7759/cureus.17456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/22/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by acute encephalopathy due to different medical conditions. This syndrome may present with a wide spectrum of neurological symptoms including headache, disorders of consciousness, visual changes, seizures, and focal neurological deficits, in addition to nonspecific symptoms such as nausea and vomiting. Neuroimaging findings of bilateral cortical and subcortical brain edema involving the parieto-occipital regions are a hallmark of the disease. We present a case report of an eight-year-old boy who complained of headache and vomiting for 20 days until the discovery of severely high blood pressure (BP). He developed altered mental status, hemiplegia, loss of visual field, and seizure, requiring transfer to the intensive care unit. Magnetic resonance imaging of the brain showed hyperintense signals in the bilateral cortical and subcortical parieto-occipital areas. The BP measure of the extremities recognized a hypertensive upper extremity and normotensive lower extremity, and an MRI angiography was consistent with coarctation of the aorta (CoA). The fundoscopic exam showed no abnormalities. The diagnosis was kept as PRES secondary to a hypertensive emergency. Later, stenting of the aorta was performed, improving overall symptoms leaving a sequel loss of peripheral vision.
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Affiliation(s)
| | - Diego M Watashi
- Pediatric Neurology, Universidade de Mogi das Cruzes, Mogi das Cruzes, BRA
| | - Diogo R Sene
- General Medicine, Hospital Dr. Arnaldo Pezzuti, Mogi das Cruzes, BRA
| | - George S Teixeira
- Pediatric Neurology, Universidade de Mogi das Cruzes, Mogi das Cruzes, BRA
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13
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Lloyd DF, van Poppel MP, Pushparajah K, Vigneswaran TV, Zidere V, Steinweg J, van Amerom JF, Roberts TA, Schulz A, Charakida M, Miller O, Sharland G, Rutherford M, Hajnal JV, Simpson JM, Razavi R. Analysis of 3-Dimensional Arch Anatomy, Vascular Flow, and Postnatal Outcome in Cases of Suspected Coarctation of the Aorta Using Fetal Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2021; 14:e012411. [PMID: 34187165 PMCID: PMC8300852 DOI: 10.1161/circimaging.121.012411] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be lifesaving but is notoriously challenging in clinical practice with a high rate of false positives. Novel fetal 3-dimensional and phase-contrast magnetic resonance imaging (MRI) offers an unprecedented means of assessing the human fetal cardiovascular system before birth. We performed detailed MRI assessment of fetal vascular morphology and flows in a cohort of fetuses with suspected CoA, correlated with the need for postnatal intervention. METHODS Women carrying a fetus with suspected CoA on echocardiography were referred for MRI assessment between 26 and 36 weeks of gestation, including high-resolution motion-corrected 3-dimensional volumes of the fetal heart and phase-contrast flow sequences gated with metric optimized gating. The relationship between aortic geometry and vascular flows was then analyzed and compared with postnatal outcome. RESULTS Seventy-two patients (51 with suspected fetal CoA and 21 healthy controls) underwent fetal MRI with motion-corrected 3-dimensional vascular reconstructions. Vascular flow measurements from phase-contrast sequences were available in 53 patients. In the CoA group, 25 of 51 (49%) required surgical repair of coarctation after birth; the remaining 26 of 51 (51%) were discharged without neonatal intervention. Reduced blood flow in the fetal ascending aorta and at the aortic isthmus was associated with increasing angulation (P=0.005) and proximal displacement (P=0.006) of the isthmus and was seen in both true positive and false positive cases. A multivariate logistic regression model including aortic flow and isthmal displacement explained 78% of the variation in outcome and correctly predicted the need for intervention in 93% of cases. CONCLUSIONS Reduced blood flow though the left heart is associated with important configurational changes at the aortic isthmus in fetal life, predisposing to CoA when the arterial duct closes after birth. Novel fetal MRI techniques may have a role in both understanding and accurately predicting severe neonatal CoA.
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Affiliation(s)
- David F.A. Lloyd
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Milou P.M. van Poppel
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Kuberan Pushparajah
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Trisha V. Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Johannes Steinweg
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Joshua F.P. van Amerom
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Thomas A. Roberts
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Alexander Schulz
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Marietta Charakida
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Gurleen Sharland
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Mary Rutherford
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - Joseph V. Hajnal
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
| | - John M. Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
| | - Reza Razavi
- School of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (D.F.A.L., M.P.M.v.P., K.P., J.S., J.F.P.v.A., T.R., A.S., M.R., J.H., R.R.)
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, United Kingdom (D.F.A.L., K.P., T.V.V., V.Z., M.C., O.M., G.S., J.M.S., R.R.)
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14
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Vigneswaran TV, Zidere V, Chivers S, Charakida M, Akolekar R, Simpson JM. Impact of prospective measurement of outflow tracts in prediction of coarctation of the aorta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:850-856. [PMID: 31875324 DOI: 10.1002/uog.21957] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Prenatal diagnosis of coarctation of the aorta (CoA) is associated with reduced mortality and morbidity, however, accurate prenatal prediction remains challenging. To date, studies have used retrospective measurements of the outflow tracts to evaluate their potential to predict CoA. Our primary objective was to evaluate prospectively acquired measurements of the outflow tracts in fetuses with prenatally suspected CoA. A secondary aim was to report the postnatal prevalence of bicuspid aortic valve in this cohort. METHODS Pregnancies with suspicion of isolated CoA and with a minimum of 6 months' postnatal follow-up available were identified from the cardiac database of a tertiary fetal cardiology center in the UK, between January 2002 and December 2017. Measurement of the aortic valve, pulmonary valve, distal transverse aortic arch (DTAA) and arterial duct (AD) diameters were undertaken routinely in fetuses with suspected CoA during the study period. Z-scores were computed using published reference ranges based on > 7000 fetuses from our own unit. RESULTS Of 149 pregnancies with prenatally suspected CoA included in the study, CoA was confirmed within 6 months after birth in 77/149 (51.7%) cases. DTAA diameter Z-score and the Z-score of second-trimester DTAA/AD diameter ratio were smaller in fetuses with postnatally confirmed CoA than those in false-positive cases (-2.8 vs -1.9; P = 0.039 and -3.13 vs -2.61; P = 0.005, respectively). Multiple regression analysis demonstrated that the Z-scores of DTAA and AD diameters were the only significant predictors of postnatal CoA (P = 0.001). Bicuspid aortic valve was identified in 30% of the false-positive cases. CONCLUSIONS Measurement of DTAA and AD diameter Z-scores can be used to ascertain risk for postnatal CoA in a selected cohort. The high incidence of bicuspid aortic valve in false-positive cases merits further study with respect to both etiology and longer-term significance. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T V Vigneswaran
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Department of Biomedical Engineering, King's College Hospital, London, UK
| | - V Zidere
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - S Chivers
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - M Charakida
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Department of Biomedical Engineering, King's College Hospital, London, UK
| | - R Akolekar
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Obstetrics & Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK
| | - J M Simpson
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- Department of Biomedical Engineering, King's College Hospital, London, UK
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15
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Sendzikaite S, Sudikiene R, Tarutis V, Lubaua I, Silis P, Rybak A, Jankauskiene A, Litwin M. Prevalence of arterial hypertension, hemodynamic phenotypes, and left ventricular hypertrophy in children after coarctation repair: a multicenter cross-sectional study. Pediatr Nephrol 2020; 35:2147-2155. [PMID: 32529324 DOI: 10.1007/s00467-020-04645-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to evaluate hemodynamic phenotypes and prevalence of left ventricular hypertrophy in children after coarctation repair with right arm and leg blood pressure difference < 20 mmHg. Secondary objectives were analysis of effects of age at intervention, residual gradient across the descending aorta, and type of correction. METHODS Blood pressure status and left ventricular hypertrophy were diagnosed according to European Society of Hypertension 2016 guidelines. RESULTS Of 90 patients with a median age 12.5 (8.9-15.8) years, 8.5 (6.0-11.8) years after coarctation repair who were included, 42 (46.7%) were hypertensive. Isolated systolic hypertension dominated among 29 hypertensive patients with uncontrolled or masked hypertension (25 of 29; 86.2%). Of the 48 patients with office normotension, 14.6% (7) had masked hypertension, 8.3% (4) had ambulatory prehypertension, and 54.2% (26) were truly normotensive. Left ventricular hypertrophy was diagnosed in 29 patients (32.2%), including 14 of 42 (33.3%) hypertensive and 15 of 48 (31.3%) normotensive patients. The peak systolic gradient across the descending aorta was greater in hypertensive subjects (33.3 ± 12.7 mmHg) compared with normotensive subjects (25 ± 8.2 mmHg, p = 0.0008). Surgical correction was performed earlier than percutaneous intervention (p < 0.0001) and dominated in 40 of 48 (83.3%) normotensive versus 24 of 42 (57.1%) hypertensive patients (p = 0.006). CONCLUSIONS Arterial hypertension with isolated systolic hypertension as the dominant phenotype and left ventricular hypertrophy are prevalent even after successful coarctation repair. Coarctation correction from the age of 9 years and older was associated with a higher prevalence of hypertension.
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Affiliation(s)
- Skaiste Sendzikaite
- Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
| | - Rita Sudikiene
- Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania
| | - Virgilijus Tarutis
- Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania
| | - Inguna Lubaua
- Clinic for Paediatric Cardiology and Cardiac Surgery, Children's Clinical University Hospital, Stradins University, Riga, Latvia
| | - Pauls Silis
- Clinic for Paediatric Cardiology and Cardiac Surgery, Children's Clinical University Hospital, Stradins University, Riga, Latvia
| | - Agata Rybak
- Department of Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Augustina Jankauskiene
- Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania
| | - Mieczyslaw Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
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16
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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? Cardiol Young 2020; 30:1305-1312. [PMID: 32693850 DOI: 10.1017/s104795112000205x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cardiovascular morbidity is high in patients with coarctation of aorta even after successful repair. This study aimed to assess the frequency of late hypertension and the relationship between ambulatory hypertension and cardiovascular target organ damage in children and adolescents after early and successful repair of coarctation of the aorta. METHODS Twenty-five children and adolescents (mean age 13.5 ± 3.43 years) with repaired coarctation of the aorta (median age at repair 4 months, arm-leg gradient <20 mmHg) and 16 healthy controls were included. Office and ambulatory blood pressure, pulse wave velocity, and left ventricular mass index were assessed. RESULTS Both day- and night-time systolic blood pressure standard deviation score and left ventricular mass index were significantly higher in patients compared to controls (p ≤ 0.001 for all), whereas pulse wave velocity did not differ. The prevalence of masked hypertension, isolated nocturnal hypertension, and left ventricular hypertrophy were 40, 28, and 24%, respectively. Left ventricular mass index was higher in patients with sustained hypertension, masked hypertension, and normotension compared to controls (p < 0.05). In multivariate analysis, higher night-time systolic blood pressure standard deviation score was the only independent predictor of left ventricular mass index. CONCLUSION The present study reveals a high prevalence of masked hypertension, isolated nocturnal hypertension, and left ventricular hypertrophy in children and adolescents with coarctation of the aorta even after early and successful repair. Ambulatory blood pressure monitoring should be considered to diagnose hypertension. All coarctation of aorta patients should be followed up lifelong and encouraged to establish a healthy lifestyle starting from childhood.
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17
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Early Postnatal Echocardiography in Neonates with a Prenatal Suspicion of Coarctation of the Aorta. Pediatr Cardiol 2020; 41:772-780. [PMID: 32034462 DOI: 10.1007/s00246-020-02310-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
Coarctation of the aorta (COA) is suspected prenatally when there is ventricular asymmetry, arterial disproportion, and hypoplasia of the aortic arch/isthmus. The presence of fetal shunts creates difficulty in prenatal confirmation of the diagnosis so serial echocardiography after birth is necessary to confirm or refute the diagnosis. The first neonatal echocardiogram in prenatally suspected cases of COA was assessed for prediction of neonatal COA repair (NCOAR). This included morphological assessment, measurement of the aortic arch and calculation of the distal arch index (DAI = distance between left common carotid and left subclavian artery/diameter of the distal arch). NCOAR was undertaken in 23/60 (38%) cases. Transverse arch, aortic isthmus z-score, and DAI had an area under the receiver operator curve of 0.88 (95% CI 0.77-0.98), 0.86 (95% CI 0.75-0.96), and 0.84 (95% CI 0.74-0.95), respectively for the prediction of NCOAR. Using transverse arch z-score threshold < - 3 gave sensitivity 100%, NPV: 100%, specificity 76%; aortic isthmus z-score < - 3: NPV 92%, specificity 62% and DAI > 1.4: NPV 88%, specificity 78%. The size of the distal aortic arch in infants with a common origin of the innominate artery and left common carotid artery who did not require COA repair was similar to the NCOAR cases (p = 0.22). The early postnatal assessment of the size and morphology of the aortic arch can assist in risk stratification for development of neonatal COA. The branching pattern of the head/neck vessels impacts on the size of the distal aortic arch adding to the complexity of predicting COA based on vessel size.
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Wang P, Jiang R. 320-slice Computed Tomography Angiography Imaging Findings and Follow-up in A Patient with Aortic Coarctation Misdiagnosed as Hypertension: A Case Report and Literature Review. Cureus 2019; 11:e6529. [PMID: 32010536 PMCID: PMC6993081 DOI: 10.7759/cureus.6529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In this case, we report a simple coarctation of the aortic isthmus (CoA) in a patient without intracardiac abnormalities or patent ductus arteriosus, who was misdiagnosed as essential hypertension for over 20 years. The patient underwent X-rays, echocardiography, and 320-slice CT angiography (CTA). Among them, CTA comprehensively showed the diameter of the aortic coarctation, the anatomy and morphology of the heart and aortic arch, and the collateral circulation before surgery. It also accurately evaluated the postoperative status of the bypass vessel. This article highlights the excellent performance of 320-slice CTA in the diagnosis, surgical planning, and follow-up in CoA. Moreover, when adolescents suffer from refractory hypertension, the possibility of organic cardiovascular disease should be considered.
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Affiliation(s)
- Peng Wang
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, CHN
| | - Rui Jiang
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu, CHN
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Abstract
OBJECTIVES Concerns exist over the long-term consequences of subclavian artery ligation in subclavian flap repair for coarctation of the aorta. We sought to analyse upper limb structural and functional performance in adults who have had surgery in childhood for coarctation of the aorta, using either subclavian flap repair or end to end aortic anastomosis. METHODS Two-group observational design using anatomical and upper limb functional performance measures. Purposive sampling from our specialist adult congenital heart disease database of patients who received subclavian flap repair or end to end anastomosis for coarctation of the aorta as children. Upper limb measurements were completed using MRI and blood flow velocity with ultrasound imaging. Bilateral standardised upper limb functional testing of assessment of strength, dexterity and a standardised self-report of upper limb disability was completed. RESULTS Eighteen right-handed patients, 9 with subclavian repair, (38 ± 12 years, 78% males) were studied. Age at repair was 4.7 ± 5.9 years; mean time from initial repair 32 ± 9 years. The subclavian group had a larger difference between right and left when compared the end to end anastomosis group in: lower arm muscle mass (94.5 ± 42.3 mls versus 37.8 ± 94.5 mls, p = 0.008), lower arm maximal cross-sectional area, (5.9 ± 2.8 cm2 versus 2.9 ± 2.6 cm2, p = 0.038) and grip strength (14.7 ± 8.3 lbs versus 5.9 ± 5.3 lbs, p = 0.016) There were no significant functional differences between groups. CONCLUSIONS In adults with repaired coarctation of the aorta, those with subclavian flap repair had a greater right to left arm muscle mass and grip strength differential when compared to those with end to end anastomosis repair.
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Karatza AA, Gkentzi D, Kostopoulou E, Rammos S. Native aortic coarctation presenting as prolonged pyrexia in a teenager with 22q11.2 deletion. J Paediatr Child Health 2019; 55:711-714. [PMID: 30636080 DOI: 10.1111/jpc.14341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/20/2018] [Accepted: 11/18/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Ageliki A Karatza
- Department of Paediatrics, University of Patras Medical School, Patras, Greece
| | - Despoina Gkentzi
- Department of Paediatrics, University of Patras Medical School, Patras, Greece
| | - Eirini Kostopoulou
- Department of Paediatrics, University of Patras Medical School, Patras, Greece
| | - Spyridon Rammos
- Department of Paediatric Cardiology and Adult with Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece
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Wahl L, Tubbs RS. A review of the clinical anatomy of hypertension. Clin Anat 2019; 32:678-681. [PMID: 30873636 DOI: 10.1002/ca.23369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 01/13/2023]
Abstract
Hypertension is defined as the persistent elevation of blood pressure above normal limits. It can be classified according to whether the contributing factors are genetics and environmental (primary hypertension) or underlying medical conditions and medications (secondary hypertension). The goal of this review is to increase recognition of the various anatomical etiologies of hypertension. Clin. Anat. 32:678-681, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lauren Wahl
- Seattle Science Foundation, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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