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Alaeddine M. Commentary: Coarctation and hypertension dilemma unsolved. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00897-3. [PMID: 39370099 DOI: 10.1016/j.jtcvs.2024.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 09/29/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Mohamad Alaeddine
- Department of Cardiothoracic Surgery, Heart Center, Phoenix Children's Hospital, Phoenix, Ariz.
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2
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Di Salvo G, Fumanelli J, Graziano S, Pozza A, Cattapan I, Moscatelli S, Castaldi B, Galzerano D. Stress Echocardiography in the Follow-Up of Young Patients with Repaired Aortic Coarctation. J Clin Med 2024; 13:5587. [PMID: 39337074 PMCID: PMC11432678 DOI: 10.3390/jcm13185587] [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: 08/03/2024] [Revised: 08/24/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Aortic coarctation (CoA) is a congenital heart disease affecting 5-8% of patients, with long-term complications persisting despite successful correction. Stress echocardiography (SE) is increasingly used for evaluating cardiac function under stress, yet its role in repaired CoA remains under-explored. Objective: This study aimed to assess the predictive value of SE and myocardial strain in repaired CoA patients with a history of hypertension without significant gradients or with borderline gradients at rest. Methods: Between June 2020 and March 2024, we enrolled 35 consecutive CoA patients with successful repairs and either a history of hypertension or borderline Doppler gradients. Baseline and peak exercise echocardiographic measurements, including left ventricular mass index (LVMi) and global longitudinal strain (LVGLS), were recorded. Patients were followed for up to 4 years. Results: At baseline, the positive SE group had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the negative SE group. The positive SE group also exhibited significantly higher basal and peak trans-isthmic gradients. Positive SE was found in 45.7% of patients, with 68.7% of these requiring re-intervention during follow-up. A peak trans-isthmic gradient > 61 mmHg during exercise predicted recoarctation with 100% sensitivity and 71% specificity (AUC = 0.836, p < 0.004). Conclusions: SE identifies at-risk patients post-CoA repair, aiding in early intervention. A peak trans-isthmic gradient > 61 mmHg during exercise is a strong predictor of recoarctation. These findings support incorporating SE into routine follow-up protocols for CoA patients, particularly those with a history of hypertension and borderline gradients, to improve long-term outcomes and quality of life.
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Affiliation(s)
- Giovanni Di Salvo
- Pediatric Cardiology and Adult Congenital Unit, Department of Women’s and Child’s Health, University of Padua, 35121 Padova, Italy; (J.F.); (S.G.); (I.C.); (B.C.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention of the Italian Society of Cardiology, 00136 Roma, Italy;
| | - Jennifer Fumanelli
- Pediatric Cardiology and Adult Congenital Unit, Department of Women’s and Child’s Health, University of Padua, 35121 Padova, Italy; (J.F.); (S.G.); (I.C.); (B.C.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention of the Italian Society of Cardiology, 00136 Roma, Italy;
| | - Serena Graziano
- Pediatric Cardiology and Adult Congenital Unit, Department of Women’s and Child’s Health, University of Padua, 35121 Padova, Italy; (J.F.); (S.G.); (I.C.); (B.C.)
| | - Alice Pozza
- Pediatric Cardiology and Adult Congenital Unit, Department of Women’s and Child’s Health, University of Padua, 35121 Padova, Italy; (J.F.); (S.G.); (I.C.); (B.C.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention of the Italian Society of Cardiology, 00136 Roma, Italy;
| | - Irene Cattapan
- Pediatric Cardiology and Adult Congenital Unit, Department of Women’s and Child’s Health, University of Padua, 35121 Padova, Italy; (J.F.); (S.G.); (I.C.); (B.C.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention of the Italian Society of Cardiology, 00136 Roma, Italy;
| | - Sara Moscatelli
- Pediatric Cardiology and Adult Congenital Unit, Department of Women’s and Child’s Health, University of Padua, 35121 Padova, Italy; (J.F.); (S.G.); (I.C.); (B.C.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention of the Italian Society of Cardiology, 00136 Roma, Italy;
| | - Biagio Castaldi
- Pediatric Cardiology and Adult Congenital Unit, Department of Women’s and Child’s Health, University of Padua, 35121 Padova, Italy; (J.F.); (S.G.); (I.C.); (B.C.)
| | - Domenico Galzerano
- Working Group on Congenital Heart Disease and Cardiovascular Prevention of the Italian Society of Cardiology, 00136 Roma, Italy;
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh 12611, Saudi Arabia
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3
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Ghorbannia A, Spearman AD, Sawalhi S, Woods RK, Maadooliat M, LaDisa JF. A Novel Diastolic Doppler Index Less Affected by Aortic Arch Anomalies Co-existing with Coarctation. Pediatr Cardiol 2024:10.1007/s00246-024-03569-8. [PMID: 38995425 DOI: 10.1007/s00246-024-03569-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024]
Abstract
Severity assessment for coarctation of the aorta (CoA) is challenging due to concomitant morphological anomalies (complex CoA) and inaccurate Doppler-based indices. Promising diagnostic performance has been reported for the continuous flow pressure gradient (CFPG), but it has not been studied in complex CoA. Our objective was to characterize the effect of complex CoA and associated hemodynamics on CFPG in a clinical cohort. Retrospective analysis identified discrete juxtaductal (n = 25) and complex CoA (n = 43; transverse arch and/or isthmus hypoplasia) patients with arm-leg systolic blood pressure gradients (BPG) within 24 h of echocardiography for comparison to BPG by conventional Doppler indices (simplified Bernoulli equation and modified forms correcting for proximal kinetic energy and/or recovered pressure). Results were interpreted using the current CoA guideline (BPG ≥ 20 mmHg) to compare diagnostic performance indicators including receiver operating characteristic curves, sensitivity, specificity, and diagnostic accuracy, among others. Echocardiography Z-scored aortic diameters were applied with computational simulations from a preclinical CoA model to understand aspects of the CFPG driving performance differences. Diagnostic performance was substantially reduced from discrete to complex CoA for conventional Doppler indices calculated from patient data, and by hypoplasia and/or long segment stenosis in simulations. In contrast, diagnostic indicators for the CFPG only modestly dropped for complex vs discrete CoA. Simulations revealed differences in performance due to inclusion of the Doppler velocity index and diastolic pressure half-time in the CFPG calculation. CFPG is less affected by aortic arch anomalies co-existing with CoA when compared to conventional Doppler indices.
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Affiliation(s)
- Arash Ghorbannia
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, 8701 W Watertown Plank Rd., Milwaukee, WI, 53226, USA.
| | - Andrew D Spearman
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, 8701 W Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Shahd Sawalhi
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ronald K Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| | - Mehdi Maadooliat
- Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, WI, USA
| | - John F LaDisa
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, 8701 W Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Departments of Physiology, and Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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4
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Pettinato AM, Kumar M, Kim AS. Identification and treatment of midaortic syndrome in an adult patient with orthostatic tachycardia and hypertension: A case report. Heliyon 2024; 10:e32186. [PMID: 38867988 PMCID: PMC11168421 DOI: 10.1016/j.heliyon.2024.e32186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/21/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
Anatomical cardiovascular etiologies are less frequently investigated and identified in cases of orthostatic intolerance, which can have a profound impact on a patient's functional status. Here, we present a 26-year-old female with a recent diagnosis of hyperadrenergic postural orthostatic tachycardia and hypertension who was found to have diminished pedal pulses. Workup revealed an underlying midaortic syndrome that was then surgically corrected with resolution of symptoms. We discuss the epidemiology, presentation, and management of this rare condition, as well as its role in our patient's symptomatology.
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Affiliation(s)
- Anthony M. Pettinato
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Manish Kumar
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Agnes S. Kim
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
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5
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Stellon M, Gober L, Culver MA, Hermsen J, Irrer D, Witzenburg C, Roldán-Alzate A, Lamers L. Surgically induced aortic coarctation in a neonatal porcine model allows for longitudinal assessment of cardiovascular changes. Am J Physiol Heart Circ Physiol 2024; 326:H1117-H1123. [PMID: 38488518 PMCID: PMC11380946 DOI: 10.1152/ajpheart.00087.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024]
Abstract
Noncritical aortic coarctation (COA) typically presents beyond early childhood with hypertension. Correction of COA does not ensure a return to normal cardiovascular health, but the mechanisms are poorly understood. Therefore, we developed a porcine COA model to study the secondary cardiovascular changes. Eight male neonatal piglets (4 sham, 4 COA) underwent left posterolateral thoracotomy with descending aorta (DAO) mobilization. COA was created via a 1-cm longitudinal DAO incision with suture closure, plication, and placement and an 8-mm external band. All animals had cardiac catheterization at 6 (11-13 kg), 12 (26-31 kg), and 20 (67-70 kg) wk of age. Aortic luminal diameters were similar along the thoracic aorta, except for the COA region [6.4 mm COA vs. 17.3 mm sham at 20 wk (P < 0.001)]. Collateral flow could be seen as early as 6 wk. COA peak systolic pressure gradient was 20 mmHg at 6 wk and persisted through 20 wk increasing to 40 mmHg with dobutamine. Pulse pressures distal to the COA were diminished at 12 and 20 wk. This model addresses many limitations of prior COA models including neonatal creation at an expected anatomic position with intimal injury and vessel sizes similar to humans.NEW & NOTEWORTHY A neonatal model of aortic coarctation was developed in a porcine model using a readily reproducible method of aortic plication and external wrap placement. This model addresses the limitations of existing models including neonatal stenosis creation, appropriate anatomic location of the stenosis, and intimal injury creation and mimics human somatic growth. Pigs met American Heart Association (AHA) criteria for consideration of intervention, and the stenoses were graded as moderate to severe.
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Affiliation(s)
- Michael Stellon
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Leah Gober
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Matthew Allen Culver
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, United States
| | - Joshua Hermsen
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Dana Irrer
- Department of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Colleen Witzenburg
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, United States
- Department of Mechanical Engineering, University of Wisconsin, Madison, Wisconsin, United States
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin, Madison, Wisconsin, United States
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Luke Lamers
- Department of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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Jha NK, Raj Kumar B, Shah N, Abdullah O, Al Ketan O, Harban F, Khan MD. Coral reef aorta: a rare form of obstruction of the ascending aorta in adolescent with aortopathy- case report. J Cardiothorac Surg 2024; 19:71. [PMID: 38326839 PMCID: PMC10851464 DOI: 10.1186/s13019-024-02553-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Supra aortic obstruction in children is uncommon and is seen in certain unique conditions. While intraluminal obstruction due to heavy calcification is seen in older populations, it is not described in pediatric populations. The coral reef aorta is a rare and distinct calcifying disease causing luminal obstruction of the suprarenal aorta in adults. The definition of this diagnosis relies entirely on the unique aspects and consistency of the lesions, which are rock-hard, irregular, gritty plaques with a white luminal surface resembling a coral reef. However, no such case has been described in children. CASE PRESENTATION We present an adolescent boy who presented with a heavily calcified ascending aortic lesion associated with aortopathy and hypertension, 12 years after an aortic coarctation repair. The investigations included echocardiography, magnetic resonance and computer-tomographic imaging. A 3-D model was printed in order to visualize and plan surgical steps in advance for safe placement of clamps and defining the extent of resection. In addition, it provided an idea about tissue quality, thickness, spatial relationship, and orientation in relation to surrounding structures. Successful resection and replacement of the diseased segment of the aorta were achieved on cardiopulmonary bypass support. Post-operative recovery was uneventful, and at 6-month follow-up, the patient is doing well. In this report, various aspects of such lesions have been discussed, including clinical presentations, complications, planning and conduct of a safe cardiopulmonary bypass, and precautions during surgery for a successful outcome. CONCLUSION Complicated obstructive aortic lesions in children require careful assessment, appropriate advanced imaging, and the use of 3-D printing technology in order to plan and perform safe and effective surgical management. The etiology of severe calcified aorta in children may be related to metabolic factors, previous surgery, use of a homograft, or an inflammatory process. However, it has yet to be proven.
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Affiliation(s)
- Neerod Kumar Jha
- Division of Paediatric Cardiac Surgery, Sheikh Khalifa Medical City, PO Box 768010, Abu Dhabi, United Arab Emirates.
| | - Benedict Raj Kumar
- Division of Paediatric Cardiac Surgery, Sheikh Khalifa Medical City, PO Box 768010, Abu Dhabi, United Arab Emirates
| | - Nishant Shah
- Paediatric Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Osama Abdullah
- Core Technology Platforms, New York University, Abu Dhabi, United Arab Emirates
| | - Oraib Al Ketan
- Core Technology Platforms, New York University, Abu Dhabi, United Arab Emirates
| | - Fraser Harban
- Paediatric Cardiac Anaesthesiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mohammad Daud Khan
- Paediatric Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Yogendran V, Mele L, Prysyazhna O, Budhram-Mahadeo VS. Vascular dysfunction caused by loss of Brn-3b/POU4F2 transcription factor in aortic vascular smooth muscle cells is linked to deregulation of calcium signalling pathways. Cell Death Dis 2023; 14:770. [PMID: 38007517 PMCID: PMC10676411 DOI: 10.1038/s41419-023-06306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023]
Abstract
Phenotypic and functional changes in vascular smooth muscle cells (VSMCs) contribute significantly to cardiovascular diseases (CVD) but factors driving early adverse vascular changes are poorly understood. We report on novel and important roles for the Brn-3b/POU4F2 (Brn-3b) transcription factor (TF) in controlling VSMC integrity and function. Brn-3b protein is expressed in mouse aorta with localisation to VSMCs. Male Brn-3b knock-out (KO) aortas displayed extensive remodelling with increased extracellular matrix (ECM) deposition, elastin fibre disruption and small but consistent narrowing/coarctation in the descending aortas. RNA sequencing analysis showed that these effects were linked to deregulation of genes required for calcium (Ca2+) signalling, vascular contractility, sarco-endoplasmic reticulum (S/ER) stress responses and immune function in Brn-3b KO aortas and validation studies confirmed changes in Ca2+ signalling genes linked to increased intracellular Ca2+ and S/ER Ca2+ depletion [e.g. increased, Cacna1d Ca2+ channels; ryanodine receptor 2, (RyR2) and phospholamban (PLN) but reduced ATP2a1, encoding SERCA1 pump] and chaperone proteins, Hspb1, HspA8, DnaJa1 linked to increased S/ER stress, which also contributes to contractile dysfunction. Accordingly, vascular rings from Brn-3b KO aortas displayed attenuated contractility in response to KCl or phenylephrine (PE) while Brn-3b KO-derived VSMC displayed abnormal Ca2+ signalling following ATP stimulation. This data suggests that Brn-3b target genes are necessary to maintain vascular integrity /contractile function and deregulation upon loss of Brn-3b will contribute to contractile dysfunction linked to CVD.
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Affiliation(s)
- Vaishaali Yogendran
- Molecular Biology Development and Disease, UCL Institute of Cardiovascular Science, London, UK
| | - Laura Mele
- Molecular Biology Development and Disease, UCL Institute of Cardiovascular Science, London, UK
| | - Oleksandra Prysyazhna
- Clinical Pharmacology Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
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Colle A, Enciso SK, Brunee L, Sluysmans T, Kefer J, Astarci P, Lacroix V, Elens M. Aortic Coarctation Stenting in Adolescents and Adults: A Single-Center Experience. Vasc Endovascular Surg 2023; 57:863-868. [PMID: 37300455 DOI: 10.1177/15385744231183476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE/BACKGROUND The aim of this study was to evaluate the short and midterm results of aortic coarctation (AoCo) stenting in an adolescent and adult population. METHODS All patients with a AoCo older than 14 years treated by stent placement between December 2000 and November 2016 were included in this study. Twenty-eight patients with an invasive peak systolic pressure gradient >20 mmHg were identified. Number of redilations, non-invasive systolic blood pressure, peak systolic pressure gradient, antihypertensive medication intake, claudication status and complications were evaluated. RESULTS Twenty-two covered and 6 uncovered stents were successfully placed. Peak systolic pressure gradient decreased immediately after stenting from a mean of 32 mmHg to 0 mmHg (± 7 mmHg). Mean AoCo diameter increased from 8 tot 16 mm (± 4 mm). Peripheral arterial injury was seen in 2 patients (7.1%). The mean follow-up time was 60 ± 49 months. Redilation of the stent was required in 4 patients, 2 to accommodate for growth and 2 for restenosis. Six (35%) patients could stop all antihypertensive medication. All claudicants (6/28) became and remained asymptomatic after surgery and during their follow-up. No aneurysms, stent fractures or dissections were noticed. There were 2 stent migrations during the first procedure with only 1 needing additional stent placement. CONCLUSION Aortic coarctation stenting is a safe and effective treatment that significantly reduces the peak systolic pressure gradient. Antihypertensive medication can be reduced, and increase of walking distance in claudicants can be obtained. Younger patients may need more frequent reinterventions to accommodate for growth.
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Affiliation(s)
- Arnaud Colle
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Stéphane Kajingu Enciso
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Louise Brunee
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Thierry Sluysmans
- Department of Paediatrics, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Joëlle Kefer
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Parla Astarci
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Valerie Lacroix
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Maxime Elens
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
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9
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Ghorbannia A, Spearman AD, Sawalhi S, Woods RK, Maadooliat M, LaDisa JF. Consistency of the continuous flow pressure gradient despite aortic arch anomalies co-existing with coarctation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.30.23297763. [PMID: 37961134 PMCID: PMC10635219 DOI: 10.1101/2023.10.30.23297763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Aims Severity assessment for coarctation of the aorta (CoA) is challenging due to concomitant morphological anomalies (complex CoA) and inaccurate Doppler-based indices. Promising diagnostic performance has been reported for the continuous flow pressure gradient (CFPG), but it has not been studied in complex CoA. Our objective was to characterize the effect of complex CoA and associated hemodynamics on CFPG in a clinical cohort. Methods and Results Retrospective analysis identified discrete juxtaductal (n=25) and complex CoA (n=43; transverse arch and/or isthmus hypoplasia) patients with arm-leg systolic blood pressure gradients (BPG) within 24 hours of echocardiography for comparison to BPG by conventional Doppler indices (simplified Bernoulli equation and modified forms correcting for proximal kinetic energy and/or recovered pressure). Results were interpreted using the current CoA guideline (BPG ≥20 mmHg) to compare diagnostic performance indicators including receiver operating characteristic curves, sensitivity, specificity, and diagnostic accuracy, among others. Echocardiography Z-scored aortic diameters were applied with computational stimulations from a preclinical CoA model to understand aspects of the CFPG driving performance differences.Diagnostic performance was substantially reduced from discrete to complex CoA for conventional Doppler indices calculated from patient data, and by hypoplasia and/or long segment stenosis in simulations. In contrast, diagnostic indicators for the CFPG only modestly dropped for complex vs discrete CoA. Simulations revealed differences in performance due to inclusion of the Doppler velocity index and diastolic pressure half-time in the CFPG calculation. Conclusion CFPG is less affected by aortic arch anomalies co-existing with CoA when compared to conventional Doppler indices.
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Affiliation(s)
- Arash Ghorbannia
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew D. Spearman
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shahd Sawalhi
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ronald K. Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Mehdi Maadooliat
- Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, Wisconsin, USA
| | - John F. LaDisa
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Departments of Physiology, and Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension 2023; 80:1970-1979. [PMID: 37476999 PMCID: PMC10530495 DOI: 10.1161/hypertensionaha.123.19454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
While coarctation of the aorta varies greatly in both severity and age at presentation, all patients are at increased risk of hypertension both before and after repair. Despite advances in knowledge about genetic etiologies, pathophysiologic mechanisms, and optimal repair strategies, patients with repaired coarctation of the aorta remain at increased risk of acquired cardiovascular disease. The aims of this review are to describe the management of coarctation of the aorta at all ages before and after repair, highlight pathophysiologic mechanisms of hypertension, and review long-term follow-up considerations.
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Affiliation(s)
- Katherine B Salciccioli
- Section of Pediatric Cardiology, Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston TX USA
| | - Justin P Zachariah
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston TX USA
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11
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Liu C, Dai X, Zhou G, Zhang Y, Liu X. Descending thoracic aortic dissection after covered stent for adult aortic coarctation: Technical or physiopathologic? Heliyon 2023; 9:e15272. [PMID: 37089362 PMCID: PMC10114236 DOI: 10.1016/j.heliyon.2023.e15272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Covered stent graft implantation is currently the most commonly used modality for the management of adult aortic coarctation. Although the risk of descending thoracic aortic dissection after covered stent graft implantation is low, sometimes it may cause serious medical consequences or even death. We report one adult aortic coarctation patient with early postoperative descending thoracic aortic dissection after covered stent graft implantation. The patient underwent second operation of thoracic endovascular aortic reconstruction and was discharged 6 days after the operation. This case is not rare, but we hope that the complete diagnosis and treatment process of this case and discussion pertaining to surgical treatment method and its complications could serve as a reference for clinicians in dealing with such situations.
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12
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Meijs TA, van Tuijl RJ, van den Brink H, Weaver NA, Siero JCW, van der Worp HB, Braun KPJ, Leiner T, de Jong PA, Zwanenburg JJM, Doevendans PA, Voskuil M, Grotenhuis HB. Assessment of aortic and cerebral haemodynamics and vascular brain injury with 3 and 7 T magnetic resonance imaging in patients with aortic coarctation. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead001. [PMID: 36751560 PMCID: PMC9898880 DOI: 10.1093/ehjopen/oead001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Aims Coarctation of the aorta (CoA) is characterized by a central arteriopathy resulting in increased arterial stiffness. The condition is associated with an increased risk of stroke. We aimed to assess the aortic and cerebral haemodynamics and the presence of vascular brain injury in patients with previous surgical CoA repair. Methods and results Twenty-seven patients with CoA (median age 22 years, range 12-72) and 25 age- and sex-matched controls (median age 24 years, range 12-64) underwent 3 T (heart, aorta, and brain) and 7 T (brain) magnetic resonance imaging scans. Haemodynamic parameters were measured using two-dimensional phase-contrast images of the ascending and descending aorta, internal carotid artery (ICA), basilar artery (BA), middle cerebral artery (MCA), and perforating arteries. Vascular brain injury was assessed by rating white matter hyperintensities, cortical microinfarcts, lacunes, and microbleeds. Pulse wave velocities in the aortic arch and descending aorta were increased and ascending aortic distensibility was decreased in patients with CoA vs. controls. Patients with CoA showed a higher mean flow velocity in the right ICA, left ICA, and BA and a reduced distensibility in the right ICA, BA, and left MCA. Haemodynamic parameters in the perforating arteries, total cerebral blood flow, intracranial volumes, and vascular brain injury were similar between the groups. Conclusion Patients with CoA show an increased flow velocity and reduced distensibility in the aorta and proximal cerebral arteries, which suggests the presence of a generalized arteriopathy that extends into the cerebral arterial tree. No substantial vascular brain injury was observed in this relatively young CoA population, although the study was inadequately powered regarding this endpoint.
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Affiliation(s)
- Timion A Meijs
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Rick J van Tuijl
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Hilde van den Brink
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Jeroen C W Siero
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Central Military Hospital, Lundlaan 1, 3584 EZ Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands
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13
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Ruthirakuhan M, Cogo‐Moreira H, Swardfager W, Herrmann N, Lanctot KL, Black SE. Cardiovascular Risk Factors and Risk of Alzheimer Disease and Mortality: A Latent Class Approach. J Am Heart Assoc 2022; 12:e025724. [PMID: 36565204 PMCID: PMC9973600 DOI: 10.1161/jaha.122.025724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Cardiovascular risk factors co-occur with one another, and little is known about the extent of their clustering and risk of Alzheimer disease (AD). We identify groups of cardiovascular risk factors in cognitively normal individuals and investigate between-group differences in incident AD and death. Methods and Results Cognitively normal individuals were recruited from the National Alzheimer's Coordinator Center. A latent class analysis was conducted with hypertension, hypercholesterolemia, heart condition, stroke, smoking history, diabetes, and high body mass index. Between-group differences in the incidence of AD, mortality, and mortality-adjusted AD were investigated. This study included 12 412 cognitively normal individuals (average follow-up, 65 months). Three groups were identified: (1) low probabilities of cardiovascular risk factors (reference; N=5398 [43%]), (2) hypertension and hypercholesterolemia (vascular-dominant; N=5721 [46%]), and (3) hypertension, hypercholesterolemia, diabetes, and high body mass index (vascular-metabolic; N=1293 [10%]). Both vascular groups were significantly older, had more men, were slightly less educated, and were slightly more cognitively impaired than the reference group (all P<0.05). However, only the vascular-metabolic group had a significantly younger age of death compared with the reference group (84.3 versus 88.7 years, P<0.001). Only the vascular-dominant group had a greater incidence of AD (odds ratio [OR], 1.30; P<0.001) compared with the reference group. Mortality was greater in the vascular-dominant (OR, 3.26; P<0.001) and vascular-metabolic groups (OR, 1.84; P=0.02). Mortality-adjusted AD was greater in the vascular-dominant (OR, 1.54; P=0.02) and vascular-metabolic groups (OR, 1.46; P=0.04). Conclusions Three distinct cardiovascular risk factor groups were identified in cognitively normal elderly individuals. Only the vascular-dominant group was associated with a greater incidence of AD. Selective mortality may contribute to the attenuated association between the vascular-metabolic group and incident AD.
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Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Hugo Cogo‐Moreira
- Department of Education, ICT and LearningOstfold University CollegeHaldenNorway,Universidade Federal de Sao PauloSao PauloBrazil
| | - Walter Swardfager
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Krista L. Lanctot
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
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14
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Ghorbannia A, Ellepola CD, Woods RK, Ibrahim ESH, Maadooliat M, Ramirez HM, LaDisa JF. Clinical, Experimental, and Computational Validation of a New Doppler-Based Index for Coarctation Severity Assessment. J Am Soc Echocardiogr 2022; 35:1311-1321. [PMID: 36122791 PMCID: PMC9729418 DOI: 10.1016/j.echo.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 08/15/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Long-term morbidity including hypertension often persists in coarctation patients despite current guidelines. Coarctation severity can be invasively assessed via peak-to-peak catheter pressure gradient (PPCG), which is estimated noninvasively via simplified Bernoulli equation and conventionally reported as peak instantaneous Doppler gradient (PIDG). However, underlying simplifications of the equation limit diagnostic accuracy. We studied the diagnostic performance of a new Doppler-based diastolic index called the continuous flow pressure gradient (CFPG) versus conventional indices in assessing coarctation severity. METHODS In a rabbit model mimicking human aortic coarctation, temporal blood pressure waveforms revealed the diastolic instantaneous pressure gradients and spectral Doppler features impacted by coarctation severity. We therefore hypothesized that CFPG provides superior correlation with coarctation gradients measured invasively. PIDG and CFPG were quantified using color flow echocardiography in humans and rabbits with discrete coarctations. Results were compared with PPCG in rabbits (n = 34) and arm-leg systolic gradients (n = 25) in humans via 1-way analysis of variance, Pearson's correlation, linear regression, and Bland-Altman analysis. RESULTS A threshold of CFPG ≥ 4.6 mm Hg was identified via the Youden index as representative of PPCG ≥ 20 mm Hg (the current guideline value for coarctation intervention) in rabbits, while a CFPG ≥1.0 mm Hg represented an arm-leg systolic gradient ≥20 mm Hg in humans. Accuracy measures revealed superior correlation of CFPG (R2 > 0.80) and mild receiver operating characteristic improvement (area under the receiver operating characteristic curve, 0.94-0.95) compared with PIDG (R2 < 0.63; area under the receiver operating characteristic curve, 0.89-0.95). Inter-/intraobserver variability tested by intraclass correlation coefficient revealed measurement reliability with differences ≤8.2% and 10.7%, respectively. Computational simulations of anesthetized versus conscious hemodynamics showed parameters were minimally impacted by isoflurane inherent in the data used to derive CFPG. These results confirm the potential diagnostic accuracy of CFPG in echocardiography-based coarctation severity assessment. We are optimistic that CFPG will be useful for translation of results from preclinical studies that revisit current guidelines to limit morbidity in humans with aortic coarctation.
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Affiliation(s)
- Arash Ghorbannia
- Department of Biomedical Engineering, Medical College of Wisconsin, and Marquette University, Milwaukee, Wisconsin; Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Chalani D Ellepola
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ronald K Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin
| | - El-Sayed H Ibrahim
- Department of Biomedical Engineering, Medical College of Wisconsin, and Marquette University, Milwaukee, Wisconsin; Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Maadooliat
- Department of Mathematics and Statistical Sciences, Marquette University, Milwaukee, Wisconsin
| | - Hilda Martinez Ramirez
- Department of Biomedical Engineering, Medical College of Wisconsin, and Marquette University, Milwaukee, Wisconsin
| | - John F LaDisa
- Department of Biomedical Engineering, Medical College of Wisconsin, and Marquette University, Milwaukee, Wisconsin; Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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15
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Tashiro H, Sato W, Seki K, Ono Y, Kato T, Sato T, Watanabe H. Asymptomatic Coarctation of the Aorta in Adults with Preserved Exercise Capacity: A Case Report. Intern Med 2022; 62:1171-1174. [PMID: 36070945 PMCID: PMC10183278 DOI: 10.2169/internalmedicine.0285-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of coarctation of the aorta (CoA) in an asymptomatic adult who had a preserved exercise capacity. A 56-year-old man with mild hypertension exhibited left ventricular hypertrophy on an electrocardiogram during an annual medical checkup. Echocardiography showed a bicuspid aortic valve and cor triatriatum sinister, and subsequent computed tomography revealed CoA with developed collaterals. Cardiopulmonary exercise testing showed a good exercise capacity. He refused surgical repair and has been asymptomatic for five years. This case is of special interest, as CoA is usually rarely noticed during adulthood if there are no severe congenital anomalies, and in addition, this patient had good exercise capacity.
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Affiliation(s)
- Haruwo Tashiro
- Division of Advanced Arrhythmia Management, Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Katsuhito Seki
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Yuto Ono
- Division of Advanced Arrhythmia Management, Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Tsukasa Kato
- Division of Advanced Arrhythmia Management, Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Teruki Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
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16
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Cardiovascular Prevention Among Young Adults with Congenital Heart Disease. Curr Atheroscler Rep 2022; 24:509-514. [PMID: 35499806 DOI: 10.1007/s11883-022-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW There are over a million adults living with congenital heart disease (CHD) in the USA. There have been improvements in CHD management which have led to an expansion of the adult congenital heart disease (ACHD) population. There is a high prevalence of atherosclerotic cardiovascular disease (ASCVD) encountered in the aging ACHD population. This review focuses on the most recent literature regarding the primary prevention of ASCVD in young ACHD patients. RECENT FINDINGS There are unique considerations for ASCVD risk reduction in ACHD patients. ASCVD may be as prevalent in ACHD compared in the general population. However, there may be a perceived shorter life expectancy in ACHD patients; therefore, primary prevention of ASCVD may not be considered important. Preventative strategies for ASCVD are underutilized in ACHD patients. As these patients are followed for a lifetime by cardiologists, we can truly pursue primary prevention in this aging population.
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17
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Sadeghipour P, Mohebbi B, Firouzi A, Khajali Z, Saedi S, Shafe O, Pouraliakbar HR, Alemzadeh-Ansari MJ, Shahdi S, Samiei N, Sadeghpour A, Babaei M, Ghadrdoost B, Afrooghe A, Rokni M, Dabbagh Ohadi MA, Hosseini Z, Abdi S, Maleki M, Bassiri HA, Haulon S, Moosavi J. Balloon-Expandable Cheatham-Platinum Stents Versus Self-Expandable Nitinol Stents in Coarctation of Aorta: A Randomized Controlled Trial. JACC Cardiovasc Interv 2022; 15:308-317. [PMID: 35144787 DOI: 10.1016/j.jcin.2021.11.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to compare the safety and efficacy of the balloon-expandable stent (BES) and the self-expandable stent (SES) in the endovascular treatment of coarctation of aorta. BACKGROUND Coarctoplasty with stents has conferred promising results. Although several nonrandomized studies have approved the safety and efficacy of the BES and the SES, no high-quality evidence exists for this comparison. METHODS In the present open-label, parallel-group, blinded endpoint randomized pilot clinical trial, adult patients with de novo native aortic coarctation were randomized into Cheatham-platinum BES and uncovered nitinol SES groups. The primary outcome of the study was a composite of procedural and vascular complications. The secondary outcomes of the study consisted of the incidence of aortic recoarctation, thoracic aortic aneurysm/pseudoaneurysm formation, and residual hypertension at a 12-month follow-up. RESULTS Among 105 patients who were screened between January 2017 and December 2019, 92 eligible patients (32 women [34.8%]) with a median age of 30 years (IQR: 20-36 years) were randomized equally into the BES and SES groups. The composite of procedural and vascular complications occurred in 10.9% of the BES group and 2.2% of the SES group (odds ratio: 0.18; 95% CI: 0.02-1.62; P = 0.20). Aortic recoarctation occurred in 5 patients (5.4%), 3 patients (6.5%) in the BES group and 2 patients (4.3%) in the SES group (odds ratio: 0.65; 95% CI: 0.10-4.09; P = 0.64). Only 1 patient (1.1%) was complicated by aortic pseudoaneurysm. Hypertension control was achieved in 50% of the study population, with an equal distribution in the 2 study groups at the 12-month follow-up. CONCLUSIONS Both the BES and the SES were safe and effective in the treatment of native coarctation.
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Affiliation(s)
- Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. https://twitter.com/psadeghipour
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Saedi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Shahdi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Behshid Ghadrdoost
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arya Afrooghe
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrad Rokni
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein-Ali Bassiri
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Stephan Haulon
- Aortic Centre, Hopital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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18
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Goodarzi Ardakani V, Goordoyal H, Ordonez MV, Sophocleous F, Curtis S, Bedair R, Caputo M, Gambaruto A, Biglino G. Isolating the Effect of Arch Architecture on Aortic Hemodynamics Late After Coarctation Repair: A Computational Study. Front Cardiovasc Med 2022; 9:855118. [PMID: 35811705 PMCID: PMC9263195 DOI: 10.3389/fcvm.2022.855118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Effective management of aortic coarctation (CoA) affects long-term cardiovascular outcomes. Full appreciation of CoA hemodynamics is important. This study aimed to analyze the relationship between aortic shape and hemodynamic parameters by means of computational simulations, purposely isolating the morphological variable. Methods Computational simulations were run in three aortic models. MRI-derived aortic geometries were generated using a statistical shape modeling methodology. Starting from n = 108 patients, the mean aortic configuration was derived in patients without CoA (n = 37, "no-CoA"), with surgically repaired CoA (n = 58, "r-CoA") and with unrepaired CoA (n = 13, "CoA"). As such, the aortic models represented average configurations for each scenario. Key hemodynamic parameters (i.e., pressure drop, aortic velocity, vorticity, wall shear stress WSS, and length and number of strong flow separations in the descending aorta) were measured in the three models at three time points (peak systole, end systole, end diastole). Results Comparing no-CoA and CoA revealed substantial differences in all hemodynamic parameters. However, simulations revealed significant increases in vorticity at the site of CoA repair, higher WSS in the descending aorta and a 12% increase in power loss, in r-CoA compared to no-CoA, despite no clinically significant narrowing (CoA index >0.8) in the r-CoA model. Conclusions Small alterations in aortic morphology impact on key hemodynamic indices. This may contribute to explaining phenomena such as persistent hypertension in the absence of any clinically significant narrowing. Whilst cardiovascular events in these patients may be related to hypertension, the role of arch geometry may be a contributory factor.
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Affiliation(s)
| | - Harshinee Goordoyal
- Department of Mechanical Engineering, University of Bristol, Bristol, United Kingdom
| | | | - Froso Sophocleous
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Stephanie Curtis
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, United Kingdom
| | - Radwa Bedair
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, United Kingdom
| | - Massimo Caputo
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alberto Gambaruto
- Department of Mechanical Engineering, University of Bristol, Bristol, United Kingdom
| | - Giovanni Biglino
- University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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19
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Troponin T Mutation as a Cause of Left Ventricular Systolic Dysfunction in a Young Patient with Previous Surgical Correction of Aortic Coarctation. Biomolecules 2021; 11:biom11050696. [PMID: 34066613 PMCID: PMC8148585 DOI: 10.3390/biom11050696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/01/2021] [Accepted: 05/01/2021] [Indexed: 12/02/2022] Open
Abstract
Coarctation of the aorta is a leading cause of morbidity and mortality among adults with congenital heart disease (ACHD). Lifelong surveillance is mandatory to screen for possible long-term cardiovascular events. Left ventricular systolic dysfunction has been reported in association with recoarctation, and association with dilated cardiomyopathy (DCMP) is very rare. Herein, we report the case of a 19-year-old boy with coarctation of the aorta who complained of mild exertional dyspnea. Cardiac magnetic resonance revealed a moderately dilated, hypokinetic left ventricle (LV), with mildly reduced EF (45%), and residual isthmic coarctation was excluded. Genetic tests revealed a heterozygous missense variant in TNNT2 (NM_001001430.2): c.518G>A (p. Arg173Gln). This case highlights the role of careful history taking: a family history of cardiomyopathy should not be overlooked even when the clinical setting seems to suggest a predisposition to hemodynamic factors for LVSD.
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20
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Magnitude and significance of interarm blood pressure differences in children and adolescents. J Hypertens 2021; 39:1341-1345. [PMID: 33657583 DOI: 10.1097/hjh.0000000000002797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An interarm difference (IAD) in blood pressure (BP) of 10 mmHg or more is a potential cardiovascular risk factor in adults, given its association with cardiovascular events/mortality. In children and adolescents, accurate BP assessment is critical for identifying risk of end organ damage. However, IAD has not been systematically studied in paediatric patients; if present and of significant magnitude, measuring BP in only one arm could lead to misclassification of hypertensive status. METHOD In 95 children/adolescents with a normal aorta (including 15 with a history of tetralogy of Fallot) aged 7-18 years attending the Royal Children's Hospital, Melbourne, we aimed to determine the magnitude of IAD, frequency of IAD of at least 10 mmHg, difference in BP classification between arms, and influence of repeat measures on IAD in a single visit. After 5 min rest, simultaneous bilateral BP was measured in triplicate with an automated device. RESULTS Absolute systolic IAD was 5.0 mmHg (median, interquartile range 2-8 mmHg) and was 10 mmHg or more in 14%, with no change on repeat measures. In patients with a history of aortic surgery, IAD of 10 mmHg or more occurred in 27% (transposition of the great arteries, n = 15) and 75% (aortic coarctation, n = 8). Differences in BP classification, based on initial left vs. right arm measures, occurred in 25% (normal aorta) and 40%/63% (aortic surgery), or 17% and 33%/50%, respectively if second and third measurements were averaged. CONCLUSION Substantial interarm BP differences were common, even in apparently healthy children and adolescents: evaluation of IAD may, therefore, be important for BP classification in the paediatric setting.
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21
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Goldstein SA, Goldstein LB. Neurologic complications of congenital heart disease in adults. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:15-22. [PMID: 33632433 DOI: 10.1016/b978-0-12-819814-8.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Congenital heart disease (CHD) is a heterogeneous group of structural abnormalities of the cardiovascular system that are present at birth. Advances in childhood medical and surgical treatment have led to increasing numbers of adults with CHD. Neurological complications of CHD in adults are varied and can include an increased risk of stroke not only related to the underlying congenital defect and its surgical management but also due to atherosclerotic disease associated with advancing age. In addition to cerebrovascular events, CHD in adults is also associated with an increased risk of neurodevelopmental disorders, cognitive impairment, psychiatric disease, and epilepsy. Collaborative multidisciplinary care with contributions from neurologists and cardiologists with expertise in adult CHD is necessary to provide optimal long-term care for this complex and rapidly evolving population.
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Affiliation(s)
- Sarah A Goldstein
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, United States
| | - Larry B Goldstein
- Department of Neurology, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KY, United States.
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22
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Dijkema EJ, Dik L, Breur JMP, Sieswerda GT, Haas F, Slieker MG, Schoof PH. Two decades of aortic coarctation treatment in children; evaluating techniques. Neth Heart J 2021; 29:98-104. [PMID: 33175331 PMCID: PMC7843778 DOI: 10.1007/s12471-020-01513-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study focuses on the evolution of treatment techniques for aortic coarctation in children and assesses long-term morbidity. METHODS This retrospective cohort study evaluates patients treated for native aortic coarctation, with at least 7 years of follow-up. To assess time-related changes, three time periods were distinguished according to year of primary intervention (era 1, 2 and 3). Operative and long-term follow-up data were collected by patient record reviews. RESULTS The study population consisted of 206 patients (177 surgical and 29 catheter-based interventions), with a median follow-up of 151 months. Anterior approach with simultaneous repair of aortic arch and associated cardiac lesions was more common in the most recent era. Median age at intervention did not change over time. Reintervention was necessary in one third of the cohort with an event-free survival of 74% at 5‑year and 68% at 10-year follow-up. Reintervention rates were significantly higher after catheter-based interventions compared with surgical interventions (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.04-3.00, p = 0.04) and in patients treated before 3 months of age (HR 2.1, 95% CI 1.27-3.55, p = 0.003). Hypertension was present in one out of five patients. CONCLUSION Nowadays, complex patients with associated cardiac defects and arch hypoplasia are being treated surgically on bypass, whereas catheter-based intervention is introduced for non-complex patients. Reintervention is common and more frequent after catheter-based intervention and in surgery under 3 months of age. One fifth of the 206 patients remained hypertensive.
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Affiliation(s)
- E J Dijkema
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands.
| | - L Dik
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M P Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands
| | - G T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Haas
- Department of Cardiothoracic Surgery, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands
| | - M G Slieker
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Schoof
- Department of Cardiothoracic Surgery, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands
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23
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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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24
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Swanson L, Owen B, Keshmiri A, Deyranlou A, Aldersley T, Lawrenson J, Human P, De Decker R, Fourie B, Comitis G, Engel ME, Keavney B, Zühlke L, Ngoepe M, Revell A. A Patient-Specific CFD Pipeline Using Doppler Echocardiography for Application in Coarctation of the Aorta in a Limited Resource Clinical Context. Front Bioeng Biotechnol 2020; 8:409. [PMID: 32582648 PMCID: PMC7283385 DOI: 10.3389/fbioe.2020.00409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/14/2020] [Indexed: 12/14/2022] Open
Abstract
Congenital heart disease (CHD) is the most common birth defect globally and coarctation of the aorta (CoA) is one of the commoner CHD conditions, affecting around 1/1800 live births. CoA is considered a CHD of critical severity. Unfortunately, the prognosis for a child born in a low and lower-middle income country (LLMICs) with CoA is far worse than in a high-income country. Reduced diagnostic and interventional capacities of specialists in these regions lead to delayed diagnosis and treatment, which in turn lead to more cases presenting at an advanced stage. Computational fluid dynamics (CFD) is an important tool in this context since it can provide additional diagnostic data in the form of hemodynamic parameters. It also provides an in silico framework, both to test potential procedures and to assess the risk of further complications arising post-repair. Although this concept is already in practice in high income countries, the clinical infrastructure in LLMICs can be sparse, and access to advanced imaging modalities such as phase contrast magnetic resonance imaging (PC-MRI) is limited, if not impossible. In this study, a pipeline was developed in conjunction with clinicians at the Red Cross War Memorial Children’s Hospital, Cape Town and was applied to perform a patient-specific CFD study of CoA. The pipeline uses data acquired from CT angiography and Doppler transthoracic echocardiography (both much more clinically available than MRI in LLMICs), while segmentation is conducted via SimVascular and simulation is realized using OpenFOAM. The reduction in cost through use of open-source software and the use of broadly available imaging modalities makes the methodology clinically feasible and repeatable within resource-constrained environments. The project identifies the key role of Doppler echocardiography, despite its disadvantages, as an intrinsic component of the pipeline if it is to be used routinely in LLMICs.
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Affiliation(s)
- Liam Swanson
- Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa
| | - Benjamin Owen
- Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, United Kingdom
| | - Amir Keshmiri
- Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, United Kingdom
| | - Amin Deyranlou
- Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, United Kingdom
| | - Thomas Aldersley
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - John Lawrenson
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Paul Human
- Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Rik De Decker
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Barend Fourie
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - George Comitis
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Mark E Engel
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Bernard Keavney
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Liesl Zühlke
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Malebogo Ngoepe
- Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa
| | - Alistair Revell
- Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, United Kingdom
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25
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Kostopoulou E, Bosdou JK, Anagnostis P, Stevenson JC, Goulis DG. Cardiovascular Complications in Patients with Turner's Syndrome. Curr Pharm Des 2020; 26:5650-5659. [PMID: 32473616 DOI: 10.2174/1381612826666200531152459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/07/2020] [Indexed: 01/15/2023]
Abstract
Turner's or Turner syndrome (TS) is the most prevalent chromosomal abnormality in live female births. Patients with TS are predisposed to an increased risk of cardiovascular diseases (CVD), mainly due to the frequently observed congenital structural cardiovascular defects, such as valvular and aortic abnormalities (coarctation, dilatation, and dissection). The increased prevalence of cardiometabolic risk factors, such as arterial hypertension, insulin resistance, diabetes mellitus, dyslipidaemia, central obesity, and increased carotid intima-media thickness, also contribute to increased morbidity and mortality in TS patients. Menopausal hormone therapy (MHT) is the treatment of choice, combined with growth hormone (GH). Although MHT may, in general, ameliorate CVD risk factors, its effect on CVD mortality in TS has not yet been established. The exact effect of GH on these parameters has not been clarified. Specific considerations should be provided in TS cases during pregnancy, due to the higher risk of CVD complications, such as aortic dissection. Optimal cardiovascular monitoring, including physical examination, electrocardiogram, CVD risk factor assessment, and transthoracic echocardiography, is recommended. Moreover, the cardiac magnetic resonance from the age of 12 years is recommended due to the high risk of aortic aneurysm and other anatomical vascular complications.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University of Patras School of Medicine, Patras, 26500, Greece
| | - Julia K Bosdou
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, United Kingdom
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol 2020; 12:167-191. [PMID: 32547712 PMCID: PMC7284000 DOI: 10.4330/wjc.v12.i5.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Hospital, Children's Heart Center, Phoenix, AZ 85016, United States
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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27
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Yugar-Toledo JC, Moreno Júnior H, Gus M, Rosito GBA, Scala LCN, Muxfeldt ES, Alessi A, Brandão AA, Moreira Filho O, Feitosa ADDM, Passarelli Júnior O, Souza DDSMD, Amodeo C, Barroso WKS, Gomes MAM, Paiva AMGD, Barbosa ECD, Miranda RD, Vilela-Martin JF, Nadruz Júnior W, Rodrigues CIS, Drager LF, Bortolotto LA, Consolim-Colombo FM, Sousa MGD, Borelli FADO, Kaiser SE, Salles GF, Azevedo MDFD, Magalhães LBNC, Póvoa RMDS, Malachias MVB, Nogueira ADR, Jardim PCBV, Jardim TDSV. Brazilian Position Statement on Resistant Hypertension - 2020. Arq Bras Cardiol 2020; 114:576-596. [PMID: 32267335 PMCID: PMC7792719 DOI: 10.36660/abc.20200198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Heitor Moreno Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Miguel Gus
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | | | - Elizabeth Silaid Muxfeldt
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Wilson Nadruz Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde Pontifícia Universidade Católica de são Paulo, São Paulo, SP - Brasil
| | - Luciano Ferreira Drager
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | | | | | | | | | - Gil Fernando Salles
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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28
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Cribbs MG. Coarctation: A Review. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2019.15.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coarctation of the aorta occurs in 0.04% of the population, and accounts for approximately 10% of lesions in adults with congenital heart disease. It can occur as an isolated lesion or as a part of a complex defect, and is most commonly associated with bicuspid aortic valve, ventricular septal defect, and mitral valve abnormalities. Since the first surgical repair in 1944, the available treatment options have expanded greatly. Perhaps one of the most important advances in the management of coarctation of the aorta has been the development of transcatheter therapy for both native and especially recurrent coarctation of the aorta. Late complications, even after apparently successful treatment, are not uncommon. For this reason, lifelong follow-up is vital.
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Affiliation(s)
- Marc G Cribbs
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, US
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29
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Keen SK, Johnson MR. Unusual Presentation of Acute Systolic Heart Failure Caused by Acquired Post-Traumatic Aortic Coarctation. Circ Heart Fail 2019; 12:e006267. [PMID: 31805781 DOI: 10.1161/circheartfailure.119.006267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Susan K Keen
- Department of Medicine (S.K.K.), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Maryl R Johnson
- Division of Cardiovascular Medicine, Department of Medicine (M.R.J.), University of Wisconsin School of Medicine and Public Health, Madison, WI
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30
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Rodrigues JCL, Jaring MFR, Werndle MC, Mitrousi K, Lyen SM, Nightingale AK, Hamilton MCK, Curtis SL, Manghat NE, Paton JFR, Hart EC. Repaired coarctation of the aorta, persistent arterial hypertension and the selfish brain. J Cardiovasc Magn Reson 2019; 21:68. [PMID: 31703697 PMCID: PMC6839237 DOI: 10.1186/s12968-019-0578-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/21/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND It has been estimated that 20-30% of repaired aortic coarctation (CoA) patients develop hypertension, with significant cardiovascular morbidity and mortality. Vertebral artery hypoplasia (VAH) with an incomplete posterior circle of Willis (ipCoW; VAH + ipCoW) is associated with increased cerebrovascular resistance before the onset of increased sympathetic nerve activity in borderline hypertensive humans, suggesting brainstem hypoperfusion may evoke hypertension to maintain cerebral blood flow: the "selfish brain" hypothesis. We now assess the "selfish brain" in hypertension post-CoA repair. METHODS Time-of-flight cardiovascular magnetic resonance angiography from 127 repaired CoA patients (34 ± 14 years, 61% male, systolic blood pressure (SBP) 138 ± 19 mmHg, diastolic blood pressure (DBP) 76 ± 11 mmHg) was compared with 33 normotensive controls (42 ± 14 years, 48% male, SBP 124 ± 10 mmHg, DBP 76 ± 8 mmHg). VAH was defined as < 2 mm and ipCoW as hypoplasia of one or both posterior communicating arteries. RESULTS VAH + ipCoW was more prevalent in repaired CoA than controls (odds ratio: 5.8 [1.6-20.8], p = 0.007), after controlling for age, sex and body mass index (BMI). VAH + ipCoW was an independent predictor of hypertension (odds ratio: 2.5 [1.2-5.2], p = 0.017), after controlling for age, gender and BMI. Repaired CoA subjects with VAH + ipCoW were more likely to have difficult to treat hypertension (odds ratio: 3.3 [1.01-10.7], p = 0.049). Neither age at time of CoA repair nor any specific repair type were significant predictors of VAH + ipCoW in univariate regression analysis. CONCLUSIONS VAH + ipCoW predicts arterial hypertension and difficult to treat hypertension in repaired CoA. It is unrelated to age at time of repair or repair type. CoA appears to be a marker of wider congenital cerebrovascular problems. Understanding the "selfish brain" in post-CoA repair may help guide management. JOURNAL SUBJECT CODES High Blood Pressure; Hypertension; Magnetic Resonance Imaging (MRI); Cardiovascular Surgery; Cerebrovascular Malformations.
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Affiliation(s)
- Jonathan C. L. Rodrigues
- Department of Cardiovascular Magnetic Resonance, Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Physiology, Pharmacology & Neuroscience, Faculty of Biomedical Science, University of Bristol, Bristol, UK
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Matthew F. R. Jaring
- Department of Radiology, Bristol Royal Infirmary, University Bristol NHS Foundation Trust, Bristol, UK
| | - Melissa C. Werndle
- Department of Radiology, Bristol Royal Infirmary, University Bristol NHS Foundation Trust, Bristol, UK
| | - Konstantina Mitrousi
- School of Physiology, Pharmacology & Neuroscience, Faculty of Biomedical Science, University of Bristol, Bristol, UK
| | - Stephen M. Lyen
- Department of Radiology, Bristol Royal Infirmary, University Bristol NHS Foundation Trust, Bristol, UK
| | - Angus K. Nightingale
- BHI CardioNomics Research Group, Clinical Research and Imaging Centre-Bristol, University of Bristol, Bristol, UK
| | - Mark C. K. Hamilton
- Department of Radiology, Bristol Royal Infirmary, University Bristol NHS Foundation Trust, Bristol, UK
| | - Stephanie L. Curtis
- Adult Congenital Heart Disease Unit, Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, UK
| | - Nathan E. Manghat
- Department of Radiology, Bristol Royal Infirmary, University Bristol NHS Foundation Trust, Bristol, UK
| | - Julian F. R. Paton
- School of Physiology, Pharmacology & Neuroscience, Faculty of Biomedical Science, University of Bristol, Bristol, UK
- BHI CardioNomics Research Group, Clinical Research and Imaging Centre-Bristol, University of Bristol, Bristol, UK
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Grafton, Auckland, New Zealand
| | - Emma C. Hart
- School of Physiology, Pharmacology & Neuroscience, Faculty of Biomedical Science, University of Bristol, Bristol, UK
- BHI CardioNomics Research Group, Clinical Research and Imaging Centre-Bristol, University of Bristol, Bristol, UK
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Martínez-Quintana E, Rodríguez-Hernández JL, Rodríguez-González F, Riaño-Ruiz M, Fraguela-Medina C, Girolimetti A, Jiménez-Rodríguez S. Cardiovascular risk factors and arterial thrombotic events in congenital heart disease patients. Int J Clin Pract 2019; 73:1-8. [PMID: 31141298 DOI: 10.1111/ijcp.13378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/26/2018] [Accepted: 05/25/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION As congenital patients get older, it can be hypothesised that cardiovascular risk factors increase. METHODS Retrospective study of congenital heart disease (CHD) patients attended between January 2008 and September 2018. Cardiovascular risk factors, myocardial infarction, stroke, peripheral vascular disease, and analytical data such as serum glucose and lipid profile were determined. RESULTS Eight hundred and eighteen CHD patients and 1955 control patients matched for age and sex were studied. CHD patients were distributed in simple (462 patients), moderate (228 patients) and great (128 patients) complexity. Median age in CHD patients was 33 (25-41) years old and 56% were male. CHD patients were significantly more hypertensive and diabetic but less dyslipidemic and smokers than patients in the control group. Twenty-seven (3.3%) CHD patients had an arterial thrombotic event: 3 coronary, 22 neurological and 2 peripheral vascular disease. No significant differences were seen in the incidence of myocardial infarction between the control and the CHD groups. However CHD patients had a significant higher incidence of arterial thrombotic events (coronary, neurological and peripheral vascular events) at the expense of strokes and transient ischaemic attacks (22 vs 2 events in CHD and control patients, respectively). Also, no significant differences were seen in age, sex, BMI, arterial hypertension, diabetes mellitus, dyslipidemia, smoking habit, serum glucose, total and LDL cholesterol, statin treatment, myocardial infarction and arterial thrombotic events according to CHD complexity. Being older and having arterial hypertension, diabetes mellitus, dyslipidemia and smoking habit were more frequent among CHD patients with arterial thrombosis. CONCLUSIONS Congenital heart diseases are more hypertensive and diabetic but less dyslipemic and smokers than patients in the control group. CHD patients have a higher incidence of neurological events but not of myocardial infarction in relation to the control population.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Fayna Rodríguez-González
- Ophthalmology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Riaño-Ruiz
- Department of Biochemistry and Clinical Analyses, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Carla Fraguela-Medina
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Angela Girolimetti
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara Jiménez-Rodríguez
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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32
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Alkashkari W, Albugami S, Hijazi ZM. Management of Coarctation of The Aorta in Adult Patients: State of The Art. Korean Circ J 2019; 49:298-313. [PMID: 30895757 PMCID: PMC6428953 DOI: 10.4070/kcj.2018.0433] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Coarctation of the aorta (CoA) is a common form of congenital heart disease. Adult patients with CoA may be asymptomatic or may present with hypertension. Over the last few years, endovascular management of adult patients with CoA emerged as the preferred strategy. Stent implantation, though technically challenging, offers the best and most lasting therapy. In this paper, we will review technical considerations and outcome of patients undergoing stent implantation for CoA.
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Affiliation(s)
- Wail Alkashkari
- King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia.,Department of Cardiology, King Faisal Cardiac Center, Ministry of national Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah international medical research center Jeddah, Saudi Arabia.
| | - Saad Albugami
- King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia.,Department of Cardiology, King Faisal Cardiac Center, Ministry of national Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah international medical research center Jeddah, Saudi Arabia
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar.,Weill Cornell Medicine, New York, NY, USA
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Dijkema EJ, Slieker MG, Leiner T, Grotenhuis HB. Arterioventricular interaction after coarctation repair. Am Heart J 2018; 201:49-53. [PMID: 29910055 DOI: 10.1016/j.ahj.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/02/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hypertension is common in patients with coarctation of the aorta (CoA), even after successful repair. Increased aortic stiffness has been implicated in the pathology of CoA-associated hypertension. This study aimed to investigate aortic vascular function and its relationship with hypertension in well-repaired CoA-patients at long-term follow-up. Furthermore, we assessed the additive effect of hypertension to adverse arterioventricular coupling associated with increased aortic stiffness. METHODS Twenty-two CoA-patients (age 30 ± 10.6 years) with successful surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) between 3 months and 16 years of age with a follow-up of >10 years and 22 healthy controls underwent cardiac magnetic resonance imaging (CMR), at mean follow-up of 29.3 years, to study aortic pulse wave velocity (PWV), aortic distensibility, global left ventricular (LV) function, LV dimensions, and LV myocardial deformation. RESULTS CoA-patients had significantly increased aortic arch PWV (5.6 ± 1.9 m/s vs. 4.5 ± 1.0 m/s, P = .02) and decreased distensibility (4.5 ± 1.8 × 10-3 mmHg-1 vs. 5.8 ± 1.8 × 10-3 mmHg-1, P = .04) compared to controls. Significant differences in aortic arch PWV were found between hypertensive patients, normotensive patients and controls (6.1 ± 1.8 m/s vs. 4.9 ± 1.9 m/s and 4.5 ± 1.0 m/s, respectively, P = .03). Aortic arch PWV and distensibility were correlated with systolic blood pressure (R = 0.37 and R = -0.37, respectively, P = .03 for both). Global LV function, LV mass, LV dimensions and myocardial deformation were similar in CoA-patients when compared to controls. CONCLUSIONS Central aortic stiffness is significantly increased in well-repaired CoA-patients long-term after repair, and is associated with hypertension. Global LV function, myocardial deformation indices and LV dimensions are however preserved.
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Affiliation(s)
- Elles J Dijkema
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Hospital Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands.
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Preserved Myocardial Deformation after Successful Coarctation Repair: A CMR Feature-Tracking Study. Pediatr Cardiol 2018; 39:555-564. [PMID: 29209744 PMCID: PMC5829108 DOI: 10.1007/s00246-017-1788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/01/2017] [Indexed: 12/28/2022]
Abstract
Arterial vasculopathy and residual aortic obstruction can lead to left ventricular (LV) dysfunction in patients with coarctation of the aorta (CoA) related to adverse ventriculo-arterial coupling. This study aimed to investigate potential differences in LV myocardial deformation indices between repaired CoA patients and healthy controls. Twenty-two CoA patients (age 30 ± 10.6 years) after surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) without residual stenosis, between 3 months and 16 years of age with > 10 years follow-up were compared to 22 healthy age- and gender-matched controls (age 30 ± 3.8 years). Cardiac magnetic resonance feature tracking (CMR-FT) was used for LV longitudinal-, circumferential-, and rotational deformation indices. Global systolic LV function was preserved in CoA patients (LV ejection fraction 58 ± 4.8 vs. 60 ± 6.8%, p = 0.56) when compared to controls, with normal LV dimensions and mass (p > 0.05). Twelve CoA patients (55%) were hypertensive, of whom 4 were on anti-hypertensive medication. LV global longitudinal strain was preserved in the four-chamber (- 18 ± 4.4 vs. - 16 ± 4.7%, p = 0.06) and two-chamber (- 22 ± 5.1 vs. - 20 ± 6.0%, p = 0.22) orientations in CoA patients. Global circumferential strain was preserved at basal (- 29 ± 4.1 vs. - 28 ± 4.8%, p = 0.43), mid-ventricular (- 27 ± 4.2 vs. - 25 ± 3.0%, p = 0.09), and apical levels (- 35 ± 7.8 vs. - 32 ± 34.9%, p = 0.32). No differences were found in global torsion (2.4 ± 1.3° vs. 2.0 ± 1.4°/cm, p = 0.28), twist (14 ± 5.8° vs. 12 ± 6.3°, p = 0.34), and recoil rate (- 17 ± 9.7° vs. - 17 ± 7.1°/cm s, p = 0.97). Analysis of intra-observer variability demonstrated good reproducibility for all CMR deformation indices. Global and rotational myocardial deformation indices are preserved in CoA patients long-term after repair without residual stenosis, despite a high incidence of hypertension.
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Is the medical treatment for arterial hypertension after primary aortic coarctation repair related to age at surgery? A retrospective cohort study. Cardiol Young 2017; 27:1701-1707. [PMID: 28595675 DOI: 10.1017/s1047951117001019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hypertension following primary coarctation repair affects up to a third of subjects. A number of studies suggest that future hypertension risk is reduced if primary repair is performed at a younger age. OBJECTIVES The objective of this study was to evaluate the risk of future medical treatment for hypertension depending on age of primary coarctation repair. METHODS This study was carried out at a tertiary paediatric cardiology referral centre. Retrospective database evaluation of children aged 28 days and ⩽12 months), and children (>12 months). Main outcome measure is the need for long-term anti-hypertensive medication. The risk for re-coarctation was also evaluated. RESULTS A total of 87 patients were analysed: 60 neonates, 17 infants, 10 children. Among them, 6.7% neonates, 29.4% infants, and 40% children required long-term anti-hypertensive medications. Group differences were statistically significant (p=0.004). After adjustment for type of repair, the risk of long-term anti-hypertensive therapy was 4.5 (95% confidence interval 1.2-16.9, p=0.025) and 10.5 times (95% confidence interval 2.6-42.3, p=0.001) higher if primary repair was carried out in infancy and childhood, respectively, compared with neonates. Among all, 13 patients developed re-coarctation: 21.7% in the neonatal group, 5.9% in the infant group, and 20% in the child group. We could not demonstrate a significant difference between these proportions or calculate a reliable risk for developing re-coarctation. CONCLUSIONS Risk of medical treatment for hypertension was lowest when primary repair was carried out during the neonatal period, rising 10-fold if first operated on as a child. Knowing the likelihood of hypertension development depending on age of primary repair is useful for long-term surveillance and counselling.
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Dijkema EJ, Leiner T, Grotenhuis HB. Diagnosis, imaging and clinical management of aortic coarctation. Heart 2017; 103:1148-1155. [PMID: 28377475 DOI: 10.1136/heartjnl-2017-311173] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.
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Affiliation(s)
- Elles J Dijkema
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
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Grøndahl C, Pedersen TAL, Hjortdal VE. The Medium-Term Effects of Treatment for Mild Aortic Recoarctation. World J Pediatr Congenit Heart Surg 2016; 8:55-61. [DOI: 10.1177/2150135116668334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess medium-term effects of treatment for mild to moderate recoarctation in an adult population. Design: We identified all patients who had coarctation repair between 1965 and 1985 in our institution. They were all (n = 156) invited to a thorough outpatient examination, which was accepted by 133. Eleven (median age 36 [28-53] years) were identified with isolated mild to moderate recoarctation and received reintervention. They comprise the patient population of the current study. We performed bicycle exercise testing, transthoracic echocardiography, magnetic resonance imaging, and 24-hour blood pressure monitoring before and 14 to 29 months after reintervention. Results: Compared to the values before reintervention, 24-hour blood pressures were reduced, but only significantly so for nighttime values. On echocardiography, wall thickness was reduced (1.2 ± 0.3 vs 1.1 ± 0.2, P > .05), and maximum flow velocity in the distal aortic arch decreased (2.8 ± 0.5 m/s vs 2.1 ± 0.4 m/s, P < .05). The invasive coarctation gradient was significantly reduced (15 ± 7 mm Hg vs 5 ± 9 mm Hg, P < .05), and the diameter at the coarctation site was increased (11 ± 3 mm vs 15 ± 3 mm, P < .05). Maximum achieved workload increased (182 ± 51 W vs 205 ± 65 W, P < .05). Cardiac symptoms were overall reduced. Conclusion: Reintervention was overall beneficial in increasing exercise capacity and reducing symptoms in the medium term, but the effects on established myocardial hypertrophy and blood pressures were less profound. Larger studies are needed in order to establish the definite role of reintervention for patients with milder recoarctation.
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Affiliation(s)
- Camilla Grøndahl
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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Olgun G, John E. Hypertension in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2016; 5:50-58. [PMID: 31110885 PMCID: PMC6512408 DOI: 10.1055/s-0035-1564796] [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: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 10/22/2022] Open
Abstract
Hypertension in the pediatric intensive care unit (PICU) is common and it contributes to the overall morbidity and mortality. Patients may present with hypertensive emergencies or hypertension can manifest itself later in PICU course. Although hypertension can be seen in most patients during hospitalization, patients with some specific diseases and conditions are more prone to hypertension. Hypertension should be recognized promptly and treated accordingly. Different pathophysiologic mechanisms can be responsible for the hypertension and management differs based on the underlying etiology. Any patient with a hypertensive emergency must be admitted to PICU, and treatment and diagnostic workup should be initiated immediately.
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Affiliation(s)
- Gokhan Olgun
- Department of Pediatric Critical Care Medicine, University of Chicago, Chicago, Illinois, United States
| | - Eunice John
- Department of Pediatric Nephrology, University of Illinois at Chicago, Illinois, United States
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Lurz P, Okon T, Riede T, Wagner R, Schuler G, Daehnert I, Desch S. Renal sympathetic denervation in uncontrolled arterial hypertension after successful repair for aortic coarctation. Int J Cardiol 2016; 202:322-7. [PMID: 26422021 DOI: 10.1016/j.ijcard.2015.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/14/2015] [Accepted: 09/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Uncontrolled arterial hypertension is a frequent problem after successful repair of CoA and has been attributed to increased central sympathetic drive as well as a blunted baroreceptor reflex. RSD is a promising therapy to reduce central sympathetic drive and improve baroreflex sensitivity. METHODS 8 patients (age: 27±6 years) with previous surgical and/or percutaneous repair of CoA, absence of any relevant restenosis (invasive gradient across the site of previous treatment 3±4 mmHg) and resistant arterial hypertension (daytime SBP≥140 mmHg on 24 hour ambulatory blood pressure measurements [ABPM] in spite of the concurrent use of 3 antihypertensive agents of different classes or intolerance to BP medications) were included. Bilateral RSD was performed using the Symplicity Flex™ catheter (Medtronic, MN, USA). RESULTS RSD was successful in all patients with no procedural complications and no evidence for renal artery stenosis 6 months post procedure. From baseline to 6 month follow-up, RSD was followed by a significant reduction in average daytime systolic BP (150.4±7.8 to 143.1±8.0 mmHg; p=0.0117) as well as systolic BP throughout 24 h (146.8±7.3 vs. 140.5±7.8, p=0.04). CONCLUSION The BP reductions observed in these patients justify engaging in a larger clinical trial on the efficacy of RSD in this specific type of secondary hypertension and bares the hope that RSD might extend the currently very limited armory against arterial hypertension in young adults with previous repair of CoA.
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Affiliation(s)
- Philipp Lurz
- Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
| | - Thomas Okon
- Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Thomas Riede
- Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Robert Wagner
- Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Gerhard Schuler
- Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Ingo Daehnert
- Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Steffen Desch
- Medical Clinic II, University Heart Center Luebeck, Luebeck, Germany
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Wang J, Liu H, Jiang NQ, Jiang B, Wei N. A rat model of aortic arch aneurysm with excellent survival. Asian Cardiovasc Thorac Ann 2015; 23:652-7. [PMID: 25746425 DOI: 10.1177/0218492315575235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The complex mechanisms of aortic arch aneurysm have not been well studied. An animal model of aortic arch aneurysm would be beneficial to study this fatal disease. In this study, we tried to establish a rat model of aortic arch aneurysm by constricting the aortic isthmus. METHODS Forty-eight male Sprague-Dawley rats were randomly divided into three groups. Rats with no aortic isthmus constriction were assigned to group A (control group). The aortic isthmus was constricted to 1.5 mm in group B and to 0.8 mm in group C. The blood pressure of the rats was measured at 0, 1, 3 and 6 months after the operation. The diameter and wall thickness of aortic arch were measured at 3 and 6 months after surgery. RESULTS Compared to group A, group B showed no significant increase in blood pressure or aortic diameter after the operation. Compared to the control group, group B showed a marked increase in wall thickness at 3 and 6 months after surgery (p < 0.05). Compared to group A, group C showed significant increases in both blood pressure (p < 0.05) and aortic diameter (p < 0.05) after the operation. Group C also showed a more than 50% increase in wall thickness at 3 and 6 months after surgery (P < 0.05). CONCLUSIONS By constricting the aortic isthmus to 0.8 mm, a rat model of aortic arch aneurysm could be induced at 3 and 6 months after surgery.
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Affiliation(s)
- Jun Wang
- Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Hong Liu
- Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Nan Qing Jiang
- Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Bo Jiang
- Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Ning Wei
- Department of Neurology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Jiangsu Province, China
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Zhang H, Li FD, Ren HL, Zheng YH. Aortic bypass and orthotopic right renal autotransplantation for midaortic syndrome: a case report. BMC Surg 2014; 14:86. [PMID: 25370165 PMCID: PMC4228160 DOI: 10.1186/1471-2482-14-86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/23/2014] [Indexed: 11/12/2022] Open
Abstract
Background Midaortic syndrome (MAS) is a rare vascular anomaly characterized by segmental narrowing of the distal descending thoracic or abdominal aorta. Renal or visceral arteries may also be affected to varying degrees. MAS is often associated with renovascular hypertension, and requires early intervention. When medical therapy and percutaneous interventions fail to control hypertension, surgical treatment is required. We report a case of MAS that failed to respond to bilateral renal artery stenting, but treated with aortic bypass and orthotopic right renal autotransplantation with good outcome. Case presentation A 31-year-old woman presented with headache and poorly controlled hypertension due to severe MAS. She had severe ostial stenoses of renal and visceral arteries. Her hypertension failed to respond to medical therapy (four drugs) and bilateral renal artery stenting. The implanted stent in the right renal artery rendered revascularization of the artery difficult. A one-stage revascularization was performed, which consisted of an aortoaortic bypass (between the suprarenal and infrarenal abdominal aorta) with a prosthetic graft, an orthotopic right renal autotransplantation and an aorto-left renal arterial bypass with autogenous saphenous vein grafts. Her recovery was uneventful. At 1-year follow-up, the patient remained well. Her hypertension improved. A postoperative computed tomography angiography showed that all the grafts were patent with no abnormalities at the anastomosis. Conclusion Multiple bypass surgery with reimplantation of autogenous vein graft onto the prosthetic graft is a feasible and effective procedure in renal artery revascularization for MAS. Orthotopic autotransplantation is the procedure of choice in complex renal artery reconstruction.
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Affiliation(s)
| | | | | | - Yue-Hong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No, 1 Shuaifuyuan, Dongcheng district, Beijing 100730, P,R China.
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Beneficial effect of high dose statins on the vascular wall in patients with repaired aortic coarctation? Int J Cardiol 2014; 176:40-7. [DOI: 10.1016/j.ijcard.2014.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 06/10/2014] [Accepted: 06/20/2014] [Indexed: 11/23/2022]
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Massingham LJ, Johnson KL, Scholl TM, Slonim DK, Wick HC, Bianchi DW. Amniotic fluid RNA gene expression profiling provides insights into the phenotype of Turner syndrome. Hum Genet 2014; 133:1075-82. [PMID: 24850140 PMCID: PMC4384642 DOI: 10.1007/s00439-014-1448-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 05/13/2014] [Indexed: 12/24/2022]
Abstract
Turner syndrome is a sex chromosome aneuploidy with characteristic malformations. Amniotic fluid, a complex biological material, could contribute to the understanding of Turner syndrome pathogenesis. In this pilot study, global gene expression analysis of cell-free RNA in amniotic fluid supernatant was utilized to identify specific genes/organ systems that may play a role in Turner syndrome pathophysiology. Cell-free RNA from amniotic fluid of five mid-trimester Turner syndrome fetuses and five euploid female fetuses matched for gestational age was extracted, amplified, and hybridized onto Affymetrix(®) U133 Plus 2.0 arrays. Significantly differentially regulated genes were identified using paired t tests. Biological interpretation was performed using Ingenuity Pathway Analysis and BioGPS gene expression atlas. There were 470 statistically significantly differentially expressed genes identified. They were widely distributed across the genome. XIST was significantly down-regulated (p < 0.0001); SHOX was not differentially expressed. One of the most highly represented organ systems was the hematologic/immune system, distinguishing the Turner syndrome transcriptome from other aneuploidies we previously studied. Manual curation of the differentially expressed gene list identified genes of possible pathologic significance, including NFATC3, IGFBP5, and LDLR. Transcriptomic differences in the amniotic fluid of Turner syndrome fetuses are due to genome-wide dysregulation. The hematologic/immune system differences may play a role in early-onset autoimmune dysfunction. Other genes identified with possible pathologic significance are associated with cardiac and skeletal systems, which are known to be affected in females with Turner syndrome. The discovery-driven approach described here may be useful in elucidating novel mechanisms of disease in Turner syndrome.
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Affiliation(s)
- Lauren J. Massingham
- Mother Infant Research Institute and Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | | | - Thomas M. Scholl
- Integrated Genetics, Esoterix Genetic Laboratories, LLC, a subsidiary of Laboratory Corporation of America® Holdings, Westborough, MA
| | - Donna K. Slonim
- Tufts University School of Medicine, Boston, MA
- Dept. of Computer Science, Tufts University, Medford MA
| | | | - Diana W. Bianchi
- Mother Infant Research Institute and Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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From balloon angioplasty to covered stents in the management of coarctation of the aorta in adults with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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