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Recco DP, Kizilski SB, Ghosh RM, Piekarski B, Prakash A, Hoganson DM. Aortic growth after arch reconstruction with patch augmentation: a 2-decade experience. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad210. [PMID: 38134426 PMCID: PMC10752579 DOI: 10.1093/icvts/ivad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Optimal aortic sizing during aortic arch reconstruction remains unknown. Negative effects of arch under- or oversizing are well-published. We aimed to characterize longitudinal aortic growth after patch-augmented arch reconstruction to identify the initial reconstructed arch size that results in normal mid-term arch dimensions. METHODS Single-centre, retrospective review of infants undergoing Damus-Kaye-Stansel (DKS) or non-DKS patch-augmented aortic arch reconstruction between 2000 and 2021. Ascending aorta, proximal and distal transverse arch, aortic isthmus (AIsth) and descending aorta dimensions were measured in postoperative echocardiograms (<3 months from index operation) and cross-sectional imaging (>12 months). Longitudinal changes to aortic dimensions and z-scores were analysed. Secondary outcomes included reintervention, valve and ventricular function, mortality and transplantation. RESULTS Fifty-four patients (16 DKS, 38 non-DKS) were included. At 6.3 [2.2, 12.0]-year follow-up, all aortic segments grew significantly in both groups, while z-scores remained unchanged except for non-DKS proximal and distal transverse arch z-scores, which significantly increased (P < 0.05 each). When stratified by initial postoperative z-score (z < -1, -1 ≤ z ≤ 1, z > 1), non-DKS patients with initial AIsth z-score <-1 had a final z-score significantly smaller than both the targeted z-score zero (P = 0.014) and final z-score in a group with initial postoperative z-score ±1 (P = 0.009). Valve and ventricular function remained stable. Eighteen patients required reintervention, 1 died and 1 underwent transplant. CONCLUSIONS Over mid-term follow-up, aortic growth after arch reconstruction with patch augmentation was proportional when repaired to normal z-score dimensions, aside from proximal transverse arch, which disproportionately dilated. AIsth undersizing prevailed mid-term and trended towards a higher reintervention rate. Initial reconstruction between z-score 0 and +1 resulted in maintenance of that z-score size at mid-term follow-up. Overall, it is crucial to achieve targeted aortic sizing at index operation to maintain appropriate aortic dimensions over time and reduce reintervention risk with specific focus on the AIsth.
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Affiliation(s)
- Dominic P Recco
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shannen B Kizilski
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Reena M Ghosh
- Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Breanna Piekarski
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ashwin Prakash
- Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - David M Hoganson
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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A computational study of aortic reconstruction in single ventricle patients. Biomech Model Mechanobiol 2023; 22:357-377. [PMID: 36335184 PMCID: PMC10174275 DOI: 10.1007/s10237-022-01650-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
Patients with hypoplastic left heart syndrome (HLHS) are born with an underdeveloped left heart. They typically receive a sequence of surgeries that result in a single ventricle physiology called the Fontan circulation. While these patients usually survive into early adulthood, they are at risk for medical complications, partially due to their lower than normal cardiac output, which leads to insufficient cerebral and gut perfusion. While clinical imaging data can provide detailed insight into cardiovascular function within the imaged region, it is difficult to use these data for assessing deficiencies in the rest of the body and for deriving blood pressure dynamics. Data from patients used in this paper include three-dimensional, magnetic resonance angiograms (MRA), time-resolved phase contrast cardiac magnetic resonance images (4D-MRI) and sphygmomanometer blood pressure measurements. The 4D-MRI images provide detailed insight into velocity and flow in vessels within the imaged region, but they cannot predict flow in the rest of the body, nor do they provide values of blood pressure. To remedy these limitations, this study combines the MRA, 4D-MRI, and pressure data with 1D fluid dynamics models to predict hemodynamics in the major systemic arteries, including the cerebral and gut vasculature. A specific focus is placed on studying the impact of aortic reconstruction occurring during the first surgery that results in abnormal vessel morphology. To study these effects, we compare simulations for an HLHS patient with simulations for a matched control patient that has double outlet right ventricle (DORV) physiology with a native aorta. Our results show that the HLHS patient has hypertensive pressures in the brain as well as reduced flow to the gut. Wave intensity analysis suggests that the HLHS patient has irregular circulatory function during light upright exercise conditions and that predicted wall shear stresses are lower than normal, suggesting the HLHS patient may have hypertension.
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Murakami T. Vascular aging in adult congenital heart disease-a narrative review. Cardiovasc Diagn Ther 2022; 12:521-530. [PMID: 36033223 PMCID: PMC9412215 DOI: 10.21037/cdt-22-218] [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: 04/30/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Many studies about the high prevalence of cardiovascular disease in adults with congenital heart disease (CHD) have been published in response to the growing number of adult patients with CHD. The aging process leads to hypertension and cardiovascular disease, which is caused by a degenerative change in the systemic arterial system characterized by the stiffening of elastic arteries (known as arteriosclerosis) and the enlargement of aorta. In patients with CHD, aortic dilatation (so-called aortopathy) is one of the most frequent complications. It is well known the anatomical and histological changes in aortopathy are similar to those in aging process. The increase of pulse wave velocity (PWV) enhances pressure wave reflection, and it augments left ventricular afterload and impairs the coronary supply-workload balance in aging. This article reviews the aortic function in patients with CHD, aiming to provide a new direction for the management of their cardiovascular aging process. Methods Papers on vascular physiology in CHD were retrieved. I searched all original papers and reviews about the vascular physiology in CHD using PubMed, published from January 1, 1973 to June 30, 2022, in English. Key Content and Findings Enhancement of pressure wave reflection has been reported in many CHDs. Although PWV in whole aorta is not necessarily elevated, the abnormal arterial stiffness gradient is common in patients with CHD. Conclusions Many reports concerning functional abnormalities of the aorta have been reported. The abnormalities can result in cardiovascular disease and organ damage. The practitioners should carefully treat patients with CHD while paying attention to their aging process.
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Affiliation(s)
- Tomoaki Murakami
- Department of Pediatrics, Sapporo Tokushukai Hospital, Sapporo, Japan
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de Vecchi A, Faraci A, Fernandes JF, Marlevi D, Bellsham-Revell H, Hussain T, Laji N, Ruijsink B, Wong J, Razavi R, Anderson D, Salih C, Pushparajah K, Nordsletten D, Lamata P. Unlocking the Non-invasive Assessment of Conduit and Reservoir Function in the Aorta. J Cardiovasc Transl Res 2022; 15:1075-1085. [PMID: 35199256 PMCID: PMC9622527 DOI: 10.1007/s12265-022-10221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
Aortic surgeries in congenital conditions, such as hypoplastic left heart syndrome (HLHS), aim to restore and maintain the conduit and reservoir functions of the aorta. We proposed a method to assess these two functions based on 4D flow MRI, and we applied it to study the aorta in pre-Fontan HLHS. Ten pre-Fontan HLHS patients and six age-matched controls were studied to derive the advective pressure difference and viscous dissipation for conduit function, and pulse wave velocity and elastic modulus for reservoir function. The reconstructed neo-aorta in HLHS subjects achieved a good conduit function at a cost of an impaired reservoir function (69.7% increase of elastic modulus). The native descending HLHS aorta displayed enhanced reservoir (elastic modulus being 18.4% smaller) but impaired conduit function (three-fold increase in peak advection). A non-invasive and comprehensive assessment of aortic conduit and reservoir functions is feasible and has potentially clinical relevance in congenital vascular conditions.
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Affiliation(s)
- Adelaide de Vecchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - Alessandro Faraci
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - Joao Filipe Fernandes
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - David Marlevi
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hannah Bellsham-Revell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK
| | - Tarique Hussain
- Pediatric Cardiology, UT Southwestern, Children's Medical Center Dallas, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Nidhin Laji
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - James Wong
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - David Anderson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK
| | - Caner Salih
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - David Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK.,Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EU, UK.
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Main pulmonary artery-to-descending aorta ratio in computed tomography: cut-off value to diagnose pulmonary hypertension in children. Pol J Radiol 2021; 86:e87-e92. [PMID: 33758633 PMCID: PMC7976230 DOI: 10.5114/pjr.2021.103943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/12/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To establish a cut-off value of main pulmonary artery (MPA)/descending aorta (DA) ratio and MPA/ascending aorta (AA) ratio by computed tomography (CT) to identify pulmonary hypertension (PHT) in children. Material and methods A total of 45 children diagnosed with PHT, who underwent both right heart catheterization (RHC) and CT, were enrolled as a case group (PHT), and their CT findings were compared with those from a control group (non-PHT). The widest short-axis diameters of DA at the level of the diaphragmatic outlet, AA, and MPA at its bifurcated level were measured. Results The most common indication to order a CT in the PHT group was congenital heart disease (CHD) (n = 30, 66.7%), and in the non-PHT group it was metastatic workup (n = 31, 68.9%). The median (IQR) diameters of MPA in the PHT and the non-PHT groups were 18.7 mm (15.5, 26.7) and 16.4 mm (13.7, 19.5) (p = 0.005). The MPA/DA ratios were 2.2 and 1.5 in the PHT and non-PHT groups (p < 0.001). The MPA/AA ratios were 1.2 and 1.1 in the PHT and non-PHT groups (p = 0.042). An MPA/DA ratio of 1.8 carried a positive likelihood ratio (LR+) of 7.5 with a sensitivity of 66.67%, specificity of 91%, positive predictive value (PPV) of 88%, and negative predictive value (NPV) of 73.21%. Conclusions The MPA/DA ratio > 1.8 suggests PHT in children and may lead to the avoidance of invasive cardiac catheterization particularly in non-CHD patients.
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High-degree Norwood neoaortic tapering is associated with abnormal flow conduction and elevated flow-mediated energy loss. J Thorac Cardiovasc Surg 2021; 162:1791-1804. [PMID: 33653609 DOI: 10.1016/j.jtcvs.2021.01.111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The Norwood neoaortic arch biomechanical properties are abnormal due to reduced vessel wall compliance and abnormal geometry. Others have previously described neoaortic geometric distortion by the degree of diameter reduction (tapering) and associated this with mismatched ventricular-neoaortic coupling, abnormal flow hemodynamic parameters, and worse patient outcome. Our purposes were to investigate the influence of neoaortic tapering (ie, diameter reduction) on flow-mediated viscous energy loss (EL') in post-Norwood palliated hypoplastic left heart syndrome patients, and correlate flow-geometry with single ventricle power generation. METHODS Twenty-six palliated hypoplastic left heart syndrome patients underwent comprehensive cardiac evaluation with 4-dimensional-flow magnetic resonance imaging. Patients were grouped into high- (group H, n = 13) and low- (group L, n = 13) degree neoaortic tapering using the median cutoff value of neoaortic diameter variance. EL' was calculated along standardized segments using 4-dimensional-flow magnetic resonance imaging. Flow-mediated power loss as a percentage of total power generated by the single ventricle was determined. RESULTS Group H had a higher prevalence of abnormal recirculating flow in the neoaorta and elevated neoaortic EL' in the ascending aorta (1.0 vs 0.6 mW; P = .004). Group H EL' was increased across the entire thoracic aorta (2.6 vs 1.3 mW; P = .002) and accounted for 0.7% of generated ventricular power versus 0.3% in group L (P = .024). EL' directly correlated with the degree of ascending aortic dilation (R = 0.49; P = .012). CONCLUSIONS Patients with high degree neoaortic tapering have more perturbed flow through the neoaorta and increased EL'. Flow-mediated energy loss due to abnormal flow represents irreversibly wasted power generated by the single right ventricle. In patients with high-degree neoaortic tapering, EL' was more than 2-fold greater than low-degree tapering patients. These data suggest that oversizing the Norwood neoaortic reconstruction should be avoided and that patients with distorted neoaortic geometry may warrant increased surveillance for single-ventricle deterioration.
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Voges I, Scheewe J, Attmann T, Uebing A, Oechtering T, Gabbert D. Abnormal aortic arch shape and vortical flow patterns are associated with descending aortic dilatation in patients with hypoplastic left heart syndrome. Int J Cardiol 2020; 323:65-67. [PMID: 32991943 DOI: 10.1016/j.ijcard.2020.09.061] [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] [Received: 04/30/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The descending aorta (DAo) in patients with hypoplastic left heart syndrome (HLHS) after Norwood procedure is frequenty enlarged and exhibits increased stiffness. Such findings of previous studies still remain unexplained given the fact that the DAo is not involved in the Norwood operation. METHODS We studied five HLHS patients with DAo dilatation (aged: 2.9-15.1 years (y), median 9.0 y), four HLHS patients without DAo dilatation (aged: 3.5-9.7 years, median 6.45 y) and 7 healthy controls (aged 6.3-41.6 y, median 26.0 y) using cardiovascular magnetic resonance imaging with acquisition of cine images, contrast-enhanced angiograms and 4D flow. 4D flow data were analyzed based on in-house developed analysis software to quantify vortical flow patterns in terms of vorticity. RESULTS All patients with DAo dilatation presented with a caliber reduction between the proximal and distal aortic arch of more than 40% (median reduction 71%, range 43%-79%) and with increased z-scores of the DAo. Vorticity in the DAo of patients with DAo dilatation (median: -24 s-1, range: -26 s-1 - -8 s-1) was significantly increased in magnitude compared to controls (median: 0 s-1, range: -2 - +2) (p < 0.01). Vorticity in the DAo of patients without DAo dilatatation was not significantly increased compared to controls. DAo z-scores were associated with increased vorticity. CONCLUSIONS The findings of signficiantly increased vorticity and its association with increased DAo z-scores can potentially explain vascular alterations in the DAo of HLHS patients. This study gives motivation for further investigations and may ultimately lead to future Norwood procedure modifications.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jens Scheewe
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Tim Attmann
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Thekla Oechtering
- Department Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Dominik Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.
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Abstract
A bicuspid aortic valve and/or coarctation of the aorta (COA) are often associated with dilatation of the ascending aorta and para-coarctation. Congenital heart diseases (CHD), such as truncus arteriosus, transposition of the great arteries (TGA), tetralogy of Fallot (TOF), hypoplastic left heart syndrome (HLHS), single ventricle with pulmonary stenosis/atresia and the Fontan procedure, are also associated with aortic root dilatation, aneurysm and rarely, dissection, which can be fatal and require aortic valve and root surgery. A significant subset of adults with complex CHD exhibit progressive dilatation of the aortic root even after repair due to aortic medial degeneration. Medial degeneration in the ascending aorta is prevalent among the above CHD. In Marfan syndrome, bicuspid aortic valve and COA, medial degeneration is more extensive and severe than in another complex CHD. Accordingly, the incidence of ascending aortic dilatation, dissection and rupture is higher in the former. This aortic medial degeneration in CHD may either be intrinsic or secondary to the increased volume overload of the aortic root due to right-to-left shunting, or a combination of both. The association of aortic pathophysiological abnormalities, aortic dilatation and aorto-ventricular interaction is clinically referred to as "aortopathy". The major purpose of medical treatment for aortopathy is to reduce the structural changes within the aortic wall and slow down the progression of aortic dilatation to reduce the risk of cardiovascular events. Several medications have been studied, including β-blockers, angiotensin II type I (AT1) receptor blockers (ARBs) and Ca-antagonists. However, the results, except for Marfan syndrome, are limited. In aortopathy, concomitant aortic valve and aortic root repair/replacement is required. The Bentall operation comprises root replacement with an aortic tube graft and mechanical valve, and has been widely applied. On the other hand, valve-sparing operations have been developed in order to preserve the aortic valve.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan
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Hays BS, Baker M, Laib A, Tan W, Udholm S, Goldstein BH, Sanders SP, Opotowsky AR, Veldtman GR. Histopathological abnormalities in the central arteries and veins of Fontan subjects. Heart 2017; 104:324-331. [PMID: 28970278 DOI: 10.1136/heartjnl-2017-311838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/07/2017] [Accepted: 07/23/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Fontan circulations have obligatory venous hypertension, depressed cardiac output and abnormal arterial elastance. Ventriculovascular coupling is known to be abnormal, but the underlying mechanisms are poorly defined. We aim to describe the histopathological features of vascular remodelling encountered in the central arteries and veins in the Fontan circulation as a possible underlying pathological representation of abnormal ventriculovascular coupling. METHODS Postmortemvasculature (inferior vena cava (IVC), superior vena cava (SVC), pulmonary artery (PA), pulmonary vein (PV) and aorta) of 13 patients with a Fontan circulation (mean age 29.9 years, range 9.0-59.8 years) and 2 biventricular controls (ages 17.9 and 30.2 years) was examined. RESULTS IVC and SVC: Eccentric and variable intimal fibromuscular proliferation occurred in 11 Fontan subjects. There was variable loss of medial smooth muscle bundles with reciprocal replacement with dense collagenous tissue.PA: Similar intimal fibromuscular proliferation was seen; however, these intimal changes were accompanied by medial thinning rather than expansion, medial myxoid degeneration and elastic alteration.PV: The PVs demonstrated intimal fibroproliferation and disorganisation of the muscular media.Aorta: The aortic lamina intima was thickened, with associated fibromuscular proliferation and elasticisation. There was also moderate lymphocytic inflammation in the aortic wall. CONCLUSIONS Vascular architectural remodelling is common in Fontan patients. The central veins demonstrate profound changes of eccentric intimal expansion and smooth muscle replacement with collagen. The pulmonary demonstrated abnormal intimal proliferation, and aortic remodelling was characterised by intima lamina thickening and a moderate degree of aortic wall inflammation.
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Affiliation(s)
- Brandon S Hays
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael Baker
- Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pathology, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Annie Laib
- Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pathology, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Wei Tan
- University of Colorado at Boulder, Boulder, Colorado, USA
| | - Sebastian Udholm
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bryan H Goldstein
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | - Gruschen R Veldtman
- Adolescent and Adult Congenital Heart Disease Program, Cincinnati Children's Hospital Medical Centre, Ohio, Cincinnati, USA
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10
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Haller C, Chetan D, Saedi A, Parker R, Van Arsdell GS, Honjo O. Geometry and growth of the reconstructed aorta in patients with hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 2017; 153:1479-1487.e1. [DOI: 10.1016/j.jtcvs.2017.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 01/12/2017] [Accepted: 02/04/2017] [Indexed: 10/20/2022]
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11
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Gerrah R, Haller SJ, George I. Mechanical Concepts Applied in Congenital Heart Disease and Cardiac Surgery. Ann Thorac Surg 2017; 103:2005-2014. [DOI: 10.1016/j.athoracsur.2017.01.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
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12
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Ohuchi H, Hayama Y, Negishi J, Noritake K, Miyazaki A, Yamada O, Shiraishi I. Determinants of Aortic Size and Stiffness and the Impact on Exercise Physiology in Patients After the Fontan Operation. Int Heart J 2017; 58:73-80. [DOI: 10.1536/ihj.16-183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
- Department of Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Yosuke Hayama
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Jun Negishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Kanae Noritake
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Osamu Yamada
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
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Voges I, Kees J, Jerosch-Herold M, Gottschalk H, Trentmann J, Hart C, Gabbert DD, Pardun E, Pham M, Andrade AC, Wegner P, Kristo I, Jansen O, Kramer HH, Rickers C. Aortic stiffening and its impact on left atrial volumes and function in patients after successful coarctation repair: a multiparametric cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2016; 18:56. [PMID: 27618813 PMCID: PMC5020476 DOI: 10.1186/s12968-016-0278-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/26/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The increased cardiovascular morbidity of adults with late repair of aortic coarctation (CoA) has been well documented. In contrast, successful CoA repair in early childhood has a generally good prognosis, though adverse vascular and ventricular characteristics may be abnormal, which could increase long-term risk. This study sought to perform a comprehensive analysis of aortic elasticity and left ventricular (LV) function in patients with aortic coarctation (CoA) using cardiovascular magnetic resonance (CMR). In a subgroup of patients, we assessed structure and function of the common carotid arteries to probe for signs of systemic vascular remodeling. METHODS Fifty-one patients (median age 17.3 years), 13.9 ± 7.5 years after CoA repair, and 54 controls (median age 19.8 years) underwent CMR. We determined distensibility and pulse wave velocity (PWV) at different aortic locations. In a subgroup, common carotid artery distensibility, PWV, wall thickness and wall area were measured. LV ejection fraction (EF), volumes, and mass were measured from short axis views. Left atrial (LA) volumes and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir) were assessed from axial cine images. RESULTS In patients distensibility of the whole thoracic aorta was reduced (p < 0.05) while PWV was only significantly higher in the aortic arch (p < 0.01). Distensibility of the descending aorta at the level of the pulmonary arteries and PWV in the descending aorta, both correlated negatively with age at CoA repair. LA volume before atrial contraction and minimal LA volume were higher in patients (p < 0.05). LAEFPassive and LAEFReservoir were reduced (p < 0.05), and LAEFReservoir correlated negatively with aortic arch PWV (p < 0.05). LVEF, volumes and mass were not different from controls. Carotid wall thickness and PWV were higher in patients compared to controls (p < 0.05). CONCLUSIONS Patients after CoA repair have impaired bioelastic properties of the thoracic aorta with impact on LV diastolic function. Reduced descending aortic elasticity is associated with older age at time of CoA repair. The remodeling of the common carotid artery in our sub-study suggests systemic vessel wall changes.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Julian Kees
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hannes Gottschalk
- Department of Diagnostic Radiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jens Trentmann
- Department of Diagnostic Radiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Christopher Hart
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Dominik D. Gabbert
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Eileen Pardun
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Minh Pham
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Ana C. Andrade
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Philip Wegner
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Ines Kristo
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Olav Jansen
- Department of Diagnostic Radiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Carsten Rickers
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
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The technique matters, it's just not clear how. J Thorac Cardiovasc Surg 2016; 152:480-1. [DOI: 10.1016/j.jtcvs.2016.03.066] [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: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 11/22/2022]
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Voges I, Jerosch-Herold M, Wegner P, Hart C, Gabbert D, Al Bulushi A, Fischer G, Andrade AC, Pham HM, Kristo I, Kramer HH, Rickers C. Frequent Dilatation of the Descending Aorta in Children With Hypoplastic Left Heart Syndrome Relates to Decreased Aortic Arch Elasticity. J Am Heart Assoc 2015; 4:e002107. [PMID: 26438562 PMCID: PMC4845122 DOI: 10.1161/jaha.115.002107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Patients with hypoplastic left heart syndrome after a Norwood operation show dilatation and reduced distensibility of the reconstructed proximal aorta. Cardiac magnetic resonance imaging (CMR) and angiographic examinations indicate that the native descending aorta (DAo) is also dilated, but this has not been studied in detail. Methods and Results Seventy‐nine children with hypoplastic left heart syndrome in Fontan circulation (aged 6.3±3.2 years) and 18 control participants (aged 6.8±2.4 years) underwent 3.0‐tesla CMR. Gradient‐echo cine and phase‐contrast imaging was applied to measure cross‐sectional areas (CSAs), distensibility, pulse wave velocity, and the incremental elastic modulus of the thoracic aorta. CSA of the DAo in patients was also compared with published percentiles for aortic CSA. Patients had significantly larger CSA of the DAo at the level of pulmonary artery bifurcation (229.1±97.2 versus 175.7±24.3 mm/m2, P=0.04) and the diaphragm (196.2±66.0 versus 142.6±16.7 mm/m2, P<0.01). In 41 patients (52%), CSA of the DAo was >95th percentile level for control participants, and the incremental elastic modulus of the aortic arch and the DAo was higher than in patients with normal CSAs (arch: 90.1±64.3 versus 45.6±38.9 m/s; DAo: 86.3±53.7 versus 47.1±47.6 m/s; P<0.01). Incremental elastic modulus of the aortic arch and the DAo correlated with the CSA of the DAo (arch: r=0.5; DAo: r=0.49; P<0.01). Conclusions Children with hypoplastic left heart syndrome frequently show dilatation of their DAo associated with increased stiffness of the aortic arch. Higher aortic impedance increases the afterload of the systemic circulation and likely contributes to the burden of the systemic right ventricle.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA (M.J.H.)
| | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Christopher Hart
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Dominik Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Abdullah Al Bulushi
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Gunther Fischer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Ana Cristina Andrade
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Hoang Minh Pham
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Ines Kristo
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
| | - Carsten Rickers
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany (I.V., P.W., C.H., D.G., A.A.B., G.F., A.C.A., H.M.P., I.K., H.H.K., C.R.)
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