title: Intravascular ultrasonic assessment of post-operative remodelling of aortic coarctation repaired by use of a subclavian flap.
abstract: BACKGROUND
  We have used intravascular ultrasound in an attempt to clarify the extent of vascular remodelling of the aortic arch after the repair of aortic coarctation by use of a subclavian flap.
  
  
  METHODS
  We investigated 13 patients with coarctation of the aorta, ranging in age from 1.4 to 43.0 months, with a mean of 20.8 months, who underwent aortoplasty by incorporation of a subclavian flap. The mean postoperative period was 19.6 months, with a range from 0.03 to 41.2 months. The luminal morphology of the aortic arch was evaluated by intravascular ultrasound at the time of post-operative catheterization.
  
  
  RESULTS
  We observed 3 cases longitudinally. Over the period of observation, we found three types o f morphology of the aorta at the site of incorporation of the subclavian flap, namely a snowman shape with two inflection points, a pisiform shape with one inflection point, and a round shape without any points of inflection. There was a correlation between the cross-sectional shapes at the site of the subclavian flap in the postoperative period (p < 0.01). In each case, we measured the cross-sectional area at the site of subclavian flap, at the descending aorta, and at the distal aortic arch. The cross-sectional area, and the increment of the cross-sectional area at the site of subclavian flap, was larger.
  
  
  CONCLUSIONS
  The shape of the lumen subsequent to repair of aortic coarctation changes progressively from a snowman, to a pisiform, and finally to a round shape. Greater growth of the subclavian flap compared to the native wall of the aorta was observed for at least the first 4 years after repair. This finding may improve our understanding of the remodelling process of the arterial trunks after surgical repair.
authors.affiliation: Nagano Children's Hospital, Department of Pediatric, Nagano, Japan. tshimizu@hsp.md.shinshu-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Gengi
authors.initials: G
authors.lastname: Satomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasukochi
mesh_terms: D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D011184:Postoperative Period; D020127:Recovery of Function; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013348:Subclavian Artery / Q000637:transplantation*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*