Late magnetic resonance surveillance of repaired coarctation of the aorta.
OBJECTIVE
Coarctation of the aorta has often been described as a simple form of congenital heart disease. However, rates of re-coarctation reported in the literature vary from 7% to 60%. Re-coarctation of the aorta may lead to worsening systemic hypertension, coronary artery disease and/or congestive cardiac failure. We aimed to describe the rates of re-coarctation in subjects who had undergone early coarctation repair (<2 years of age) and referred for clinically indicated or routine magnetic resonance (MR) surveillance.


METHODS
We retrospectively identified 50 consecutive subjects (20.2+/-6.9 years post-repair) imaged between 2004 and 2008. Patient characteristics, rates of re-coarctation and LV/aortic dimensions were examined.


RESULTS
Forty percent of subjects had bicuspid aortic valves (BAV). There were 40 cases of end-to-end repair and 10 cases of subclavian flap repair. Re-intervention with balloon angioplasty or repeat surgery had been performed in 32% of subjects. The MRI referrals were clinically indicated in 34% and routine in 66% of patients. Re-coarctation was considered moderate or severe in 34%, mild in 34% and no re-coarctation was identified in 32% of patients. There was no significant difference in the number of cases of re-coarctation identified in the clinically indicated versus routine referrals for MR imaging (p=0.20). There were no cases of aortic dissection or aneurysm formation identified amongst the subjects. The mean indexed left ventricular mass and ejection fraction was 72+/-16g/m(2) and 66+/-6%, respectively. Amongst those subjects with BAV there were larger aortic sinus (30+/-1mm vs 27+/-1mm, p=0.03) and ascending aortic (27+/-1mm vs 23+/-1mm, p=0.01) dimensions when compared to subjects with morphologically tricuspid aortic valves.


CONCLUSIONS
We demonstrate that many years after early repair of coarctation of the aorta, MR surveillance detects significant rates of re-coarctation. These findings were independent of whether or not there was a clinical indication for imaging. Those patients with BAV disease had larger ascending aortic dimensions and may require more frequent non-invasive surveillance.
Puranik
Rajesh
R
Great Ormond Street Hospital for Children, NHS trust, Cardiac Unit, London UK.
Tsang
Victor T
VT
Puranik
Smrithi
S
Jones
Rodney
R
Cullen
Seamus
S
Bonhoeffer
Phillip
P
Hughes
Marina L
ML
Taylor
Andrew M
AM
D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000473:pathology; D001017:Aortic Coarctation / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D012008:Recurrence; D012086:Reoperation; D013318:Stroke Volume; D055815:Young Adult