title: Prevalence and prognostic implication of restenosis or dilatation at the aortic coarctation repair site assessed by cardiovascular MRI in adult patients late after coarctation repair.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) is ideal for assessing patients with repaired aortic coarctation (CoA). Little is known on the relation between long-term complications of CoA repair as assessed by CMR and clinical outcome. We examined the prevalence of restenosis and dilatation at the repair site and the long-term outcome in patients with repaired CoA.
  
  
  RESULTS
  CMR imaging and clinical data for adult CoA patients (247 patients aged 33.0 ± 12.8 years, 60% male), were analyzed. The diameter of the aorta at the repair site was measured on CMR and its ratio to the aortic diameter at the diaphragm (repair site-diaphragm ratio, RDR) was calculated. Restenosis (RDR≤70%) was present in 31% of patients (and significant in 9% [RDR<50%]), and dilatation (RDR>150%) in 13.0%. A discrete aneurysm at the repair site was observed in 9%. Restenosis was more likely after resection and end-end anastomosis, whereas dilatation after patch repair. Systemic hypertension was present in 69% of patients. Of the hypertensive patients, blood pressure (133 ± 20/73 ± 10 mm Hg) was well controlled in 93% with antihypertensive therapy. Mortality rate over a median length of 5.9 years was low (0.69% per year, 95% CI: 0.33-1.26), but significantly higher than age-matched healthy controls (standardised mortality ratio 2.86, CI 1.43-5.72, p<0.001).
  
  
  CONCLUSIONS
  Restenosis or dilatation at the CoA repair site as assessed by CMR is not uncommon. Medium term survival remains good, however, albeit lower than in the general population. Life-long follow-up and optimal blood pressure control are likely to secure a good longer term outlook in these patients.
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK.
authors.forename: S S M
authors.initials: SS
authors.lastname: Chen
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK; Imperial College, London SW36LY, UK.
authors.forename: K
authors.initials: K
authors.lastname: Dimopoulos
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK.
authors.forename: R
authors.initials: R
authors.lastname: Alonso-Gonzalez
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK.
authors.forename: E
authors.initials: E
authors.lastname: Liodakis
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK.
authors.forename: E
authors.initials: E
authors.lastname: Teijeira-Fernandez
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK.
authors.forename: M
authors.initials: M
authors.lastname: Alvarez-Barredo
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kempny
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK; Imperial College, London SW36LY, UK.
authors.forename: G
authors.initials: G
authors.lastname: Diller
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Uebing
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK; Imperial College, London SW36LY, UK.
authors.forename: D
authors.initials: D
authors.lastname: Shore
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK; Imperial College, London SW36LY, UK.
authors.forename: L
authors.initials: L
authors.lastname: Swan
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK; Imperial College, London SW36LY, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Kilner
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK; Imperial College, London SW36LY, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Gatzoulis
authors.affiliation: Royal Brompton Hospital, London SW36NP, UK; Imperial College, London SW36LY, UK. Electronic address: r.mohiaddin@rbht.nhs.uk.
authors.forename: R H
authors.initials: RH
authors.lastname: Mohiaddin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001017:Aortic Coarctation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001018:Aortic Diseases / Q000453:epidemiology; D001021:Aortic Valve; D000082882:Bicuspid Aortic Valve Disease; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D015897:Comorbidity; D003323:Coronary Aneurysm / Q000209:etiology / Q000401:mortality; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D055815:Young Adult
keywords: Adult congenital heart disease; Aortic coarctation; Cardiac magnetic resonance; Hypertension; Outcomes