title: How successful is successful? Aortic arch shape after successful aortic coarctation repair correlates with left ventricular function.
abstract: Even after successful aortic coarctation repair, there remains a significant incidence of late systemic hypertension and other morbidities. Independently of residual obstruction, aortic arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch 3-dimensional shape features with functional data obtained from cardiac magnetic resonance scans.
  
  
  
  Three-dimensional aortic arch shape models of 53 patients (mean age, 22.3 ± 5.6 years) 12 to 38 years after aortic coarctation repair were reconstructed from cardiac magnetic resonance data. A novel validated statistical shape analysis method computed a 3-dimensional mean anatomic shape of all aortic arches and calculated deformation vectors of the mean shape toward each patient's arch anatomy. From these deformations, 3-dimensional shape features most related to left ventricular ejection fraction, indexed left ventricular end-diastolic volume, indexed left ventricular mass, and resting systolic blood pressure were extracted from the deformation vectors via partial least-squares regression.
  
  
  
  Distinct arch shape features correlated significantly with left ventricular ejection fraction (r = 0.42, P = .024), indexed left ventricular end-diastolic volume (r = 0.65, P < .001), and indexed left ventricular mass (r = 0.44, P = .014). Lower left ventricular ejection fraction, larger indexed left ventricular end-diastolic volume, and increased indexed left ventricular mass were identified with an aortic arch shape that has an elongated ascending aorta with a high arch height-to-width ratio, a relatively short proximal transverse arch, and a relatively dilated descending aorta. High blood pressure seemed to be linked to gothic arch shape features, but this did not achieve statistical significance.
  
  
  
  Independently of hemodynamically important arch obstruction or residual aortic coarctation, specific aortic arch shape features late after successful aortic coarctation repair seem to be associated with worse left ventricular function. Analyzing 3-dimensional shape information via statistical shape modeling can be an adjunct to long-term risk assessment in patients after aortic coarctation repair.
authors: Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors: Jan L
authors: JL
authors: Bruse
authors: Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors: Abbas
authors: A
authors: Khushnood
authors: Simula Research Laboratory, Cardiac Modeling Department, Oslo, Norway; Inria, Asclepios Team, Sophia Antipolis, France.
authors: Kristin
authors: K
authors: McLeod
authors: Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors: Giovanni
authors: G
authors: Biglino
authors: Inria, Asclepios Team, Sophia Antipolis, France.
authors: Maxime
authors: M
authors: Sermesant
authors: Inria, Asclepios Team, Sophia Antipolis, France.
authors: Xavier
authors: X
authors: Pennec
authors: Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors: Andrew M
authors: AM
authors: Taylor
authors: Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom. Electronic address: hsiat@gosh.nhs.uk.
authors: Tain-Yen
authors: TY
authors: Hsia
authors: Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
authors: Silvia
authors: S
authors: Schievano
mesh_terms: D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D001017:Aortic Coarctation / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult
keywords: aortic arch; coarcation of the aorta; shape analysis