Risk factors for aortic complications in adults with coarctation of the aorta

Hospital Universitario La Paz, Madrid, Madrid, Spain
Journal of the American College of Cardiology (Impact Factor: 16.5). 11/2004; 44(8):1641-7. DOI: 10.1016/j.jacc.2004.07.037
Source: PubMed


We sought to determine the prevalence and predisposing condition for aortic wall complications in adults with either repaired or non-repaired coarctation of the aorta.
Aortic wall complications may develop in adults with coarctation of the aorta, despite successful surgical repair in childhood.
A total of 235 adults with coarctation (mean age 27 +/- 13 years) were retrospectively reviewed. Treatment had been performed by surgery in 181 patients (group I) or by balloon angioplasty or stenting in 28 patients (group II). No previous intervention had been carried out in 26 patients with mild coarctation at diagnosis (group III).
Forty-four aortic wall complications were found in 37 patients (16%). There were no differences among the three groups with respect to total complications (15%, 18%, and 15%, respectively), ascending aortic aneurysms (9%, 11%, and 12%), or descending aortic aneurysms (4% in all three groups). Multivariate analysis did not show a significant relationship between previous repair, type of repair, age at repair, residual Doppler pressure gradient, or systemic hypertension and the occurrence of aortic complications. Only aging (risk ratio [RR] 1.4 per decade of age, 95% confidence interval [CI] 1.1 to 1.8, p = 0.002) and bicuspid aortic valve (RR 3.2, 95% CI 1.3 to 7.5, p = 0.005) were significantly related to these complications.
Aortic wall complications are frequent in adults with coarctation of the aorta beyond that attributable to associated hemodynamic derangement or previous repair. The only independent risk factors appear to be advanced age and bicuspid aortic valve.

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Available from: José M Oliver, Oct 24, 2014
    • "Aneurysms and pseudo-aneurysms have been described as late complications of coarctation of aorta that may develop in both repaired and un-repaired patients. In those undergoing repair, aneurysm formation at or near the site has been associated with both surgical and transcatheter relief of the coarctation.[5] The formation of aneurysms at the site of coarctation repair appears to correlate to the time elapsed since the surgical correction and has a prevalence of ~5.4% post-coarctation repair.[6] "
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    ABSTRACT: A mycotic aneurysm is a rare condition occasionally seen in patients with a history of prior cardiac or vascular surgery. Here we report the presentation of a mycotic aneurysm in a pediatric patient at the site of prior aortic coarctation repair. This patient's initial presentation suggested rheumatologic or oncologic disease, and after diagnosis he continued to show evidence of splenic, renal and vascular injury distal to the mycotic aneurysm site while being treated with antibiotics. We discuss the diagnosis, treatment and management of this condition.
    Annals of Pediatric Cardiology 05/2014; 7(2):138-41. DOI:10.4103/0974-2069.132493
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    • "Additionally, patients with COA and BAV are at higher risk of developing secondary complications even after successful surgical repair both directly related to intervention and secondary to systemic arteriopathy. Indeed, in the cohort of patients with COA investigated by Oliver et al. (2004), from the 10 cases of aneurysm, developed at the site of the previous COA repair, 8 patients had both COA and BAV. As a consequence, despite advancements in surgical techniques, life expectancy for patients with COA and BAV remains reduced due to long-term morbidity [5]. "
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    ABSTRACT: Up to 80% of patients with coarctation of the aorta (COA) have a bicuspid aortic valve (BAV). Patients with COA and BAV have elevated risks of aortic complications despite successful surgical repair. The development of such complications involves the interplay between the mechanical forces applied on the artery and the biological processes occurring at the cellular level. The focus of this study is on hemodynamic modifications induced in the aorta in the presence of a COA and a BAV. For this purpose, numerical investigations and magnetic resonance imaging measurements were conducted with different configurations: (1) normal: normal aorta and normal aortic valve; (2) isolated COA: aorta with COA (75% reduction by area) and normal aortic valve; (3) complex COA: aorta with the same severity of COA (75% reduction by area) and BAV. The results show that the coexistence of COA and BAV significantly alters blood flow in the aorta with a significant increase in the maximal velocity, secondary flow, pressure loss, time-averaged wall shear stress and oscillatory shear index downstream of the COA. These findings can contribute to a better understanding of why patients with complex COA have adverse outcome even following a successful surgery.
    PLoS ONE 08/2013; 8(8):e72394. DOI:10.1371/journal.pone.0072394 · 3.23 Impact Factor
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    • "More recently the new surgical techniques, based on an advanced valve preserved procedure, have shown a behavior of either the valve gradient in post operative phase or of the expected valve longevity, better than in standard bioprosthesis. In case of bioprosthesis, the freedom of reoperation is approximately 12 years in 80% of subjects and the re-operative mortality risk is similar than in the first line [59]. Respect of mitral valve repair, where the surgical procedure has been well codified with an high reproducibility, BAV offers several different kinds of surgical approaches that sometimes involve the reconstruction of the sinotubular junction in addition to the valve repair only. "
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    ABSTRACT: Bicuspid aortic valve (BAV) is a common congenital cardiac disease, usually asymptomatic for a long time. BAV has an incidence of 0.9% to 2% in the general population [1] as well as in competitive athletes [2], with strong male prevalence [2, 3]. As a congenital cardiac disease, BAV can be associated in different percentage with other aortic abnormalities, including aortic dilatation [4, 5], coartaction [6], and acute dissection[7] and other cardiovascular malformations like mitral valve prolapsed interventricular septal defect, patent ductus arteriosus [8] Despite the progressive enlargement with age of the aortic tract in BAV has been confirmed from several authors [9] either in general population or in athletes, a new interesting aspect regarding the possible involvement of the myocardial structure of the left ventricle chamber is recently emerging. Anyway t he natural history of BAV is not yet completely clarified. The natural course of BAV results to be more interesting mainly in athletes where regular sport activity could be an additional factor in heart workload and therefore decisive for the evolution of the disease. This one of the reasons why, mainly in athletes population, it has to be taken into strong consideration to assure an echo exam at least one in a life before to start with a regular training. Anyway BAV is often compatible with regular sports activity, specifically when the valvular incompetence is slight and the degree of the aortic stenosis is not critical. More recently, a 5-years follow-up echo analysis conducted in a cohort of BAV athletes, at Sports Medicine Center in Florence-Italy, has confirmed a progressive enlargement of LV chamber in them respect of controls. These observations are suggestive for a different behaviour in this particular group of athletes and sustain the proposal for a regular non invasive follow-up in them. The assessment of the LV performance can be completed using other non invasive methods like physical echo-stress to evaluate haemodinamical response to a physical exercise in order to follow-up the persistence of a normal EF.
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