Intraventricular Haemodynamic Changes Caused by Increased Left Ventricular Afterload in Re-coarctation of Aorta: a Case Report

Overview

Journal Eur Heart J Case Rep

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2023 Nov 9

PMID 37942351

Authors

Yuki Shibagaki

Hideharu Oka

Kouichi Nakau

Satoru Takahashi

Affiliations

Soon will be listed here.

Abstract

Background: Long-term re-coarctation of the aorta can cause aortic dilatation, hypertension, and cardiac dysfunction due to increased left ventricular (LV) afterload. It is difficult to detect changes in LV function due to increased afterload if the contractile force of the left ventricle is maintained. Herein, we have reported a case of re-coarctation of the aorta, for which four-dimensional (4D) flow magnetic resonance imaging (MRI) scan was obtained both before and after balloon dilatation for aortic re-coarctation. Ultimately, improvement in aortic helical flow and LV haemodynamics was observed.

Case Summary: A 29-year-old female was diagnosed with coarctation of the aorta and a bicuspid aortic valve after birth and underwent surgery at 1 month. At 8 years of age, she underwent balloon dilatation for re-coarctation. At the age of 28 years, she was diagnosed with re-coarctation triggered by hypertension. She underwent balloon dilatation as her cardiac catheterization revealed a systolic pressure gradient of 40 mmHg. Pretreatment 4D flow MRI demonstrated helical flow in the ascending aorta and descending thoracic aorta and LV blood flow analysis revealed a decrease in LV kinetic energy during systole; these improved after treatment.

Discussion: The use of helical flow evaluation by 4D flow MRI for aortic re-coarctation is well known in clinical practice. However, our report is the first to evaluate intraventricular blood flow before and after the re-coarctation treatment. The MRI evaluation demonstrated that the helical flow and LV blood flow distribution improved after re-coarctation treatment due to the reduction of afterload.

References

Hope M, Meadows A, Hope T, Ordovas K, Saloner D, Reddy G . Clinical evaluation of aortic coarctation with 4D flow MR imaging. J Magn Reson Imaging. 2010; 31(3):711-8. DOI: 10.1002/jmri.22083. View

Stoll V, Hess A, Rodgers C, Bissell M, Dyverfeldt P, Ebbers T . Left Ventricular Flow Analysis. Circ Cardiovasc Imaging. 2019; 12(5):e008130. PMC: 6544522. DOI: 10.1161/CIRCIMAGING.118.008130. View

Jonas R . Coarctation: do we need to resect ductal tissue?. Ann Thorac Surg. 1991; 52(3):604-7. DOI: 10.1016/0003-4975(91)90957-r. View

Senzaki H, Iwamoto Y, Ishido H, Matsunaga T, Taketazu M, Kobayashi T . Arterial haemodynamics in patients after repair of tetralogy of Fallot: influence on left ventricular after load and aortic dilatation. Heart. 2007; 94(1):70-4. DOI: 10.1136/hrt.2006.114306. View

Chiu H, Wang J, Chen Y, Chiu I, Chang C, Lin M . Long-Term Outcomes of Native Coarctation of the Aorta after Balloon Angioplasty or Surgical Aortoplasty in Newborns and Young Infants Less Than 3 Months of Age. Acta Cardiol Sin. 2016; 29(2):168-74. PMC: 4804779. View

Baumgartner H, De Backer J, Babu-Narayan S, Budts W, Chessa M, Diller G . 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2020; 42(6):563-645. DOI: 10.1093/eurheartj/ehaa554. View

Desai L, Stefek H, Berhane H, Robinson J, Rigsby C, Markl M . Four-Dimensional flow Magnetic Resonance Imaging for Assessment of Pediatric Coarctation of the Aorta. J Magn Reson Imaging. 2021; 55(1):200-208. PMC: 9084555. DOI: 10.1002/jmri.27802. View

Fiore A, Fischer L, Schwartz T, Jureidini S, Balfour I, Carpenter D . Comparison of angioplasty and surgery for neonatal aortic coarctation. Ann Thorac Surg. 2005; 80(5):1659-64. DOI: 10.1016/j.athoracsur.2005.03.143. View

Kische S, Schneider H, Akin I, Ortak J, Rehders T, Chatterjee T . Technique of interventional repair in adult aortic coarctation. J Vasc Surg. 2010; 51(6):1550-9. DOI: 10.1016/j.jvs.2009.12.063. View

10.

Kaur H, Assadi H, Alabed S, Cameron D, Vassiliou V, Westenberg J . Left Ventricular Blood Flow Kinetic Energy Assessment by 4D Flow Cardiovascular Magnetic Resonance: A Systematic Review of the Clinical Relevance. J Cardiovasc Dev Dis. 2020; 7(3). PMC: 7569817. DOI: 10.3390/jcdd7030037. View

11.

Eriksson J, Dyverfeldt P, Engvall J, Bolger A, Ebbers T, Carlhall C . Quantification of presystolic blood flow organization and energetics in the human left ventricle. Am J Physiol Heart Circ Physiol. 2011; 300(6):H2135-41. DOI: 10.1152/ajpheart.00993.2010. View