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Coarctation of Aorta and Ascending Aortic Aneurysm
Quick Takes
- Patients with bicuspid aortic valve (BAV) and those with BAV and concomitant coarctation of the aorta had larger aortic root and ascending aortic size as compared to those patients with isolated coarctation.
- Patients with BAV and those with BAV with coarctation had a more progressive enlargement of the aortic root and ascending aortic size during follow-up as compared to those with isolated coarctation.
- The presence of BAV and modifiable risk factors such as hypertension were independently associated with large aortic size at baseline, and more progressive aortic enlargement during follow-up.
Study Questions:
What is the relationship between coarctation of the aorta (COA), bicuspid aortic valve (BAV), and thoracic aortic aneurysms?
Methods:
A retrospective study was performed at a single center. Patients with COA were matched 1:1:1 to patients with isolated BAV and patients without structural heart disease (No-SHD group). The COA group was further subdivided into COA+BAV subgroup and COA with tricuspid aortic valve (COA+TAV) subgroup. Aortic dimensions were assessed at baseline, 3, 5, and 7 years with echocardiogram and cross-sectional imaging (when available).
Results:
A total of 867 patients with COA were studied, with 65% of patients in the COA+TAV group and 35% in the COA+BAV subgroup. Compared to the No-SHD group, the COA+BAV subgroup had larger aortic root diameter (37 vs. 32 mm, p < 0.001), and mid-ascending aortic diameters (34 vs. 28 mm, p = 0.008). The BAV group had larger aortic root (27 vs. 32 mm, p < 0.001) and mid ascending aorta diameter (35 vs. 28 mm, p < 0.001). Compared to the COA+TAV subgroup, the COA+BAV subgroup and BAV group were associated with larger aortic root and mid ascending aorta diameter at baseline and follow-up. The risk of acute aortic complications was low in all groups.
Conclusions:
The authors conclude that BAV, not COA, was associated with ascending aortic dimensions, and that patients with COA+TAV were not at a greater risk of developing aortic aneurysm as compared to patients without SHD.
Perspective:
COA has been felt to be associated with increased risk of aortic complications. The most recent thoracic aortic guidelines include coarctation as a risk factor to prompt aortic intervention at smaller diameters. This study nicely demonstrated that the risk is not due to coarctation itself, but due to the association with BAV. Additionally, those with BAV and hypertension were at elevated risk for having larger aortic size at baseline and more progressive aortic enlargement, highlighting the need for meticulous blood pressure control in patients with BAV and COA.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Vascular Medicine, Aortic Surgery, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease
Keywords: Aortic Coarctation, Aortic Aneurysm
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