Giardini Alessandro, Piva Tommaso, Picchio Fernando Maria, Lovato Luigi, Donti Andrea, Rocchi Guido, Gargiulo Gaetano, Fattori Rossella
Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
Int J Cardiol. 2007 Jun 25;119(1):21-7. doi: 10.1016/j.ijcard.2006.07.036. Epub 2006 Oct 17.
We sought to assess the impact of persistent hypoplasia of the transverse aortic arch (TAA) after repair of aortic coarctation (AoC), on blood pressure response to exercise, left ventricular (LV) hypertrophy and presence of collateral circulation.
34 consecutive patients with end-to-end repair of AoC (age at repair 3.2+/-2.5 years) underwent exercise echocardiography and magnetic resonance imaging (MRI) at 24+/-7 years of age (range 11.3 to 44.6 years). Systolic Doppler pressure gradient (SPG) across the descending aorta and blood pressure at the right arm were measured at baseline and every minute throughout all exercise. Magnetic resonance imaging was used to measure LV mass index, presence and amount of collateral flow, and the diameters of the aortic isthmus and TAA indexed to the diameter of the diaphragmatic.
Aortic isthmus index was higher than that of the TAA (p=0.006). We observed LV hypertrophy in 15 patients (45%) and presence of collateral circulation in 14 (41%). Eighteen patients (53%) had an abnormal blood pressure response to exercise. Patients with abnormal pressure response to exercise had smaller TAA index (p=0.0005), but similar aortic isthmus index (p=0.09). They also had higher exercise SPG (p<0.0001), higher LV mass index (p<0.0001) and prevalence of LV hypertrophy (p=0.007), higher prevalence of collateral circulation (p<0.0001) and a higher amount of collateral flow (p<0.0001). TAA index, but not aortic isthmus index, correlated with exercise blood pressure (r=-0.59, p=0.003), exercise SPG (r=-0.70, p=0.0005), amount of collateral flow (r=-0.74, p=0.0002) and LV mass index (r=-0.68, p=0.0007).
After repair of AoC, hypoplasia of the TAA may be responsible for abnormal blood pressure response to exercise, persistence of collateral circulation and LV hypertrophy.
我们试图评估主动脉缩窄（AoC）修复术后持续性主动脉弓横部（TAA）发育不全对运动血压反应、左心室（LV）肥厚及侧支循环存在情况的影响。
34例接受AoC端端修复术的连续患者（修复时年龄3.2±2.5岁）在24±7岁（范围11.3至44.6岁）时接受运动超声心动图和磁共振成像（MRI）检查。在基线时以及整个运动过程中每分钟测量降主动脉的收缩期多普勒压力阶差（SPG）和右臂血压。磁共振成像用于测量LV质量指数、侧支血流的存在情况和数量，以及以膈肌水平直径为指标的主动脉峡部和TAA的直径。
主动脉峡部指数高于TAA指数（p = 0.006）。我们观察到15例患者（45%）存在LV肥厚，14例（41%）存在侧支循环。18例患者（53%）运动血压反应异常。运动血压反应异常的患者TAA指数较小（p = 0.0005），但主动脉峡部指数相似（p = 0.09）。他们还具有更高的运动SPG（p < 0.0001）、更高的LV质量指数（p < 0.0001）和LV肥厚患病率（p = 0.007）、更高的侧支循环患病率（p < 0.0001）和更多的侧支血流（p < 0.
