Ou Phalla, Celermajer David S, Mousseaux Elie, Giron Alain, Aggoun Yacine, Szezepanski Isabelle, Sidi Daniel, Bonnet Damien
Department of Pediatric Radiology, University Rene Descartes-Paris V, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.
J Am Coll Cardiol. 2007 Feb 27;49(8):883-90. doi: 10.1016/j.jacc.2006.10.057. Epub 2007 Feb 8.
This study was designed to investigate the influence of aortic arch geometry on vascular remodeling after anatomically successful repair of coarctation of the aorta (CoA).
Abnormalities of the precoarctation vasculature are known to occur after CoA repair and appear related to adverse outcomes. The influence of aortic arch geometry on such abnormalities is unknown.
Sixty-three postcoarctectomy subjects (age 15.9 +/- 6.3 years) were compared with 63 control volunteers. Aortic arch shape was characterized on magnetic resonance imaging using both qualitative classification, identifying 3 subtypes of arch geometry (Gothic, Crenel, Romanesque), and a quantitative index, height/width ratio (H/W) of the aorta. Using ultrasound, we measured carotid artery intima-media thickness (IMT) and stiffness index and distensibility, as well as right brachial artery flow-mediated dilation (FMD) and glyceryl trinitate (GTN)-induced dilatation, to assess the precoarctation vasculature of these subjects.
Gothic arch type was associated with higher carotid IMT and stiffness index, lower carotid distensibility (p < 0.001 for all), and lower brachial reactivity (FMD, p < 0.01; GTN response, p < 0.001) compared with Crenel and Romanesque geometries and with control subjects. The height/width ratio was also significantly related to these vascular abnormalities. Even in CoA subjects with Romanesque arch geometry, arterial function and stiffness parameters were significantly impaired compared with control subjects.
In young adult survivors of anatomically successful CoA repair, a gothic-type aortic arch with high H/W is associated with abnormal IMT, higher aortic stiffness index, and impaired arterial reactivity in the pre-CoA vasculature.
本研究旨在探讨主动脉弓几何形态对主动脉缩窄（CoA）解剖修复成功后血管重塑的影响。
已知CoA修复后会出现缩窄前血管系统异常，且这些异常似乎与不良预后相关。主动脉弓几何形态对这类异常的影响尚不清楚。
将63例主动脉缩窄切除术后患者（年龄15.9±6.3岁）与63名对照志愿者进行比较。通过磁共振成像对主动脉弓形状进行特征描述，采用定性分类法确定3种弓几何形态亚型（哥特式、城垛式、罗马式），并使用主动脉高度/宽度比（H/W）这一定量指标。我们利用超声测量颈动脉内膜中层厚度（IMT）、僵硬度指数和扩张性，以及右肱动脉血流介导的扩张（FMD）和硝酸甘油（GTN）诱导的扩张，以评估这些受试者的缩窄前血管系统。
与城垛式和罗马式几何形态以及对照受试者相比，哥特式弓型与更高的颈动脉IMT和僵硬度指数、更低的颈动脉扩张性（所有p<0.001）以及更低的肱动脉反应性（FMD，p<0.01；GTN反应，p<0.001）相关。高度/宽度比也与这些血管异常显著相关。即使在具有罗马式弓几何形态的CoA受试者中，与对照受试者相比，动脉功能和僵硬度参数也显著受损。
在CoA解剖修复成功的年轻成年幸存者中，高H/W的哥特式主动脉弓与缩窄前血管系统中异常的IMT、更高的主动脉僵硬度指数以及受损的动脉反应性相关。
