Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Int J Cardiol. 2018 Jan 1;250:106-109. doi: 10.1016/j.ijcard.2017.07.017.
In roughly half of patients with coarctation of the aorta (CoA), the aorta may be enlarged. It is uncertain whether enlargement is independent of aortic valve morphology. We sought to compare aortic size in CoA with a tricuspid valve (TAV) to those with bicuspid aortic valve (BAV).
Sixty-eight CoA patients and 20 healthy controls with prior cardiac magnetic resonance (CMR) imaging were included. CMR was retrospectively reanalyzed to measure aortic root and mid-ascending aorta. The maximum aortic diameter was compared between CoA with TAV, CoA with BAV, and control groups.
CoA with TAV patients (n=27) had smaller aortic root diameters than CoA with BAV (n=41) (32±4.9 vs. 37±5.8mm, p=0.001), despite being older (40 vs. 32years, p=0.01). Similarly, TAV CoA patients had a smaller mid-ascending aortic diameter (28±4.5 vs. 33±6.9mm, p=0.019) than BAV patients. TAV CoA was similar to controls in all metrics. Twenty-four patients (35%) with CoA had dilated aortas (>37mm), of which 79% had BAV. A history of hypertension did not predict larger aortic root or mid-ascending aortic dimensions.
In patients with CoA, TAV is associated with smaller aortic size compared to those with BAV, and similar to healthy controls. Aortic size in CoA is independent of hypertension. Therefore, aortopathy associated with BAV is likely a reflection of the BAV phenotype rather than CoA or its physiologic effects. This distinction may have implications for the frequency and types of monitoring and treatment of CoA patients.
在大约一半的主动脉缩窄（CoA）患者中，主动脉可能会增大。目前尚不确定这种增大是否独立于主动脉瓣形态。我们试图比较 CoA 合并三尖瓣（TAV）与合并二叶式主动脉瓣（BAV）患者的主动脉大小。
共纳入 68 例 CoA 患者和 20 例有既往心脏磁共振（CMR）成像的健康对照者。对 CMR 进行回顾性重新分析，以测量主动脉根部和升主动脉中段。比较 CoA 合并 TAV、CoA 合并 BAV 与对照组的最大主动脉直径。
CoA 合并 TAV 患者（n=27）的主动脉根部直径小于 CoA 合并 BAV 患者（n=41）（32±4.9 比 37±5.8mm，p=0.001），尽管前者年龄更大（40 岁比 32 岁，p=0.01）。同样，TAV CoA 患者的升主动脉中段直径也较小（28±4.5 比 33±6.9mm，p=0.019）。TAV CoA 在所有指标上均与对照组相似。24 例（35%）CoA 患者的主动脉扩张（>37mm），其中 79%为 BAV。高血压病史并不能预测主动脉根部或升主动脉中段尺寸更大。
在 CoA 患者中，与 BAV 相比，TAV 与较小的主动脉大小相关，与健康对照者相似。CoA 患者的主动脉大小与高血压无关。因此，与 BAV 相关的主动脉病变很可能反映了 BAV 表型，而不是 CoA 或其生理效应。这种区别可能对 CoA 患者的监测和治疗的频率和类型产生影响。
