Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Čiurlionis str. 21, LT-03101 Vilnius, Lithuania.
Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, LT-08406 Vilnius, Lithuania.
Medicina (Kaunas). 2024 May 28;60(6):886. doi: 10.3390/medicina60060886.
: The configuration of the aortic arch, particularly a Gothic arch shape, in individuals with corrected coarctation of the aorta (CoA) has been associated with a decreased systolic wave amplitude across the arch, which could potentially impair renal perfusion and elevate the risk of arterial hypertension. This study aims to explore the relationship between the morphological characteristics of the aortic arch and their impact on renal perfusion in patients with CoA. : Seventy-one subjects with corrected CoA underwent continuous 24 h ambulatory blood pressure monitoring, computed tomography to assess the aortic arch, and renal perfusion scanning. Subjects were stratified into three groups based on the height-to-width (H/W) ratio of their aortic arch: Group 1 with a H/W ratio of <0.65, Group 2 with a H/W ratio between 0.65 and 0.85, and Group 3 with a H/W ratio of >0.85. : Groups 1 and 2 (53,78% and 62.63%) presented with a higher hypertension prevalence of elevated blood pressure than Group 3 (38.89%). Notable variations were observed among the subjects in the time to peak perfusion (Tmax) in the left kidney across the groups. Group 1 showed a median T at 0.27, Group 2 at 0.13, and Group 3 at -0.38 (-value = 0.079). The differences in T for the right kidney followed a similar trend but were not statistically significant (Group 1 at 0.61, Group 2 at 0.22, and Group 3 at 0.11; -value = 0.229). : This study suggests that variations in the aortic arch morphology might not significantly influence renal perfusion in CoA patients. This indicates the potential adaptability of the renal blood flow, which appears to compensate for reduced perfusion, thus minimizing adverse effects on the kidney function. This adaptability suggests an inherent physiological resilience, emphasizing the need for further targeted research to understand the specific interactions and impacts on treatment strategies for CoA.
升主动脉形态与先天性主动脉缩窄患者肾灌注的关系研究
探讨升主动脉形态与先天性主动脉缩窄（CoA）患者肾灌注之间的关系。
对 71 例接受过矫正手术的 CoA 患者进行 24 小时连续动态血压监测、计算机断层扫描评估升主动脉形态和肾灌注扫描。根据升主动脉高度与宽度（H/W）比值将患者分为三组：组 1（H/W<0.65）、组 2（H/W0.65-0.85）和组 3（H/W>0.85）。
组 1 和组 2（53.78%和 62.63%）的高血压患病率高于组 3（38.89%）。三组之间左肾灌注峰值时间（Tmax）存在显著差异。组 1 的 Tmax 中位数为 0.27，组 2 为 0.13，组 3 为-0.38（-值=0.079）。右肾 Tmax 也呈现类似趋势，但无统计学意义（组 1 为 0.61，组 2 为 0.22，组 3 为 0.11；-值=0.229）。
升主动脉形态的变化可能不会显著影响 CoA 患者的肾灌注。这表明肾血流具有潜在的适应性，可能通过代偿来减轻灌注减少的影响，从而最大限度地减少对肾功能的不利影响。这种适应性提示了内在的生理弹性，强调需要进一步进行有针对性的研究，以了解特定的相互作用以及对 CoA 治疗策略的影响。
