Fricke Katrin, Christierson Lea, Heiberg Einar, Sjöberg Pia, Hedström Erik, Steiner Kristoffer, Weismann Constance G, Töger Johannes, Liuba Petru
Pediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.
Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Front Cardiovasc Med. 2025 Jan 6;11:1518070. doi: 10.3389/fcvm.2024.1518070. eCollection 2024.
Recurrent coarctation of the aorta (re-CoA) is a well-known although not fully understood complication after surgical repair, typically occurring in 10%-20% of cases within months after discharge.
To (1) characterize geometry of the aortic arch and blood flow from pre-discharge magnetic resonance imaging (MRI) in neonates after CoA repair; and (2) compare these measures between patients that developed re-CoA within 12 months after repair and patients who did not.
Neonates needing CoA repair, without associated major congenital heart defects, were included. Transthoracic echocardiography (echo) and 4D phase-contrast MRI were performed prior to discharge after CoA repair to assess 3D arch geometry, flow velocity and flow pattern in the distal aortic arch corresponding to the area at risk for re-CoA. Arch geometry was assessed by measuring angles of the aortic arch and its branches using 3D patient-specific geometries segmented from MRI. Continuous data are presented as median and interquartile range.
The median age at CoA surgery was 9 days. Four out of the included 28 patients (14%) developed re-CoA within the first 12 months after surgery. Re-CoA was associated with repair technique (lateral thoracotomy 100% vs. 33%, = 0.02), higher postoperative isthmic flow velocity by echocardiography (1.9 [0. 9] m/s vs. 1.25 [0.5] m/s, = 0.04) and postoperative crenel aortic arch (100% vs. 21%, = 0.007) with a larger distance between the first and last branching points (12.6 [3.1] mm vs. 7.3 [7.0] mm; = 0.01). A smaller angle between the ascending aorta and the brachiocephalic artery (89 [58]° vs. 122 [37]°, = 0.05) and between the proximal aortic arch and the left carotid artery (75° vs. 97 [37]°, = 0.04), with a more pronounced caliber change between the ascending aorta and the proximal (1.85 vs. 0.86 [0.76]; = 0.03) and distal aortic arch (2.19 [2.42] vs. 1.01 [0.94]; = 0.03) were observed in re-CoA patients. Patients who developed re-CoA had more left-handed helical flow in systole ( = 0.045), more right-handed helical flow in diastole ( = 0.02), and less vortical flow ( = 0.05).
Subtle changes in aortic arch geometry and flow pattern early after neonatal CoA repair may contribute to the risk of re-CoA.
主动脉缩窄复发（re-CoA）是手术修复后一种已知但尚未完全了解的并发症，通常在出院后数月内发生在10%-20%的病例中。
（1）通过出院前磁共振成像（MRI）对新生儿主动脉缩窄修复术后主动脉弓的几何形状和血流进行特征描述；（2）比较修复后12个月内发生re-CoA的患者与未发生re-CoA的患者之间的这些指标。
纳入需要进行主动脉缩窄修复且无相关重大先天性心脏缺陷的新生儿。在主动脉缩窄修复术后出院前进行经胸超声心动图（echo）和4D相位对比MRI，以评估主动脉弓的三维几何形状、远端主动脉弓对应re-CoA风险区域的流速和血流模式。通过使用从MRI分割出的三维患者特异性几何形状测量主动脉弓及其分支的角度来评估主动脉弓几何形状。连续数据以中位数和四分位数间距表示。
主动脉缩窄手术时的中位年龄为9天。纳入的28例患者中有4例（14%）在术后12个月内发生re-CoA。Re-CoA与修复技术有关（侧胸切开术100% vs. 33%，P = 0.02），超声心动图显示术后峡部流速较高（1.9 [0.9] m/s vs. 1.25 [0.5] m/s，P = 0.04），以及术后有锯齿状主动脉弓（100% vs. 21%，P = 0.007），第一个和最后一个分支点之间的距离更大（12.6 [3.1] mm vs. 7.3 [7.0] mm；P = 0.01）。在发生re-CoA的患者中观察到升主动脉与头臂动脉之间的夹角较小（89 [58]° vs. 122 [37]°，P = 0.05），近端主动脉弓与左颈动脉之间的夹角较小（75° vs. 97 [37]°，P = 0.04），升主动脉与近端（1.85 vs. 0.86 [0.76]；P = 0.03）和远端主动脉弓（2.19 [2.42] vs. 1.01 [0.94]；P = 0.03）之间的管径变化更明显。发生re-CoA的患者在收缩期有更多左旋螺旋血流（P = 0.045），在舒张期有更多右旋螺旋血流（P = 0.02），且涡流较少（P = 0.05）。
新生儿主动脉缩窄修复术后早期主动脉弓几何形状和血流模式的细微变化可能导致re-CoA的风险增加。
