Usefulness of screening cardiovascular magnetic resonance imaging to detect aortic abnormalities after repair of coarctation of the aorta

Abstract

Guidelines recommend screening cardiovascular magnetic resonance (Sc-CMR) imaging for all patients after coarctation of the aorta repair, although there are limited data verifying its clinical utility. Therefore, we sought to assess the value of Sc-CMR in detecting aortic complications and at-risk abnormalities after coarctation of the aorta repair and to identify significant risk factors. We reviewed 76 patients (mean age 31 ± 10 years), including 40 with symptomatically indicated CMR (Sx-CMR) and 36 with Sc-CMR studies. CMR angiograms were evaluated for aortic abnormalities. Recoarctation was defined as residual narrowing/descending aorta at the diaphragm ≤0.5 (at risk ≤0.75), ascending aorta aneurysm as maximum ascending cross-sectional area/height ≥10 (at risk ≥5), and descending aorta aneurysm as maximum descending diameter/descending aorta at the diaphragm ≥1.5 (at risk ≥1.25). Aortic complications or abnormalities were found in 45 patients (59%). No patient met criteria for recoarctation (at risk 10 Sx-CMR vs 5 Sc-CMR). Significant risk factors included heart failure symptoms and female gender (p <0.05). One patient (Sc-CMR) had ascending aneurysm (at risk 17 Sx-CMR vs 8 Sc-CMR). Time from repair was a significant predictor (p <0.05). There were 10 patients (6 Sx-CMR vs 4 Sc-CMR) with descending aneurysm (at risk 8 Sx-CMR vs 7 Sc-CMR). Cardiovascular symptoms, hypertension, and echocardiogram were not predictive. In conclusion, >50% of patients undergoing Sc-CMR had aortic abnormalities, which was not significantly different from those undergoing Sx-CMR. In particular, Sc-CMR identified descending aorta aneurysms that were not predicted by clinical parameters or echocardiogram.