Prevalence and prognostic implication of restenosis or dilatation at the aortic coarctation repair site assessed by cardiovascular MRI in adult patients late after coarctation repair

Int J Cardiol. 2014 May 1;173(2):209-15. doi: 10.1016/j.ijcard.2014.02.012. Epub 2014 Feb 22.


Background: Cardiovascular magnetic resonance (CMR) is ideal for assessing patients with repaired aortic coarctation (CoA). Little is known on the relation between long-term complications of CoA repair as assessed by CMR and clinical outcome. We examined the prevalence of restenosis and dilatation at the repair site and the long-term outcome in patients with repaired CoA.

Methods and results: CMR imaging and clinical data for adult CoA patients (247 patients aged 33.0 ± 12.8 years, 60% male), were analyzed. The diameter of the aorta at the repair site was measured on CMR and its ratio to the aortic diameter at the diaphragm (repair site-diaphragm ratio, RDR) was calculated. Restenosis (RDR≤70%) was present in 31% of patients (and significant in 9% [RDR<50%]), and dilatation (RDR>150%) in 13.0%. A discrete aneurysm at the repair site was observed in 9%. Restenosis was more likely after resection and end-end anastomosis, whereas dilatation after patch repair. Systemic hypertension was present in 69% of patients. Of the hypertensive patients, blood pressure (133 ± 20/73 ± 10 mm Hg) was well controlled in 93% with antihypertensive therapy. Mortality rate over a median length of 5.9 years was low (0.69% per year, 95% CI: 0.33-1.26), but significantly higher than age-matched healthy controls (standardised mortality ratio 2.86, CI 1.43-5.72, p<0.001).

Conclusion: Restenosis or dilatation at the CoA repair site as assessed by CMR is not uncommon. Medium term survival remains good, however, albeit lower than in the general population. Life-long follow-up and optimal blood pressure control are likely to secure a good longer term outlook in these patients.

Keywords: Adult congenital heart disease; Aortic coarctation; Cardiac magnetic resonance; Hypertension; Outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aortic Coarctation / diagnosis
  • Aortic Coarctation / mortality*
  • Aortic Coarctation / surgery*
  • Aortic Diseases / epidemiology
  • Aortic Valve
  • Bicuspid Aortic Valve Disease
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / mortality*
  • Comorbidity
  • Coronary Aneurysm / etiology
  • Coronary Aneurysm / mortality
  • Coronary Restenosis / diagnosis
  • Coronary Restenosis / etiology
  • Coronary Restenosis / mortality*
  • Female
  • Heart Defects, Congenital / epidemiology
  • Heart Valve Diseases / epidemiology
  • Humans
  • Hypertension / epidemiology
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality*
  • Prevalence
  • Prognosis
  • Young Adult