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Session: Cardiovascular diseases
Session starts: Friday 25 January, 13:00
Presentation starts: 13:45
Room: Lecture room 558

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Joe Juffermans (LUMC)
Ineke Nederend (LUMC)
Pieter van den Boogaard (LUMC)
Hildo Lamb (LUMC)
Arno Roest (LUMC)
Jos Westenberg (LUMC)

Abstract:
Background: Uncertainties exists whether the abnormal hemodynamic situation in coarctation (CoA) patients before curative reconstruction causes aortic wall deterioration Therefore, this study evaluated the effect of age at curative reconstruction on the arterial wall stiffness expressed in pulse wave velocity (PWV) and the 3D wall shear stress (WSS) in CoA patients with curative reconstruction. Additionally, effects of valve morphology was evaluated. Methods: 21 patients (13.7±2.6 years) were included; incorporating 14 subjects with a bicuspid aortic valve. MRI was performed at a mean time after curative reconstruction of 12.6±3.0 years. For normal PWV comparison 19 volunteers (13.3±2.8 years) were included. PWV was determined from two high-temporal 1-directional velocity encoded acquisitions, for the ascending aorta (AO) plus the aortic arch and the descending AO. The peak WSS was determined from 4D flow MRI, acquired on 3T MRI (Ingenia, Philips Healthcare) using CAAS MR Solutions v5.0 (Pie Medical Imaging). The peak WSS over 5 systolic phases was determined for three segments: ascending AO, aortic arch and descending AO. Results: There were no significant differences between volunteers and patients neither in subject characteristics nor for PWV. A positive correlation between age and PWV in both aortic segments for the entire population was found (proximal AO: r=.322, p=.042; descending AO: r=.361, p=.022). For patients with a tricuspid aortic valve (TAV), a significant good positive correlation was found between age at reconstruction and descending AO PWV (r=.796, p=.010). Conclusion: In line with the scientific literature, the correlation between age and PWV describes AO vessel wall stiffening over time. The absence of significant PWV differences between volunteers and patients indicates that curative reconstruction does not result in AO wall stiffening. However, the correlation within TAV patients between the age at curative reconstruction and descending AO PWV suggests that a prolonged period of abnormal hemodynamic exposure before reconstruction may result in increased AO vessel wall stiffening.