How successful is successful? Aortic arch shape after successful aortic coarctation repair correlates with left ventricular function

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• 作者：Jan L. Bruse ; MSc^a ; Abbas Khushnood ; MD^a ; Kristin McLeod ; PhD^b ; ^c ; Giovanni Biglino ; PhD^a ; Maxime Sermesant ; PhD^c ; Xavier Pennec ; PhD^c ; Andrew M. Taylor ; MD^a ; Tain-Yen Hsia ; MD^a ; ^{hsiat@gosh.nhs.uk} ; Silvia Schievano ; PhD^a ; for the Modeling of Congenital Hearts Alliance Collaborative Group^&lowast ; ; Andrew M. Taylor ; Sachin Khambadkone ; Silvia Schievano ; Marc de Leval ; Tain-Yen Hsia ; Edward Bove ; Adam Dorfman ; G. Hamilton Baker ; Anthony Hlavacek ; Francesco Migliavacca ; Giancarlo Pennati ; Gabriele Dubini ; Alison Marsden ; Irene Vignon-Clementel ; Richard Figliola
• 关键词：coarcation of the aorta ; shape analysis ; aortic arch
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：153
• 期：2
• 页码：418-427
• 全文大小：1368 K
• 卷排序：153

文摘

Even after successful aortic coarctation repair, there remains a significant incidence of late systemic hypertension and other morbidities. Independently of residual obstruction, aortic arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch 3-dimensional shape features with functional data obtained from cardiac magnetic resonance scans.MethodsThree-dimensional aortic arch shape models of 53 patients (mean age, 22.3 ± 5.6 years) 12 to 38 years after aortic coarctation repair were reconstructed from cardiac magnetic resonance data. A novel validated statistical shape analysis method computed a 3-dimensional mean anatomic shape of all aortic arches and calculated deformation vectors of the mean shape toward each patient's arch anatomy. From these deformations, 3-dimensional shape features most related to left ventricular ejection fraction, indexed left ventricular end-diastolic volume, indexed left ventricular mass, and resting systolic blood pressure were extracted from the deformation vectors via partial least-squares regression.ResultsDistinct arch shape features correlated significantly with left ventricular ejection fraction (r = 0.42, P = .024), indexed left ventricular end-diastolic volume (r = 0.65, P < .001), and indexed left ventricular mass (r = 0.44, P = .014). Lower left ventricular ejection fraction, larger indexed left ventricular end-diastolic volume, and increased indexed left ventricular mass were identified with an aortic arch shape that has an elongated ascending aorta with a high arch height-to-width ratio, a relatively short proximal transverse arch, and a relatively dilated descending aorta. High blood pressure seemed to be linked to gothic arch shape features, but this did not achieve statistical significance.ConclusionsIndependently of hemodynamically important arch obstruction or residual aortic coarctation, specific aortic arch shape features late after successful aortic coarctation repair seem to be associated with worse left ventricular function. Analyzing 3-dimensional shape information via statistical shape modeling can be an adjunct to long-term risk assessment in patients after aortic coarctation repair.