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. 2023 Jun 15;25(1):31.
doi: 10.1186/s12968-023-00941-0.

Comparison of aortic stiffness and hypertension in repaired coarctation patients with a bicuspid versus a tricuspid aortic valve

Kwannapas Saengsin  1   2 , Kimberlee Gauvreau  1   2 , Ashwin Prakash  3   4
Affiliations

Comparison of aortic stiffness and hypertension in repaired coarctation patients with a bicuspid versus a tricuspid aortic valve

Kwannapas Saengsin et al. J Cardiovasc Magn Reson. .

Abstract

Background: Coarctation of the aorta (COA) is associated with reduced aortic distensibility and systemic hypertension (HTN). 60-85% of COA patients have a bicuspid aortic valve (BAV). It is not known if the presence of a BAV accentuates the aortopathy and HTN in CoA patients. We examined whether patients with COA and a BAV had lower aortic distensibility by CMR, and a higher prevalence of systemic HTN compared with COA patients with a tricuspid aortic valve (TAV).

Methods: In successfully repaired COA patients excluding those with residual COA, ascending aorta (AAO) and descending aorta (DAO) distensibility was calculated by CMR. HTN was assessed using standard pediatric and adult criteria.

Results: Among 215 COA patients (median age 25.3 years), 67% had a BAV, and 33% had a TAV. Median AAO distensibility z-score was lower in the BAV group (- 1.2 versus - 0.7; p = 0.014) but DAO distensibility was similar in BAV and TAV patients. HTN prevalence was similar in BAV (32%) and TAV groups (36%, p = 0.56). On multivariable analysis controlling for confounders, HTN was not associated with BAV but was associated with male gender (p = 0.003) and older age at follow-up (p = 0.004).

Conclusions: In young adults with treated COA, those with a BAV had stiffer AAO compared to those with a TAV, but DAO stiffness was similar. HTN was not related to BAV. These results suggest that although the presence of a BAV in COA exacerbates the AAO aortopathy, it does not exacerbate the more generalized vascular dysfunction and associated HTN.

Keywords: Aortic dilation; Bicuspid aortic valve; Cardiac MRI; Coarctation of the aorta; Vascular stiffness.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Planimetry of the AAO and DAO to measure the CSA in both systole and diastole; b Cross-reference synchronized image of the oblique coronal left ventricular outflow tract used to select the slice that crosses the AAO at the widest perpendicular point at the level of the right pulmonary artery; c Cross-reference synchronized image of the oblique sagittal long-axis aortic arch perpendicular point at the level of the right pulmonary artery; d Cross-reference synchronized image of left ventricular outflow tract long-axis. AAO ascending aorta, CSA cross-sectional area, DAO descending
Fig. 2
Fig. 2
Summary of included and excluded patients
Fig. 3
Fig. 3
a Box plot comparing AAO distensibility in BAV and TAV patients; b Box plot comparing DAO distensibility in BAV and TAV patients; c Bar plot comparing prevalence of HTN in BAV and TAV patients. AAO ascending aorta, BAV bicuspid aortic valve, DAO descending, TAV tricuspid aortic valve
See this image and copyright information in PMC

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