Skip to main content
×
×
Home

Assessment of cerebral blood flow in adult patients with aortic coarctation

  • Rachel Wong (a1), Waheed Ahmad (a2), Allan Davies (a2), Neil Spratt (a1) (a3) (a4), Andrew Boyle (a2), Christopher Levi (a2) (a4), Peter Howe (a1) and Nicholas Collins (a2)...
Abstract
Background

Survival into adult life in patients with aortic coarctation is typical following surgical and catheter-based techniques to relieve obstruction. Late sequelae are recognised, including stroke, hypertension, and intracerebral aneurysm formation, with the underlying mechanisms being unclear. We hypothesised that patients with a history of aortic coarctation may have abnormalities of cerebral blood flow compared with controls.

Methods

Patients with a history of aortic coarctation underwent assessment of cerebral vascular function. Vascular responsiveness of intracranial vessels to hypercapnia and degree of cerebral artery stiffness using Doppler-derived pulsatility indices were used. Response to photic stimuli was used to assess neurovascular coupling, which reflects endothelial function in response to neuronal activation. Patient results were compared with age- and sex-matched controls.

Results

A total of 13 adult patients (males=10; 77%) along with 13 controls underwent evaluation. The mean age was 36.1±3.7 years in the patient group. Patients with a background of aortic coarctation were noted to have increased pulse pressure on blood pressure assessment at baseline with increased intracranial artery stiffness compared with controls. Patients with a history of aortic coarctation had less reactive cerebral vasculature to hypercapnic stimuli and impaired neurovascular coupling compared with controls.

Results

Adult patients with aortic coarctation had increased intracranial artery stiffness compared with controls, in addition to cerebral vasculature showing less responsiveness to hypercapnic and photic stimuli. Further studies are required to assess the aetiology and consequences of these documented abnormalities in cerebral blood flow in terms of stroke risk, cerebral aneurysm formation, and cognitive dysfunction.

Copyright
Corresponding author
Correspondence to: N. Collins, Cardiovascular Unit, John Hunter Hospital, Newcastle, New South Wales 2305, Australia. Tel: +61 249214277; Fax: +61 249214210; E-mail: Nicholas.Collins@hnehealth.nsw.gov.au
References
Hide All
1. Brickner, ME, Hillis, LD, Lange, RA. Congenital heart disease in adults. First of two parts. N Engl J Med 2000; 342: 256263.
2. Celermajer, DS, Greaves, K. Survivors of coarctation repair: fixed but not cured. Heart 2002; 88: 113114.
3. de Divitiis, M, Rubba, P, Calabro, R. Arterial hypertension and cardiovascular prognosis after successful repair of aortic coarctation: a clinical model for the study of vascular function. Nutr Metab Cardiovasc Dis 2005; 15: 382394.
4. Hauser, M. Exercise blood pressure in congenital heart disease and in patients after coarctation repair. Heart 2003; 89: 125126.
5. Connolly, HM, Huston, J III, Brown, RD Jr, Warnes, CA, Ammash, NM, Tajik, AJ. Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients. Mayo Clin Proc 2003; 78: 14911499.
6. Rosenthal, E. Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart 2005; 91: 14951502.
7. Lanz, J, Brophy, JM, Therrien, J, Kaouache, M, Guo, L, Marelli, AJ. Stroke in adults with congenital heart disease: incidence, cumulative risk, and predictors. Circulation 2015; 132: 23852394.
8. van Sloten, TT, Sedaghat, S, Laurent, S, et al. Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis. J Am Coll Cardiol 2015; 66: 21162125.
9. Selvaraj, S, Steg, PG, Elbez, Y, et al. Pulse pressure and risk for cardiovascular events in patients with atherothrombosis: from the REACH Registry. J Am Coll Cardiol 2016; 67: 392403.
10. Chobanian, AV, Bakris, GL, Black, HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 12061252.
11. Tegeler, CH, Crutchfield, K, Katsnelson, M, et al. Transcranial Doppler velocities in a large, healthy population. J Neuroimaging 2013; 23: 466472.
12. Nagai, H, Moritake, K, Takaya, M. Correlation between transcranial Doppler ultrasonography and regional cerebral blood flow in experimental intracranial hypertension. Stroke 1997; 28: 603608.
13. Bude, RO, Rubin, JM. Relationship between the resistive index and vascular compliance and resistance. Radiology 1999; 211: 411417.
14. Wijnhoud, AD, Koudstaal, PJ, Dippel, DW. The prognostic value of pulsatility index, flow velocity, and their ratio, measured with TCD ultrasound, in patients with a recent TIA or ischemic stroke. Acta Neurol Scand 2011; 124: 238244.
15. Wong, RHX, Nealon, RS, Scholey, A, Howe, PRC. Low dose resveratrol improves cerebrovascular function in type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2016; 26: 393399.
16. Spelsberg, B, Bohning, A, Kompf, D, Kessler, C. Visually induced reactivity in posterior cerebral artery blood flow. J Neuroophthalmol 1998; 18: 263267.
17. Cohen, M, Fuster, V, Steele, PM, Driscoll, D, McGoon, DC. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840845.
18. LaDisa, JF Jr, Dholakia, RJ, Figueroa, CA, et al. Computational simulations demonstrate altered wall shear stress in aortic coarctation patients treated by resection with end-to-end anastomosis. Congenit Heart Dis 2011; 6: 432443.
19. Chalouhi, N, Hoh, BL, Hasan, D. Review of cerebral aneurysm formation, growth, and rupture. Stroke 2013; 44: 36133622.
20. Schievink, WI, Mokri, B, Piepgras, DG, Gittenberger-de Groot, AC. Intracranial aneurysms and cervicocephalic arterial dissections associated with congenital heart disease. Neurosurgery 1996; 39: 685689; discussion 689–690.
21. Reinhard, M, Schwarzer, G, Briel, M, et al. Cerebrovascular reactivity predicts stroke in high-grade carotid artery disease. Neurology 2014; 83: 14241431.
22. Gardiner, HM, Celermajer, DS, Sorensen, KE, et al. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 1994; 89: 17451750.
23. Gidding, SS, Rocchini, AP, Moorehead, C, Schork, MA, Rosenthal, A. Increased forearm vascular reactivity in patients with hypertension after repair of coarctation. Circulation 1985; 71: 495499.
24. de Divitiis, M, Pilla, C, Kattenhorn, M, et al. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol 2003; 41: 22592265.
25. de Divitiis, M, Pilla, C, Kattenhorn, M, et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 2001; 104: I165I170.
26. Rinnstrom, D, Dellborg, M, Thilen, U, et al. Left ventricular hypertrophy in adults with previous repair of coarctation of the aorta; association with systolic blood pressure in the high normal range. Int J Cardiol 2016; 218: 5964.
27. Silvestrini, M, Pasqualetti, P, Baruffaldi, R, et al. Cerebrovascular reactivity and cognitive decline in patients with Alzheimer disease. Stroke 2006; 37: 10101015.
28. Gaynor, JW, Stopp, C, Wypij, D, et al. Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 2015; 135: 816825.
29. Li, Y, Yin, S, Fang, J, et al. Neurodevelopmental delay with critical congenital heart disease is mainly from prenatal injury not infant cardiac surgery: current evidence based on a meta-analysis of functional magnetic resonance imaging. Ultrasound Obstet Gynecol 2015; 45: 639648.
30. Hsia, TY, Gruber, PJ. Factors influencing neurologic outcome after neonatal cardiopulmonary bypass: what we can and cannot control. Ann Thorac Surg 2006; 81: S2381S2388.
31. Dormanns, K, Brown, RG, David, T. The role of nitric oxide in neurovascular coupling. J Theor Biol 2016; 394: 117.
32. Cook, SC, Hickey, J, Maul, TM, et al. Assessment of the cerebral circulation in adults with coarctation of the aorta. Congenit Heart Dis 2013; 8: 289295.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 2
Total number of PDF views: 73 *
Loading metrics...

Abstract views

Total abstract views: 322 *
Loading metrics...

* Views captured on Cambridge Core between 1st June 2017 - 15th August 2018. This data will be updated every 24 hours.