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Assessment of cerebral blood flow in adult patients with aortic coarctation

Published online by Cambridge University Press:  01 June 2017

Rachel Wong ,
Waheed Ahmad ,
Allan Davies ,
Neil Spratt ,
Andrew Boyle ,
Christopher Levi ,
Peter Howe  and
Nicholas Collins
Rachel Wong
Affiliation:
School of Biomedical Science and Pharmacy, University of Newcastle, New South Wales, Australia
Waheed Ahmad
Affiliation:
Cardiovascular UnitJohn Hunter Hospital, Hunter New England, Australia
Allan Davies
Affiliation:
Cardiovascular UnitJohn Hunter Hospital, Hunter New England, Australia
Neil Spratt
Affiliation:
School of Biomedical Science and Pharmacy, University of Newcastle, New South Wales, Australia Department of Neurology, John Hunter Hospital, Hunter New England, Australia Priority Research Centre for Stroke and Brain Injury, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia
Andrew Boyle
Affiliation:
Cardiovascular UnitJohn Hunter Hospital, Hunter New England, Australia
Christopher Levi
Affiliation:
Cardiovascular UnitJohn Hunter Hospital, Hunter New England, Australia Priority Research Centre for Stroke and Brain Injury, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia
Peter Howe
Affiliation:
School of Biomedical Science and Pharmacy, University of Newcastle, New South Wales, Australia
Nicholas Collins*
Affiliation:
Cardiovascular UnitJohn Hunter Hospital, Hunter New England, Australia
*
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
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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.

Keywords

Aortic coarctationCHDstrokehypertensioncerebral aneurysm
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1606 - 1613
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Copyright
© Cambridge University Press 2017 

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