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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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References

1. Brickner, ME, Hillis, LD, Lange, RA. Congenital heart disease in adults. First of two parts. N Engl J Med 2000; 342: 256–263.Google Scholar
2. Celermajer, DS, Greaves, K. Survivors of coarctation repair: fixed but not cured. Heart 2002; 88: 113–114.Google Scholar
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: 382–394.Google Scholar
4. Hauser, M. Exercise blood pressure in congenital heart disease and in patients after coarctation repair. Heart 2003; 89: 125–126.CrossRefGoogle ScholarPubMed
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: 1491–1499.Google Scholar
6. Rosenthal, E. Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart 2005; 91: 1495–1502.Google Scholar
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: 2385–2394.Google Scholar
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: 2116–2125.Google Scholar
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: 392–403.CrossRefGoogle ScholarPubMed
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: 1206–1252.CrossRefGoogle ScholarPubMed
11. Tegeler, CH, Crutchfield, K, Katsnelson, M, et al. Transcranial Doppler velocities in a large, healthy population. J Neuroimaging 2013; 23: 466–472.Google Scholar
12. Nagai, H, Moritake, K, Takaya, M. Correlation between transcranial Doppler ultrasonography and regional cerebral blood flow in experimental intracranial hypertension. Stroke 1997; 28: 603–608.CrossRefGoogle ScholarPubMed
13. Bude, RO, Rubin, JM. Relationship between the resistive index and vascular compliance and resistance. Radiology 1999; 211: 411–417.CrossRefGoogle ScholarPubMed
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: 238–244.Google Scholar
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: 393–399.Google Scholar
16. Spelsberg, B, Bohning, A, Kompf, D, Kessler, C. Visually induced reactivity in posterior cerebral artery blood flow. J Neuroophthalmol 1998; 18: 263–267.Google Scholar
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: 840–845.Google Scholar
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: 432–443.Google Scholar
19. Chalouhi, N, Hoh, BL, Hasan, D. Review of cerebral aneurysm formation, growth, and rupture. Stroke 2013; 44: 3613–3622.Google Scholar
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: 685–689; discussion 689–690.Google Scholar
21. Reinhard, M, Schwarzer, G, Briel, M, et al. Cerebrovascular reactivity predicts stroke in high-grade carotid artery disease. Neurology 2014; 83: 1424–1431.Google Scholar
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: 1745–1750.Google Scholar
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: 495–499.Google Scholar
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: 2259–2265.Google Scholar
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: I165–I170.Google Scholar
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: 59–64.Google Scholar
27. Silvestrini, M, Pasqualetti, P, Baruffaldi, R, et al. Cerebrovascular reactivity and cognitive decline in patients with Alzheimer disease. Stroke 2006; 37: 1010–1015.Google Scholar
28. Gaynor, JW, Stopp, C, Wypij, D, et al. Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 2015; 135: 816–825.Google Scholar
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: 639–648.CrossRefGoogle Scholar
30. Hsia, TY, Gruber, PJ. Factors influencing neurologic outcome after neonatal cardiopulmonary bypass: what we can and cannot control. Ann Thorac Surg 2006; 81: S2381–S2388.Google Scholar
31. Dormanns, K, Brown, RG, David, T. The role of nitric oxide in neurovascular coupling. J Theor Biol 2016; 394: 1–17.Google Scholar
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: 289–295.CrossRefGoogle ScholarPubMed