Rates and determinants of progressive aortic valve dysfunction in aortic coarctation

• Published in: International journal of cardiology Vol. 167; no. 6; pp. 2841 - 2845
• Main Authors: Luijendijk, Paul, Stevens, Arnaud W.J.M, de Bruin-Bon, Rianne H.A.C.M, Boekholdt, S. Matthijs, Vriend, Joris W.J, Vliegen, Hubert W, Bouma, Berto J, Mulder, Barbara J.M
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 10.09.2013; Elsevier
• Subjects: Adolescent; Adult; Aortic coarctation; Aortic Coarctation - diagnosis; Aortic Coarctation - epidemiology; Aortic dilatation; Aortic Valve; Aortic valve regurgitation; Aortic valve stenosis; Bicuspid aortic valve; Bicuspid Aortic Valve Disease; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Databases, Factual - trends; Disease Progression; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - epidemiology; Heart Valve Diseases - diagnosis; Heart Valve Diseases - epidemiology; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Registries; Young Adult; Aortic coarctation; Aortic dilatation; Aortic valve stenosis; Aortic valve regurgitation; Bicuspid aortic valve; Aortic stenosis; Cardiovascular disease; Aortic regurgitation; Arterial disease; Vascular disease; Cardiac valvular disease; Dilatation; Blood vessel; Aorta; Cardiology; Determinant; Rate; Congenital disease; Artery; Progressive; Malformation; Dysfunction; Circulatory system; Aortic valve; Aortic disease
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.07.028

Abstract Purpose Aortic valve dysfunction is common in coarctation patients(CoA). Bicuspid aortic valve (BAV) in CoA is associated with aortic valve stenosis (AS), aortic valve regurgitation (AR), and ascending aortic dilatation. The aim of this study was to evaluate the progression of and predictors for aortic valve dysfunction in CoA. Methods 96 CoA patients prospectively underwent echocardiography twice between 2001 and 2010. AS was defined as an aortic valve gradient ≥ 20 mm Hg, AR as none/minor, or moderate/severe. Aortic dilatation as an ascending aortic diameter ≥ 37 mm. Results All patients (median age 28.0 years, range 17–61 years; male 57%) were followed with a median follow-up of 7.0 years. Sixty patients (63%) had BAV. At baseline 10 patients had AS (10%, 9 BAV), 6 patients AR (6%, 3 BAV) and 11 patients aortic dilatation (11%, 11 BAV). At follow-up 15 patients had AS (15%, 13 BAV) and 12 patients AR. (13%, 8 BAV). Median AS progression was 1.1 mm Hg/5 years (range — 13–28). Determinants for AS at follow-up were age (ß = 0.20, P = 0.01), aortic dilatation (ß = 4.6, P = 0.03), and baseline aortic valve gradient (ß = 0.93, P < 0.001). BAV was predictive for AR. (ß = 0.91, P = 0.049). Conclusion Progression of AS in adult CoA patients is mild in this young population. Older age, aortic dilatation and the baseline aortic valve gradient are determinants for AS at follow-up. BAV is predictive for AR. These findings point towards a common embryological pathway of both valvular and aortic disease in CoA.