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|Number 10-18: Aortic Coarctation Repair with Associated Bicuspid Aortic Valve|
Number 10-18: Aortic Coarctation Repair with Associated Bicuspid Aortic Valve
Case from: Camastra GS, Cacciotti L, Sbarbati S, Danti M, Marconi F, Della Sala WS, Ansalone G
Clinical history: A 30 year old male with native coarctation of the aorta was referred for breathlessness and uncontrolled hypertension. He was noted to have elevated blood pressures in his bilateral arms and hypotension in his legs. Echocardiography revealed a bicuspid aortic valve with dilated aortic root and a coarctation of the descending thoracic aorta with a pressure gradient of 60 mmHg. The patient was referred for MRI to further define the anatomic location of the coarctation. Following the scan the decision was made to proceed with percutaneuos intervention of the coarctation.
Movie 1: Bicuspid aortic valve Movie 2: Dilated aortic root
CINE CMR: Short axis and coronal SSFP were performed to demonstrate the bicuspid aortic valve (Movie 1) and proximal aorta (Movie 2).
Movie 3: MRA Coarctation pre stent Movie 4: MRA Coarctation post stent
3D Contrast enhanced MRA: Coarctation of the descending thoracic aorta distal to the left subclavian artery is demonstrated (Movie 3). Following stent placement there is signal loss within the lumen although minimal residual stenosis is present (Movie 4). The enlarged still images below show the coarctation before (Figure 1A, 1C) and after stenting (Figure 1B, 1D). Note minimal artifact created outside of the stent and reduction of signal enhancment within.
Figure 1: Enlarged MRA Pre and post stenting of coarctation
Perspective: Coarctation of the aorta is a relatively common defect that occurs in approximately 6-8 % of patients with congenital heart disease and is commonly associated with a bicuspid aortic valve. Intravascular stents are finding increased applications in the treatment of patients with native coarctation of the aorta and percutaneous intervention is a reasonable alternative to surgical correction. 4D flow MR imaging has shown promise in the evaluation of both the clinical significance of the coarctation through the demonstration of collateral blood flow and the persistence of helical flow after coarctation repair.
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