Magnetic resonance imaging in long-term assessment after surgery for aortic coarctation

• Published in: Anales de pediatría (Barcelona, Spain : 2003) Spain : 2003), 2007-10, Vol.67 (4), p.319-328
• Main Authors: Cabrera Duro, A, Galdeano Miranda, J M, Cabrera-Zubizarreta, A, Pastor Menchaca, E, Rodrigo Carbonero, D, Alcibar Villa, J, García, M Luis, Sáez Garmendía, F, Aramendi Gallardo, J I
• Format: Article
• Language: Spanish
• Subjects: Aortic Aneurysm - pathology; Aortic Aneurysm - surgery; Aortic Coarctation - pathology; Aortic Coarctation - surgery; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Postoperative Period; Time Factors
• ISSN: 1695-4033

Spin echo or gradient echo magnetic resonance imaging provides enough information to plan patient management and can be completed with the use of three-dimensional magnetic resonance angiography to evaluate the need for reintervention, assess follow-up, or discharge the patient. From 1990-2003, we evaluated 101 patients after initial corrective surgery for aortic coarctation at the age of 3.1 +/- 3 years, with subsequent postoperative assessment at 1 year and again 12.4 +/- 4.2 years later. No mortality was registered during the follow-up. Corrective surgery was performed in 32 patients (31.6 %) before the first month of life. All the patients were evaluated with spin-echo and echo gradient and 34 were evaluated with magnetic resonance angiography. The patients were classified into two groups: group A consisted of 68 patients (11 < 1 month old) with no complications. End-to-end anastomosis was performed in 55, the Alvarez technique in five, the Waldhausen technique in six, and conduit in two. Group B consisted of 33 patients complicated with early aortic recoarctation (21 corrected before the age of 1 month). End-to-end anastomosis was performed in 29, the Alvarez technique in two, and grafting in two. During the follow-up, 43 reinterventions were performed. Isthmus diameter/descending aorta diameter at the diaphragmatic level and repaired site diameter/descending aorta diameter at the diaphragmatic level were measured. Group A: the isthmus diameter/descending aorta diameter at the diaphragmatic level index was 0.92 +/- 0.08 and the repaired site diameter/ descending aorta diameter at diaphragmatic level index was 0.90 +/- 0.05. Twenty-three patients were assessed by means of three-dimensional magnetic resonance angiography, which revealed two late stenosis (one in a 10-year-old patient with an end-to-end anastomosis performed previously, and another in an 18-year-old patient with a proximal and distal obstructed conduit). Group B: the isthmus diameter/descending aorta diameter index was 0.84 +/- 0.1 and the repaired site diameter/ descending aorta diameter index was 0.82 +/- 0.11. Eleven patients were assessed by means of three-dimensional magnetic resonance angiography, which revealed five stenosis indexes (0.53-0.73) surgically corrected before the age of 2 months, four with an initial technique based on end-to-end anastomosis and one with a graft. Our results support the influence of young age, the use of end-to-end anastomosis and grafts in recoarctat