MRI visualization of aortic recoarctation in the long-term period after surgery (case report)

Case study. Aortic coarctation refers to well-known and well-studied congenital malformations of the cardiovascular system. The success of cardiovascular surgery significantly increased the survival rate of patients, but, unfortunately, did not reduce the risks of serious cardiovascular complications in the long-term postoperative period. One of the significant complications remains recoarctation – repeated narrowing in the area of surgery, which can initiate other complications.
The purpose of the study: to present the features of blood flow in the aorta in a patient with aortic coarctation in the long-term postoperative period on the clinical example of a complex MR examination.
Material and methods. A 12-year-old patient, at the age of 6, she underwent balloon angioplasty of aortic coarctation. Echocardiographic data revealed a residual gradient at the isthmus of the aorta and expansion of the descending aorta. To clarify the diagnosis, MRI angiography of the heart was performed with intravenous contrast and the use of a cardiopackage for 4D flow analysis (4D flow).
Results and discussion. According to the MRI study, a narrowing of the distal aortic arch with aortic dilation after the departure of the left subclavian artery was revealed, which is confirmed by the obtained absolute values of blood flow indicators. MR-angiography of the aortic arch made it possible to visually determine the “gothic” shape of the aortic arch and present 3D reconstructions. 4D flow maps showed acceleration of blood flow to the systole in the area of aortic narrowing, additional vortex flow below the area of aortic narrowing and spiral flow in the descending aorta, which persisted throughout the diastole.
One explanation for the abnormal spiral flow in the descending thoracic aorta may be the presence of a “gothic” aortic arch. Also, residual hypoplasia of the aortic arch and narrowing of the isthmus are the leading parameters affecting the pathophysiology of changes in blood pressure during exercise.
Conclusion. The 4D-flow MR package in vivo makes it possible to study the flow geometry and blood flow parameters in detail, to obtain a detailed picture of the aortic condition, which gives potential advantages in a comprehensive examination of patients with aortic coarctation under dynamic observation.

1. Levchenko E.G., Svobodov А.А. Resection of coarctation of the aorta in children: the problem in the long term. Bulletin of Bakoulev Center for Cardiovascular Diseases. 2018; 19 (3): 271–279. http://doi.org/10.24022/1810-0694-2018-19-3-271-279 (In Russian)

2. Ilin A.S., Teplov P.V., Sakovich V.A. Aorta coarctation as a pathology of cardiovascular system. Our potential in surgery. Siberian Medical Review. 2018; 3: 24–33. http://doi.org/10.20333/2500136-2018-3-24-33 (In Russian)

3. Dias M.Q., Barros A., Leite-Moreira A., Miranda J.O. Risk factors for recoarctation and mortality in infants submitted to aortic coarctation repair: a systematic review. Pediatr. Cardiol. 2020; 41 (3): 561–575. http://doi.org/10.1007/s00246-020-02319-w

4. Dijkema E.J., Leiner T., Grotenhuis H.B. Diagnosis, imaging and clinical management of aortic coarctation. Heart. 2017; 103: 1148–55. http://doi.org/10.1136/heartjnl2017-311173

5. Hope M.D., Meadows A.K., Hope T.A. et al. Clinical evaluation of aortic coarctation with 4D flow MR imaging. J. Magn. Reson. Imaging. 2010; 31 (3): 711–718. http://doi.org/10.1002/jmri.22083

6. Yurpolskaya L.A., Shlyappo M.A., Makarenko V.N., Svobodov A.A., Levchenko E.G., Makarenko M.V. et al. 4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery. Kardiologiia. 2020; 60 (8): 54–64. (In Russian)

7. Ntsinjana H.N., Biglino G., Capelli C. et al. Aortic arch shape is not associated with hypertensive response to exercise in patients with repaired congenital heart diseases. J. Cardiovasc. Magn. Reson. 2013; 15 (1): 101. http://doi.org/10.1186/1532-429X-15-101