Coarctation of the Aorta Before and After Correction: The Role of Cardiovascular MRI
Eli Konen1,2,
Naeem Merchant1,
Yves Provost1,
Peter R. McLaughlin3,
Jane Crossin1 and
Narinder S. Paul1
1 Department of Diagnostic Imaging, Mount Sinai Hospital and the University
Health Network, 600 University Ave., Toronto, ON M5G 1X5, Canada.
2 Present address: Department of Diagnostic Imaging, Chaim Sheba Medical Center,
Tel Hashomer 52621, Israel.
3 Division of Cardiology, Congenital Cardiac Centre for Adults, University of
Toronto, University Health Network, Toronto, ON, Canada.
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Fig. 1A. —49-year-old man with native coarctation of aorta.
Volume-rendering (A) and maximal-intensity-projection (B)
reformations obtained from MR angiography delineate exact location of stenosis
(curved arrow), its spatial relationship with left subclavian artery
(asterisk), prominent and multiple collateral arteries in mediastinum
and posterior chest wall (small arrows), and large internal mammary
arteries (large arrows) bypassing coarctation.
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Fig. 1B. —49-year-old man with native coarctation of aorta.
Volume-rendering (A) and maximal-intensity-projection (B)
reformations obtained from MR angiography delineate exact location of stenosis
(curved arrow), its spatial relationship with left subclavian artery
(asterisk), prominent and multiple collateral arteries in mediastinum
and posterior chest wall (small arrows), and large internal mammary
arteries (large arrows) bypassing coarctation.
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Fig. 1C. —49-year-old man with native coarctation of aorta. Oblique
axial reformation from MR angiography along plane of maximal narrowing reveals
pinpoint (curved arrow) stenosis. Note prominent internal mammary
arteries (large arrows) and multiple mediastinal collateral vessels
(small arrows).
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Fig. 1D. —49-year-old man with native coarctation of aorta. Axial
T1-weighted double inversion recovery image obtained at level of
aortopulmonary window shows prominent intercostal (small arrows),
mediastinal (open arrows), and internal mammary (large
arrows) arteries.
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Fig. 2A. —25-year-old woman with native aortic coarctation combined
with inferior arch aneurysm and aberrant right subclavian artery. Sagittal
maximal-intensity-projection image obtained from MR angiography shows that
narrowed aortic segment (arrow) starts immediately distal to origin
of dilated left subclavian artery (asterisk) and associated inferior
bulging saccular aneurysm (dot), which most probably represents
aneurysm of ductus arteriosus stump.
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Fig. 2B. —25-year-old woman with native aortic coarctation combined
with inferior arch aneurysm and aberrant right subclavian artery. Posterior
image of volume-rendering reformation shows right aberrant subclavian artery
(arrows) arising distal to coarctation. Asterisk = dilated subclavian
artery.
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Fig. 2C. —25-year-old woman with native aortic coarctation combined
with inferior arch aneurysm and aberrant right subclavian artery.
Phase-contrast study obtained throughout neck shows retrograde flow in right
vertebral artery, indicating right subclavian steal syndrome. Magnitude image
(C on right), velocity-encoded image (C on left), and resulting
flow velocity graph (D) show opposite flow direction in right vertebral
artery (blue line) compared with left vertebral (white
line), right carotid (green line), and left carotid (red
line) arteries.
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Fig. 2D. —25-year-old woman with native aortic coarctation combined
with inferior arch aneurysm and aberrant right subclavian artery.
Phase-contrast study obtained throughout neck shows retrograde flow in right
vertebral artery, indicating right subclavian steal syndrome. Magnitude image
(C on right), velocity-encoded image (C on left), and resulting
flow velocity graph (D) show opposite flow direction in right vertebral
artery (blue line) compared with left vertebral (white
line), right carotid (green line), and left carotid (red
line) arteries.
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Fig. 2E. —25-year-old woman with native aortic coarctation combined
with inferior arch aneurysm and aberrant right subclavian artery.
Phase-contrast study was obtained throughout proximal descending thoracic
aorta just below coarctation. Both corresponding magnitude image (right) and
velocity-encoded image (left) are shown; the latter enabled computerized
analysis, which showed peak velocity of blood at that level to be almost 3
m/sec, suggesting significant pressure gradient throughout coarctation of 36
mm Hg.
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Fig. 3A. —44-year-old man with corrected coarctation (not shown) and
bicuspid aortic valve. Oblique axial image of cine MRI obtained in systole
shows two-leaflet aortic valve (arrows).
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Fig. 3B. —44-year-old man with corrected coarctation (not shown) and
bicuspid aortic valve. Magnification of A with computerized measurement
shows increased cross-sectional area of aortic valve, 4.8 cm2.
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Fig. 3C. —44-year-old man with corrected coarctation (not shown) and
bicuspid aortic valve. Phase-contrast study was obtained in oblique axial
plane above aortic valve. Magnitude image (C on right), velocity
encoded image (C on left), and resulting graph (D) of blood flow
during single R-R interval show large systolic flow (delineated by graph below
zero line) and slower diastolic flow in opposite direction (delineated by
graph above zero line), indicating aortic valve regurgitation. Relationship
between graph areas below and above zero enables quantification of
regurgitation.
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Fig. 3D. —44-year-old man with corrected coarctation (not shown) and
bicuspid aortic valve. Phase-contrast study was obtained in oblique axial
plane above aortic valve. Magnitude image (C on right), velocity
encoded image (C on left), and resulting graph (D) of blood flow
during single R-R interval show large systolic flow (delineated by graph below
zero line) and slower diastolic flow in opposite direction (delineated by
graph above zero line), indicating aortic valve regurgitation. Relationship
between graph areas below and above zero enables quantification of
regurgitation.
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Fig. 4A. —40-year-old man with patch correction aortoplasty for
coarctation and associated hypoplastic aortic arch. Sagittal (A) and
coronal (B) maximal-intensity-projection reformations from MR
angiography show narrowed aortic arch (large arrow, A)
measuring 8.8 x 13.5 mm and aneurysmal dilatation at level of patch
aortoplasty (small arrow, A).
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Fig. 4B. —40-year-old man with patch correction aortoplasty for
coarctation and associated hypoplastic aortic arch. Sagittal (A) and
coronal (B) maximal-intensity-projection reformations from MR
angiography show narrowed aortic arch (large arrow, A)
measuring 8.8 x 13.5 mm and aneurysmal dilatation at level of patch
aortoplasty (small arrow, A).
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Fig. 5. —45-year-old-man with native complex coarctation of aorta
(arrow) involving origin of left subclavian artery. Left common
carotid artery is missing. Maximal-intensity-projection reformation of MR
angiography shows dilated left subclavian (asterisk) and innominate
(dot) arteries. Note that only right internal mammary artery
(arrowheads) is dilated because of increased collateral flow. Left
internal mammary artery is of normal size because it originates from left
subclavian artery, which branches distal to aortic narrowing and thus does not
serve as collateral vessel. Left subclavian dilatation is presumably secondary
to poststenotic turbulence.
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Fig. 6A. —43-year-old-man with recoarctation after end-to-end repair of
aortic coarctation in childhood and associated ascending and descending
aortopathy. Right sagittal image of volume-rendering reformation from MR
angiography shows restenosis of aorta (arrow) and diffuse dilatation
of ascending (As) and descending (Ds) thoracic aorta, measuring on axial
images (not shown) 45 and 39 mm, respectively.
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Fig. 6B. —43-year-old-man with recoarctation after end-to-end repair of
aortic coarctation in childhood and associated ascending and descending
aortopathy. Cine MR image obtained throughout left ventricular outflow tract
in diastole shows dilated aortic root (between arrows) and dephasing
jet (arrowheads) through aortic valve toward left ventricle
(asterisk), indicating regurgitation.  = left atrium.
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Fig. 7A. —38-year-old-man with native complex coarctation associated
with partial anomalous pulmonary venous return and sinus atrial defect.
Sagittal maximum-intensity-projection reformation from MR angiography shows
pinpoint aortic coarctation.
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Fig. 7B. —38-year-old-man with native complex coarctation associated
with partial anomalous pulmonary venous return and sinus atrial defect.
Oblique coronal multiplanar reformations of venous phase show aberrant
pulmonary vein (PAPVR) (B) draining part of right lung into small right
superior vena cava (SVC) and associated left (Lt) persistent SVC
(C).
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Fig. 7C. —38-year-old-man with native complex coarctation associated
with partial anomalous pulmonary venous return and sinus atrial defect.
Oblique coronal multiplanar reformations of venous phase show aberrant
pulmonary vein (PAPVR) (B) draining part of right lung into small right
superior vena cava (SVC) and associated left (Lt) persistent SVC
(C).
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Fig. 8. —35-year-old-man with elephant trunk implantation for aortic
coarctation. Posterior image of volume-rendering reformation from MR
angiography shows interruption of distal aortic arch (Ar) and large graft (G)
connecting ascending with descending aorta (Ds). LA = left atrium, =
pulmonary veins.
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Fig. 9. —77-year-old-man with coarctation and end-to-end anastomosis
repair. Sagittal maximum-intensity-projection reformation from MR angiography
shows typical mild and nonsignificant waist at level of repair
(arrow). Phase-contrast studies (not shown) revealed normal peak
velocities at level of repair and no evidence of collateral flow. Note typical
distal origin of left subclavian artery, which was reimplanted during
surgery.
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Fig. 10A. —27-year-old-man with coarctation and tube graft repair
complicated by false aneurysm. Posterior image of volume-rendering reformation
from MR angiography shows false aneurysm arising at mid descending aorta at
distal end of graft.
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Fig. 10B. —27-year-old-man with coarctation and tube graft repair
complicated by false aneurysm. Angiogram obtained during endovascular stent
repair shows finding identical to that in A.
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Copyright © 2004 by the American Roentgen Ray Society.
