Skip to main content
SpringerLink
Log in

Coarctation of the aorta: pre and postoperative evaluation with MRI and MR angiography; correlation with echocardiography and surgery

  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Aims

To compare MRI and MRA with Doppler-echocardiography (DE) in native and postoperative aortic coarctation, define the best MR protocol for its evaluation, compare MR with surgical findings in native coarctation.

Materials and methods

136 MR studies were performed in 121 patients divided in two groups: Group I, 55 preoperative; group II, 81 postoperative. In group I, all had DE and surgery was performed in 35 cases. In group II, DE was available for comparison in 71 cases. MR study comprised: spin-echo, cine, velocity-encoded cine (VEC) sequences and 3D contrast-enhanced MRA.

Results

In group I, diagnosis of coarctation was made by DE in 33 cases and suspicion of coarctation and/or aortic arch hypoplasia in 18 cases. Aortic arch was not well demonstrated in 3 cases and DE missed one case. There was a close correlation between VEC MRI and Doppler gradient estimates across the coarctation, between MRI aortic arch diameters and surgery but a poor correlation in isthmic measurements. In group II, DE detected a normal isthmic region in 31 out of 35 cases. Postoperative anomalies (recoarctation, aortic arch hypoplasia, kinking, pseudoaneurysm) were not demonstrated with DE in 50% of cases.

Conclusions

MRI is superior to DE for pre and post-treatment evaluation of aortic coarctation. An optimal MR protocol is proposed. Internal measurement of the narrowing does not correspond to the external aspect of the surgical narrowing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

3D CE MRA:

three-dimensional contrast-enhanced Magnetic Resonance Angiography

BFFE:

balanced fast field-echo sequence

Cine MIP:

cine maximum intensity projection

CT:

Computed Tomography

DE:

Doppler Echocardiography

GE:

gradient-echo sequence

MIP:

maximum intensity projection

MPR:

multiplanar reformatting

MR:

Magnetic Resonance

MRI:

Magnetic Resonance Imaging

SR:

surface rendering

VEC MRI:

velocity-encoded cine Magnetic Resonance Imaging

VR:

volume rendering

References

  1. 1. Sechtem U (1995). Imaging of aortic coarctation; difficult choices. Eur Heart J 16:1315–1316

    PubMed  CAS  Google Scholar 

  2. 2. Engvall J, Sjoqvist L, Nylander E, Thuomas KA, Wranne B (1995). Biplane transoesophageal echocardiography, transthoracic Doppler, and magnetic resonance imaging in the assessment of coarctation of the aorta. Eur Heart J 16:1399–1409

    PubMed  CAS  Google Scholar 

  3. 3. Amparo EG, Higgins CB, Schafton EG (1984). Demonstration of coarctation of the aorta by magnetic resonance imaging. AJR 143:1192–1194

    PubMed  CAS  Google Scholar 

  4. 4. Didier D, Higgins CB, Fisher MR, Osaki L, Silvermann NH, Cheitlin MD (1986). Gated magnetic resonance imaging in congenital heart disease: experience in initial 72 patients. Radiology 158:227–235

    PubMed  CAS  Google Scholar 

  5. 5. Von Schultess GK, Higashino S, Higgins S, Didier D, Fisher M, Higgins CB (1986). Coarctation of the aorta: MR Imaging. Radiology 158:469–474

    PubMed  Google Scholar 

  6. 6. Mohiaddin RH, Kilner PJ, Rees S, Longmore DB (1993). Magnetic resonance volume flow and jet velocity mapping in aortic coarctation. J Am Coll Cardiol 22:1515–1521

    PubMed  CAS  Google Scholar 

  7. 7. Powell AJ, Geva T (2000). Blood flow measurement by magnetic resonance imaging in congenital heart disease. Pediatr Cardiol. 21:47–58

    Article  PubMed  CAS  Google Scholar 

  8. 8. Bogren HG, Buonocore MH (1994). Blood flow measurements in the aorta and major arteries with MR velocity mapping. JMRI 4:119–130

    Article  PubMed  CAS  Google Scholar 

  9. 9. Prince MR, Narasimham DL, Jacoby WT et al (1996). Three-dimensional gadolinium-enhanced MR angiography of the thoracic aorta. AJR 166:1387–1397

    PubMed  CAS  Google Scholar 

  10. 10. Krinsky GA, Rofsky NM, Flyer M et al (1997). Thoracic aorta: comparison of Gadolinium-enhanced three-dimensional MR angiography and conventional MR imaging. Radiology 202:183–193

    PubMed  CAS  Google Scholar 

  11. 11. Smith Maia MM, Cortes TM, Parga JR, et al (2004). Evolutional aspects of children and adolescents with surgically corrected aortic coarctation: clinical, echocardiographic, and magnetic resonance image analysis of 113 patients. J Thorac Cardiovasc Surg. 127:712–20

    Article  PubMed  Google Scholar 

  12. 12. Muhler EG, Neuerburg JM, Ruben A, et al (1993). Evaluation of aortic coarctation after surgical repair: role of magnetic resonance imaging and Doppler ultrasound. Br Heart J. 70:285–90

    Article  PubMed  CAS  Google Scholar 

  13. 13. Bogaert J, Kuzo R, Dymarkowski S, et al (2000). Follow-up of patients with previous treatment for coarctation of the thoracic aorta: comparison between contrast-enhanced MR angiography and fast spin-echo MR imaging. Eur Radiol. 10:1847–54

    Article  PubMed  CAS  Google Scholar 

  14. 14. Didier D, Ratib O, Friedli B, et al (1993). Cine gradient-echo MR imaging in the evaluation of cardiovascular diseases. RadioGraphics 13:561–573

    CAS  Google Scholar 

  15. 15. Didier D, Ratib O, Beghetti M, Oberhaensli I, Friedli B (1999). Morphologic and functional evaluation of congenital heart disease by magnetic resonance imaging. J Magn Reson Imaging. 10:639–55

    Article  PubMed  CAS  Google Scholar 

  16. 16. Lim DS, Ralston MA (2002). Echocardiographic indices of Doppler flow patterns compared with MRI or angiographic measurements to detect significant coarctation of the aorta. Echocardiography. 19:55–60

    Article  PubMed  Google Scholar 

  17. 17. Carvalho JS, Redington AN, Shinebourne EA, Rigby ML, Gibson D (1990). Continuous wave Doppler echocardiography and coarctation of the aorta: gradients and flow patterns in the assessment of severity. Br Heart J. 64:133–7

    Article  PubMed  CAS  Google Scholar 

  18. 18. Glancy DL, Morrow AG, Simon AL, Roberts WC (1983). Juxtaductal aortic coarctation Analysis of 84 patients studied hemodynamically, angiographically, and morphologically after age 1 year. Am J Cardiol. 51:537–51

    Article  PubMed  CAS  Google Scholar 

  19. 19. Pinzon JL, Burrows PE, Benson LN, et al (1991). Repair of coarctation of the aorta in children: postoperative morphology. Radiology 180:199–203

    PubMed  CAS  Google Scholar 

  20. 20. Bogaert J, Gewillig M, Rademakers F, et al (1995). Transverse arch hypoplasia predisposes to aneurysm formation at the repair site after patch angioplasty for coarctation of the aorta. J Am Coll Cardiol. 26:521–7

    Article  PubMed  CAS  Google Scholar 

  21. 21. Gutberlet M, Hosten N, Vogel M, et al (2001). Quantification of morphologic and hemodynamic severity of coarctation of the aorta by magnetic resonance imaging. Cardiol Young. 11:512–20

    Article  PubMed  CAS  Google Scholar 

  22. 22. Soler R, Rodriguez E, Requejo I, Fernandez R, Raposo I (1998). Magnetic resonance imaging of congenital abnormalities of the thoracic aorta. Eur Radiol. 8:540–6

    Article  PubMed  CAS  Google Scholar 

  23. 23. Weinberg PM, Fogel MA (1998). Cardiac MR imaging in congenital heart disease. Cardiol Clin. 16:315–48

    Article  PubMed  CAS  Google Scholar 

  24. 24. Greenberg SB, Marks LA, Eshaghpour EE (1997). Evaluation of magnetic resonance imaging in coarctation of the aorta: the importance of multiple imaging planes. Pediatr Cardiol. 18:345–9

    Article  PubMed  CAS  Google Scholar 

  25. 25. Simpson IA, Chung KJ, Glass RF, Sahn DJ, Sherman FS, Hesselink J (1988). Cine magnetic resonance imaging for evaluation of anatomy and flow relations in infants and children with coarctation of the aorta. Circulation. 78:142–8

    PubMed  CAS  Google Scholar 

  26. 26. Castillo E, Lima JA, Bluemke DA (2003). Regional myocardial function: advances in MR imaging and analysis. Radiographics 23:S127–40

    Article  PubMed  Google Scholar 

  27. 27. Di Cesare E, Giordano AV, Cerone G, Splendiani A, Michelini O, Masciocchi C (1999). 3-dimensional magnetic resonance angiography in apnea with the rapid infusion of a paramagnetic contrast medium in studying the thoracic aorta. Radiol Med 98:361–7

    CAS  PubMed  Google Scholar 

  28. 28. Ho VB, Prince MR (1998). Thoracic MR aortography: imaging techniques and strategies. Radiographics 18:287–309

    PubMed  CAS  Google Scholar 

  29. 29. Godart F, Labrot G, Devos P, McFadden E, Rey C, Beregi JP (2002). Coarctation of the aorta: comparison of aortic dimensions between conventional MR imaging, 3D MR angiography, and conventional angiography. Eur Radiol. 12:2034–9

    PubMed  Google Scholar 

  30. 30. Okuda S, Kikinis R, Geva T, Chung T, Dumanil H, Powell AJ (2000). 3D-shaded surface rendering of gadolinium-enhanced MR angiography in congenital heart disease. Pediatr Radiol. 30:540–5

    Article  PubMed  CAS  Google Scholar 

  31. 31. Stern HC, Locher D, Wallnofer K, et al (1991). Noninvasive assessment of coarctation of the aorta: comparative measurements by two-dimensional echocardiography, magnetic resonance, and angiography. Pediatr Cardiol. 12:1–5

    Article  PubMed  CAS  Google Scholar 

  32. 32. Mendelsohn AM, Banerjee A, Donnelly LF, Schwartz DC (1997). Is echocardiography or magnetic resonance imaging superior for precoarctation angioplasty evaluation?. Cathet Cardiovasc Diagn. 42:26–30

    Article  PubMed  CAS  Google Scholar 

  33. 33. Rebergen SA, van der Wall EE, Doornbos J, et al (1993). Magnetic resonance measurements of velocity and flow: Technique, validation and cardiovascular applications. Am Heart J 126:1439–1456

    Article  PubMed  CAS  Google Scholar 

  34. 34. Bogren HG, Buonocore MH (1994). Blood flow measurements in the aorta and major arteries with MR velocity mapping. J Magn Reson Imaging 4:119–30

    Article  PubMed  CAS  Google Scholar 

  35. 35. Szolar DH, Sakuma H, Higgins CB (1996). Cardiovascular applications of magnetic resonance flow and velocity measurements. J Magn Reson Imaging. 6:78–89

    Article  PubMed  CAS  Google Scholar 

  36. 36. Firmin D, Underwood R (1991). Magnetic resonance flow imaging. In: Underwood R, Firmin D (eds), Magnetic Resonance of the cardiovascular system. Blackwell Scientific Publications, Oxford

    Google Scholar 

  37. 37. Higgins CB, Sakuma H (1996). Heart disease: Functional evaluation with MR imaging. Radiology 199:307–315

    PubMed  CAS  Google Scholar 

  38. 38. Mohiaddin RH, Pennell DJ (1998). MR blood flow measurement. Clinical application in the heart and circulation. Cardiol Clin 16:161–187

    Article  PubMed  CAS  Google Scholar 

  39. 39. Henk CB, Grampp S, Koller J, et al (2002). Elimination of errors caused by first-order aliasing in velocity encoded cine-MR measurements of postoperative jets after aortic coarctation: in vitro and in vivo validation. Eur Radiol. 12:1523–31

    Article  PubMed  Google Scholar 

  40. 40. Marx GR, Allen HD (1986). Accuracy and pitfalls of Doppler evaluation of the pressure gradient in aortic coarctation. J Am Coll Cardiol. 7:1379–85

    PubMed  CAS  Google Scholar 

  41. 41. Levine RA, Jimoh A, Cape EG, McMillan S, Yoganathan AP, Weyman AE (1989). Pressure recovery distal to a stenosis: potential cause of gradient “overestimation” by Doppler echocardiography. J Am Coll Cardiol. 13:706–15

    Article  PubMed  CAS  Google Scholar 

  42. 42. Holmqvist C, Stahlberg F, Hanseus K, et al (2002). Collateral flow in coarctation of the aorta with magnetic resonance velocity mapping: correlation to morphological imaging of collateral vessels. J Magn Reson Imaging. 15:39–46

    Article  PubMed  Google Scholar 

  43. 43. Steffens JC, Bourne MW, Sakuma H, O’Sullivan M, Higgins CB (1994). Quantification of collateral blood flow in coarctation of the aorta by velocity encoded cine magnetic resonance imaging. Circulation. 90:937–43

    PubMed  CAS  Google Scholar 

  44. 44. Dodge-Khatami A, Backer CL, Mavroudis C (2000). Risk factors for recoarctation and results of reoperation: a 40-year review. J Card Surg. 15:369–77

    Article  PubMed  CAS  Google Scholar 

  45. 45. De Mey S, Segers P, Coomans I, Verhaaren H, Verdonck P (2001). Limitations of Doppler echocardiography for the post-operative evaluation of aortic coarctation. J Biomech. 34:951–60

    Article  PubMed  Google Scholar 

  46. 46. Therrien J, Thorne SA, Wright A, Kilner PJ, Somerville J (2000). Repaired coarctation: a “cost-effective” approach to identify complications in adults. J Am Coll Cardiol. 35:997–1002

    Article  PubMed  CAS  Google Scholar 

  47. 47. Oshinski JN, Parks WJ, Markou CP, et al (1996). Improved measurement of pressure gradients in aortic coarctation by magnetic resonance imaging. J Am Coll Cardiol. 28:1818–26

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital of Geneva, Geneva, Switzerland

    D. Didier, C. Saint-Martin, C. Lapierre & J. P. Vallee

  2. Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland

    P. T. Trindade

  3. Division of Cardiac Surgery, University Hospital of Geneva, Geneva, Switzerland

    N. Lahlaidi & A. Kalangos

  4. Department of Pediatrics, Pediatric Cardiology Unit, Geneva, Switzerland

    B. Friedli & M. Beghetti

  5. Department of Radiology, Hôpital Cantonal Universitaire de Genève, 24 rue Micheli du Crest, 1211, Geneva 14, Switzerland

    D. Didier

Authors
  1. D. Didier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Saint-Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Lapierre
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. T. Trindade
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Lahlaidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. P. Vallee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Kalangos
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. Friedli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Beghetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Didier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Didier, D., Saint-Martin, C., Lapierre, C. et al. Coarctation of the aorta: pre and postoperative evaluation with MRI and MR angiography; correlation with echocardiography and surgery. Int J Cardiovasc Imaging 22, 457–475 (2006). https://doi.org/10.1007/s10554-005-9037-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-005-9037-8

Keywords:

Search

Navigation