PDF(Pubmed)
Abstract：
Objectives: The configuration of the aortic arch, particularly a Gothic arch shape, in individuals with corrected coarctation of the aorta (CoA) has been associated with a decreased systolic wave amplitude across the arch, which could potentially impair renal perfusion and elevate the risk of arterial hypertension. This study aims to explore the relationship between the morphological characteristics of the aortic arch and their impact on renal perfusion in patients with CoA. Methods: Seventy-one subjects with corrected CoA underwent continuous 24 h ambulatory blood pressure monitoring, computed tomography to assess the aortic arch, and renal perfusion scanning. Subjects were stratified into three groups based on the height-to-width (H/W) ratio of their aortic arch: Group 1 with a H/W ratio of <0.65, Group 2 with a H/W ratio between 0.65 and 0.85, and Group 3 with a H/W ratio of >0.85. Results: Groups 1 and 2 (53,78% and 62.63%) presented with a higher hypertension prevalence of elevated blood pressure than Group 3 (38.89%). Notable variations were observed among the subjects in the time to peak perfusion (Tmax) in the left kidney across the groups. Group 1 showed a median Tmax at 0.27, Group 2 at 0.13, and Group 3 at -0.38 (p-value = 0.079). The differences in Tmax for the right kidney followed a similar trend but were not statistically significant (Group 1 at 0.61, Group 2 at 0.22, and Group 3 at 0.11; p-value = 0.229). Conclusions: This study suggests that variations in the aortic arch morphology might not significantly influence renal perfusion in CoA patients. This indicates the potential adaptability of the renal blood flow, which appears to compensate for reduced perfusion, thus minimizing adverse effects on the kidney function. This adaptability suggests an inherent physiological resilience, emphasizing the need for further targeted research to understand the specific interactions and impacts on treatment strategies for CoA.
摘要：
目的：主动脉弓的构型，尤其是哥特式拱形，在校正主动脉缩窄（CoA）的个体中，与跨弓的收缩压波振幅降低有关，这可能会损害肾脏灌注并增加动脉高血压的风险。本研究旨在探讨CoA患者主动脉弓形态特征及其对肾脏灌注的影响之间的关系。方法:对71例CoA校正患者进行连续24h动态血压监测,计算机断层扫描来评估主动脉弓，和肾灌注扫描.根据主动脉弓的高宽比（H/W）将受试者分为三组：第1组，H/W比<0.65，第2组，H/W比在0.65和0.85之间，第3组，H/W比>0.85。结果：第1组和第2组（53,78％和62.63％）的高血压患病率高于第3组（38.89％）。在各组中,在受试者中观察到左肾的峰值灌注时间(Tmax)的显著变化。第1组显示0.27的中值Tmax,第2组在0.13,第3组在-0.38(p值=0.079)。右肾的Tmax差异遵循类似的趋势，但没有统计学意义（第1组0.61，第2组0.22，第3组0.11；p值=0.229）。结论：这项研究表明，主动脉弓形态的变化可能不会显着影响CoA患者的肾脏灌注。这表明肾脏血流的潜在适应性，这似乎补偿了减少的灌注，从而减少对肾功能的不利影响。这种适应性表明了一种内在的生理弹性，强调需要进一步进行有针对性的研究，以了解CoA治疗策略的具体相互作用和影响。
