14 year-old female status post aortic coarctation repair.
Repaired Coarctation of the Aorta. Four contiguous double inversion recovery fast spin echo magnetic resonance (MR) images in LAO (â€ťcandy caneâ€ť) projection show an area of narrowing at the level of the proximal descending thoracic aorta, the site of the patientâ€™s surgical repair. At the point of maximal narrowing, the aorta measures 13mm.
Bright blood (SSFP) MR images in LAO and a tangential oblique coronal plane through the region of the coarctation repair shows no evidence of a flow jet, which if present suggests a hemodynamically significant coarctation.
Bright blood (fast GRE) MR image in LAO projection shows no evidence of a flow jet.
Coarctation repair (history known, no differential diagnosis list necessary)
Dx: Aortic coarctation repair; postsurgical imaging
Dx Confirmed by: Known prior surgical history
Patient will receive continued imaging and clinical follow-up; she is currently asymptomatic.
Please see factoid.
Magnetic resonance imaging (MRI) plays an important role in the postoperative evaluation of aortic coarctation repair. Coarctation of the aorta can be treated with resection and anastamosis, patch grafts, tube grafts, or use of catheter-based techniques. Restenosis/late recoarctation and pseudoaneurysms are the most common postoperative complications which can be demonstrated by MR examination (1). Aneurysm formation is most commonly seen opposite the side of patch replacement, and the risk of rupture is high when the ratio between dilated aorta to the diaphragmatic aorta is greater than 1:1.5. Velocity-encoded studies can be used to determine the pressure differential across a region of stenosis at the site of repair, with a value greater than 20mm Hg likely to represent a significant gradient (2). Additionally, images should be examined for the presence of a stenotic jet at the site of repair.
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