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J Thorac Cardiovasc Surg 2000;120:1053-1063
© 2000 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

The effect of synthetic patch repair of coarctation on regional deformation of the aortic wall

From the Departments of Physiology^a and Engineering Science,^c University of Auckland, Auckland, New Zealand; Department of Surgery,^b University of Alabama at Birmingham, Birmingham, Ala; and the Department of Cardiology,^d The Prince Charles Hospital, Brisbane, Australia.

Supported by a grant from the National Heart Foundation of Australia (grant No. G89B2741).

Address for reprints: David McGiffin, MD, Department of Surgery, Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, 780 Lyons-Harrison Research Building, 1919 Seventh Ave South, Birmingham, AL 35294-0007.

Background: A long-term complication of synthetic patch repair of coarctation is true aneurysm formation.Aim: An in vitro study was undertaken to determine the effects of patch angioplasty on aortic geometry and strain adjacent to the patch.
Methods: Segments of human descending thoracic aorta were subject to 10 pressure loading cycles (10-120 mm Hg; 1.36-16.32 kPa) before and after simulated coarctation repair with a synthetic patch. Local curvature and strain were estimated by fitting a geometric model to reconstructed three-dimensional surface marker points.
Results: In the control aortas, when pressure increased from 11 ± 1.0 to 124 ± 4.0 mm Hg (1.5 ± 0.14 to 16.86 ± 0.54 kPa), average circumferential curvature decreased from 0.1543 ± 0.03 to 0.1065 ± 0.03 mm^–1. The average major extension reached a maximum of 1.43 ± 0.08. After patch implantation, the average circumferential curvature was reduced relative to control at all pressures. Average major extensions were significantly greater than paired control values and reached a maximum of 1.55 ± 0.08 at 122 ± 4.0 mm Hg (16.59 ± 0.54 kPa). Substantial strain inhomogeneity was observed and major extensions were greatest immediately adjacent to the patch.
Inference: Synthetic patch repair of coarctation of the aorta increases wall strain and produces significant regional gradients in strain. With control aortic material properties there may be a substantial increase in wall stress immediately adjacent to the aorta, which could lead to true aneurysm formation.

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