[Morphological and functional MRI studies after correction of aortic isthmus stenosis]

Case Report: Occurrence of Severe Thoracic Aortic Aneurysms (Involving the Ascending, Arch, and Descending Segments) as a Result of Fibulin-4 Deficiency: A Rare Pathology With Successful Management

Aortic diseases requiring surgery in childhood are distinctive and rare. Very few reports in the literature account for the occurrence of multiple thoracic aortic aneurysms in the same pediatric patient because of a genetic cause. We report a rare occurrence of severe thoracic aortic aneurysms (involving the ascending, arch and descending aortic segments) with severe aortic insufficiency in a 7-year-old female child secondary to the extremely rare and often lethal genetic disorder, cutis laxa. She was eventually identified as a carrier of a homozygous EFEMP2 (alias FBLN4) mutation. This gene encodes the extracellular matrix protein fibulin-4, and its mutation is associated with autosomal recessive cutis laxa type 1B that leads to severe aortopathy with aneurysm formation and vascular tortuosity. Parents of the child were not known to be consanguineous. Significant symptomatic improvement in the patient could be discerned after timely intervention with the valve-sparing aortic root replacement (David V procedure) and a concomitant aortic arch replacement. This is a unique report with a successful outcome that highlights the occurrence of a rare hereditary aortopathy associated with a high morbidity and mortality, and the importance of an early diagnosis and timely management. It also offers insight to physicians in having a very broad differential and multimodal approach in handling rare pediatric cardio-pathologies with a genetic predisposition.

Aneurysm of the aortic root in the setting of Wiskott-Aldrich syndrome

Wiskott-Aldrich syndrome is a rare X-linked disease, associated with immunodeficiency, infections, thrombocytopaenia, and eczema. Aortitis and formation of aneurysms have also been described. We describe here our experience with a 7-year-boy with this syndrome. He survived replacement of the aortic root because of an aneurysmal ascending aorta, and subsequent bone marrow transplantation.

Mesure des diamètres aortiques dans le suivi IRM des coarctations

OBJECTIVE

During aortic coarctation follow-up, accurate diameter measurements using MRI are required. The purpose of this study was to compare the reproducibility of aortic measurements on axial and sagittal views using black blood (Fast-Spin-Echo) and three-dimensional Gadolinium-enhanced MR angiography.

SUBJECTS AND METHODS

We studied 34 patients who underwent evaluation after surgical treatment in the first year of life. The aortic measurements were made at six thoracic levels. We calculated the mean difference between the two sequences, and used Bland and Altman method and the comparison to zero.

RESULTS

With black blood, either on axial or sagittal views, aortic measurements were in agreement. Between two sequences, we considered as acceptable a mean difference of 0,5 mm with limits of agreement of +/- 3 mm. Difficulties were found for proximal ascending aorta measurements on all sequences. Using MR angiography, the highest agreement at the site of repair was on sagittal view, while the highest agreement at other sites was on axial views.

CONCLUSION

Black blood sequence provides a better reproducibility for aortic measurements than native slices of MR angiography.