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Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

Irene Martin de Miguel1, C. Charles Jain1, Alexander C. Egbe1, Jason H. Anderson2, Heidi M. Connolly1, William R. Miranda1,*

1 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
2 Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA

* Corresponding Author: William R. Miranda. Email:

Congenital Heart Disease 2022, 17(6), 605-615.


Background: Coarctation of the aorta (CoA) is associated with a generalized arteriopathy and long-term complications despite repair. Data on invasive exercise hemodynamics in this population are lacking. Accordingly, we reviewed adults with CoA undergoing exercise catheterization to assess 1. hemodynamic profile; 2. feasibility for assessment of CoA severity. Methods: Twenty patients undergoing exercise cardiac catheterization (12 arm adduction and 8 supine cycle ergometry) at a quaternary care center between 2004 and 2021 were identified. Resting and exercise hemodynamic data were abstracted from the procedure logs. Results: Mean age was 43.6 ± 12.0 years. Eleven patients (55%) had resting pulmonary arterial wedge pressure (PAWP) >15 mmHg; among those undergoing arterial catheterization, left ventricular end-diastolic pressure was >15 mmHg in 63%. Eleven patients (55%) had pulmonary hypertension: 7 (35%) combined and 4 (20%) isolated post-capillary. At peak exercise, ΔPAWP/Δcardiac output (CO) ≥2 and Δmean pulmonary artery pressure/ΔCO ≥3 mmHg/l/min were found in 7 (78%) and 6 (67%) patients, respectively; the composite of exercise PAWP ≥25 mmHg or ΔPAWP/ΔCO >2 was seen in 12 (86%). CoA peak-to-peak gradients at baseline (n = 14) and during exercise (n = 9) were 12 (3–16) and 16 mmHg (9–28), respectively. Only 2 patients had an increase in CoA gradient to >20 mmHg with exercise. Conclusions: Diastolic dysfunction and pulmonary hypertension were highly prevalent, with exercise unmasking abnormal diastolic and pulmonary vascular reserve in some individuals. Most patients failed to show significant increases in CoA peak-to-peak gradients with exercise. Further studies are warranted to establish the best diagnostic method for CoA severity assessment.


Cite This Article

Martin, I., Jain, C. C., Egbe, A. C., Anderson, J. H., Connolly, H. M. et al. (2022). Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta. Congenital Heart Disease, 17(6), 605–615.

This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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