Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta.
OBJECTIVE
To investigate the role of the geometry of the aortic arch in resting hypertension after successful repair of coarctation (CoA).


RESULTS
105 patients (15.3+/-6 years) with successful repair of aortic CoA underwent blood pressure (BP) measurements at rest and magnetic resonance imaging (MRI) of the aortic arch and left ventricle. Three categories of aortic arch shape were defined based on the global geometry of the aortic arch: gothic, crenel and normal. The ratio of the maximum height/transverse diameter of the aortic arch (A/T), the percentage of residual stenosis (RS), the growth index of the aortic arch segments (GIA), and the left ventricular mass index (LVMI) were calculated. Twenty-seven (25.7%) patients had hypertension (HT). HT was more frequent in patients with gothic arch geometry (20/44, 45.5%) than in crenel geometry (5/18, 27.8%) and in normal geometry (2/43, 4.6%) (P<0.001). Resting systolic BP and LVMI were significantly higher with gothic arch geometry. In multivariate analysis, the only correlates to HT, to level of systolic BP or to LVMI were A/T and gothic arch geometry.


CONCLUSIONS
Gothic geometry of the aortic arch is associated with resting hypertension in patients having undergone successful repair of CoA. This raises concern about methods to harmoniously repair CoA in order to prevent or delay rest hypertension in adulthood.
Cardiologie Pédiatrique, Department of Pediatrics, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sevres, 75015 Paris, France.
Phalla
P
Ou
Damien
D
Bonnet
Louis
L
Auriacombe
Elisa
E
Pedroni
Fanny
F
Balleux
Daniel
D
Sidi
Elie
E
Mousseaux
D000293:Adolescent; D001013:Aorta, Thoracic / Q000473:pathology*; D001017:Aortic Coarctation / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000473:pathology