[The role of aortic morphology in the occurrence of hypertension in patients undergoing surgery for coarctation of the aorta before the age of 1 year].
OBJECTIVE
Hypertension on effort can be observed following surgical treatment of coarctation of the aorta even if the operation has been performed early and has been judged to be satisfactory. The pathophysiology of this hypertension has not been completely elucidated. The aim of our study was to look for a residual morphological anomaly of the aortic arch which might be responsible.


METHODS
This was a retrospective study of patients aged over 10 years who had undergone surgery for coarctation of the aorta before the age of 1 year, consecutively between 1979 and 1993, and free from re-coarctation clinically or with Doppler. All of them had a blood pressure effort test on a cycling machine, echocardiography and an MRI of the thoracic aorta.


RESULTS
61 patients were included. Their median age was 15 years, 59% were male, 15% were hypertensive at rest and 56% on effort. With univariate analysis, only the average blood pressure (p=0.03) and the resting pulse pressure (p=0.001) were associated with hypertension on effort. With multivariate analysis the only factors that correlated independently with maximum arterial pressure on effort were the height of the patient (p=0.02) and the pulse pressure (p<0.0001). The surgical technique and the age at intervention were not associated with hypertension on effort (p=0.96 and 0.69 respectively). The diameter of the horizontal aorta and the aorta at the site of repair, measured on MRI, added to the diameter of the descending aorta at the diaphragm were not lower in patients with hypertension on effort (p=0.77 and 0.38). There were proportionally more Roman type aortic arches than Gothic types in patients with hypertension on effort, but this difference was not significant (p=0.18).


CONCLUSIONS
In our study, the patients with hypertension on effort following correction of coarctation of the aorta did not display any residual obstruction at the level of the aortic cross on MRI. However, they had a resting pulse pressure that was significantly higher than the non hypertensive patients, reflecting an increase in the aortic wall rigidity.
Bergoënd
E
E
Service de chirurgie cardiaque pédiatrique, Centre de pédiatrie Clocheville, hôpital Trousseau, CHU de Tours. bergoend@med.univ-tours.fr
Texier
N
N
Legendre
A
A
Alison
D
D
Sirinelli
D
D
Neville
P
P
Marchand
M
M
Chantepie
A
A
D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000002:abnormalities*; D001017:Aortic Coarctation / Q000503:physiopathology / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D002648:Child; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D012146:Rest; D012189:Retrospective Studies; D013223:Statistics as Topic