title: Angular (Gothic) aortic arch leads to enhanced systolic wave reflection, central aortic stiffness, and increased left ventricular mass late after aortic coarctation repair: evaluation with magnetic resonance flow mapping.
abstract: OBJECTIVE
  We sought to investigate the mechanism whereby a particular deformity of the aortic arch, an angulated Gothic shape, might lead to hypertension late after anatomically successful repair of aortic coarctation.
  
  
  METHODS
  Fifty-five normotensive patients with anatomically successful repair of aortic coarctation and either a Gothic (angulated) or a Romanesque (smooth and rounded) arch were studied with magnetic resonance angiography and flow mapping in both the ascending and descending aortas. Systolic waveforms, central aortic stiffness, and pulse velocity were measured. We hypothesized that arch angulation would result in enhanced systolic wave reflection with loss of energy across the aortic arch, as well as increased central aortic stiffness.
  
  
  RESULTS
  Twenty patients were found to have a Gothic, and 35 a Romanesque, arch. Patients with a Gothic arch showed markedly augmented systolic wave reflection (12 +/- 6 vs 5 +/- 0.3 mL, P < .001) and greater loss of systolic wave height in the distal aorta (30% +/- 16% vs 22% +/- 12%, P < .01) compared with that of subjects with a Romanesque arch. Pulse wave velocity was also increased with a Gothic arch (5.6 +/- 1.1 vs 4.1 +/- 1 m/s, P < .0001), as well as left ventricular mass index (85 +/- 15 vs 77 +/- 20 g/m2). Patients with a Romanesque arch had increased aortic stiffness compared with that of control subjects (stiffness beta-index, 3.9 +/- 0.9 vs 2.9 +/- 1; P = .03).
  
  
  CONCLUSIONS
  Angulated Gothic aortic arch is associated with increased systolic wave reflection, as well as increased central aortic stiffness and left ventricular mass index. These findings explain (at least in part) the association between this pattern of arch geometry and late hypertension at rest and on exercise in subjects after coarctation repair.
authors.affiliation: INSERM UMR_S678, CHU la Pitié-Salpétrière, Paris, France. phalla.ou@nck.ap-hop-paris.fr
authors.forename: Phalla
authors.initials: P
authors.lastname: Ou
authors.forename: David S
authors.initials: DS
authors.lastname: Celermajer
authors.forename: Olivier
authors.initials: O
authors.lastname: Raisky
authors.forename: Odile
authors.initials: O
authors.lastname: Jolivet
authors.forename: Fanny
authors.initials: F
authors.lastname: Buyens
authors.forename: Alain
authors.initials: A
authors.lastname: Herment
authors.forename: Daniel
authors.initials: D
authors.lastname: Sidi
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.forename: Elie
authors.initials: E
authors.lastname: Mousseaux
mesh_terms: D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic; D001017:Aortic Coarctation / Q000503:physiopathology* / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology / Q000503:physiopathology; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D013599:Systole; D014656:Vascular Surgical Procedures / Q000009:adverse effects*