Moderately hypoplastic arches: do they reliably grow into adulthood after conventional coarctation repair?
To determine whether conventional coarctation repair results in sustained growth of hypoplastic transverse arches, we examined the follow-up of 20 patients operated through a thoracotomy between 1990 and 1995 who had available serial echocardiographic examinations. Mean age at operation was 8.6+/-5.7 days. In the distal transverse arch, maximum change was observed in the early postoperative period and sustained growth was observed thereafter. At last follow-up, no patients had Z-scores of less than -2. In contrast, only minimal growth occurred in the proximal transverse arch (mean Z-score diameter before and after repair: -1.87+/-0.12 vs. -1.66+/-0.09; P=0.05) in the postoperative period. At last follow-up, seven patients (35%) kept a diameter Z-score of less than -2, and 5 of them had a gradient of 15 mmHg (P=0.01). No correlation was found between the size of the proximal arch at last follow-up and its size before repair or technique used.


CONCLUSIONS
Patients with moderately hypoplastic arch treated by conventional coarctation repair have adequate growth of the distal arch demonstrated at long-term follow-up, but one-third of them keep a small proximal arch. This subset of patients is at risk of developing hypertension and may warrant further investigation.
Liu
Jessie Y J
JY
Department of Cardiac Surgery, Royal Children's Hospital, University of Melbourne and the Murdoch Children's Research Institute, Melbourne, Australia.
Kowalski
Remi
R
Jones
Bryn
B
Konstantinov
Igor E
IE
Cheung
Michael M H
MM
Donath
Susan
S
Brizard
Christian P
CP
d'Udekem
Yves
Y
D000293:Adolescent; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D001017:Aortic Coarctation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007231:Infant, Newborn; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult