title: Persistent Aortic Arch Hypoplasia After Coarctation Treatment Is Associated With Late Systemic Hypertension.
abstract: BACKGROUND
  Mild transverse aortic arch (TAA) hypoplasia is common after coarctation treatment, but is considered benign in the absence of an arm-leg systolic blood pressure (SBP) difference. Hypertension (HTN) is a common long-term morbidity after successful coarctation treatment. We examined whether mild TAA hypoplasia after coarctation treatment is associated with late systemic HTN.
  
  
  RESULTS
  We retrospectively reviewed 92 patients (median age, 19.9 years; range, 4.9 to 57.8; 60% male) 14.1±10.3 years after successful coarctation treatment (surgery in 63, stent in 16, and balloon dilation in 13), excluding those with resting right arm-leg blood pressure gradient >20 mm Hg, atypical coarctation, and major associated heart defects. Minimum body-surface area (BSA)-adjusted TAA cross-sectional area (CSA) was calculated from cardiac magnetic resonance (CMR) images. On follow-up, 38 of 92 (41%) patients had systemic HTN using standard criteria. Systemic HTN was independently associated with smaller TAA CSA/BSA (P=0.006; odds ratio [OR], 6.41 per 0.5 cm(2)/m(2) decrease), higher age at CMR (P=0.03; OR, 1.57 per 5-year increase), and in a subset (n=61), higher arm-leg SBP difference during exercise (P=0.05; OR, 1.03 per 1-mm-Hg increase). Lower ratio of TAA diameter/descending aorta diameter was associated with a larger increase in right arm SBP during peak exercise (P=0.006; r(2)=0.11).
  
  
  CONCLUSIONS
  Persistent mild aortic arch hypoplasia, even in the absence of an arm-leg SBP difference at rest, is associated with late systemic HTN. Further studies should be undertaken to determine whether more-aggressive arch reconstruction at initial repair can reduce the incidence of systemic HTN.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA (S.Q., A.J.P., T.G., A.P.).
authors.forename: Sophie
authors.initials: S
authors.lastname: Quennelle
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA (S.Q., A.J.P., T.G., A.P.) Department of Pediatrics, Harvard Medical School, Boston, MA (A.J.P., T.G., A.P.).
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Powell
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA (S.Q., A.J.P., T.G., A.P.) Department of Pediatrics, Harvard Medical School, Boston, MA (A.J.P., T.G., A.P.).
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA (S.Q., A.J.P., T.G., A.P.) Department of Pediatrics, Harvard Medical School, Boston, MA (A.J.P., T.G., A.P.).
authors.forename: Ashwin
authors.initials: A
authors.lastname: Prakash
mesh_terms: D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D001017:Aortic Coarctation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001794:Blood Pressure; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D016014:Linear Models; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult
keywords: cardiac MRI; coarctation; hypertension; transverse aortic arch