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J Thorac Cardiovasc Surg 2006;132:1105-1111
© 2006 The American Association for Thoracic Surgery

Surgery for Congestive Heart Disease

Aortic arch shape deformation after coarctation surgery: Effect on blood pressure response

Phalla Ou, MDa,b,*, Elie Mousseaux, MD, PhDc, David S. Celermajer, MBBS, DSc, FRACPd, Elisa Pedroni, MDe, Pascal Vouhe, MD, PhDf, Daniel Sidi, MD, PhDe, Damien Bonnet, MD, PhDe,g

a INSERM UMR_S678, Faculté de Médecine Pitié Salpétrière, Paris, France
b Department of Pediatric Radiology, AP-HP, Paris, France
e Department of Pediatric Cardiology, AP-HP, Paris, France
f Department of Pediatric Cardiovascular Surgery, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
c Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou, AP-HP, France
d Department of Medicine, University of Sydney, Sydney, Australia
g INSERM E0016, Faculté de Médecine Necker-Enfants Malades, Paris, France

Received for publication March 4, 2006; revisions received May 15, 2006; accepted for publication May 30, 2006.

* Address for reprints: Phalla Ou, MD, Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, 149, rue de Sèvres 75743 Paris Cedex 15, France (Email: phalla.ou{at}nck.ap-hop-paris.fr).

OBJECTIVE: We sought to investigate the effect of particular deformations of aortic arch shape on blood pressure response in children who had undergone successful repair of coarctation of the aorta.

METHODS: We studied normotensive patients (aged 15.1 ± 5.8 years) who had undergone coarctation surgery by means of simple (n = 43) or extended (n = 32) end-to-end anastomosis. All patients underwent systematic exercise testing during follow-up, as well as magnetic resonance imaging. Three types of aortic arch geometry were evident on magnetic resonance imaging: gothic arch with angular geometry and an increased height/width ratio of the arch, crenel arch with a rectangular shape, and normal arch with a smooth rounded shape. For each subject's arch, the continuous variable height/width ratio was calculated.

RESULTS: Exercise-induced hypertension was more frequent in patients with gothic arch, with a prevalence of 83% at 15 years after surgical intervention (95% confidence interval, 69%-97%) versus 25% (95% confidence interval, 0%-50%) in those with crenel and 21% (95% confidence interval, 10%-46%) in those with normal arch geometry (P < .001). The cumulative incidence of exercise-induced hypertension as a function of aortic arch geometry was significantly higher in patients with gothic arch geometry throughout follow-up. On multivariate analysis, both gothic arch geometry and higher height/width ratio were significantly correlated with exercise-induced hypertension.

CONCLUSION: An angulated gothic arch is independently associated with abnormal blood pressure response. This deformation of the aortic arch identifies a subgroup of subjects with postoperative coarctation at high risk of hypertension in young adult life.

Abbreviations and Acronyms BP = blood pressure; CI = confidence interval; CoA = coarctation of the aorta; H/W = height/width; MRI = magnetic resonance imaging; RS = residual stenosis




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