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J Thorac Cardiovasc Surg 2008;135:62-68
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

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

^a INSERM UMR_S678, CHU la Pitié-Salpétrière, Paris, France
^b Department of Pediatric Radiology, UFR Necker-Enfants Malades, University Rene Descartes Paris V, AP-HP, Paris, France
^d Department of Pediatric Cardiovascular Surgery, UFR Necker-Enfants Malades, University Rene Descartes Paris V, AP-HP, Paris, France
^e Department of Pediatric Cardiology,UFR Necker-Enfants Malades, University Rene Descartes Paris V, AP-HP, Paris, France
^c Department of Medicine, University of Sydney, Sydney, Australia
^f Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou, University Rene Descartes Paris V, AP-HP, Paris, France.

Received for publication September 28, 2006; revisions received March 14, 2007; accepted for publication March 29, 2007.

^_* 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 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 β-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.

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