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J Thorac Cardiovasc Surg 2008;135:568-572
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Acute angulation of the aortic arch predisposes a patient to ascending aortic dilatation and aortic regurgitation late after the arterial switch operation for transposition of the great arteries

^a Department of Pediatric Cardiology, UFR Necker-Enfants Malades, University Rene Descartes Paris V, Paris, France
^b Department of Medicine, University of Sydney, Sydney, Australia
^c Hôpital des Enfants, Genève, EU

Received for publication April 27, 2007; revisions received August 18, 2007; accepted for publication October 16, 2007.

^_* Address for reprints: Gabriella Agnoletti, PhD, Service de Cardiologie Pédiatrique, Groupe Hospitalier Necker Enfants Malades, AP-HP, 149, rue de Sèvres, 75743 Paris, France, EU. (Email: gabriella.agnoletti{at}nck.ap-hop-paris.fr).

Objective: We assessed the contribution of acute aortic arch angulation and enhanced systolic pulse wave reflection to dilatation of the ascending aorta and aortic regurgitation late after the arterial switch operation for transposition of the great arteries.

Methods: We performed aortography, radial artery applanation tonometry, and transthoracic echocardiography in 47 children (aged 5–6 years) who underwent the arterial switch operation and in 20 matched healthy controls. The aortic arch angle, ratio of ascending/descending aortic diameter, degree of aortic regurgitation, central pulse pressure, aortic augmentation pressure, and augmentation index were measured.

Results: The aortic arch angle was more acute (55 ± 6.5 degrees vs 68 ± 5 degrees, respectively, P < .001) and the ratio of the ascending/descending aorta diameter was significantly greater (1.98 ± 0.4 vs 1.55 ± 0.06, respectively, P < .001) in the patients who underwent the arterial switch operation compared with controls. Augmentation pressure and augmentation index were higher in the patients who underwent the arterial switch operation than in controls (7.5 ± 4.6 vs 3.4 ± 5.8, respectively P = .04; 21 ± 10 vs 8 ± 13, respectively, P = .005). A more acute aortic angle was associated with a higher aortic augmentation index (r = 0.41, P < .01), a greater ratio of the ascending to descending aorta (r = –0.6, P < .001), and the degree of aortic regurgitation (r = 0.39, P < .01).

Conclusion: Sharper angulation of the aortic arch is associated with early pulse wave reflection, dilatation of the ascending aorta, and aortic regurgitation late after the arterial switch operation for transposition of the great arteries.

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