Congenital heart diseaseAbstractsLate systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta
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Study question
In patients following coarctation repair, does aortic arch geometry impact the development of resting hypertension?
Methods
This was a prospective, cohort study of patients who had undergone successful coarctation repair without significant residual gradient. Resting blood pressure (BP) was measured simultaneously in right arm and leg. Hypertension (HTN) was defined as systolic blood pressure >140 mm Hg or diastolic blood pressure >90 in adults, or systolic or diastolic BP >95th percentile in children. All patients had MRI with measurement of LV mass index (LVMI), ascending, transverse, isthmus, descending, and
Results
A total of 105 consecutive patients were studied. The mean follow-up postsurgery was 13.7 years. The age at operation ranged from 0.1 to 216 months (median age 2.1 months). Repair was with end-to-end anastomosis in 90%; subclavian flap aortoplasty was performed in others. Residual stenosis and aortic arch growth index were similar across arch types. HTN was seen in 25.7% of patients. On bivariate analysis, hypertensive patients were older at surgery, older at the time of the study, taller,
Conclusions
Gothic geometry of the aortic arch is associated with resting HTN in patients who have undergone successful coarctation repair.
Perspective
The pathophysiology of HTN in patients following coarctation repair is probably multifactorial. Gothic arch geometry is thought to form from impaired growth of the length of the transverse arch. It is possible that this is the result of a particular type of surgical repair; however, not all patients with gothic arch geometry had the same type of repair. Age at operation and length of the coarctation segment may also be contributing factors to the development of gothic arch geometry; neither one
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Eur Heart J 2004;25:1853–9.