Copyright © 2004 by the European Society of Cardiology.
Clinical research
Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta
a Cardiologie Pédiatrique, Department of Pediatrics, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sevres, 75015 Paris, France
b INSERM E0016, Faculté de Médecine Necker-Enfants Malades, Paris, France
c INSERM U494, Faculté de Médecine Pitié Salpétrière, Paris, France
d Service de Radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
Received January 27, 2004; revised July 8, 2004; accepted July 15, 2004 * Corresponding author. Tel.: +33 1 44 49 43 44; fax: +33 1 44 49 43 40 (E-mail: damien.bonnet{at}nck.ap-hop-paris.fr).
AIMS: To investigate the role of the geometry of the aortic arch in resting hypertension after successful repair of coarctation (CoA).
METHODS AND RESULTS: 105 patients (15.3±6 years) with successful repair of aortic CoA underwent blood pressure (BP) measurements at rest and magnetic resonance imaging (MRI) of the aortic arch and left ventricle. Three categories of aortic arch shape were defined based on the global geometry of the aortic arch: gothic, crenel and normal. The ratio of the maximum height/transverse diameter of the aortic arch (A/T), the percentage of residual stenosis (RS), the growth index of the aortic arch segments (GIA), and the left ventricular mass index (LVMI) were calculated. Twenty-seven (25.7%) patients had hypertension (HT). HT was more frequent in patients with gothic arch geometry (20/44, 45.5%) than in crenel geometry (5/18, 27.8%) and in normal geometry (2/43, 4.6%) (P<0.001). Resting systolic BP and LVMI were significantly higher with gothic arch geometry. In multivariate analysis, the only correlates to HT, to level of systolic BP or to LVMI were A/T and gothic arch geometry.
CONCLUSION: Gothic geometry of the aortic arch is associated with resting hypertension in patients having undergone successful repair of CoA. This raises concern about methods to harmoniously repair CoA in order to prevent or delay rest hypertension in adulthood.
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