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

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.

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.

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.

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.