Moderately hypoplastic arches: do they reliably grow into adulthood after conventional coarctation repair?

To determine whether conventional coarctation repair results in sustained growth of hypoplastic transverse arches, we examined the follow-up of 20 patients operated through a thoracotomy between 1990 and 1995 who had available serial echocardiographic examinations. Mean age at operation was 8.6+/-5.7 days. In the distal transverse arch, maximum change was observed in the early postoperative period and sustained growth was observed thereafter. At last follow-up, no patients had Z-scores of less than -2. In contrast, only minimal growth occurred in the proximal transverse arch (mean Z-score diameter before and after repair: -1.87+/-0.12 vs. -1.66+/-0.09; P=0.05) in the postoperative period. At last follow-up, seven patients (35%) kept a diameter Z-score of less than -2, and 5 of them had a gradient of 15 mmHg (P=0.01). No correlation was found between the size of the proximal arch at last follow-up and its size before repair or technique used.

Patients with moderately hypoplastic arch treated by conventional coarctation repair have adequate growth of the distal arch demonstrated at long-term follow-up, but one-third of them keep a small proximal arch. This subset of patients is at risk of developing hypertension and may warrant further investigation.