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Persistent Aortic Arch Hypoplasia After Coarctation Treatment Is Associated With Late Systemic Hypertension

Sophie Quennelle1, Andrew J Powell2, Tal Geva2

  • 1Department of Cardiology, Boston Children's Hospital, Boston, MA (S.Q., A.J.P., T.G., A.P.).

Journal of the American Heart Association
|June 27, 2015
PubMed

Insights

Mild transverse aortic arch hypoplasia after coarctation treatment is linked to late systemic hypertension. This finding suggests further investigation into aortic arch reconstruction is warranted to prevent long-term blood pressure issues.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Pediatric Cardiology

Background:

  • Mild transverse aortic arch (TAA) hypoplasia is a common finding post-coarctation treatment.
  • It is often considered benign if no resting arm-leg systolic blood pressure (SBP) difference exists.
  • Systemic hypertension (HTN) is a frequent long-term complication after successful coarctation repair.

Purpose of the Study:

  • To investigate the association between mild TAA hypoplasia and the development of late systemic HTN.
  • To determine if TAA hypoplasia is an independent risk factor for long-term HTN in patients treated for coarctation.

Main Methods:

  • Retrospective review of 92 patients treated for coarctation (median age 19.9 years).
  • Cardiac magnetic resonance (CMR) imaging was used to calculate body-surface area (BSA)-adjusted TAA cross-sectional area (CSA).
  • Patients with significant resting arm-leg SBP gradient, atypical coarctation, or major heart defects were excluded.

Main Results:

  • 41% of patients developed systemic HTN on follow-up.
  • Smaller TAA CSA/BSA was independently associated with systemic HTN (OR, 6.41 per 0.5 cm(2)/m(2) decrease).
  • Higher age at CMR and increased arm-leg SBP difference during exercise were also linked to HTN.

Conclusions:

  • Persistent mild aortic arch hypoplasia is associated with late systemic HTN, even without resting SBP discrepancies.
  • These findings suggest a need for further research into more aggressive aortic arch reconstruction during initial repair to mitigate late HTN incidence.
Abstract

Keywords:
cardiac MRIcoarctationhypertensiontransverse aortic arch

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