Persistent transverse arch hypoplasia is associated with systemic hypertension after coarctation of aorta repair

Sophie Quennelle,Ashwin Prakash

doi:10.1186/1532-429x-17-s1-o59

Abstract

Methods A retrospective review of clinical, CMR and exercise data on patients after coarctation repair was performed to include patients who had CMR from 2005-2014. Patients with atypical coarctation, major heart defects, residual coarctation (right arm-leg blood pressure gradient > 20 mm Hg) or >mild semilunar or atrioventricular valve stenosis/regurgitation were excluded. Patients satisfying standard criteria for resting hypertension and those on anti-hypertensive medication were classified as being “hypertensive”. In a subset of patients, exercise testing was used to evaluate the increase in right arm systolic blood pressure (SBP) and arm-leg SBP gradient during peak exercise. CMR images were analyzed to calculate the minimum TAA diameter z-score, the ratio of TAA and thoracic descending aorta (DAO) diameters, isthmus diameter z-score and, LV mass/BSA.

Highlights

A high prevalence of systemic hypertension after coarctation repair has been shown to be related to vascular dysfunction
We examined the association between persistent transverse aortic arch (TAA) hypoplasia and hypertension late after coarctation repair
Being in the “hypertensive” group was associated with a smaller TAA (p=0.002, odds ratio 1.5 for 0.1 point decrease in TAA/ descending aorta (DAO) diameter ratio) and higher age (p=0.04, odds ratio 1.05 for 1 year increase in age) but not with isthmus diameter z-score, age or type of repair or need for a second procedure

Summary

Background

A high prevalence of systemic hypertension after coarctation repair has been shown to be related to vascular dysfunction. Mild transverse aortic arch (TAA) hypoplasia is common after coarctation repair, its role in the development of hypertension remains unclear. We examined the association between persistent TAA hypoplasia and hypertension late after coarctation repair

Methods

Results

Conclusions