Abstract 3650: Angular (“Gothic”) Aortic Arch after “Successful” Coarctation Repair Predisposes to Exercise-Induced and Resting Hypertension
Background: Post-operative hypertension (HT) is a common and important complication after coarctation (CoA) repair. We performed MRI of the aortic arch to assess the relationship of arch geometry to late HT in this setting.
Methods: Ninety-eight consecutive consenting survivors of end-to-end CoA repair and no residual obstruction (age at MRI 8 ±1.7years; median age at repair 0.22 months) had routine bi-annual blood pressure (BP) measures at rest and during formal exercise testing. We noted two distinct aortic arch geometries; “gothic” (G; angular arch, arch height/width H/W ratio=0.8 ±0.14, n=31) and “romanesque” (R; round arch, H/W=0.6 ± 0.12, n=67). Exercise and resting HT were defined as age-related values >95th centile for normal children.
Result: The table⇓ shows results 8 and 15 years after CoA surgery. On multivariate analysis, arch type (G or R) and continuous arch H/W ratio were both significant predictors of late resting and exercise-induced HT, independent of height, weight and age at surgery.
Conclusion We conclude that angular “gothic” aortic arch is a significant risk factor for late hypertension, after coarctation repair.