Persistent Aortic Arch Hypoplasia After Coarctation Treatment Is Associated With Late Systemic Hypertension
Sophie Quennelle, Andrew J Powell, Tal Geva, Ashwin Prakash, Sophie Quennelle, Andrew J Powell, Tal Geva, Ashwin Prakash
Abstract
Background: Mild transverse aortic arch (TAA) hypoplasia is common after coarctation treatment, but is considered benign in the absence of an arm-leg systolic blood pressure (SBP) difference. Hypertension (HTN) is a common long-term morbidity after successful coarctation treatment. We examined whether mild TAA hypoplasia after coarctation treatment is associated with late systemic HTN.
Methods and results: We retrospectively reviewed 92 patients (median age, 19.9 years; range, 4.9 to 57.8; 60% male) 14.1±10.3 years after successful coarctation treatment (surgery in 63, stent in 16, and balloon dilation in 13), excluding those with resting right arm-leg blood pressure gradient >20 mm Hg, atypical coarctation, and major associated heart defects. Minimum body-surface area (BSA)-adjusted TAA cross-sectional area (CSA) was calculated from cardiac magnetic resonance (CMR) images. On follow-up, 38 of 92 (41%) patients had systemic HTN using standard criteria. Systemic HTN was independently associated with smaller TAA CSA/BSA (P=0.006; odds ratio [OR], 6.41 per 0.5 cm(2)/m(2) decrease), higher age at CMR (P=0.03; OR, 1.57 per 5-year increase), and in a subset (n=61), higher arm-leg SBP difference during exercise (P=0.05; OR, 1.03 per 1-mm-Hg increase). Lower ratio of TAA diameter/descending aorta diameter was associated with a larger increase in right arm SBP during peak exercise (P=0.006; r(2)=0.11).
Conclusions: Persistent mild aortic arch hypoplasia, even in the absence of an arm-leg SBP difference at rest, is associated with late systemic HTN. Further studies should be undertaken to determine whether more-aggressive arch reconstruction at initial repair can reduce the incidence of systemic HTN.
Keywords: cardiac MRI; coarctation; hypertension; transverse aortic arch.
© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
Figures
References
- O’Sullivan J. Late hypertension in patients with repaired aortic coarctation. Curr Hypertens Rep. 2014;16:421.
- Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation. 1989;80:840–845.
- Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002;89:541–547.
- Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D, Mousseaux E. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J. 2004;25:1853–1859.
- O’Sullivan JJ, Derrick G, Darnell R. Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement. Heart. 2002;88:163–166.
- Sehested J, Baandrup U, Mikkelsen E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Implications for baroreceptor function. Circulation. 1982;65:1060–1065.
- The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–576.
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, Jones DW, Materson BJ, Oparil S, Wright JT, Jr, Roccella EJ National Heart L, Blood Institute Joint National Committee on Prevention DE, Treatment of High Blood P, National High Blood Pressure Education Program Coordinating C. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–2572.
- Haycock GB, Schwartz GJ, Wisotsky DH. Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr. 1978;93:62–66.
- Prakash A, Torres AJ, Printz BF, Prince MR, Nielsen JC. Usefulness of magnetic resonance angiography in the evaluation of complex congenital heart disease in newborns and infants. Am J Cardiol. 2007;100:715–721.
- Nielsen JC, Powell AJ, Gauvreau K, Marcus EN, Prakash A, Geva T. Magnetic resonance imaging predictors of coarctation severity. Circulation. 2005;111:622–628.
- Krieger EV, Clair M, Opotowsky AR, Landzberg MJ, Rhodes J, Powell AJ, Colan SD, Valente AM. Correlation of exercise response in repaired coarctation of the aorta to left ventricular mass and geometry. Am J Cardiol. 2013;111:406–411.
- Ntsinjana HN, Biglino G, Capelli C, Tann O, Giardini A, Derrick G, Schievano S, Taylor AM. Aortic arch shape is not associated with hypertensive response to exercise in patients with repaired congenital heart diseases. J Cardiovasc Magn Reson. 2013;15:101.
- Pedersen TAL, Munk K, Andersen NH, Lundorf E, Pedersen EB, Hjortdal VE, Emmertsen K. High long-term morbidity in repaired aortic coarctation. Congenit Heart Dis. 2011;6:573–582.
- Lee MGY, Kowalski R, Galati JC, Cheung MMH, Jones B, Koleff J, d’Udekem Y. Twenty-four-hour ambulatory blood pressure monitoring detects a high prevalence of hypertension late after coarctation repair in patients with hypoplastic arches. J Thorac Cardiovasc Surg. 2012;144:1110–1118.
- Buys R, Van De Bruaene A, Muller J, Hager A, Khambadkone S, Giardini A, Cornelissen V, Budts W, Vanhees L. Usefulness of cardiopulmonary exercise testing to predict the development of arterial hypertension in adult patients with repaired isolated coarctation of the aorta. Int J Cardiol. 2013;168:2037–2041.
- Bluemke DA, Kronmal RA, Lima JA, Liu K, Olson J, Burke GL, Folsom AR. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol. 2008;52:2148–2155.
- Dickinson CJ, Thomson AD. High blood-pressure and stroke. Necropsy study of heart-weight and left ventricular hypertrophy. Lancet. 1960;2:342–345.
- de Divitiis M, Pilla C, Kattenhorn M, Donald A, Zadinello M, Wallace S, Redington A, Deanfield J. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol. 2003;41:2259–2265.
- Ou P, Celermajer DS, Jolivet O, Buyens F, Herment A, Sidi D, Bonnet D, Mousseaux E. Increased central aortic stiffness and left ventricular mass in normotensive young subjects after successful coarctation repair. Am Heart J. 2008;155:187–193.
- Devereux RB, Roman MJ. Left ventricular hypertrophy in hypertension: stimuli, patterns, and consequences. Hypertens Res. 1999;22:1–9.
- Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550–1558.
- Bella JN, Wachtell K, Palmieri V, Liebson PR, Gerdts E, Ylitalo A, Koren MJ, Pedersen OL, Rokkedal J, Dahlof B, Roman MJ, Devereux RB. Relation of left ventricular geometry and function to systemic hemodynamics in hypertension: the LIFE Study. Losartan Intervention for Endpoint Reduction in Hypertension Study. J Hypertens. 2001;19:127–134.
Source: PubMed