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

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. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.