Document Detail

Angular (Gothic) aortic arch leads to enhanced systolic wave reflection, central aortic stiffness, and increased left ventricular mass late after aortic coarctation repair: evaluation with magnetic resonance flow mapping.
MedLine Citation:
PMID:  18179920     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We sought to investigate the mechanism whereby a particular deformity of the aortic arch, an angulated Gothic shape, might lead to hypertension late after anatomically successful repair of aortic coarctation. METHODS: Fifty-five normotensive patients with anatomically successful repair of aortic coarctation and either a Gothic (angulated) or a Romanesque (smooth and rounded) arch were studied with magnetic resonance angiography and flow mapping in both the ascending and descending aortas. Systolic waveforms, central aortic stiffness, and pulse velocity were measured. We hypothesized that arch angulation would result in enhanced systolic wave reflection with loss of energy across the aortic arch, as well as increased central aortic stiffness. RESULTS: Twenty patients were found to have a Gothic, and 35 a Romanesque, arch. Patients with a Gothic arch showed markedly augmented systolic wave reflection (12 +/- 6 vs 5 +/- 0.3 mL, P < .001) and greater loss of systolic wave height in the distal aorta (30% +/- 16% vs 22% +/- 12%, P < .01) compared with that of subjects with a Romanesque arch. Pulse wave velocity was also increased with a Gothic arch (5.6 +/- 1.1 vs 4.1 +/- 1 m/s, P < .0001), as well as left ventricular mass index (85 +/- 15 vs 77 +/- 20 g/m2). Patients with a Romanesque arch had increased aortic stiffness compared with that of control subjects (stiffness beta-index, 3.9 +/- 0.9 vs 2.9 +/- 1; P = .03). CONCLUSIONS: Angulated Gothic aortic arch is associated with increased systolic wave reflection, as well as increased central aortic stiffness and left ventricular mass index. These findings explain (at least in part) the association between this pattern of arch geometry and late hypertension at rest and on exercise in subjects after coarctation repair.
Phalla Ou; David S Celermajer; Olivier Raisky; Odile Jolivet; Fanny Buyens; Alain Herment; Daniel Sidi; Damien Bonnet; Elie Mousseaux
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  135     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-08     Completed Date:  2008-02-07     Revised Date:  2008-12-30    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  62-8     Citation Subset:  AIM; IM    
INSERM UMR_S678, CHU la Pitié-Salpétrière, Paris, France.
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MeSH Terms
Aorta, Thoracic*
Aortic Coarctation / physiopathology*,  surgery*
Aortic Diseases / etiology,  physiopathology
Hypertension / etiology,  physiopathology*
Hypertrophy, Left Ventricular / etiology,  physiopathology
Magnetic Resonance Angiography
Vascular Surgical Procedures / adverse effects*
Comment In:
J Thorac Cardiovasc Surg. 2008 Oct;136(4):1103-4   [PMID:  18954671 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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