Abstract
The aim of this study was to explore the clinical impact of transverse aortic arch hypoplasia (TAH) after stent implementation for isthmal coarctation of the aorta (CoA). From a retrospective chart review, 51 children (median age 11.1 years) were identified who had TAH and a CoA stent implanted between 10/1995 and 4/2015. Arm–leg cuff blood pressure measurements, echocardiographic arch imaging, and 24-h ambulatory blood pressure monitoring, prior to and after stent implantation, were reviewed. At catheterization, peak systolic gradients across the CoA’s were 25 mmHg before and 4 mmHg after stent implantation. At a median 37-month follow-up, echocardiographic imaging showed no significant catch-up growth in the transverse arch (median z-score; proximal and distal arch −1.54 and −1.99 vs. −1.78 and −1.63, p = 0.13 and 0.90). A trend to increasing systolic blood pressure (SBP) differentials between the right and left arms was noted (11 mmHg [prior to]; 16 mmHg [follow-up], p = 0.09). Age-adjusted percentiles for right arm SBP decreased from 99.7% prior to, and 87.6% in follow-up (p < 0.001). The median time to re-intervention was 5.6 years (95% CI [2.8, 7.8]) and the proportion of children using anti-hypertensive in follow-up was not significantly different before the implantation (38% [prior to]; 45% [follow-up]). Elevated right arm blood pressure persists after successful stent implantation in the setting of associated TAH and there appears to be no catch-up growth of the transverse arch with time. Medical management can be difficult and approaches to surgical arch augmentation or stent implantation should be considered to avoid unilateral arm hypertension.
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References
Teo LL, Cannell T, Babu-Narayan SV, Hughes M, Mohiaddin RH (2011) Prevalence of associated cardiovascular abnormalities in 500 patients with aortic coarctation referred for cardiovascular magnetic resonance imaging to a tertiary center. Pediatr Cardiol 32:1120–1127
Forbes TJ, Kim DW, Du W, Turner DR, Holzer R, Amin Z, Hijazi Z, Ghasemi A, Rome JJ, Nykanen D, Zahn E, Cowley C, Hoyer M, Waight D, Gruenstein D, Javois A, Foerster S, Kreutzer J, Sullivan N, Khan A, Owada C, Hagler D, Lim S, Canter J, Zellers T, CCISC Investigators (2011) Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am Coll Cardiol 58:2664–2674
Szopos M, Poussineau N, Maday Y, Canniffe C, Celermajer DS, Bonnet D, Ou P (2014) Computational modeling of blood flow in the aorta–insights into eccentric dilatation of the ascending aorta after surgery for coarctation. J Thorac Cardiovasc Surg 148:1572–1582
Holzer RJ, Chisolm JL, Hill SL, Cheatham JP (2008) Stenting complex aortic arch obstructions. Catheter Cardiovasc Interv 71:375–382
Olivieri LJ, de Zelicourt DA, Haggerty CM, Ratnayaka K, Cross RR, Yoganathan AP (2011) Hemodynamic Modeling of Surgically Repaired Coarctation of the Aorta. Cardiovasc Eng Technol 2: 288–295
Morgan GJ, Lee KJ, Chaturvedi R, Bradley TJ, Mertens L, Benson L (2013) Systemic blood pressure after stent management for arch coarctation implications for clinical care. JACC Cardiovasc Interv 6:192–201
Ohno N, Chaturvedi R, Lee KJ, Horlick EM, Osten MD, Benson LN (2013) Experience with the Atrium Advanta covered stent for aortic obstruction. J Interv Cardiol 26:411–416
Trivedi KR, Pinzon JL, McCrindle BW, Burrows PE, Freedom RM, Benson LN (2002) Cineangiographic aortic dimensions in normal children. Cardiol Young 12:339–344
National High Blood Pressure Education Program Working Group on High Blood Pressure in Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(Suppl ii):555–576
Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21:922–934
Morrow WR, Huhta JC, Murphy DJ Jr, McNamara DG (1986) Quantitative morphology of the aortic arch in neonatal coarctation. J Am Coll Cardiol 8:616–620
Myers JL, McConnell BA, Waldhausen JA (1992) Coarctation of the aorta in infants: does the aortic arch grow after repair? Ann Thorac Surg 54:869–874
Weber HS, Cyran SE, Grzeszczak M, Myers JL, Gleason MM, Baylen BG (1993) Discrepancies in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 21:1002–1007
Ovaert C, Benson LN, Nykanen D, Freedom RM (1998) Transcatheter treatment of coarctation of the aorta: a review. Pediatr Cardiol 19:27–44
Pushparajah K, Sadiq M, Brzezinska-Rajszys G, Thomson J, Rosenthal E, Qureshi SA (2013) Endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv 82:E491–E499
Pihkala J, Pedra CA, Nykanen D, Benson LN (2000) Implantation of endovascular stents for hypoplasia of the transverse aortic arch. Cardiol Young 10:3–7
Boshoff D, Budts W, Mertens L, Eyskens B, Delhaas T, Meyns B, Daenen W, Gewillig M (2006) Stenting of hypoplastic aortic segments with mild pressure gradients and arterial hypertension. Heart 92:1661–1666
Bentham JR, Oswal N, Yates R (2012) Stenting across head and neck vessels using covered stents for persisting aortic arch obstruction. Cardiol Young 22:610–614
Bogaert J, Gewillig M, Rademakers F, Bosmans H, Verschakelen J, Daenen W, Baert AL (1995) Transverse arch hypoplasia predisposes to aneurysm formation at the repair site after patch angioplasty for coarctation of the aorta. J Am Coll Cardiol 26:521–527
Valverde I, Gomez G, Coserria JF, Suarez-Mejias C, Uribe S, Sotelo J, Velasco MN, Santos De Soto J, Hosseinpour AR, Gomez-Cia T (2015) 3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv 85:1006–1012
Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D, Mousseaux E (2004) Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J 25:1853–1859
Vriend JW, Oosterhof T, Hazekamp MG, Mulder BJ (2005) Aortic arch morphology and hypertension in post-coarctectomy patients. Eur Heart J 26:94
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This work was supported in part by the Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (VGHKS 105-109), and the Ministry of Science and Technology, Taipei, Taiwan (MOST 105-2314-B-075B-001) to Dr. Wen-Hsien Lu.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional ethics board, and due to the retrospective nature of the study, individual informed consent was waived.
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Lu, W.H., Fan, CP.S., Chaturvedi, R. et al. Clinical Impact of Stent Implantation for Coarctation of the Aorta with Associated Hypoplasia of the Transverse Aortic Arch. Pediatr Cardiol 38, 1016–1023 (2017). https://doi.org/10.1007/s00246-017-1611-z
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DOI: https://doi.org/10.1007/s00246-017-1611-z