Pediatric Cardiology

, Volume 38, Issue 5, pp 1016–1023 | Cite as

Clinical Impact of Stent Implantation for Coarctation of the Aorta with Associated Hypoplasia of the Transverse Aortic Arch

  • W. H. Lu
  • Chun-Po Steve Fan
  • Rajiv Chaturvedi
  • Kyong-Jin Lee
  • Cedric Manlhiot
  • Lee Benson
Original Article


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.


Coarctation of the aorta Stent Transverse arch hypoplasia Systemic hypertension 



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.

Compliance with Ethical Standards

Conflict of interest

There are no conflicts of interest either perceived or real involving any author.

Ethical Approval

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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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick ChildrenThe University of Toronto School of MedicineTorontoCanada
  2. 2.Department of PediatricsKaohsiung Veterans General HospitalKaohsiungTaiwan, Republic of China
  3. 3.Department of PediatricsTaiwan National Yang-Ming UniversityTaipeiTaiwan, Republic of China

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