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CLINICAL RESEARCH: ADULT CONGENITAL HEART DISEASE

Vascular Remodeling After "Successful" Repair of Coarctation

Impact of Aortic Arch Geometry

Phalla Ou, MD^_*,,_*, David S. Celermajer, MBBS, DSc, FRACP, Elie Mousseaux, MD, PhD^,, Alain Giron, PhD, Yacine Aggoun, MD^||, Isabelle Szezepanski^||, Daniel Sidi, MD, PhD^|| and Damien Bonnet, MD, PhD^||,¶

^_* Department of Pediatric Radiology, University Rene Descartes-Paris V, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
INSERM UMR-S678, Faculté de Médecine Pitié Salpétrière, Paris, France
Department of Medicine, University of Sydney, Sydney, Australia
Department of Cardiovascular Radiology, University Rene Descartes-Paris V, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
^|| Department of Pediatric Cardiology, University Rene Descartes-Paris V, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
^¶ INSERM EMI-U 0016, University Rene Descartes-Paris V, Paris, France.

Manuscript received March 6, 2006; revised manuscript received September 22, 2006, accepted October 9, 2006.

^_* Reprint requests and correspondence: Dr. Phalla Ou, Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris Cedex 15, France. (Email: phalla.ou{at}nck.ap-hop-paris.fr).

OBJECTIVES: This study was designed to investigate the influence of aortic arch geometry on vascular remodeling after anatomically successful repair of coarctation of the aorta (CoA).

BACKGROUND: Abnormalities of the precoarctation vasculature are known to occur after CoA repair and appear related to adverse outcomes. The influence of aortic arch geometry on such abnormalities is unknown.

METHODS: Sixty-three postcoarctectomy subjects (age 15.9 ± 6.3 years) were compared with 63 control volunteers. Aortic arch shape was characterized on magnetic resonance imaging using both qualitative classification, identifying 3 subtypes of arch geometry (Gothic, Crenel, Romanesque), and a quantitative index, height/width ratio (H/W) of the aorta. Using ultrasound, we measured carotid artery intima-media thickness (IMT) and stiffness index and distensibility, as well as right brachial artery flow-mediated dilation (FMD) and glyceryl trinitate (GTN)-induced dilatation, to assess the precoarctation vasculature of these subjects.

RESULTS: Gothic arch type was associated with higher carotid IMT and stiffness index, lower carotid distensibility (p < 0.001 for all), and lower brachial reactivity (FMD, p < 0.01; GTN response, p < 0.001) compared with Crenel and Romanesque geometries and with control subjects. The height/width ratio was also significantly related to these vascular abnormalities. Even in CoA subjects with Romanesque arch geometry, arterial function and stiffness parameters were significantly impaired compared with control subjects.

CONCLUSIONS: In young adult survivors of anatomically successful CoA repair, a gothic-type aortic arch with high H/W is associated with abnormal IMT, higher aortic stiffness index, and impaired arterial reactivity in the pre-CoA vasculature.

Abbreviations and Acronyms   BP = blood pressure   CoA = coarctation   Einc = incremental elastic modulus of elasticity   FMD = flow-mediated dilation   GTN = glyceryltrinitate   H/W = height/width ratio   IMT = intima-media thickness   MRI = magnetic resonance imaging

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