Abnormalities of aortic arch shape after successful repair of aortic coarctation and systemic arterial hypertension

Abstract

After successful repair of aortic coarctation (AoCo), many patients remain at risk for cardiovascular problems and major adverse prognostic factors have been identified [1][2][3][4] . After AoCo repair, different pathogenic mechanisms leading to persistent systemic arterial hypertension have been identified, including mild residual arch stenosis, increased aortic wall stiffness, hyperactivity of reninangiotensin system, impairment of the baroreflex system and peripheral vascular reactivity 4 .An abnormal aortic arch shape has been associated with rest or exercise-induced arterial hypertension in the long-term follow-up of patients after repair of AoCo, without any residual arch obstruction 3,5 . Native aortic arch morphology, age at repair and surgical approach were all identified as possible causes for a persistent postoperative abnormal arch shape; however all these findings are still debated. An abnormal arch shape with either gothic or crenel morphology after surgical repair leads to an abnormal central aortic flow dynamic and increased aortic wall stiffness 6 , which can both contribute to the development of systemic arterial hypertension in the long-term 7,8 (see Figure 1 and Figure 2).