Department of Cardiology
Academic Medical Center, B2-216
Meibergdreef 9
1105 AZ Amsterdam
The Netherlands
Tel:+31 20 5668679
Fax:+31 20 6914940
E-mail address:
j.w.vriend{at}amc.uva.nl
Department of Cardiology
Academic Medical Center, B2-216
Meibergdreef 9
1105 AZ Amsterdam
The Netherlands
Department of Cardiothoracic Surgery
Leiden University Medical Center
Leiden
The Netherlands
Department of Cardiology
Academic Medical Center, B2-216
Meibergdreef 9
1105 AZ Amsterdam
The Netherlands
We read with great interest the paper by Ou et al.1 who report a significant association between the so-called gothic aortic arch morphology and resting hypertension in patients after successful surgical repair of aortic coarctation. The article, however, raises several questions.
A large population of post-coarctectomy patients is followed in our tertiary referral centre and cardiac magnetic resonance (CMR) imaging is performed at regular intervals in every patient. We were not able to classify all patients based on CMR angiography images using the classification given by the authors. The figure provides an example (Figure 1). The transverse aortic arch segment in this patient is not absent, therefore excluding the classification gothic arch morphology. The form of the aortic arch is not rectangular because the ascending aortic segment retains its curvature which excludes crenel arch morphology. Neither can this specific morphology be classified as normal. So, we feel that the classification given by the authors does not cover all aortic arch morphologies, thus complicating the interpretation of their results.
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The authors state that the gothic arch geometry is not associated with a specific type of coarctation repair. However, the vast majority of their patients (90%) were repaired by simple resection and end-to-end anastomosis, making the analysis of type of repair on aortic arch geometry virtually impossible.
All patients after successful repair of aortic coarctation are, regardless of aortic arch geometry, at risk of sustained hypertension and should undergo regular ambulatory blood pressure monitoring.2 The authors acknowledge that reoperation for restoring aortic arch geometry is probably too dangerous, thereby automatically questioning the clinical relevance of their findings because in every hypertensive post-coarctectomy patient without significant residual aortic stenosisregardless of aortic arch geometrythe only therapy for hypertension is anti-hypertensive medication.
References
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