No CrossRef data available.
Article contents
Can arch anatomy predict the outcome of repaired aortic coarctation? A novel radiological parameter
Published online by Cambridge University Press: 17 October 2025
Abstract
Purpose:
The impact of arch anatomy on the prognosis of aortic coarctation of the aorta (COA) is not well established. We aim to assess the relationship between arch anatomy and the short- and long-term prognosis after surgical repair.
Methods:
Patients with COA operated on the period between 11/2007 and 03/2016 were retrospectively recruited. Anatomical analysis of the aortic arch was done using Multidetector CT with measurement of the inter-branch distances between left common carotid artery, innominate artery, and left subclavian. We classified patients into group I, whose distance ratio (LCCA- IA)/(LSCA-IA) is short and less than 50%, and group II with such ratio ≥ 50%.
Results:
Seventy-three patients were recruited. The distance (LCCA-IA) had a range of Zero (common origin) to 22.3 mm. The distance ratio (LCCA-IA)/(LSCA-IA) ranged between Zero and 89%. Group I had a significantly higher incidence of adverse outcomes, including recoarctation, re-elevation of blood pressure, and re-elevation of pressure gradient, compared to Group II (p = 0.0001, 0.011, and 0.014, respectively). A positive correlation exists between the distance ratio and the residual SPG across the repaired segment (P = 0.0001). Only the anatomical distance ratio (LCCA-IA)/(LSCA-IA) can independently predict recoarctation in the long term.
Conclusion:
There is a strong association between the anatomical distance LCCA-IA and recoarctation. This novel parameter is the only anatomical independent predictor of recoarctation.
Information
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2025. Published by Cambridge University Press
References
Rosenthal, E. Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart 2005; 91: 1495–1502.CrossRefGoogle ScholarPubMed
Kuehl, KS, Loffredo, CA, Ferencz, C. Failure to diagnose congenital heart disease in infancy. Pediatrics [Internet] 1999; 103: 743–747. https://www.scopus.com/inward/record.uri?eid=2-s2.0-0032987676&doi=10.1542%2Fpeds.103.4.743&partnerID=40&md5=01e7751c0044ecbe344348e86521e763.CrossRefGoogle ScholarPubMed
Hamdan, M. Coarctation of the aorta: a comprehensive review. J Arab Neonatal Forum 2006; 3: 5–13.Google Scholar
Jenkins, NP. Coarctation of the aorta: natural history and outcome after surgical treatment. QJM - Mon J Assoc Physicians 1999; 92: 365–371.CrossRefGoogle ScholarPubMed
Secchi, F, Iozzelli, A, Papini, GDE, Aliprandi, A, Di Leo, G, Sardanelli, F. Coartazione aortica: studio con tecniche RM. Radiol Medica 2009; 114: 524–537.CrossRefGoogle Scholar
Evangelista, A, Flachskampf, FA, Erbel, R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 2010; 11: 645–658.CrossRefGoogle ScholarPubMed
Turkvatan, A, Buyukbayraktar, FG, Olcer, T, Cumhur, T. Congenital Anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. KOREAN J Radiol 2009; 10: 176–184.CrossRefGoogle ScholarPubMed
Berko, NS, Jain, VR, Godelman, A, Stein, EG, Ghosh, S, Haramati, LB. Variants and Anomalies of thoracic vasculature on computed tomographic angiography in adults. J Comput Assist Tomogr 2009; 33: 523–528.CrossRefGoogle ScholarPubMed
Finlay, A, Johnson, M, Forbes, TL. Surgically relevant aortic arch mapping using computed tomography. Ann Vasc Surg [Internet] 2012; 26: 483–490.CrossRefGoogle ScholarPubMed
Shepherd, B, Abbas, A, McParland, P, et al. MRI in adult patients with aortic coarctation: diagnosis and follow-up. Clin Radiol [Internet] 2015; 70: 433–445. https://www.sciencedirect.com/science/article/pii/S0009926014005467.CrossRefGoogle ScholarPubMed
Dikmen, N, Ozcinar, E, Eyileten, Z, et al. Comparative analysis of surgical and endovascular approaches for isolated aortic coarctation repair across age groups: outcomes and long-term efficacy. J Clin Med 2024; 13: 5814.CrossRefGoogle ScholarPubMed
Buonacera, A, Stancanelli, B, Malatino, L. Stroke and hypertension: an appraisal from pathophysiology to clinical practice. Curr Vasc Pharmacol 2019; 17: 72–84.CrossRefGoogle ScholarPubMed
El Tahlawi, M, Abdelbaset, M, Gouda, M, Hussein, I. Can we predict the presence of coronary lesions from blood pressure measurement? A new clinical method. Hypertens Res 2015; 38: 260–263.CrossRefGoogle ScholarPubMed
Hamrahian, SM, Falkner, B. Hypertension in chronic kidney disease. Adv Exp Med Biol 2017; 956: 307–325.CrossRefGoogle ScholarPubMed
Bouet, J, Bonello, B, El Tahlawi, M, et al. Residual hypertension and aortic wall abnormalities at mid-term follow-up after native aortic coarctation stenting. Eur Heart J 2010; 31: 178.Google Scholar
Rotundu, A, Nedelcu, AH, Tepordei, RT, et al. Medical–Surgical implications of branching variation of human aortic arch known as bovine aortic arch (BAA). J Pers Med 2024; 14: 678.CrossRefGoogle ScholarPubMed
Dodge-Khatami, A, Ott, S, Bernardo, SD, Berger, F. Carotid-subclavian artery index: new echocardiographic index to detect coarctation in neonates and infants. Ann Thorac Surg [Internet] 2005; 80: 1652–1657. https://www.sciencedirect.com/science/article/pii/S0003497505007411.CrossRefGoogle ScholarPubMed
Doshi, AR, Chikkabyrappa, S. Coarctation of aorta in children. Cureus 2018; 10: e3690.Google ScholarPubMed
Huuskonen, A, Hui, L, Runeckles, K, et al. Growth of unrepaired hypoplastic proximal aortic arch and reintervention rate after aortic coarctation repair. J Thorac Cardiovasc Surg 2023; 165: 1631–1640.e1.CrossRefGoogle ScholarPubMed
Buyens, A, Gyselaers, W, Coumans, A, et al. Difficult prenatal diagnosis: fetal coarctation. Facts, views Vis ObGyn [Internet] 2012; 4: 230–236, Available from: https://pubmed.ncbi.nlm.nih.gov/24753914.Google ScholarPubMed
Turek, JW, Conway, BD, Cavanaugh, NB, et al. Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg [Internet] 2018; 155: 1178–1183. DOI: 10.1016/j.jtcvs.2017.10.055.CrossRefGoogle ScholarPubMed
Ashcraft, TM, Jones, K, Border, WL, et al. Factors affecting long-term risk of aortic arch recoarctation after the norwood procedure. Ann Thorac Surg 2008; 85: 1397–1401.CrossRefGoogle ScholarPubMed
Ou, P, Celermajer, DS, Raisky, O, et al. Angular (Gothic) aortic arch leads to enhanced systolic wave reflection, central aortic stiffness, and increased left ventricular mass late after aortic coarctation repair: evaluation with magnetic resonance flow mapping. J Thorac Cardiovasc Surg 2008; 135: 62–68.CrossRefGoogle ScholarPubMed
Meyer, AM, Turek, JW, Froud, J, et al. Insights into arch vessel development in the bovine aortic arch. Pediatr Cardiol [Internet] 2019; 40: 1445–1449. DOI: 10.1007/s00246-019-02156-6.CrossRefGoogle ScholarPubMed
Lashley, D, Curtin, J, Malcolm, P, Clark, A, Freeman, L. Aortic arch morphology and late systemic hypertension following correction of coarctation of aorta. Congenit Heart Dis [Internet] 2007; 2: 410–415. DOI: 10.1111/j.1747-0803.2007.00133.x.CrossRefGoogle ScholarPubMed
Ou, P, Bonnet, D, Auriacombe, L, et al. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J 2004; 25: 1853–1859.CrossRefGoogle ScholarPubMed
Iriart, X, Laïk, J, Cremer, A, et al. Predictive factors for residual hypertension following aortic coarctation stenting. J Clin Hypertens 2019; 21: 291–298.CrossRefGoogle ScholarPubMed
London, GM. Role of arterial wall properties in the pathogenesis of systolic hypertension. Am J Hypertens 2005; 18: 19S–22S.CrossRefGoogle ScholarPubMed
Ou, P, Mousseaux, E, Celermajer, DS, et al. Aortic arch shape deformation after coarctation surgery: effect on blood pressure response. J Thorac Cardiovasc Surg 2006; 132: 1105–1111.CrossRefGoogle ScholarPubMed
Siewers, RD, Ettedgui, J, Pahl, E, Tallman, T, Delnido, PJ. oarctation and hypoplasia of the aortic-arch - will the arch grow Ann Thorac Surg 1991, 52:608–614.CrossRefGoogle ScholarPubMed
El Tahlawi, M, Tharwat, M. P447The importance of anatomical characteristics of aortic arch in aortic coarctation for the prognosis after its treatment. Cardiovasc Res 2018; 114: S107–S107.CrossRefGoogle Scholar
Reinshagen, L, Vodiskar, J, Mühler, E, Hövels-Gürich, HH, Vazquez-Jimenez, JF. Bicarotid trunk: how much is “not uncommon”? Ann thorac surg 2014, 97:945–949.CrossRefGoogle ScholarPubMed
Vasile, CM, Laforest, G, Bulescu, C, Jalal, Z, Thambo, J-B, Iriart, X. From crafoord’s end-to-end anastomosis approach to percutaneous interventions: coarctation of the aorta management strategies and reinterventions. J Clin Med 2023; 12: 7350.CrossRefGoogle ScholarPubMed
Backer, CL, Mavroudis, C, Zias, EA, Amin, Z, Weigel, TJ. Repair of coarctation with resection and extended end-to-end anastomosis. Ann Thorac Surg [Internet] 1998; 66: 1365–1370. DOI: 10.1016/S0003-4975(98)00671-7.CrossRefGoogle ScholarPubMed
Margarint, IM, Youssef, T, Robu, M, et al. The management of aortic coarctation associated with hypoplastic arches and particular arch anatomies: a literature review. J Pers Med 2024; 14: 732.CrossRefGoogle ScholarPubMed
Liu, JYJ, Jones, B, Cheung, MMH, et al. Favourable anatomy after end-to-side repair of interrupted aortic arch. Hear Lung Circ [Internet] 2014; 23: 256–264.CrossRefGoogle ScholarPubMed
McElhinney, DB, Yang, SG, Hogarty, AN, et al. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardiovasc Surg 2001; 122: 883–890.CrossRefGoogle Scholar
Burch, PT, Cowley, CG, Holubkov, R, et al. Coarctation repair in neonates and young infants: is small size or low weight still a risk factor? J Thorac Cardiovasc Surg [Internet] 2009; 138: 547–552.CrossRefGoogle ScholarPubMed
Huang, F, Liu, WX, Wu, H, Lai, QQ, Cai, C. The role of dual-source computed tomography angiography in evaluating the aortic arch vessels in acute type a aortic dissection: a retrospective study of 42 patients. Med Sci Monit 2019; 25: 9933–9938.CrossRefGoogle ScholarPubMed
Lehnert, A, Villemain, O, Gaudin, R, Méot, M, Raisky, O, Bonnet, D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg 2019; 29: 469–475.CrossRefGoogle ScholarPubMed
Kaushal, S, Backer, CL, Patel, JN, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg 2009; 88: 1932–1938.CrossRefGoogle ScholarPubMed
Truong, DT, Tani, LY, Minich, LL, Burch, PT, Bardsley, TR, Menon, SC. Factors associated with recoarctation after surgical repair of coarctation of the aorta by way of thoracotomy in young infants. Pediatr Cardiol 2014; 35: 164–170.CrossRefGoogle ScholarPubMed
Callahan, CP, Saudek, D, Creighton, S, Kuhn, EM, Mitchell, ME, Tweddell, JS, et al. Proximal arch in left thoracotomy repair of neonatal and infant coarctation-how small is too small? WORLD J Pediatr Congenit Hear Surg 2019; 10: 469–474.CrossRefGoogle Scholar
Sakrana, AA, Nasr, MM, Ashamallah, GA, Abuelatta, RA, Naeim, HA, El Tahlawi, MA. Paravalvular leak after transcatheter aortic valve implantation: is it anatomically predictable or procedurally determined? MDCT study. Clin Radiol 2016; 71: 1095–1103.CrossRefGoogle ScholarPubMed
Bartolozzi, C, Neri, E, Caramella, D. CT in vascular pathologies. Eur Radiol 1998; 8: 679–684.CrossRefGoogle Scholar
Tulzer, A, Mair, R, Kreuzer, M, Tulzer, G. Outcome of aortic arch reconstruction in infants with coarctation: importance of operative approach. J Thorac Cardiovasc Surg [Internet] 2016; 152: 1506–1513.e1. DOI: 10.1016/j.jtcvs.2016.08.029.CrossRefGoogle ScholarPubMed