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

Objective: We sought to investigate the mechanism whereby a particular deformity of the aortic arch, an angulated Gothic shape, might lead to hypertension late after anatomically successful repair of aortic coarctation. Methods: Fifty-five normotensive patients with anatomically successful repair of aortic coarctation and either a Gothic (angulated) or a Romanesque (smooth and rounded) arch were studied with magnetic resonance angiography and flow mapping in both the ascending and descending aortas. Systolic waveforms, central aortic stiffness, and pulse velocity were measured. We hypothesized that arch angulation would result in enhanced systolic wave reflection with loss of energy across the aortic arch, as well as increased central aortic stiffness. Results: Twenty patients were found to have a Gothic, and 35 a Romanesque, arch. Patients with a Gothic arch showed markedly augmented systolic wave reflection (12 +/- 6 vs 5 +/- 0.3 mL, P < .001) and greater loss of systolic wave height in the distal aorta (30% +/- 16% vs 22% +/- 12%, P < .01) compared with that of subjects with a Romanesque arch. Pulse wave velocity was also increased with a Gothic arch (5.6 +/- 1.1 vs 4.1 +/- 1 m/s, P < .0001), as well as left ventricular mass index (85 +/- 15 vs 77 +/- 20 g/m(2)). Patients with a Romanesque arch had increased aortic stiffness compared with that of control subjects (stiffness beta-index, 3.9 +/- 0.9 vs 2.9 +/- 1; P = .03). Conclusions: Angulated Gothic aortic arch is associated with increased systolic wave reflection, as well as increased central aortic stiffness and left ventricular mass index. These findings explain (at least in part) the association between this pattern of arch geometry and late hypertension at rest and on exercise in subjects after coarctation repair.