• Melissa G Y Lee, Remi Kowalski, John C Galati, Michael M H Cheung, Bryn Jones, Jane Koleff, and Yves d'Udekem.
• Department of Cardiac Surgery, The Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
• J. Thorac. Cardiovasc. Surg.. 2012 Nov 1;144(5):1110-6.

ObjectivesTo determine by 24-hour blood pressure monitoring the risk of hypertension late after coarctation repair in patients with arch hypoplasia.MethodsSixty-two of 116 consecutive patients (age, ≥10 years) who had coarctation repair and were quoted subjectively by the surgeon or the cardiologist to have arch hypoplasia at the time of the repair underwent a transthoracic echocardiogram and 24-hour blood pressure monitoring. Median age at repair was 11 days (range, 6-48 days). Mean preoperative z score of the proximal transverse arch was -2.43 ± 0.46. Eight patients had a repair via sternotomy (6 end-to-side anastomoses, 2 patch repairs) and 54 had a conventional repair via thoracotomy.ResultsAfter a follow-up of 18 ± 5 years, 27% of the patients (17/62) had resting hypertension and 60% (37/62) had abnormal ambulatory blood pressure. Sensitivity of high resting blood pressure in detecting an abnormal 24-hour ambulatory blood pressure was 41%. Twenty patients had arch obstruction at last follow-up. Eighteen of them (90%) had abnormal ambulatory blood pressure. None of the patients operated on with end-to-side repair via sternotomy had reobstruction compared with 33% (18/54) of those repaired via thoracotomy.ConclusionsPatients with a hypoplastic arch operated via thoracotomy have an alarming prevalence of hypertension. Regular follow-up with 24-hour ambulatory blood pressure monitoring is warranted, especially in patients who have had a smaller aortic arch at the time of the initial operation.Crown Copyright © 2012. Published by Mosby, Inc. All rights reserved.

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