Distal Transverse Arch to Left Carotid Artery Ratio Helps to Identify Infants With Aortic Arch Hypoplasia

Factors Associated With an Abnormal Blood Pressure Response During Exercise After Coarctation Repair

“…Our surgical algorithm stratified infants to a sternotomy approach and aortic arch repair under any one or more of the following circumstances: 1) the echocardiographically determined ratio between the distal transverse arch and left carotid artery (DTA:LCA) was ≤ 1.0, 2) the presence of a common brachiocephalic trunk, or 3) in conjunction with a coexisting intracardiac lesion requiring repair. 3,7 In all other cases, a thoracotomy and EEA were performed. The length of the hypoplastic proximal or distal transverse arch were not measured or used as a variable within the algorithm.…”

“…The risk of hypertension following the repair of CoA and arch obstruction has been described for > 40 years. [1][2][3][4][5][6][7][8] Multiple variables including residual obstruction, changes in vascular compliance/stenosis, obesity, medications, and endothelial dysfunction may, either in isolation or in combination, be associated with hypertension. [16][17][18][19][20][21] The surgical approach is one modifiable factor, but is often dependent upon the surgeon and surgical center.…”

“…[1][2][3] Several strategies have been developed to guide the surgical approach with the goals of minimizing perioperative morbidity and preventing residual aortic arch obstruction. [3][4][5][6] Although multiple strategies have demonstrated good results, [3][4][5][6][7] these studies have primarily investigated blood pressure gradients at rest. An understanding of which factors are associated with an abnormal blood pressure response during exercise is unknown.…”

“…3 Reliance on this algorithm has, in general, been associated with low rates of reoperation or catheter-based re-interventions and has been associated with near physiologic arm:leg blood pressure (A:L BP) gradients at rest. 3,7 However, blood pressure gradients immediately following exercise have not been routinely evaluated. Exercise may unmask a dynamic obstruction, increasing the A:L BP gradient, which may have been otherwise physiologic at rest.…”

Neurodevelopmental Delay After the Neonatal Repair of Coarctation and Arch Obstruction

“…DHCA was used through 2012 for all ARs after which time RCP was used exclusively. Preoperative assessment, operative technique, and intraoperative management are detailed in the Supplemental Material 19,23,24 .…”