Response to Letter Regarding Article, “Unknown Complication of Arterial Switch Operation: Resistant Hypertension Induced by a Strong Aortic Arch Angulation”

Abstract

1and their constructive comments. We totally agree that the normal gradient of stiffness between ascending (low stiffness) and descending aorta (higher stiffness) is profoundly altered in Transposition of Great Arteries (TGA) patients. 2,3 This impedance mismatch was not measured in our patient, but it is quite evident from the cineloops on cardiac magnetic resonance imaging. It is very likely that it has an additive role to the one of the severe angulation of the aortic arch in our case. Indeed, aortopathy has been extensively described in TGA patients, whatever the surgical procedure performed (atrial or arterial switch operation). [2][3][4][5] We recently showed that distensibility of the ascending aorta was also impaired in TGA after atrial switch and associated with increase strain of the descending aorta, despite the fact that great arteries were not mobilized in this surgery. 3Several studies have further showed a relation between aortic stiffness and left ventricle remodeling. This relation was also disclosed in TGA after arterial switch. 5 In our case the subendocardial viability ratio or Buckberg index was normal (99 and 104 on 2 different acquisitions), which is in line with the observations of Murakami et al 2 in children. Nevertheless, this index may decrease with age and impact on left ventricular function and coronary perfusion as suggested by Murakami and Niwa. We agree with the authors that aortic properties should be systematically assessed in congenital heart disease because the aorta is involved in the mechanism of early reflection wave and the increase of central pressure attributable to aortic impedance change along the aortic arch. Further studies on biomechanics of the aorta and its relation with left ventricular function would be an important field in conotruncal congenital heart diseases and after aorta reconstruction, because they could predict future cardiovascular events in this population, which gains importance because of increased life expectancy. DisclosuresNone. Magalie Ladouceur, MD

Is the Lecompte technique the last word on transposition of the great arteries repair for all patients? A magnetic resonance imaging study including a spiral technique two decades postoperatively

“…Stronger and more extended helical flow patterns could also be due to the steeper angle of the aortic arch in Lecompte patients, which may have a negative impact on the development of aortic regurgitation as well as systemic hypertension (Supplementary Fig. S2, Table 1) [11,22]. In the present study, we did not find aortic regurgitation above the trivial levels in the spiral group whereas we found 2 patients with mild (regurgitant fraction 8%) and moderate (regurgitant fraction 37%) insufficiency, respectively, in the Lecompte group.…”

Pediatric Hypertension: A Condition That Matters

“…Beyond COA, various other CHDs also predispose individuals to HTN, including Tetralogy of Fallot, D-transposition of great arteries, common arterial trunk, single ventricles with Fontan palliation, and some syndromes like Williams Syndrome and Turner Syndrome [16][17][18][19][20][21][22]. For instance, renal stenosis, but also supravalvular aortic stenosis, typical features of Williams Syndrome, may cause HTN [20].…”