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Ann Thorac Surg 1997;64:516-520
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Hypoplastic Aortic Arch Morphology Pertinent to Growth After Surgical Correction of Aortic Coarctation

Masato Machii, MD, Anton E. Becker, MD

Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Accepted for publication February 8, 1997.

Background. Whether a hypoplastic transverse arch will grow after successful coarctectomy remains controversial.

Methods. We studied 15 coarctation specimens with hypoplastic transverse arch. Eight patients were less than 1 month old and 7 were between 1 and 3 months. The diameter and length of the various segments of the aortic arch were measured. The number of elastin lamellae was determined histologically. Collagen density was quantified with a microdensitophotometer. Using immunohistochemistry, we determined {alpha}-actin–positive smooth muscle cells in the media of the ascending aorta and the hypoplastic transverse arch.

Results. Despite a hypoplastic transverse arch, the ascending and descending aorta grew. The absolute number of elastin lamellae in the hypoplastic transverse arch was low, but when expressed as a ratio versus its diameter, this number was high (p < 0.05). Collagen density showed high absolute values in the descending aorta. In the older group, 4 of 7 showed no staining for {alpha}-actin in the hypoplastic transverse arch, whereas under 1 month of age, only 2 of 8 cases were negative.

Conclusions. The hypoplastic transverse arch is characterized by a relatively high number of elastin lamellae. Fewer {alpha}-actin–positive cells in the hypoplastic transverse arch occur in older specimens, which could indicate a diminished potential growth.




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