The Aortic and Renovascular Center for Hypertension (ARCH)

When a child is diagnosed with midaortic syndrome — a rare condition where part of the aorta (the largest blood vessel coming from the heart) and its major branches narrow — this can lead to an impaired blood flow to vital organs. This is just one of several diagnoses found in children of all ages treated by the multidisciplinary team from the Washington University Aortic and Renovascular Center for Hypertension (ARCH) at St. Louis Children’s Hospital.

ARCH offers world-class care from Washington University specialists in pediatric nephrology, pediatric interventional cardiology and vascular surgery, along with their fellow St. Louis Children’s Hospital clinicians to provide unified care of the whole patient in a single center. Working together, these physicians tailor their treatment approach based on each patient’s complex individualized need to ensure the best possible, comprehensive care.

ARCH helps to diagnose children with midaortic syndrome and related conditions, including renovascular hypertension (high blood pressure from decreased blood flow to the kidneys), and better understand the underlying cause. Many children with midaortic syndrome experience severe hypertension, which is addressed using medical, endovascular, and surgical approaches depending on each patient’s need. The team of Washington University physicians works together to develop treatment plans for children so they may avoid the long-term complications associated with chronic and severe hypertension, such as heart failure, stroke and kidney disease.

Conditions treated

Patients of the ARCH clinic may be seen for these and other medical conditions that can lead to renovascular hypertension:

Alagille syndrome – a genetic disorder that can affect the liver, heart and other systems of the body
Middle aortic syndrome, also known as midaortic syndrome – narrowing of part of the aorta (the main artery of the heart) and its major branches, leading to impaired blood flow to vital organs in the chest, abdomen and the lower limbs.
Neurofibromatosis – a genetic condition that can affect nearly every organ system in the body
Takayasu arteritis – a rare type of vasculitis that causes blood vessel inflammation, which can damage the aorta and its main branches
Williams syndrome – a rare genetic disorder associated with developmental delays and medical problems affecting multiple parts of the body

Why choose the Aortic and Renovascular Center for Hypertension?

As the only center of its kind in the St. Louis area and one of only a few in the United States, our goal is to develop a comprehensive care plan to meet the individual needs of our patients. Our specialists meet as a team in advance to review each child’s medical records, including existing test results, to determine a comprehensive, well-rounded visit, which may include additional testing and meeting one or more of the physicians based on the child’s specialized care. We will stay in contact with the patient’s referring physician to keep them up-to-date and informed about any treatment plans being developed, and they will be a partner with us in the child’s care.

We understand that a visit to the hospital can be stressful, so we want parents to know that we will work to ensure their child’s ARCH clinic visit can be completed in a timely and efficient manner. Because each child has their own unique anatomy that contributes to their disease, the ARCH team is focused on providing optimal care and tailored therapy that is best for the patient.

Meet our team

The ARCH multidisciplinary team is comprised of physicians and other clinicians from nephrology, interventional cardiology and vascular surgery who are here to provide their expertise in partnership with one another. Our Washington University physicians include:

David Balzer, MD, Washington University pediatric interventional cardiologist
Westley Ohman, MD, Washington University vascular surgeon
Brian Stotter, MD, Washington University pediatric nephrologist