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Abnormal responses for blood pressure in children and adults with surgically corrected aortic coarctation

Published online by Cambridge University Press:  19 August 2008

Michael Hauser ,
Andreas Kuehn  and
Neil Wilson
Michael Hauser*
Affiliation:
Deutsches Herzzentrum, Department of Paediatric Cardiology, Munich, Germany
Andreas Kuehn
Affiliation:
Deutsches Herzzentrum, Department of Paediatric Cardiology, Munich, Germany
Neil Wilson
Affiliation:
Royal Hospital for Sick Children, Glasgow, UK
*
Dr. Michael Hauser, Deutsches Herzzentrum, Department of Paediatric Cardiology, Lazarettstr. 36, 80636 Munich, Germany. Tel: 0049–89–1218–2305; Fax. 0049–89–1218–3333; E-mail: [email protected]
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Abstract

Background

Despite successful surgical repair of aortic coarctation, life expectancy is reduced, and up to one-third of patients remain or become hypertensive. So as to characterize the responses for blood pressure, we have studied 55 patients with surgically repaired coarctation. Their mean age was 11.3 ± 5.97 years. We documented maximal uptake of oxygen, anaerobic threshold, plasma renin activity and blood pressures during a Bruce protocol treadmill test. The velocity across the site of repair as imaged by crosssectional echocardiography was measured before and after exercise. We measured the changes in heart rate and blood pressure subsequent to an infusion of 1 ug per kg of isoprenalin, monitoring blood pressure over 24 hours in all patients.

Results

When compared with 40 healthy age-matched controls, the patients with coarctation had a normal exercise capacity. Resting systolic blood pressures above the 95th percentile were present in 45% of the patients. Exercise-induced hypertension, and an elevation in the average systolic 24 hour blood pressures, were observed, but less frequently than elevated baseline values, suggesting that socalled white-coat” hypertension may be present in this population. Abnormal reactions and elevation of plasma renin activity were related to a history of paradoxical hypertension at the time of surgery. Attenuation of the circadian rhythm for blood pressure was a frequent finding, and may have implications in the development of long-term damage to end-organs. A high correlation was found between mean systolic blood pressure measured by 24 hour monitoring and left ventricular hypertrophy (r=0.65, p<0.05).

Conclusions

Abnormalities in blood pressure occurred independently of significant mechanical obstruction. Despite successful surgical repair, abnormalities in the shape of the aortic arch, reduced sensitivity of baroreceptor reflexes, and neurohumoral factors may all contribute to the development of hypertension.

Keywords

surgical repairspiroergometryisoprenalinbaroreceptor reflex
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 4 , July 2000 , pp. 353 - 357
Copyright
Copyright © Cambridge University Press 2000

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References

1.Cohen, M, Fuster, V, Steele, P, Driscoll, D, McGoon, D. Coarctation of the aorta: long-term follow up and prediction of outcome after surgical correction. Circulation 1989; 80: 840—845CrossRefGoogle ScholarPubMed
2.Clarkson, PM, Nicholson, MR, Barratt-Boyes, BG, Neutze, JM, Whitlock, RM. Results after repair of coarctation of the aorta beyond infancy: a 10—28 year follow up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 1481—1488.CrossRefGoogle Scholar
3.Lawrie, GM, DeBakey, ME, Morris, GC, Crawford, ES, Wagner, WF, Glaeser, DH. Late repair of coarctation of the descending thoracic aotta in 190 patients. Arch Surg 1981; 116: 1557—1560.Google Scholar
4.Liberthson, PR, Pennington, RR, Jacobs, ML, Scully, H, Goldblatt, A, Dagget, WM. Coarctation of the aorta: review of 234 patients and clarification of management problems. Am J Cardiol 1979;43: 835—840Google Scholar
5.Beaver, WL, Wassermann, K, Whipp, BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986;60: 2020—2027Google Scholar
6.Report of the second task fotce on blood pressure control in children—1987. Pediatrics 1987; 79: 1—25Google Scholar
7.Lentner, C. M-mode echocardiography: cardiac dimensions according to body mass in children, adolescents and adults. Geigy Scientific Tables, Heart and Circulation 1990; 5: 81—83.Google Scholar
8.James, F, Kaplan, S, Glueck, C, Tsay, JK, Knight, M, Sawar, C. Responses of normal children and young adults to controlled exercise. Circulation 1980; 61: 902—912.CrossRefGoogle Scholar
9.Soergel, M, Kirschstein, M, Busch, C, Danne, T, Holl, R, Krull, F, Reichert, H, Reusz, GS, Rascher, W. Oscillometric 24 hr blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178—184.Google Scholar
10.Parish, MD, Torres, E, Peshock, R, Fixler, DE. Ambulatory blood pressure in patients with occulr recurrent coarctation of the aorta. Pediatr Cardiol 1995; 16: 166—171.CrossRefGoogle Scholar
11.Straznicky, NE, Howes, LG, Barrington, VE, Lam, W, Louis, WJ. Effects of dietary lipid modification on adrenoceptor-mediated cardiovascular responsiveness and baroreflex sensitivity in normotensive subjects. Blood Press. 1997; 6: 96—102.Google Scholar
12.Weber, HS, Cyran, SE, Grzeszczak, M, Myers, JL, Gleason, MM, Baylen, BG. Discrepancies in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 1993; 21: 1002—1007.CrossRefGoogle ScholarPubMed
13.Siewers, RD, Ettedgui, J, Pahl, E, Tallmann, T, DelNido, PJ. Coarctation and hypoplasia of the aortic arch: will the arch grow? AnnThorac Surg 1991; 52: 608—614.CrossRefGoogle ScholarPubMed
14.Houston, AB, Simpson, IA, Pollock, JC, Jamieson, MP, Doig, WB, Coleman, EN. Doppler ultrasound in the assessment of coarctation of the aorta and interruption of the aortic arch. Br Heart J 1987; 57: 38—43.CrossRefGoogle ScholarPubMed
15.Gardiner, HM, Celermajer, DS, Sorensen, KE, Georgakopoulos, D, Robinson, J, Thomas, O, Deanfield, JE. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 1994; 89: 1745—1750.CrossRefGoogle ScholarPubMed
16.Pelech, AN, Kartodihardjo, W, Balfe, JA, Olley, PM, Leenen, F. Exercise in children before and after coarctectomy: hemodynamic, echocardiography, and biochemical assessment. Am Heart J 1986; 112: 1263—1270.CrossRefGoogle ScholarPubMed
17.Ross, RD, Clapp, SK, Gunther, S, Paridon, S, Humes, R, Farooki, ZQ, Pinsky, WW. Augmented norepinephrine and renin output in response to maximal exercise in hypertensive coarctectomy patients. Am Heart J 1992; 123: 1293—1299.Google Scholar
18.Sehested, J, Schultze, G. Vasomotor wave and blood pressure response to erect posture after operation for aortic coarctation. Br Heart J 1982; 48: 357—363.CrossRefGoogle ScholarPubMed
19.Beekmann, RH, Katz, P, Morehead—Steffens, C, Rocchini, AP. Altered baroreceptor function in children with systolic hypertension after coarctation repair. Am J Cardiol 1983; 52: 112—117.Google Scholar
20.Mancia, G, Santucciu, C, Gelosa, M, Rivolta, MR, Sega, R. Clinical value of ambulatory blood pressure monitoring. J Cardiovasc Pharmacol 1994; 23 Suppl 5: 1—4CrossRefGoogle ScholarPubMed