Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood.

Abstract

Despite successful repair of coarctation in childhood, arterial dilation is significantly impaired in the precoarctation vascular bed of healthy young adults. This may be an important contributor to exercise-related hypertension and late morbidity or mortality.

Vascular and neuroendocrine components in altered blood pressure regulation after surgical repair of coarctation of the aorta

“…20 Several hypotheses have been proposed to explain the persistence and/or return of arterial hypertension in patients operated on for aortic coarctation. 7,9,[22][23][24] Firstly, increased systemic vascular resistance because of sequellar and/or recurrent aortic stenosis has been held responsible. However, some patients remain hypertensive after successful aortic surgical repair.…”

“…However, some patients remain hypertensive after successful aortic surgical repair. 7,23 But most patients who are normotensive after surgical repair have mild persistent and/or recurrent aortic luminal narrowing. 6 Brachial BP is frequently increased during submaximal effort in children and adults believed to have undergone successful repair who are normotensive at rest.…”

“…6 Brachial BP is frequently increased during submaximal effort in children and adults believed to have undergone successful repair who are normotensive at rest. 7,22,25 A gradient of pressure often develops at the level of the surgical repair when cardiac output is increased. 6 In some of our patients, a significant pressure gradient is likely to persist at rest at the level of the surgical repair.…”

“…Most patients after surgical repair have mild residual and/or recurrent aortic narrowing and increased brachial BP during submaximal effort. [5][6][7] A pressure gradient develops at the level of the surgical repair when cardiac output is increased. Inappropriate vascular reactivity at the level of the precoarctation arterial beds and altered baroreflex function often persist after successful repair of aortic coarctation.…”

“…Inappropriate vascular reactivity at the level of the precoarctation arterial beds and altered baroreflex function often persist after successful repair of aortic coarctation. [7][8][9] However, the implications of these alterations in the pathophysiology of recurrent elevated BP remain unclear.…”