Influence of the postoperative period and surgical procedure on ambulatory blood pressure-determination of hypertension load after successful surgical repair of coarctation of the aorta

Johnson, Dominique; Perrault, Hélène; Vobecky, Suzanne; Fournier, Anne; Davignon, A

doi:10.1053/euhj.1997.0804

Cited by 11 publications

(10 citation statements)

References 35 publications

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“…End to end anastomosis had been used in nine patients and left subclavian flap angioplasty in one. Calculation of blood pressure loads as previously reported3 showed that patients had a similar daytime prevalence of systolic and diastolic hypertension (14 (5)% and 1.5 (1)%) as controls (12 (4)% and 1 (0.5)%). Electrocardiographic and echocardiographic variables were normal in all patients.…”

Section: Methodssupporting

confidence: 53%

“…A notable increase in the prevalence of systolic hypertension is further observed for post-surgical periods greater than 10 years 12 Using 24 hour ambulatory blood pressure monitoring, we have recently shown that daytime systolic hypertension was present in 49% of recordings from patients successfully operated on more than 10 years previously for coarctation of the aorta, compared with 20% of recordings in patients with a shorter postoperative period 3. In the absence of recoarctation or other complication, a clear explanation for this higher incidence of hypertension after repair of coarctation is still lacking.…”

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confidence: 99%

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Resetting of the cardiopulmonary baroreflex 10 years after surgical repair of coarctation of the aorta

Johnson¹,

Perrault²,

Vobecky³

et al. 2001

Heart

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Objective-To characterise cardiopulmonary baroreflex responses and examine the eVects of a 45 minute cycling bout late after successful repair of coarctation of the aorta. Subjects-10 young adults (mean (SEM) age 18.1 (2.6 years)) operated on for coarctation of the aorta 12.7 (3.5) years earlier, and 10 healthy controls. Design-Forearm blood flow (venous occlusion plethysmography) and vascular resistance, left ventricular internal diastolic diameter, and central venous pressure estimated from an antecubital vein were measured in the supine position at baseline and during five minute applications of lower body negative pressure (LBNP) at −15 mm Hg (LBNP −15 ) and −40 mm Hg (LBNP −40 ). Venous samples were obtained at baseline and during LBNP −40 for noradrenaline (norepinephrine), adrenaline (epinephrine), renin activity, and aldosterone. The tests were repeated after 45 minutes of moderate exercise. Results-Baseline heart rate (78 (9) v 64 (6) beats/min), echocardiographic cardiac output (6.9 (1.1) v 5.0 (0.2) l/min), shortening fraction (41.7 (1.8)% v 33.3 (1.3)%), and forearm blood flow (3.4 (0.4) v 2.3 (0.3) ml/100 g/min) were higher in the coarctation group than in the controls (p < 0.05). Changes in forearm blood flow and forearm vascular resistance from baseline to LBNP −40 were similar in both groups, but the relation between forearm vascular resistance and estimated central venous pressure or left ventricular internal diastolic diameter was shifted downward in the coarctation group. Plasma adrenaline was increased in the coarctation group (baseline: 3.2 (0.6) v 2.4 (0.3) pmol/l in controls; LBNP −40 : 687 (151) v 332 (42) pmol/l) (p < 0.05). Both groups showed a similar downward displacement of forearm vascular resistance (p < 0.05) after exercise.Conclusions-There appears to be resetting of the cardiopulmonary baroreflex to a lower forearm vascular resistance in young adults operated on for coarctation of the aorta, associated with hyperdynamic left ventricular function. Raised circulating adrenaline could contribute to the lower forearm vascular resistance. (Heart 2001;85:318-325)

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confidence: 53%

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confidence: 99%

Resetting of the cardiopulmonary baroreflex 10 years after surgical repair of coarctation of the aorta

Johnson¹,

Perrault²,

Vobecky³

et al. 2001

Heart

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“…The studies that have been carried out using this technology (table 3) found a significantly higher mean 24 hour blood pressure in coarctation patients than in controls. [20][21][22][23][24][25] Some of these studies have used control data from the literature to define hypertension using the 24 hour blood pressure results and the prevalence of hypertension varies in these studies from 19-45%. However, these studies are of selected patients and cannot be used as a reliable measure of the prevalence of hypertension in this population.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement

O’Sullivan

2002

Heart

226

131

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Objective: To study the prevalence of hypertension in a cohort of patients using the current strategy of repair in early childhood. Patients: The cohort of patients with coarctation of the aorta born between 1983 and 1992. Intervention: Casual (mean of three resting readings) and 24 hour blood pressure were measured in 119 children and compared with data from 1034 normal controls. The arch repair and left ventricular parameters were assessed using Doppler echocardiography. Results: Median ages at first intervention and at blood pressure measurement were 0.2 years (interquartile range 0.04-2.0) and 12.0 years (9.0-14.5), respectively. Doppler velocity in the descending aorta was significantly associated with blood pressure (r = 0.28, p = 0.002 for casual systolic blood pressure (SBP); r = 0.26, p = 0.005 for mean 24 hour SBP). Patients were classified as having "no" (n = 70) or "mild" (n = 49) arch obstruction. Casual SBP was > 95th centile in 28% (34 of 119) overall and in 21% (15 of 70) of the no arch obstruction group. Mean 24 hour SBP was > 95th centile in 30% (36 of 119) overall and in 19% (13 of 70) of the no obstruction group. The sensitivity and specificity of casual SBP in detecting increased 24 hour SBP were 66% and 88%, respectively. Conclusions: This unique study of a large cohort of patients treated for coarctation in early childhood showed that a disappointingly high prevalence of hypertension is already apparent in children aged 7-16 years in the absence of significant arch obstruction, whether assessed by 24 hour or by casual blood pressure measurement.

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“…111 However, many recommend exercise or ambulatory blood pressure monitoring, despite questions regarding its predictive value and clinical relevance postcoarctation repair 127,128 because hypertension is frequently found even if normotensive at rest. 9,26,38,51,77,[129][130][131] Although systolic parameters are the most frequently used in the literature, there is mounting evidence for diastolic dysfunction in coarctation, which is associated with left ventricular hypertrophy. 50,60 It is known that stent placement reduces the increased end diastolic pressures and trend toward left ventricular hypertrophy.…”

Section: Primary Successmentioning

confidence: 99%

Endovascular Management of Coarctation of the Aorta

Turner¹,

Gaines²

2007

Semin intervent Radiol

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Untreated thoracic aortic coarctation leads to early death predominantly because of hypertension and its cardiovascular sequelae. Surgical treatment has been available for > 50 years and has improved hypertension and survival. More recently, endovascular techniques have offered a minimally invasive alternative to traditional open repair. Early and intermediate results suggest angioplasty and stenting have an important role in the management of aortic coarctation, particularly in adults and older children.

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Influence of the postoperative period and surgical procedure on ambulatory blood pressure-determination of hypertension load after successful surgical repair of coarctation of the aorta

Cited by 11 publications

References 35 publications

Resetting of the cardiopulmonary baroreflex 10 years after surgical repair of coarctation of the aorta

Resetting of the cardiopulmonary baroreflex 10 years after surgical repair of coarctation of the aorta

Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement

Endovascular Management of Coarctation of the Aorta

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