Long-term systemic hypertension in children after successful repair of coarctation of the aorta

Simsolo, Rosa B.; Grunfeld, B; Giménez, María Isabel; López, Marta Reyero; Berri, Gustavo; Becú, L; Barontini, Marta

doi:10.1016/0002-8703(88)90020-8

Cited by 54 publications

(21 citation statements)

References 17 publications

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“…The present results are in agreement with previous reports [38][39][40][41][42] showing baseline plasma noradrenaline and aldosterone concentrations, as well as plasma renin activity, to be in the normal range of values for adolescents having successful surgery in early childhood. Raised plasma renin activity has, however, also been reported in the long term follow up of coarctation of the aorta, and was associated with an increase in adrenergic stimulation, presumably resulting from a lower renal perfusion secondary to a potential recoarctation.…”

Section: Hormonal Responses To Lower Body Negative Pressure Applicationsupporting

confidence: 93%

Magnetic resonance image of a large, fatal angiosarcoma of the heart

Rigatelli¹

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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Section: Hormonal Responses To Lower Body Negative Pressure Applicationsupporting

confidence: 93%

Magnetic resonance image of a large, fatal angiosarcoma of the heart

Rigatelli¹

2001

Heart

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“…[111][112][113][114] Various potential mechanisms have been identified, including resetting of the renin-angiotensin system, impaired small-resistance-vessel reactivity, and abnormal aortic distensibility. [115][116][117][118][119][120][121][122][123] Coarctation repair after the age of 14 years is associated with more hypertension and decreased survival, whereas surgical repair before 3 years of age is associated with an increased incidence of recoarctation. 124 Understandably, patients with hypertension after late repair are at an increased risk for developing heart failure, accelerated atherosclerosis, stroke, and progressive aortic disease.…”

Section: Aboulhosn and Child Left Ventricular Outflow Obstructionmentioning

confidence: 99%

Left Ventricular Outflow Obstruction

2006

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“…Persistent resting and exercise-induced hypertension have been reported in 10 -46% [4,5] and 30-60% [6,7], respectively, and these have been suggested to be the main cause of post-operative cardiovascular events [8]. Although several mechanisms of persistent arterial hypertension have been suggested, the underlying pathophysiology has not yet been clearly defined [9 -13].…”

Section: Introductionmentioning

confidence: 99%