Regulation of Sympathetic Activity in Children with Various Congenital Heart Diseases

Abstract

We studied the a-and P-adrenoceptor activity and catecholamine and cAMP levels in 112 children and infants admitted to the hospital for diagnostic or inte~entional catheterization of tetralogy of Fallot, ventricular septa1 defects with or without hypertension, pulmonary stenosis, coarctation of the aorta, and various complex cyanotic congenital cardiac diseases and compared them with 14 children undergoing transcatheter occlusion of patent ductus arteriosus with insignificant left-to-right-shunts. The mean total platelet a-adrenoceptor density of the study population was elevated by 73%. Both the increases in acyanotic ( p < 0.05) and cyanotic ( p < 0.005) patients as well as the difference between the two groups ( p < 0.01) were significant.Based on the congenital disease classification, the elevation in receptor density was also significant in all groups of patients, except coarctation of the aorta. On the other hand, the mean lymphocyte P-adrenoceptor density was attenuated by 27%, showing significant difference between the acyanotic and the patent ductus arteriosus groups, but none between acyanotic and cyanotic or cyanotic and the patent ductus arteriosus groups. Among the congenital groups, only the left-to-right shunts and the pulmonary stenosis group showed significant ( p < 0.05) decrease in P-adrenoceptor density, whereas the affinity of all the groups toward [125~]iodocyanopindolol was hardly influenced. The plasma levels of all three catecholamines, norepinephrine, epinephrine, and dopamine, were elevated, but cAMP remained unchanged. It seems that the sympathetic nervous system responds to changes triggered by some congenital heart diseases by stimulating a-adrenoceptors, which may be further increased by cyanosis and an attenuation of P-adrenoceptors associated with an increase in plasma catecholamine levels. (Pediatr Res 38: 55-60, 1995) Abbreviations ACY, acyanotic group CYN, cyanotic group TOF, tetralogy of Fallot LRS, left-to-right shunts PST, pulmonary stenosis COA, coarctation of the aorta CPL, complex cyanotic heart diseases PDA, patent ductus arteriosus QpIQs ratio, ratio of pulmonary blood flow to systemic blood flow

Endogenous catecholamine levels and function of the systemic right ventricle following atrial switch

“…This is in accordance with the findings of elevated norepinephrine levels in patients with pulmonary stenosis and in patients with residual right ventricular outflow tract obstruction following surgery [27][28][29]. The limitation of cardiac output might be partially responsible [30].…”

Porcine Pulmonary Artery and Bronchial Responses to Endothelin-1 and Norepinephrine on Recovery from Hypoxic Pulmonary Hypertension

“…We have now shown that norepinephrineinduced relaxation is also significantly decreased in the airways. Hislop (21) found that the normal postnatal increase in ␤ adrenoceptor density was attenuated in both pulmonary arterial endothelium and bronchial epithelium in piglets exposed to hypoxia from birth for 3 d. Similarly lymphocyte ␤ adrenoceptor density was attenuated by 27% and platelet ␣ adrenoceptor density was increased in children with congenital heart disease with left-to-right shunts and pulmonary hypertension (22). This reduction of ␤ adrenoceptors in pulmonary hypertension, in addition to impaired endothelial nitric oxide release (9), may explain the reduced adrenoceptor stimulated pulmonary arterial and bronchorelaxation we observed in our study.…”

Patent ductus arteriosus in preterm infants is associated with cardiac autonomic alteration and predominant parasympathetic stimulation

“…The decrease in HF power was proportionally less than that of the LF power between the Control group and the PDA group, leading to a decrease in LF/HF ratio from 5.52 ± 3.28 (Control group) to 2.74 ± 1.67 (PDA group), consistent with parasympathetic dominance. In children and neonates, major reduction in HRV power has been described in intracerebral haemorrhage [9], severe sepsis [10], RDS, the aftermath of Fontan open-heart surgery [11] and pulmonary stenosis [12]. The low HRV power observed in our study in preterm infants with PDA (i.e.…”