Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-24T17:14:53.287Z Has data issue: false hasContentIssue false
  • English
  • Français

The influence of different surgical procedures on hypertension after repair of coarctation

Published online by Cambridge University Press:  16 September 2005

Ugo Giordano ,
Salvatore Giannico ,
Attilio Turchetta ,
Fatma Hammad ,
Flaminia Calzolari  and
Armando Calzolari
Ugo Giordano
Affiliation:
Cardiorespiratory Medicine and Sports Unit, Bambino Gesù Children's Hospital – Research Institute, Rome, Italy
Salvatore Giannico
Affiliation:
Department of Cardiology, Bambino Gesù Children's Hospital – Research Institute, Rome, Italy
Attilio Turchetta
Affiliation:
Cardiorespiratory Medicine and Sports Unit, Bambino Gesù Children's Hospital – Research Institute, Rome, Italy
Fatma Hammad
Affiliation:
Cardiorespiratory Medicine and Sports Unit, Bambino Gesù Children's Hospital – Research Institute, Rome, Italy
Flaminia Calzolari
Affiliation:
Cardiorespiratory Medicine and Sports Unit, Bambino Gesù Children's Hospital – Research Institute, Rome, Italy
Armando Calzolari
Affiliation:
Cardiorespiratory Medicine and Sports Unit, Bambino Gesù Children's Hospital – Research Institute, Rome, Italy
Get access Rights & Permissions [Opens in a new window]

Abstract

We measured resting and exercise haemodynamics, as well as 24-hour ambulatory blood pressure, so as to study the influence on development of hypertension in children after repair of coarctation by either construction of a subclavian flap or end-to-end anastamosis. The patients in both groups were studied a mean time of 13 years after surgery. Thus, we divided 43 children who had undergone surgical repair of coarctation, and who were not on antihypertensive therapy, into a group of 22 patients who had undergone subclavian flap repair, with a mean age of 14 plus or minus 2.6 years, and another group of 21 patients undergoing end-to-end anastomosis, with a mean age of 13.5 plus or minus 3.9 years. We examined blood pressure at rest and during exercise, along with the measurement of cardiac output using impedance cardiography, and during 24-hour ambulatory monitoring. We recorded systolic and diastolic blood pressures, pulse pressure, cardiac output and total peripheral vascular resistance at rest and at peak exercise. During ambulatory monitoring, we measured mean pressures over 24 hours, in daytime and nighttime, 24-hour pulse pressure, and 24-hour mean arterial pressure. Student's t test was used to judge significance, accepting this when p was less than 0.05. The group repaired using the subclavian flap showed significantly disadvantageous differences for diastolic blood pressure at rest, systolic blood pressure at peak exercise and for 24-hour systolic and diastolic blood pressure, 24-hour mean arterial pressure, and daytime and nighttime systolic blood pressure during ambulatory monitoring. Our findings suggest that, after repair using the subclavian flap in comparison to end-to-end anastomosis, patients show a higher incidence of late hypertension, both during exercise and ambulatory monitoring. The data indicate different residual aortic stiffnesses, these being lower after end-to-end anastomosis, which may be due to the greater resection of the abnormal aortic tissue when coarctation is repaired using the latter technique.

Keywords

High blood pressuresubclavian flapend-to-end anastomosis
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 5 , October 2005 , pp. 477 - 480
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cohen EM, Fuster V, Steele PM, Driscoll D, McGoon DC. Coarctation of the aorta: long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.Google Scholar
Nanton MA, Olley PM. Residual hypertension after coartectomy in children. Am J Cardiol 1976; 37: 769–772.Google Scholar
Leandro J, Smallhorn JF, Benson L, et al. Ambulatory blood pressure monitoring and left ventricular mass and function after successful surgical repair of coarctation of the aorta. J Am Coll Cardiol 1992; 20: 197–204.Google Scholar
Giordano U, Matteucci MC, Calzolari A, Turchetta A, Rizzoni G, Alpert BS. Ambulatory blood pressure monitoring in children with aortic coarctation and kidney transplantation. J Pediatr 2000; 136: 520–523.Google Scholar
Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long term follow-up of patients after coarctation of the aorta repair. Am J Cardiol 2002; 89: 541–547.Google Scholar
Baker CL. Coarctation: the search for the Holy Grail. J Thorac Cardiovasc Surg 2003; 126: 329–331.Google Scholar
Gibbs JL. Treatment options for coarctation of the aorta. Heart 2000; 84: 11–13.Google Scholar
Giordano U, Turchetta A, Crosio G, et al. End-to-end anastomosis vs. subclavian flap for the repair of aortic coarctation: cardiovascular hemodynamics and blood pressure differences. Abstracts of the American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery. Pediatr Cardiol 2003; 24: 630 (A127).Google Scholar
Update on the 1987 Second Task Force Report on High Blood Pressure in Children and adolescents: a working group report from the National High Blood Pressure Education Programme. Pediatrics 1996; 98: 649–658.
James FW. Exercise testing in normal individuals and with cardiovascular disease. Cardiovasc Clin 1980; 11: 227–246.Google Scholar
Soergel M, Kirschstein M, Busch C, et al. Oscillometric twenty-four hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178–184.Google Scholar
Clarkson PM, Nicholson MR, Barrat-Boyes BG, Neutze JM, Whitlock RM. Results after repair of coarctation of the aorta beyond infancy: a 10-to-28 years follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 1481–1488.Google Scholar
Freed MD, Rocchini A, Rosenthal A, Nadas AS, Castaneda AR. Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am J Cardiol 1979; 43: 253–258.Google Scholar
Johnson D, Perrault H, Vobecky SJ, Fournier A, Davignon A. Influence of the postoperative period and surgical procedure on ambulatory blood pressure determinations of hypertension load after successful surgical repair of coarctation of the aorta. Eur Heart J 1998; 19: 638–646.Google Scholar
Giordano U, Turchetta A, Calzolari F, Crosio G, Giannico S, Calzolari A. Exercise blood pressure response, cardiac output and 24 h ambulatory blood pressure monitoring in children after aortic coarctation repair. Ital Heart J 2003; 4: 408–412.Google Scholar
Sehested J, Baandrup U, Mikkelsen E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Circulation 1982; 65: 1060–1065.Google Scholar
Ong CM, Canter CE, Gutierrez FR, Sekarski DR, Goldring DR. Increased stiffness and persistent narrowing of the aorta after successful repair of coarctation of the aorta. Am Heart J 1992; 123: 1594–1600.Google Scholar
Benetos A, Zureich M, Morcet J, et al. A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men. J Am Coll Cardiol 2000; 35: 673–680.Google Scholar
Benetos A, Safar ME, Rudnichi A, et al. Pulse pressure: a predictor of long term mortality in a French male population. Hypertension 1997; 30: 1410–1415.Google Scholar