Evidence for General Distribution of Peripheral Resistance in Coarctation of the Aorta: Report of Three Cases

Steele, J. Murray

doi:10.1172/jci101241

Cited by 67 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Steele (50) found 44 per cent with a raised diastolic pressure in at least one arm: he used a level of 100 mm. as the upper limit of normal, but the method of recording the diastolic pressure was not described.…”

Section: Discussionmentioning

confidence: 99%

Immediate and Remote Effects of Resection on the Hypertension in Coarctation of the Aorta

March¹,

Hultgren²,

Gerbode³

1960

Heart

View full text Add to dashboard Cite

Twenty-five years ago Sir Thomas Lewis summarized the state of knowledge regarding this important congenital lesion (34)* and thought that "new records of cases can have little value unless they reveal new features of interest and importance to the study of the condition." Yet hardly more than a decade later the first patients with coarctation of the aorta were to be successfully operated upon in Sweden (11) and the United States (23). A new era of progress in the treatment and understanding of the pathological physiology of this lesion began. By 1953 Gross had operated on 270 patients (24), and more recently it has been possible to collect data on 1601 patients surgically treated by 36 surgeons (52). It is apparent that operative intervention for coarctation of the aorta has become widely practised. Its broad acceptance appears to be justified not only by the demonstration that the classical pulse abnormalities can be largely reversed (5a, b), but also by the reasonable safety of the procedure and by the subjective improvement of patients (7,8, 24).The cure of the characteristic hypertension has been included among the benefits of surgical treatment in reports from a number of clinics (6,10,20, 24,27,35). Indeed a fall in blood pressure does usually follow successful intervention, but most communications have described the condition shortly after the operative procedure, and the criteria for evaluation of the blood pressure response are usually referred to an arbitrary or ideal value. With few exceptions (6, 9, 59) systematic observations at remote intervals after treatment have not been made, and in one of these (9) the conclusions appear to be at variance with the more numerous and optimistic results reported just after operation. In this latter work alone were the data given careful statistical treatment.Obviously this question is of prognostic importance since the complications of hypertension are the cause of a quarter of the deaths in coarctation (24), and since in untreated cases there is a progressive increase in systolic pressure during the first two decades of life (6). Moreover, the issue is of interest from the theoretical point of view since the mechanism of most forms of hypertension is poorly understood, and that of coarctation has evoked considerable disagreement. The classical view that it is caused by the mechanical obstruction (3, 4,34) has been challenged on a number of grounds by those who hold that it is caused by an interference with the renal arterial flow producing a generalized increase in peripheral resistance (38,44,45). Finally, there has been speculation about the mechanism and significance of the abdominal pain and the paradoxical rise of blood pressure that not infrequently follow resection of the coarctation (2,43, 47). These considerations suggested that an immediate and long-term study of the effect of operation on coarctation hypertension would be desirable. MATERIALS AND METHODSIn the ten years, [1948][1949][1950][1951][1952][1953][1954][1955][1956][1957][1958] 80 patients ...

show abstract

Section: Discussionmentioning

confidence: 99%

Immediate and Remote Effects of Resection on the Hypertension in Coarctation of the Aorta

March¹,

Hultgren²,

Gerbode³

1960

Heart

View full text Add to dashboard Cite

show abstract

“…The inhalation of CO. was used to estimate circulation time from the lungs to the respiratory center in seven patients (15) (Table II). 5We are indebted to Dr. J. M. Steele for referring Cases 2 and 5 to us. They are Cases A. C. and W. G. in his paper (22). 6 Mascosol, a solution described by Spier, Wright, and Saylor (14) containing magnesium sulphate, calcium gluconate, and sodium chloride, was supplied to us for these studies by The Nepera Chemical Co., Inc., of Yonkers, N. Y. consumption increased slightly at the time of the second estimation but the basal metabolic rate was unchanged (6 per cent and 3 per cent, respectively).…”

Section: Methodsmentioning

confidence: 90%

“…Steele (22) reviewed the knowledge of levels of arterial pressure in 203 cases of coarctation of the aorta and, by intra-arterial measurement, found the diastolic pressure to be elevated above 100 mm. Hg in the femoral as well as the radial arteries in two of three cases he studied.…”

Section: Methodsmentioning

confidence: 99%

The Cardiac Output and Other Measurements of the Circulation in Coarctation of the Aorta 1

Stewart¹,

Bailey²

1941

J. Clin. Invest.

View full text Add to dashboard Cite

“…The control group consisted of 12 Table I indicates that in the upper extremity maximal muscle blood flow was also significantly decreased (P < 0.05), whereas in the lower extremity there was no difference from normal control levels. Values measured in the upper extremity were lower than in the lower extremity (P < 0.001).…”

Section: Methodsmentioning

confidence: 97%

Differences in muscle blood flow in upper and lower extremities of patients after correction of coarctation of the aorta.

Šamánek¹,

Goetzová²,

Fiserová³

et al. 1976

Circulation

View full text Add to dashboard Cite

SUMMARY Using the method of "3Xe clearance we investigated blood flow and calculated vascular resistances simultaneously in the muscles of the upper and lower extremities in 58 patients following successful surgical correction of aortic coarctation carried out at age 11.5 (±2.9) years. The interval from operation to investigation was 11.5 (±4.5) years. Resting and maximal ischemic exercise blood flows in the upper extremity were decreased and the duration of maximal blood flow was shortened. Values recorded from the lower ex-IN CONGENITAL NARROWING OF THE THO-RACIC AORTA the peripheral vascular bed is divided into two segments which differ hemodynamically. In the aorta proximal to the coarctation, and in vascular beds supplied by arteries from this part of the aorta, the blood pressure is elevated and of high amplitude. In the aorta distal to the coarctation and in arteries arising from it, systolic pressure is in most cases below normal values; in some cases it may remain normal. Diastolic pressure is in most cases increased; only rarely is it normal or decreased.' The typical pressure curve from the femoral artery has a sharp peak which is shifted to the first phase of systole and characteristically shows a very low pulse pressure. Hallenbeck2 found by direct measurement in 50 patients with coarctation of the aorta an average ratio of 0.57 between systolic pressures in the femoral and radial arteries, as opposed to average values of 0.99 in healthy subjects. Even more striking is the difference between values of pulse pressure. In healthy subjects the mean ratio between the femoral and radial arteries is 1.02, whereas in patients with coarctation values varied from 0.15 to 0.50, with a mean of 0.30.After surgical correction of coarctation, differences between hemodynamic parameters in the two parts of the vascular bed disappear. Pressures in both extremities become equal, pulse waves take on a normal shape in both upper and lower extremities and the time shift between pulse waves in the two halves of the body is corrected.3 Vascular impedance also becomes normal.' This does not, however, suggest that the abnormal hemodynamics, existing from birth, has not left lasting sequelae in the structure, physical properties, and reactivity of vessels.Simultaneous measurement of blood flow in the forearm and in the calf musculature in adults operated on in childhood for coarctation of the aorta has been undertaken to determine whether the hemodynamic conditions in early life influenced the function of vascular bed in striated muscle. tremities did not differ from normal controls. The difference between upper and lower extremities was statistically significant. Vascular resistance during maximal blood flow was higher in the upper extremities than in the lower. Differences between upper and lower extremities did not change after vasodilation elicited by amyl nitrite. The degree of differences was not dependent upon the age at operation, the age of the patients at investigation, or on the time interval between operation and...

show abstract

Evidence for General Distribution of Peripheral Resistance in Coarctation of the Aorta: Report of Three Cases

Cited by 67 publications

References 26 publications

Immediate and Remote Effects of Resection on the Hypertension in Coarctation of the Aorta

Immediate and Remote Effects of Resection on the Hypertension in Coarctation of the Aorta

The Cardiac Output and Other Measurements of the Circulation in Coarctation of the Aorta 1

Differences in muscle blood flow in upper and lower extremities of patients after correction of coarctation of the aorta.

Contact Info

Product

Resources

About