Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection

Guenthard, J.; Wyler, F

doi:10.1016/s0002-9149(99)80418-4

Cited by 41 publications

(22 citation statements)

References 19 publications

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“…3 Meanwhile, similar findings were demonstrated with different diagnostic methods such as nuclear perfusion scanning, 3 measurement of vascular resistance, 24 2D echocardiography, 10 -14 and measurement of flow-mediated dilatation or analysis of pulse-wave velocity. [5][6][7][8][9] However, almost all previous studies investigated patients substantially later after surgical correction without any preoperative data.…”

Section: Discussionmentioning

confidence: 99%

“…4 Noninvasive assessment of the elastic properties of peripheral conduit arteries is possible through measurement of flow-mediated dilatation and analysis of pulse-wave velocity. [5][6][7][8][9] Recently, distensibility and wall stiffness of the aortic wall has also been measured by means of transthoracic, 10 -12 transesophageal, 13 or intravascular echocardiography. 14 Examinations in patients with coarctation of the aorta showed reduced elasticity of the vascular system in the prestenotic region even after successful surgical correction.…”

mentioning

confidence: 99%

“…14 Examinations in patients with coarctation of the aorta showed reduced elasticity of the vascular system in the prestenotic region even after successful surgical correction. [5][6][7][8][9][10][11][12][13][14] Early surgical correction (Ͻ4 months) seems to be associated with better preserved elastic properties of conduit arteries in the upper part of the body. 5 The fact that early surgery can prevent long-term alterations of arterial stiffness in conduit arteries might be explained by 2 theories: Either vascular stiffness in newborns with coarctation is not impaired primarily and changes happen later in life, or elastic properties in newborns are affected primarily but can improve and become normal if surgery is done early.…”

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confidence: 99%

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Impaired Elastic Properties of the Ascending Aorta in Newborns Before and Early After Successful Coarctation Repair

Vogt

Kühn²,

Baumgartner³

et al. 2005

Circulation

158

106

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Background-Despite successful surgical correction, morbidity of patients with coarctation of the aorta is increased. It is well known that these patients have impaired elastic properties of the prestenotic arteries. To find out whether these abnormalities are primarily present or develop later, we studied 17 newborns before and early after surgical repair. Methods and Results-Aortic wall stiffness index and distensibility were calculated using ascending and abdominal aortic diameters determined by M-mode echocardiography and noninvasive estimation of aortic pulse pressure in the right arm and leg.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Impaired Elastic Properties of the Ascending Aorta in Newborns Before and Early After Successful Coarctation Repair

Vogt

Kühn²,

Baumgartner³

et al. 2005

Circulation

158

106

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“…A clear explanation for the higher prevalence of hypertension with longer postoperative intervals has not yet been provided. A decrease in vascular resistance and in vascular reactivity of vascular beds supplied by arteries originating from the portion of the aorta proximal to the coarctation has been described in normotensive post-coarctectomy patients [26][27][28] . This could be related to alterations in vascular smooth muscle and collagen content [29] or vascular endothelium properties [30,31] .…”

Section: Influence Of Post-surgical Interval On Hypertension Prevalencementioning

confidence: 99%

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

Perrault²,

Vobecky³

et al. 1998

European Heart Journal

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Aims This study quantified hypertension load using 24-h ambulatory blood pressure monitoring after successful repair of coarctation of the aorta less than (1) or more than 10 years previously (2) and examined the influence of the surgical procedure (anastomosis or subclavian flap). Methods and ResultsAmbulatory blood pressure recordings were obtained using an Accutracker II monitor every 30 min during the day and hourly, at night. Day and night systolic and diastolic values were higher in coarctation of the aorta than in controls: (day: systolic blood pressure/ diastolic blood pressure: 133/71 6/4 vs 115/66 3/2 night: systolic blood pressure/diastolic blood pressure: 117/61 4/ 4 vs 107/57 3/2 mmHg, P<0·01) and at all times, were higher in coarctation of the aorta (2) than in coarctation of the aorta (1). Clinical daytime systolic hypertension was observed in 20% of recordings from coarctation of the aorta (1) and 49% from coarctation of the aorta (2) while diastolic hypertension was not observed. However, systolic blood pressure and diastolic blood pressure responses to daily activities were significantly higher in coarctation of the aorta than in controls and this was more marked in coarctation of the aorta (2) than in coarctation of the aorta (1). Type of surgery did not affect either hypertension prevalence or blood pressure reactivity. ConclusionsThese observations indicate exaggerated systolic blood pressure and diastolic blood pressure reactivity after repair of coarctation of the aorta, the prevalence of systolic hypertension doubling 10 years after surgery.

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“…Persistent vascular dysfunction has been suspected to be an important contributor to abnormal blood pressure regulation and, thus, late cardiovascular morbidity and mortality after successful coarctation repair (47)(48)(49). Modification of the upper limb vascular phenotype has been demonstrated in patients operated upon in early infancy, suggesting that endothelial and smooth muscle functional abnormalities could persist despite early repair.…”

Section: "Nonclassic" Cardiovascular Risk Factorsmentioning

confidence: 99%

Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events in Children

2005

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Noninvasive assessment of vascular dysfunction in the pediatric population has taken advantage of the development of high-resolution ultrasound techniques. The most frequently used methods are the quantification of flow-mediated endotheliumdependent dilation of the brachial artery and measurement of the intima-media thickening of the carotid artery. Both reduced flow-mediated dilation and increased intima-media thickness have been proven to correlate with late cardiovascular events and/or mortality in adults. As these noninvasive methods can easily be applied in children, there have been recent investigations in high-risk pediatric patients harboring classical cardiovascular risk factors. Endothelial dysfunction and increased thickness of the intima media are currently observed in children with familial hypercholesterolemia, obesity, and type 1 diabetes mellitus. The association of early vascular dysfunction with a known risk factor is an important issue as these anomalies precede the formation of atherosclerotic plaques. Therefore, they may help in stratification of the risk for cardiovascular event and to better tailor therapeutic interventions in at risk children. Finally, these methods have been applied in specific pediatric populations, such as children with end-stage renal disease, chronic parenteral nutrition, HIV infection, and coarctation of the aorta. In these conditions, endothelial dysfunction and vascular remodeling are also present early in life and these data raise new possibilities in the understanding of the pathogenesis of atherosclerosis in these populations. Atherosclerosis begins in childhood as deposits of cholesterol and its esters, referred to as fatty streaks, in the intima of large muscular arteries. Evidence regarding the associations of adult coronary artery disease risk factors with atherosclerosis in young persons have been described (1). These observations raise implications for the long-range prevention of coronary artery disease, starting in the pediatric practice. Before the use of high-resolution ultrasound techniques to assess vascular function, anatomical and functional evidence for atherogenesis could only be recognized by invasive investigations or on postmortem examination (2). Today, these noninvasive methods are commonly used to assess endothelial function and to detect early anatomical evidence of atherogenesis in adult and pediatric populations. The most widely used test to evaluate endothelial function measures the vasodilator response to increased blood flow of the brachial artery (flow mediated vasodilatation) (3). Adult studies have demonstrated that the endothelial function of the peripheral circulation is closely related to that of the coronary circulation. The remodeling of the large arteries can be evaluated by the measure of the thickening of the intima and media of the common carotid arteries, or of the aorta (4). These approaches give an estimation of the local or regional function of the examined arterial bed. However, a more global evaluation of the physic...

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Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection

Cited by 41 publications

References 19 publications

Impaired Elastic Properties of the Ascending Aorta in Newborns Before and Early After Successful Coarctation Repair

Impaired Elastic Properties of the Ascending Aorta in Newborns Before and Early After Successful Coarctation Repair

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

Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events in Children

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