Circulation, Vol 89, 1745-1750, Copyright © 1994 by American Heart Association
HM Gardiner, DS Celermajer, KE Sorensen, D Georgakopoulos, J Robinson, O Thomas and JE Deanfield
BACKGROUND: Despite successful repair of coarctation of the aorta in
childhood, adult survivors often have hypertension at rest or on exercise,
and their life expectancy is shorter than normal because of premature
coronary and cerebrovascular disease. This may be related to persistent
structural and functional arterial abnormalities after surgery. METHODS AND
RESULTS: Using high-resolution ultrasound, we studied the right brachial
arteries of 25 normotensive young adults who had undergone successful
repair of coarctation in childhood (mean age at repair, 62 months; range, 0
to 167 months, including 8 patients operated on in infancy; mean age at
study, 19 years; range, 14 to 27 years) and 50 age- and sex-matched control
subjects. We assessed the degree of reactive hyperemia (RH) produced after
distal cuff occlusion and release and the changes in arterial diameter in
response to RH (with increased flow causing endothelium-dependent dilation)
and to glyceryltrinitrate (GTN, an endothelium-independent dilator). The
response of the right femoral artery to GTN was also measured in 12
coarctation subjects and 12 control subjects. Studies were performed 13.7
years (range, 7 to 21 years) after surgery. RH was significantly lower in
coarctation subjects (343 +/- 130% versus 482 +/- 147%), as were
endothelium-dependent dilation (3.8 +/- 3.3% versus 8.8 +/- 3.6%) and GTN
response (13.3 +/- 6.0% versus 20.5 +/- 6.1%) (P < .001 for each),
reflecting abnormal dilatory capacity in both the resistance and conduit
arteries. In contrast, GTN-induced dilation in the femoral arteries was
similar to that in control subjects (9.5 +/- 2.6% versus 10.1 +/- 4.1%, P =
.70). On multivariate analysis, GTN response and systolic blood pressure at
peak exercise were inversely correlated (r = -.52, P = .04). Vascular
responses were not related to the age at repair. CONCLUSIONS: Despite
successful repair of coarctation in childhood, arterial dilation is
significantly impaired in the precoarctation vascular bed of healthy young
adults. This may be an important contributor to exercise-related
hypertension and late morbidity or mortality.
ARTICLES
Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood
Cardiothoracic Unit, Hospital for Sick Children, London, UK.
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