Abstract
The hypothesis that mild recurrent aortic obstruction produces subtle changes in ambulatory blood pressure was investigated by performing 24-hour monitoring on 11 postoperative coarctation patients. Patients (age 16.1±2.7 years) were compared with normal controls (age 15.7±2.5 years,n=15). Surgery (end-to-end anastomosis) was performed at 6.0±1.0 years of age. There were no significant differences between patients and controls in terms of baseline blood pressure (right arm 123/78±4/3 mmHg versus 120/75±3/2 mmHg) or right leg systolic pressure (125±6 mmHg versus 123±4 mmHg). Of the 11 patients 8 had recoarctation by Doppler study (mean gradient 25.3±2.1 mmHg), 5 of 11 had a postexercise arm-leg pressure difference of>30 mmHg, and 6 patients had aortic diameters at the site of surgery <70% of the descending aortic diameter (by magnetic resonance imaging). There were no significant differences between the coarctation and control groups in terms of mean ambulatory systolic (125±3 mmHg versus 119±2 mmHg) or diastolic (69±2 mmHg versus 72±2 mmHg) pressures throughout the day. However, coarctation patients had a larger number of systolic pressures that exceeded the 95th percentile (18.2±5.6% versus 6.8±1.2%). These labile increases in systolic pressure correlated with residual coarctation (r=0.642,p=0.003). Ambulatory monitoring is a useful tool for detecting and monitoring subtle abnormalities of blood pressure control after coarctation repair.
Similar content being viewed by others
References
Alpert BS, Flood NL, Balfour IC, Strong WB (1982) Automated blood pressure measurement during ergometer exercise in children.Cathet Cardiovasc Diagn 8:525–533
Beaver WL, Wasserman K, Whipp BJ (1986) A new method for detecting anaerobic threshold by gas exchange.J Appl Physiol 60:2020–2027
Beekman RH, Katz BP, Moorehead-Steffens C, Rocchini AP (1983) Altered baroreceptor function in children with systolic hypertension after coarctation repair.Am J Cardiol 52:112–117
Beekman RH, Rocchini AP, Behrendt DM, et al (1986) Long-term outcome after repair of coarctation in infancy: subclavian angioplasty does not reduce the need for reoperation.J Am Coll Cardiol 8:1406–1411
Boxer RA, LaCorte MA, Singh S, et al (1986) Nuclear magnetic resonance imaging in evaluation and follow-up of children treated for coarctation of the aorta.J Am Coll Cardiol 7:1095–1098
Carpenter MA, Dammann JF, Watson DD, et al (1985) Left ventricular hyperkinesia at rest and during exercise in normotensive patients 2 to 27 years after coarctation repair.J Am Coll Cardiol 6:879–886
Clarkson PM, Nicholson MR, Barratt-Boyes BG, Neutze JM, Whitlock RM (1983) Results after repair of coarctation of the aorta beyond infancy: a 10 to 28 year follow-up with particular reference to late systemic hypertension.Am J Cardiol 51:1481–1488
Daniels SR, James FW, Loggie JMH, Kaplan S (1987) Correlates of resting and maximal exercise systolic blood pressure after repair of coarctation of the aorta: a multivariable analysis.Am Heart J 113:349–353.
Foster ED (1984) Reoperation for aortic coarctation. Ann Thorac Surg 38:81–89.
Freed MD, Rocchini A, Rosenthal A, Nadas AS, Castaneda AR (1979) Exercise-induced hypertension after surgical repair of coarctation of the aorta.Am J Cardiol 43:253–258.
Gidding SS, Rocchini AP, Moorehead C, Schork MA, Rosenthal A (1985) Increased forearm vascular reactivity in patients with hypertension after repair of coarctation.Circulation 71:495–499
Godfrey S (1974)Exercise Testing in Children. Saunders, London, pp 66–101
Gupta TC, Wiggers CJ (1951) Basic hemodynamic changes produced by aortic coarctation of different degrees.Circulation 3:17–31
Hartmann AF, Goldring D, Hernandez A, et al (1970) Recurrent coarctation of the aorta after successful repair in infancy.Am J Cardiol 25:405–410
Henry WL, Ware J, Gardin JM, et al (1978) Echocardiographic measurements in normal subjects.Circulation 57:278–285
Hubbell MM, O'Brien RG, Krovetz LJ, Mauck HP, Tompkins DG (1979) Status of patients 5 or more years after correction of coarctation of the aorta over age 1 year.Circulation 60:73–80
Kamau P, Miles V, Toews W, et al (1981) Surgical repair of coarctation of the aorta in infants less than six months of age.J Thorac Cardiovasc Surg 91:171–179
Kimball BP, Shurvell BL, Houle S, et al (1986) Persistent ventricular adaptations in postoperative coarctation of the aorta.J Am Coll Cardiol 8:172–178.
Kirkendall WM, Feinleib M, Freis ED, Mark AL (1980) Recommendations for human blood pressure determination by sphygmomanometers.Circulation 62:1145A-1155A
Leandro J, Smallhorn JF, Benson L, et al (1992) Ambulator blood pressure monitoring and left ventricular mass and function after successful surgical repair of coarctation of the aorta.J Am Coll Carrdiol 20:197–204
Markel H, Rocchini AP, Beekman RH, et al (1986) Exerciseinduced hypertension after repair of coarctation of the aorta: arm versus leg exercise.J Am Coll Cardiol 8:165–171.
Moskowitz WB, Schieken RM, Mosteller M, Bossano R (1990) Altered systolic and diastolic function in children after “successful” repair of coarctation of the aorta.Am Heart J 120:103–109
Nanton MA, Olley PM (1976) Residual hypertension after coarctectomy in children.Am J Cardiol 37:769–772
Parker FB, Streeten DH, Blackman MS, Sondheimer HM, Anderson GH (1980) Hypei tensive mechanisms in coarctation of the aorta.J Thorac Cardiovasc Surg 80:568–573
Parker FB, Streeten DH, Farrell B, et al (1982) Preoperative and postoperative renin levels in coarctation of the aorta.Circulation 66:513–514
Pelech AN, Kartodihardjo W, Balfe JA, et al (1986) Exercise in children before and after coarctectomy: hemodynamic echocardiographic, and biochemical assessment.Am Heart J 112:1263–1270
Report of the second task force on blood pressure control in children—1987. (1987)Pediatrics 79:1–25
Santucci S, Steiner D, Zimbler M, James G, Pickering TG (1988) A validation study of the SpaceLabs 90202 and 5200 ambulatory blood pressure monitors.J Ambul Monit 1:211–216
Sehested J, Baandrup U, Mikkelsen E (1982) Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation.Circulation 65:1060–1065
Smith RT, Sade RM, Riopel DA, et al (1984) Stress testing for comparison of synthetic patch aortoplasty with resection and end to end anastomosis for repair of coarctation in childhood.J Am Coll Cardiol 4:765–770
Stern HC, Locher D, Wallrofer K, et al (1991) Nonivasive assessment of coarctation of the aorta: comparative measurements by two-dimensional echocardiography, magnetic resonance, and angiography.Pediatr Cardiol 12:1–5
Williams WG, Shindo G, Trusler GA, Dische MR, Olley PM (1980) Results of repair of coarctation of the aorta during infancy.J Thorac Cardiovasc Surg 79:603–608
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Parrish, M.D., Torres, E., Peshock, R. et al. Ambulatory blood pressure in patients with occult recurrent coarctation of the aorta. Pediatr Cardiol 16, 166–171 (1995). https://doi.org/10.1007/BF00794187
Issue Date:
DOI: https://doi.org/10.1007/BF00794187