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Discrepancies in aortic growth explain aortic arch gradients during exercise
H S Weber1, S E Cyran, M Grzeszczak
1Section of Pediatrics (Cardiology) and Surgery (Cardiothoracic), Pennsylvania State University, Milton S. Hershey Medical Center, Hershey 17033.
Journal of the American College of Cardiology
|March 15, 1993
Summary
Exercise testing reveals hypertension and aortic arch gradients in patients with repaired coarctation. These issues stem from growth discrepancies in the aortic arch, not recoarctation.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Vascular Surgery
Background:
- Recurrent aortic arch obstruction after coarctation repair varies widely (0-60%).
- Obstruction is typically linked to restenosis at the surgical site.
Purpose of the Study:
- To assess exercise-induced hypertension and aortic arch gradients in patients with seemingly successful coarctation repair.
- To investigate the underlying causes of these exercise-related abnormalities.
Main Methods:
- Maximal treadmill exercise with Doppler echocardiography in 28 patients post-coarctation repair.
- Cardiac catheterization and aortography were used for further evaluation.
Main Results:
- 29% of patients developed exercise-induced systolic hypertension and significant aortic arch gradients (mean 45 mmHg).
- Cardiac catheterization showed increased gradients and cardiac index during isoproterenol infusion.
- Aortography revealed hypoplasia of the left common carotid and subclavian arteries in affected patients.
Conclusions:
- Exercise testing effectively identifies hypertension and arch gradients missed by resting assessments.
- Abnormalities are attributed to differential growth of the transverse aortic arch, not true recoarctation.