Discrepancies in aortic growth explain aortic arch gradients during exercise

Howard Weber, Stephen Cyran, Marek Grzeszczak, John Myers, Marie M. Gleason, Barry G. Baylen

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objectives. This study was conducted to evaluate the incidence and etiology of hypertension and aortic arch gradients during exercise in patients who have apparent good coarctation repair assessed at rest. Background. The reported incidence of recurrent aortic arch obstruction (rest gradient >20 mm Hg) after previous successful surgical repair varies from 0% to 60% and usually is associated with recurrent stenosis at the site of surgical repair. Methods. Maximal treadmill exercise with Doppler echocardiographic gradient estimation was performed in 28 patients with a good coarctation repair at rest (normal blood pressure and arch gradient <20 mm Hg) who had isolated coarctation repair a mean of 7.8 years previously. Results. Eight (29%) developed systolic hypertension for age and a mean Doppler gradient of 45 ± 13 mm Hg. At cardiac catheterization, the rest peak to peak systolic gradient (6 ± 6 to 28 ± 7 mm Hg, p < 0.001), peak systolic instantaneous gradient (16 ± 11 to 48 ± 9 mm Hg, p < 0.01) and cardiac index (3.5 ± 0.7 to 5.9 ± 1.1 liters/m per m2, p < 0.001) all increased during isoproterenol infusion. Angiographic systolic aortic arch measurements proximal to the innominate artery, left common carotid artery, left subclavian artery and the narrowest dimension at the coarctation repair site demonstrated hypoplasia at the left common carotid artery (11.8 ± 1.7 vs. 16.7 ± 2.9 mm/m2, p < 0.01) and left subclavian artery (11.6 ± 1.7 vs. 15.4 ± 3.1 mn/m2, p < 0.05) compared with findings in 10 patients with normal aortograms. Transverse aortic arch ratios were also smaller in the eight patients with abnormal findings. Preoperative angiographic ratios were not predictive of late postoperative findings. Conclusions. Exercise testing detects hypertension and arch gradients in patients with a good coarctation repair as assessed at rest. The hypertension and arch "obstruction" appear to be related to discrepancies in the growth of the transverse aortic arch proximal to the repair site, rather than a "recoarctation" of the aorta.

Original languageEnglish (US)
Pages (from-to)1002-1007
Number of pages6
JournalJournal of the American College of Cardiology
Volume21
Issue number4
DOIs
StatePublished - Mar 15 1993

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Thoracic Aorta
Exercise
Hypertension
Growth
Subclavian Artery
Common Carotid Artery
Brachiocephalic Trunk
Incidence
Cardiac Catheterization
Isoproterenol
Aorta
Pathologic Constriction
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{b37cbfb89a344f998216e1201bfc80b4,
title = "Discrepancies in aortic growth explain aortic arch gradients during exercise",
abstract = "Objectives. This study was conducted to evaluate the incidence and etiology of hypertension and aortic arch gradients during exercise in patients who have apparent good coarctation repair assessed at rest. Background. The reported incidence of recurrent aortic arch obstruction (rest gradient >20 mm Hg) after previous successful surgical repair varies from 0{\%} to 60{\%} and usually is associated with recurrent stenosis at the site of surgical repair. Methods. Maximal treadmill exercise with Doppler echocardiographic gradient estimation was performed in 28 patients with a good coarctation repair at rest (normal blood pressure and arch gradient <20 mm Hg) who had isolated coarctation repair a mean of 7.8 years previously. Results. Eight (29{\%}) developed systolic hypertension for age and a mean Doppler gradient of 45 ± 13 mm Hg. At cardiac catheterization, the rest peak to peak systolic gradient (6 ± 6 to 28 ± 7 mm Hg, p < 0.001), peak systolic instantaneous gradient (16 ± 11 to 48 ± 9 mm Hg, p < 0.01) and cardiac index (3.5 ± 0.7 to 5.9 ± 1.1 liters/m per m2, p < 0.001) all increased during isoproterenol infusion. Angiographic systolic aortic arch measurements proximal to the innominate artery, left common carotid artery, left subclavian artery and the narrowest dimension at the coarctation repair site demonstrated hypoplasia at the left common carotid artery (11.8 ± 1.7 vs. 16.7 ± 2.9 mm/m2, p < 0.01) and left subclavian artery (11.6 ± 1.7 vs. 15.4 ± 3.1 mn/m2, p < 0.05) compared with findings in 10 patients with normal aortograms. Transverse aortic arch ratios were also smaller in the eight patients with abnormal findings. Preoperative angiographic ratios were not predictive of late postoperative findings. Conclusions. Exercise testing detects hypertension and arch gradients in patients with a good coarctation repair as assessed at rest. The hypertension and arch {"}obstruction{"} appear to be related to discrepancies in the growth of the transverse aortic arch proximal to the repair site, rather than a {"}recoarctation{"} of the aorta.",
author = "Howard Weber and Stephen Cyran and Marek Grzeszczak and John Myers and Gleason, {Marie M.} and Baylen, {Barry G.}",
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Discrepancies in aortic growth explain aortic arch gradients during exercise. / Weber, Howard; Cyran, Stephen; Grzeszczak, Marek; Myers, John; Gleason, Marie M.; Baylen, Barry G.

In: Journal of the American College of Cardiology, Vol. 21, No. 4, 15.03.1993, p. 1002-1007.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Discrepancies in aortic growth explain aortic arch gradients during exercise

AU - Weber, Howard

AU - Cyran, Stephen

AU - Grzeszczak, Marek

AU - Myers, John

AU - Gleason, Marie M.

AU - Baylen, Barry G.

PY - 1993/3/15

Y1 - 1993/3/15

N2 - Objectives. This study was conducted to evaluate the incidence and etiology of hypertension and aortic arch gradients during exercise in patients who have apparent good coarctation repair assessed at rest. Background. The reported incidence of recurrent aortic arch obstruction (rest gradient >20 mm Hg) after previous successful surgical repair varies from 0% to 60% and usually is associated with recurrent stenosis at the site of surgical repair. Methods. Maximal treadmill exercise with Doppler echocardiographic gradient estimation was performed in 28 patients with a good coarctation repair at rest (normal blood pressure and arch gradient <20 mm Hg) who had isolated coarctation repair a mean of 7.8 years previously. Results. Eight (29%) developed systolic hypertension for age and a mean Doppler gradient of 45 ± 13 mm Hg. At cardiac catheterization, the rest peak to peak systolic gradient (6 ± 6 to 28 ± 7 mm Hg, p < 0.001), peak systolic instantaneous gradient (16 ± 11 to 48 ± 9 mm Hg, p < 0.01) and cardiac index (3.5 ± 0.7 to 5.9 ± 1.1 liters/m per m2, p < 0.001) all increased during isoproterenol infusion. Angiographic systolic aortic arch measurements proximal to the innominate artery, left common carotid artery, left subclavian artery and the narrowest dimension at the coarctation repair site demonstrated hypoplasia at the left common carotid artery (11.8 ± 1.7 vs. 16.7 ± 2.9 mm/m2, p < 0.01) and left subclavian artery (11.6 ± 1.7 vs. 15.4 ± 3.1 mn/m2, p < 0.05) compared with findings in 10 patients with normal aortograms. Transverse aortic arch ratios were also smaller in the eight patients with abnormal findings. Preoperative angiographic ratios were not predictive of late postoperative findings. Conclusions. Exercise testing detects hypertension and arch gradients in patients with a good coarctation repair as assessed at rest. The hypertension and arch "obstruction" appear to be related to discrepancies in the growth of the transverse aortic arch proximal to the repair site, rather than a "recoarctation" of the aorta.

AB - Objectives. This study was conducted to evaluate the incidence and etiology of hypertension and aortic arch gradients during exercise in patients who have apparent good coarctation repair assessed at rest. Background. The reported incidence of recurrent aortic arch obstruction (rest gradient >20 mm Hg) after previous successful surgical repair varies from 0% to 60% and usually is associated with recurrent stenosis at the site of surgical repair. Methods. Maximal treadmill exercise with Doppler echocardiographic gradient estimation was performed in 28 patients with a good coarctation repair at rest (normal blood pressure and arch gradient <20 mm Hg) who had isolated coarctation repair a mean of 7.8 years previously. Results. Eight (29%) developed systolic hypertension for age and a mean Doppler gradient of 45 ± 13 mm Hg. At cardiac catheterization, the rest peak to peak systolic gradient (6 ± 6 to 28 ± 7 mm Hg, p < 0.001), peak systolic instantaneous gradient (16 ± 11 to 48 ± 9 mm Hg, p < 0.01) and cardiac index (3.5 ± 0.7 to 5.9 ± 1.1 liters/m per m2, p < 0.001) all increased during isoproterenol infusion. Angiographic systolic aortic arch measurements proximal to the innominate artery, left common carotid artery, left subclavian artery and the narrowest dimension at the coarctation repair site demonstrated hypoplasia at the left common carotid artery (11.8 ± 1.7 vs. 16.7 ± 2.9 mm/m2, p < 0.01) and left subclavian artery (11.6 ± 1.7 vs. 15.4 ± 3.1 mn/m2, p < 0.05) compared with findings in 10 patients with normal aortograms. Transverse aortic arch ratios were also smaller in the eight patients with abnormal findings. Preoperative angiographic ratios were not predictive of late postoperative findings. Conclusions. Exercise testing detects hypertension and arch gradients in patients with a good coarctation repair as assessed at rest. The hypertension and arch "obstruction" appear to be related to discrepancies in the growth of the transverse aortic arch proximal to the repair site, rather than a "recoarctation" of the aorta.

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