Author + information
- Received December 27, 1983
- Revision received May 3, 1984
- Accepted May 11, 1984
- Published online October 1, 1984.
- Richard T. Smith Jr., MD1,
- Robert M. Sade, MD, FACC1,
- Donald A. Riopel, MD, FACC1,
- Ashby B. Taylor, MD1,
- Fred A. Crawford Jr., MD, FACC1 and
- Arno R. Hohn, MD, FACC1,*
- ↵*Address for reprints: Amo R. Hohn, MD, Children's Hospital of Los Angeles, Division of Cardiology, 4650 Sunset Boulevard. PO Box 54700, Los Angeles, California 90054-0700.
Excellent clinical results have been achieved by both resection with end to end anastomosis and synthetic patch aortoplasty for the repair of coarctation of the aorta in older children. Increasing experience with exercise stress testing in the postoperative evaluation of patients with coarctation has allowed the discovery of less obvious differences between the two procedures. To evaluate these differences further, the stress tests of 50 postoperative patients who underwent coarctation repair were reviewed: 26 patients with end to end anastomosis and 24 with synthetic patch aortoplasty. Twenty normal control subjects were similarly exercised. Systolic blood pressure in the arm and leg was evaluated before and after the test. Heart rate, electrocardiogram and arm blood pressure were monitored during the test.
The mean arm systolic blood pressure was higher at all points of measurement in the patients who under-went repair by end to end anastomosis than in the group who underwent patch aortoplasty. These systolic pressure differences reached statistical significance only for standing arm blood pressure before exercise (p < 0.05) and for supine arm systolic blood pressure immediately after exercise (p < 0.01). There was no difference in arm-leg pressure gradient between the two study groups before exercise; however, after exercise the group with end to end anastomosis had significantly higher arm-leg pressure gradients (p < 0.001).
Significant differences between the two types of repair not apparent at rest were found immediately after exercise. The long-term prognostic importance of an exercise-induced arm-leg blood pressure gradient remains to be determined. However, exercise stress testing is sensitive in demonstrating these differences.
- Received December 27, 1983.
- Revision received May 3, 1984.
- Accepted May 11, 1984.
- American College of Cardiology Foundation