| Autor: |
Deane Waldman, J., Goodman, Allan H., Ray Tumeo, A., Lamberti, John J., Turner, Searle Wm., Danz, N., Misiraca, U., Rose, G.P., Loeffler, T. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; August 1980, Vol. 80 Issue: 2 p187-197, 11p |
| Abstrakt: |
A technique has been developed for noninvasive physiological assessment of coarctation of the aorta in which Doppler instrumentation is used to measure simultaneous arm and leg pressures. This technique was applied at rest and with stress in 31 infants and children, 18 before and after operation for coarctation of the aorta, 10 only after operation, and three who have had no operation. Before operation and in a resting state, most patients with coarctation had arm hypertension; arm-leg systolic pressure gradient varied from —5 to 125 mm Hg. Stress often induced a large increase in gradient in those with small resting gradients but had little effect on those whose resting gradient was greater than 60 mm Hg. Operations performed were resection with end-to-end anastomosis (18), patch aortoplasty (five), tube graft insertion (two), and subclavian artery-descending aorta anastomosis (two); in one child, resection was combined with subclavian arterioplasty. Postoperatively, at rest, most patients were normotensive and 23 of 28 had no gradient; however, nine of these 23 patients developed gradients with stress (gradient range 3 to 43 mm Hg). In those with a postoperative gradient at rest (average 20.5 mm), a large increase was usually seen with stress (average gradient 69 mm Hg). Simultaneous determination of arm and leg systolic blood pressure at rest and after stress allows precise quantification of obstruction in aortic coarctation. Stress testing—an integral part of the evaluation of coarctation—can now be done reliably in neonates and in the immediate postoperative period. Only by assessment of initial operative result can residual coarctation be distinguished from recurrent coarctation. Following operation for coarctation, residual/recurrent obstruction may be present without arm hypertension or a gradient at rest; some children develop a gradient only with stress. Valid long-term evaluation of various surgical techniques for coarctation can be performed by comparing groups in which there was complete initial relief of coarctation. |
| Databáze: |
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