Vascular dysfunction after repair of coarctation of the aorta: Impact of Early Surgery
Vascular dysfunction after repair of coarctation of the aorta: Impact of Early Surgery
复制标题
主动脉缩窄修复术后血管功能障碍：早期手术的影响
作者：
M. de Divitiis;C. Pilla;M. Kattenhorn;M. Zadinello;A. Donald;P. Leeson;S. Wallace;A. Redington;J. Deanfield
背景：血管收缩修复的患者，尽管修复成功，但高血压和心血管疾病的风险增加。我们研究了缩窄修复术后患者上肢和下肢导管动脉的功能及其与手术年龄的关系。方法与结果：采用高分辨率超声测量64例缩窄患者（男44例，女20例，年龄19±10岁，手术中位年龄4个月）和45例对照组（男28例，女17例，年龄19±10岁）肱动脉血流介导扩张（FMD）和舌下硝酸甘油（NTG, 25 &mgr;g）及37例患者和22例对照组的胫骨后动脉。通过肱桡足束和股背足束的脉搏波速度（PWV）测定动脉僵硬度。与对照组相比，患者肱FMD（7.16±3.4%比8.62±2.3%,P =0.02）和NTG（11.46±4.3%比13.21±4.6%,P =0.046）较低，肱桡PWV（9.17±3.1比8.06±1.9 m/s, P =0.05）较高。相比之下，胫骨后侧FMD、NTG和下肢PWV具有可比性。修复时的年龄（月）与肱桡PWV相关（r =0.42, P =0.002），但与肱FMD或NTG无关。结论：主动脉缩窄修复后的患者导管动脉功能受损，对血流和NTG反应异常，仅限于上半身的血管僵硬度增加。早期修复与保留导管动脉的弹性特性有关，但反应性仍然降低。
Background—Patients with repaired coarctation are at increased risk of hypertension and cardiovascular disease despite successful repair. We studied the function of conduit arteries in upper and lower limbs of patients late after successful coarctation repair and its relation to age at surgery. Methods and Results—Flow-mediated dilatation (FMD) and the dilatation after sublingual nitroglycerin (NTG, 25 &mgr;g) were measured by using high-resolution ultrasound in the brachial artery in 64 coarctation patients (44 males and 20 females, aged 19±10 years; median age at operation 4 months) and 45 control subjects (28 males and 17 females, aged 19±10 years) and in the posterior tibial artery in 37 patients and 22 control subjects. Arterial stiffness was determined by pulse-wave velocity (PWV) of the brachioradial and femoral-dorsalis pedis tracts. Patients, compared with control subjects, had lower brachial FMD (7.16±3.4% versus 8.62±2.3%, respectively;P =0.02) and NTG (11.46±4.3% versus 13.21±4.6%, respectively;P =0.046) and higher brachioradial PWV (9.17±3.1 versus 8.06±1.9 m/s, respectively;P =0.05). In contrast, posterior tibial FMD, NTG, and lower limb PWV were comparable. Age (months) at the time of repair was related to brachioradial PWV (r =0.42, P =0.002) but not to brachial FMD or NTG. Conclusions—Patients with repaired aortic coarctation have impaired conduit artery function, with abnormal responses to flow and NTG, and increased vascular stiffness confined to the upper part of the body. Early repair is associated with preserved elastic properties of conduit arteries, but reduced reactivity remains.
患有慢性冠状动脉压力超负荷的清醒犬的选择性大冠状动脉内皮功能障碍。
DOI：
10.1152/ajpheart.1998.274.2.h539
发表时间：
1998
期刊：
The American journal of physiology
影响因子：
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作者：
Ghaleh,B;Hittinger,L;Kim,SJ;Kudej,RK;Iwase,M;Uechi,M;Berdeaux,A;Bishop,SP;Vatner,SF
通讯作者：
Vatner,SF