Áreynslubundinn háþrýstingur eftir aðgerð vegna ósæðarþrengsla

Abstract

The purpose of this investigation was to study exercise induced hypertension after surgical repair of Coarctation of the Aorta (CoA). Twenty seven patients with CoA, 16 male and 11 female patients age 6 to 21 years were exercised to exhaustion using the Bruce protocol. Twenty seven healthy children served as controls. We also divided our patients into two groups according to at which age the CoA operation took place. Fourteen patients underwent surgery in the first year of life (group A) and 13 patients were operated on after their first birthday (group B). Systolic blood pressure in arm and leg were measured before, during and after exercise along with the pulse rate to evaluate changes in the BP and arm/leg BP gradient with exercise. There was no significant difference in the systolic BP at rest between the patients and controls, nor was there a difference between the groups in the pulse rate during the exercise test. The maximal endurance time was also similar. The systolic BP was significantly higher in the patients in all stages of the exercise test (p<0.01). The arm/leg BP gradient was also significantly higher in the patients both before and after exercise (p<0.01) and it increased significantly with exercise in the patient group (p<0.05). The correlation between the magnitude of BP gradient and maximal systolic blood pressure was good in those patients who had a positive gradient at rest (r=0.749 and p=0.02). Nine patients (33%) had a gradient higher than 10 mmHg after exercise and four patients (15%) had maximal systolic blood pressure over 200 mmHg. We found hypertension to be a more common and severe problem in group B who had significantly higher blood pressure than their controls at rest as well as during exercise. Exercise induced hypertension was also more common in group B (23%) than in group A (7%). Our conclusion is that exercise induced hypertension and recoarctation of some degree is a problem in the post op CoA patient and that exercise testing is a very efficient test in the follow up of these patients. We find exercise induced hypertension to be more common in patients with CoA operated on after the first year of life. From these results we suggest that surgery for CoA take place at the first convenient moment after its diagnosis and preferably in the first year of life.

Markmið þessarar rannsóknar var að athuga áreynslubundinn háþrýsting eftir aðgerð vegna ósæðarþrengsla (coarctatio aortae, CoA). Tuttugu og sjö sjúklingar með CoA, 16 karlar og 11 konur, sex til 21 árs og 27 aldurs-og kynparaðir samanburðareinstaklingar voru áreynsluprófaðir samkvæmt Bruce aðferð. Sjúklingahópnum var einnig skipt í tvennt eftir því hvort þeir fóru í aðgerð fyrir (hópur A) eða eftir (hópur B) eins árs aldur. Slagbilsþrýstingur (systólískur blóðþrýstingur) var mældur í handlegg og fæti fyrir, við og eftir áreynslu. Einnig var mældur hjartsláttarhraði. Ekki reyndist munur milli sjúklinganna og samanburðareinstaklinganna hvað varðar hjartsláttarhraða í hvíld eða við áreynslu og slagbilsþrýstingur í hvíld var svipaður. Hækkun blóðþrýstings við áreynslu var hins vegar meiri hjá sjúklingunum og var marktækur munur þar á við öll stig áreynslunnar (p<0,01) Munur á blóðþrýstingi milli efri og neðri útlima (blóðþrýstingsstigli) var marktækt meiri hjá sjúklingum en samanburðarhópnum (p<0,01) og hann jókst marktækt við áreynslu hjá sjúklingunum (p<0,05). Fylgni mældist milli stærðar blóðþrýstingsstiguls og hæsta slagbilsþrýstings við áreynslu (r=0,75 og p=0,02). Þrjátíu prósent af sjúklingunum mældust með jákvæðan blóðþrýstingsstigul >10 mmHg eftir áreynslu og 15% höfðu hæsta slagbilsþrýsting við áreynslu yfir 200 mmHg. Háþrýstingur reyndist algengari í hópi B en í hópi A og áreynslubundinn háþrýstingur var líka algengari í hópi B (23%) en í hópi A (7%). Niðurstöður okkar eru þær að áreynslubundinn háþrýstingur sé talsvert vandamál hjá CoA sjúklingum og að áreynsluprófið sé góð rannsókn til að fylgjast með þessum sjúklingum. Þá er áreynslubundinn háþrýstingur algengari hjá sjúklingum sem skornir voru eftir eins árs aldur. Álit okkar er að aðgerðina beri að framkvæma við fyrsta hentuga tækifæri eftir greiningu, og helst á fyrsta æviári sjúklings.