Læknablaðið - 15.05.1993, Blaðsíða 29

LÆKNABLAÐIÐ
199
okkar að skynsamlegt sé að aðgerð vegna
CoA fari fram við fyrsta hentuga tækifæri eftir
greiningu, hver sem aldur sjúklingsins er.
SUMMARY
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.
ÞAKKIR
Eftirtaldir aðilar fá sérstakar þakkir fyrir
framlag og stuðning við rannsóknina:
1. Rannsóknarsjóður Háskóla Islands.
2. Hanna Ástvaldsdóttir, hjartarannsóknadeild
Landspítalans: Aðstoð við framkvæmd
áreynsluprófana.
3. Jón Þór Sverrisson sérfræðingur,
Fjórðungssjúkrahúsinu á Akureyri: Aðstoð
við áreynsluprófun og afnot af tækjum
lyflækningadeildar sjúkrahússins.
4. Þórður Harðarson prófessor, yfirlæknir
lyflækningadeildar Landspítalans: Afnot
af áhöldum hjartarannsóknarstofu.
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