Exercise performance and blood pressure responses in children after stenting of aortic coarctation

Abstract 

Background

The impact on cardiopulmonary function after endovascular stenting of an aortic arch obstruction is not well defined. We sought to determine in children following stenting whether they had normal cardiopulmonary responses to exercise and 24-h blood pressure (BP) monitoring.

Methods

Children after arch stenting without clinical evidence of persistent resting obstruction underwent a standard Bruce treadmill exercise test, echocardiographic arch flow assessment at rest and at peak exercise and 24-h ambulatory BP monitoring.

Results

There were 5 males (42%) and 7 females. Age at stent implantation was 14±4 years and time from implantation to this study 2.5±2.1 years. Mean arm systolic blood pressure at rest was 123±12 mm Hg and at peak exercise 184±31 mm Hg, with a mean arm to leg blood pressure gradient of 6 mm Hg (range −6 to 68 mm Hg) and 33 mm Hg (range −6 to 150 mm Hg), respectively. Left ventricular (LV) mass/height³ index was 30.0±6.7 with 5 children above the normal range. All children but 1 had a normal exercise endurance and heart rate response, with a maximal oxygen consumption and anaerobic threshold of 85±20% and 99±11% predicted normal, respectively. Four children had significant systolic hypertension, two diastolic hypertension and four a loss of the normal nocturnal BP reduction on 24-h recordings. Echocardiographic BP gradients do not correlate with non-invasive BP gradients. Resting and peak exercise BP and echocardiographic Doppler gradients did not identify children with abnormal 24-h BP monitoring.

Conclusion

Children with stented arch obstructions have normal exercise performance and the majority minimal increases in BP gradients at peak exercise. LV hypertrophy occurs commonly, but does not correlate with either residual arch gradients or abnormal 24-h BP measurements.

Keywords: Exercise performance, Blood pressure responses, Aortic coarctation