Kim Ki-Sung, Eryu Yoshihiko, Asakai Hiroko, Hayashi Taiyu, Kaneko Masahide, Kato Hitoshi
Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Int. 2012 Aug;54(4):461-4. doi: 10.1111/j.1442-200X.2012.03572.x. Epub 2012 Apr 9.
The exercise test is considered useful in selecting high-risk patients with repaired coarctation of the aorta (CoA), but it is difficult to obtain the cooperation of pediatric patients. The present study determines the feasibility of the isoproterenol stress test (IST) among pediatric patients with CoA.
Thirteen patients with repaired or mild preoperative CoA aged 1-207 (median 13) months underwent 16 IST during cardiac catheterization. Peak-to-peak pressure gradients (PG) over the coarctation site were measured at baseline and at IST. Balloon angioplasty (BAP) was applied to patients with significant stenosis on angiography.
The PG between the ascending and the descending aorta was significantly higher at IST than at baseline (20.5 ± 11.5 vs 5.6 ± 3.9 mmHg, P < 0.0001). Heart rate, the systolic blood pressure measured at the ascending aorta, and pulse pressure were all significantly higher at IST than at baseline. The PG at IST decreased >10 mmHg in three of six patients after BAP.
Significant pressure gradients over the coarctation site develop at IST in pediatric patients with repaired CoA or in preoperative patients with mild coarctation.
运动试验被认为有助于筛选接受过主动脉缩窄（CoA）修复术的高危患者，但很难获得儿科患者的配合。本研究确定了异丙肾上腺素负荷试验（IST）在患有CoA的儿科患者中的可行性。
13例年龄在1至207个月（中位数13个月）之间、接受过CoA修复术或术前CoA症状较轻的患者在心脏导管插入术期间接受了16次IST。在基线和IST时测量缩窄部位的峰峰值压力梯度（PG）。对血管造影显示有明显狭窄的患者进行球囊血管成形术（BAP）。
IST时升主动脉和降主动脉之间的PG显著高于基线时（20.5±11.5对5.6±3.9 mmHg，P<0.0001）。IST时心率、升主动脉测量的收缩压和脉压均显著高于基线时。6例患者中有3例在BAP后IST时的PG下降>10 mmHg。
在接受过CoA修复术的儿科患者或术前CoA症状较轻的患者中，IST时缩窄部位会出现明显的压力梯度。
