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Isoproterenol stress test during catheterization of patients with coarctation of the aorta

Authors

  • Ki-Sung Kim,

    Corresponding author
    1. Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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    • These authors equally contributed to this work.

  • Yoshihiko Eryu,

    1. Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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    • These authors equally contributed to this work.

    • Current addresses: Department of Pediatrics, Fujita Health University, 1–98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470–1192, Japan.

  • Hiroko Asakai,

    1. Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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    • Cardiology Department, The Royal Children's Hospital, Flemington Road, Parkville Vic. 3052, Australia.

  • Taiyu Hayashi,

    1. Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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    • Department of Pediatrics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.

  • Masahide Kaneko,

    1. Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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  • Hitoshi Kato

    1. Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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Ki-Sung Kim, MD, Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Email: kkin-tky@umin.ac.jp

Abstract

Background:  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.

Methods:  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.

Results:  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.

Conclusions:  Significant pressure gradients over the coarctation site develop at IST in pediatric patients with repaired CoA or in preoperative patients with mild coarctation.

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