Peripheral Vasodilatory Dysfunction in Adult Patients with Congenital Heart Disease and Severely Elevated Pulmonary Vascular Resistance

Several studies have demonstrated that pulmonary vascular abnormalities precede alterations in aortic circulation downstream in animal models of heart failure. The relationship between increased pulmonary vascular resistance (PVR) and agonist-induced limb vasodilatory response remains unknown in pat...

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Bibliographic Details
Published in:Angiology 2002-11, Vol.53 (6), p.715-720
Main Authors: Nakamura, Motoyuki, Yoshida, Hiroaki, Naganuma, Yujiro, Kon, Hisashi, Sugawara, Shoma, Hiramori, Katsuhiko
Format: Article
Language:English
Subjects:
Acetylcholine - pharmacology
Biological and medical sciences
Blood vessels
Cardiac patients
Cardiovascular system
Case studies
Case-Control Studies
Congenital heart disease
Dilatation
Eisenmenger Complex - physiopathology
Forearm - blood supply
Health aspects
Heart Defects, Congenital - physiopathology
Humans
Hypertension, Pulmonary - diagnosis
Investigative techniques of hemodynamics
Investigative techniques, diagnostic techniques (general aspects)
Medical sciences
Middle Aged
Nitroprusside - pharmacology
Physiological aspects
Pulmonary Artery - physiopathology
Pulmonary Veins - physiopathology
Vascular resistance
Vascular Resistance - physiology
Vasodilation - drug effects
Vasodilation - physiology
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Summary:Several studies have demonstrated that pulmonary vascular abnormalities precede alterations in aortic circulation downstream in animal models of heart failure. The relationship between increased pulmonary vascular resistance (PVR) and agonist-induced limb vasodilatory response remains unknown in patients with congenital cardiovascular shunt lesions (CSL). The authors hypothesized that patients with CSL and severely elevated PVR will show a defective vasomotor response in the peripheral vascular bed. To examine this hypothesis we measured forearm blood flow (FBF) responses to the endothelium-dependent vasodilator acetylcholine and the endothelium-independent vasodilator sodium nitroprusside. The values for these FBF responses were compared with PVR in adult patients with CSL (n = 20) and healthy age- and sex-matched controls (n = 15). When patients with CSL were divided into 2 subgroups by median value of PVR, in the lower PVR subgroup, acetylcholine-induced FBF changes were selectively and significantly lower than in the healthy control group (p < 0.05). In the higher PVR subgroup, FBF responses to both acetylcholine and sodium nitroprusside were significantly blunted compared to healthy controls (both p
ISSN:0003-3197
1940-1574
DOI:10.1177/000331970205300613