The Journal of Thoracic and Cardiovascular Surgery, Vol 80, 182-186, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Technical and pharmacologic management of distal hypotension during repair of coarctation of the aorta
NN Moreno, T de Campo, GA Kaiser and VS Pallares
Neurologic and abdominal complications can occur in the postoperative
period of aortic coarctation repair, ischemia being the pathogenic factor
most likely to be involved. This study was designed to evaluate the extent
of the hemodynamic changes proximal and distal to the coarctation at the
time of cross-clamping, as well as the effects of pentolinium and
isoproterenol upon the hemodynamic changes. Included in the study were 17
patients with adult type coarctations who had dual hemodynamic monitoring.
During cross-clamping, there was an increase in the gradient between
proximal and distal pressures, with severe distal hypotension (< 50 mm
Hg) occurring in six patients. Isoproterenol corrected the hypotension in
five patients, but the sixth required a surgical shunt. Pentolinium was
effective for the treatment of proximal hypertension; however, it also
decreased distal pressure. The ligation of collateral vessels was
associated with a decrease in distal pressures as well. During
cross-clamping, pentolinium was useful for the management of proximal
hypertension and isoproterenol increased the distal pressures in some of
the patients who presented distal hypotension. However, because of the
difficulties in predicting the individual response, their administration
would be best guided by dual pressure monitoring. It is postulated that the
recognition and proper treatment of distal hypotension may be an important
factor in the prophylaxis of postoperative complications.
