Abnormal cardiac autonomic nervous activity after right ventricular outflow tract reconstruction

Citation
H. Ohuchi et al., Abnormal cardiac autonomic nervous activity after right ventricular outflow tract reconstruction, CIRCULATION, 102(22), 2000, pp. 2732-2738
Citations number
28
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
CIRCULATION
ISSN journal
0009-7322 → ACNP
Volume
102
Issue
22
Year of publication
2000
Pages
2732 - 2738
Database
ISI
SICI code
0009-7322(20001128)102:22<2732:ACANAA>2.0.ZU;2-U
Abstract
Background-There are few studies of cardiac autonomic nervous activity (CAN A) in patients with congenital heart disease. Methods and Results-We evaluated CANA in 54 patients after closure of an at rial/ventricular septal defect (group A), 54 patients after successful righ t ventricular outflow tract reconstruction (RVOTR) (group B1), 35 RVOTR pat ients with residual stenosis (group B2), and 47 controls. Cardiac parasympa thetic nervous activity (PSNA) was estimated by heart rate (HR) change afte r cholinergic blockade, HR variability, and arterial baroreflex sensitivity (BRS). Cardiac sympathetic nervous activity was estimated by the heart-to- mediastinum I-123-metaiodobenzylguanidine activity ratio (H/M) and HR incre ase after isoproterenol infusion (beta). HR response (Delta HR) and peak ox ygen uptake ((V) over dot o(2)) were measured by exercise test. There was n o difference in beta among study groups. Group A exhibited mildly impaired PSNA, which recovered 1 year after surgery, and no change in H/M. Impaired PSNA and low H/M were found in groups BI and B2 compared with controls (P<0 .001), although the PSNA tended to recover 1 year after re-RVOTR. In group BI, PSNA and <beta> were related to Delta HR, and BRS correlated inversely with the number of surgical procedures and age at RVOTR and positively corr elated with the follow-up period, whereas Delta HR correlated with peak (V) over dot o(2) (P<0.01 to 0.001). Conclusions-After RVOTR, postsynaptic <beta>-sensitivity is maintained and is important in Delta HR during exercise, as is PSNA, although ventricular sympathetic denervation is common. Impaired PSNA immediately after RVOTR im proves with improved Delta HR and results in future amelioration of aerobic capacity, whereas ventricular sympathetic reinnervation is uncertain.