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Göteborgs universitets publikationer

Cardiac autonomic function in adolescents operated by arterial switch surgery.

Författare och institution:
Cecilia Falkenberg (Institutionen för kliniska vetenskaper, sektionen för kvinnors och barns hälsa, Avdelningen för pediatrik); Ingegerd Östman-Smith (Institutionen för kliniska vetenskaper, sektionen för kvinnors och barns hälsa, Avdelningen för pediatrik); Thomas Gilljam (Institutionen för kliniska vetenskaper, sektionen för kvinnors och barns hälsa, Avdelningen för pediatrik); Gavin Lambert (-); Peter Friberg (Institutionen för medicin, avdelningen för molekylär och klinisk medicin)
Publicerad i:
International journal of cardiology, 168 ( 3 ) s. 1887–1893
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
BACKGROUND: Children with transposition of the great arteries, in whom an arterial switch operation (ASO) is performed, have been shown to have an increased incidence of sudden death, which may be due to cardiac autonomic imbalance and repolarisation instability. We hypothesised that i) cardiac norepinephrine (NE) kinetics and ii) arterial baroreflex sensitivity (BRS), reflecting sympathetic activity and vagal function respectively, are altered in this group. METHODS AND RESULTS: 17 children (15.8±1.5years of age) with ASO-surgery in the neonatal period were studied. 17 had cardiac BRS assessed by spontaneous fluctuations of systolic blood pressure and RR-interval, and repolarisation was measured as QT variability index. Matched healthy subjects were controls. Cardiac vagal function and repolarisation pattern were unchanged following ASO-surgery. At cardiac catheterisation, we infused tritiated NE in 8 of these children to examine total body and cardiac sympathetic function at baseline and following 5min of adenosine infusion to induce reflex sympathetic activation. Blood was sampled simultaneously from the aorta and coronary sinus. Cardiac fractional extraction of ([3H])NE was substantially lower in operated children, being 56±10 vs. 82±9% (p=0.0001). Following i.v. adenosine in the operated group, NE total body spillover doubled vs. baseline (p<0.002) and the coronary venous-arterial concentration gradient of ([3H])dihydroxyphenylglycol increased 4-fold (p=0.04). CONCLUSIONS: Arterial switch operation performed neonatally appears to leave cardiac vagal function intact and, although cardiac sympathetic activation in response to adenosine occurs, cardiac neuronal NE reuptake is impaired. This may be pro-arrhythmic by reducing removal capacity of NE from the cardiac synaptic cleft.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Klinisk medicin ->
Klinisk medicin ->
Postens nummer:
Posten skapad:
2013-02-13 13:37
Posten ändrad:
2013-10-29 14:51

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