Abstract
16/56 infants (ages 2 wks to 6 mos) with isolated coarctation of the thoracic aorta presented with congestive heart failure and severe systemic hypertension ranging from 210/140 to 150/80 mmHg. Because of the surgical risks in symptomatic infants and the probability of recoarctation, conventional anticongestive medical management was instituted. The response to the anticongestive measures was markedly enhanced by diminishing after-load with chronic oral propranolol (.05-1.0 mg/kg/day) with maximal antihypertensive effects noted by 1-4 wks. Rebound hypertension was noted in 4 patients with propranolol withdrawal. This clinical response noted is consistent with high renin hypertension. No complications related to beta blockade have been seen in the infants treated. From this data we conclude that the antihypertensive effects from propranolol far outweigh the negative inotropic effects in the treatment of coarctation of the aorta. Further, thr treatment of severe hypertension in infants with coarctation of the aorta may allow deferral of surgery to a more optimal size and clinical status.
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