Normalization of Autonomic Function in Children With Coarctation of the Aorta After Surgical Correction in Infancy

Abstract

To the Editor: Systemic hypertension affects ≥20% of patients with coarctation of the aorta (CoA) by adolescence, despite early surgical repair.1 This leads to premature death and is arguably the most important outcome variable in these patients. We have previously demonstrated reduced spontaneous baroreceptor reflex sensitivity (BRS) and heart rate variability (HRV) in preoperative neonates with CoA compared with age-matched controls, suggesting early autonomic dysfunction.2 Altered BRS has also been demonstrated in older children after late surgical repair,3 however, little is known about BRS and autonomic function in younger patients after successful neonatal repair. In the current study, we re-evaluated spontaneous BRS, HRV, and blood pressure (BP) variability (BPV) from our initial cohort at 5 years on to determine whether there was persisting abnormality of cardiovascular autonomic variables as a precursor to arterial hypertension. We re-examined 6 of the 7 living CoA patients and 7 of the 12 living age- and sex-matched control patients from the initial cohort. The remaining 5 controls could no longer be traced, and 1 CoA patient was not included because of severe developmental delay. None of the subjects were taking medications. …