Baroreceptor Failure Research Articles

Hypertensive Crisis Secondary to Afferent Baroreceptor Failure following Head and Neck Radiation

Hypertensive Crisis Secondary to Afferent Baroreceptor Failure following Head and Neck Radiation

Carotid baroreceptor dysfunction after carotid body tumour resections

ObjectiveCarotid body tumours (CBTs) and baroreceptor failure (BRF) are two distinct but interrelated conditions, affecting the carotid body and its regulatory mechanisms. We aim to describe and quantify BRF after unilateral and bilateral CBT resections. MethodsProspective cohort study. We included all patients with unilateral or bilateral CBT undergoing resection from April 2021 to January 2023. Demographics and CBTs characteristics were analysed; baroreceptor sensitivity assessment was conducted using the Composite Autonomic Severity Score (CASS). Statistical analyses were performed using R. Significance level was set at a 2-tailed α = 0.05. ResultsA total of 30 patients with CBT underwent surgical resection, twenty-three were included in the study (18 unilateral and 5 bilateral CBTs). All 23 (100 %) were females, median age of 60 years. Regarding patients with unilateral CBT; preoperatively, 13 had BRF, the most common dysfunction subtype was mixed. Postoperatively, the most common dysfunction subtype was sympathetic failure. With regards to bilateral CBTs; 2 patients did not have autonomic dysfunction preoperatively. After bilateral surgical resection one patient remained without autonomic dysfunction; however, all other patients persisted with BRF. ConclusionBRF was present in 13 patients with unilateral CBT and 3 patients with bilateral tumours preoperatively; most will remain with BRF and will only change the characteristics postoperatively. No associations were found between type, severity of BRF and Shamblin classification or laterality. It is paramount that research in this area continues as many features are yet unknown regarding CBT pathogenesis, hence, BRF may be present yet not affect significantly quality of life.

170 Radiation Induced Baroreceptor Failure: Importance of Telehealth Blood Pressure Monitoring

170 Radiation Induced Baroreceptor Failure: Importance of Telehealth Blood Pressure Monitoring

Physiological and clinical impact in the carotid baroreceptor function following the surgical management of bilateral carotid body tumors.

The bilateral presentation of Carotid Body Tumors (CBT) is rare; the surgical resection of these masses remains the mainstay management due to the malignant potential. We aim to describe, classify, and quantify baroreceptor failure (BRF) after the surgical management of patients with bilateral CBT to better understand the clinical consequences. Retrospective review of patients that underwent bilateral CBT resection to assess the changes in baroreceptor function. We describe the clinical events associated to BRF after surgery, baseline patient's demographics, characteristics, comorbidities. Additionally, clinical and a quantitative evaluation of baroreceptor sensitivity were conducted using the Composite Autonomic Severity Score (CASS). From 1986 to 2020, a total 146 CBT resections were performed in 132 patients in our institution. Tumors were removed bilaterally in staged procedures in seven patients with a mean age of 61years (Standard Deviation 11), six (85%) were females, and there was no family history of paragangliomas. The clinical presentation were palpable masses in 5 (71%), and odynophagia in 2 (29%) cases; malignant histopathology following surgery was found in one case. BRF occurred in one patient after unilateral CBT resection, consisting of bradycardia and a 40s asystole that was not previously associated to BR sensitivity. Three (43%) patients presented BRF in the immediate postoperative period of the contralateral CBT excision, consisting of volatile hypertensive crisis in two cases, and supraventricular tachycardia in one. All the patients developed (100%) chronic baroreceptor sensitivity symptoms consisting in syncope, vertigo and fatigue in 4 (57%), tachycardia in 2 (28%), and orthostatic headache in one (14%). Autonomic testing showed mixed sympathetic and parasympathetic failure in five (71%), severe sympathetic failure in 1 (14%), and parasympathetic dysfunction in one patient (14%). Postoperative autonomic assessment confirmed BRF in all studied patients that underwent staged bilateral CBT resection with mixed, sympathetic, and parasympathetic dysfunction. Further studies are necessary to evaluate the incidence and physiological mechanisms of these sequelae to anticipate possible complications and offer the appropriate perioperative management.

Impact Bilateral Carotid Body Tumor Resection in the Carotid Baroreceptor Function

Baroreflexes are responsible for maintaining blood pressure (BP) homeostasis and avoiding volatile hemodynamic changes. The baroreflex arc is a negative feedback loop that acts as a buffer for BP and heart rate during postural changes, physical or emotional stress. When some afferent component of this arc fails, prompting changes in the function of the baroreceptors, it is known as baroreceptor failure (BRF). Four forms of presentation have been described: hypertensive crisis, volatile hypertension, and orthostatic malignant vagotonia.

Baroreceptor failure syndrome after head and neck tumor surgery

With the continuous updating of head and neck surgery concepts and techniques, more and more head and neck surgeries are developing in the direction of refinement.however, the more complete the surgery, the greater the possibility of subsequent nerve exposure and injury. Even a slight perturbation of the nerve may cause serious complications, such as pressure receptor failure.It is necessary to review the mechanisms and the characteristics of baroreceptor failure syndrome after head and neck tumor surgery.

Syncope from radiation-induced baroreceptor failure

Orthostatic hypotension has a vast differential that has been previously described throughout the literature. However, baroreceptor failure as a sequela of head and neck radiation is not often recognised as...

Baroreceptor reflex failure: Review of the literature and the potential impact on patients with head and neck cancer.

Baroreceptor dysfunction and reflex failure may occur after surgery affecting the carotid artery. The implications for patients undergoing treatment for head and neck cancer are not well described. A literature search of PubMed was performed between March 2016 and May 2016. Search terms used individually and in combination included: "baroreflex failure," "carotid sinus sensitivity," "carotid endarterectomy," "carotid body tumor," and "head and neck cancer." Bibliographies of included articles were also reviewed for additional pertinent articles. There is evidence of baroreceptor failure in certain patients after interventions associated with the carotid artery, including carotid endarterectomy and carotid body tumor excision. Few studies have been performed investigating the potential effect of head and neck surgery treatment, including surgery and/or radiation, on baroreflex function. Head and neck cancer treatment has the potential to cause baroreflex failure, and this is likely an underrecognized and underdiagnosed condition.

Individualized treatment of bilateral carotid body tumor

Objective: To investigate individualized therapeutic strategy for bilateral carotid body tumors. Methods: Clinical data of 16 patients with bilateral carotid body tumor treated from January 2003 to August 2016 were retrospectively studied. Of the 16 patients, 9 were males and 7 were females; 5 were sporadic and 11 were familial; 8 cases were observed, 1 cases was malignant and treated with chemotherapy, and 7 cases were treated with surgery. The treatment course, perioperative complications and clinical efficacy were assessed. Comprehensive evaluation of bilateral carotid body tumors was performed based on the size of bilateral tumor, clinical manifestations, genetic tests and other indicators. Individual treatment strategies included observation, surgery and observation, bilateral surgery, radiotherapy or chemotherapy. Surgical resection of carotid body tumor was unilateral in 3 cases and bilateral in 3 cases; removal of bilateral carotid body tumors plus unilateral jugular bulb in 1 case; and the internal carotid artery was reconstructed with autologous greater saphenous vein in 1 case. Results: All patients were followed up for 3 months to 12 years. There was no patient death during perioperative period. Superior laryngeal nerve injury occurred in 2 case. Baroreceptor failure syndrome occurred in one patient, but it gradually recoverd with medical treatments. Conlusion: It is important to identify whether bilateral carotid body tumors are hereditary and to make an individualized therapeutic strategy for each patient with bilateral carotid body tumors, focusing on the improvement in the quality of life of patient.

Treatment of carotid paraganglioma

Carotid paragangliomas, commonly known as carotid body tumors, are the most commonly reported head and neck paragangliomas. They are slow growing and always associated with the carotid arteries and adjacent nerves. They are rarely malignant. The estimates for familial transmission of this tumor range from 30%-50%. When multiple paragangliomas are present, the most common combination is 2 carotid paragangliomas. There are no absolute indications for surgical resection, but tumors expressing biochemical activity, a growth rate >1-2 mm per year or demonstrating airway or alimentary tract compression should be resected. Patients younger than 50 years should have small-to-medium sized paragangliomas resected. Patients with significant comorbidities or a contralateral cranial nerve dysfunction should not have surgery. Large carotid paragangliomas involving the skull base would likely result in multiple lower cranial nerve dysfunction after resection requiring multispecialty care afterwards. When dealing with bilateral carotid paragangliomas, resection of the smaller tumor first is recommended. Simultaneous carotid paraganglioma excision is discouraged because of acute baroreceptor failure. The second carotid paraganglioma may be observed for growth or it may be radiated depending on symptoms, size, or growth. The role and indications for angiography and embolization are covered elsewhere in this issue. If a carotid paraganglioma is biochemically active, alpha-adrenergic blockade followed by beta blockade is recommended and should be commenced 10 days before surgery. The complications associated with carotid paraganglioma excision are lower cranial nerve palsies and cerebrovascular accidents, although these are quite uncommon for small-to-medium sized tumors. Meticulous surgery and control of the carotid arteries can decrease these morbidities dramatically. Recently, a “top down” or craniocaudal approach to these tumors has gained acceptance among many surgeons. This approach controls the cephalad internal carotid artery and external carotid artery and removes the tumor down to the bifurcation. This technique has decreased the incidence of cranial neuropathy and blood loss in these patients. Following treatment, the uncomplicated patient requires yearly follow-up consisting of physical examination and magnetic resonance imaging. The familial patient should be genetically tested for succinate dehydrogenase mutations. Depending on the type of mutation yearly imaging and evaluation of siblings, parents and children is strongly advised. As metachronous lesions are possible, this follow-up is a lifetime undertaking.

Baroreceptor failure related to bilateral carotid artery disease: an uncommon cause of labile hypertension

Baroreceptor failure related to bilateral carotid artery disease: an uncommon cause of labile hypertension

Abstract 8890: Artificial Baroreceptor Fully Antagonizes Baroreflex Failure Induced Volume Intolerance

Backgrounds: Patients with heart failure with preserved ejection fraction have severe atherosclerosis and thereby baroreflex failure resulting from stiffened baroreceptors. We demonstrated that baroreflex failure induces striking volume intolerance and predisposes to pulmonary edema irrespective of left ventricular (LV) function. At present, however, there is no treatment for baroreceptor failure. The aim of this study is to develop artificial baroreceptor (ABaro) to restore physiological volume buffering function. Methods: We vascularily isolated the baroreceptor regions in 14 Sprague-Dawley rats. The intra-carotid sinus pressure (CSP) was controlled by a servo-controlled pump. We randomly perturbed CSP and identified the transfer function from CSP to arterial pressure (AP). We randomly, electrically stimulated aortic depressor nerves (ADN) and identified the transfer function from ADN stimulation to AP. Taking the ratio of those two transfer functions yielded the transfer function (H ABS ) required for the ABaro. ABaro translates AP real-time to ADN stimulation according to H ABS . We implemented ABaro and observed the left atrial pressure (LAP) response against stepwise infusions of dextran (Fig. 1). ABaro fully restored the physiological LAP-infused volume relationship (Fig. 2) and markedly increased the infused volume required to raise LAP to 20 mmHg (native: 20.1±3.2, baroreflex failure: 16.6±4.4, ml/kg ABaro: 21.0±3.0 ml/kg). Conclusion: ABaro reinstitutes the native baroreflex and would be an attractive tool in preventing pulmonary edema in patients with poor baroreceptor function irrespective of LV systolic function.

Baroreceptor Failure Syndrome After Bilateral Carotid Body Tumor Surgery

A 41-year-old healthy man was diagnosed with bilateral carotid body tumors. The patient had a staged surgical removal of the tumors approximately 8 months apart. Postoperative recovery was uneventful after removal of the first and largest tumor; however, after removal of the second tumor, the patient developed tachycardia and hypertension. He was diagnosed with baroreceptor failure syndrome after ruling out other possible causes. Baroreceptor failure syndrome is a rare and important complication known to be associated with many conditions, one of them being inadvertent baroreceptor denervation during bilateral carotid body tumor resection. Medical management of this condition is necessary to prevent cerebrovascular events; thus, it is important for the surgeon and the internist to recognize and treat it aggressively.

Baroreceptor failure after bilateral resection of carotid artery paragangliomas

Multiple head and neck paragangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery paragangliomas who developed baroreceptor failure after their resection. Although this is an infrequent complication, it is important to be aware of it in order to ensure speedy diagnosis and treatment so as to avoid major post-surgical complications.

Fallo barorreceptor tras la resección bilateral de paragangliomas carotídeos

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications.

Carotid body tumors: a review of 30 patients with 46 tumors.

Minimal morbidity occurs with resection of most carotid body tumors (CBT). With larger tumors significant injury to the cranial nerves has been reported. In order to assess the operative sequelae rate, 30 patients with CBT were reviewed. Sixteen patients either presented with bilateral carotid body tumors or had previously undergone a resection of the contralateral carotid body tumors, for a total carotid body tumor count of 46. Sixteen patients demonstrated a familial pattern while 14 were nonfamilial. Within the familial group, 14 of 16 presented with multiple paragangliomas as compared to 6 of 14 in the nonfamilial group. Tumor size ranged from 0.8 to 12 cm. Vascular replacement occurred in 2 of 20 patients with tumors < 5.0 cm, compared with 5 of 9 with tumors > 5.0 cm. Four patients lost cranial nerves with the resection: superior laryngeal nerve (SLN), 4; cranial nerve X, 1; cranial nerve XII, 1. Ten patients developed baroreceptor failure secondary to bilateral loss of carotid sinus function. First-bite pain occurred in 10 of 25 operative patients. Cranial nerve loss can be minimal with resection of carotid body tumors, however, baroreceptor failure and first-bite pain are postoperative sequelae that are often disregarded in the postoperative period.