Skip to main content

Advertisement

Log in

Preserved Flow-Mediated Dilation in Adults with Cyanotic Congenital Heart Disease

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Adults with cyanotic congenital heart disease (CCHD) have been shown to have endothelial dysfunction in the forearm resistance vessels as assessed with venous occlusion plethysmography. Whether these abnormalities are confined to the microvasculature or reflect generalized endothelial dysfunction remain unknown. We used high-resolution ultrasound to compare flow responses and endothelial-dependent flow-mediated dilation (FMD) in the brachial artery of 13 adult patients with CCHD and 14 healthy controls. High-dose vitamin C was infused to evaluate the possible role of reactive oxygen species on endothelial vasomotor function. FMD was measured both prior to and after vitamin C infusion. Sublingual glyceryl nitrate was given to assess endothelium-independent responses. FMD did not differ among patients with CCHD and controls either before (6.2 ± 4.1, 5.1 ± 2.6%, p = 0.44) or after (5.1 ± 2.8, 5.2 ± 3.1%, p = 0.90) vitamin C infusion. Endothelium-independent vasodilatation was similar in both groups (14.3 ± 3.7, 13.2 ± 4.4%). There were no differences in baseline flow or in measures of reactive hyperemia. Adults with CCHD appear to have preserved endothelial function in their conduit arteries. This suggests that these patients are not at an increased risk of premature atherosclerotic cardiovascular events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brili S, Tousoulis D, Antoniades C, Aggeli C, Roubelakis A, Papathanasiu S, Stefanadis C (2005) Evidence of vascular dysfunction in young patients with successfully repaired coarctation of aorta. Atherosclerosis 182:97–103

    Article  PubMed  CAS  Google Scholar 

  2. Celermajer DS, Sorensen KE, Bull C, Robinson J, Deanfield JE (1994) Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol 24:1468–1474

    Article  PubMed  CAS  Google Scholar 

  3. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, Lloyd JK, Deanfield JE (1992) Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 340:1111–1115

    Article  PubMed  CAS  Google Scholar 

  4. Cross JM, Donald AE, Nuttall SL, Deanfield JE, Woolfson RG, MacAllister RJ (2003) Vitamin C improves resistance but not conduit artery endothelial function in patients with chronic renal failure. Kidney Int 63:1433–1442

    Article  PubMed  CAS  Google Scholar 

  5. Defouilloy C, Teiger E, Sediame S, Andrivet P, Roudot-Thoraval F, Chouaid C, Housset B, Adnot S (1998) Polycythemia impairs vasodilator response to acetylcholine in patients with chronic hypoxemic lung disease. Am J Respir Crit Care Med 157:1452–1460

    PubMed  CAS  Google Scholar 

  6. Gardiner HM, Celermajer DS, Sorensen KE, Georgakopoulos D, Robinson J, Thomas O, Deanfield JE (1994) Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 89:1745–1750

    PubMed  CAS  Google Scholar 

  7. Hamabe A, Takase B, Uehata A, Kurita A, Ohsuzu F, Tamai S (2001) Impaired endothelium-dependent vasodilation in the brachial artery in variant angina pectoris and the effect of intravenous administration of vitamin C. Am J Cardiol 87:1154–1159

    Article  PubMed  CAS  Google Scholar 

  8. Heimansohn DA, Turrentine MW, Kesler KA, King H, Brown JW (1993) New trends in the management of congenital heart disease. World J Surg 17:356–362

    Article  PubMed  CAS  Google Scholar 

  9. Irace C, Ceravolo R, Notarangelo L, Crescenzo A, Ventura G, Tamburrini O, Perticone F, Gnasso A (2001) Comparison of endothelial function evaluated by strain gauge plethysmography and brachial artery ultrasound. Atherosclerosis 158:53–59

    Article  PubMed  CAS  Google Scholar 

  10. Jelic S, Padeletti M, Kawut SM, Higgins C, Canfield SM, Onat D, Colombo PC, Basner RC, Factor P, LeJemtel TH (2008) Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117:2270–2278

    Article  PubMed  CAS  Google Scholar 

  11. Levine GN, Frei B, Koulouris SN, Gerhard MD, Keaney JF Jr, Vita JA (1996) Ascorbic acid reverses endothelial vasomotor dysfunction in patients with coronary artery disease. Circulation 93:1107–1113

    PubMed  CAS  Google Scholar 

  12. Mullen MJ, Kharbanda RK, Cross J, Donald AE, Taylor M, Vallance P, Deanfield JE, MacAllister RJ (2001) Heterogenous nature of flowmediated dilatation in human conduit arteries in vivo: relevance to endothelial dysfunction in hypercholesterolemia. Circ Res 88:145–151

    PubMed  CAS  Google Scholar 

  13. Neunteufl T, Heher S, Stefenelli T, Pabinger I, Gisslinger H (2001) Endothelial dysfunction in patients with polycythaemia vera. Br J Haematol 115:354–359

    Article  PubMed  CAS  Google Scholar 

  14. Oechslin E, Kiowski W, Schindler R, Bernheim A, Julius B, Brunner-La Rocca HP (2005) Systemic endothelial dysfunction in adults with cyanotic congenital heart disease. Circulation 112:1106–1112

    Article  PubMed  Google Scholar 

  15. Rimar S, Gillis CN (1993) Selective pulmonary vasodilation by inhaled nitric oxide is due to hemoglobin inactivation. Circulation 88:2884–2887

    PubMed  CAS  Google Scholar 

  16. Sairanen HI, Nieminen HP, Jokinen EV (2005) Late results and quality of life after pediatric cardiac surgery in Finland: a population-based study of 6,461 patients with follow-up extending up to 45 years. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 168–172

  17. Sampson MJ, Gopaul N, Davies IR, Hughes DA, Carrier MJ (2002) Plasma F2 isoprostanes: direct evidence of increased free radical damage during acute hyperglycemia in type 2 diabetes. Diabetes Care 25:537–541

    Article  PubMed  CAS  Google Scholar 

  18. Sorensen KE, Celermajer DS, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Thomas O, Deanfield JE (1995) Non-invasive measurement of human endothelium dependent arterial responses: accuracy and reproducibility. Br Heart J 74:247–253

    Article  PubMed  CAS  Google Scholar 

  19. Stephens JW, Gable DR, Hurel SJ, Miller GJ, Cooper JA, Humphries SE (2006) Increased plasma markers of oxidative stress are associated with coronary heart disease in males with diabetes mellitus and with 10-year risk in a prospective sample of males. Clin Chem 52:446–452

    Article  PubMed  CAS  Google Scholar 

  20. Ting HH, Timimi FK, Boles KS, Creager SJ, Ganz P, Creager MA (1996) Vitamin C improves endothelium-dependent vasodilation in patients with non-insulin-dependent diabetes mellitus. J Clin Invest 97:22–28

    Article  PubMed  CAS  Google Scholar 

  21. Wykretowicz A, Trojnarska O, Guzik P, Katarzyska A (2007) Arterial stiffness in adult patients with cyanotic congenital heart disease. Congenit Heart Dis 2:134–138

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funded by Fondation Leducq and NIHR Biomedical Research Centre Programme.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christian M. Pedersen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pedersen, C.M., Schmidt, M.R., Mortensen, B. et al. Preserved Flow-Mediated Dilation in Adults with Cyanotic Congenital Heart Disease. Pediatr Cardiol 30, 965–970 (2009). https://doi.org/10.1007/s00246-009-9489-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-009-9489-z

Keywords

Navigation