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Asian Cardiovasc Thorac Ann 2002;10:379
© 2002 Asia Publishing EXchange Pte Ltd

LETTER TO THE EDITOR

Unexplained Systemic Hypertension After Closure of Ductus Arteriosus

S Bert Litwin, MD

Department of Cardiothoracic Surgery Children’s Hospital of Wisconsin 9000 West Wisconsin Avenue P.O. Box 1997 Milwaukee, WI 53201 USA
I read with interest the case study by Davierwala and associates.1 They made a case for hypertension caused by catecholamine release, but this temporary hypertension can be explained more simply. The acute obliteration of a large left-to-right shunt creates a hypervolemic state since the pulmonary vascular bed is no longer overdistended. This was shown in an elegant study carried out by Gazzaniga and colleagues2 in 1966 studying patients before and after repair of atrial or ventricular septal defect. A similar mechanism has been shown in the presence of a peripheral arteriovenous fistula or patent ductus arteriosus.3

Accepting this thesis as the cause of hypertension, normally no treatment is necessary. If the hypertension is at a critical level, peripheral vascular dilators and/or diuretics would be the treatment of choice.

REFERENCES

  1. Davierwala P, Thakur N, Babu P, Reddy S, Kumar P, Menon R, et al. Unexplained systemic hypertension after closure of ductus arteriosus. Asian Cardiovasc Thorac Ann 2002;10:78–9.[Abstract/Free Full Text]

  2. Gazzaniga AB, Replogle RL, Gross RE. Blood volume changes following closure of intracardiac left-to-right shunts. JAMA 1966;198:989–92.[Abstract/Free Full Text]

  3. Cassels DE, Morse M. Blood volume in congenital heart disease. J Pediatr 1947;31:485–95.





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Right arrow Congenital - acyanotic

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