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Cardiologists have often described aortic coarctation as “simple” rather than “complex” congenital heart disease; nothing could be further from the truth
Systolic blood pressure rises with increased dynamic work load as a result of increasing cardiac output.1 At each level of exercise there is a more consistent increase in systolic blood pressure during the first few minutes, and then a steady state is attained. Systolic blood pressure generally correlates with the maximal exercise level achieved.2 Normal values of maximal systolic blood pressure can be defined.3 After performing maximal exercise, there is a decline in systolic blood pressure, reaching basal levels usually in six to seven minutes, and then often remaining lower than pre-exercise levels for several hours. During exercise there is an immediate vasodilatation of the arteries and capillaries in active skeletal muscle tissue because of increased metabolic demands in contrast to tissue that is not involved where peripheral vascular resistance increases. The total result is a decrease in overall systemic vascular resistance.4 While systolic blood pressure increases simultaneously, diastolic blood pressure usually remains about the same.
During leg exercise using a treadmill or bicycle, blood pressure at the arm can easily be measured, whereas leg recordings, for assessing eventual blood pressure gradients in patients after coarctation repair, are hampered because of movement artefacts. Therefore arm–leg gradients during ergometry can only be measured by invasive methods. Several investigators have …