Early corrective surgery may prevent Baroreflex impairment in congenital heart diseases

Abstract

Arrhythmias in tetralogy of Fallot (ToF) and transposition of the great arteries (TGA) could be the consequence of reduced baroreflex-sensitivity (BRS). Hypoxia until the first surgical correction in these patients may impair BRS. We aimed to compare the BRS of ToF, TGA and control subjects and test the effect of the timing of operation on BRS.

19 patients with ToF, 22 patients with TGA and 19 healthy controls were enrolled. Carotid pulse pressure (PPc) was similar in ToF and TGA patients but lower in controls. BRS was lower in the ToF group compared to the control or to the TGA groups. The first operation was performed later in patients with ToF than in patients with TGA. Adjustment for PPc attenuated the difference in BRS between ToF and control subjects. Adjustment for age at corrective surgery abolished the difference in BRS between the ToF and the TGA groups.

In ToF patients, reduced BRS could be explained by the stiffening of central arteries and the later corrective surgery. Earlier surgical correction may prevent irreversible deterioration of baroreflex-function and arrhythmia development in ToF patients.