title: Excessive anaerobic metabolism during exercise after repair of aortic coarctation.
abstract: OBJECTIVE
  To determine whether survivors of surgery for coarctation of the aorta (CoA) have an excessive reliance on anaerobic metabolism during exercise.
  
  
  BACKGROUND
  Patients with peripheral vascular disease cannot increase blood flow to their muscles normally during exercise. Consequently they acquire an early, excessive reliance on anaerobic metabolism and have depression of the ventilatory anaerobic threshold (VAT) and of the slope of the oxygen consumption-work rate relationship (delta VO2/delta WR). We speculated that the capacity to augment blood flow to the lower extremities during exercise may be impaired after CoA surgery and would result in similar metabolic disturbances.
  
  
  METHODS
  Progressive exercise tests were performed on 15 patients (ages 19 +/- 7 years; range, 10 to 32) after successful repair of CoA (residual resting gradient, 7.7 +/- 7.1 mm Hg; range, 0 to 18), 15 age- and sex-matched healthy control subjects, and 10 patients (ages 13 +/- 3 years; range, 10 to 20) who had undergone ligation of a patent ductus arteriosus.
  
  
  RESULTS
  The CoA patients' VAT averaged 14.8 +/- 3.8 ml O2/kg per minute versus 19.3 +/- 3.1 ml O2/kg per minute for the control subjects (p < 0.01), and their delta VO2/delta WR averaged 8.2 +/- 1.8 ml/watt compared with 10.1 +/- 1.4 ml/watt for control subjects (p < 0.01). Furthermore, 10 of 15 CoA patients had a VAT of less than 40% of predicted maximal oxygen consumption, and 9 of 16 had a delta VO2/delta WR of less than 8.7 ml O2/watt (generally accepted abnormal values). Patients with patent ductus arteriosus resembled the healthy control subjects with regard to anaerobic metabolism during exercise.
  
  
  CONCLUSIONS
  Patients who have had CoA repairs commonly manifest an excessive reliance on anaerobic metabolism during exercise. This phenomenon may result from persistent blood flow abnormalities across the aortic arch during exercise, which may be present even after apparently successful surgery.
authors.affiliation: Division of Pediatric Cardiology, Floating Hospital for Children, Tufts-New England Medical Center, Boston, Massachusetts, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rhodes
authors.forename: R L
authors.initials: RL
authors.lastname: Geggel
authors.forename: G R
authors.initials: GR
authors.lastname: Marx
authors.forename: L
authors.initials: L
authors.lastname: Bevilacqua
authors.forename: Y B
authors.initials: YB
authors.lastname: Dambach
authors.forename: Z M
authors.initials: ZM
authors.lastname: Hijazi
mesh_terms: D000293:Adolescent; D000328:Adult; D015308:Anaerobic Threshold / Q000502:physiology*; D000693:Anaerobiosis; D001017:Aortic Coarctation / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D004374:Ductus Arteriosus, Patent / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D004734:Energy Metabolism / Q000502:physiology; D005080:Exercise Test; D006801:Humans; D007866:Leg / Q000098:blood supply; D008026:Ligation; D018482:Muscle, Skeletal / Q000098:blood supply; D010101:Oxygen Consumption / Q000502:physiology; D016491:Peripheral Vascular Diseases / Q000378:metabolism / Q000503:physiopathology; D005082:Physical Exertion / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D017741:Survivors; D014937:Work / Q000502:physiology