PEDIATRICS Vol. 91 No. 4 April 1993, pp. 761-765
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Oscillometric Blood Pressures in the Arm, Thigh, and Calf in Healthy Children and Those With Aortic Coarctation

Myung K. Park MD1, Da-Hae Lee MD1, and Glory Ann Johnson RN1

1 From the Department of Pediatrics, University of Texas Health Science Center, San Antonio

Comparing blood pressure (BP) obtained in the arm with that obtained in the thigh or calf is important in the diagnosis of aortic coarctation. However, normative mean and range of differences in BP between the arm and lower extremity sites are not available for normal children. It is also not known how accurately the differences in BP between the arm and the lower extremity sites predict the pulsed Doppler estimation of systolic pressure (SP) gradient across an aortic coarctation. To resolve these questions, the authors obtained two BP measurements by an oscillometric (Dinamap) method in the arm, thigh, and calf in 74 healthy children aged 4 to 16 years. Oscillometric BP was also obtained in 21 children aged 3 to 17 years with preoperative or postoperative aortic coarctation and BP gradients were compared with that estimated by the pulsed Doppler method. Overall, SP was higher in the thigh and calf than in the arm. The gradients in SP expressed as arm SP minus calf SP [S(A - C)] and arm SP minus thigh SP [S(A - T)] were significantly greater in children 4 through 8 years old than in those 9 to 16 years old. The S(A - C) was –9.3 (±7.4 SD) mm Hg in the 4- through 8-year group and –5.0 (±6.9 SD) mm Hg in the 9- to 16-year group. The S(A - T) was –7.1 (±6.8 SD) mm Hg in the 4- through 8-year group and –2.4 (±7.7 SD) mm Hg in the 9- to 16-year group. Diastolic and mean arterial BP levels were lower in the calf (9 and 1 mm Hg, respectively) and the thigh (11 and 4 mm Hg, respectively) than in the arm. The S(A - C) in all patients with preoperative aortic coarctation and those with significant residual coarctation was greater than the mean + 2 SD for healthy children. The S(A - C) and S(A - T) values in patients with preoperative or postoperative coarctation correlated well with the pulsed Doppler-based estimates of the gradient (r = .908 and .936, respectively). This correlation and the comparison of known cases of coarctation with the normative gradients suggest (1) if the Dinamap SP in the calf or thigh is lower than that in the arm, the presence of aortic coarctation is suspicious, and (2) if the S(A - C) and/or S(A - T) is greater than the mean + 2 SD for normal children, the diagnosis of aortic coarctation is likely. It appears that, in addition to testing for a delayed pulse in the leg, properly obtaining oscillometric values for systolic BP in the arm and the calf or thigh is important in the diagnosis, management, and postoperative evaluation of aortic coarctation.

Key Words: blood pressure • aortic coarctation • oscillometric blood pressure • leg blood pressure

Submitted on August 7, 1992
Accepted on November 6, 1992




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