Pediatric Heart Expert Forum
6 year old with Hypoplastic Left Heart
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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6 year old with Hypoplastic Left Heart

My daughter is 6 and was born with Hypolplastic Left Heart Syndrome.  She just had a physical and her doctor mentioned that her blood pressure was a little high.  What is normal for a girl her age who has had the 3 stage paliative repair?  
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773637_tn?1327450515
Dear Heart Mom,

Actually, her blood pressure should be that of any other 6 year old girl.  Assessment of blood pressure is based on age, gender, and height; I only have 2 of those pieces of information here, so I can’t be exact for you.  However, a systolic blood pressure (the upper number) should be at or under 104 to 111 mmHg (depending on her height).  

There are a few potential reasons that her blood pressure may be high.  In hypoplastic left heart syndrome, in which the left ventricle, mitral valve, aortic valve, and ascending aorta do not adequately form and are quite small, it is not uncommon to have coarctation of the aorta occur.  This is an obstruction of the aorta.  This can occur because the aorta has to be reconstructed from parts of the original small aorta as well as the pulmonary artery.  Scarring in the healing process as well as residual tissue from the ductus arteriosus can cause the aorta to shrink somewhat and lead to obstruction of varying degrees.  Another reason that it can be high is actually a false reason:  the blood pressure was not correctly measured.   Appropriate measurement of a blood pressure includes the patient coming in and sitting down in a chair with their feet on the floor and their back supported for at least 5 minutes.  The blood pressure should be measured in the right arm with a manual blood pressure cuff (not a machine) with an appropriate sized cuff for the patient.  If neither of these things is causing her blood pressure to be high, a diagnosis of hypertension is typically not made until there are 3 separate elevated blood pressure measurements made.  She would then require further evaluation for reasons for this, including kidney diseases, obesity, and some other rare diseases.
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The Children’s Hospital of Philadelphia
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