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J Am Coll Cardiol. 2007 Nov 6;50(19):1876-83. Epub 2007 Oct 23.

Somatic growth in children with single ventricle physiology impact of physiologic state.

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1
Division of Cardiology, Department of Pediatrics, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract

OBJECTIVES:

We sought to define somatic growth patterns for patients with single ventricle (SV) physiology and associated factors.

BACKGROUND:

Infants with SV physiology might have somatic growth retardation associated with volume overload and hypoxemia, which might improve after surgical palliation.

METHODS:

We reviewed 126 patients (35% male) who underwent the Fontan procedure from 1994 to 2004. Demographic data, hemodynamic variables, and surgical procedures were recorded. Serial weights and heights were converted to z-scores. Linear regression analysis adjusted for repeated measures was used to model growth trends.

RESULTS:

Median z-score for weight was -0.7 at birth, -1.6 before bidirectional cavopulmonary shunt (BCPS), -0.7 before Fontan procedure, and -0.7 after Fontan procedure. A significant decline in z-scores for weight was seen before BCPS, which was reversed after the hemi-Fontan and stabilized after Fontan procedure. The z-scores for weight before the BCPS were lower in patients with lower birth weight (p < 0.01), nutritional difficulties (p = 0.01), and higher right atrial pressures (p = 0.02). After the BCPS, impaired growth was seen in patients who had systemic venous collaterals (p < 0.01). Patients who had collaterals embolized had the same growth trends as patients with no collaterals (p = 0.29).

CONCLUSIONS:

Infants with SV physiology show impaired somatic growth before BCPS. Although catch-up growth occurs after BCPS, effective interventions such as more intensive nutritional strategies before BCPS might be targeted at this high-risk population. The presence of systemic venous collaterals might impede growth secondary to hemodynamic impairment. Embolization of collaterals might allow for maximum growth potential.

PMID:
17980255
DOI:
10.1016/j.jacc.2007.07.050
[Indexed for MEDLINE]
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