Objective-To assess the nutritional status of children with congenital heart disease.Design-Six anthropometric, 24 biochemical, and five haematological markers of nutritional wellbeing were measured in children with congenital heart disease. Setting-The west of Scotland. Patients-48 children admitted consecutively for surgical correction of congenital heart disease. Main outcome measures-Height, weight, and triceps and subscapular skin fold thicknesses were considered abnormal if they were below the third centile compared with standard reference data for age matched British children. Midarm circumference and arm muscle circumference were considered abnormal if they fell below the fifth centile compared with standard data. Biochemical and haematological data were compared with age matched and locally validated laboratory normals. Results-A marked degree of undernutrition was evident in all children; 52% had weight less than the third centile, 37% were below the third centile for height, and 12-5% were below the third centile for triceps skin fold thickness and 18-8% for subscapular skin fold thickness. Midarm circumference and arm muscle circumference were below the fifth centile in 20*1% and 16*7% of children respectively. Five or more of the 29 biochemical and haematological measurements were abnormal in 83-3% of patients; 10 or more were abnormal in 12-5% of patients. Conclusions-Children with congenital heart disease are frequendy undernourished, irrespective of the nature of cardiac defect and the presence or absence of cyanosis. (Br HeartJ_ 1995;73:277-283)

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SUMMARY Doppler ultrasound was used to investigate 48 infants and children (age 2 days-16 years, weight 1 0-58 kg) with aortic arch abnormalities. In only 38 of the 42 with an important coarctation was an increased blood flow velocity from the distal arch demonstrated. In three with interruption of the aortic arch an increased velocity recorded from the region of the distal arch was thought to represent ductal flow. There was little difference between the peak to peak and instantaneous maximum gradients in the 20 patients with important coarctation in whom direct pressure measurements both proximal and distal to the obstruction were made at catheterisation. There were poor agreements between Doppler and measured peak to peak and instantaneous gradients in the 17 patients found to have both an increased velocity and important coarctation.It is concluded that although an increased blood flow velocity in the distal arch is usually demonstrated in coarctation this may not occur with severe obstruction. Furthermore, the maximum velocity is not related to the anatomical severity of the obstruction and the Doppler estimate of pressure drop in coarctation may not even reliably predict that measured at catheterisation. summarises the age groupings, investigation, and findings. At catheterisation the pressure was measured directly through a fluid filled system both proximal and distal to the obstruction in 23. Pressures on both sides of the obstruction were measured simultaneously in 12; the proximal measurement was made with a catheter in the left ventricle (9) or the aortic arch through the coarctation (3) and the distal one through a needle in the femoral artery or the side arm of a sheath in the iliac artery. In the remaining 11 patients pressures were measured by catheter withdrawal across the coarctation and tracings distal to the coarctation were superimposed on proximal ones to simulate simultaneous pressure measurements; to minimise error, beats with almost equal R-R intervals were chosen. The peak to peak and maximum instantaneous pressure differences were measured from each tracing. Catheterisation was undertaken in seven infants with a ductus arteriosus, with pressures being measured in both the pulmonary artery and descending aorta in five.The Doppler investigations were performed by means of a 2 MHz probe with a continuous and pulsed wave system (Alfred, Vingmed) and a spectrum analyser (Doptek). After echocardiographic examination a routine Doppler study was performed, the suprasternal or left upper parasternal positions being used to obtain the optimal signal of flow through the aortic arch and coarctation site. From the Doppler signals from the ascending aorta and aortic arch the maximum velocity of blood flow in m/s (V) was measured and the modified Bernoulli equation (A3P = 4V2)4 was used to convert this into Doppler estimate of gradient in mm Hg (P). We then compared the Doppler measurement of flow velocity in the ascending and descending aorta and the maximum Doppler gradient in the descending aorta ...

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The aim of this study was to measure total body water in children with congenital heart disease before and after cardiac surgery and to compare the results of deuterium and 18oxygen dilution methods. Seventeen children (aged 4 to 33 months) were given aliquots of isotopically labeled water 1 week before and 6 hours after cardiac surgery. Isotope equilibration and analysis of the declining enrichment of daily urine samples allowed calculation of the total body water content. Before operation, total body water was significantly elevated (p < 0.001, Wilcoxon test); after operation it fell to approximately normal values. This finding is in contrast to those of previous reports, but may be explained in that the method used for calculation depended on measurements taken over a 7-day period rather than on a single measurement of isotope dilution as used elsewhere. Nevertheless, these results do suggest that surgery can correct the preoperative fluid overload. Comparison of deuterium and 18oxygen dilution methods showed a 2% to 2.5% overestimation of the total body water content with deuterium sampling.