Cardiological and general health status in preschool- and school-age children after neonatal arterial switch operation

Hövels-Gürich, Hedwig H.; Seghaye, Marie-Christine; Däbritz, S; Messmer, Bruno J.; Bernuth, G. von

doi:10.1016/s1010-7940(97)00232-7

Cited by 35 publications

(19 citation statements)

References 26 publications

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“…Lupinetti and colleagues 3 reported that, of their 115 patients who were assessed by echocardiography at a mean duration of 12 months after ASO, all but one had normal FS and LV wall motion. 3 Similarly, Hovels-Gurich and colleagues 5 observed normal LV shortening fraction in 77 children assessed at a mean of 5.4 years after ASO. Colan and colleagues 4 further used a preload independent, afterload adjusted myocardial contractility index, and showed that LV contractility was normal in 32 patients at five to 50 months after ASO.…”

Section: Discussionmentioning

confidence: 87%

“…[1][2][3][4][5][6][7] Load dependent echocardiographic indexes in previous studies have shown normal systolic and diastolic function of the left ventricle at short and intermediate term follow up. 3 5 7 Further studies of the left ventricular (LV) end systolic wall stress-velocity of fibre shortening relation, a preload independent, afterload adjusted index, have also shown normal LV contractility at intermediate term follow up.…”

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confidence: 99%

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Assessment of left ventricular function long term after arterial switch operation for transposition of the great arteries by dobutamine stress echocardiography

Hui

Chau²,

Leung³

et al. 2005

Heart

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Objectives: To use dobutamine stress echocardiography to determine left ventricular (LV) function and wall motion of children long term after arterial switch operation (ASO) for transposition of the great arteries. Design and patients: 31 patients (24 boys) with ASO performed at a mean (SD) of 15.5 (4.3) days of life were studied at an age of 9.4 (2.0) years. All had normal coronary angiographic findings. LV echocardiographic indexes, including fractional shortening, ejection fraction, rate corrected velocity of circumferential fibre shortening (VCFc), and wall stress, as well as LV wall motion abnormalities were determined at rest and under dobutamine stress. The results were compared with those of 20 healthy age matched control participants. Setting: Tertiary paediatric cardiac centre. Results: Fractional shortening, ejection fraction, and VCFc were significantly lower in patients than in controls at rest (all with p , 0.001). Stress-velocity index detected impaired LV contractility in 19 (61%) patients at rest. An older age at operation (p = 0.01), longer bypass (p = 0.01) and circulatory arrest times (p = 0.045), and an unusual coronary artery pattern (p = 0.059) were associated with impaired resting LV contractility. Dobutamine stress echocardiography unmasked wall motion abnormalities in 23 (74%) patients. Exercise myocardial perfusion scan, performed in 22 patients, showed reversible myocardial perfusion defects in 17. These defects corresponded to segments of hypokinesia as detected by dobutamine stress echocardiography. Conclusion: A significant proportion of children, albeit asymptomatic, had impaired baseline LV contractility and reversible myocardial perfusion defects and mild wall motion abnormalities on stress after ASO. 4 6 However, as long term success of ASO depends on adequacy of the coronary arterial circulation among other factors, the need for coronary artery implantation in ASO remains a cause for concern. Recently, impaired myocardial blood flow during vasodilatation with adenosine and attenuation of coronary flow reserve have been observed in asymptomatic children with TGA a decade after ASO. 8 Although the clinical consequences are unclear, these findings suggest a possibility of long term stress induced LV dysfunction in patients after ASO. Dobutamine stress echocardiography (DSE) has been used for early detection of LV dysfunction in long term childhood cancer survivors 9 and children with thalassaemia 10 through evaluation of myocardial contractile reserve. Furthermore, DSE has been shown to be useful in the diagnosis of myocardial ischaemia secondary to congenital or acquired coronary artery abnormalities.11 12 To our knowledge, DSE has not been applied to evaluate LV function in children with TGA after ASO. Given the previous findings of reduced coronary flow reserve after ASO and sensitivity of DSE in early detection of myocardial dysfunction, we hypothesised that DSE can unmask LV dysfunction in apparently asymptomatic children with TGA after ASO in the long term. To examine this ...

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Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

Assessment of left ventricular function long term after arterial switch operation for transposition of the great arteries by dobutamine stress echocardiography

Hui

Chau²,

Leung³

et al. 2005

Heart

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“…17,18 Masterson et al 6 used a parent-completed version of the CHQ to evaluate general health status in 160 children at 8 years of age. They found that the overall physical and psychosocial health status after ASO was similar to a normative population.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life of Children After Repair of Transposition of the Great Arteries

Culbert

Ashburn²,

Cullen-Dean³

et al. 2003

Circulation

109

104

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Background— We sought to assess quality of life of children with transposition of the great arteries (TGA) enrolled during transition in management strategy from atrial to arterial switch operation. Methods and Results— Neonates enrolled by the Congenital Heart Surgeons Society in a prospective study of TGA between 1985 and 1989 were eligible. A Child Health Questionnaire was sent for completion by the child between February and June 2000. Data were compared with published normative values. Child Health Questionnaires were completed by 306 of 708 survivors at a mean age of 13±1 years. Diagnosis included TGA (n=202, 66%), TGA/ventricular septal defect (VSD) (n=84, 27%), and TGA/VSD/pulmonary stenosis (n=20, 7%). Repair type was arterial switch (n=189, 62%), atrial switch (n=105, 34%; Senning=58, Mustard=47), or Rastelli (n=12, 4%). Children with TGA scored significantly higher than published norms in all categories except self-esteem. TGA/VSD/pulmonary stenosis was associated with lower scores than TGA and TGA/VSD in physical functioning ( P =0.002), general health perceptions ( P =0.012), and mental health ( P =0.048). Arterial repair was associated with higher scores than atrial or Rastelli repair in physical functioning ( P <0.001), pain ( P =0.004), mental health ( P =0.019), self-esteem ( P =0.004), and general health perceptions ( P <0.001). By multivariable analyses, the most common independent factors impacting scores were repair type, perfusion parameters, and gender. Conclusions— Quality of life and health status as perceived by children 11 to 15 years after TGA repair is excellent when compared with published normative data and is better after arterial switch operation than after atrial repair.

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“…Therefore, from the cardiological point of view, children after neonatal ASO for TGA represent a uniform group of patients with excellent health [18][19][20] are particularly appropriate for study of long term psychosocial outcome.…”

Section: Discussionmentioning

confidence: 99%

Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries

Hövels-Gürich

Konrad

Wiesner

et al. 2002

Archives of Disease in Childhood

141

128

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Aims: To evaluate behavioural outcome and quality of life in children aged 8-14 years after neonatal arterial switch operation for transposition of the great arteries. Methods: Sixty children operated as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were evaluated at age 7.9-14.3 years by the Child Behaviour Checklist (CBCL) and the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL). Results: Parent reported behavioural outcome on all CBCL problem and competence scores was worse, whereas quality of life on self reported IQCL scores was not reduced compared to the normal population. On multivariate analysis, severe preoperative hypoxia was related to parent reported social problems; peri-and postoperative cardiocirculatory insufficiency was associated with internalising, externalising, attention, and total behavioural problems. Reduced expressive language was associated with total behavioural problems, and poor academic achievement was related to parent reported deficits in school performance. Impaired neurological status and reduced endurance capacity both predicted self reported stress by illness. Conclusions: The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent reported long term behavioural impairment, but not with self reported general reduction in quality of life. This discrepancy may be a result of different perception of illness. In our experience, increased risk of long term psychosocial maladjustment after neonatal corrective cardiac surgery is related to the presence of neurological impairment and reduced endurance capacity.

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Cardiological and general health status in preschool- and school-age children after neonatal arterial switch operation

Cited by 35 publications

References 26 publications

Assessment of left ventricular function long term after arterial switch operation for transposition of the great arteries by dobutamine stress echocardiography

Assessment of left ventricular function long term after arterial switch operation for transposition of the great arteries by dobutamine stress echocardiography

Quality of Life of Children After Repair of Transposition of the Great Arteries

Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries

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