2 results
Improvement in growth, and levels of insulin-like growth factor-I in the serum, after cavopulmonary connections
- Elisabeth V. Stenbøg, Vibeke E. Hjortdal, Hanne B. Ravn, Christian Skjørbøk, Keld E. Sørensen, Ole Kromann Hansen
-
- Journal:
- Cardiology in the Young / Volume 10 / Issue 5 / September 2000
- Published online by Cambridge University Press:
- 19 August 2008, pp. 440-446
-
- Article
- Export citation
-
Introduction
The total cavopulmonary connection, and the bidirectional Glenn anastomosis, are widely used for palliation of patients with complex functionally univentricular hearts. Little attention has been paid to the potential for postoperative growth in children after these operations, which are now performed at increasingly younger age.
Material and ResultsPhysical growth, and levels of insulin–like growth factor I in the serum, were measured in 20 patients, aged 11·5 ± 5·6 years, 2 (0·5–6) years after a total cavopulmonary connection in 12, or a Glenn anastomosis in 8. All patients were in functional class I or II of the categorisation of the New York Heart Association, with excellent haemodynamic and angiographic findings. None of the patients had clinical signs of protein losing enteropathy. Controls included 33 healthy children, aged 11·5 ± 2·7 years.
Preoperatively, the mean Z-scores for weight and height were negative, −1·1 ± 0·8 and −0·5 ± 1·5. At follow-up, both parameters had improved significantly by 1·1 ± 0·9 and 0·8 ±1·2 percentiles, and Z-scores were comparable between the two groups (p = 0·81 for weight and p = 0·88 for height). No correlations were found between haemodynamics and the improvement in growth noted during follow-up. Increases equal to, or greater than 2 standard deviations for weight and height were seen only in children undergoing surgery before the age of 5 years. A significant correlation between age at operation and improvement in growth, however, could not be found.
Levels of growth factor measured in the serum were not statistically different from levels in healthy children for either group of patients (p=0·07 for girls and p=0·37 for boys).
ConclusionsPhysical growth improved significantly following the surgical procedures. The concentrations of the growth factor measured in the serum were not different from levels in healthy children, suggesting normal nutritional status in both palliative situations.
The pulmonary vasculature in a neonatal porcine model with increased pulmonary blood flow and pressure
- Elisabeth V. Stenbøg, Daniel A. Steinbrüchel, Anne Bloch Thomsen, Ulrik Baandrup, Lene Heickendorff, Jørgen Ingerslev, Niels Trolle Andersen, Kristian Emmertsen
-
- Journal:
- Cardiology in the Young / Volume 11 / Issue 4 / July 2001
- Published online by Cambridge University Press:
- 15 August 2006, pp. 420-430
-
- Article
- Export citation
-
Introduction: Hypertension and hyperperfusion of the pulmonary vascular bed in the setting of congenital cardiac malformations may lead to progressive pulmonary vascular disease. To improve the understanding of the basic mechanisms of this disease, there is a need for clinically relevant animal models which reflect the disease process. Material and Results: We randomly allocated 45 newborn pigs, at the age of 48 hrs, to groups in which there was either construction of a 3 mm central aorto-pulmonary shunt, undertaken in 9, or ligation of the left pulmonary artery, achieved in 13. Controls included sham operations in 13, or no operations in 10 pigs. Follow-up was continued for three months. The interventions were compatible with survival in most pigs. The shunts resulted in an acute 85% increase in systolic pulmonary arterial pressure, and a more than twofold increase in pulmonary blood flow. By three months of age, nearly all shunts had closed spontaneously, and haemodynamics were normal. Ligation of the left pulmonary artery resulted in a normal total pulmonary blood flow, despite only the right lung being perfused, and a 33% increase in systolic pulmonary arterial pressure. These haemodynamic changes were maintained throughout the period of study. In both groups, histomorphometry revealed markedly increased muscularity of the intra-acinar pulmonary arteries. Circulating levels of endothelin were normal in the shunted animals, and elevated in those with ligation of the left pulmonary artery. Conclusion: In neonatal porcine models of pulmonary vascular disease, created by construction of 3 mm central aorto-pulmonary shunts and ligation of one pulmonary artery, we observed histopathological changes of the pulmonary vasculature similar to early hypertensive pulmonary vascular disease in humans. Elevated circulating levels of endothelin were associated with abnormal haemodynamics rather than abnormal pathology. These findings could be valuable for future studies on the pathogenesis of hypertensive pulmonary vascular disease associated with congenital cardiac malformations.