scholarly journals Aspirin Resistance in Children with Congenital Heart Disease and Its Relationship with Laboratory and Clinical Parameters

2021 ◽  
Vol 31 (2) ◽  
Author(s):  
Sevcan Erdem ◽  
Eray Akay ◽  
Tolga Akbas ◽  
Fadli Demir ◽  
Nazan Ozbarlas
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Platelet Aggregation ◽  
Congenital Heart ◽  
Fibrinogen Level ◽  
Laboratory Data ◽  
Aspirin Resistance ◽  
Blood Smears ◽  
Significant Difference ◽  
The Difference

Background: Patients with congenital heart disease (CHD) are more prone to thromboembolism. Aspirin is the most commonly used medication around the world to prevent thrombosis in cardiovascular diseases. Objectives: This study aimed to define the frequency of aspirin resistance in pediatric patients with CHD and to evaluate the correlation of clinical and laboratory parameters with aspirin resistance. Methods: The study population consisted of 103 patients using aspirin, including 53 cases of cyanotic CHD and 50 cases of non-cyanotic CHD. Platelet aggregation was measured by the AggreGuide A-100 ADP Assay. Results: The prevalence of aspirin resistance was 36.9% in children with CHD. Although aspirin resistance in cyanotic CHD patients (41.5%) was higher than in non-cyanotic patients (32%), the difference was not statistically significant (P = 0.414). There was no significant association between aspirin responsiveness or resistance and the patient’s sex, age, duration of aspirin use, and concomitant medication use. Comparison of the laboratory data of aspirin-responsive and -resistant patients showed no significant difference between these groups, except for albumin (P = 0.032) and serum fibrinogen (P = 0.0001) levels. The fibrinogen level and thromboembolism history were independent risk factors for aspirin resistance. Also, there was a significant correlation between platelet aggregation in peripheral blood smears and aspirin resistance (P = 0.0001). Conclusions: Our findings suggest that measurement of the serum fibrinogen level and platelet aggregation in blood smears may be the first step to predict aspirin resistance.

scholarly journals COMPARISON OF SERUM VITAMIN A LEVELS BETWEEN NEONATES WITH CONGENITAL HEART DISEASE AND CONTROLS

2018 ◽  
Vol 11 (10) ◽  
pp. 130
Author(s):  
Saeed Abtahi ◽  
Zahra Mostafavian ◽  
Babak Behnam ◽  
Zahra Abbasi Shaye
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Vitamin A ◽  
Congenital Heart ◽  
Laboratory Data ◽  
Serum Vitamin ◽  
Analysis Of Covariance ◽  
Cyanotic Heart Disease ◽  
Significant Difference ◽  
The Mean

Objective: Prevention of congenital heart disease (CHD) has been hampered by a lack of information about the known modifiable risk factors for abnormalities in cardiac development. Vitamin A plays an important role in the periods of rapid cellular growth and differentiation, especially during pregnancy. Assuming a link between Vitamin A levels and congenital malformations, hypothetical different levels of Vitamin A were evaluated in neonates with and without CHD, in this study.Methods: In a case–control study that was conducted in 2015 in Mashhad/Iran, serum levels of Vitamin A in 30 neonates with CHD were compared to 30 healthy controls. The cases were diagnosed by echocardiography and recruited by convenience sampling. Demographic and laboratory data including age, sex, and serum Vitamin A level in each group were collected. Data analysis was done in SPSS V 20 software, and descriptive statistics, t-test, and analysis of covariance were used.Results: The mean age in cases was 11±3.4 days and in controls was 12.5±4.8 days. A total of 18 patients (60%) were male. In CHD patients, 10 cases (33.3%) had cyanotic heart disease, and 20 cases (66.7%) had non-cyanotic heart disease. The mean serum Vitamin A values in subjects (11.54±9.56 μg/dL) and controls (21.84±14.3 μg/dL) were significantly different, (p<0.05) and in case group was lower than the normal range.Conclusion: There was a significant difference in serum Vitamin A values in subjects and controls. Therefore, awareness of people about the importance of this vitamin in preventing CHD in children seems necessary.

scholarly journals The level of superoxide dismutase and catalase in acyanotic congenital heart disease children with heart failur

2021 ◽  
Vol 16 (1) ◽  
pp. 150-156
Author(s):  
Henry Wicaksono ◽  
Mahrus A Rahman ◽  
Roedi Irawan ◽  
I Ketut Alit Utamayasa ◽  
Teddy Ontoseno ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Superoxide Dismutase ◽  
Heart Disease ◽  
Congenital Heart ◽  
Control Group ◽  
Case Group ◽  
Significant Difference ◽  
The Difference ◽  
Acyanotic Congenital Heart Disease

Background: The most common complication in acyanotic congenital heart disease (CHD) is heart failure which definitive diagnosis and therapy remain unsatisfactory. Heart failure’s progression is often associated with oxidative stress process. Superoxide dismutase (SOD) is the first line antioxidant of defense against superoxide anion. While Catalase (CAT) breaks down hydrogen peroxide into water and oxygen molecules which complements previous detoxification carried out by SOD. Objective: This study aimed to compare the differences of SOD and CAT levels in acyanotic CHD patients between those with and without heart failure. Methods: A case-control study was conducted on three to ten years old children with a left-to-right shunt acyanotic CHD with and without heart failure in the Pediatric Cardiology outpatient clinic, ward, and emergency room of Dr. Soetomo Hospital Surabaya from April-July 2020. Echocardiography was used to establish the diagnosis of CHD, while Pediatric Heart Failure Score (PHFS) criteria was used to indicate heart failure. T-test was undertaken for analysing the difference between both groups. Results: The total samples were 41 children, consisted of 29 subjects in the case group (CHD with heart failure) and 12 subjects in the control group (without heart failure). The level of SOD in CHD with heart failure was lower (74.670+15.705) than those without it (109.163+3.111) (p<0.05). In contrast, level of CAT in CHD with heart failure was higher (25.895) than those without it (13.976) (p<0.05). Conclusion: There was a significant difference of SOD and CAT levels in acyanotic CHD between those with and without heart failure.

scholarly journals Cyanotic congenital heart disease: Impact on growth and endocrine functions.

2021 ◽  
Vol 28 (10) ◽  
pp. 1477-1483
Author(s):  
Muhammad Sohail Arshad ◽  
Waqas Imran Khan ◽  
Arif Zulqarnain ◽  
Hafiz Muhammad Anwar-ul-Haq ◽  
Mudasser Adnan
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Pulmonary Stenosis ◽  
Tertiary Care ◽  
Cyanotic Congenital Heart Disease ◽  
P Value ◽  
Common Diagnosis ◽  
Significant Difference ◽  
The Impact

Objective: To find out the impact of Cyanotic Congenital Heart Disease (CCHD) on growth and endocrine functions at a tertiary care child healthcare facility of South Punjab. Study Design: Case Control study. Setting: Department of Pediatric Cardiology and Department of Pediatric Endocrinology, Institute of Child’s Health (ICH), Multan, Pakistan. Period: December 2018 to March 2020. Material & Methods: During the study period, a total of 53 cases of Echocardiography confirmed CCHD were registered. Along with 53 cases, 50 controls during the study period were also enrolled. Height, weight, body mass index (BMI) along with hormonal and biochemical laboratory investigations were done. Results: There was no significant difference between gender and age among cases and controls (p value>0.05). Most common diagnosis of CCHD among cases, 24 (45.3%) were Tetralogy of Fallot (TOF) followed by 9 (17.0%) transposition of the great arteries (TGA) with Ventricular Septal Defect (VSD) with Pulmonary Stenosis (PS). Mean weight of CCHD cases was significantly lower in comparison to controls (21.19+6.24 kg vs. 26.48+8.1 kg, p value=0.0003). Blood glucose was significantly lower among cases in comparison to controls (77.58+14.58 mg/dl vs. 87.25+11.82 mg/dl, p value=0.0004). No significant difference was found in between cases and controls in terms of various hormone levels studied (p value>0.05) except Insulin-like Growth Factor-1 (IGF-1) levels (p value<0.0001). Conclusion: Children with cyanotic congenital heart disease seem to have negative effects on nutrition and growth. Change in pituitary-adrenal axis is suspected while pituitary-thyroid axis seemed to be working fine among CCHD cases. Serum glucose and IGF-1 levels were significantly decreased among CCHD cases.

Abstract 13794: Serial Brain Metabolism in Term Neonates With Congenital Heart Disease: Association With Clinical Factors and Neurodevelopmental Outcomes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anna L Harbison ◽  
Jodie K Votava-Smith ◽  
Sylvia Del Castillo ◽  
S Ram Kumar ◽  
Vincent K Lee ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Brain Metabolism ◽  
Clinical Factors ◽  
Neurodevelopmental Outcomes ◽  
Term Neonates ◽  
Significant Difference ◽  
Serial Brain

Objectives: Term congenital heart disease (CHD) neonates demonstrate pre-operative (op) abnormal brain metabolism (reduced N-acetylaspartate (NAA), elevated lactate) on long echo MR spectroscopy (MRS). We sought to delineate associations between serial brain metabolism and patient and perioperative clinical factors in term neonates with CHD using short echo MRS. We measured NAA and lactate as well as other metabolites important for brain connectivity such as neurotransmitters glutamate/glutamine and GABA. Methods: Subjects were prospectively enrolled to undergo pre and post-op 3T short echo single voxel MRS of parietal white matter with absolute quantitation of 15 metabolites using LCModel. Neurodevelopment (ND) was assessed via 18 month Battelle Developmental Inventory. Linear and logistic regression with false discovery rate correction was used for statistical analysis. Results: Eighty subjects were enrolled 2009-2015 and 21 term CHD infants underwent both pre and post-op MRS. Eight infants had at least one MRS and ND. NAA and glutamate were significantly decreased post-op compared to pre-op (p<0.0001), with no significant difference in other metabolites. Pre-op factors including lower Apgar score, birth weight, head circumference and PaO2 and higher arterial pH and serum lactate were associated with lower NAA (p<0.002). Single ventricle anatomy was associated with low NAA, high myo-inositol and low glutamine/glutamate compared to two ventricles (p<0.01). Longer cardipulmonary bypass time, but not deep hypothermic circulatory arrest, was associated with reduced NAA (p<0.001). Post-op, global alteration in multiple serial brain metabolites (NAA, lactate, glutamate/glutamine, GABA, myo-inostol) were associated with longer ICU and hospital stay (p<0.03). In those with ND testing, high GABA correlated with low cognitive domain score, while high glutamine correlated with low motor score (p<0.03). Conclusion: In term CHD neonates, serial brain metabolism by MRS demonstrates alterations beyond NAA, including neurotransmitters GABA and glutamate/glutamine. These abnormalities are associated with multiple clinical pre and post-op factors and also predict prolonged hospital stay and 18 month ND.

Abstract 240: Hypertension Prevalence and Management Among Adult Congenital Heart Disease Patients

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Joshua R Thomas ◽  
Ricky T Munoz ◽  
Mark D Fox ◽  
Angela T Yetman
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Hypertension Prevalence ◽  
Significant Difference ◽  
Adult Congenital ◽  
The Mean

Background: Cardiovascular risk factors (CRFs) are poorly defined among the population of adults with congenital heart disease. In particular, the prevalence of pre-hypertension (pre-HTN) and hypertension (HTN) are currently unknown. Objective: To determine the prevalence of pre-HTN and HTN among adults with congenital heart disease; and to assess HTN control rates among different clinic types. Methods: A retrospective analysis of a cohort of adults with congenital heart disease (CHD) was conducted. Data regarding CHD patients' blood pressure (BP), medications, and provider specialty were analyzed. Results: The cohort consisted of 971 patients. The mean age was 30.4 years (SD = 10.4), with 51% male. Thirty-two percent had HTN (n = 304). There was no statistically significant difference in the prevalence of Pre-HTN and HTN by clinic type (i.e. specialty vs. non-specialty)( p = .225, p= .633 respectively). However, a statistically significant association exists between clinic type and HTN control rates χ 2 (1) = 3.185, p = .07 (Table 1). Those receiving care from a specialty clinic are 1.6 times more likely to have controlled HTN. Conclusions: Pre-HTN and HTN are common among adults with congenital heart disease. These CRFs are better managed in specialty clinics devoted to this population.

Dynamics of respiratory gas exchange during exercise after correction of congenital heart disease

1996 ◽  
Vol 80 (2) ◽  
pp. 458-463 ◽  
Author(s):  
T. Reybrouck ◽  
L. Mertens ◽  
N. Kalis ◽  
M. Weymans ◽  
M. Dumoulin ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Aerobic Exercise ◽  
Congenital Heart ◽  
Anaerobic Metabolism ◽  
Assessment Method ◽  
Co2 Production ◽  
Ventilatory Anaerobic Threshold ◽  
The Difference ◽  
Response To Exercise

In pediatric exercise testing, conventional measures of aerobic exercise function such as maximal O2 uptake or the ventilatory anaerobic threshold (VAT) use only one value for the assessment of exercise capacity. We studied a more comprehensive approach to evaluate aerobic exercise function by analyzing the steepness of the slope of CO2 production (VCO2) vs. VO2 above the VAT (S3). This was calculated in 32 patients operated on for congenital heart disease [16 for transposition of the great arteries (TGA) and 16 for tetralogy of Fallot (TF)] and was compared with 16 age-matched controls (nl). The results show that the reproducibility of this new assessment method was excellent (coefficient of variation for S3: 8.6%). S3 was significantly steeper (P<0.05) in the patients (1.31 +/- 0.22 for TGA and 1.28 +/- 0.16 for TF) compared with the nl (1.10 +/- 0.22). Also, the difference between S3 and the slope of VCO2 vs. VO2 below the VAT was significantly higher in the patients (0.37 +/- 0.22 for TGA and 0.31 +/- 0.10 for TF) than in controls (0.22 +/- 0.06). The steeper slopes were associated with lower than normal values for VAT and O2 during exercise. It is concluded that the analysis of the steepness of the slope of CO2 is a sensitive, reproducible, and objective approach to evaluate the integrative cardiopulmonary response to exercise. It complements the assessment of a subnormal VAT by reflecting the extent of anaerobic metabolism.

Hypoxic Challenge Testing (Fitness to Fly) in children with complex congenital heart disease

Heart ◽  
2018 ◽  
Vol 104 (16) ◽  
pp. 1333-1338 ◽  
Author(s):  
Nitha Naqvi ◽  
Victoria L Doughty ◽  
Luke Starling ◽  
Rodney C Franklin ◽  
Simon Ward ◽  
...  
Keyword(s):  
Heart Rate ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Qt Interval ◽  
Congenital Heart ◽  
Supplemental Oxygen ◽  
Complex Congenital Heart Disease ◽  
Challenge Testing ◽  
Significant Difference ◽  
Fraction Of Inspired Oxygen

ObjectiveCommercial airplanes fly with an equivalent cabin fraction of inspired oxygen of 0.15, leading to reduced oxygen saturation (SpO2) in passengers. How this affects children with complex congenital heart disease (CHD) is unknown. We conducted Hypoxic Challenge Testing (HCT) to assess need for inflight supplemental oxygen.MethodsChildren aged <16 years had a standard HCT. They were grouped as (A) normal versus abnormal baseline SpO2 (≥95% vs <95%) and (B) absence versus presence of an actual/potential right-to-left (R–L) shunt. We measured SpO2, heart rate, QT interval corrected for heart rate and partial pressure of carbon dioxide measured transcutaneously (PtcCO2). A test failed when children with (1) normal baseline SpO2 desaturated to 85%, (2) baseline SpO285%–94% desaturated by 15% of baseline; and (3) baseline SpO275%–84% desaturated to 70%.ResultsThere were 68 children, mean age 3.3 years (range 10 weeks–14.5 years). Children with normal (n=36) baseline SpO2 desaturated from median 99% to 91%, P<0.0001, and 3/36 (8%) failed the test. Those with abnormal baseline SpO2 (n=32) desaturated from median 84% to 76%, P<0.0001, and 5/32 (16%) failed (no significant difference between groups). Children with no R–L shunt (n=25) desaturated from median 99% to 93%, P<0.0001, but 0/25 failed. Those with an actual/potential R–L shunt (n=43) desaturated from median 87% to 78%, P<0.0001, and 8/43 (19%) failed (difference between groups P<0.02). PtcCO2, heart rate and QT interval corrected for heart rate were unaffected by the hypoxic state.ConclusionsThis is the first evidence to help guide which children with CHD need a preflight HCT. We suggest all children with an actual or potential R–L shunt should be tested.

scholarly journals Lung function test in children with left-to-right shunt congenital heart disease

2018 ◽  
Vol 58 (4) ◽  
pp. 165-9
Author(s):  
Carolina Kurniawan ◽  
Indah Kartika Murni ◽  
Sasmito Nugroho ◽  
Noormanto Noormanto ◽  
Roni Naning
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Lung Function ◽  
Congenital Heart ◽  
Vital Capacity ◽  
Septal Defect ◽  
Forced Expiratory Volume ◽  
Significant Difference ◽  
Restrictive Lung Function

Background Increased pulmonary blood flow may lead to abnormal lung function in children with left-to-right (L to R) shunt congenital heart disease. This condition has been linked to considerable mortality and morbidity, including reduced lung function. Objective To assess for lung function abnormality in children with L to R shunt congenital heart disease. Methods We conducted a cross-sectional study involving children aged 5-18 years and diagnosed with L to R shunt congenital heart disease at Dr. Sardjito Hospital from March to May 2017. Subjects underwent spirometry tests to measure forced expiratory volume-1 (FEV-1), forced vital capacity (FVC), and forced expiratory volume-1 (FEV-1)/forced vital capacity (FVC). Results Of 61 eligible subjects, 30 (49.2%) children had atrial septal defect (ASD), 25 (41%) children had ventricular septal defect (VSD), and 6 (9.8%) children had patent ductus arteriosus (PDA). Spirometry revealed lung function abnormalities in 37 (60.7%) children. Restrictive lung function was documented in 21/37 children, obstructive lung function in 11/37 children, and mixed pattern of lung function abnormality in 5/37 children. Pulmonary hypertension was found in 21 children. There was no significant difference in lung function among children with and without pulmonary hypertension (P=0.072). Conclusion Abnormal lung function is prevalent in 60.7% of children with L to R shunt congenital heart disease, of which restrictive lung function is the most common. There was no significant difference in lung function among children with and without pulmonary hypertension.

Regional differnces in birth prevalence of congenital heart disease in Malta

1999 ◽  
Vol 9 (2) ◽  
pp. 150-154 ◽  
Author(s):  
Victor Grech ◽  
Hugo Agius-Muscat ◽  
Charles Savona-Ventura ◽  
Joe Pace
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Odds Ratio ◽  
Congenital Heart ◽  
The South ◽  
Birth Prevalence ◽  
North West ◽  
Live Births ◽  
Cardiac Malformations ◽  
Significant Difference

AbstractAimRecent studies have shown a correlation between environmental pollutants and increased risk of selected congenital malformations. The South-East area of the Island of Malta is much more industrialised than the more rural North-West area. The aim of this study was to test the null hypothesis that there are no regional differences in Malta in the prevalence at birth of congenital cardiac malformations. Methods: Live born infants with congenital cardiac malformations born between 1990 and 1994 were allocated to 10 areas, and thence to 2 regions of 5 areas each, so as to constitute North-West and South-East Malta. Official publications gave population totals and growth rates. Those infants with congenital cardiac malformations were then compared between the different regions using χ2and the Mann-Whitney U test.ResultsThe overall prevalence of congenital heart disease at birth was 8.8/1000 live births. The birth prevalence for the South-East region (10.1/1000 LB – 95% CI 8.4–12.3/1000 live births) was significantly higher than for the North-West (7.4/1000 live births – 95% CI 6.0–9.0/1000 live births) – p=0.03, Odds ratio 1.38 (95% CI 1.05–2.61). The Mann-Whitney U test showed a significant difference in the distribution amongst the 10 defined areas (p=0.016). The Central-East area had the highest prevalence of cardiac malformations in the entire Island – p=0.02, Odds ratio 1.70 (95% CI 1.10–2.61). Demography showed an efflux of individuals from the South-East of Malta.ConclusionThe higher prevalence of congenital heart disease noted at birth in South-East Malta is unlikely to be due to genetic factors, as these would have migrated North-West along with the population movement. An environmental factor, therefore, seems more likely to be responsible for the increased predisposition to congenital heart disease in the South-East of Malta.

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