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[Hemodynamics and delayed growth in children after surgery for atrial septal defect]
J Ardura Fernández1, C González Herrera, M P Aragón García
1Sección de Cardiología Pediátrica. Hospital Universitario. Facultad de Medicina de Valladolid. España.
Insights
Growth issues in children with atrial septal defect (ASD) are common, but hemodynamic factors alone don't explain failure to thrive. Surgical repair can improve growth, though not universally.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Growth and Development
Background:
- Ostium secundum atrial septal defect (ASD) often presents with disproportionate growth issues in children, unlike more severe congenital heart conditions.
- While generally well-tolerated in childhood, ASD's impact on growth warrants further investigation.
Purpose of the Study:
- To investigate if hemodynamic disturbances are the primary cause of failure to thrive in children with ASD.
- To evaluate the impact of surgical repair on growth and nutritional status in pediatric ASD patients.
Main Methods:
- Studied 72 children undergoing ASD surgery (mean age 8y 8m) with a 17-month follow-up.
- Assessed somatometric and hemodynamic parameters, correlating them to understand growth influences.
- Evaluated the effect of surgery and age at operation on somatometric changes.
Main Results:
- 52% of patients exhibited malnutrition, and 28% had affected height prior to surgery.
- No significant correlation was found between hemodynamic and somatometric parameters.
- Surgery improved growth disturbances, reducing malnutrition from 52% to 32% and affected height from 28% to 16%.
Conclusions:
- Hemodynamic factors are not the sole contributors to growth and nutritional deficits in ASD.
- Surgical intervention offers benefits for growth but does not resolve all issues in every patient.
Background:
Ostium secundum-type atrial septal defect (ASD) is usually well tolerated, without severe complications in childhood. However, in many patients its effect on growth is disproproportionate when compared with that of more serious congenital heart disease.
Objectives:
To test the hypothesis that hemodynamic disturbances are responsible for failure to thrive in congenital heart disease, we studied growth and the effect of surgical repair in children with ASD.
Patients And Methods:
The study was performed in 72 patients who underwent surgery at a mean age of 8 years and 8 months. The mean follow-up was 17 months. Somatometric and hemodynamic parameters were studied and the correlation between them was verified. The effect of surgery and of age at operation on somatometric changes was evaluated.
Results:
Fifty-two percent of the patients were malnourished and height was affected in 28 %. The correlation between weight and age at operation was r 5 0.78 (p < 0.05) for the entire group, r 5 0.81 (p < 0.05) for the malnourished subgroup and r 5 0.88 (p < 0.05) for the subgroup with normal nutrition. No relationship was found between hemodynamic and somatometric parameters. Surgery improved growth disturbances but not in all patients (weight: from 52 % to 32 %; height: from 28 % to 16 %).
Conclusions:
Hemodynamic factors are not the only cause of growth and nutritional alterations.
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