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Somatic growth in 94 single ventricle children -- comparing systemic right and left ventricle patients
Trine Witzner Hessel1, Gorm Greisen, Lars Idorn
1Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. Trinehessel@gmail.com
Insights
Children with single ventricle heart defects and a systemic left ventricle show better weight gain after the Glenn anastomosis compared to those with a systemic right ventricle. This finding is crucial for understanding single ventricle growth patterns.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Pediatric Cardiac Surgery
Background:
- Single ventricle (SV) heart defects present complex physiological challenges.
- Growth patterns in SV patients vary based on ventricular morphology.
- Understanding growth is vital for optimizing surgical and medical management.
Purpose of the Study:
- To compare growth trajectories in single ventricle children based on systemic ventricle type (right vs. left).
- To assess growth at key developmental and surgical time points: birth, pre-neonatal surgery, pre-Glenn anastomosis, and pre/post-Fontan operation up to 11 years.
- To identify differences in catch-up growth between systemic left ventricle (SLV) and systemic right ventricle (SRV) populations.
Main Methods:
- Retrospective review of 116 single ventricle patients operated between 1987-2007.
- Data collection included surgical procedures, feeding, hemodynamics, and anthropometrics (weight, height).
- Measurements were converted to z-scores for standardized growth assessment.
Main Results:
- No significant difference in gestational age or birth weight between SLV and SRV groups.
- Both groups exhibited similar growth retardation before neonatal surgery and the Glenn anastomosis.
- Significant catch-up growth differences emerged pre-Fontan operation, with SRV patients showing lower weight-for-age z-scores (-1.9 pre-Fontan, -1.1 post-Fontan) compared to SLV patients (-1.6 pre-Fontan, -0.7 post-Fontan).
Conclusions:
- Single ventricle children with a systemic left ventricle demonstrate superior weight gain post-Glenn anastomosis compared to those with a systemic right ventricle.
- This suggests a potential impact of ventricular dominance on long-term growth and development in single ventricle physiology.
- Further research may elucidate mechanisms driving these differential growth patterns.
Aim:
We sought to compare and assess growth in single ventricle children with a systemic right or left ventricle in five time periods: at birth, before neonatal surgery, before the Glenn anastomosis and finally before and after the Fontan operation to 11 years of age.
Methods:
We reviewed medical records on 116 single ventricle patients operated at Rigshospitalet, Denmark from 1987 to 2007. Surgical procedures, feeding route, hemodynamic variables and anthropometric measurements such as weight and height were registered and converted to z-scores.
Results:
Ninety four single ventricle patients were included for analysis. Gestational age and birth weight was not significantly different between the left and right ventricle group. Before neonatal surgery and before the Glenn anastomosis, both groups showed equal growth retardation. However, a significant difference in catch-up growth was found before the Fontan operation. Thus, patients in the right ventricle group had a smaller median weight-for-age z-score compared with the left ventricle group in the pre-Fontan period (-1.9 and -1.6; p = 0.049) and in the post-Fontan period (-1.1 and -0.7; p = 0.034).
Conclusion:
After the Glenn anastomosis single ventricle children with a systemic left ventricle have better weight gain compared with children with a systemic right ventricle.
