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Leg Venous Properties in Children With Myelomeningocele
Małgorzata Domagalska-Szopa1, Andrzej Szopa2, Maximilian Puchner3
1Department of Medical Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Insights
Children with myelomeningocele (MMC) have impaired leg vein function, showing increased retrograde flow in the great saphenous vein (GSV). Clinical factors like defect level and muscle strength worsen venous insufficiency in MMC patients.
Area of Science:
- Vascular Biology
- Pediatric Medicine
- Biomedical Engineering
Background:
- Vascular properties in individuals with myelomeningocele (MMC) are under-researched.
- Assessing leg venous properties in children with MMC is crucial for understanding potential complications.
Purpose of the Study:
- To evaluate the venous properties, specifically the duration of retrograde flow (RF) in the great saphenous vein (GSV), in children with MMC.
- To compare GSV RF between children with MMC and typically developing (TD) children.
- To investigate the influence of MMC clinical features on GSV function.
Main Methods:
- Thirty ambulant children with MMC and 30 TD children (ages 7-12) were studied.
- Physical examination included gross motor, muscle strength, and duplex ultrasound of GSV reflux.
- Retrograde flow duration was measured at four GSV sites in horizontal and vertical positions.
Main Results:
- Children with MMC exhibited prolonged retrograde flow in both proximal and peripheral GSV sites compared to TD peers.
- GSV reflux was more prevalent in peripheral segments than proximal ones.
- Higher spinal cord defect level, reduced muscle strength, and lower functional independence negatively impacted GSV sufficiency in MMC patients.
Conclusions:
- Children with MMC demonstrate altered leg venous hemodynamics, increasing the risk of venous insufficiency.
- Clinical severity of MMC correlates with impaired GSV function.
- Findings support the development of screening and treatment strategies for venous insufficiency in spina bifida (SB) patients.
Abstract:
Introduction: The vascular properties of individuals with myelomeningocele (MMC) are an underestimated problem, as evidenced by the lack of relevant research. Therefore, this study was conducted to assess the venous properties of the leg in children with MMC. This study compared the duration of retrograde flow (RF) of the distal and proximal sites of the great saphenous vein (GSV) in children with MMC and typically developing (TD) children. Additionally, the impact of MMC clinical features, such as the anatomical level of the spinal cord defect, muscle strength of the lower limbs, and level of gross motor functional abilities on the of GSV sufficiency were assessed. Methods: Thirty ambulant children between 7 and 12 years with MMC and an age- and sex-matched sample of thirty children with typical development (TD) were included in the study. All participants underwent a complete physical examination that included gross motor assessment, manual muscle testing, and duplex ultrasound examination of the GSV reflux. The duration of retrograde flow (RT) in the GSV was evaluated at four sites: P1: proximal thigh; P2: medial thigh; P3: upper leg; and P4: lower leg. The measurements were performed in two body positions: horizontal position (HP) and vertical position (VP). Results: Children with MMC showed increased duration of RT of both the proximal and peripheral sites of GSV, as compared with the TD peers. The prevalence of GSV reflux in peripheral segments was significantly higher than in the proximal segments. The severity of MMC (expressed by higher level of the spinal cord defect), deficit of thigh and leg muscle strength, and lower functional independence negatively influenced the GSV sufficiency in patients with MMC. Gravity directly influenced GSV reflux occurrence and reflux hemodynamic parameters in MMC. Conclusion: These findings may help better understand aspects concerning the risk of developing venous insufficiency in children with MMC and determine better screening, prevention, and treatment algorithms for venous insufficiency in patients with SB.
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