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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Respiratory morbidity in children with congenital heart disease
S Guerin1, N Bertille2, D Khraiche3
1Pediatric Pulmonology, Centre de référence des Maladies Respiratoires Rares - RESPIRARE, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France; Current address for Sophie GUERIN: Unité de pneumologie pédiatrique - Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Insights
Children with congenital heart disease (CHD) may experience reduced total lung capacity (TLC), especially those with left-to-right shunts or early surgical repair. This highlights potential long-term respiratory complications impacting lung development.
Area of Science:
- Pediatric Cardiology
- Respiratory Medicine
- Congenital Heart Disease Research
Background:
- Congenital heart disease (CHD) affects lung development and function.
- Understanding long-term respiratory outcomes is crucial for pediatric patients.
- Recent management strategies necessitate re-evaluation of respiratory health in CHD.
Observation:
- A prospective study evaluated 8-year-old children with isolated CHD.
- Children were grouped by CHD pathophysiology: left-to-right shunt (n=212) or right outflow tract obstruction (n=113).
- Wheezing rates were similar, but total lung capacity (TLC) differed significantly between groups.
Findings:
- Children with left-to-right shunts had significantly lower TLC (88.72% predicted) compared to those with right outflow tract obstruction (91.84% predicted).
- Multivariate analysis identified left-to-right shunt and early surgical repair (before 2 months) as independent factors for reduced TLC.
- No significant difference in current wheezing episodes was observed between the two CHD groups.
Implications:
- Lower TLC is a persistent long-term complication in children with CHD, particularly those with left-to-right shunts.
- Early surgical intervention in CHD may be associated with impaired lung development.
- Increased pulmonary blood flow in left-to-right shunts might directly impact lung growth, warranting further investigation.
Objective:
To evaluate the respiratory outcome in children with congenital heart disease (CHD), considering recent management procedures and the CHD pathophysiology.
Design And Setting:
Clinical and functional respiratory outcome were evaluated in 8-year-old children with isolated CHD followed up from birth in the prospective population-based EPICARD cohort.
Patients:
Children were assigned to two groups, based on the pathophysiology of the CHD: CHDs with left-to-right shunt (n = 212) and CHDs with right outflow tract obstruction (n = 113).
Results:
Current wheezing episodes were observed in 15% of the children with isolated CHD and left-to-right shunt, and 11% of the children with isolated CHD and right outflow tract obstruction (not significant). Total lung capacity (TLC) was the only respiratory function parameter that significantly differed between the two groups. It was lower in children with left-to-right shunt (88.72 ± 0.65% predicted) than in those with right outflow tract obstruction (91.84 ± 0.96, p = 0.006). In multivariate analysis, CHD with left-to-right shunt (coeff. [95% CI]: -3.17 [-5.45; -0.89]) and surgery before the age of 2 months (-6.52 [-10.90; -2.15]) were identified as independent factors associated with significantly lower TLC values.
Conclusion:
Lower TLC remains a long-term complication in CHD, particularly in cases with left-to-right shunt and in patients requiring early repair. These findings suggest that an increase in pulmonary blood flow may directly impair lung development.
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