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The prevalence of abnormal spirometry in children with CHD
Geena Y Zhou1, Daniel Cerrone2, Katherine Lewinter2
1Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Children with congenital heart disease (CHD) often have reduced lung function, particularly forced vital capacity. Single ventricle patients show lower lung function, but some two ventricle conditions also present similar deficits, indicating complex pulmonary issues.
Area of Science:
- Pediatric Cardiology
- Pulmonary Medicine
- Congenital Heart Disease Research
Background:
- Pulmonary disease burden in pediatric congenital heart disease (CHD) is often underestimated.
- Previous studies indicate reduced forced vital capacity (FVC) in children with single ventricle (SV) and two ventricle (TV) heart disease.
- This study aimed to further investigate pulmonary function in pediatric CHD patients.
Purpose of the Study:
- To analyze spirometry data in children with congenital heart disease.
- To compare pulmonary function between single ventricle and two ventricle CHD patient groups.
- To identify factors associated with abnormal lung function in pediatric CHD.
Main Methods:
- Retrospective review of spirometry data from CHD patients over three years.
- Spirometry results were size, age, and gender-corrected and analyzed using z-scores.
- Data from 260 pediatric patients (80 SV, 180 TV) were analyzed.
Main Results:
- Single ventricle patients exhibited significantly lower median forced vital capacity z-scores compared to two ventricle patients (p=0.0133).
- Abnormal forced vital capacity prevalence was 41% in SV and 29% in TV patients.
- TV patients with Tetralogy of Fallot and Truncus Arteriosus showed FVC comparable to SV patients; prior cardiac surgeries predicted abnormal FVC in some TV patients.
Conclusions:
- Pulmonary morbidity, characterized by decreased forced vital capacity, is prevalent in both SV and TV pediatric CHD patients.
- While SV patients generally have lower FVC, specific TV conditions (Tetralogy of Fallot, Truncus Arteriosus) present similar lung function deficits.
- The multifactorial nature of pulmonary disease in pediatric CHD is suggested by the varied impact of surgical history on FVC.
Background:
The burden of pulmonary disease in children with CHD remains under-recognised. Studies have examined children with single ventricle and two ventricle heart disease and documented a decreased forced vital capacity. Our study sought to further explore the pulmonary function of children with CHD.
Methods:
A retrospective review was performed of spirometry in CHD patients over a 3-year period. Spirometry data were corrected for size, age, and gender and analysed using z-scores.
Results:
The spirometry of 260 patients was analysed. About 31% had single ventricle (n = 80, 13.6 years (interquartile range 11.5-16.8)) and 69% had two ventricle circulation (n = 180, 14.4 years (interquartile range 12.0-17.3)). Single ventricle patients were found to have a lower median forced vital capacity z-score compared to two ventricle patients (p = 0.0133). The prevalence of an abnormal forced vital capacity was 41% in single ventricle patients and 29% in two ventricle patients. Two ventricle patients with tetralogy of Fallot and truncus arteriosus had similar low forced vital capacity comparable to single ventricle patients. The number of cardiac surgeries predicted an abnormal forced vital capacity in two ventricle patients except tetralogy of Fallot patients.
Conclusion:
Pulmonary morbidity in patients with CHD is common with a decreased forced vital capacity noted in single ventricle and two ventricle patients. Forced vital capacity is lower in patients with single ventricle circulation; however, two ventricle patients with tetralogy of Fallot or truncus arteriosus have similar lung function in comparison to the single ventricle group. The number of surgical interventions was predictive of forced vital capacity z-score in some but not all two ventricle patients and not predictive in single ventricle patients suggesting a multifactorial to pulmonary disease in children with CHD.
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