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Morbidity in children and adolescents after surgical correction of truncus arteriosus communis - 07/09/13

Doi : 10.1016/j.ahj.2013.05.023 
Michael L. O'Byrne, MD a, , Laura Mercer-Rosa, MD MSCE a, Huaqing Zhao, PhD b, Xuemei Zhang, MS c, Wei Yang, PhD d, Amy Cassedy, PhD e, Mark A. Fogel, MD a, Jack Rychik, MD a, Ronn E. Tanel, MD f, Bradley S. Marino, MD, MPP, MSCE e, Stephen Paridon, MD a, Elizabeth Goldmuntz, MD a
a Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 
b Temple Clinical Research Center, Temple University School of Medicine, Philadelphia, PA 
c Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 
d Department of Biostatistics and Epidemiology, Center of Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 
e Division of Pediatric Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 
f Division of Pediatric Cardiology, UCSF Benioff Children's Hospital, Department of Pediatrics, UCSF School of Medicine, San Francisco, CA 

Reprint requests: Michael L. O'Byrne, MD, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104.

Résumé

Background

Studies of outcome after operative correction of truncus arteriosus communis (TA) have focused on mortality and rates of reintervention. We sought to investigate the clinical status of children and adolescents with surgically corrected TA.

Methods and Results

A cross-sectional study of subjects with TA was performed. Subjects underwent concurrent genetic testing, electrocardiogram, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and completed questionnaires assessing health status and health-related quality of life. Review of their medical history provided retrospective information on cardiac reintervention and use of medical care. Twenty-five subjects with a median age of 11.8 (8.1-18.99) years were enrolled. The prevalence of 22q11.2 deletion was 32%. Incidence of hospitalization, cardiac reintervention, and noncardiac operations was highest in the first year of life. Combined catheter-based and operative reintervention rates were 52% on the conduit and 56% on the pulmonary arteries. Right ventricular ejection fraction and end-diastolic volume were normal. Moderate or greater truncal valve insufficiency was seen in 11% of subjects, and truncal valve replacement occurred in 8% of subjects. Maximal oxygen consumption (P = .0002), maximal work (P < .0001), and forced vital capacity (P < .0001) were all lower than normal for age and sex. Physical health status and health-related quality of life were both severely diminished.

Conclusion

Patients with TA demonstrate significant comorbid disease throughout childhood, significant burden of operative and catheter-based reintervention, and deficits in exercise performance, functional status, and health-related quality of life.

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 The work in this manuscript was supported by the National Institute of Health (Grant No. P50-HL74731) and the National Center for Research Resources (Grant No. UL1RR023134). The content is solely the responsibility of the authors and does not necessarily reflect the official view of the National Center for Research Resources or the National Institutes of Health.


© 2013  Mosby, Inc. Tous droits réservés.
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Vol 166 - N° 3

P. 512-518 - septembre 2013 Retour au numéro
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