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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Somatic Growth in Children With Single Ventricle Physiology

Impact of Physiologic State

Kelly N. Vogt, BSc^_*, Cedric Manlhiot, BSc^_*, Glen Van Arsdell, MD, Jennifer L. Russell, MD^_*, Seema Mital, MD^_* and Brian W. McCrindle, MD, MPH^_*,_*

^_* Division of Cardiology, Department of Pediatrics, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Division of Cardiothoracic Surgery, Department of Surgery, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.

Manuscript received June 18, 2007; revised manuscript received July 24, 2007, accepted July 31, 2007.

^_* Reprint requests and correspondence: Dr. Brian W. McCrindle, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. (Email: brian.mccrindle{at}sickkids.ca).

Objectives: We sought to define somatic growth patterns for patients with single ventricle (SV) physiology and associated factors.

Background: Infants with SV physiology might have somatic growth retardation associated with volume overload and hypoxemia, which might improve after surgical palliation.

Methods: We reviewed 126 patients (35% male) who underwent the Fontan procedure from 1994 to 2004. Demographic data, hemodynamic variables, and surgical procedures were recorded. Serial weights and heights were converted to z-scores. Linear regression analysis adjusted for repeated measures was used to model growth trends.

Results: Median z-score for weight was –0.7 at birth, –1.6 before bidirectional cavopulmonary shunt (BCPS), –0.7 before Fontan procedure, and –0.7 after Fontan procedure. A significant decline in z-scores for weight was seen before BCPS, which was reversed after the hemi-Fontan and stabilized after Fontan procedure. The z-scores for weight before the BCPS were lower in patients with lower birth weight (p < 0.01), nutritional difficulties (p = 0.01), and higher right atrial pressures (p = 0.02). After the BCPS, impaired growth was seen in patients who had systemic venous collaterals (p < 0.01). Patients who had collaterals embolized had the same growth trends as patients with no collaterals (p = 0.29).

Conclusions: Infants with SV physiology show impaired somatic growth before BCPS. Although catch-up growth occurs after BCPS, effective interventions such as more intensive nutritional strategies before BCPS might be targeted at this high-risk population. The presence of systemic venous collaterals might impede growth secondary to hemodynamic impairment. Embolization of collaterals might allow for maximum growth potential.

Abbreviations and Acronyms   BCPS = bidirectional cavopulmonary shunt   SV = single ventricle