Reversibility of Cardiac Abnormalities in Morbidly Obese Adolescents
Holly M. Ippisch, MD, MS*,*,
Thomas H. Inge, MD, PhD ,
Stephen R. Daniels, MD, PhD, FACC ,
Baiyang Wang, MS*,
Philip R. Khoury, MS*,
Sandra A. Witt, RDCS*,
Betty J. Glascock, RDCS*,
Victor F. Garcia, MD and
Thomas R. Kimball, MD, FACC*
* Division of Cardiology, Cincinnati Children’s Hospital, Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital, Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Department of Pediatrics, The Children’s Hospital, Denver, Colorado.
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Figure 1 Roux-en-Y Procedure
Diagram of Roux-en-Y gastric bypass surgery. In this procedure, a small stomach pouch is created at the gastroesophageal junction (arrow, A), resulting in restricted intake. In addition, the jejunum is brought up and sewn to the new stomach pouch (arrow, B), bypassing the majority of the absorptive stomach and duodenum, creating a mildly malabsorptive state. The proximal jejunum is then anastamosed to the side of the distal jejunum (arrow, C), creating the jejunojejunostomy and allowing for egress of secretory fluids and bile acids. (Artist illustration by Jan Warren, Cincinnati Children’s Hospital Medical Center).
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Figure 2 Change in Indexed LV Mass Versus Change in Percent Over Ideal Body Weight
The larger the decrease in percent over ideal body weight, the larger the decrease in indexed left ventricular (LV) mass.
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Figure 3 Effects of Weight Loss on LV Geometry Patterns
With weight loss, the percent of patients with concentric left ventricular hypertrophy (CLVH) decreased from 28% pre-operatively to 3% post-operatively and the percent of patients with normal left ventricular (LV) geometry improved from 36% pre-operatively to 79% post-operatively. The overall post-operative (post-op) geometry distribution was significantly improved compared with the pre-operative (pre-op) distribution (p < 0.0001). *p < 0.05. CR = concentric remodeling; ELVH = eccentric left ventricular hypertrophy.
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