Abstract-To determine whether carotid intima media thickness is increased in children with primary hypertension, the current study compared carotid intima media thickness in hypertensive children with that of normotensive control subjects matched closely for body mass index and determined the relationship between carotid intima media thickness and hypertension severity determined by ambulatory blood pressure monitoring. Children with newly diagnosed office hypertension (nϭ28) had carotid intima media thickness, left ventricular mass index, and ambulatory blood pressure monitoring performed. Carotid intima media thickness was performed in normotensive control subjects (nϭ28) matched pairwise to hypertensive subjects for age (Ϯ1 year), gender, and body mass index (Ϯ10%). Eighty-two percent of subjects were overweight or obese (body mass index Ն85th percentile). The median carotid intima media thickness of hypertensive subjects was greater than that of matched controls (0.67 versus 0.63 mm; Pϭ0.045). In the hypertensive subjects, carotid intima media thickness correlated strongly with several ambulatory blood pressure monitoring parameters, with the strongest correlation for daytime systolic blood pressure index (rϭ0.57; Pϭ0.003). In the hypertensive group, the prevalence of left ventricular hypertrophy was 32%, but unlike carotid intima media thickness, left ventricular mass index did not correlate with ambulatory blood pressure monitoring. Together, the findings that hypertensive subjects had increased carotid intima media thickness compared with matched controls and that higher carotid intima media thickness correlated with more severe hypertension by ambulatory blood pressure monitoring provide strong evidence that carotid intima media thickness is increased in childhood primary hypertension, independent of the effects of obesity.

Objective-To determine if children with white coat hypertension (WCH) have evidence of targetorgan damage by comparing left ventricular mass index (LVMI) of subjects with WCH to that of matched normotensive and hypertensive controls.Study design-Each WCH subject was matched by body mass index (± 10%), age (± 1 year), and sex to a normotensive control and to a hypertensive control. Echocardiograms were reviewed to determine LVMI for each subject. These triple matches were analyzed using repeated measures analysis of variance to detect differences in LVMI between the three groups.Results-Twenty-seven matched triplets were established. The groups were comparable for sex, age, and body mass index (BMI). Mean LVMI was 29.2, 32.3, and 35.1 g/m 2.7 , for normotensives, WCH, and sustained hypertensives, respectively (normotensive vs. WCH, p = 0.028; WCH vs. sustained hypertensive, p = 0.07). Left ventricular hypertrophy was not present in any subject in the normotensive or WCH groups, but was present in 26% of the sustained hypertensive subjects (p < 0.001).Conclusions-After controlling closely for BMI, children with WCH had a LVMI which was intermediate between that of normotensives and sustained hypertensives, suggesting that WCH may be associated with hypertensive end-organ effects.White coat hypertension (WCH) occurs when blood pressure is elevated in the medical office but is normal outside the office setting. In adults, there is concern that WCH may be an independent risk factor for cardiovascular disease or that it may represent a prehypertensive state, with increased risk of progression to sustained hypertension. 1 Numerous adult studies have evaluated left ventricular mass index (LVMI) in subjects with WCH. Many, but not all, Corresponding Author: Marc B. Lande, MD, 601 Elmwood Ave, Box 777, Rochester, NY 14642, Phone: 585-275-9784, Fax: 585-756-8054, Email: marc_lande@urmc.rochester.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The objective of the current study was to determine if children with WCH have evidence of hypertensive target-organ effects by comparing LVMI in children with WCH, normotension, and sustained hypertension, closely matching subjects for BMI, sex, and age. NIH Public Access MethodsThe study was performed at the University of Rochester Medical Center in Rochester, NY. At this center, ABPM has been used in the evaluation of pediatric primary hypertension since October 2002. The clinical purpose of ABPM has been primarily to differentiate between sustained hypertension and white coat hypertension. It has been our practice to obtain ech...

Background-Supravalvar pulmonary stenosis (SVPS) is frequently observed after arterial switch. Traditionally the coronary arteries are removed from the neopulmonic root by excising the entire sinus of Valsalva. As a result, reconstruction of the neopulmonic root requires a pericardial patch encompassing two-thirds of the anastomosis between the neopulmonic root and pulmonary artery. We present a technique where the coronary arteries are removed as limited buttons of sinus tissue, leaving the transected edge of the neopulmonic root intact. We hypothesize that maintaining native arterial tissue in the anastomosis between the neopulmonic root and the pulmonary artery bifurcation reduces postoperative SVPS. Methods and Results-We performed a retrospective review of neonates with D-transposition of the great arteries undergoing arterial switch procedure from 1996 to 2009. Charts were reviewed, and clinical outcomes recorded for each patient. Most recent echocardiograms were evaluated for right ventricular outflow tract obstruction. A total of 120 patients received arterial switch using this technique. There was 99% survival and no injuries to the coronary arteries regardless of anatomy. Total follow-up was 564 patient-years. Mean follow-up at last clinical visit was 66Ϯ46 months. Evaluation of the most recent outpatient echocardiogram revealed an average peak instantaneous gradient across the neopulmonic root of 22.5Ϯ5 mm Hg. Only 7 (5%) patients required reintervention (balloon dilation, nϭ5; surgery, nϭ2). Conclusions-Our technique of removing the coronary arteries as limited buttons, and anastomosis of the pulmonary artery using only native arterial tissue provides excellent midterm results with minimal SVPS. (Circulation. 2012;126[suppl 1]:S118 -S122.)

The duration of cortical isoelectric states seems related to neurodevelopmental outcomes. Strategies using continuous EEG monitoring to minimize isoelectric states may be useful during complex congenital heart surgery.

For aortic coarctation repair in infancy, a strategy designed to directly address aortic arch hypoplasia results in excellent intermediate-term results with normal BP, physiologic arm:leg BP relationship, and near normal descending aortic blood flow velocities by Doppler.