Functional outcomes in children with anatomically repaired transposition of the great arteries with regard to congenital ventricular septal defect and coronary pattern

Abstract

ObjectiveDespite decreasing mortality, functional impairments in children with transposition of the great arteries (TGA) are still a concern. This study analyses health-related physical fitness (HRPF), arterial stiffness and health-related quality of life (HRQoL) in children with anatomically repaired TGA regarding congenital ventricular septal defect (VSD) and coronary patterns.Patients and methods68 children with anatomically repaired TGA with or without VSD (12.9±3.7 years, 19.1% female) were investigated between August 2014 and October 2017. HRPF was assessed by five tests of the FITNESSGRAM, arterial stiffness was measured by oscillometric measurement using Mobil-O-Graph and HRQoL was analysed with a self-report questionnaire (KINDL-R). All test results were compared with a healthy reference cohort (n=2116, 49.1% female) adjusted for sex and age.ResultsChildren with anatomically repaired TGA had significantly worse HRPF (z-score: −0.58±0.81, p<0.001), increased pulse wave velocity (TGA: 4.9±0.3 m/s vs healthy: 4.8±0.3 m/s, p=0.028) and central systolic blood pressure (TGA: 105.9±5.8 mm Hg vs healthy: 103.3±5.7 mm Hg, p=0.001). No difference was found for HRQoL between the two groups (total HRQoL score: TGA: 76.5±10.2 vs healthy: 75.2±10.1, p=0.315). Neither the coronary pattern nor a congenital VSD resulted in significant differences in all functional outcomes.ConclusionChildren with anatomically repaired TGA exhibit impaired HRPF and increased arterial stiffness whereas their HRQoL is normal. The underlying coronary pattern seems to have no influence on the functional outcome, nor does an accompanied congenital VSD.

Vascular Structure and Function in Children and Adolescents: What Impact Do Physical Activity, Health-Related Physical Fitness, and Exercise Have?

“…Parameters measured with this devices include compliance, distensibility, stiffness index, reflection index, elastic modulus, augmentation index (AI), and PWV. Pediatric populations with elevated cardiovascular risk can present reduced compliance or increased stiffness, for example children with hypertension (12), obesity (12,13), hypercholesterolemia (14), metabolic syndrome (15), diabetes (16), and congenital heart disease (17).…”

Longitudinal development of central SBP in children with congenital heart disease

“…8 Another cross-sectional analysis showed increased cSBP in children with anatomically corrected TGA compared with healthy peers. 9 Patients with CoA have also been found to have a high incidence of arterial hypertension and cerebrovascular disease, even after surgical correction of the narrowing. 20,21 Upon these cross-sectional findings of increased cSBP, our study indicates that there is a longitudinal increase in cSBP over time in CHD children.…”

“…cSBP was obtained by a single measurement recording brachial oscillometric blood pressure waves using an automated, noninvasive Mobil-O-Graph device (I.E.M., Stolberg, Germany), as previously described 9,10 . Measurements were performed at the left upper arm in a supine position after 5 min of rest with cuff size adjusted for individual arm circumference.…”

Association between Objectively Measured Physical Activity and Arterial Stiffness in Children with Congenital Heart Disease

“…MVPA and steps were analyzed for every single day and computed to weekly averages for statistical purposes. The association between PA, in the form of MVPA and step count, and surrogates of arterial stiffness was analyzed using multivariate linear regression analyses adjusted for age, sex, zscore of the body mass index (BMI), peripheral systolic blood pressure (pSBP) heart rate and intake of hypertensive agents (yes/no) as in our previous analysis on this topic [22,23]. The activity level of CHD subgroups was compared to the WHO recommendation of average 60 min per day with one-sample t-test.…”

“…Aortic PWV and cSBP was obtained by a single measurement recording brachial oscillometric blood pressure waves using an automated Mobil-o-Graph ® device (I.E.M, Stolberg, Germany) as previously described [22,23]. HMS software version 4.7 with C1 calibration was used.…”