Chronic Hypoxemia in Children with Cyanotic Heart Disease

Vascular Health in Congenital Heart Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Congenital heart disease (CHD) affects 1% of live births and is a risk factor for cardiovascular disease and reduced life expectancy. Previous studies have suggested CHD is associated with impaired vascular health, but this has not been established. Therefore, the objective of this study was to examine the effect of CHD on vascular health.

METHODS

Eight electronic databases were searched through April 12, 2024. Studies of all designs (except case studies and reviews) that reported on the population (individuals with CHD of any age), comparator (individuals without CHD), and outcomes of interest: endothelial dependent (flow-mediated vasodilation, reactive hyperemia index) and independent (nitroglycerin-mediated dilation) vascular function, arterial stiffness (pulse wave velocity, stiffness index, augmentation index, distensibility, and compliance), and carotid intima-media thickness were included. Results are presented as standardized mean difference (SMD) with 95% confidence interval (CI) and as effect size.

RESULTS

We included 138 studies (N = 16,115) in the meta-analysis. Individuals with CHD exhibited decreased vascular function compared with those without including decreased low-mediated vasodilation (SMD, -0.96 [95% CI, -1.22 to -0.70]; I2 = 85%; large effect size), reactive hyperemia index using ultrasound (SMD, -2.88 [95% CI, -4.85 to -0.90]; I2 = 96%; large effect size), and nitroglycerin-mediated dilation (SMD, -0.98 [95% CI, -1.35 to -0.61]; I2 = 87%; large effect size). Various CHD subtypes including coarctation of the aorta, transposition of the great arteries, and tetralogy of Fallot, after the Fontan procedure showed significant vascular dysfunction. Shunt lesions did not show significant vascular dysfunction.

CONCLUSIONS

CHD is associated with vascular dysfunction, increased arterial stiffness, and greater carotid intima-media thickness in pediatric and adult patients.

Systemic hypoxia inhibits T cell response by limiting mitobiogenesis via matrix substrate-level phosphorylation arrest

Systemic oxygen restriction (SOR) is prevalent in numerous clinical conditions, including chronic obstructive pulmonary disease (COPD), and is associated with increased susceptibility to viral infections. However, the influence of SOR on T cell immunity remains uncharacterized. Here we show the detrimental effect of hypoxia on mitochondrial-biogenesis in activated mouse CD8⁺ T cells. We find that low oxygen level diminishes CD8⁺ T cell anti-viral response in vivo. We reveal that respiratory restriction inhibits ATP-dependent matrix processes that are critical for mitochondrial-biogenesis. This respiratory restriction-mediated effect could be rescued by TCA cycle re-stimulation, which yielded increased mitochondrial matrix-localized ATP via substrate-level phosphorylation. Finally, we demonstrate that the hypoxia-arrested CD8⁺ T cell anti-viral response could be rescued in vivo through brief exposure to atmospheric oxygen pressure. Overall, these findings elucidate the detrimental effect of hypoxia on mitochondrial-biogenesis in activated CD8⁺ T cells, and suggest a new approach for reducing viral infections in COPD.

Study on bone age in pediatric patients with congenital heart disease and its relation with cyanosis and pulmonary artery pressure

The aim of this study is to evaluate the growth failure in children with Congenital Heart Diseases (CHD) associated with the Pulmonary Hypertension (PH) and cyanosis. Growth parameters including weight, height and head circumference of 120 cases with congenital heart defects aged 6 months to 14 years were compared with standard growth curves (50th percentile) between November 2007 and November, 2008. Of all, sixty five (54.1%) were male and 55 (45.8%) were female. The patients were classified into four groups based on the presence or absence of PH and cyanosis. The gap between chronological age and bone age (BA) for all subjects was determined. Growth disturbance in weight, height and head circumference was detected in 80 (66.7%), 79 (65.8%) and 41 (34.2%) of the patients, respectively. Bone age delay was seen in fifty five percent of the cases. Generally, delay in all parameters was more seen in acyanotic patients with pulmonary hypertension. In subjects with cyanosis whether in addition to PH or not, bone age was significantly retarded. Etiology of growth failure in children with CHD is multifactorial. Further studies are required to assess the role of different factors in this field.

Growth and development of children with congenital heart disease

BACKGROUND

Children with congenital heart disease (CHD) commonly experience delayed growth. Because growth and development are closely related, both should be considered when a child's progress is examined.

PURPOSE

This paper reports a study to evaluate and compare the growth and development of preschool children with CHD to those of normal preschool children.

METHODS

The heights and weights of 42 preschool children with CHD and 116 normal preschool children were compared with standard growth curves. Differences in development of personal and social skills, fine motor skills and adaptability, language, and gross motor skills were evaluated. Developmental skills were assessed using the Denver Developmental Screening Test II.

RESULTS

A significant difference was found in both body height (P < 0.05) and weight (P < 0.05) between the two groups. More preschoolers with congenital hear disease were below the 50th percentile in height (P < 0.05) and weight (P < 0.001). Preschoolers with CHD had more suspicious interpretations than non-CHD preschoolers, specifically in the language (P < 0.01) and gross motor sections (P < 0.001). Nevertheless, there were two items in the personal-social section and one in the language section on which the children with heart disease passed in the range of 55.6-63.2%. Problems were encountered with the Denver II test because of differences in language, culture and childrearing methods between Taiwanese and Western societies. These cultural differences must be considered when the test is used to assess development.

CONCLUSIONS

Learning about the growth and developmental differences between children with CHD and normal children may help parents of the former to detect problems associated with delayed growth and development earlier. These children and their families should have the opportunity to participate in a long-term, follow-up programme that provides information and encourages developmental progress. The results could serve as a reference for those in both clinical and community workers who provide nursing care to children with CHD.