Hostname: page-component-77c89778f8-cnmwb Total loading time: 0 Render date: 2024-07-17T11:51:28.583Z Has data issue: false hasContentIssue false

Improvement in growth, and levels of insulin-like growth factor-I in the serum, after cavopulmonary connections

Published online by Cambridge University Press:  19 August 2008

Elisabeth V. Stenbøg*
Affiliation:
Department of Cardiotboracic Surgery, University of Aarbus, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiotboracic Surgery, University of Aarbus, Denmark
Hanne B. Ravn
Affiliation:
Anaesthesiology, University of Aarbus, Denmark
Christian Skjørbøk
Affiliation:
Cardilogy(SKS), Aarbus University HospitalDenmark
Keld E. Sørensen
Affiliation:
The institute of Expermental Clinical ResearchUniversity of AarbusDenmark
*
Elisabeth V. Stenbøg, MD, PhD, Department of Cardiothoracic Surgery, Aarhus University Hospital, SKS, DK- 8200 Aarhus N. Tel: +45 8949 5428; Fax: +45 8949 6005; e-mail: elisabethstenboeg@dadlnet.dk

Abstract

Introduction

The total cavopulmonary connection, and the bidirectional Glenn anastomosis, are widely used for palliation of patients with complex functionally univentricular hearts. Little attention has been paid to the potential for postoperative growth in children after these operations, which are now performed at increasingly younger age.

Material and Results

Physical growth, and levels of insulin–like growth factor I in the serum, were measured in 20 patients, aged 11·5 ± 5·6 years, 2 (0·5–6) years after a total cavopulmonary connection in 12, or a Glenn anastomosis in 8. All patients were in functional class I or II of the categorisation of the New York Heart Association, with excellent haemodynamic and angiographic findings. None of the patients had clinical signs of protein losing enteropathy. Controls included 33 healthy children, aged 11·5 ± 2·7 years.

Preoperatively, the mean Z-scores for weight and height were negative, −1·1 ± 0·8 and −0·5 ± 1·5. At follow-up, both parameters had improved significantly by 1·1 ± 0·9 and 0·8 ±1·2 percentiles, and Z-scores were comparable between the two groups (p = 0·81 for weight and p = 0·88 for height). No correlations were found between haemodynamics and the improvement in growth noted during follow-up. Increases equal to, or greater than 2 standard deviations for weight and height were seen only in children undergoing surgery before the age of 5 years. A significant correlation between age at operation and improvement in growth, however, could not be found.

Levels of growth factor measured in the serum were not statistically different from levels in healthy children for either group of patients (p=0·07 for girls and p=0·37 for boys).

Conclusions

Physical growth improved significantly following the surgical procedures. The concentrations of the growth factor measured in the serum were not different from levels in healthy children, suggesting normal nutritional status in both palliative situations.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Weintraub, RG, Menahem, S. Early surgical closure of a large ventricular septal defect: influence on long-term growth. J Am Coll Cardiol 1991; 18 (2): 552558.CrossRefGoogle ScholarPubMed
Rosenthal, A, Castaneda, AR. Growth and development after cardiovascular surgery in infants and children. Progress in Cardiovasc Diseases 1975; 18 (1): 2737.CrossRefGoogle ScholarPubMed
Weintraub, RG, Swan, JW, Menahem, S. Growth before and after correction of congenital heart disease. Annual of Cardiac Surgery 1991; 4549Google Scholar
Baum, D, Beck, RQ, Haskell, WL. Growth and tissue abnormalities in young people with cyanotic congenital heart disease recieving systemic-pulmonary artery shunts. Am J Cardiol 1983; 52: 349352.CrossRefGoogle Scholar
Keiss, W, Kessler, U, Schmitt, S, Funk, P Growth hormone and insulin-like growth factor 1: basic aspects. In: Flyvbjerg, AOerskov, H, Alberti, G (ed). Growth Hormone and Insulin-like Growth Factor I in Human and Experimental Diabetes. Chichester, New York: Wiley and Sons Ltd, 1993, p. 121.Google Scholar
Barton, JS, Hindmarsh, PC, Preece, MA.Serum insulin-like growth factor I in congenital heart disease. Arch Dis Child 1996; 75 (2): 162163.CrossRefGoogle ScholarPubMed
Kerpel-Fronius, E, Kiss, S, Kardos, G. Somatomedin and growth hormone in patients with retarded growth and atrophy due to congenital heart disease or malabsorption. Monatsschr Kinderheilk 1977; 125: 783786.Google ScholarPubMed
Andersen, E, Hutchings, B, Jansen, J, Nyholm, M. Heights and weights of Danish children. Ugeskr Laeger 1982; 144(24): 17601765.Google ScholarPubMed
Frystyk, J, Dinesen, B, Orskov, H. Non-competitive timeresolved immunofluorometric assays for determination of human insulin-like growth factor I and II. Growth Regul 1995; 5 (4): 169176.Google ScholarPubMed
Sholler, GF, Celermajer, JM. Cardiac surgery in the first year of life: the effect on weight gains of infants with congenital heart disease. Aust Paediatr J 1986; 22 (4): 305308.Google ScholarPubMed
Rychik, J, Jacobs, JL, Norwood, WI Jr. Acute changes in left ventricular geometry after volume reduction operation. Ann Thorac Surg 1995; 60 (5): 12671273.CrossRefGoogle ScholarPubMed
Menon, G, Poskitt, EM. Why does congenital heart disease cause failure to thrive? Arch Dis Child 1985; 60 (12): 11341139.CrossRefGoogle ScholarPubMed
Hansen, SR, Dorup, I. Energy and nutrient intakes in congenital heart disease. Acta Paediatr 1993; 82(2): 166172.CrossRefGoogle ScholarPubMed
Mitchell, IM, Logan, RW; Pollock, JC, Jamieson, MPNutritional status of children with congenital heart disease. Br Heart J 1995; 73 (3): 277283.CrossRefGoogle ScholarPubMed
Weintraub, RG, Menahem, S. Growth and congenital heart disease. J Paediatr Child Health 1993; 29 (2): 9598.CrossRefGoogle ScholarPubMed
Canalis, E. Clinical review 35: Growth factors and their potential clinical value. J Clin Endocrinol Metab 1992; 75(1): 14.Google ScholarPubMed
Juul, A, Bang, P, Hertel, NT, Main, K, Dalgaard, P, Jorgensen, K, Muller, J, Hall, K, Skakkebaek, NE. Serum insulin-like growth factor-I in 1030 healthy children, adolescents, and adults: relation to age, sex, stage of puberty, testicular size, and body mass index. J Clin Endocrinol Metab 1994; 78(3): 744752.Google ScholarPubMed