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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 ,
Vibeke E. Hjortdal ,
Hanne B. Ravn ,
Christian Skjørbøk ,
Keld E. Sørensen  and
Ole Kromann Hansen
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
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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.

Keywords

Fontancongenital heart diseasephysical growthinsulin-like growth factorIGF-Inutritional status
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 5 , September 2000 , pp. 440 - 446
Copyright
Copyright © Cambridge University Press 2000

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