[Glucose tolerance and insulin secretion in infants with the left to right shunt congenital heart disease].
Between 1980 and 1988, 32 infants under three years of age with left to right shunt congenital heart disease underwent cardiac catheterizations, and their glucose tolerance and insulin secretion were investigated. These patients were divided into three groups by weight and compared. Group I consisted of 11 patients whose weights were 80% or more of the ideal body weight (IBW) for their age. Group II consisted of 10 patients whose weights were between 70% and 80% of the IBW. Group III consisted of 11 patients whose weights were less than 70% of the IBW. The CTR and biochemical blood studies showed no difference. By cardiac catheterization, Group III showed higher pulmonary/systemic vascular pressure ratio (Pp/Ps) than Group I. The mixed venous O2 saturation (SvO2) were 69.5 +/- 6.41% in Group I, 64.8 +/- 5.78% in Group II, 57.2 +/- 3.59% in Group III. Group III showed the lowest SvO2 of the three. Group III also showed the lowest arterial O2 saturation (SaO2). This indicates that the patients of Group III had the most serious congestive heart failure. In the 0.5 g/kg intravenous glucose tolerance tests, the K values (glucose disappearance rates) were as follows: Group I: 3.30 +/- 0.597, Group II: 2.91 +/- 0.624, Group III: 2.48 +/- 0.417. Group III showed the lowest values of the three. This indicates the deterioration of glucose tolerance in Group III. In the examination of serum insulin secretion, Group III showed the lowest serum insulin levels: 26.6 +/- 18.3 mmu/ml at 3-minute intervals, 22.8 +/- 14.3 mmu/ml at 5-minute intervals. After cardiac catheterization, corrective operations were performed on 17 patients out of 32. Fifteen patients survived, though 2 patients of Group III died early postoperatively. The results of glucose tolerance test and serum insulin levels before and after operation in 12 survivors were compared. Although the K values had been 2.8 +/- 0.41 before operation, it rose up to 3.81 +/- 0.81 three to four weeks after operation. The serum insulin levels at 3, 5, 10 and 15-minute intervals also rose after operation. This indicates the improvement of glucose tolerance and insulin secretion due to the improved circulation. It is suggested that the adequate nutritional management before and after operation on infants with serious congestive heart failure, because they tend to have malnutrition before operation. Aggressive and careful nutritional management is advisable.
Kanazawa
H
H
Second Department of Surgery, Niigata University School of Medicine, Japan.
D001786:Blood Glucose / Q000378:metabolism*; D002100:Cachexia / Q000209:etiology / Q000378:metabolism; D002675:Child, Preschool; D005260:Female; D005951:Glucose Tolerance Test; D006330:Heart Defects, Congenital / Q000150:complications / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D008297:Male
D001786:Blood Glucose; D007328:Insulin