Following the arterial switch operation, obese children have risk factors for early cardiovascular disease.
BACKGROUND
Children who have undergone the arterial switch operation (ASO) are at risk for premature coronary artery disease due to coronary re-implantation. Obesity may also pose cardiovascular risk. The purpose of this study was to evaluate comorbidities and markers of early cardiovascular disease in obese ASO patients.


METHODS
Obese [body mass index (BMI) >or= 95th %] and normal weight (NW, BMI < 85th %) ASO patients, and NW controls without heart disease were enrolled, and underwent prospective vascular, echocardiographic, laboratory, exercise, and ambulatory blood pressure (BP) testing. Results were compared between groups. BP load was defined as proportion of recordings >or= 95th %.


RESULTS
Thirty patients [13.2 years (11.2-16.8), 57% male] were evaluated: 10 obese ASO, 10 NW ASO, and 10 NW controls. Obese ASO patients, in comparison to NW ASO and controls, had higher systolic BP% [96% (90-99) vs. 67% (30-91) P= 0.07 (trend) and 34% (21-43) P= 0.005], night-time diastolic BP load [18% (14-24) vs. 0% (0-0) P= 0.01 and 0% (0-0) P= 0.01], left ventricular mass index [51.7 g/m(2.7) (46.6-53.3) vs. 40.7 g/m(2.7) (29.2-41.6) P < 0.01 and 28.9 g/m(2.7) (27.3-33.7) P < 0.01], and lower brachial artery reactivity [8.7% (6.2-11.9) vs. 14.6% (10.8-23.0) P= 0.03, and 16.7% (12.8-17.8) P= 0.05]. There was a trend toward increased carotid intima-media thickness, and significantly higher triglyceride and lower high-density lipoprotein levels in obese ASO patients.


CONCLUSIONS
Following the ASO, obese patients have associated comorbidities, and markers of early cardiovascular disease. These may pose additional risk for future cardiovascular events in this unique population who underwent coronary artery re-implantation in infancy.
Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. pasqualisk@gmail.com
Sara K
SK
Pasquali
Bradley S
BS
Marino
Darryl J
DJ
Powell
Michael G
MG
McBride
Stephen M
SM
Paridon
Kevin E
KE
Meyers
Emile R
ER
Mohler
Susan A
SA
Walker
Stephanie
S
Kren
Meryl S
MS
Cohen
D000293:Adolescent; D017668:Age of Onset; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D001916:Brachial Artery / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002648:Child; D003331:Coronary Vessels / Q000601:surgery*; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006801:Humans; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008297:Male; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D012092:Replantation / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000601:surgery*; D014664:Vasodilation; D016277:Ventricular Function, Left
D015415:Biomarkers; D008055:Lipids