Vascular Function in Children With Repaired Tetralogy of Fallot




We compared the endothelial function and vascular wall characteristics of 11 children with tetralogy of Fallot (TOF) (age 13 ± 3 years) with the characteristics of 17 age-matched peers (12 ± 2 years). Echocardiographic Doppler measurements were performed under standardized conditions to assess (1) the carotid and femoral artery diameter and intima–media thickness, (2) brachial artery endothelial function using flow-mediated dilation, and (3) central and peripheral compliance using pulsewave velocity. In addition, the physical activity level was assessed using a validated questionnaire. We found that the physical activity level of the children with TOF was lower than that of the controls, but the difference did not reach statistical significance (4.5 vs 5.9 h/wk, p = 0.087). A significantly larger femoral artery intima–media thickness was observed in those with TOF, and the carotid and brachial artery diameter and intima–media thickness were comparable between groups. The children with TOF demonstrated a significantly lower brachial artery flow-mediated dilation than that of the controls. The central and peripheral compliance did not differ between the 2 groups. In conclusion, children with TOF demonstrated an impaired brachial artery endothelial function and increased intima–media thickness of the femoral artery compared to their healthy peers. In conclusion, our findings have, therefore, indicated that children with TOF, already at a young age, have changes in vascular function and structure.


Endothelial dysfunction is an early marker for the development of atherosclerosis, which occurs before the clinical presentation of atherosclerosis. Also, artery wall thickening and reduced compliance of the large and middle-size conduit arteries are associated with an increased risk of developing cardiovascular disease. Previous studies have demonstrated that these vascular abnormalities can be present in children with comprised cardiovascular risk profiles, including children with familial hypercholesterolemia, renal disease, type 1 diabetes mellitus, and obesity. To date, little is known about whether children with tetralogy of Fallot (TOF) demonstrate such changes in vascular function and structure. Because of the hemodynamic abnormalities and lower physical fitness evident in children with TOF, we hypothesized that they would demonstrate impaired vascular function and structural adaptations in the artery wall.


Methods


The children eligible for participation in the study were selected from a database of the Department of Pediatric Cardiology and included patients with TOF who had undergone surgery from 1990 to 1999 at the Radboud University Nijmegen Medical Centre (Nijmegen, The Netherlands; Table 1 ). Patients with metabolic, neurologic, muscular, or orthopedic anomalies were excluded from the present study. Also, patients with syndromes with congenital heart defects as one of their features (including 22q11 microdeletions), heart failure (New York Heart Association class I or greater), resting cyanosis (oxygen saturation <90%), and familial hypercholesterolemia were excluded. Patients taking medication that affect vascular function were excluded (e.g., statins, diuretics). The siblings of these children were included as the control group. A total of 11 children with TOF and 17 control subjects were included. The local ethical committee approved the study, and the children and their parents provided written informed consent.



Table 1

Patient characteristics








































































































































































































































































































































































































































































































































































































































Group Gender Age (y) BMI (kg/m 2 ) Waist (cm) MAP (mm Hg) SO 2 (%) Surgery Type Age at Surgery (mo) Complications
TC TPC TAP PV LPA BT RVOT RBBB PI TVI LAD PVS
TOF Male 8 16.1 56 74 90 + 0 + 0 0 0 0 3 0 + 0 0 0
TOF Male 9 15.6 60 71 100 + 0 + 0 0 0 0 2–8 + + + 0 0
TOF Male 11 20.8 73 83 100 + 0 + + 0 0 0 5–182 + 0 + 0 0
TOF Male 12 16.6 65 83 99 0 + 0 0 0 0 0 7 + 0 0 + 0
TOF Male 12 17.3 67 79 99 + 0 0 0 + 0 0 21–150 + + 0 0 +
TOF Male 15 17.2 66 79 99 + 0 + 0 0 + 0 5 + + 0 + 0
TOF Male 16 21.7 76 91 100 + 0 0 0 0 0 0 15 + + 0 0 0
TOF Male 17 19.2 74 81 100 0 + 0 0 0 0 + 5–70 + 0 0 0 +
TOF Female 9 18.8 63 81 100 + 0 0 0 0 0 + 14 + 0 0 0 0
TOF Female 14 21.9 71 85 98 + 0 + 0 0 0 0 13 + + 0 0 0
TOF Female 18 22.6 73 83 99 + 0 + 0 0 0 0 6 + + 0 0 0
Control Male 8 16.3 57.75 71 99
Control Male 9 17.9 65.75 79 100
Control Male 10 15.5 66 69 98
Control Male 11 15.7 59 71 100
Control Male 12 16.0 59 75 97
Control Male 14 19.3 67 73 98
Control Female 11 13.7 52.5 77 99
Control Female 11 15.6 55.75 71 100
Control Female 11 16.0 57 79 98
Control Female 11 20.7 71 81 100
Control Female 11 21.1 68.75 73 100
Control Female 12 16.5 56 76 100
Control Female 12 16.6 61.75 75 98
Control Female 13 16.5 60 75 100
Control Female 13 21.1 68 78 100
Control Female 14 20.2 67.5 83 100
Control Female 15 18.8 62.5 92 99

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Dec 22, 2016 | Posted by in CARDIOLOGY | Comments Off on Vascular Function in Children With Repaired Tetralogy of Fallot

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