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• W3203053057 abstract "<h3>Background</h3> Congenital heart disease (CHD) can increase long-term cardiovascular disease risk. Studying arterial stiffness, an independent predictor of cardiovascular morbidity and mortality, can improve understanding of the pathophysiology of cardiovascular disease in CHD. <h3>Objectives</h3> To systematically review the literature to examine how CHD affects arterial stiffness in children ≤ 12 years, following PRISMA guidelines. <h3>Methods</h3> PubMed was searched using the terms: ‘pulse wave velocity’ (PWV), ‘carotid intima-media thickness’ (cIMT), ‘arterial stiffness index’ (SIx), ‘flow-mediated dilation’ (FMD), ‘flow imaging’, ‘laser flow Doppler’, ‘venous plethysmography’, ‘cardi* magnetic resonance imaging’, ‘aortic intima-media thickness’ (aIMT), ‘vascular ultrasound’ and ‘neonat*’, ‘paediatric’, ‘infant*’, ‘child*’. Case reports, case series, reviews, commentaries, conference proceedings, animal studies, articles not in English and articles with children >12 years were excluded. Articles exploring the effect of CHD on arterial stiffness measures were included. <h3>Results</h3> 13/1084 identified studies were included. 7 studies measured PWV, 4 studies measured SIx of the ascending or descending aorta, and 6 studies measured distensibility as measures of arterial stiffness; methods included MRI, M-mode ultrasound, and oscillometry. One study performed FMD assessing endothelial function. Patients with hypoplastic left heart syndrome following surgical correction had lower ascending aorta distensibility than healthy controls and those with other single-ventricle anatomy (3.5±2.9×10⁻³ vs 7.8±3.7×10^-3 mmHg⁻¹, <i>p</i>=004). Toddlers with single-ventricle pathologies had lower brachial artery FMD (2.4±3.7% vs 11.3±6.0%, p<0.0005) but similar carotid-femoral PWV than those with double-ventricle circulations. In a similar cohort, aortic PWV was higher in patients with dilated aortic roots, suggesting that PWV may be an independent determinant of aortic dilatation. Thoracic aorta PWV was higher in children with Tetralogy of Fallot (TOF) than controls in three studies, both before and after surgery. PWV was an independent determinant of aortic dilatation in TOF too. Neonates with coarctation of the aorta had reduced ascending aortic distensibility and increased SIx pre- and postoperatively compared to controls: findings persisted three years post-surgery. Similar results were reported in asymptomatic school-aged children: higher SIx compared to healthy controls at rest (4.87±1.94 vs 3.57±1.19, p=0.021) and after exercise (4.33±1.91 vs 3.2±1.26, p=0.034). However, the method of CoA repair may affect stiffness: 6-year-olds had higher right-arm PWV and systolic blood pressure following subclavian flap repair than end-to-end anastomosis. Aortic SIx was higher in patients with PDA requiring transcatheter closure compared to healthy controls. The delayed closure (>1y) group had higher SIx before (9.4±2.7 vs 6.7±2.8; p<0.05) and after closure (6.3±2.4 vs 3.8±1.4; p<0.05), than the early closure (<1y) group. Ascending aorta distensibility was reduced in 36 children who had previously undergone arterial switch operations for transposition of the great arteries. <h3>Conclusions</h3> CHD can significantly increase arterial stiffness; the method or timing of correction may have an influence. Proposed mechanisms include damage to vasa vasorum due to surgery, and hypoxaemia-induced endothelial dysfunction. Differences in conditions studied, techniques used, and demographics may explain inter-study variability. Increased aortic stiffness causes premature reflected waves, leading to hypertension and increased cardiovascular disease risk. Therefore, CHD patients might benefit from arterial function monitoring. Longitudinal studies examining the progression of arterial stiffness in different forms of CHD would be beneficial." @default.
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• W3203053057 date "2021-09-30" @default.
• W3203053057 modified "2023-10-14" @default.
• W3203053057 title "1418 Arterial function in preadolescent children with congenital heart disease: a systematic review" @default.
• W3203053057 doi "https://doi.org/10.1136/archdischild-2021-rcpch.631" @default.
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