Children exposed to parental smoking have worst intima-media thickness as young adults

Despite the decreasing prevalence of smoking in developed world, those most likely to smoke are in their 20-40s, the period that corresponds to parenthood. Several cross sectional studies in children have shown that exposure to passive smoke affects vascular health, including impaired endothelial function, arterial stiffness, and greater intima-media thickness. In a new prospective study which pulled together data from 2 previous studies undertaken in Finland and Australia, Gall and colleagues studied the effect of exposure to parental smoking on vascular health in a large group of children. The authors found that intima-media thickness of the carotid artery, which is an important and sensitive marker of arterial health, was higher in young adults who were exposed to parental smoke in childhood. The vascular age of the carotid arteries of young adults who had been exposed to parental smoking from both parents was 3.3 years greater than that of young adults who had not been exposed to parental smoke. These findings were independent of other important confounders, like subject smoking status, age and gender. These results highlight how important it is to prevent smoke exposure in children to reduce the future burden of cardiovascular disease.

The full text article is available at: http://www.ncbi.nlm.nih.gov/pubmed/24595866.

Dr. Alessandro Giardini

Paediatric Cardiologist in London

www.childheartspecialist.com

Contemporary outcomes after Ross operation in children

The Ross proceudre is a mainstay in the surgical treatment of irreparable aortic valve disease and outflow tract obstruction in children. Generally, in children, the expectation is that re-interventions on the homograft would be more common than those on the autograft. The recently published Italian multicenter Paediatric Ross Registry presented the 23 years nationwide experience with Ross operation in children, with paritcular attention to the second decade after Ross operation.
In a group of 305 children, the authors report very good survival which extended in the second decade after the Ross operation. However the study showed a higher than anticipated autograft reintevention rate, even higher than homograft related reintervention rate. Pulmonary autograft reoperation rate was 6% at 5 years from Ross operation, 14% at 10 years and  25% at 15 years. Risk fators for autograft reinterventions were age younger than 1 year at Ross operation, prior aortic procedure, use of subcoronary technique and need for associated procedures.
The present report confirms that the Ross operation is a safe and reproducible operation. However, left heart morbidity is higher than expected in the second decade after the operation. The identification of demographic and operative variables which impact on long term morbidity might optimize the selction of patients for the Ross procedure.
The full text is available at:http://www.ncbi.nlm.nih.gov/pubmed/25056868

Dr. Alessandro Giardini

Paediatric Cardiologist in London

www.childheartspecialist.com

Normal endothelial function after surgical repair of coarctation of the aorta

The classical teachings suggest that endothelial dysfunction is very common in older children and adults with repaired coarctation of the aorta. Such abnormal endothelial function, in association with increased aortic wall stiffness, has been considered a potential cause of hypertension in those patients without evidence of re-coarctation.
Recent new research however suggests that endothelial dysnfunction in adults with repaired coarctation could be much less common than what previsously thought.
The most recent study investigating the prevalence of endothelial dysfunction in this setting is a paper from Munster, Germany. Using a comprehensive and sophisticad array of investigations, the authors demonstrated normal endothelial function in a group of adults with repaired aortic coarctation. When compared to healthy individuals who were matched for age and gender, the investigators found no evidence of endothelial dysfunction on molecular, cellular and vascular level in aortic coarctation patients.
The authors raised the fascinating possiblity that optimal blood pressure control in their patients might justify the difference with previous studies which have shown a more common occurrence of endothelial dysfunction. This hypothesis, even if unproven deserves consideration. Indeed, 2 prospective trials which used statins and ACE-inhibitors have shown that endothelial dysfunction may, in fact, be reversible.
The full text is available at:http://www.ncbi.nlm.nih.gov/pubmed/25095828

Dr. Alessandro Giardini

Paediatric Cardiologist in London

www.childheartspecialist.com

Aspirin unresponsivness in children following cardiac surgery

Aspirin unresponsivness in children following cardiac surgery

Development of clots after cardiac surgery is not uncommon and is associated with complications and the risk of reintervention. Aspirin is able to block platelets, which are the blood cells responsible for initial clot formation and aspirin use leads to less thrombosis. For this reason many children will receive aspirin after cardiac surgery in order to reduce the risk of clots building up in their heart and circulation. However, despite the use of aspirin some children will still develop clots. Iniatial studies have shown that up to 1 in 4 children, as previosuly shown in adults with coronary artery diesease, may present with limited responses to a similar dose of aspirin, a phenomenon called aspirin resistance.
A group of researchers from the USA has recently tested the response of cardiac children to varying doses of aspirin and found that children who do not seem to respond to aspirin (children whose's platelets are still working well despite aspirin) are at higher risk of developing clots. The researchers also observed that a lower response to aspirin was associated to a lower dose of aspirin given. It also appeared that increasing the dose of aspirin in some children was able to block the platelet function effectively. An issue which is raised by this study is whether testing platelet function should become a standard or practice to identify no- or low-responders who could benefit from higher doses of aspirin or from the use of other medications.
The full paper is available at the following link: http://www.jtcvsonline.org/article/S0022-5223(14)00761-2/abstract

Screening of siblings of children with bicuspid aortic valve

Bicuspid aortic valve is the most common congenital heart defect, affecting 1% of all children and adults. In this condition, not only is the aortic valve malformed but also it may not work properly (it can be either too narrow or leaky), putting the heart under high strain. Furthermore, the wall of the aorta, the major artery of the body to which the aortic valve is connected, can be weak in children and adults with bicuspid aortic valve and thus the aorta can swell and dilate over time, causing an aneurysm. An invasive treatment (either by catheter or key-hole or open heart surgery) on the valve is required in roughly 1 out of 4 people by age 50 years.

Published recommendations from the American College of Cardiology suggested screening of first-degree relatives (siblings, parents, sons and daughters) of adults affected by bicuspid aortic valve. This recommendation was based on the fact that there are families with multiple members affected, for which a common genetic cause is very likely.

Recent research in children supports the recommendations by showing that 10% (or 1 in 10) of siblings of a child or adolescent with bicuspid aortic valve have a similar problem. As bicuspid aortic valve can be readily diagnosed by an echocardiogram, the authors suggest that all siblings of a child diagnosed with bicuspid aortic valve should be screened for the same conditions. Even though complications related to bicuspid aortic valve are uncommon in the paediatric age, finding the problem might allow the correct follow-up with a paediatric cardiologist to be put in place. You can read the original article at http://www.ncbi.nlm.nih.gov/pubmed/24709923.

Dr. Alessandro Giardini

Paediatric Cardiologist in London

www.childheartspecialist.com

Stay tuned, paediatric cardiology posts to follow soon

Sharing current, useful medical information in a carefully presented way is our responsibility as physicians.
I will share with you some of the most recent advances in the understanding and treatment of congenital heart disease in children. Sources will be from my own practise and experience, my own research activity and the published medical literature in general. I am already working on the first issue of the blog!
I hope you will find this useful.
Dr. Alessandro Giardini