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