Late results of pediatric cardiac surgery in Finland: a population-based study with 96% follow-up.

BACKGROUND: This population-based study characterizes the history and progress of pediatric cardiac surgery in Finland. For the first time, all defects and procedures are included in an outcome study, reflecting the true effectiveness of operative treatment. METHODS AND RESULTS: All data relating to the operations were collected retrospectively from hospital records. Current patient status was obtained from the population registry. Survival was evaluated with the Kaplan-Meier method applied to all patients and separately to subgroups of patients with the most common defects. The survival rates were compared with those of an age- and sex-matched general population. During the 37 years (1953 to 1989), 6461 patients underwent surgery; 96% of them were traced. The number of operations and the constellation of defects treated increased dramatically over time. Actuarial survival for the 45 years ended October 28, 1998 (the ending date of this study) was 78% for patients versus 93% for the general population. Survival and the number of operations per patient varied widely with the defect. The survival of patients with a surgically closed atrial septal defect was comparable to that of the general population, and such patients rarely needed a reoperation, whereas only 15% of patients with univentricular heart survived for 34 years, and almost all needed at least 2 operations. CONCLUSIONS: The overall survival of patients with cardiac defects corrected surgically in childhood is good compared with their estimated natural course. The increasing number of surgically treatable defects and the growing number of operations per patient reflect the increasing ability to treat more difficult cases.

No association between plasma lipoprotein(a) concentrations and the presence or absence of coronary atherosclerosis in African-Americans.

Elevated plasma concentrations of lipoprotein(a) [Lp(a)] are associated with coronary atherosclerosis in Caucasians. Although African-Americans have a higher median plasma Lp(a) concentration than Caucasians, they do not have a greater incidence of coronary atherosclerosis. This study was performed to determine whether the plasma concentration of Lp(a) is associated with coronary atherosclerosis in African-Americans. The fasting plasma concentrations of Lp(a) and lipoproteins were measured in 140 African-American subjects (62 men, 78 women, aged 31 to 80 years) 18 +/- 16 months (mean +/- SD) after they underwent coronary angiography: 72 had angiographically normal coronary arteries and 68 had > 70% luminal diameter narrowing of one or more major epicardial coronary arteries. The groups were similar in age, sex, and other risk factors for atherosclerosis. The subjects with coronary artery disease had higher plasma concentrations of total cholesterol, triglycerides, and VLDL and LDL cholesterol (P = .04) and lower concentrations of HDL cholesterol (P = .0001) than subjects without coronary artery disease, but there was no significant difference in the plasma concentration of Lp(a). The distribution of apolipoprotein(a) alleles by size was also not significantly different between the two groups. These results suggest that the plasma concentration of Lp(a) is not an independent risk factor for coronary artery disease in African-Americans.

Regulation of the very low density lipoprotein receptor by thyroid hormone in rat skeletal muscle.

A new member of the low density lipoprotein receptor gene family that binds and internalizes very low density lipoprotein (VLDL) particles was previously cloned and characterized from the rabbit and human. The physiological role of this putative VLDL receptor is not known, but its tissue distribution and ligand specificity suggest a possible role in the delivery of triglycerides to peripheral tissue. To learn more about the potential function of this receptor, we measured the changes in VLDL receptor mRNA and protein in various tissues following dietary or hormonal manipulation of rats. No significant changes in the VLDL receptor mRNA or protein were seen after a 48-h fast and subsequent to refeeding. A striking change in receptor mRNA and protein was observed in skeletal muscle of hypothyroid and hyperthyroid rats. In hypothyroid rats, the amount of immunodetectable VLDL receptor was reduced by 80%, while in the hyperthyroid animals it was increased by 300%. These maneuvers did not affect VLDL receptor mRNA or protein levels in adipose tissue or heart. The changes in VLDL receptor mRNA in muscle were opposite to those observed with lipoprotein lipase. These studies suggest that the VLDL receptor plays a role in a metabolic process in muscle that is regulated by thyroid hormone.