ABSTRACT
OBJECTIVES: The aim of this study was to investigate the possible effects of antiretroviral therapy (ART) in utero on cardiac development and function in human immunodeficiency virus (HIV)-negative children. BACKGROUND: ART reduces vertical HIV transmission. Long-term cardiotoxicity after in utero exposure to ART is unknown in children but has occurred in young animals. METHODS: Using a prospective multisite cohort study design, echocardiograms taken between birth and 24 months were compared in 2 groups of HIV-negative infants of HIV-positive mothers: 136 infants exposed to ART (ART+) and 216 unexposed infants (ART-). RESULTS: Mean left ventricular (LV) mass z-scores were consistently lower in ART+ girls than in ART- girls: differences in mean z-scores were -0.46 at birth (p = 0.005), -1.02 at 6 months (p < 0.001), -0.74 at 12 months (p < 0.001), and -0.79 at 24 months (p < 0.001). Corresponding differences in z-scores for boys were smaller: 0.13 at 1 month (p = 0.42), -0.44 at 6 months (p = 0.01), -0.15 at 12 months (p = 0.37), and -0.21 at 24 months (p = 0.21). Septal wall thickness and LV dimension were smaller than expected in ART+ infants, but LV contractility was consistently about 1 SD higher at all ages (p < 0.001). In ART+ infants, LV fractional shortening was higher than in ART- infants; girls showed a greater difference. CONCLUSIONS: Fetal exposure to ART is associated with reduced LV mass, LV dimension, and septal wall thickness z-scores and increased LV fractional shortening and contractility up to age 2 years. These effects are more pronounced in girls than in boys. Fetal ART exposure may impair myocardial growth while improving depressed LV function.
Subject(s)
Anti-Retroviral Agents/adverse effects , HIV Seropositivity/drug therapy , HIV/immunology , Heart/drug effects , Maternal Exposure/adverse effects , Pregnancy Complications, Infectious/drug therapy , Ventricular Function, Left/drug effects , Adult , Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active/adverse effects , Child, Preschool , Female , Follow-Up Studies , Heart/embryology , Humans , Infant , Infant, Newborn , Infectious Disease Transmission, Vertical , Male , Pregnancy , Prospective Studies , Risk FactorsABSTRACT
Severe truncal valve stenosis, due to dysplastic valve, may be found in a small number of patients with truncus arteriosus. Its presence complicates the surgical management of this anomaly due to lack of optimal therapeutic options and associated ventricular dysfunction. We report a case of truncal root replacement using a homograft for the management of such condition, and review the literature related to its management and outcome.
Subject(s)
Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/therapy , Pulmonary Valve Stenosis/diagnosis , Pulmonary Valve Stenosis/therapy , Aortic Valve Stenosis/diagnostic imaging , Catheterization , Echocardiography , Humans , Infant, Newborn , Male , Pulmonary Valve Stenosis/diagnostic imaging , Severity of Illness Index , Truncus Arteriosus, Persistent/complications , Truncus Arteriosus, Persistent/diagnosis , Truncus Arteriosus, Persistent/therapyABSTRACT
Plastic bronchitis is a condition in which large, bronchial casts with rubber-like consistency develop in the tracheobronchial tree and cause airway obstruction. We describe a 4-year-old girl who had Fontan physiology and who developed plastic bronchitis and report for the first time the use of aerosolized tissue plasminogen activator for treatment of this condition. The literature is reviewed with emphasis placed on the occurrence of this disorder in patients with single ventricle physiology.
