RESUMO
OBJECTIVE: To evaluate the long-term cardiovascular effects of extremely preterm birth in a cohort of adolescents followed prospectively, who were largely free from intrauterine growth restriction. STUDY DESIGN: Central blood pressures, aortic and cardiac dimensions, left ventricle (LV) function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were measured in 18-year-old subjects born extremely preterm at <28 weeks' gestation (n = 109) and term-born controls (n = 81). RESULTS: Compared with controls, preterm adolescents had higher systolic (124 ± 13 vs 118 ± 10 mm Hg, P = .002) and diastolic (72 ± 8 vs 67 ± 7 mm Hg, P < .001) blood pressures, but lower ascending aortic z-scores (0.13 ± 0.89 vs 0.42 ± 0.78, P = .02), LV diastolic (48.5 ± 4 vs 50.3 ± 4.5 mm, P = .007) and systolic (30.2 ± 3.5 vs 31.9 ± 4.0 mm, P = .003) diameters, and a reduced LV mass (130 ± 34 vs 145 ± 41 g, P = .01) and mass index (75 ± 14 vs 81 ± 16 g/m(2), P = .02). However, LV relative wall thickness, LV function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were similar. Within the ex-preterm group, there were no significant relationships between birthweight z-scores and any cardiovascular measures, once the latter were adjusted for current body size. CONCLUSIONS: Extremely preterm birth had relatively minor cardiovascular effects in late-adolescence, with increased blood pressures, decreased LV, and aortic size, but preserved LV function, macrovascular properties, and microvascular function. In utero growth was not independently related to cardiovascular function within the ex-preterm cohort.
Assuntos
Aorta/fisiopatologia , Pressão Sanguínea/fisiologia , Ventrículos do Coração/fisiopatologia , Hipertensão/fisiopatologia , Lactente Extremamente Prematuro , Adolescente , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Estudos Prospectivos , Análise de Onda de Pulso , Função Ventricular Esquerda/fisiologiaRESUMO
OBJECTIVE: To determine the prevalence of Turner syndrome in girls presenting with coarctation of the aorta (CoA). STUDY DESIGN: A total of 132 girls with known structural CoA was identified. Those girls who had no previous karyotype analysis performed were asked to participate in a research study in which a banded karyotype with 50-cell count was performed. RESULTS: Of 132 girls with CoA, 55 (41.7%) had karyotype analysis within 6 months of cardiac diagnosis. Three girls underwent karyotyping later because of clinical concerns. Of the 74 girls with CoA who had not had a karyotype, 38 (51.4%) consented to the study. Results were available for 37 girls. All were 46,XX. Five patients with Turner syndrome were identified in the 95 girls with CoA who had karyotype analysis (4 from early karyotype and 1 diagnosed later), which translated into a minimum prevalence of 5.3% of Turner syndrome in this group of girls with CoA. In addition, one infant with a 20-cell 46,XX karyotype had features of Turner syndrome. CONCLUSION: Our study demonstrated for the first time in a large cohort that 5.3% of girls presenting with CoA are found to have Turner syndrome when karyotyping is performed. Given the spectrum of preventable and treatable health problems after the diagnosis of Turner syndrome, we believe that all girls with CoA should have a karyotype analysis, ideally with at least 50-cell count, at the time of diagnosis of CoA.