Vascular and Autonomic Function in Preschool-aged Children with Congenital Heart Disease

Objective. To compare indices of vascular health and heart rate variability in preschool-aged children with repaired congenital heart disease (CHD) including tetralogy of Fallot (n = 6) and coarctation of the aorta (n = 6). Design. A cross-sectional study design was used. All measures were noninvasive and collected over a single testing session under the supervision of a parent/guardian. Setting. Data collection took place in a quiet, temperature-controlled room (23 degrees +/- 1 degrees C) with the participant in a supine position. Patients. Twelve (six females, six males) preschool-aged children with repaired CHD (CHD: 4 +/- 1 years) and 12 age- and gender-matched healthy controls (CON: 5 +/- 1 years) participated in the study. Outcome Measures. Supine, resting measures of heart rate variability (time, frequency, and nonlinear domains), whole-body pulse wave velocity (ventricular depolarization to dorsalis pedis artery), brachial blood pressures, and carotid artery distensibility, lumen diameter, intima-media thickness, and wall/lumen ratio were collected in both groups. Results. The groups were similar in age, height, and weight; however, CON had significantly higher body mass index values (CON: 16.9 +/- 2.2, CHD: 15.1 +/- 1.0, P < .05) and body mass index percentiles (CON: 69 +/- 27%tile, CHD: 36 +/- 24%tile, P < .01) compared to CHD. No group differences were found for resting brachial blood pressures, whole-body pulse wave velocity, heart rate variability, and carotid artery distensibility, lumen diameter, and intima-media thickness (P > .05). Carotid artery pulse pressures (CHD: 38 +/- 6 mm Hg, CON: 31 +/- 6 mm Hg, P < .05) and wall/lumen ratios (CHD: 0.091 +/- 0.007, CON: 0.085 +/- 0.006, P < .01) were significantly higher in the CHD group. Conclusions. These results may indicate that preschool-aged children with repaired CHD display early signs of vascular remodeling, but not autonomic or vascular dysfunction. The effects of larger wall/lumen ratios on cardiovascular disease risk require further investigation.