The investigation of growth pattern in patients with congenital heart disease after corrective surgery

The presence of somatic growtlı retardation and nutritional disorders in children with congenital heart disease (CHD) has long heen recognized. Nutritional deficiency and malnutrition are claimed to be the most important cause of growtlı retardation. Although !here is a relation between t.lıe type of cardiac !esion aru! hemodynamic abnormality, it has not been completely clarified. Those with congestive heart disease, pulmonaıy hypertension and cyanotic . heart disease have the most marked growth retardation. Linear growth is influenced less from obstructive type lesions such as aorta coarctation and pulmonary stenosis. As malnutrition and growth retardation affect mortality and morbidity is important, their diagnosis and treatment has assumed great importance in prognosis and quality of life. Various studies have reported improvement in children with CHD, after palliative and corrective surgiacal operations. In order to investigate !he growtlı characteristics of children with CHD, overall 60 cases diagnosed with CHD and of whom 28 (46.7 %) were girls and 32 (53.7 %) were boys, between the ages of 8.7 ± 4.8 months (1-17) were evaluated in terms of growth at 45 days, 3 months, 6 months and 1 year postoperatively. According to the results of angiography, out of 60 cases 6 (10 %) had cyanotic heart disease with pulmonaıy hypertension, 20 (33.3 %) had cyanotic disease without pulmonaıy hypertension, 25 ( 41. 7 % ) cases had acyanotic heart disease with pulmonaıy hypertension and 9 (15 %) had acyanotic heart disease without pulmonary hypertension. Body weight, height and head circumference of ali children were measured before and after operation and their percentiles and standard deviation scores were established. In addition, mean calorie and protein intake rates were calculated from the diet history of the !ast three days. Duration and degree of malnutrition were established with Waterlow classifü:ation (height for age and weight for height were determined) and Gomez lassification (weight for age), respectively. In ali cases, blood samples were taken for the measurement of whole blood count, liver, kidney function tesis, serum total protein, albumin, prealbumin, zinc, iron, iron binding capacity, ferritin, transferrin and oxygen saturation at the fırst control and for the measurement of WBC, serum iron, iron binding capacity, ferritin, transferrin, albumin, prealbumin and zinc levels at 1he control visits at 45 days, 6 monl:l:ıs and 1 year. lnfomıation was obta.ined on the socioeconomic !eve! of the fiımily, infections in the previous year ands the number of hospitalizations. The majority of our cases with CHD (75 %) were within normal range of birth weight. In the preoperative period, growth retardation was frequently encountered in cyanotic group and those with Jeft to right shunt. In cyanotic cases, both height and weight were affected together whilst in cases with left to right shunt, particularly body weight was affucted . However, the fact that body weight was more vulnerable to the above efrects during all perimi of fullow up ııttrncted our alliıntion. When nutrition status was compared in groups before corrective surgery, it was seen that acute malnutrition rate was high in ali groups. K washiorkor symptoıns did not occur in any patient as deficiency of calorie was more pronounced in our patients. lt was observed that at the control 3 months after the operation, nutritional status of the patients improved substantially, resulting 111 the improvement of antropometric measurements, notably body weight. Parallel to the improvement of nutritional status, serum prealbumin and zinc levels increased and the finding of nutritional iron deficiency disappeared. At one -year follow -up, it was observed that out of 60 cases, only 7 had body weight under 10th percentile (11 %), 3 had height (5 %) and head circumference ımder l 0th percentile. In addition, 5 of these 7 cases had a history of long term diuretic use associated with residual cardiac defect and received inadequat,ı caloriı,ıs för their age. in conclusion, the time to begin supplementary food, the number of prevıous hospitalizations, the type of heart disease, the presence of pulmonary hypertension mıd complications 111 intensive cııre ıınit affi:cted the nutritional status and rowth of the cases in the first three rnonths after operation. However, during follow ııp period, the nurnber of infections and previous hospitalizations, the inadequacy of the calories in diet, low body weight preoperatively, and residual heart defects were closely associated with the growth and especially weight gain of the child. Besides, it was established that in the long term, low socioeconomic !eve! along with the education and !he lack of nutritioruıl information of fue molher had an adverse effect on growth. As a result, in children with CHD; after the correction of ımderlying abnormal hernodynamics with corrective operations, and a satisfactory nutrition program, nutritional status of the children improved and they were abl;ı to catch the growth rates of healthy children with at their ages. Key words: Congenital heart disease, growth retardation, nutritionally insufficient, corrective cardiac surgery.