Maternal first trimester metabolic profile in pregnancies with transposition of the great arteries

Background: Higher maternal body mass index (BMI) and abnormal glucose metabolism during early pregnancy are associated with congenital heart defects in the offspring, but the exact mechanisms are unknown.Methods: We evaluated the association between maternal first trimester metabolic profile and transposition of the great arteries (TGA) in the offspring in a matched case-control study with 100 TGA mothers and 200 controls born in Finland during 2004-2014. Cases and controls were matched by birth year, child sex, and maternal age and BMI. Serum samples collected between 10- and 14-weeks of gestation were analyzed for 73 metabolic measures. Conditional logistic regression was used to assess the risk for TGA in the offspring, and a subgroup analysis among mothers with high BMI was conducted.Results: Higher concentrations of four subtypes of extremely large very-low-density lipoprotein (VLDL) particles and one of large VLDL particles were observed in TGA mothers. This finding did not reach statistical significance after multiple testing correction. The pooled odds ratio (OR) of the all metabolic variables was slightly higher in TGA mothers in the subgroup with maternal BMI over 25 (OR 1.25) and significantly higher in the subgroup with maternal BMI over 30 (OR 1.95) compared to the original population (OR 1.18).Conclusions: Our findings indicate that an abnormal maternal early pregnancy metabolic profile might be associated with TGA in the offspring, especially in obese mothers. A trend indicating altered VLDL subtype composition in TGA pregnancies warrants further research.Peer reviewe

Risk factors for mortality in patients with hypoplastic left heart syndrome after the Norwood procedure

BACKGROUND: Several studies have reported mortality risk factors associated with hypoplastic left heart syndrome (HLHS). However, these data are ambiguous and mainly focused on the independent effect of these factors. We examined both the independent and the cumulative effect of preoperative risk factors for poor outcome in patients undergoing the Norwood procedure. Moreover, we studied the risk factors associated with prolonged initial hospital stay in these patients. METHODS: We performed a retrospective national 18-year observational study of preoperative risk factors for one-year, as well as total follow-up mortality or need for transplant in HLHS-patients (N=99) born in Finland between 1 January 2004 and 31 December 2021. RESULTS: Overall, one-year survival was 85.6%. In a multivariable analysis, major extracardiac anomaly and being small for gestational age were significant predictors of one-year mortality or need for transplant. Aortic atresia was a predictor of total follow-up mortality. When analyzing the cumulative effect, the presence of two risk factors was associated with higher mortality. CONCLUSIONS: HLHS remains the defect with the highest procedural risks for mortality in paediatric cardiac surgery. From a prognostic point of view, recognition of independent preoperative risk factors as well as the cumulative effect of risk factors for mortality is essential.BAKGRUND: Flera studier har rapporterat om riskfaktorer för mortalitet associerade med hypoplastiskt vänsterhjärtsyndrom (HLHS). Datan är emellertid tvetydiga och fokuserar främst på de oberoende effekterna av dessa faktorer. Vi undersökte både de oberoende och kumulativa effekterna av preoperativa riskfaktorer för mortalitet och behov av hjärttransplantation hos patienter som genomgick Norwood-operationen. Ytterligare studerade vi riskfaktorerna för förlängd initial sjukhusvistelse hos dessa patienter. METODER: Vi genomförde en retrospektiv nationell 18-årig observationsstudie av preoperativa riskfaktorer för ettårsöverlevnad samt total uppföljning av dödlighet eller behov av transplantation hos HLHS-patienter (N=99) födda i Finland mellan 1 januari 2004 och 31 december 2021. RESULTAT: Totalt överlevde 85,6% efter ett år. I en multivariabel analys var allvarliga extrakardiala anomalier och liten för gestationsåldern signifikanta prediktorer för ettårsdödlighet eller behov av transplantation. Atresi av aortan var en prediktor för total uppföljningsdödlighet. Vid analys av den kumulativa effekten var närvaron av två riskfaktorer associerad med högre dödlighet. SLUTSATSER: HLHS förblir defekten med högst operativa risker för dödlighet inom pediatrisk hjärtkirurgi. Från ett prognostiskt perspektiv är det väsentligt att känna igen oberoende preoperativa riskfaktorer samt den kumulativa effekten av riskfaktorer för dödlighet

Risk factors for mortality in patients with hypoplastic left heart syndrome after the Norwood procedure

OBJECTIVES: Several studies have reported mortality risk factors associated with hypoplastic left heart syndrome (HLHS). However, these data are ambiguous and mainly focused on the independent effects of these factors. We examined both the independent and the cumulative effect s of preoperative risk factors for poor outcome in patients undergoing the Norwood procedure. Moreover, we studied the risk factors associated with prolonged initial hospital stays in these patients.METHODS: We performed a retrospective national 18-year observational study of preoperative risk factors for 1 year, as well as total follow-up mortality or need for transplant in patients with HLHS (N = 99) born in Finland between 1 January 2004 and 31 December 2021.RESULTS: Overall, one-year survival was 85.6%. In a multivariable analysis, having a major extracardiac anomaly and being small for gestational age were significant predictors of one-year mortality or the need for a transplant. Aortic atresia was a predictor of total follow-up mortality. An analysis of the cumulative effect indicated that the presence of 2 risk factors was associated with higher mortality.CONCLUSIONS: HLHS remains the defect with the highest procedural risks for mortality in paediatric cardiac surgery. From a prognostic point of view, recognition of independent preoperative risk factors as well as the cumulative effect of risk factors for mortality is essential.Peer reviewe

Maternal first trimester metabolic profile in pregnancies with transposition of the great arteries

Abstract Background: Higher maternal body mass index (BMI) and abnormal glucose metabolism during early pregnancy are associated with congenital heart defects in the offspring, but the exact mechanisms are unknown. Methods: We evaluated the association between maternal first trimester metabolic profile and transposition of the great arteries (TGA) in the offspring in a matched case–control study with 100 TGA mothers and 200 controls born in Finland during 2004–2014. Cases and controls were matched by birth year, child sex, and maternal age and BMI. Serum samples collected between 10- and 14-weeks of gestation were analyzed for 73 metabolic measures. Conditional logistic regression was used to assess the risk for TGA in the offspring, and a subgroup analysis among mothers with high BMI was conducted. Results: Higher concentrations of four subtypes of extremely large very-low-density lipoprotein (VLDL) particles and one of large VLDL particles were observed in TGA mothers. This finding did not reach statistical significance after multiple testing correction. The pooled odds ratio (OR) of the all metabolic variables was slightly higher in TGA mothers in the subgroup with maternal BMI over 25 (OR 1.25) and significantly higher in the subgroup with maternal BMI over 30 (OR 1.95) compared to the original population (OR 1.18). Conclusions: Our findings indicate that an abnormal maternal early pregnancy metabolic profile might be associated with TGA in the offspring, especially in obese mothers. A trend indicating altered VLDL subtype composition in TGA pregnancies warrants further research