Comparative Cardiorespiratory Fitness in Children: Racial Disparity May Begin Early in Childhood.

African American (AA) adults are reported to have lower levels of cardiorespiratory fitness (CRF) as compared to Caucasian adults. CRF is linked to cardiovascular morbidity and mortality. We hypothesized that the disparities start early in childhood. This was a retrospective analysis of the cardiopulmonary exercise test (CPET). We included normal healthy children, ≤ 18 years of age, who had normal electrocardiograms and normal cardiac function. We excluded patients with congenital heart disease, obesity and suboptimal exercise test. The entire cohort was divided into two groups based on race (Caucasian vs. AA) and then further subcategorized by gender. The cohort of 248 patients had a mean ± SD age of 14.4 ± 2.1 years. 158 (60.8%) were males and 158 (60.8%) were Caucasians. Oxygen consumption was higher among Caucasian children when compared to the AA children (48.7 ± 7.9 vs. 45.4 ± 7 mL/kg/min, p = 0.01). This racial disparity continued to persist when comparisons were performed separately for girls and boys. Upon comparing the four groups, the AA females were found to have the lowest values of VO2max, exercise time and METS (p = 0.001). Thus, in conclusion, the AA children have significantly lower level of CRF, as measured by VO2max and exercise time. The racial disparity is independent of gender. African American females show the lowest level of aerobic capacity. The findings of our study suggest that the racial disparity in the CRF levels seen in the adult population may begin early in childhood.

Complete tracheal rings and hypoplastic left heart variant: a rare and fatal association.

Congenital complete tracheal rings are usually associated with pulmonary slings. We report a rare association of congenital complete tracheal rings with hypoplastic left heart variant. A term infant with diagnosis of a mildly hypoplastic mitral valve, unicuspid aortic valve, and moderately hypoplastic aortic arch with severe coarctation underwent a hybrid procedure initially. Upon failing extubation attempts, complete tracheal rings were seen on direct laryngoscopy. The combination of the lesions resulted in a poor outcome. In patients with failure of extubation post-cardiac surgery, a diagnosis of complete tracheal rings should be included in the differential and a direct laryngoscopy should be considered.

Outcomes of mitral regurgitation associated with large ventricular septal defect and a normal mitral valve apparatus: does intact atrial septum have an impact?

The hemodynamics of isolated large ventricular septal defect with an intact atrial septum results in greater mitral valve (MV) annular dilation and an increased incidence of mitral regurgitation (MR). MR will resolve in most patients after surgical VSD closure alone without MV repair.