Follow-up of Secundum ASD, Muscular VSD, or PDA Diagnosed During Newborn Hospitalization.

Background: The ideal follow-up of neonates who have a secundum atrial septal defect (ASD), muscular ventricular septal defect (VSD) or patent ductus arteriosus (PDA) remains uncertain. Methods: Newborns with findings limited to a secundum ASD, muscular VSD and/or PDA on their last birth hospital echocardiogram and at least one outpatient follow-up echocardiogram performed between 9-1-17 and 9-1-21 were evaluated and patient follow-up assessed through 9-1-23. Results: 95 babies met inclusion criteria. 43 babies had a secundum ASD, 41 had a muscular VSD and 54 had a PDA at newborn hospital discharge. 39/95 had more than one intracardiac shunt. 56 were discharged from care, 26 were still in follow-up and 13 were lost to recommended follow-up.No patients required intervention during the follow-up period of 2 to 6 years. Of those 43 with a secundum ASD 16 (37.2%) had demonstrated closure of the ASD and 13 (30.2%) were discharged from care with and ASD < 3.5 mm in diameter. 3/43 infants with secundum ASD had a defect large enough to easily warrant further follow-up. Conclusion: Even in this group who had early clinical follow-up recommended by a pediatric cardiologist, no baby discharged from their birth hospitalization with a secundum ASD, muscular VSD or PDA needed any intervention from 2 to 6 years of follow-up. Ongoing follow-up with echocardiography of those infants with a secundum ASD is of greater value than of those with muscular VSD or PDA.

Progressive Aortic Stenosis in Homozygous Familial Hypercholesterolemia After Liver Transplant.

Early onset coronary artery disease and aortic calcifications are characteristic features of patients with homozygous familial hypercholesterolemia. Standard medical therapy includes dietary modification, pharmacotherapy, and lipoprotein apheresis to lower serum low-density lipoprotein cholesterol (LDL-C). Liver transplant is a surgical option for the treatment of homozygous familial hypercholesterolemia and can lead to normal cholesterol levels. Vascular calcifications are known to progress despite standard medical therapy and have been reported after liver transplant in the setting of rejection. We present the first report of progressive severe aortic valve stenosis in a patient despite liver transplant with normalization of lipid levels and no history of graft rejection.

Cardiovascular risk factor screening and management of obese patients at an outpatient pediatric cardiology center.

OBJECTIVE: To evaluate documentation of cardiovascular (CV) risk factors and obesity management by pediatric cardiologists. STUDY DESIGN: Review of medical records of obese (≥95th body mass index percentile) 2-17 year-old children presenting to outpatient pediatric cardiology over 1 year. Subjects were categorized as: heart disease (HD) with increased risk for atherosclerosis; HD with average risk for atherosclerosis; or no HD. Data were evaluated on documentation of the assessment of seven CV risk factors [including recognition of elevated blood pressure (BP)] and management of obesity. Multivariable logistic regression (LR) examined physician documentation of obesity intervention by risk groups, including age and gender. RESULTS: Data on 730 subjects were analyzed; 16 % had HD with increased risk for atherosclerosis, 41 % had HD with average risk for atherosclerosis, and 43 % had no HD. Documentation of risk factor assessment was highest for physical inactivity (53 %) and recognition of obesity (47 %). Other factors (child dyslipidemia, diet, dysglycemia, and cigarette exposure) were documented less frequently. Elevated BP was found in 144 patients (20 %); 53/144 (37 %) had documentation of elevated BP recognition. An obesity intervention was documented in 62 % of records and did not significantly differ between risk groups. In the multivariate LR, physician documentation of obesity intervention did not significantly differ between risk groups. CONCLUSIONS: Complete assessment of CV risk factors in obese patients is low. The number of risk factors assessed was similar among patients with HD with average risk of atherosclerosis and HD with increased risk of atherosclerosis. Increased care coordination between cardiologists and primary care providers may lead to uniform, comprehensive CV risk assessment.