Taisto Sarkola

Pediatrics, Cardiology

MD, PhD
31.30

Publications

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    ABSTRACT: Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS) resulting in a postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life remains poorly defined. The primary aim of this study was to describe the natural history of fetal aortic stenosis and, secondarily, to test previously published criteria designed to identify cases of evolving HLHS with the potential for a biventricular (BV) outcome following FV. We report the natural history of 107 fetuses in continuing pregnancies that did not undergo FV from a retrospective multicenter study in Europe of 214 fetuses with aortic stenosis (2005–2012). We examined longitudinal changes in Z-scores of aortic and mitral valve and left ventricular dimensions, and documented direction of flow across foramen ovale and aortic arch, and mitral valve inflow pattern and any changes to determine those fetuses satisfying the Boston criteria for emerging HLHS and to estimate the proportion of these that would also have been considered ideal FV candidates. We applied the threshold score where a score of 1 was awarded to fetuses for each Z-score meeting the following: left ventricular length and width > 0; mitral valve width > −2 and aortic valve width > −3.5 and also where the pressure gradient across either the mitral or aortic valve was > 20 mmHg and compared the predicted circulation with known survival and final postnatal circulation (BV; UV or conversion from BV to UV). In the 107 ongoing pregnancies there were 8 spontaneous fetal deaths, resulting in 99 live-born children. 5 were lost during follow up, 5 had comfort care and 4 had mild aortic stenosis not requiring intervention. There was an intention to treat in the remaining 85 but 5 of them died before surgery before the circulation could be determined. Thus 80 underwent postnatal procedures with 44 BV, 29 UV and 7 BV-UV outcomes. 70/85 children (82%) with an intention to treat had ≥30 day survival. Survival was superior in BV circulation at median 6 years (p=0.041). Aortic valve size was significantly smaller at presentation in fetuses with UV outcomes (p=0.004) but its growth velocity was similar in both circulatory outcomes. In contrast the mitral valve (p=0.008) and left ventricular inlet length (p=0.0042) and width (p= 0.0017) were significantly reduced by term in fetuses with UV compared to BV outcomes. Fetal data from 70 treated neonates, recorded before 30 completed gestational weeks was evaluated for emerging HLHS. Forty-four had moderate or severe left ventricular depression and 38 of these had retrograde flow in the aortic arch with a further two having left to right flow at atrial level and a–wave reversal in the pulmonary veins. Thus 40 of the 70 satisfied the criteria associated with emerging HLHS and a BV circulation was documented in 13, (33%). Twelve of the 40 fetuses (30%) had a threshold score of 4 or 5, with a BV circulation in 5 (42%) of them without fetal intervention. Our natural history cohort of children diagnosed with aortic stenosis with known outcomes shows that a substantial proportion of fetuses meeting the criteria for emerging HLHS, with or without favorable selection criteria for FV, had a sustained BV circulation without fetal intervention. This indicates that further work is needed to refine selection criteria to offer appropriate therapy to fetuses with aortic stenosis.
    Full-text · Article · Feb 2016 · Ultrasound in Obstetrics and Gynecology

  • No preview · Article · Feb 2016 · Bone Marrow Transplantation
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    ABSTRACT: Background: Endovascular stenting has emerged as a treatment option for children with coarctation of the aortic (CoA), but the impact on left ventricular (LV) function has been poorly documented. The aim of this study was to characterize the LV myocardial and hemodynamic response to exercise in young patients who underwent endovascular stenting for CoA during childhood using semisupine bicycle exercise stress echocardiography. Methods: This was a single-center prospective cross-sectional study including 30 patients with CoA and 30 age- and gender-matched control subjects who underwent semisupine bicycle exercise stress echocardiography. Color Doppler tissue imaging peak systolic (s') and early diastolic (e') velocities in the LV lateral wall and basal septum, LV myocardial acceleration during isovolumic acceleration were measured at rest and with incremental heart rate (HR). The relationship with increasing HR was evaluated for each parameter by plotting the values at each stage of exercise versus HR. Results: At rest, HR was similar between the two groups. LV ejection fraction and fractional shortening were within the normal range in the CoA group. LV lateral wall and basal septal s' and e' velocities did not differ between the two groups, but isovolumic acceleration values were significantly lower in the CoA group. At peak exercise, HR was similar between the groups, but all Doppler tissue imaging parameters were lower in patients than in control subjects. When assessing the increase of each parameter versus HR, the increase in slope was significantly lower in patients than in control subjects for LV lateral wall Doppler tissue imaging s' and e' velocities, and septal e' velocity, but not for septal s'. The relationship of isovolumic acceleration with HR was significantly reduced in the CoA group. Conclusion: The results of this study demonstrate reduced systolic and diastolic myocardial reserve in patients with CoA compared with control subjects. An abnormal myocardial contractile response to exercise was also found, as shown by an abnormal LV force-frequency relationship in patients with stented CoA. The prognostic clinical implications require further study.
    Full-text · Article · Dec 2015 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: We report a fetal case with fatal outcome having a novel mutation in the HADHB gene, coding the beta-subunit of the mitochondrial trifunctional protein. Parents had a previous pregnancy loss due to fetal heart failure and hydrops. The next pregnancy led to left ventricular noncompaction and increasing pleural effusions after 29 gestational weeks. The fetus was small for gestational age, and long bones were abnormally short. The baby was born severely asphyxiated at 32 gestational weeks by cesarean section. Intensive care was withdrawn due to failure to thrive and suspicion of a severe mitochondrial disorder. Postmortem brain MRI suggested microcephaly with a simplified gyral pattern. The lateral cerebral ventricles were normal. Chromosome analysis was normal (46, XX). Fibroblasts cultured from a skin biopsy of the baby revealed the large homozygous deletion c.1109+243_1438-703del in the HADHB gene, and heterozygous mutations were detected in both parents. The deletion has not been reported earlier. It is important to differentiate systemic metabolic diseases from disorders that affect only the cardiac muscle. Trifunctional protein deficiency is a relatively rare disorder of the fatty acid β-oxidation cycle. The mutation in the HADHB gene causes a systemic disease with early-onset cardiomyopathy. Understanding the molecular genetic defect of the patient allows appropriate genetic counseling of the family. What is Known: • Mitochondrial disorders as a group are an important etiology for fetal cardiomyopathies including human trifunctional protein (TFP) disorders and several other mitochondrial diseases. What is New: • We report a fetal case with fatal outcome having a novel mitochondrial trifunctional protein mutation (c.1109+243_1438-703del in the HADHB gene).
    No preview · Article · Jun 2015 · European Journal of Pediatrics
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    ABSTRACT: Background The aim of the study was to evaluate arterial morphology and function in a national cohort of long-term survivors of high-risk neuroblastoma (NBL) treated with high-dose chemotherapy and autologous hematopoietic stem cell transplantation with or without total body irradiation (TBI).Methods and ResultsCommon carotid, femoral, brachial, and radial artery morphology were assessed with very-high-resolution vascular ultrasound (25–55 MHz), and carotid artery stiffness and brachial artery flow-mediated dilatation measured with conventional vascular ultrasound in 19 adult or pubertal (age 22.7 ± 4.9 years, range 16–30) NBL survivors transplanted during 1984–1999 at the mean age of 2.5 ± 1.0 years. Results were compared with 20 age- and sex-matched healthy controls. The cardiovascular risk assessment included history, body mass index, fasting plasma lipids, glucose, and 24-h ambulatory blood pressure (BP). The survivors had consistently smaller arterial lumens, increased carotid intima-media thickness (IMT), plaque formation (N = 3), and stiffness, as well as increased radial artery intima thickness (N = 5) compared with the control group. Survivors displayed higher plasma triglyceride and cholesterol levels, and increased heart rate, as well as increased systolic and diastolic BPs. TBI (N = 10) and a low body surface area were independent predictors for decreased arterial lumen size and increased IMT. Three out of five survivors with subclinical intima thickening had arterial plaques. Plaques occurred only among TBI-treated survivors.Conclusions Long-term childhood cancer survivors treated with TBI during early childhood display significant signs of premature arterial aging during young adulthood. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.
    Full-text · Article · May 2015 · Pediatric Blood & Cancer
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    Sundholm JKM · Olander RFW · Ojala TH · Sture Andersson · Taisto Sarkola
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    ABSTRACT: Background: Non-invasive transcutaneous very-high resolution ultrasound (VHRU, 25-55 MHz) has recently been developed to quantify superficial vascular structures in humans. The performance of the method has yet not been evaluated in vivo in neonates. The aim of the study was to compare VHRU with conventional high-resolution ultrasound (HRU, 7-12 MHz), and to assess the feasibility and precision of VHRU in this population. Methods: 150 images from central elastic (common carotid, CCA) and peripheral muscular (brachial, BA; femoral, FA) arteries were obtained in 25 neonates of different gestational ages (range 33+0 to 41+5 gestational weeks) and weights (range 1570 to 4950 g) with VHRU, and the use of HRU for comparison assessed in five. Results: Images were captured from CCAs with 35 MHz, FAs using 35 and 55 MHz, and BAs using 55 MHz. 12 MHz was unable to assess FAs and BAs, and the CCA IMT was grossly overestimated compared with 35-55MHz. IMTs of the smallest BAs and FAs were beyond the axial resolution of VHRU (<0.05 mm), thus immeasurable. For VHRU, the intra-, inter- and test-retest coefficients of variation (CV) were for LDs (range 1.44-2.62 mm, CVs between 1.6 ’ 4.8%), IMATs (range 0.141-0.161 mm, CVs between 8.8-19.9%), and IMTs (range 0.062-0.165 mm, CVs between 12.8-24.8%) for the different arteries. Conclusion: VHRU is feasible, accurate and precise in the assessment of superficial proximal conduit arteries but unable to assess the abdominal aorta in human neonates HRU-derived neonatal conduit arterial wall layer thicknesses are below the ultrasound axial solution.
    Full-text · Article · Feb 2015 · Atherosclerosis
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    ABSTRACT: In pediatric echocardiography, pulse wave Doppler, and tissue Doppler imaging velocities are widely used to assess cardiac function. Current reference values and Z scores, allowing adjustment for growth are limited by inconsistent methodologies and small sample size. Using a standardized approach for parametric modeling and Z score quality assessment, we propose new pediatric reference values and Z score equations for most left ventricular pulse wave Doppler and tissue Doppler imaging measurements. Two hundred thirty-three healthy pediatric subjects 1 to 18 years of age were prospectively recruited. Thirteen pulse wave Doppler and 14 tissue Doppler imaging measurements were recorded. Normalization for growth was done via a complete and standardized approach for parametric nonlinear regression modeling. Several analyses were performed to ensure adequate Z score distribution and to detect potential residual associations with growth or residual heteroscedasticity. Most measurements adopted a nonlinear relationship with growth and displayed significant heteroscedasticity. Compared with age, height, and weight, normalization for body surface area was most efficient in removing the effect of growth. Generally, polynomial and allometric models yielded adequate goodness-of-fit. Residual values for several measurements had significant departure from the normal distribution, which could be corrected using logarithmic or reciprocal transformation. Overall, weighted parametric nonlinear models allowed us to compute Z score equations with adequate normal distribution and without residual association with growth. We present Z scores for normalized pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Further studies are needed to define the threshold beyond which health becomes a disease by integrating other important factors such as ventricular morphology, loading conditions, and heart rate. © 2015 American Heart Association, Inc.
    No preview · Article · Feb 2015 · Circulation Cardiovascular Imaging
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    ABSTRACT: The majority of congenital heart defects (CHD) occur without identifiable risk factors. Detection rates are therefore highly dependent on the experience and expertise of the obstetrical screening operator. In first trimester the risk of CHD increases with increasing nuchal thickness (NT) (≥2.5 mm detects 44% of major CHD), but due to the amount of false positives, the positive predictive value is only a few percent. The anatomy of major CHD may be delineated in less than half of the fetuses during early second trimester. The reported yield of CHD detection during the mid-gestational routine obstetrical screening has improved over time and detection rates up to 85% of major CHD have been reported when outflow tract and 3-vessel views are included in conjunction with the 4-chamber view. Improved detection rates have been achieved following screening operator training interventions combined with a low referral threshold to obtain a detailed fetal echocardiographic study.This article is protected by copyright. All rights reserved.
    Full-text · Article · Dec 2014 · Acta Obstetricia Et Gynecologica Scandinavica
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    Tomas Gustavsson · Taisto Sarkola · Johnny Sundholm

    Full-text · Dataset · May 2014
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    Johnny Sundholm · Tomas Gustavsson · Taisto Sarkola
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    ABSTRACT: The aim was to evaluate the accuracy, precision and feasibility of semi-automatic border detection software (AMS) in comparison to manual electronic calipers (EC) in the analysis of arterial images obtained with transcutaneous very-high resolution vascular ultrasound (VHRU, 25-55 MHz). 100 images from central elastic and peripheral muscular arteries were obtained on two separate imaging occasions from 10 healthy subjects, and independently measured with AMS and EC. No bias between AMS and EC was found. The intraobserver coefficients of variation (CV) for carotid lumen dimension (mean dimension 5.60 mm) was lower with AMS compared with EC (0.4 vs. 1.9%, p = 0.033; N = 20). No consistently significant differences in intra, inter or test-retest CVs were observed overall for muscular artery dimensions between AMS and EC. The intra CV for adventitial thickness (AT, mean 0.111 mm; 15.6 vs 24.8%, p = 0.011; N = 41) and inter CV for intima-media thickness (IMT, mean 0.219 mm; 14.3 vs. 21.2%, p = 0.001; N = 58) obtained with AMS in higher quality thin muscular artery images was lower compared with EC. The mean reading time was significantly lower with AMS compared with EC (71.5 s vs. 156.6 s, p < 0.001). AMS is accurate, precise, and feasible in the analysis of arterial images obtained with VHRU. Minor, although statistically significant, differences in the precision of AMS and EC-systems were found. The precision of AMS was superior for AT and IMT in higher quality images likely related to a decrease in the technical variability imposed by the observer.
    Full-text · Article · Mar 2014 · Atherosclerosis
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    ABSTRACT: To develop a normative data set and to study the relationship among arterial structure, different anthropometric measures, blood pressure, and arterial function during healthy childhood using very-high-resolution ultrasound (25-55 MHz). In 135 healthy children between 0 and 18 years of age, we assessed the structure of the carotid arteries, larger peripheral arteries, aorta, and left ventricle with ultrasound. Arterial stiffness was assessed by pulse wave velocity and endothelial function by brachial flow-mediated dilation. Reference curves adjusted for age and body surface area of arterial lumen diameters, intima-media thickness, and adventitia thickness were developed. Arterial walls thicken during childhood predominantly as a result of a progressive increase in intima-media thickness. There were significant associations among lumen diameter (R(2) range, 0.20-0.88 for different arteries; P<0.001), intima-media thickness (R(2) range, 0.47-0.85; P<0.001), left ventricular mass (R(2)=0.90; P<0.001), and adventitia thickness (R(2) range, 0.15-0.22; P<0.001) with sex, age, body surface, and systolic blood pressure. Arterial wall stress was associated with lumen diameter (R(2) range, 0.52-0.83; P<0.001) and intima-media thickness (R(2) range, 0.53-0.88; P<0.001). Limited relationships were found among arterial wall layer thickness, stiffness, and endothelial function. In healthy children, the evolution of the arterial structure is mainly related to anthropometrics and blood pressure.
    Full-text · Article · Jul 2012 · Arteriosclerosis Thrombosis and Vascular Biology
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    ABSTRACT: To study the accuracy and feasibility of very-high resolution ultrasound (VHRU, 25-55 MHz) and conventional high resolution ultrasound (HRU, 12 MHz) in the assessment of common carotid intima-media thickness (IMT) in healthy children between 0 and 18 years of life. IMT was measured with VHRU and HRU in 135 children. Seventeen similar sized porcine arterial specimens were imaged with VHRU and HRU, and the IMT measurements compared to histology. Adequate imaging was obtained and IMT quantified in all children with 25 and 35 MHz, but the far wall was rarely reached with 55 MHz, even in small children. HRU-IMT was significantly thicker compared with VHRU-IMT in young children (<12 years; HRU: 0.434 ± 0.040 vs. VHRU: 0.341 ± 0.054 mm, N = 66; p < 0.001). No differences between HRU-IMT and VHRU-IMT were found among older children. No differences were found between far and near wall VHRU-IMT. An increase in porcine arterial IMT with decreasing transducer frequency was observed in comparison to histology. HRU-IMT was significantly overestimated compared with VHRU-IMT and histology-IMT in porcine vessels with an IMT within the pediatric range (0.20-0.50 mm). VHRU is feasible and more accurate than HRU in quantifying CIMT in young children (<12 years). We recommend using the highest ultrasound transducer frequency applicable to quantify CIMT in the pediatric population.
    Full-text · Article · Jun 2012 · Atherosclerosis
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    ABSTRACT: To study the relations between postnatal maternal morbidity, child morbidity and welfare interventions in families with prenatal alcohol or substance abuse. A register-based longitudinal retrospective cohort study. The exposed cohort included 638 children born to 524 women followed-up during pregnancy for alcohol or substance abuse 1992-2001. Non-exposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Perinatal and follow-up data of both cohorts were collected from national registers until 2007. Postnatal maternal abuse-related healthcare utilization and use of medication were associated with child out-of-home care. Significant differences were in particular observed in the categories of maternal mental and behavioural disorders caused by psychoactive substance use as well as injury and poisoning. Maternal inpatient care for mental and behavioural disorders peaked at the time of child out-of-home care. Maternal abuse-related healthcare utilization was associated with early child healthcare utilization and use of medication for mental and behavioural disorders. These associations were largely explained by the association with child out-of-home care. Postnatal maternal abuse-related morbidity is associated with significant early child morbidity, use of medication and timing of out-of-home care.
    Full-text · Article · Mar 2012 · Acta Paediatrica
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    ABSTRACT: The Fontan circulation is associated with an increased central venous pressure, decreased ventricular preload, and increased afterload. We postulated that these central hemodynamic abnormalities would have consequences for the structural and functional properties of the peripheral arteries and veins, and performed a cross-sectional study in a tertiary health-care setting. We prospectively examined venous and arterial wall morphology by very high resolution ultrasound (VHRU, 25-55 MHz), and function by conventional vascular ultrasound (flow-mediated dilatation, FMD) and applanation tonometry (pulse wave velocity, PWV) in 28 patients after the Fontan procedure (age 14.8 ± 1.3 years) and 54 age-matched controls. Pig venous samples were studied with VHRU and compared with histology for accuracy. The precision of the venous VHRU method was studied in healthy volunteers. The lumen dimension was reduced in Fontans compared with controls in the common carotid, brachial, radial, and femoral arteries (p < 0.05). The common carotid, brachial, radial, ulnar, femoral, and dorsal tibial artery intima-media thicknesses (IMTs) and the brachial, ulnar, and femoral artery adventitial thicknesses were decreased (p < 0.05 for all), while the cubital and dorsal tibial vein IMTs were increased in Fontans (p < 0.001). FMD, abdominal aortic stiffness, and carotid-femoral PWV were similar, while carotid-radial artery PWV was increased in Fontans (p < 0.01). Venous wall layer assessment with VHRU was accurate and precise. The Fontan circulation is associated with significant arterial and venous remodeling, presumably reflecting abnormalities of central hemodynamics. These novel data may be of clinical importance in the circulatory management as well as the understanding of the early pathogenesis of vasculopathy in patients after the Fontan procedure.
    No preview · Article · Feb 2012 · Heart and Vessels
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    ABSTRACT: Changes in vascular and myocardial structure and function have been demonstrated in obese children, but limited data are available on how these changes are related. The aims of this study were to investigate vascular and myocardial changes in obese children with lipid abnormalities and to study the interactions between vascular and myocardial parameters. A cross-sectional, prospective observational study was conducted. Twenty-one obese and 27 normal-weight controls aged 14 ± 2 years participated. Cardiac assessment included geometric parameters and myocardial deformation (strain and strain rate) analysis by color tissue Doppler and speckle-tracking echocardiography. Vascular assessment included carotid intima-media thickness, flow-mediated dilatation, pulse-wave velocity, and other stiffness measures of the aorta and carotid artery, as well as noninvasive estimation of arterial elastance and left ventricular (LV) end-systolic elastance. Obese children compared with controls had lower color tissue Doppler-derived LV systolic radial strain values (45 ± 11% vs 56 ± 12%, P = .002), lower speckle-tracking echocardiography-derived LV systolic longitudinal strain values (-18 ± 2% vs -21 ± 2%, P < .001), and lower speckle-tracking echocardiography-derived LV early diastolic strain rate values (1.7 ± 0.3 vs 2.5 ± 0.4, P < .001). Carotid intima-media thickness was increased, pulse-wave velocity was faster, and arterial distension coefficients were lower in obese children. The ratio of arterial elastance to LV end-systolic elastance (a marker of ventricular-arterial coupling) was lower in obese children than controls (0.73 ± 0.32 vs 0.47 ± 0.15, P = .003). Changes in vascular parameters were correlated with changes in longitudinal myocardial deformation parameters. Obese children with lipid abnormalities have reduced systolic and diastolic LV deformation characteristics, early vessel wall changes, and increased arterial stiffness. Abnormal ventricular-vascular interaction is suggested by these data and warrants further investigation.
    No preview · Article · Jan 2012 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: ObjectivesThe objective was to determine the severity of residual cardiovascular abnormalities in youths after coarctation of the aorta (CoA) repair and their relation to regional blood pressure (BP).DesignProspective cross-sectional study in tertiary health care setting.MethodsThirty-six CoAs (age 16±1 years; neonatal surgery only: n=16; surgery and/or stent implantation: n=20) and 37 age-matched controls were examined by very-high resolution ultrasound, echocardiography and applanation tonometry.ResultsCoA was associated with increased right arm systolic BP (p<0.001), intima-media thickness (IMT) in the common carotid (p<0.001), right brachial (p<0.05) and radial (p<0.05) arteries and ascending aortic stiffness (p<0.05). Carotid IMT correlated positively with age at first intervention (r=0.36, p<0.05). With left subclavian flap type repair, left arm systolic BP (p<0.001) and left brachial (p<0.001), radial (p<0.001) and ulnar (p<0.05) arterial IMTs were all reduced. When adjusted for BP, body mass index, age and gender, only carotid IMT (p<0.001) and LV-mass (p=0.013) of stented patients, as well as left arm arterial IMTs (p<0.01) in subclavian flap type repair patients remained different from controls. The significant associations of stented patients disappeared after adjustment for later patient age at intervention (median 8.7 vs 0.03 years, p<0.001). Residual arm-leg BP gradients correlated positively with carotid and brachial IMT.ConclusionCoA repair in early childhood is associated with increased preductal arterial IMT, LV mass and ascending aortic stiffness in adolescents. The more pronounced cardiovascular abnormalities after CoA stent implantation are likely related to the older patient age at the time of intervention.
    Preview · Article · Sep 2011 · Heart (British Cardiac Society)
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    ABSTRACT: Atherosclerosis begins during early life and is accelerated in individuals with cardiovascular risk factors. We hypothesized that very-high resolution ultrasound (VHRU, 25-55 MHz) could feasibly detect early arterial changes in adolescents with risk factors. We prospectively imaged the carotid, brachial and radial arterial morphology (far wall intima-media thickness, IMT; adventitia thickness, AT) by VHRU in 58 youths (age 14 ± 2 years) attending a Pediatric Preventive Cardiology Clinic for assessment and management of cardiovascular risk factors and compared the findings to those from an age-matched group of 67 controls. Brachial and radial imaging was successful for all subjects. The carotid far wall could not be imaged in 7% of the patients due to limitations in penetration. VHRU image quality was related to body size and imaging depth. Imaging and analysis time were 12 ± 3 and 18 ± 3 min, respectively. Carotid IMT was increased in patients (0.42 ± 0.05 vs. 0.40 ± 0.06 mm, p = 0.05). No differences were found in brachial or radial IMT or AT vs. controls. Age, male gender, body mass index, systolic blood pressure (BP), but not lipid levels, were associated with arterial IMT in regression analyses. VHRU is feasible in imaging carotid and peripheral muscular artery IMT in adolescents. The arterial IMT is associated with age, gender, adiposity and systolic BP, but not lipid levels, in this adolescent population. Further studies including patients with manifest clinical atherosclerosis are needed to assess if VHRU has applications in atherosclerosis research.
    No preview · Article · Aug 2011 · Atherosclerosis
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    ABSTRACT: Early childhood healthcare utilization, mortality and welfare interventions were studied among children of mothers with identified gestational alcohol and/or substance abuse. Register-based retrospective cohort study. The exposed cohort consisted of 638 children born to 524 women followed up antenatally 1992-2001 at special outpatient clinics in the capital area of Finland. Nonexposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Postnatal data of both cohorts were collected from national registers until 2007. The exposed cohort displayed twice the amount of in- and outpatient hospital care episodes compared with nonexposed children. Differences attributable to exposure were found in categories of conditions originating in the perinatal period, mental and behavioural disorders, and nonspecific factors influencing health status and contact with health services. This was reflected in amounts of reimbursements for drugs of the central nervous system, as well as special care allowances and rehabilitation for mental and behavioural disorders. The highest degree of healthcare utilization was observed among exposed children placed in out-of-home care. One-third of these children received outpatient care and one-tenth required inpatient care for a mental and behavioural disorder. No significant differences were found in early mortality. The exposed children displayed significant neonatal and early mental and behavioural healthcare utilization, and need for significant psychosocial support during their first decade of life.
    No preview · Article · Apr 2011 · Acta Paediatrica
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    ABSTRACT: High-resolution ultrasound (HRU) is used to measure carotid intima-media thickness (IMT). We postulated that very-high-resolution ultrasound (VHRU, 25-55MHz) provides more detailed information on arterial morphology. Rabbit and pig arterial specimens and artificial elastin membranes were studied with HRU and VHRU, and compared to histology. Bilateral carotid, brachial, radial, ulnar, femoral, and tibial arteries were imaged in vivo in 15 humans to determine the precision of VHRU and in 53 teenagers to compare VHRU to HRU. The assessment of IMT, adventitia thickness (AT) and combined intima-media-adventitia thickness (IMAT) in muscular arteries was accurate and precise by VHRU with the exception that the AT of the smallest arteries was not delineated with 25MHz. VHRU was accurate and precise for IMAT in small and for IMT in large elastic arteries and allowed to qualitatively assess elastin fibers of the media. HRU was accurate for IMT of large muscular and elastic arteries only. Intima thickness (IT) was grossly overestimated by both VHRU and HRU. Transcutaneous VHRU provides a noninvasive method of quantifying elastic and muscular arterial AT, IMT and IMAT in children and adults, but neither VHRU nor HRU is able to assess IT in non-diseased vessels.
    Full-text · Article · Oct 2010 · Atherosclerosis
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    ABSTRACT: A register-based retrospective case-control study to investigate the long-term morbidity, mortality, and welfare among women with alcohol and/or substance misuse identified during pregnancy. Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland. The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age, parity, date of birth and hospital of index delivery. Both groups were followed-up until end of 2007. 7.9% (42/524) of the cases and 0.2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38, 95% CI 14-108). The cases displayed significant morbidity requiring in-patient care in the areas of mental disorders (AOR 8.8, 95% CI 6.5-11.9), viral (AOR 23.5, 95% CI 8.8-62.7) and bacterial (AOR 6.1, 95% CI 3.5-10.4) infections, skin diseases (AOR 3.9, 95% CI 2.0-7.8) and injury and poisoning (AOR 4.2, 95% CI 3.1-5.6). The cases displayed more out-patient visits (OR 2.7, 95% CI 2.7-2.8). Their mean length of hospital stay was longer compared to controls (10.3 vs. 4.4 days, p<0.001). The risk of pension granted due to a disorder, disease or disability (OR 8.8, 95% CI 6.0-13.0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2.1, 95% CI 1.8-2.5). These women display significant long-term morbidity, mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse.
    Full-text · Article · Oct 2010 · Drug and alcohol dependence

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