Infants With Congenital Heart Disease at Risk of Early Atherosclerotic Disease

BACKGROUND: Aortic intima-media thickness (aIMT) measurement is an established indicator of preclinical atherosclerosis. We aimed to describe the aIMT in infants with congenital heart disease undergoing cardiac surgery over the first year of life and explore its association with cardiopulmonary bypass, growth velocity, and a diagnosis of left heart obstruction. METHODS AND RESULTS: A prospective cohort study measuring mean and maximum aIMT preoperatively, at 3 months, and 1 year of age in neonates with congenital heart disease undergoing cardiac surgery. Twenty-four infants with a median gestation of 39 weeks and a median birth weight of 3184 g were included. Sixteen (67%) infants had left outflow tract obstruction. Gestation correlated inversely with baseline mean aIMT (beta=-0.027, P=0.018) and positively with the percentage of increase in mean and maximum aIMT between baseline and 3 months (beta=17%, P=0.027 and beta=15%, P=0.023). The presence of left outflow obstruction was significantly associated with increasing mean and maximum aIMT between baseline and 1 year (mean aIMT change: beta=34%, P=0.017 and maximum aIMT change beta=43%, P=0.001). Both subgroups of left heart obstruction and non-left heart obstruction significantly changed over time (P=0.001 and P<0.001) but trends were not statistically different between both subgroups (P=0.21). Growth velocity and cardiopulmonary bypass were not associated with baseline or change in aIMT over the first year of life. CONCLUSIONS: AIMT significantly increased over the first 3 months in our cohort of infants with repaired congenital heart disease. Increasing gestation was associated with decreasing aIMT at 3 months. Growth velocity and cardiopulmonary bypass were not associated with aIMT changes over the first year. Left heart obstruction was associated with a trend toward increased aIMT.