Comparison of Long-Term Outcomes Following Percutaneous and Surgical Treatment of Congenital Pulmonary Valve Stenosis

Abstract

understood. In particular, the retinal vasculature is of interest as a window to the cerebral circulation. Methods: Fourteen adults with CCHD (40± 13 years) and 14 age and sex matched healthy controls had flowmediated dilatation (FMD) testing of the brachial artery and dynamic vessel analysis of the retina, including arterial flicker responses. Circulating endothelial progenitor cells (EPCs) were assessed by flow cytometry and cell culture. Results: FMD was 44% lower in the cyanosed adults (p= 0.019, n= 11). Retinal arterial response was also significantly impaired (maximal dilatation was 2.9± 2.9% versus 5.0± 2.1%, p= 0.05, area under the curve (AUC)was 46% lower than controls, p= 0.046, n= 12). Similarly maximal venous dilatation was impaired (3.39± 0.95% versus 5.22± 2.33%, p= 0.02, AUC was 36% lower, p= 0.02) as was post-stimulation venous constriction (0.67± 0.75% versus 0.96± 0.52%, p= 0.02). Circulating CD34+45dim133+ cells and CD34+45dim133+VEGF+ progenitor cells were also reduced with cyanosis (p= 0.02, n= 11 for both). The number of EPCs cultured from peripheral blood also tended to be lower with cyanosis (p= 0.07, n= 11). Conclusions: Endothelial function is impaired in the systemic arteries and retinal arteries and veins in adults with cyanotic CHD, suggesting a widespread endotheliopathy. Diminished numbers of endothelial progenitor cellsmayprovideanexplanationwarranting further study. http://dx.doi.org/10.1016/j.hlc.2012.05.712