Thorac Cardiovasc Surg 2013; 61(01): 079-084
DOI: 10.1055/s-0032-1326774
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Gender-Specific Algorithms Recommended for Patients with Congenital Heart Defects: Review of the Literature

Samir Sarikouch
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hanover Medical School, Hanover, Germany
,
Dietmar Boethig
2   Department of Pediatric Cardiology and Pediatric Intensive Care, Hanover Medical School, Hanover, Germany
,
Philipp Beerbaum
3   Departments of Radiology and Pediatric Cardiology, Radboud Medical University, Nijmegen, The Netherlands
› Author Affiliations
Further Information

Publication History

14 May 2012

07 July 2012

Publication Date:
10 January 2013 (online)

Abstract

In the past surgeons did not consider gender to be an important factor in the treatment of congenital heart defects (CHDs). However, gender differences in morbidity and mortality are well documented for acquired heart disease, but data are sparse for CHDs. The purpose of this review is to update the knowledge on the influence of gender on the size and function of the heart during childhood and adolescence. Gender does play an important role already in childhood documented by significant differences in cardiac chamber size, cardiac function, and metabolic exercise testing in healthy young reference populations. Illustrated by the example of tetralogy of Fallot (ToF), gender influence in CHD also appears relevant, for example, biventricular volumes and mass—indexed to body surface area—are significantly higher in male ToF patients, ∼10% for volumes and ∼20% for muscle mass. Accordingly, there is also new evidence that gender has an important role on the outcome of CHDs as shown in recent registry studies which underlines the need for gender-specific algorithms in CHD.

 
  • References

  • 1 Oertelt-Prigione S, Regitz-Zagrosek V. Gender aspects in cardiovascular pharmacology. J Cardiovasc Transl Res 2009; 2 (3) 258-266
  • 2 Schneider B, Athanasiadis A, Stollberger C , et al. Gender differences in the manifestation of tako-tsubo cardiomyopathy. Int J Cardiol 2011; Dec 20 [Epub ahead of print]
  • 3 Fermin DR, Barac A, Lee S , et al. Sex and age dimorphism of myocardial gene expression in nonischemic human heart failure. Circ Cardiovasc Genet 2008; 1 (2) 117-125
  • 4 Takagi H, Manabe H, Umemoto T. A contemporary meta-analysis of gender differences in mortality after coronary artery bypass grafting. Am J Cardiol 2010; 106 (9) 1367
  • 5 Ky B, Kirwan BA, de Brouwer S , et al. Gender differences in cardiac remodeling and clinical outcomes in chronic stable angina pectoris (from the ACTION Trial). Am J Cardiol 2010; 105 (7) 943-947
  • 6 Lindinger A, Schwedler G, Hense HW. Prevalence of congenital heart defects in newborns in Germany: Results of the first registration year of the PAN Study (July 2006 to June 2007). Klin Padiatr 2010; 222 (5) 321-326
  • 7 Kaguelidou F, Fermont L, Boudjemline Y, Le Bidois J, Batisse A, Bonnet D. Foetal echocardiographic assessment of tetralogy of Fallot and post-natal outcome. Eur Heart J 2008; 29 (11) 1432-1438
  • 8 Klitzner TS, Lee M, Rodriguez S, Chang RK. Sex-related disparity in surgical mortality among pediatric patients. Congenit Heart Dis 2006; 1 (3) 77-88
  • 9 Verheugt CL, Uiterwaal CS, van der Velde ET , et al. Mortality in adult congenital heart disease. Eur Heart J 2010; 31 (10) 1220-1229
  • 10 Verheugt CL, Uiterwaal CS, van der Velde ET , et al. Gender and outcome in adult congenital heart disease. Circulation 2008; 118 (1) 26-32
  • 11 Dubowy KO, Baden W, Bernitzki S, Peters B. A practical and transferable new protocol for treadmill testing of children and adults. Cardiol Young 2008; 18 (6) 615-623
  • 12 Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44 (1) 45-60
  • 13 Sarikouch S, Peters B, Gutberlet M , et al. Sex-specific pediatric percentiles for ventricular size and mass as reference values for cardiac MRI: assessment by steady-state free-precession and phase-contrast MRI flow. Circ Cardiovasc Imaging 2010; 3 (1) 65-76
  • 14 Sarikouch S, Koerperich H, Boethig D , et al. Reference values for atrial size and function in children and young adults by cardiac MR: a study of the German competence network congenital heart defects. J Magn Reson Imaging 2011; 33 (5) 1028-1039
  • 15 Kutty S, Kuehne T, Gribben P , et al. Aortic Root and Main Pulmonary Artery Areas Derived from Cardiovascular Magnetic Resonance as Reference Values for Normal Subjects and Repaired Tetralogy of Fallot. Circ Cardiovasc Imaging. 2012; June 22 [Epub ahead of print]
  • 16 Apitz C, Webb GD, Redington AN. Tetralogy of Fallot. Lancet 2009; 374 (9699) 1462-1471
  • 17 Sarikouch S, Koerperich H, Dubowy KO , et al; German Competence Network for Congenital Heart Defects Investigators. Impact of gender and age on cardiovascular function late after repair of tetralogy of Fallot: percentiles based on cardiac magnetic resonance. Circ Cardiovasc Imaging 2011; 4 (6) 703-711
  • 18 Broberg CS, Aboulhosn J, Mongeon FP , et al; Alliance for Adult Research in Congenital Cardiology (AARCC). Prevalence of left ventricular systolic dysfunction in adults with repaired tetralogy of Fallot. Am J Cardiol 2011; 107 (8) 1215-1220
  • 19 Khairy P, Aboulhosn J, Gurvitz MZ , et al; Alliance for Adult Research in Congenital Cardiology (AARCC). Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation 2010; 122 (9) 868-875
  • 20 Oosterhof T, van Straten A, Vliegen HW , et al. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 2007; 116 (5) 545-551
  • 21 Marelli A, Gauvreau K, Landzberg M, Jenkins K. Sex differences in mortality in children undergoing congenital heart disease surgery: a United States population-based study. Circulation 2010; 122 (11, Suppl) S234-S240
  • 22 Samyn MM, Powell AJ, Garg R, Sena L, Geva T. Range of ventricular dimensions and function by steady-state free precession cine MRI in repaired tetralogy of Fallot: right ventricular outflow tract patch vs. conduit repair. J Magn Reson Imaging 2007; 26 (4) 934-940
  • 23 Babu-Narayan SV, Kilner PJ, Li W , et al. Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of Fallot and its relationship to adverse markers of clinical outcome. Circulation 2006; 113 (3) 405-413
  • 24 Frigiola A, Redington AN, Cullen S, Vogel M. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation 2004; 110 (11) (Suppl. 01) II153-II157
  • 25 Gatzoulis MA, Balaji S, Webber SA , et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356 (9234) 975-981
  • 26 Geva T. Indications and timing of pulmonary valve replacement after tetralogy of Fallot repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006; •••: 11-22
  • 27 Harrild DM, Berul CI, Cecchin F , et al. Pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia. Circulation 2009; 119 (3) 445-451
  • 28 Hövels-Gürich HH, Konrad K, Skorzenski D , et al. Long-term behavior and quality of life after corrective cardiac surgery in infancy for tetralogy of Fallot or ventricular septal defect. Pediatr Cardiol 2007; 28 (5) 346-354
  • 29 Kirklin JW, Wallace RB, McGoon DC, DuShane JW. Early and late results after intracardiac repair of Tetralogy of Fallot. 5-year review of 337 patients. Ann Surg 1965; 162 (4) 578-589
  • 30 Redington AN. Determinants of short- and long-term outcome in the surgical correction of tetralogy of Fallot. Curr Opin Pediatr 1993; 5 (5) 619-622
  • 31 Redington AN. Physiopathology of right ventricular failure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006; •••: 3-10
  • 32 Therrien J, Siu SC, Harris L , et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 2001; 103 (20) 2489-2494
  • 33 Uebing A, Fischer G, Schlangen J, Apitz C, Steendijk P, Kramer HH. Can we use the end systolic volume index to monitor intrinsic right ventricular function after repair of tetralogy of Fallot?. Int J Cardiol 2011; 147 (1) 52-57
  • 34 Wald RM, Haber I, Wald R, Valente AM, Powell AJ, Geva T. Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot. Circulation 2009; 119 (10) 1370-1377
  • 35 Wald RM, Lyseggen E, Oechslin EN, Webb GD, Silversides CK. Variability in surgical referral patterns for pulmonary valve replacement in adults with repaired tetralogy of Fallot. Congenit Heart Dis 2009; 4 (4) 231-238
  • 36 Wald RM, Redington AN, Pereira A , et al. Refining the assessment of pulmonary regurgitation in adults after tetralogy of Fallot repair: should we be measuring regurgitant fraction or regurgitant volume?. Eur Heart J 2009; 30 (3) 356-361
  • 37 Frigiola A, Tsang V, Bull C , et al. Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome?. Circulation 2008; 118 (14, Suppl) S182-S190
  • 38 Murphy JG, Gersh BJ, Mair DD , et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329 (9) 593-599
  • 39 Kipps AK, Graham DA, Harrild DM, Lewis E, Powell AJ, Rhodes J. Longitudinal exercise capacity of patients with repaired tetralogy of Fallot. Am J Cardiol 2011; 108 (1) 99-105
  • 40 2012 Workshop report on “Sex-specific reporting of scientific research” of the National Institute of Medicine. http://www.nap.edu/openbook.php?record_id=13307&page=1