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Introduction: Ideal timing for elective delivery of infants with single ventricle heart disease, balancing benefits of fetal growth with risk of fetal demise, remains unclear. Improved understanding of fetal growth in late gestation and postnatal outcomes related to gestational age (GA) may improve insight. Hypothesis: Patients with single ventricle heart disease and aortic hypoplasia have decreased fetal growth velocity in late gestation, but longer gestation results in improved outcomes. Methods: This was a retrospective cohort analysis of patients in phase 2 of the National Pediatric Cardiology Quality Improvement Collaborative database from 2016-2019 who were anticipated to need stage 1 palliation (S1P) and had a GA of > 36 weeks. Birth weight (BW) and BW z-scores were compared across GA to normative values. Outcome measures of survival to stage 2 palliation (S2P), post-S1P length of stay, and duration of mechanical ventilation were compared by GA. Results: The cohort included 1290 infants. There was an increase in mean BW with increasing GA (2.83 kg at 36-37 weeks, 3.15 kg at 38 weeks, 3.33 kg at 39 weeks, 3.40 kg at > 40 weeks; p > 40 weeks; p > 40 weeks; p=0.0001). Among 1083 survivors to discharge or S2P if not discharged, there was no difference in post S1P length of hospitalization across GA (p=0.19). Infants who reached S2P readiness milestones were more likely to undergo S2P if born after longer gestation (p=0.0001). Conclusions: Infants with single ventricle heart disease and aortic hypoplasia have decreased growth velocity in late gestation, but growth continues. Infants born after longer gestation have improved outcomes with shorter duration of ventilation and greater likelihood of undergoing S2P.

Objective Cardiovascular disease is the leading cause of death in women, but little is known about the attitudes and experiences of the 6.4 million American women who have a diagnosis of heart disease. We assessed the knowledge, attitudes, and experiences of women with heart disease and the effect of the disease on their lives. Subjects A total of 204 women with a self-reported diagnosis of heart disease were the subjects. Methods A telephone survey with open-ended questions was used to ask women about their diagnoses, symptoms, interactions with the health care system, knowledge of risks and symptoms, satisfaction with care, and the effect of the disease on their lifestyle, psychosocial well-being, finances, interpersonal relationships, and spirituality. Results Most of the women (73%) had a diagnosis of coronary artery disease (CAD), with the remainder having diagnoses of other cardiac diseases. Most women took multiple medications and had undergone several diagnostic and therapeutic interventions. Almost half the women had been unaware that they were at risk of CAD and, after the condition was diagnosed, almost one-fourth of the respondents did not seek additional information about their diagnosis or treatment options from their physicians. More than half expressed dissatisfaction with their health care, most often because of physician-related knowledge and communication problems. Many women reported that they were unable or unwilling to make appropriate lifestyle changes after the diagnosis was made because of insufficient social, medical, or educational support. Educational opportunities may have been limited because less than 60% of women with CAD received cardiac rehabilitation services. Respondents reported significant changes in their interpersonal relationships, mental health, and financial and spiritual well-being as a result of having heart disease. Conclusion Heart disease affects many aspects of women’s lives. A significant percentage of surveyed women continue to have adverse consequences long after the diagnosis is made. Furthermore, proven beneficial lifestyle changes may not be implemented, most likely because of dissatisfaction with care, lack of educational and rehabilitative resources, symptoms of depression and anxiety, and suboptimal social support. This study identifies several problems that may help explain why women with heart disease have poorer medical outcomes than men with heart disease. Further investigation and better definition of these problems may help improve outcomes among women.