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8. Endurance training may improve exercise capacity, lung function and quality of life in Fontan patients.

Author

Hedlund, Eva and Lundell, Bo

Subjects
*AEROBIC capacity, *QUALITY of life, *LUNGS, *PHYSICAL fitness, *OPERATIVE surgery
Abstract

Children born with univentricular hearts undergo staged surgical procedures to a Fontan circulation. Long‐term experience with Fontan palliation has shown dramatically improved survival but also of a life‐long burden of an abnormal circulation with significant morbidity. Many Fontan patients have reduced exercise capacity, oxygen uptake, lung function and quality of life. Endurance training may improve submaximal, but not maximal, exercise capacity, lung function and quality of life. Physical activity and endurance training is also positively correlated with sleep quality. Reviewing the literature and from our single‐centre experience, we believe there is enough evidence to support structured individualised endurance training in most young Fontan patients. [ABSTRACT FROM AUTHOR]

Published
2022
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9. Fontan circulation has improved life expectancy for infants born with complex heart disease over the last 50 years but has also resulted in significant morbidity.

Author

Hedlund, Eva and Lundell, Bo

Subjects
*LIFE expectancy, *HEART diseases, *OPERATIVE surgery, *CARDIAC surgery, *INFANTS
Abstract

The prognosis for infants born with complex heart disease improved dramatically with the introduction of the Fontan circulation 50 years ago. With today's carefully designed and staged operations to a Fontan circulation, life expectancy has increased and most children will survive into adult life. The Fontan circulation entails an unphysiological circulation with high risk for multiple organ system dysfunction. Neurodevelopmental disabilities with adverse psychosocial effects are prevalent. The Fontan circulation may eventually fail and necessitate heart transplantation. Conclusion: Fifty years development of the Fontan circulation to today's staged surgical procedures has improved survival but also revealed the burden of a high morbidity for a growing number of patients. [ABSTRACT FROM AUTHOR]

Published
2022
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16. Snus users had high levels of nicotine, cotinine and 3‐hydroxycotinine in their breastmilk, and the clearance was slower than in smoking mothers.

Author

Nordenstam, Felicia, Lundell, Bo, Edstedt Bonamy, Anna‐Karin, Raaschou, Pauline, and Wickström, Ronny

Subjects
*BREAST milk, *NICOTINE, *SMOKELESS tobacco, *SMOKING, *PREGNANT women
Abstract

Aim: Using snus, an oral moist tobacco, has increased among pregnant women in Sweden, the only European Union country where sales are legal. This study evaluated whether snus generated similar concentrations of nicotine and its metabolites in breastmilk to cigarette smoking. Methods: We analysed 49 breastmilk samples from 33 nursing mother – 13 snus users, six cigarette smokers and 14 controls – for concentrations of nicotine, cotinine and 3‐hydroxycotinine. The mothers were recruited at antenatal clinics in Sweden from 2007 to 2012. Results: The median nicotine concentration in breastmilk of the snus users was 38.7 ng/mL (0–137) versus 24.0 ng/mL (0–56) in smokers, with median cotinine levels of 327.6 ng/mL (37–958) versus 164.4 ng/mL and median 3‐hydroxycotinine levels of 202.7 ng/mL (28–452) versus 112.4 (0–231), respectively. Nicotine was still detected in the breastmilk of eight of the 13 snus users after abstaining from tobacco for a median duration of 11 hours (0.6–12.5), while the breastmilk of the smokers was nicotine‐free after four hours' abstinence. Conclusion: Snus users had high levels of nicotine and metabolites in their breastmilk and nicotine was found even after 12.5 hours of abstinence. [ABSTRACT FROM AUTHOR]

Published
2019
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20. Long-term survival in children with atrioventricular septal defect and common atrioventricular valvar orifice in Sweden

Author

Frid, Christina, Björkhem, Gudrun, Jonzon, Anders, Sunnegårdh, Jan, Annerén, Göran, Lundell, Bo, Frid, Christina, Björkhem, Gudrun, Jonzon, Anders, Sunnegårdh, Jan, Annerén, Göran, and Lundell, Bo

Abstract

BACKGROUND: The survival for patients with atrioventricular septal defect has improved markedly over the last decades and, during the same period, the survival of children with Down's syndrome has also increased. The aim of our study was to investigate long-term survival in patients having atrioventricular septal defect with common valvar orifice, but without associated significant congenital heart defects, in the setting of Down's syndrome, comparing the findings to those in chromosomally normal children with the same malformation. METHODS AND RESULTS: In a population-based retrospective study, we scrutinised the medical records from 801 liveborn children with atrioventricular septal defect born in Sweden during the period 1973 through 1997. Data on gender, presence or absence of Down's syndrome, associated congenital heart defects, date of birth, operation and death were recorded and followed up until 2001. An isolated atrioventricular septal defect with common atrioventricular valvar orifice was present in 502 children, of whom 86% had Down's syndrome. We found a significant reduc tion over time in age at operation, and in postoperative mortality at 30 days, from 28 to 1%. Using a multiple logistic regression model, we found no significant differences in mortality between genders, nor between those with or without Down's syndrome. Early corrective surgery could not be identified as a significant independent factor for survival. The 5-year postoperative survival in patients with Down's syndrome increased from 65% over the period from 1973 through 1977, to about 90% in the period 1993 through 1997, and the same trend was observed in chromosomally normal patients. CONCLUSIONS: Survival in uncomplicated atrioventricular septal defect with common atrioventricular valvar orifice has greatly increased, and surgical correction is now equally successful in patients with Down's syndrome and chromosomally normal patients, and for both genders. Death in connection with surge

Published
2004

22. Mortality in Down's syndrome in relation to congenital malformations

Author

Frid, Christina, Drott, Peder, Lundell, Bo, Rasmussen, Finn, Annerén, Göran, Frid, Christina, Drott, Peder, Lundell, Bo, Rasmussen, Finn, and Annerén, Göran

Abstract

Down's syndrome (DS) is the most common form of intellectual disability. The syndrome is characterized by congenital malformations, especially of the heart and gastrointestinal tract, which can result in high mortality rates in the affected population. Many improvements have been made in the medical treatment of this syndrome during the past few decades and the survival of individuals with DS has increased in the industrial world. The aim of the present study was to investigate mortality in relation to congenital malformations. Medical records from all liveborn children with DS delivered between 1973 and 1980 in northern Sweden were studied, and malformations and causes of death were recorded. Out of the 219 children included in the study, a congenital heart defect was reported in 47.5% of subjects, 42.1% of whom had complete atrioventricular septal defect. Gastrointestinal tract malformations were present in 7.3% of subjects, and was frequently associated with a cardiac malformation and a very high mortality rate. Other major and minor congenital anomalies were present in 5.5% and 5.5% of subjects, respectively. In the 14.5-year follow-up of 213 children, the rate of survival was 75.6%. Mortality rates within one and 10 years after birth were 14.6% and 23.5%, respectively. Mortality within 10 years differed significantly between children with (44.1%) and without (4.5%) a congenital heart defect. A very high mortality rate was observed among children with a congenital heart defect, especially when it was combined with a gastrointestinal malformation.

Published
1999

27. Magnetic resonance imaging and echocardiography in assessment of ventricular function in atrially corrected transposition of the great arteries.

Author

Lidegran, Marika, Odhner, Lena, Jacobsson, Lilly Ann, Greitz, Dan, Lundell, Bo, Lidegran, M, Odhner, L, Jacobsson, L A, Greitz, D, and Lundell, B

Subjects
TRANSPOSITION of great vessels, ECHOCARDIOGRAPHY, HEART ventricle diseases, CLINICAL trials, COMPARATIVE studies, DOPPLER echocardiography, LEFT heart ventricle, RIGHT heart ventricle, CARDIAC surgery, HEART atrium, LONGITUDINAL method, MAGNETIC resonance imaging, RESEARCH methodology, MEDICAL cooperation, PATIENT monitoring, PROBABILITY theory, RESEARCH, SURGICAL complications, EVALUATION research, RANDOMIZED controlled trials, DISEASE complications
Abstract

Objective: Patients with atrial correction of transposition of the great arteries (TGA) may develop right ventricular (RV) failure with time. A reliable non-invasive method for assessment of ventricular function is therefore needed. To evaluate the accuracy of echocardiography in assessment of ventricular volumes and function in these patients we compared echocardiography with magnetic resonance imaging (MRI) in 10 patients late after the Mustard and Senning procedures.Design: Prospective echocardiography and MRI examinations were performed on the same day. Two different echocardiography technicians examined all patients. All echocardiography and MRI examinations were performed at the university hospital outpatient clinic and MRI department respectively. Ten patients, age 14.0+/-2.9 years, who had been operated on with atrial correction of TGA at 8 (2-60) months of age (median and range) were examined. Echocardiography RV and left ventricular (LV) end-systolic volumes (ESVs), end-diastolic volumes (EDVs), stroke volumes (SVs) and ejection fractions (EFs) were calculated, using the modified Simpson method, and compared with the same measurements obtained from MRI.Results: For RV function there was good agreement between echocardiography- and MRI-derived measurements. Both echocardiography and MRI revealed reduced RV function with EFs of 42.6+/-9.1% and 46.4+/-7.2% respectively. For RV volumes there were no significant differences between echocardiography and MRI. LV function was significantly overestimated by echocardiography (EF with echocardiography = 72.7+/-4.4% vs. MRI = 50.5+/-7.6%) while all LV volumes were greatly underestimated. Echocardiography measurements of volumes in repeated examinations by different technicians showed large variations, 13-50%, for different variables in individual patients.Conclusion: Echocardiography can provide clinically important information concerning RV function in follow-up of patients late after atrial correction of TGA. It has limited value in assessment of LV function in these patients. Volume measurements by echocardiography are, however, highly user-dependent and interobserver variation is high. MRI may accordingly serve as an important reference method in individual patients. [ABSTRACT FROM AUTHOR]

Published
2000
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29. Early Postnatal Changes in Intracranial Arterial Blood Flow Velocities in Term Infants

Author

SONESSON, SVEN-ERIK, WINBERG, PER, and LUNDELL, BO P W

Abstract

A range-gated Doppler technique was used to assess intracranial arterial blood flow velocity changes in 20 healthy term infants during the first 3 days after birth. Systolic, diastolic, and mean flow velocity decreased during the first 30 min after birth whereas arterial pressure and heart rate did not change. Mean flow velocity did not change from 30 min to 72 h of life, although systolic and diastolic flow velocity changed in opposite directions. Systolic flow velocity increased to 2 h of age and thereafter decreased. Diastolic flow velocity decreased to a minimum value at 2 h and thereafter increased to 24 h of age. These flow velocity changes suggest an initial decrease in cerebral perfusion, followed by a constant cerebral blood flow during normal circulatory transition after birth

Published
1987

30. Tonsillar Hyperplasia in Children: A Cause of Obstructive Sleep Apneas, CO2 Retention, and Retarded Growth

Author

Lind, Magnus G. and Lundell, Bo P. W.

Abstract

• Tonsillar hyperplasia causing obstructive sleep apneas in children is a well-defined clinical entity with nocturnal CO2 retention, retarded growth, and impaired physical and psychological status. Pulmonary hypertension, cor pulmonale, and ultimately, death may develop in a small number of these children. This syndrome may also develop in children with only moderately enlarged tonsils in association with neuromuscular hypothonia or anatomical defects. Anamnesis will readily detect the children at risk. The syndrome is cured completely by tonsillectomy. The CO2 retention disappears and length and weight growths are accelerated after surgery.(Arch Otolaryngol 1982;108:650-654)

Published
1982
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35. [Improved prenatal diagnosis of congenital heart defects. A follow-up study of prenatal ultrasound screening].

Author

Bergman G, Borgström E, Lundell B, and Sonesson SE

Subjects
Echocardiography methods, Echocardiography standards, Echocardiography statistics & numerical data, Female, Follow-Up Studies, Gestational Age, Humans, Pregnancy, Pregnancy Outcome, Retrospective Studies, Heart Defects, Congenital diagnostic imaging, Ultrasonography, Prenatal methods, Ultrasonography, Prenatal standards, Ultrasonography, Prenatal statistics & numerical data
Published
2008

36. [Pediatric cardiology--a Swedish matter].

Author

Lundell B

Subjects
Child, Heart Function Tests history, Heart Function Tests methods, History, 20th Century, Humans, Prenatal Diagnosis, Sweden epidemiology, Cardiology history, Cardiology trends, Heart Defects, Congenital diagnosis, Heart Defects, Congenital genetics, Heart Defects, Congenital mortality, Heart Defects, Congenital therapy, Pediatrics history, Pediatrics trends
Published
2005

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