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J Thorac Cardiovasc Surg 1994;107:374-0380
© 1994 Mosby, Inc.

Surgery for Congenital Heart Disease

Energy expenditure in children with congenital heart disease, before and after cardiac surgery

Glasgow, Scotland, and Cambridge, England

Sponsored by, D. J. Wheatley, MD

Glasgow, Scotland

Funded by grants from the Association for Children with Heart Disorders and the Greater Glasgow Health Board Research Support Group.

Read at the Seventy-third Annual Meeting of The American Association for Thoracic Surgery, Chicago, Ill., April 25-28, 1993.

Address for reprints: Ian M. Mitchell, FRCS, Department of Cardiac Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, England.

Abstract

Failure to thrive is a common feature of children with congenital heart disease. Whether this is the result of poor nutrition or an abnormally high basal metabolic rate is unknown, yet the state of nutrition has a profound effect on the metabolic response to injury and strongly influences the outcome of surgical treatment. The aim of this study was therefore to measure the preoperative and postoperative energy requirements of children with congenital heart disease. Eighteen children (aged 4 to 33 months) were given two oral doses of doubly labeled water (H₂¹⁸O and²H₂O), the first 1 week before operation and the second 6 hours after the end of cardiac surgery. By measuring the relative loss of each isotope from the body water pool, we were able to calculate the rate of carbon dioxide production and therefore total energy expenditure. In five patients, energy expenditure was clearly elevated, suggesting that a raised basal metabolic rate is an important factor in the observed failure to thrive in at least a proportion of such children. Postoperatively, energy expenditure fell to values below normal for healthy children (not having an operation), which suggests that the stress of surgery leads to smaller energy requirements than have previously been thought. (J THORAC CARDIOVASC SURG 1994;107:374-80)

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