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J Thorac Cardiovasc Surg 2004;128:7-10
© 2004 The American Association for Thoracic Surgery

Editorial

Gender differences in pediatric cardiac surgery: The cardiologist's perspective

^a Department of Anesthesiology and Pediatrics (Cardiology), Baylor College of Medicine, Houston, Tex, USA
^b Department of Pediatrics (Cardiology), University of California, San Francisco, Calif, USA

Received for publication March 30, 2004; revisions received April 6, 2004; accepted for publication April 16, 2004.

^* Address for reprints: Wanda C. Miller-Hance, MD, Baylor College of Medicine, SM1003, One Baylor Plaza, Houston, TX 77030, USA
wmh@bcm.tmc.edu

The first 300 words of the full text of this article appear below.

There is much evidence that gender differences become manifest very early in life; in fact, they may begin before life. Sperm carrying the X chromosome differ in motility from the Y chromosome–bearing sperm.^1,2 Once the ovum is fertilized, genetically normal male fetuses have a higher death rate than female fetuses.³ Neonatologists have long noted gender differences in their practice. Boys are more likely to be delivered prematurely.⁴ Deaths resulting from respiratory distress syndrome⁵ and neonatal neurologic complications⁶ are greater for boys. Preterm girls have higher levels of beneficial catecholamines than boys,⁷ and this may account for their better outcomes.

Despite these indications that gender may affect the impact of disease in children, investigations into gender influences in congenital heart disease (CHD) are sparse. When compared with information on gender differences in adult acquired heart disease incidence, treatment, and outcome, there is a relative dearth of information regarding these data in congenital or acquired heart disease in children. The reason for this is likely due to multiple factors and is probably broader than the assumption that before adolescence, the cardiovascular physiology is unaffected by gender. For instance, the delay in diagnosis and treatment in women with ischemic heart disease that was so well documented in the 1990s is not likely to be found in infant girls with significant heart disease, because the presentation of CHD is often quite objective. Treatment in adult cardiology may have been biased in the past by exclusion of women from randomized drug trials, yet prospective clinical trials are much less common in pediatric cardiology⁸ for many reasons, including small numbers of patients, lack of treatment uniformity both between centers and over time within centers, and the need for multicenter trials. When a prospective clinical trial is performed, patient recruitment is difficult enough that exclusion of one . . . [Full Text of this Article]