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Outcome of muscle and bone development in congenital heart disease

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Muscles and bones of patients with congenital heart disease (CHD) are subject to various potentially deleterious influences during growth. The aim of the present study was to analyse the outcome of bone and muscle parameters in adolescents and young adults with a spectrum of CHD. Bone and muscle parameters of the forearm were examined at two standard sites, 4% and 65%, in 29 adolescents and young adults with CHD, aged 14–24 years, by quantitative computed tomography. For the entire study population, bone and muscle parameters did not deviate significantly from the reference values except for age- and gender-corrected body height (ASDS-height: −0.6±1.2, p=0.01). Both age- and gender- and height- and gender-corrected (HSDS) abnormal bone mass (BMC) was found at the distal radius in patients with Fontan repair (ASDS-BMC4%:−1.5±0.9, p=0.008; HSDS-BMC4%:−1.2±1.0, p=0.05) and in those in NYHA class III (ASDS-BMC4%:−1.3±0.4, p=0.001; HSDS-BMC4%:−1.4±0.5, p=0.004). There was minimal overlap between Fontan patients (n=6) and NYHA class III (5 Fontan patients were in NYHA class I or II). In conclusion, most patients with CHD show a normal muscle and bone development in proportion to their reduced body height. Further follow-up is required to determine whether patients in a worse clinical status (NYHA III) and those with single ventricle physiology are at increased risk of osteoporosis and fractures.

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Fig. 1
Fig. 2



Age and sex-specific standard deviation score


Bone mass at the 4%-measuring point


Ratio of bone mass at the 65%-measuring point and muscle cross-sectional area


Trabecular volumetric bone mineral density at the 4%-measuring point


Complex acyanotic heart disease


Complex cyanotic heart disease with no surgery or only palliation


Complex cyanotic heart disease anatomically or functionally corrected


Congenital heart disease


Dual energy x-ray absorptiometry


Body height and sex-specific standard deviation score


Isolated defects


Muscle cross-sectional area


Peripheral quantitative computed tomography


Bone strength strain index at the 65%-measuring point


Transcutaneous oxygen saturation


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We thank the Cologne Fortune Program, Faculty of Medicine, University of Cologne for financial support. The authors are gratefully indebted to Barbara Tutlewski and Angelika Stabrey for their continuing support and help.

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Correspondence to Cordelia Witzel.

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The research reported here has been supported by the Cologne Fortune Programme, Faculty of Medicine, University of Cologne.

None of the authors have any potential, perceived, or real conflicts of interest, especially any financial arrangement, with a company whose product is mentioned in this manuscript.

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Witzel, C., Sreeram, N., Coburger, S. et al. Outcome of muscle and bone development in congenital heart disease. Eur J Pediatr 165, 168–174 (2006). https://doi.org/10.1007/s00431-005-0030-y

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  • Adolescents
  • Young adults
  • Osteoporosis
  • Peripheral quantitative computed tomography