PubMed Health⌕ Search

Biomedical subjects

S D Colan

Publications and source records attributed to S D Colan.

At least 145 records · Page 8Linked to original sources
PubMed1985

Use of the calibrated carotid pulse tracing for calculation of left ventricular pressure and wall stress throughout ejection.

Calibrated carotid pulse tracings have been found previously to provide accurate estimates of end-systolic pressure. This study extends this technique to the estimation of arterial pressure throughout ejection. In twenty patients without aortic stenosis (age range 8 to 67 years), simultaneous recordings were made of the pressure tracing in the ascending aorta, externally recorded carotid pulse tracing, phonocardiogram, left ventricular echocardiogram, and peripheral blood pressure. Data were computer digitized and plots of arterial pressure were derived from the aortic pressure tracing (PA) and from the carotid pulse tracing (Pc). Left ventricular (LV) wall stress was then calculated throughout ejection using PA or Pc. The noninvasive estimation of pressure was excellent, with a maximum difference of 3.4 mm Hg between population means. This occurred within the first third of ejection. The wall stress calculations were similar, with a maximum mean population error of 3.5 gm/cm2 at 20% of ejection. The peak wall stress values had a mean difference of 1.4 gm/cm2; mean wall stress over the LV ejection period was 0.5 gm/cm2 higher when calculated from Pc than from PA. Thus, the carotid pulse tracing provides an accurate reproduction of the morphology of the pressure tracing recorded from the ascending aorta, and when calibrated by peripheral blood pressure measurement, it can be used to calculate LV pressure throughout ejection. These pressure estimates can be used to calculate wall stress throughout ejection with a high degree of accuracy.

Adolescent↗
PubMed1985

Early diastolic left ventricular function in children and adults with aortic stenosis.

Pressure overload hypertrophy of the left ventricle is associated with abnormal left ventricular early diastolic filling. The roles of the extent of cardiac hypertrophy, depressed left ventricular systolic function and aging in the pathogenesis of left ventricular diastolic dysfunction have not, however, been fully defined. To determine the relative importance of these factors in the pathogenesis of diastolic dysfunction in pressure overload hypertrophy, 16 children and 25 adults with aortic stenosis were compared with 48 normal children and adults, using rates of left ventricular early diastolic filling and wall thinning derived from M-mode echocardiography. Left ventricular early diastolic filling and wall thinning rates were significantly depressed in both children and adults with aortic stenosis as compared with values in normal subjects. Filling and thinning rates correlated negatively with age, left ventricular peak systolic pressure and wall thickness in all subjects. Furthermore, the effect of age on diastolic function appeared to be mediated by age-related increases in systolic pressure and wall thickness. In adults with aortic stenosis, early diastolic filling and wall thinning rates were depressed to a similar extent in subjects with normal and abnormal systolic function; thus, diastolic dysfunction does not appear to be a manifestation of abnormal systolic loading and ejection performance. These results suggest that extent of hypertrophy itself plays a dominant role in the mechanism of impaired left ventricular early diastolic filling in pressure overload due to aortic stenosis.

Adolescent↗
PubMed1985

Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy.

Left ventricular hypertrophy due to aortic stenosis, hypertension and other forms of heart disease is associated with abnormalities of diastolic function. It is uncertain whether these changes are an inherent consequence of the hypertrophic process or represent additional pathologic factors. To investigate this issue, echocardiographic indexes of left ventricular early diastolic function in highly trained athletes were compared with those in age-matched normal control subjects. Athletes were equally classified into two groups: 11 swimmers who had a pattern of myocardial hypertrophy with normal wall thickness to dimension ratio and 11 power lifters whose wall thickness to dimension ratio was increased. The peak rates of left ventricular dimension increase and wall thinning in swimmers and power lifters were greater than in control subjects despite significantly higher left ventricular wall thickness and left ventricular mass index in the athletes. This increase in diastolic function indexes was associated with greater ventricular size and systolic performance. Normalization of the peak rate of dimension increase for end-diastolic dimension and adjustment of the peak rate of wall thinning for the fractional systolic thickening resolved any differences between groups. Thus, after the effects of ventricular size and systolic function were taken into consideration, diastolic function was normal in these subjects with considerable physiologic hypertrophy. This is in contrast to the findings in patients with hypertrophy associated with left ventricular pressure or volume overload, and suggests that abnormalities of diastolic function seen in pathologic hypertrophy are due to factors other than cardiac hypertrophy itself.

Adolescent↗
PubMed1985

Two-dimensional echocardiographic findings in double orifice mitral valve.

Between December 1981 and April 1984, five children ranging in age from 1 month to 5 1/2 years examined by two-dimensional echocardiography appeared to have a double orifice mitral valve. The diagnosis was verified in one patient at surgery, one patient by angiography and one patient by necropsy. Associated malformations included mitral stenosis and regurgitation, coarctation of the aorta, ostium primum and secundum atrial septal defect, ventricular septal defect and hypoplastic left heart syndrome. Three varieties of double orifice mitral valve were observed: an incomplete bridge type (one patient), in which a small strand of tissue connected the anterior and posterior leaflets at the leaflet edge level; a complete bridge type (three patients), in which a fibrous bridge divided the atrioventricular orifice completely into equal or unequal parts and a hole type (one patient), in which an additional orifice with subvalvular apparatus occurred in the posterior commissure of the mitral valve. These three types could be distinguished by sweeping the transducer in cross-sectional view from the apex toward the base of the heart. Both orifices could be seen throughout the scan in the complete bridge type while in the incomplete bridge type the two orifices could be seen only at the level of the papillary muscles. In the hole type, the second orifice was seen at about midleaflet level. In all three types, the chordae surrounding each orifice attached to only one papillary muscle. Congenital mitral stenosis or regurgitation was evident in three patients. The type of the double orifice mitral valve did not predict the presence or severity of symptoms.

Child, Preschool↗
PubMed1985

Two-dimensional echocardiographic evaluation of right ventricular size and function in newborns with severe right ventricular outflow tract obstruction.

Critical pulmonary stenosis or atresia with intact ventricular septum represents a congenital cardiac lesion for which the long-term prognosis appears to depend partly on the size of the right ventricle. Thus, the capability of noninvasive assessment of right ventricular size to predict operative outcome was examined in 15 infants (aged 1 to 30 days, mean 5.6) with severe right ventricular outflow tract obstruction (either critical pulmonary stenosis [7 patients] or pulmonary atresia with intact ventricular septum [8 patients]). Using echocardiography in two orthogonal subxiphoid views, right ventricular volume, wall thickness, area change fraction, ejection fraction and tricuspid anulus dimension were measured. All patients with a normalized right ventricular enddiastolic volume of less than 5 ml/m2 and a normalized tricuspid anulus dimension of less than 1.0 cm/m2/3 required a shunt operation. Only one patient with a volume of more than 6 ml/m2 and a normalized tricuspid anulus dimension of more than 1.4 cm/m2/3 required more than relief of right ventricular outflow tract obstruction. In this patient, residual severe pulmonary stenosis necessitated the shunt procedure. One patient with a volume of more than 6 ml/m2 had an anulus diameter of less than 1.4 cm/m2/3 and one patient with an anulus diameter of more than 1.4 cm/m2/3 had a volume of less than 6 ml/m2; both required shunt procedures. It therefore appears that if either the ventricular volume or tricuspid anulus size is excessively small, a shunt procedure is necessary. Wall thickness, area change fraction and ejection fraction measurements were not significantly correlated with right ventricular volume or postoperative outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Volume↗
PubMed1985

Altered left ventricular mechanics in patients with valvular aortic stenosis and coarction of the aorta: effects on systolic performance and late outcome.

Despite similar degrees of left ventricular systolic hypertension shortening characteristics are usually greater in patients with congenital valvular aortic stenosis (VAS) than in patients with coarctation of the aorta (CoA). We hypothesized that these dissimilarities were caused by differences in myocardial mechanics rather than by alterations in contractile state. Eleven patients with VAS (ages 6 to 41 years) and 11 with CoA were matched for age, body surface area, and peak systolic ejection gradient. Results were compared with data from 22 normal subjects matched for age and body surface area. Echocardiographic tracings of the left ventricle were recorded in conjunction with left ventricular pressure measurements (VAS) or calibrated carotid pulse tracings (CoA and normal subjects). Peak and end-systolic wall stresses as well as left ventricular shortening fraction (% delta D) and rate-corrected velocity of fiber shortening (Vcfc) were calculated. No differences for left ventricular dimensions, heart rate or peak wall stress were present. Ventricular peak systolic pressures and wall mass were higher for the patients with VAS or CoA than for the normal subjects (p less than .001). These parameters did not differ between the VAS and CoA groups. The patients with VAS had higher % delta D and Vcfc than either the CoA or normal groups (p less than .01). Afterload, as quantified by end-systolic stress, was 41% lower than normal for the patients with VAS (p less than .001) and 13% higher than normal for those with CoA (p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Global and regional right ventricular function in normal infants and infants with transposition of the great arteries after Senning operation.

Echocardiographic assessment of right ventricular size, global function, and regional wall motion was performed in 29 normal infants and 19 infants with transposition of the great arteries 1 to 41 months after they underwent the Senning procedure. Sixteen of the patients with transposition of the great arteries were in clinically good condition and three had congestive heart failure. The right ventricular endocardial surface was digitized frame by frame for a complete cardiac cycle in both subxiphoid long-axis (coronal plane) and short-axis (parasagittal plane) views, and the cross-sectional area and the area change fraction (AF) were calculated. In each plane the right ventricular wall was subdivided into four anatomic regions (infundibular, free wall, diaphragmatic, and septal). With the use of a floating point center of mass model the direction and average extent of motion of the endocardium was determined for each region. In normal infants the infundibular and free wall portions of the right ventricle exhibited the greatest inward motion and the septal segments the least inward motion. Although the maximal area in both long-axis (r = .85) and short-axis (r = .85) views was highly correlated with body surface area (BSA), neither global nor regional function was significantly correlated with age or BSA. In clinically well patients after Senning procedure regional right ventricular function followed an entirely different pattern than that seen in normal infants. The endocardium of the septal segments showed the greatest inward motion in systole. In contrast to those in normal infants, maximal and minimal cross-sectional areas did not correlate significantly with BSA.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1984

Use of the indirect axillary pulse tracing for noninvasive determination of ejection time, upstroke time, and left ventricular wall stress throughout ejection in infants and young children.

The use of indirect axillary pulse tracings was investigated as an alternative method to record the carotid pulse in infants and young children. Simultaneous high-speed recordings of ascending aortic pressure and indirect axillary pulse tracings with noninvasive peripheral blood pressures were recorded in 30 young children (aged 1 day to 48 months, median 9 months) during cardiac catheterization. In 15 patients, simultaneous left ventricular (LV) M-mode echocardiograms and phonocardiograms were also performed. Systolic ejection time (SET) and the half-time of the pulse upstroke determined by both methods were compared. Computer analysis of digitized echocardiographic and pulse tracing data was used to generate plots of LV wall stress throughout ejection. Values for wall stress derived from calibrated indirect axillary pulse tracings were compared with those derived from central aortic pressure. SET calculated from axillary tracings was within 5% of the aortic value in 91% of cases, with a mean error for all subjects of -1 +/- 3%. The half-time of the pulse upstroke was within 15% of the aortic value in 91% of cases, with a mean error for all subjects of 6 +/- 12%. LV wall stress was compared at the onset of ejection, peak wall stress, midsystole, and endsystole for each patient, and 98% of values calculated from axillary data were within 10% of the wall stress values calculated from aortic pressure measurements. Thus, indirect axillary pulse tracings provide an excellent representation of the aortic pressure contour and can be used for accurate calculation of SET.(ABSTRACT TRUNCATED AT 250 WORDS)

Axillary Artery↗
PubMed1984

Combined fluid-filled and micromanometer-tip catheter system for high-fidelity pressure recordings in infants.

Investigation of pressure-derived indices of systolic and diastolic function in infants and young children has been limited, in part due to difficulty in obtaining high-fidelity pressure recordings. Standard fluid-filled catheter-manometer systems have a frequency response which is inadequate for this purpose, whereas high-frequency response micromanometer-tip catheters systems are difficult to use in this age group. Therefore, a system was investigated whereby a micromanometer-tip catheter (Millar) was connected directly to a standard pigtail catheter. The frequency response of this combined system was defined using 3.2 Fr pigtails of 40, 50, and 65 cm, 4.0 Fr pigtails of 50, 65, and 80 cm, and 5.0 Fr pigtails of 80 and 100 cm. In three different catheters of each diameter and length, minimal variation in response was seen. The 3.2 Fr-40-cm system demonstrated a flat line (100%) response to 90 Hz with a resonant frequency of 130 Hz. This is certainly adequate for determination of pressure derivatives for heart rates up to 120 beats per minute. The longer 3.2 Fr catheters demonstrated a poorer frequency response. The 4.0-Fr-50-cm system was flat line to 60 Hz, rising to 175% response at the resonant frequency of 85 Hz. This is adequate for determination of pressure derivatives at heart rates up to 120 beats per minute. Increasing the diameter or length of the pigtail catheter resulted in further deterioration of the frequency response. Thus, this system provides high-fidelity tracings suitable for assessment of pressure-derived indices of systolic and diastolic function in infants and young children.

Blood Pressure↗
PubMed1984

Incidence and significance of primary abnormalities of cardiac rhythm in infants at high risk for sudden infant death syndrome.

The exact relationship between cardiac arrhythmias and sudden infant death syndrome (SIDS) is uncertain. Several reports have implicated both ventricular and supraventricular arrhythmias in isolated cases, but there have been no studies of the incidence or type of arrhythmias that occur in populations at risk for SIDS. Of 1699 infants at high risk for SIDS, 60 (4%) were found to have a primary cardiac arrhythmia (i.e., not associated with disordered respiration or apnea). The incidence of atrial and ventricular premature beats, supraventricular tachycardia, and Wolff-Parkinson-White syndrome was similar to the incidence found in normal infants. Primary bradycardia (defined as a heart rate less than 60 for greater than 10 s not associated with abnormal respiration) was the most common arrhythmia, occurring with a frequency and severity not seen in normal infants. Thirty-two infants experienced periodic bradycardia. In 19 of these latter infants, there were symptoms associated with these bradyarrhythmias that necessitated treatment. Heart rates as low as 20 beats/min were recorded. One infant presented with an episode of ventricular fibrillation and on further evaluation was noted to have recurrent bradyarrhythmias. In no infant was there abnormal prolongation of the QT interval. Primary bradyarrhythmias are seen at an increased incidence in infants at high risk for SIDS and may play a causal role in this syndrome. Most symptomatic infants can be adequately controlled with sympathomimetic or parasympatholytic therapy. Other cardiac arrhythmias occur at a rate similar to that in normal infants and are therefore unlikely to play a major role in SIDS.

Arrhythmias, Cardiac↗
PubMed1984

Left ventricular end-systolic wall stress-velocity of fiber shortening relation: a load-independent index of myocardial contractility.

The velocity of circumferential fiber shortening (Vcf) is an index of myocardial performance which, although sensitive to contractile state, has limited usefulness because of its dependence on left ventricular loading conditions. This study investigated the degree and velocity of left ventricular fiber shortening as it relates to wall stress in an attempt to develop an index of contractility that is independent of preload and heart rate while incorporating afterload. Studies were performed in 78 normal subjects using M-mode echocardiography, phonocardiography and indirect carotid pulse tracings under baseline conditions. In addition, studies were performed on 25 subjects during afterload augmentation with methoxamine, 8 subjects before and during afterload challenge after increased preload with dextran and 7 subjects with enhanced left ventricular contractility with dobutamine. The relation of end-systolic stress to the velocity of fiber shortening and to the rate-corrected velocity of shortening (corrected by normalization to an RR interval of 1) was inversely linear with correlation coefficients of -0.72 and -0.84, respectively. Alterations in afterload, preload or a combination of the two did not significantly affect the end-systolic wall stress/rate-corrected velocity of shortening relation, whereas during inotropic stimulation, the values were higher, with 94% of the data points above the normal range. Age did not appear to affect the range of normal values for this index. In contrast, the end-systolic wall stress/fractional shortening relation was not independent of preload status, responding in a manner similar to that seen with a positive inotropic intervention. Thus, the velocity of circumferential fiber shortening normalized for heart rate is inversely related to end-systolic wall stress in a linear fashion. Accurate quantitation can be performed by noninvasive means and a range of normal values determined. This index is a sensitive measure of contractile state that is independent of preload, normalized for heart rate and incorporates afterload. In contrast, the end-systolic wall stress/fractional shortening relation is dependent on end-diastolic fiber length in the range of physiologically relevant changes in preload.

Adolescent↗
PubMed1983

Effects of enhanced afterload (methoxamine) and contractile state (dobutamine) on the left ventricular late-systolic wall stress-dimension relation.

Although the left ventricular (LV) end-systolic pressure-dimension relation is a load-independent, sensitive index of contractile state, its accurate determination requires afterload manipulation. The slope value of the late-systolic stress-dimension relation determined under resting conditions has been suggested as an alternative index of contractility that can be assessed without pharmacologic intervention. To evaluate this relation, 14 normal subjects were studied by M-mode echocardiography, phonocardiography and indirect carotid pulse tracings during infusion of methoxamine to increase afterload. Seven of these subjects were also studied after infusion of dobutamine to increase contractility. Continuous systolic stress-dimension trajectories were computer generated from digitized tracings. The late-systolic portions of these curves were found to be linear and the slope and intercept were determined. The slope value was sensitive to both afterload and contractility, and the magnitude of change in slope value was relatively greater during afterload enhancement than during inotropic stimulation. A strong correlation of slope value with peak systolic stress was found. Thus, the late-systolic stress-dimension relation is linear with a slope value which is dependent on both LV contractility and afterload. Like other ejection phase indexes, the usefulness of this index is limited by its inability to distinguish changes in contractile state from alterations in loading conditions.

Adolescent↗
PubMed1983

Noninvasive determination of systolic, diastolic and end-systolic blood pressure in neonates, infants and young children: comparison with central aortic pressure measurements.

Noninvasive determinations of systolic and diastolic blood pressure using the oscillometric method for pressure measurement were combined with externally recorded axillary pulse tracings to estimate end-systolic pressure in 32 neonates, infants and young children. Results were compared with central aortic pressure measurements made at the time of central aortic catheter placement. Studies were performed in patients aged 1 day to 48 months who weighed 0.9 to 18.1 kg. A wide range of systolic (41 to 141 mm Hg), diastolic (22 to 73 mm Hg) and end-systolic (30 to 111 mm Hg) pressure values were found. The mean absolute pressure differences and percent errors (pressure difference divided by central aortic pressure) were 1.8 mm Hg and 2.5% for systolic, 0.8 mm Hg and 0.8% for diastolic and 1.4 mm Hg and 2.1% for end-systolic pressure. No correlation was noted between percent error and age, weight, heart rate, cardiac index or systemic vascular resistance. The ability to perform reliable noninvasive pressure measurements should prove invaluable for clinical and research purposes. In addition, this method of end-systolic blood pressure determination enables sensitive indexes of left ventricular contractility to be measured noninvasively in small children.

Aorta↗
PubMed1982

Multifocal or chaotic atrial rhythm: report of nine infants, delineation of clinical course and management, and review of the literature.

Nine infants with episodic or continuous chaotic atrial rhythm (CAR) are presented. In addition to 3 or more different P-wave contours, atrial rates greater than 100 per minute, variable PP, RR, and PR intervals, and a discrete isoelectric baseline, findings included atrial rates that varied from a low of 50 to 120 to a high of 140 to 270 per minute, ventricular rates that varied from a low of 40 to 50 to a high of 180 to 270 per minute, and periodic sinus arrest with junctional escape rhythm. Except for the arrhythmia, all had a normal cardiac examination, ECG, chest x-ray film, and echocardiogram. Six infants were otherwise normal; one had an orbital rhabdomyosarcoma; one had neonatal asphyxia; and one had respiratory distress, bronchopulmonary dysplasia, and an intraventricular cerebral hemorrhage. The CAR persisted from 3 days to 20 months; it spontaneously reverted to normal sinus rhythm in 8 infants and persists in 1 infant at age 7 months. Digoxin (4 patients), propranolol hydrochloride (3 patients), quinidine sulfate (2 patients), and lidocaine (1 patient) did not alter the CAR. No patient had heart failure secondary to the CAR, although three also had episodes of sustained atrial tachycardia, which while present caused heart failure. All patients are functioning normally at home and have normal findings on cardiac examination and have normal ECGs at ages 3 to 38 months. Seven are in normal sinus rhythm, one has rare atrial premature contractions, and one has persistent CAR. We conclude that specific treatment was not necessary in these infants with CAR, except in those with associated sustained atrial tachycardia, which itself may cause heart failure.

Anti-Arrhythmia Agents↗
PubMedDate not supplied

Electrocardiography and 24-hour electrocardiographic ambulatory recording (Holter monitor) studies in children infected with human immunodeficiency virus type 1. The Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV-1 Infection Study Group.

Limited data are available on the electrocardiogram and ambulatory electrocardiogram recording (Holter) in children infected with the human immunodeficiency virus type 1 (HIV-1). The purpose of this study was to estimate the prevalence and cumulative incidence of rhythm and conduction abnormalities in HIV-1-infected children. Electrocardiograms and Holter monitoring studies were performed annually on 205 HIV-1-infected children enrolled after 28 days of life (group I), 93 HIV-1-infected infants enrolled during pregnancy or during the first 28 days of life (group IIa), and 463 HIV-1-uninfected infants enrolled during pregnancy or during the first 28 days of life (group IIb). The 5-year cumulative incidence in the group I children of second-degree atrioventricular block or supraventricular or ventricular tachycardia was 13.4%, and the 5-year incidence was higher for the older infected group I children (16.8% for children > or =4 years old at first study and 11.4% for children <4 years, p = 0.04). The mean corrected QT interval was also longer for the older infected group I children (p = 0.002) and prolonged in the HIV-1-infected compared to the HIV-1-uninfected group II children (p = 0.02). None of the children had atrial fibrillation or flutter. Arrhythmias are uncommon in children infected with HIV-1 and in children of HIV-1-infected mothers and the arrhythmias identified tend to be benign. Therefore, routine Holter monitoring does not appear to be indicated in asymptomatic children.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Utility of intraoperative transesophageal echocardiography in the assessment of residual cardiac defects.

To investigate the accuracy of immediate postbypass transesophageal echocardiography in the assessment of residual cardiac defects, we compared intraoperative transesophageal echocardiograms with intra/postoperative data in 86 patients, aged 4 days to 30.7 years (median = 1.4 years), at risk for a total of 174 postoperative lesions: right (n = 55) or left (n = 26) ventricular outflow tract obstruction, ventricular septal defect (n = 65), aortic (n = 12) or mitral regurgitation (n = 8), or mitral stenosis (n = 8). Accuracy of intraoperative transesophageal echocardiography was evaluated based on comparison with (1) immediate post-bypass left (n = 4) or right (n = 9) ventricular outflow tract pressure gradients by pullback in the operating room, (2) direct surgical inspection of residual ventricular septal defects (n = 3), (3) pulmonary artery oxygen saturation (n = 49), (4) right ventricular outflow tract pullback gradient (n = 24), and (5) transthoracic echocardiogram (n = 51) performed within 40 days of surgery. The results indicate that intraoperative transesophageal echocardiography agreed with intra/postoperative data in 87% of patients at risk for right ventricular outflow tract obstruction, 96% at risk for left ventricular outflow tract obstruction, 97% at risk for ventricular septal defect, and 100% at risk for aortic regurgitation, mitral regurgitation, or mitral stenosis. Significant residual lesions led to immediate surgical revision in 11 cases: 3 ventricular septal defects, 6 right and 2 left ventricular outflow tract obstructions. Of these, intraoperative transesophageal echocardiography confirmed and quantified suspected residual lesions in 7 and identified unsuspected lesions in 4 cases. Immediate postbypass transesophageal echocardiography proved reliable for assessing residual ventricular septal defect, mitral stenosis, and mitral or aortic regurgitation. Although accurate for assessment of the left and right ventricular outflow tracts in most patients, transesophageal echocardiography may not reliably reflect the severity of obstruction in all cases.

Adolescent↗
PubMedDate not supplied

Cardiac, aortic, and pulmonary arteriopathy in HIV-infected children: the Prospective P2C2 HIV Multicenter Study.

Arteriopathy in human immunodeficiency virus (HIV)-infected patients is being increasingly recognized, especially in children. However, few studies have histologically evaluated the coronary arteries in HIV-infected children, and none have systematically assessed the aorta and pulmonary arteries. The coronary arteries, thoracic aorta, and the main and branch pulmonary arteries from the postmortem hearts of 14 HIV-infected children were systematically reviewed for vasculopathic lesions and compared with 14 age-matched controls. Findings from the HIV-infected children were compared with clinical, laboratory, and other postmortem findings. Coronary arteriopathy, seen in seven (50%) of the HIV-infected children, was primarily calcific, and it was associated with decreased CD3 and CD4 peripheral blood counts. Large vessel arteriopathy, seen in 9 (64%) of the 14 HIV-infected children, was primarily centered on the vasa vasorum and consisted mainly of medial hypertrophy and chronic inflammation. Large vessel lesions were associated with increased left ventricular mass z-scores (P = 0.02), and 78% of patients with large vessel arteriopathy had postmortem cardiomegaly. Coronary and large vessel arteriopathies are common in pediatric HIV-infection and have different clinicopathologic features suggesting different pathogenesis.

Aorta↗