ORLANDO — Abnormalities in cardiac size and shape were significantly improved following gastric bypass surgery and weight loss in a series of 33 morbidly obese adolescents.
This finding suggests that early intervention with bariatric surgery may be particularly beneficial in obese adolescents because it can normalize cardiac abnormalities early in life and may thereby reduce the long-term risk of heart disease, Dr. Holly M. Ippisch said while presenting a poster at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.
Although the adolescents remained obese following surgery, after an average 9 months of follow-up their body mass index (BMI) fell from 60 kg/m
Gastric bypass surgery for morbidly obese teens was first reported in 1994, and began at Cincinnati Children's Hospital in 2001. The surgery has been slow to be adopted as a routine procedure in the United States, Dr. Ippisch said in an interview. For example, in 2004, about 350 surgeries were done throughout America, although it's estimated that more than 400,000 American adolescents have a BMI of 40 kg/m
Another criterion for considering gastric bypass in an adolescent is their need to already have a mature skeleton, because bypass may affect calcium absorption. Most teens who are morbidly obese fulfill this because their high weight speeds their skeletal development. A psychologic assessment is also used to assess an adolescent's ability to deal with the surgery, and their likely commitment to compliance with their limited diet and vitamin supplements after surgery.
The 25 girls and 8 boys who underwent bariatric surgery at Cincinnati Children's since 2001 ranged in age from 13 to 18 years, with an average age of 16. By 9 months after surgery, they also had significant improvements in heart rate, systolic blood pressure, left ventricular mass index, and left ventricular wall thickness (see table).
Prior to surgery, about 30% of the patients had concentric left ventricular hypertrophy, about 20% had eccentric hypertrophy, and about 10% had concentric remodeling; the remaining 40% had a normal left ventricular shape. At follow-up, all three types of structurally abnormalities had substantially resolved. Overall, about 20% of the treated patients still had an abnormally shaped left-ventricle 9 months after their surgery.
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