51
|
Ebert AK, Zwink N, Jenetzky E, Stein R, Boemers TM, Lacher M, Fortmann C, Obermayr F, Fisch M, Mortazawi K, Schmiedeke E, Eisenschmidt V, Schäfer M, Hirsch K, Rösch WH, Reutter H. Association Between Exstrophy-epispadias Complex And Congenital Anomalies: A German Multicenter Study. Urology 2019; 123:210-220. [DOI: 10.1016/j.urology.2018.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/29/2018] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
|
52
|
Stöcker F, Neidenbach R, Fritz C, Oberhoffer RM, Ewert P, Hager A, Nagdyman N. Oxygen Availability in Respiratory Muscles During Exercise in Children Following Fontan Operation. Front Pediatr 2019; 7:96. [PMID: 30972311 PMCID: PMC6443956 DOI: 10.3389/fped.2019.00096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: As survival of previously considered as lethal congenital heart disease forms is the case in our days, issues regarding quality of life including sport and daily activities emerge. In patients with Fontan circulation, there is no pump to propel blood into the pulmonary arteries since the systemic veins are directly connected to the pulmonary arteries. The complex hemodynamics of Fontan circulation include atrial function, peripheral muscle pump, integrity of the atrioventricular valve, absence of restrictive, or obstructive pulmonary lung function. Therefore, thoracic mechanics are of particular importance within the complex hemodynamics of Fontan circulation. Methods: To understand the physiology of respiratory muscles, the aim of this study was to examine the matching of auxiliary respiratory muscle oxygen delivery and utilization during incremental exercise in young male Fontan patients (n = 22, age = 12.04 ± 2.51) and healthy Controls (n = 10, age = 14.90 ± 2.23). All subjects underwent a cardiopulmonary exercise test (CPET) to exhaustion whereas respiratory muscle oxygenation was measured non-invasively using a near-infrared spectrometer (NIRS). Results: CPET revealed significantly lower peak power output, oxygen uptake and breath activity in Fontan patients. The onset of respiratory muscle deoxygenation was significantly earlier. The matching of local muscle perfusion to oxygen demand was significantly worse in Fontans between 50 and 90% V . O 2 peak . Findings: The results indicate that (a) there is high strain on respiratory muscles during incremental cycling exercise and (b) auxiliary respiratory muscles are worse perfused in patients who underwent a Fontan procedure compared to healthy Controls. This might be indicative of a more general skeletal muscle strain and worse perfusion in Fontan patients rather than a localized-limited to thoracic muscles phenomenon.
Collapse
Affiliation(s)
- Fabian Stöcker
- Department for Sport and Health Sciences, Teaching and Educational Center, Technical University Munich, Munich, Germany
| | - Rhoia Neidenbach
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich, Germany
| | - Celina Fritz
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich, Germany
| | - Renate M Oberhoffer
- Department for Sport and Health Sciences, Chair of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich, Germany
| | - Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich, Germany
| |
Collapse
|
53
|
Congenital heart disease: New challenges. Rev Port Cardiol 2018; 37:933-934. [PMID: 30458974 DOI: 10.1016/j.repc.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
54
|
Santana I. Congenital heart disease: New challenges. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
55
|
Helm PC, Bauer UMM, Abdul-Khaliq H, Baumgartner H, Kramer HH, Schlensak C, Pickardt T, Kahlert AK, Hitz MP. Patients with congenital heart defect and their families support genetic heart research. CONGENIT HEART DIS 2018; 13:685-689. [PMID: 30272834 DOI: 10.1111/chd.12630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) affects up to 1% of live births the etiology remains relatively poorly understood. Thus, cardiac research is needed to understand the underlying pathomechanisms of the disease. About 51 000 CHD patients are registered in the German National Register for Congenital Heart Defects (NRCHD). Patients and relatives were interviewed online about their willingness to support genetic heart research in order to donate a biological sample. METHODS Study participants were recruited via the database of the NRCHD. Seven thousand nine hundred eighty-nine patients were invited to participate in the study. Participants have been asked to rate three questions on a ten-staged Likert scale about their willingness to provide a saliva/blood sample and their motivation to ask family members to support genetic heart research. RESULTS Overall, 2035 participants (patients/relatives) responded the online survey (25.5%). Two-thirds of the participants are willing to donate a saliva sample. Whereas the motivation to provide a blood sample is slightly lower (patients: 63.8%, relatives: 60.6%). Female relatives are more fain to provide a saliva sample as well as a blood sample compared to men (saliva sample: P < .001, blood sample: P < .01). The motivation to ask an additional family member for a biological sample was significantly higher in relatives (59.2%) compared to patients (48.4%). CONCLUSIONS The motivation to provide biological samples is high reflecting the need for genetic research to unravel the pathomechanism of CHD. A future aim should be to offer an individual risk assessment for each patient based on the underlying genetics.
Collapse
Affiliation(s)
- Paul C Helm
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Competence Network for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Hashim Abdul-Khaliq
- Competence Network for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Paediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Helmut Baumgartner
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Center for Adults with Congenital Heart Defects (EMAH-Center), University Hospital Muenster, Muenster, Germany
| | - Hans-Heiner Kramer
- Department for Congenital Heart Disease and Pediatric Cardiology, DZHK (German Centre for Cardiovascular Research), University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Christian Schlensak
- Competence Network for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Thomas Pickardt
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Anne-Karin Kahlert
- Department for Congenital Heart Disease and Pediatric Cardiology, DZHK (German Centre for Cardiovascular Research), University Hospital Schleswig-Holstein - Campus Kiel, Germany.,Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Marc-Phillip Hitz
- Department for Congenital Heart Disease and Pediatric Cardiology, DZHK (German Centre for Cardiovascular Research), University Hospital Schleswig-Holstein - Campus Kiel, Germany
| |
Collapse
|
56
|
Chakraborty A, Gorla SR, Swaminathan S. Impact of prenatal diagnosis of complex congenital heart disease on neonatal and infant morbidity and mortality. Prenat Diagn 2018; 38:958-963. [DOI: 10.1002/pd.5351] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Abhishek Chakraborty
- Division of Pediatric Cardiology, Department of Pediatrics; Jackson Memorial Hospital/University of Miami, Miller School of Medicine; Miami Florida
| | - Sudheer R. Gorla
- Division of Pediatric Cardiology, Department of Pediatrics; Jackson Memorial Hospital/University of Miami, Miller School of Medicine; Miami Florida
| | - Sethuraman Swaminathan
- Division of Pediatric Cardiology, Department of Pediatrics; Jackson Memorial Hospital/University of Miami, Miller School of Medicine; Miami Florida
| |
Collapse
|
57
|
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 513] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
58
|
Lee CH, Kang HG, Lee JS, Ryu HU, Jeong SK. Microbubble signal and trial of org in acute stroke treatment (TOAST) classification in ischemic stroke. J Neurol Sci 2018; 390:150-155. [DOI: 10.1016/j.jns.2018.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
|
59
|
van der Ven JPG, van den Bosch E, Bogers AJCC, Helbing WA. State of the art of the Fontan strategy for treatment of univentricular heart disease. F1000Res 2018; 7. [PMID: 30002816 PMCID: PMC6024235 DOI: 10.12688/f1000research.13792.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Abstract
In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival. However, the resulting Fontan physiology is associated with high morbidity. In this review, we discuss the state of the art of the Fontan strategy by assessing survival and risk factors for mortality. Complications of the Fontan circulation, such as cardiac arrhythmia, thromboembolism, and protein-losing enteropathy, are discussed. Common surgical and catheter-based interventions following Fontan completion are outlined. We describe functional status measurements such as quality of life and developmental outcomes in the contemporary Fontan patient. The current role of drug therapy in the Fontan patient is explored. Furthermore, we assess the current use and outcomes of mechanical circulatory support in the Fontan circulation and novel surgical innovations. Despite large improvements in outcomes for contemporary Fontan patients, a large burden of disease exists in this patient population. Continued efforts to improve outcomes are warranted. Several remaining challenges in the Fontan field are outlined.
Collapse
Affiliation(s)
- Jelle P G van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Ad J C C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| |
Collapse
|
60
|
Petersen J, Kazakov A, Böhm M, Schäfers HJ, Laufs U, Abdul-Khaliq H. Cardiopulmonary bypass reduces myocardial oxidative stress, inflammation and increases c-kit +CD45 - cell population in newborns. J Transl Med 2018; 16:111. [PMID: 29703225 PMCID: PMC5921779 DOI: 10.1186/s12967-018-1478-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to characterize the influence of cardiopulmonary bypass (CPB) on myocardial remodeling in newborns and children. Methods Biopsies from the right atrium were taken before and after CPB from 4 newborns (5–11 days old) and 7 children (8 months–16 years old). Immunostainings on 10 µm heart tissue frozen sections were performed to detect c-kit+ cells, leukocytes (CD45+ cells), Ki67+ cycling cells. The percentage of 8-hydroxy-guanosine (8-dOHG)+cardiomyocytes and non-cardiomyocytes [(8-dOHG)+-index] were determined to quantify oxidative stress. Results Δ c-kit+CD45− cells (resident cardiac stem cells) were increased in newborns (2.2 ± 1.9/mm2) and decreased in children − 1.5 ± 0.7/mm2, p < 0.01. The (8-dOHG)+-index was reduced by 43% in newborns and by 20% in children. CPB did not influence cardiac cell turnover; high cell proliferation was seen in newborns before and after CPB. Cardiopulmonary bypass significantly decreased the leucocyte infiltration in newborns to 40 ± 8%, p < 0.05, but not in children. Infiltration with eosinophils (eosinophils/CD45%) was completely abolished in the myocardium of newborns p < 0.05 and reduced to 22 ± 8% in children after CPB, n.s. Conclusions Immediate response and remodeling of the myocardium to CPB differs between newborns, older infants and children. Especially an increased number of c-kit expressing CD45 cells after CPB were seen in neonates in comparison to children. The clinical value of such observation needs to be further assessed in larger cohorts of patients. Electronic supplementary material The online version of this article (10.1186/s12967-018-1478-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Johannes Petersen
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany.,Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Andrey Kazakov
- Department of Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Böhm
- Department of Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Medical Center Leipzig, Leipzig, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany.
| |
Collapse
|
61
|
Abu-Halima M, Kahraman M, Henn D, Rädle-Hurst T, Keller A, Abdul-Khaliq H, Meese E. Deregulated microRNA and mRNA expression profiles in the peripheral blood of patients with Marfan syndrome. J Transl Med 2018. [PMID: 29530068 PMCID: PMC5848586 DOI: 10.1186/s12967-018-1429-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background MicroRNAs (miRNAs) are small RNAs regulating gene expression post-transcriptionally. While acquired changes of miRNA and mRNA profiles in cancer have been extensively studied, little is known about expression changes of circulating miRNAs and messenger RNAs (mRNA) in monogenic constitutional anomalies affecting several organ systems, like Marfan syndrome (MFS). We performed integrated miRNA and mRNA expression profiling in blood samples of Marfan patients in order to investigate deregulated miRNA and mRNA networks in these patients which could serve as potential diagnostic and prognostic tools for MFS therapy. Methods MiRNA and mRNA expression profiles were determined in blood samples from MFS patients (n = 7) and from healthy volunteer controls (n = 7) by microarray analysis. Enrichment analyses of altered mRNA expression were identified using bioinformatic tools. Results A total of 28 miRNAs and 32 mRNAs were found to be significantly altered in MFS patients compared to controls (> 2.0-fold change, adjusted P < 0.05). The expression of 11 miRNA and 6 mRNA candidates was validated by RT-qPCR in an independent cohort of 26 MFS patients and 26 matched HV controls. Significant inverse correlations were evident between 8 miRNAs and 5 mRNAs involved in vascular pathology, inflammation and telomerase regulation. Significant positive correlations were present for 7 miRNAs with age, for 2 miRNAs with the MFS aortic root status (Z-score) and for 7 miRNAs with left ventricular end-diastolic diameter in MFS patients. In addition, miR-331-3p was significantly up-regulated in MFS patients without mitral valve prolapse (MVP) as compared with patients with MVP. Conclusions Our data show deregulated gene and miRNA expression profiles in the peripheral blood of MFS patients, demonstrating several candidates for prognostic biomarkers for cardiovascular manifestations in MFS as well as targets for novel therapeutic approaches. A deregulation of miRNA expression seems to play an important role in MFS, highlighting the plethora of effects on post-transcriptional regulation of miRNAs and mRNAs initiated by constitutional mutations in single genes. Trial registration Nr: EA2/131/10. Registered 28 December, 2010 Electronic supplementary material The online version of this article (10.1186/s12967-018-1429-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Masood Abu-Halima
- Institute of Human Genetics, Saarland University, 66421, Homburg/Saar, Germany.
| | - Mustafa Kahraman
- Chair for Clinical Bioinformatics, Saarland University, 66041, Saarbrücken, Germany
| | - Dominic Henn
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Tanja Rädle-Hurst
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, 66041, Saarbrücken, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Eckart Meese
- Institute of Human Genetics, Saarland University, 66421, Homburg/Saar, Germany
| |
Collapse
|
62
|
Helm PC, Kempert S, Körten MA, Lesch W, Specht K, Bauer UMM. Congenital heart disease patients' and parents' perception of disease-specific knowledge: Health and impairments in everyday life. CONGENIT HEART DIS 2018; 13:377-383. [DOI: 10.1111/chd.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/09/2017] [Accepted: 12/19/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Paul C. Helm
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
| | - Sebastian Kempert
- Institute for Educational Studies, Humboldt University of Berlin; Berlin Germany
| | - Marc-André Körten
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
| | - Wiebke Lesch
- Competence Network for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
| | - Katharina Specht
- Competence Network for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
| | - Ulrike M. M. Bauer
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
- Competence Network for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
| |
Collapse
|
63
|
Kordjalik P, Tobota Z, Respondek-Liberska M. Selected data from the Polish National Prenatal Cardiac Pathology Registry from the year 2016. PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2017-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: Analysis have been subjected to evaluate standard data reports from the Polish National Prenatal Cardiac Pathology Registry from the year 2016, compared to previous years. Material and methods: The methodology of this work was comparison of the data from previous years that have been published in the Prenatal Cardiology and records generated in www. orpkp.pl from the year 2016. The total number of records entered in the Registry in the year 2016 was n=774. Results: Top 10 most common prenatal CHD in 2016 were such as follow: HLHS, AVSD, VSD, d-TGA, TOF, AvS, muscular VSD, Aberrant origin R subclavian artery, RAA, CoA. In the centers Lodz and Krakow the most common prenatal congenital heart defects were severe CHD requiring surgery in 1 st month of life. In the contrast, in Warsaw the first place was taken by a “critical heart defects” regardless whether cardiac surgery was planned in first week (contemporary definition of prenatal critical heart defects) or first month - contemporary definition of severe planned heart defects of postnatal life. Conclusion: The fact that in 2016 most common cause of referrals to targeted the fetal chocardiography was abnormal, large vessels view and not the abnormal 4 chamber view of the heart, suggests more and better training of hysicians performing the screening or basic study of fetal heart in Poland.
Collapse
Affiliation(s)
- Paulina Kordjalik
- Department of Diagnoses and Prevention Fetal Malformations Medical University of Lodz, Lodz , Poland
| | - Zdzisław Tobota
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz , Poland
| | | |
Collapse
|
64
|
Pfitzer C, Helm PC, Rosenthal LM, Berger F, Bauer UMM, Schmitt KR. Dynamics in prevalence of Down syndrome in children with congenital heart disease. Eur J Pediatr 2018; 177:107-115. [PMID: 29127498 DOI: 10.1007/s00431-017-3041-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 01/22/2023]
Abstract
UNLABELLED We assessed the dynamics in the prevalence of children with congenital heart disease (CHD) and Down syndrome in Germany with regard to phenotype, severity, and gender. Data from patients with CHD and Down syndrome born between 1980 and 2014 were analyzed, who are registered with the German National Register for Congenital Heart Defects. One thousand six hundred eighteen CHD patients with Down syndrome were identified. The prevalence of children born with both Down syndrome and CHD was constant from 2005 to 2009 but increased from 2010 to 2014. Regarding CHD groups, complex and simple lesions have become more equal since 2005. The number of simple lesions with shunt has a peak prevalence in the period of 2010-2014. Atrioventricular septal defect was the most common CHD phenotype, but temporal changes were found within the group of CHD phenotypes over the observation period. CONCLUSION Our findings suggest a growing number of CHD and Down syndrome, which may be the result of improved medical management and progress in educational, social, and financial support. This development is noteworthy as it adds new aspects to present discussions in the media and political settings. What is known: • Congenital heart disease is regarded to be the most important clinical phenomenon in children with Down syndrome, due to its significant impact on morbidity and mortality. • New developments in prenatal diagnostic and therapy management of congenital heart disease continue to influence the number of patients diagnosed with congenital heart disease and Down syndrome. What is New: • This study provides essential data giving the first overview of the dynamics in the prevalence of congenital heart disease and Down syndrome over an extended length of time up to 2015 in a large patient cohort, taking recent developments into account. • Our data suggest a growing prevalence of congenital heart disease and Down syndrome, which may be the result of improved medical management for Down syndrome patients and progress in educational, social, and financial support for their families; this development is noteworthy as it adds new aspects to the present discussion in the media and political settings.
Collapse
Affiliation(s)
- Constanze Pfitzer
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
| | - Paul C Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Lisa-Maria Rosenthal
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Paediatric Cardiology, Charite-Universitaetsmedizin, Berlin, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Katharina Rl Schmitt
- Department of Congenital Heart Disease-Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| |
Collapse
|
65
|
Abstract
UNLABELLED Purpose Through this study we aimed to assess the educational level and employment status of adults with CHD in Germany. METHODS Data were acquired from an online survey carried out in 2015 by the German National Register for Congenital Heart Defects. A total of 1458 adults with CHD participated in the survey (response rate: 37.6%). For 1198 participants, detailed medical information, such as main cardiac diagnosis and information from medical reports, was available. RESULTS Of the participants surveyed (n=1198), 54.5% (n=653) were female, and the mean age was 30 years. The majority of respondents (59.4%) stated that they had high education levels and that they were currently employed (51.1%). Patients with simple CHD had significantly higher levels of education (p<0.001) and were more likely to be employed (p=0.01) than were patients with complex CHD. CONCLUSIONS More than half of the participants had high education levels and the majority were employed. The association between CHD and its severity and individuals' educational attainment should be investigated more closely in future studies.
Collapse
|
66
|
Is having a job a protective factor? Employment status and state of medical care as subjectively perceived by adults with CHD in Germany. Cardiol Young 2017; 27:1110-1117. [PMID: 27830637 DOI: 10.1017/s1047951116002146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most patients born with CHD nowadays reach adulthood, and thus quality of life, life situation, and state of medical care aspects are gaining importance in the current era. The present study aimed to investigate whether patients' assessment depends on their means of occupation. The findings are expected to be helpful in optimising care and for developing individual treatment plans. METHODS The present study was based on an online survey conducted in cooperation with patient organisations. Participants were recruited from the database of the German National Register for Congenital Heart Defects. In total, 1828 individuals (777 males, 1051 females) took part. Participants were asked to rate aspects such their state of health on a six-tier scale (1=worst specification). Response behaviour was measured against the background of occupational details. RESULTS Training for or pursuing a profession was found to be significantly associated with participants' rating of five of the six examined aspects (p<0.05). Sex seemed to play an important part in four of the six aspects. CONCLUSIONS An optimal treatment plan for adults with CHD should always consider aspects such as sex and employment status. To work out such an optimal and individual treatment plan for each adult CHD patient, an objective tool to measure patients' actual CHD-specific knowledge precluding socially accepted response bias would be very useful.
Collapse
|
67
|
Baehner T, Dewald O, Heinze I, Mueller M, Schindler E, Schirmer U, Baumgarten G, Hoeft A, Ellerkmann RK. The provision of pediatric cardiac anesthesia services in Germany: current status of structural and personnel organization. Paediatr Anaesth 2017; 27:801-809. [PMID: 28419616 DOI: 10.1111/pan.13153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anesthesia for pediatric cardiac surgery requires a high level of expert knowledge. There are currently no recommendations and standards for anesthetic management for congenital cardiac surgery in Germany. AIM The aim of the present study was to assess the current status of structural and personnel anesthetic standards at pediatric cardiac surgery centers in Germany. METHODS All cardiac surgical centers in Germany were reviewed for an active program for congenital heart surgery. Centers with an active program were invited to respond to an online survey. The questionnaire containing 55 items in 16 categories assessed current practice in pediatric cardiac anesthesia. RESULTS An active program for pediatric cardiac surgery was identified at 27 centers. The response rate to the survey was 96.3%. A specialized group of anesthesiologists for pediatric cardiac anesthesia was reported from 26 centers (92.3%). The mean size of this group was 4.8 anesthesiologists per center. However, the annual case load of centers and relative annual case load per specialized anesthesiologist varied considerably between 12.5 and 250. Nonanesthesiologists performed sedation and general anesthesia for diagnostic and therapeutic interventions outside the operating theater in children with congenital heart diseases in 24 centers (77%). Although special equipment, for example, pediatric TEE, near-infrared spectroscopy, and devices for mechanical auto transfusion were available in most centers, their routine use was not always part of standard operating procedures. The proposal for mean adequate training in pediatric cardiac anesthesia as estimated by the participating centers was 10.8 months. CONCLUSION The present study represents the current structural situation for anesthesia at German pediatric cardiac surgery centers.
Collapse
Affiliation(s)
- Torsten Baehner
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Matthias Mueller
- Pediatric Heart Centre, Justus-Liebig University, Giessen, Germany
| | - Ehrenfried Schindler
- Department of Pediatric Anesthesiology and Critical Care Medicine, Asklepios Children's Hospital Sankt Augustin, Sankt Augustin, Germany
| | - Uwe Schirmer
- Department of Anesthesiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Richard K Ellerkmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
68
|
Pfitzer C, Helm PC, Ferentzi H, Rosenthal LM, Bauer UMM, Berger F, Schmitt KRL. Changing prevalence of severe congenital heart disease: Results from the National Register for Congenital Heart Defects in Germany. CONGENIT HEART DIS 2017; 12:787-793. [DOI: 10.1111/chd.12515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Constanze Pfitzer
- Department of Congenital Heart Disease - Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
- Berlin Institute of Health (BIH); Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin; Germany
| | - Paul C. Helm
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
| | - Hannah Ferentzi
- Department of Congenital Heart Disease - Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
- Unit for Psychosomatic Medicine, German Heart Center Berlin; Berlin Germany
| | - Lisa-Maria Rosenthal
- Department of Congenital Heart Disease - Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
| | - Ulrike M. M. Bauer
- National Register for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research); Berlin Germany
- Competence Network Congenital Heart Defects; Berlin Germany
| | - Felix Berger
- Department of Congenital Heart Disease - Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin; Germany
- Department of Pediatric Cardiology; Charité University Hospital Berlin; Berlin Germany
| | - Katharina R. L. Schmitt
- Department of Congenital Heart Disease - Pediatric Cardiology; German Heart Center Berlin; Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin; Germany
| |
Collapse
|
69
|
Abu-Halima M, Poryo M, Ludwig N, Mark J, Marsollek I, Giebels C, Petersen J, Schäfers HJ, Grundmann U, Pickardt T, Keller A, Meese E, Abdul-Khaliq H. Differential expression of microRNAs following cardiopulmonary bypass in children with congenital heart diseases. J Transl Med 2017; 15:117. [PMID: 28558735 PMCID: PMC5450060 DOI: 10.1186/s12967-017-1213-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Children with congenital heart defects (CHDs) are at high risk for myocardial failure after operative procedures with cardiopulmonary bypass (CPB). Recent studies suggest that microRNAs (miRNA) are involved in the development of CHDs and myocardial failure. Therefore, the aim of this study was to determine alterations in the miRNA profile in heart tissue after cardiac surgery using CPB. Methods In total, 14 tissue samples from right atrium were collected from patients before and after connection of the CPB. SurePrint™ 8 × 60K Human v21 miRNA array and quantitative reverse transcription-polymerase chain reaction (RT-qPCR) were employed to determine the miRNA expression profile from three patients before and after connection of the CPB. Enrichment analyses of altered miRNA expression were predicted using bioinformatic tools. Results According to miRNA array, a total of 90 miRNAs were significantly altered including 29 miRNAs with increased and 61 miRNAs with decreased expression after de-connection of CPB (n = 3) compared to before CPB (n = 3). Seven miRNAs had been validated using RT-qPCR in an independent cohort of 11 patients. Enrichment analyses applying the KEGG database displayed the highest correlation for signaling pathways, cellular community, cardiovascular disease and circulatory system. Conclusion Our result identified the overall changes of the miRNome in right atrium tissue of patients with CHDs after CPB. The differentially altered miRNAs lay a good foundation for further understanding of the molecular function of changed miRNAs in regulating CHDs and after CPB in particular. Electronic supplementary material The online version of this article (doi:10.1186/s12967-017-1213-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Masood Abu-Halima
- Department of Human Genetics, Saarland University, 66421, Homburg/Saar, Germany. .,Department of Human Genetics, Saarland University Medical Center, 66421, Homburg/Saar, Germany.
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Nicole Ludwig
- Department of Human Genetics, Saarland University, 66421, Homburg/Saar, Germany
| | - Janine Mark
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Ina Marsollek
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Christian Giebels
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Johannes Petersen
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Ulrich Grundmann
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, National Register for Congenital Heart Defects, DZHK, 13347, Berlin, Germany
| | - Andreas Keller
- Department of Clinical Bioinformatics, Saarland University, 66041, Saarbruecken, Germany
| | - Eckart Meese
- Department of Human Genetics, Saarland University, 66421, Homburg/Saar, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421, Homburg/Saar, Germany.,Competence Network for Congenital Heart Defects, National Register for Congenital Heart Defects, DZHK, 13347, Berlin, Germany
| |
Collapse
|
70
|
Bronshtein M, Blumenfeld Z, Khoury A, Gover A. Diverse outcome following early prenatal diagnosis of pulmonary stenosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:213-218. [PMID: 27741366 DOI: 10.1002/uog.17332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 07/09/2016] [Accepted: 10/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the natural history and outcome of fetal pulmonary stenosis (PS), particularly that detected at 14-17 weeks' gestation. METHODS In this retrospective study we searched an electronic database of women from the general Israeli population attending a private ultrasound institute (Al-Kol ultrasound institute in Haifa) for routine complete early fetal ultrasound, including all fetal systems and a fetal echocardiogram, between 2004 and 2015. Ninety-seven percent of the women were at low risk of fetal malformations, and 3% had risk factors such as maternal Type-1 diabetes mellitus, exposure during pregnancy to teratogenic drugs, or anomalies in previous pregnancies or in other family members. At presentation at 14-17 weeks of gestation, color and pulsed Doppler imaging were performed across the four cardiac valves. We identified cases in which abnormal flow was detected, leading to suspicion of PS; in these cases, a follow-up examination was carried out at 17-19 weeks and then monthly until delivery or resolution of the finding, and postnatal echocardiography was performed at birth, 4-6 weeks thereafter, and yearly afterwards. Outcome data for suspicious cases, including postnatal diagnosis and general or specific symptoms, were collected by contacting the parents via email or telephone. RESULTS Among 24 185 early prenatal transvaginal ultrasound screening examinations, 23 cases of suspected PS were identified. They were classified into three groups, according to their ultrasound findings. In Group A (n = 8), the ultrasound screen was normal except for high flow velocity across the pulmonary valve. In six cases, this finding had resolved by 20-21 weeks of gestation and all were found to be normal at postnatal follow-up, one case underwent termination of pregnancy at 19 weeks and PS was confirmed at autopsy and one case was lost to follow-up. In Group B (n = 12), there was aliasing across the pulmonary valve. Two of these cases were normal postnatally and eight had mild-to-moderate PS; the remaining two cases developed hypoplastic right ventricle and pulmonary atresia at 19-20 weeks and the pregnancies were terminated. In Group C (n = 3) PS was associated with other anomalies; all three pregnancies were terminated. There were an additional six cases (Group D) not identified in early gestation, in which PS was late-onset. One had tricuspid regurgitation at the early screen, but was subsequently diagnosed with Ebstein's anomaly and pulmonary atresia, at 22 weeks, and was terminated. The other cases had completely normal early ultrasound screening examinations: one case had Ebstein's anomaly and PS was diagnosed at birth; four had isolated mild PS, of which one was diagnosed at 22 weeks' gestation and the other three were diagnosed postnatally, before 3 months of age. The sensitivity for detection of the ascertained cases of PS was 64% (11/17) and the specificity was > 99%. CONCLUSION There is a diverse spectrum of presentation of fetal PS in the early mid-trimester. A possible explanation for this could be different pathophysiological pathways. Further study is needed to explain the different prenatal sonographic presentations in an unselected population. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- M Bronshtein
- Faculty of Social Welfare & Health Science, University of Haifa, Haifa, Israel
- Al-Kol Ultrasound Clinic, Haifa, Israel
| | - Z Blumenfeld
- Department of Ob/Gyn, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - A Khoury
- Pediatric Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - A Gover
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| |
Collapse
|
71
|
Helm PC, Kaemmerer H, Breithardt G, Sticker EJ, Keuchen R, Neidenbach R, Diller GP, Tutarel O, Bauer UMM. Transition in Patients with Congenital Heart Disease in Germany: Results of a Nationwide Patient Survey. Front Pediatr 2017; 5:115. [PMID: 28580351 PMCID: PMC5437851 DOI: 10.3389/fped.2017.00115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/02/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A growing number of adults with congenital heart disease (ACHD) pose a particular challenge for health care systems across the world. Upon turning into 18 years, under the German national health care system, ACHD patients are required to switch from a pediatric to an adult cardiologist or an ACHD-certified provider. To date, reliable data investigating the treatment situation of ACHD patients in Germany are not available. MATERIALS AND METHODS An online survey was conducted in collaboration with patient organizations to address the life situation and the conditions of health care provision for ACHD patients in Germany. ACHD patients were recruited from the database of the National Register for Congenital Heart Defects (NRCHD) and informed about the survey via email, websites, and social networks. A total of 1,828 ACHD patients (1,051 females) participated in this study. The mean age was 31.7 ± 11.7 years. Participants were surveyed about treating physicians and the institution mainly involved in the treatment of their CHD. In addition, participants were asked questions to assess the level of trust toward their treating physician and their familiarity with the term "ACHD-certified provider." RESULTS Among the surveyed patients, 25.4% stated that they attended a specific ACHD clinic at a heart center regularly, 32.7% were treated in a private practice setting by a pediatric cardiologist, 32.4% in a private practice (adult) cardiology setting, and 9.5% were treated by an "other physician." Only 24.4% of the male and 29.7% of the female ACHD patients were familiar with the term "ACHD-certified provider." CONCLUSION The transfer from pediatric cardiology to ACHD care requires further attention as many adult patients have not transferred to certified ACHD providers. The question of whether ACHD patients in Germany are offered consistent and adequate care should also be investigated in more detail. The answers regarding the ACHD certification are particularly disappointing and indicative of a large information gap and inadequate education in clinical practice.
Collapse
Affiliation(s)
- Paul C Helm
- National Register for Congenital Heart Defects, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Harald Kaemmerer
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Günter Breithardt
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine University Hospital of Münster, Münster, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| | | | | | - Rhoia Neidenbach
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine University Hospital of Münster, Münster, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Oktay Tutarel
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Competence Network for Congenital Heart Defects, Berlin, Germany
| |
Collapse
|
72
|
3D Real-Time Echocardiography Combined with Mini Pressure Wire Generate Reliable Pressure-Volume Loops in Small Hearts. PLoS One 2016; 11:e0165397. [PMID: 27776179 PMCID: PMC5077139 DOI: 10.1371/journal.pone.0165397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pressure-volume loops (PVL) provide vital information regarding ventricular performance and pathophysiology in cardiac disease. Unfortunately, acquisition of PVL by conductance technology is not feasible in neonates and small children due to the available human catheter size and resulting invasiveness. The aim of the study was to validate the accuracy of PVL in small hearts using volume data obtained by real-time three-dimensional echocardiography (3DE) and simultaneously acquired pressure data. METHODS In 17 piglets (weight range: 3.6-8.0 kg) left ventricular PVL were generated by 3DE and simultaneous recordings of ventricular pressure using a mini pressure wire (PVL3D). PVL3D were compared to conductance catheter measurements (PVLCond) under various hemodynamic conditions (baseline, alpha-adrenergic stimulation with phenylephrine, beta-adrenoreceptor-blockage using esmolol). In order to validate the accuracy of 3D volumetric data, cardiac magnetic resonance imaging (CMR) was performed in another 8 piglets. RESULTS Correlation between CMR- and 3DE-derived volumes was good (enddiastolic volume: mean bias -0.03ml ±1.34ml). Computation of PVL3D in small hearts was feasible and comparable to results obtained by conductance technology. Bland-Altman analysis showed a low bias between PVL3D and PVLCond. Systolic and diastolic parameters were closely associated (Intraclass-Correlation Coefficient for: systolic myocardial elastance 0.95, arterial elastance 0.93, diastolic relaxation constant tau 0.90, indexed end-diastolic volume 0.98). Hemodynamic changes under different conditions were well detected by both methods (ICC 0.82 to 0.98). Inter- and intra-observer coefficients of variation were below 5% for all parameters. CONCLUSIONS PVL3D generated from 3DE combined with mini pressure wire represent a novel, feasible and reliable method to assess different hemodynamic conditions of cardiac function in hearts comparable to neonate and infant size. This methodology may be integrated into clinical practice and cardiac catheterization programs and has the capability to contribute to clinical decision making even in small hearts.
Collapse
|
73
|
KinCor, a national registry for paediatric patients with congenital and other types of heart disease in the Netherlands: aims, design and interim results. Neth Heart J 2016; 24:628-639. [PMID: 27632192 PMCID: PMC5065536 DOI: 10.1007/s12471-016-0892-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective Studies in children with heart disease have been hampered by a lack of easily identifiable patient groups. Currently, there are few prospective population-based registries covering the entire spectrum of heart disease in children. KinCor is a Dutch national registry for children with heart diseases. This paper presents the aims, design and interim results of the KinCor project. Methods All children presenting at a Dutch university medical centre with a diagnosis of heart disease from 2012 onwards were eligible for registration in the KinCor database. Data entry is through a web-based portal. Entry codes have been synchronised with the European Paediatric Cardiac Coding system, allowing coupling with similar databases for adults, such as CONCOR. Results Between June 2012 and July 2015, 8421 patients were registered (76 % of those eligible). Median age of the patients was 9.8 years, 44.7 % were female; 6782 patients had morphological congenital heart disease. The most prevalent morphological congenital heart defects were ventricular septal defects (18 %), Tetralogy of Fallot (10 %) and transposition of great arteries (9 %). For 42 % of the patients additional diagnoses were registered. Sixty percent of patients had undergone at least one intervention (catheter intervention or surgery). Conclusion The KinCor database has developed into a large registry of data of children with all types of heart disease and continues to grow. This database will provide the opportunity for epidemiological research projects on congenital and other types of heart disease in children. Entry codes are shared with the CONCOR database, which may provide a unique dataset.
Collapse
|
74
|
Representativeness of the German National Register for Congenital Heart Defects: a clinically oriented analysis. Cardiol Young 2016; 26:921-6. [PMID: 26443325 DOI: 10.1017/s1047951115001547] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Approximately 6000 children are born with CHD in Germany each year. It is increasingly rare that these children die from their chronic illness. In the present study, data recorded in the National Register for Congenital Heart Defects with respect to the prevalence of specific lesions and sex distribution are compared with that recorded in a published German prevalence study (Prevalence Study) and with the meta-analysis by van der Linde et al. METHODS A descriptive data analysis was performed using a minimal data set. The demographic data included sex and birth year; the medical data comprised the cardiovascular diagnosis according to the short list of the International Paediatric and Congenital Cardiac Code. RESULTS As the data analysis shows, the National Register is a clinical register including primarily clinical cases/cases relevant to healthcare. The prevalence values and sex ratios recorded in the register are closer to the values given in the literature than those determined by the Prevalence Study. Severe CHD was slightly over-represented in the National Register compared with the van der Linde et al meta-analysis. The deviations with respect to prevalence values are within an acceptable range. CONCLUSION With its 48,000 patients, the National Register plays a unique and important role for research in the field of CHD. Samples from the National Register can be used as a gold standard for future studies, as the patient population registered in it can be considered representative of CHD in Germany and Europe.
Collapse
|
75
|
Pickardt T, Niggemeyer E, Bauer UMM, Abdul-Khaliq H. A Biobank for Long-term and Sustainable Research in the Field of Congenital Heart Disease in Germany. GENOMICS PROTEOMICS & BIOINFORMATICS 2016; 14:181-90. [PMID: 27132144 PMCID: PMC4996858 DOI: 10.1016/j.gpb.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/17/2022]
Abstract
Congenital heart disease (CHD) is the most frequent birth defect (0.8%-1% of all live births). Due to the advance in prenatal and postnatal early diagnosis and treatment, more than 90% of these patients survive into adulthood today. However, several mid- and long-term morbidities are dominating the follow-up of these patients. Due to the rarity and heterogeneity of the phenotypes of CHD, multicenter registry-based studies are required. The CHD-Biobank was established in 2009 with the aim to collect DNA from patients and their parents (trios) or from affected families, as well as cardiovascular tissues from patients undergoing corrective heart surgery for cardiovascular malformations. Clinical/phenotype data are matched to the International Paediatric and Congenital Cardiac Code (IPCCC) and the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The DNA collection currently comprises samples from approximately 4200 participants with a wide range of CHD phenotypes. The collection covers about 430 trios and 120 families with more than one affected member. The cardiac tissue collection comprises 1143 tissue samples from 556 patients after open heart surgery. The CHD-Biobank provides a comprehensive basis for research in the field of CHD with high standards of data privacy, IT management, and sample logistics.
Collapse
Affiliation(s)
- Thomas Pickardt
- National Register for Congenital Heart Defects, 13353 Berlin, Germany.
| | - Eva Niggemeyer
- National Register for Congenital Heart Defects, 13353 Berlin, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, 13353 Berlin, Germany; Competence Network for Congenital Heart Defects, 13353 Berlin, Germany
| | - Hashim Abdul-Khaliq
- Saarland University Medical Center, Department of Paediatric Cardiology, 66421 Homburg, Germany; Competence Network for Congenital Heart Defects, 13353 Berlin, Germany
| |
Collapse
|
76
|
Niggemeyer E. [Competence Network for Congenital Heart Defects: innovative research for a young patient group]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:497-505. [PMID: 26961866 DOI: 10.1007/s00103-016-2321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital heart disease is the most frequent congenital malformation in humans and affects almost 1 % of all newborns. Thanks to advances in diagnostics and treatment, over 90 % of those affected reach adulthood today. Patient numbers are therefore growing constantly. The majority of those affected, however, remain chronically ill throughout life and require continuous specialized care. The spectrum of different clinical pictures is vast. Since this is a relatively young patient group, both research and care are lacking relevant knowledge and experience. OBJECTIVE The Competence Network for Congenital Heart Defects (CNCHD) was founded in 2003 to tackle the challenge of heterogeneity and accordingly small sample sizes by means of networked research. The following article offers an overview of the network and its mode of operation. MATERIAL AND METHODS The Germany-wide research network involves all relevant levels of research, public health care, the patient community and the general public. On the basis of a complex and flexible database infrastructure, it facilitates multicenter and interdisciplinary research in the field of congenital heart disease. RESULTS AND DISCUSSION The CNCHD succeeded in establishing research on congenital heart disease throughout Germany by providing a powerful research network and a suitable infrastructure. Scientists from across Germany and all over the world use this basis to jointly find answers to burning questions in the field of congenital heart disease.
Collapse
Affiliation(s)
- Eva Niggemeyer
- Kompetenznetz Angeborene Herzfehler e. V., Augustenburger Platz 1, 13353, Berlin, Deutschland.
| |
Collapse
|
77
|
Grohmann J, Sigler M, Siepe M, Stiller B. A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience. Catheter Cardiovasc Interv 2016; 87:E143-50. [DOI: 10.1002/ccd.26393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/14/2015] [Accepted: 12/13/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care; University Hospital Göttingen; Göttingen Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery; Heart Center, University of Freiburg; Freiburg Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| |
Collapse
|
78
|
Hövels-Gürich HH. Factors Influencing Neurodevelopment after Cardiac Surgery during Infancy. Front Pediatr 2016; 4:137. [PMID: 28018896 PMCID: PMC5156661 DOI: 10.3389/fped.2016.00137] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/01/2016] [Indexed: 12/14/2022] Open
Abstract
Short- and long-term neurodevelopmental (ND) disabilities with negative impact on psychosocial and academic performance, quality of life, and independence in adulthood are known to be the most common sequelae for surviving children after surgery for congenital heart disease (CHD). This article reviews influences and risk factors for ND impairment. For a long time, the search for independent risk factors was focused on the perioperative period and modalities of cardiopulmonary bypass (CPB). CPB operations to ensure intraoperative vital organ perfusion and oxygen supply with or without circulatory arrest or regional cerebral perfusion bear specific risks. Examples of such risks are embolization, deep hypothermia, flow rate, hemodilution, blood gas management, postoperative hyperthermia, systemic inflammatory response, and capillary leak syndrome. However, influences of these procedure-specific risk factors on ND outcome have not been found as strong as expected. Furthermore, modifications have not been found to support the effectiveness of the currently used neuroprotective strategies. Postoperative factors, such as need for extracorporal membrane oxygenation or assist device support and duration of hospital stay, significantly influence ND parameters. On the other hand, the so-called "innate," less modifiable patient-specific risk factors have been found to exert significant influences on ND outcomes. Examples are type and severity of CHD, genetic or syndromic abnormalities, as well as prematurity and low birth weight. Structural and hemodynamic characteristics of different CHDs are assumed to result in impaired brain growth and delayed maturation with respect to the white matter. Beginning in the fetal period, this so-called "encephalopathy of CHD" is suggested a major innate risk factor for pre-, peri-, and postoperative additional hypoxic or ischemic brain injury and subsequent ND impairment. Furthermore, MRI studies on brain volume, structure, and function in adolescents have been found correlated with cognitive, motor, and executive dysfunctions. Finally, family and environmental factors independently moderate against ND outcomes. In conclusion, the different mediating factors may exert independent effects on ND and interactive influences. Implications for the future comprise modifying clinical risk factors, such as perioperative cerebral oxygen delivery, conducting brain MRI studies in correlation to ND outcomes, and extending psychosocial interventions leading to adequate resilience.
Collapse
|
79
|
Butts RJ, Chowdhury SM, Baker GH, Bandisode V, Savage AJ, Atz AM. Effect of Sildenafil on Pressure-Volume Loop Measures of Ventricular Function in Fontan Patients. Pediatr Cardiol 2016; 37:184-91. [PMID: 26409473 PMCID: PMC4833409 DOI: 10.1007/s00246-015-1262-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/27/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Sildenafil has been reported to improve exercise capacity in Fontan patients, but the physiologic mechanisms behind these findings are not completely understood. The objective of this study was to study the acute effect of sildenafil on pressure-volume loop (PVL) measures of ventricular function in Fontan patients. Patients after Fontan operation who were presenting for a clinically indicated catheterization were enrolled. Patients were randomized in a double-blinded fashion to receive placebo (n = 9) or sildenafil (n = 10) 30-90 min prior to catheterization. PVLs were recorded using microconductance catheters at baseline and after infusion of dobutamine (10 mcg/kg/min). The primary outcome was change in ventriculoarterial (VA) coupling. For the entire cohort, VA coupling trended toward improvement with dobutamine (1.4 ± 0.4 to 1.8 ± 0.9, p = 0.07). End-systolic elastance showed improvement (2.6 ± 0.9 to 3.8 ± 1.4 mmHg m(2)/ml, p < 0.01) with dobutamine infusion. The cohorts had similar VA coupling at baseline (p = 0.32), but the sildenafil cohort trended toward having less of an improvement in VA coupling with dobutamine stress (p = 0.06). There were no differences between PVL measures of systolic or diastolic function between treatment groups, both at baseline and after dobutamine infusion. Patients with Fontan circulation had improved contractility and trended toward improvement in VA coupling with dobutamine stress. Acute sildenafil administration was not associated with improved PVL measurements of ventricular function in this population. These results suggest that clinical improvements seen with administration of sildenafil in Fontan patients are not associated with an acute improvement in ventricular function. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov ; Clinicaltrials.gov Identifier: NCT01815502.
Collapse
Affiliation(s)
- Ryan J. Butts
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC 29425, USA
| | - Shahryar M. Chowdhury
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC 29425, USA
| | - George H. Baker
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC 29425, USA
| | - Varsha Bandisode
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC 29425, USA
| | - Andrew J. Savage
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC 29425, USA
| | - Andrew M. Atz
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 165 Ashley Avenue, MSC 915, Charleston, SC 29425, USA
| |
Collapse
|
80
|
Debost-Legrand A, Ouchchane L, Francannet C, Goumy C, Perthus I, Beaufrère AM, Gallot D, Lemery D, Lusson JR, Laurichesse-Delmas H. Impact of prenatal diagnosis on the outcome of patients with a transposition of great arteries: A 24-year population-based study. ACTA ACUST UNITED AC 2015; 106:178-84. [DOI: 10.1002/bdra.23474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Anne Debost-Legrand
- Service de Santé Publique, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
- EA 4681, PEPRADE, Clermont Université; Université d'Auvergne Clermont-Ferrand France
| | - Lemlih Ouchchane
- Service de Biostatistiques, Informatique Médicale et Technologies de la Communication, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
- ISIT, UMR CNRS 6284; Clermont-Ferrand France
| | - Christine Francannet
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
- Centre d'Etude des Malformations Congénitale; CEMC-Auvergne, BP31 Chamalières France
| | - Carole Goumy
- Service de Cytogénétique Médicale, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
| | - Isabelle Perthus
- EA 4681, PEPRADE, Clermont Université; Université d'Auvergne Clermont-Ferrand France
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
- Centre d'Etude des Malformations Congénitale; CEMC-Auvergne, BP31 Chamalières France
| | - Anne-Marie Beaufrère
- Service de Foetopathologie, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
| | - Denis Gallot
- Pôle Gynéco-Obstétrique-Reproduction Humaine, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
- R2D2-EA7281, Université d'Auvergne, Clermont Université; Clermont-Ferrand France
| | - Didier Lemery
- EA 4681, PEPRADE, Clermont Université; Université d'Auvergne Clermont-Ferrand France
- Pôle Gynéco-Obstétrique-Reproduction Humaine, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
| | - Jean-René Lusson
- ISIT, UMR CNRS 6284; Clermont-Ferrand France
- Service de Cardiologie, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
| | - Hélène Laurichesse-Delmas
- EA 4681, PEPRADE, Clermont Université; Université d'Auvergne Clermont-Ferrand France
- Centre d'Etude des Malformations Congénitale; CEMC-Auvergne, BP31 Chamalières France
- Pôle Gynéco-Obstétrique-Reproduction Humaine, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
| |
Collapse
|
81
|
NT-proBNP Indicates Left Ventricular Impairment and Adverse Clinical Outcome in Patients With Tetralogy of Fallot and Pulmonary Regurgitation. Can J Cardiol 2015; 32:1247.e29-1247.e36. [PMID: 26927857 DOI: 10.1016/j.cjca.2015.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The goal of this study was to interrelate N-terminal B-type natriuretic peptide (NT-proBNP) levels and cardiac magnetic resonance imaging-derived ventricular function, mass, and volumes in adults with pulmonary regurgitation after Fallot repair and to evaluate the prognostic relevance of these parameters regarding adverse clinical outcome. METHODS Eighty-one patients (aged 26.3 ± 7.4 years; male sex, 45.7%; New York Heart Association class I, 72.8%; pulmonary valve velocity, < 3 m/s) were included. At baseline cardiac magnetic resonance imaging and NT-proBNP measurements were performed. RESULTS During a mean observation time of 6.9 ± 2.6 years, 13 patients (16.1%) had sustained supraventricular arrhythmias or heart failure (2.4 per 100 patient-years). Multivariate Cox analysis identified NT-proBNP, left ventricular (LV) end-systolic volume index and LV ejection fraction, right ventricular (RV) end-diastolic volume index, and tricuspid regurgitation as independent predictors of adverse events. NT-proBNP correlated with LV but not with RV parameters. In receiver operating characteristic curve analysis using significant variables of the multivariate analysis, NT-proBNP was superior to all other parameters to detect patients at risk (area under the curve [AUC], 0.873; 95% confidence interval, 0.772-0.974). LV end-systolic volume index (AUC, 0.734), RV end-diastolic volume index (AUC, 0.645) und tricuspid regurgitation (AUC, 0.747) showed lower diagnostic accuracy. CONCLUSIONS Even in mildly symptomatic patients with pulmonary regurgitation after Fallot repair NT-proBNP is a strong predictor of adverse outcome. It is rather associated with LV but not with RV impairment. In severe pulmonary regurgitation an increase in the level of NT-proBNP and LV impairment seem to provide additional useful information for the timing of pulmonary valve replacement.
Collapse
|
82
|
Transcatheter Closure of Perimembranous Ventricular Septal Defects with Left Ventricular to Right Atrial Shunt. Pediatr Cardiol 2015; 36:1386-92. [PMID: 25894760 DOI: 10.1007/s00246-015-1170-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
During the development of so-called aneurysmal transformation of perimembranous ventricular septal defects (pmVSD), tricuspid valve (TV) morphology and function may be altered resulting in left ventricular (LV) to right atrial (RA) shunting. The feasibility and outcome of interventional closure of these pmVSD has not been investigated so far. Interventional closure of pmVSD associated with mild to moderate LV-to-RA shunt was performed in four patients (aged 6.5-12.5 years). pmVSD were closed under fluoroscopic guidance by establishing an arteriovenous wire loop via a femoral artery and advancing the delivery sheath from a femoral vein. Before device release (or withdrawal if necessary), residual shunting across the device and TV valve function was investigated by transthoracic echocardiography and LV angiography. pmVSD sizes of 4, 5.5, 8 and 8.5 mm were closed with a 4/4 and 6/6 Amplatzer duct occluder II and an 8- and 10-mm Amplatzer muscular VSD occluder device, respectively. There were no or only minor residual postinterventional LV-to-RA shunts. No atrioventricular blocks were observed during a mean follow-up of 12.5 months (range 6.5-17 months). Transthoracic echocardiography indicated that the elimination of the VSD jet pushing the antero-superior TV leaflet open is the key mechanism for LV-to-RA shunt reduction after transcatheter pmVSD closure. Interventional closure in pmVSD associated with mild to moderate indirect LV-to-RA shunting is feasible and results in significant reduction in or elimination of LV-to-RA shunting.
Collapse
|
83
|
Liu L, He YH, Li ZA, Cui CY, Zhang LZ, Li T, Liao SX, Fan TB, Peng BT, Yao HM, Huang L. Analysis of etiology, chromosome and prognosis for small left heart system development in 69 fetuses. J Matern Fetal Neonatal Med 2015; 29:493-503. [PMID: 25731651 DOI: 10.3109/14767058.2015.1007037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To provide a basis for evaluating the prognosis of small left heart system development in fetuses, we analyzed its related factors. METHODS The fetal echocardiogram was performed in 3859 pregnant women, and then small left heart system development was identified in 69 fetuses. The data of prenatal and postnatal echocardiograms, postnatal cardiac surgical treatment, chromosome and autopsy after induced labor were analyzed in the 69 fetuses. RESULTS Except 1320 cases losing follow-up, 2539 cases had complete data. Among the 2539 cases, small left heart system development was identified in 69 fetuses. Of the 69 fetuses, 12 had hypoplastic left heart syndrome, 20 premature closure of foramen ovale, 13 total anomalous pulmonary venous drainage, 2 common pulmonary vein lumen atresia, 21 aortic coarctation or interruption and 1 right pulmonary hypoplasia. Among the 69 fetuses, chromosome abnormality was found in 7. CONCLUSION There are many etiological factors causing small left heart system development. The prognosis is poor in the fetuses with hypoplastic left heart syndrome, common pulmonary vein lumen atresia, pulmonary hypoplasia, other malformations or/and chromosome abnormality. Fetal echocardiography combined with chromosome examination can provide important bases for making diagnosis and evaluating the prognosis regarding small left heart system development.
Collapse
Affiliation(s)
- Lin Liu
- a Department of Cardiovascular Ultrasound , Henan Provincial People's Hospital , Zhengzhou , China
| | - Yi-Hua He
- b Department of Ultrasound , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Zhi-An Li
- b Department of Ultrasound , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Cun-Ying Cui
- a Department of Cardiovascular Ultrasound , Henan Provincial People's Hospital , Zhengzhou , China
| | - Lian-Zhong Zhang
- a Department of Cardiovascular Ultrasound , Henan Provincial People's Hospital , Zhengzhou , China
| | - Tao Li
- c Institute of Medical Genetics, Henan Provincial People's Hospital , Zhengzhou , China
| | - Shi-Xiu Liao
- c Institute of Medical Genetics, Henan Provincial People's Hospital , Zhengzhou , China
| | - Tai-Bing Fan
- d Children's Heart Center, Henan Provincial People's Hospital , Zhengzhou , China , and
| | - Bang-Tian Peng
- d Children's Heart Center, Henan Provincial People's Hospital , Zhengzhou , China , and
| | - Hui-Mei Yao
- e Department of Ultrasound , The Seventh People's Hospital , Zhengzhou , China
| | - Lei Huang
- e Department of Ultrasound , The Seventh People's Hospital , Zhengzhou , China
| |
Collapse
|
84
|
|
85
|
[Chronic and vaccine-preventable diseases in children and adolescents in Germany: results of the KiGGS study: first follow up (KiGGS wave 1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:779-88. [PMID: 24950827 DOI: 10.1007/s00103-014-1976-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 2003-2006 is the first nationwide comprehensive study on the health of children and adolescents living in Germany. The KiGGS first interview follow-up is a telephone interview study that collected, among other things, data on a number of chronic and vaccine-preventable diseases in 2009-2012 and is a combined cross-sectional and longitudinal study based on a population registry sample from the 167 KiGGS study points. The analysis is based on 12,368 respondents (7913 KiGGS follow-up participants aged 7-17 years, response 72 % and 4455 newly recruited 0- to 6-year-olds, response 42 %). Based on parent reports the lifetime prevalence of both chickenpox and pertussis has decreased in the population targeted by recently changed vaccination recommendations. For measles the prevalence remained unsatisfactorily high in each investigated age group. Of the children and adolescents aged 0-17 years 16 % (95 % confidence interval CI 15.2-17.0 %) had a long-standing chronic health condition according to the parents. Of these, however, only one in five was affected in their routine daily activities. The lifetime prevalence in 7- to 17-year-olds was 1.2 % (0.9-1.6) for epilepsy (0.4 % for the past 12 months), 5.0 % (4.4-5.7) for migraine, 0.2 % (0.1-0.3) for diabetes and in 0 to 6-year-olds 2.0 % (1.5-2.6) for heart conditions and 3.1 % (2.5-3.8) for febrile seizures with a -prevalence in 0 to 2-year-olds which are most affected of 1.0 % (0.6-1.6) in the past 12 months. The vast majority of children and adolescents in Germany are in good or very good health as suggested by other results reported in this issue; however, chronic conditions are not rare and need continuous monitoring. These results confirm that implementation of the vaccination recommendations of the German Standing Committee on Vaccination (STIKO) can lead to effective prevention of infectious diseases in Germany.
Collapse
|
86
|
van Velzen CL, Clur SA, Rijlaarsdam MEB, Bax CJ, Pajkrt E, Heymans MW, Bekker MN, Hruda J, de Groot CJM, Blom NA, Haak MC. Prenatal detection of congenital heart disease--results of a national screening programme. BJOG 2015; 123:400-7. [PMID: 25625301 DOI: 10.1111/1471-0528.13274] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme. DESIGN Geographical cohort study. SETTING Large referral region of three tertiary care centres. POPULATION Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012. METHODS Cases were divided into two groups: before and after the introduction of screening. MAIN OUTCOME MEASURES Detection rates were calculated. RESULTS The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5-28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0-26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the 'late' referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3-29.3). CONCLUSIONS This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.
Collapse
Affiliation(s)
- C L van Velzen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - S A Clur
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands
| | - M E B Rijlaarsdam
- Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C J Bax
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - M N Bekker
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Hruda
- Department of Paediatric Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - N A Blom
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands.,Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
87
|
Abstract
PURPOSE OF REVIEW Fetal cardiology is a rapidly evolving field. Imaging technology continues to advance as do approaches to in-utero interventions and care of the critically ill neonate, with even greater demand for improvement in prenatal diagnosis of congenital heart disease (CHD) and arrhythmias. RECENT FINDINGS Reviewing the advances in prenatal diagnosis of CHD in such a rapidly developing field is a broad topic. Therefore, we have chosen to focus this review of recent literature on challenges in prenatal detection of CHD, challenges in prenatal counseling, advances in fetal arrhythmia diagnosis, and potential benefits to patients with CHD who are identified prenatally. SUMMARY As methods and tools to diagnose and manage CHD and arrhythmias in utero continue to improve, future generations will hopefully see a reduction in both prenatal and neonatal morbidity and mortality. Prenatal diagnosis can and should be used to optimize location and timing of delivery and postnatal interventions.
Collapse
|
88
|
Herberg U, Bolay J, Graeve P, Hecher K, Bartmann P, Breuer J. Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin-twin transfusion syndrome: comparison of donor, recipient and normal values. Arch Dis Child Fetal Neonatal Ed 2014; 99:F380-5. [PMID: 24972991 DOI: 10.1136/archdischild-2013-305034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In twin-to-twin transfusion syndrome (TTTS), genetically identical twins are exposed to different haemodynamic conditions during fetal life, which are considered to be the cause of prenatal and postnatal cardiovascular differences between the donor and the recipient. OBJECTIVE To assess intertwin differences on childhood cardiac outcome after intrauterine laser coagulation therapy (LC) of severe TTTS. DESIGN AND PATIENTS Prospective, detailed, echocardiographic follow-up of 31 twin pairs aged 9.95±0.8 years (mean±SD) with severe TTTS treated by LC, and the comparison with reference values. RESULTS Cardiac function was normal and did not show intertwin differences in twins without structural heart disease. Discordant birth weight or birth weight <3rd centile for gestational age had no influence on blood pressure and cardiac indices. Pulmonary stenosis was more common (5/62; 8.1%) than in the general population (prevalence 0.066%, relative risk 134.4, 95% CI 42.1 to 428.8, p<0.0001) and affected both donor and recipient. Intertwin differences in late diastolic right ventricular filling (peak velocities: recipient 0.51±0.11 m/s vs donor 0.45±0.10 m/s, mean difference 0.74 m/s, 95% CI 0.23 to 1.24, p=0.009) and early septal relaxation (mean myocardial velocities: recipient -8.2±1.5 cm/s vs donor -8.9±1.2 cm/s, mean difference 0.7 cm/s, 95% CI 0.02 to 1.38, p=0.044) were found only when twins with right heart disease were included. CONCLUSIONS Despite severe prenatal cardiac involvement, childhood cardiac function is normal in the majority of surviving donors and recipients after successful LC of severe TTTS. This underlines the favourable impact of intrauterine LC on postnatal cardiovascular performance.
Collapse
Affiliation(s)
- Ulrike Herberg
- Division of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - Julian Bolay
- Division of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - Pauline Graeve
- Division of Neonatology, University of Bonn, Bonn, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bartmann
- Division of Neonatology, University of Bonn, Bonn, Germany
| | - Johannes Breuer
- Division of Pediatric Cardiology, University of Bonn, Bonn, Germany
| |
Collapse
|
89
|
Butts RJ, Chowdhury SM, Buckley J, Hlavacek AM, Hsia TY, Khambadkone S, Baker GH. Comparison of echocardiographic and pressure-volume loop indices of systolic function in patients with single ventricle physiology: a preliminary report. CONGENIT HEART DIS 2014; 10:E17-24. [PMID: 24869911 DOI: 10.1111/chd.12191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Differences in ventricular geometry and physiology of patients with single ventricle anatomy complicate the application of traditional, noninvasive measurements of systolic function. We compared noninvasive measures of ventricular systolic function in single ventricle patients with invasive measures to evaluate their validity in this population. METHODS A secondary analysis of patients with single ventricle physiology enrolled in the multi-institutional research project, "multi-scale modeling of single ventricle hearts," was performed. Pressure-volume loops (PVLs) were recorded using microconductance catheters. Transthoracic echocardiogram and cardiac magnetic resonance imaging were performed on the same day. PVL indices of systolic function including end-systolic elastance (Ees), maximal rate of pressure increase (dP/dTmax), and stroke work indexed to end-diastolic volume (SW/EDV) were compared with noninvasive measures, including echocardiographic myocardial performance index (MPI), rate of pressure rise (AV valve dP/dT), isovolumic acceleration, longitudinal shortening fraction (longSF), and fractional area change (FAC). RESULTS Fifteen patients had PVLs available for analysis. Eleven had a dominant right ventricle, three were status poststage 1 repair, five had superior cavopulmonary anastomosis, and seven had a total cavopulmonary anastomosis. FAC correlated with Ees (r = 0.69, P < .01), SW/EDV (r = 0.64, P = .01), and dP/dTmax (r = 0.59, P = .03). LongSF correlated with dP/dTmax (r = 0.61, P = .02) MPI, AV valve dP/dT, and isovolumic acceleration did not correlate with pressure-volume loop indices of systolic function. CONCLUSIONS Obtaining PVLs via microconductance catheters can reliably be performed in the single ventricle population and serve as a method to validate echocardiographic indices in this high-risk population. Of the echocardiographic variables, FAC showed the best correlation with PVL indices. Future studies controlling for stage of palliation should be performed to further validate echocardiographic measures of systolic function in this patient population.
Collapse
Affiliation(s)
- Ryan J Butts
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | | | | | | |
Collapse
|
90
|
Abstract
By improvement of the medical care, children with congenital heart disease survive in much greater numbers: the figure of ACHD-patients in Germany is estimated up to 203,000 to 301,000. The need for a specialized care of these patients is accepted by the scientific societies, who introduced a certification for doctors and centers and created guidelines. The medical problems include imaging, treatment of arrhythmia, congestive heart failure and cyanosis, prophylaxis of infectious endocarditis, exercise and pregnancy. For the most frequent defects, indication for treatment and postoperative care is summarized.
Collapse
|
91
|
Iyengar AJ, Winlaw DS, Galati JC, Gentles TL, Weintraub RG, Justo RN, Wheaton GR, Bullock A, Celermajer DS, d'Udekem Y. The Australia and New Zealand Fontan Registry: description and initial results from the first population-based Fontan registry. Intern Med J 2014; 44:148-55. [DOI: 10.1111/imj.12318] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/30/2013] [Indexed: 11/27/2022]
Affiliation(s)
- A. J. Iyengar
- Department of Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Heart Research Group; Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - D. S. Winlaw
- Heart Centre for Children; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - J. C. Galati
- Heart Research Group; Murdoch Children's Research Institute; Melbourne Victoria Australia
- Clinical Epidemiology and Biostatistics Unit; Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Mathematics and Statistics; La Trobe University; Melbourne Victoria Australia
| | - T. L. Gentles
- Green Lane Congenital Cardiac Service; Starship Children's Hospital; Auckland New Zealand
| | - R. G. Weintraub
- Heart Research Group; Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- Department of Cardiology; Royal Children's Hospital; Melbourne Victoria Australia
| | - R. N. Justo
- Paediatric Cardiology; Queensland Paediatric Cardiac Service; Mater Children's Hospital; Brisbane Queensland Australia
| | - G. R. Wheaton
- Department of Cardiology; Women's and Children's Hospital; Adelaide South Australia Australia
| | - A. Bullock
- Children's Cardiac Centre; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - D. S. Celermajer
- Department of Cardiology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Heart Research Institute; University of Sydney; Sydney New South Wales Australia
| | - Y. d'Udekem
- Department of Cardiac Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- Heart Research Group; Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
92
|
Percutaneous closure of a gigantic patent ductus arteriosus (PDA) with pulmonary hypertension with an atrial septal defect occluder in a 35-year-old woman. Clin Res Cardiol 2013; 103:319-23. [DOI: 10.1007/s00392-013-0650-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/09/2013] [Indexed: 11/25/2022]
|
93
|
Salameh A, Blanke K, Daehnert I. Role of connexins in human congenital heart disease: the chicken and egg problem. Front Pharmacol 2013; 4:70. [PMID: 23760510 PMCID: PMC3669755 DOI: 10.3389/fphar.2013.00070] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/15/2013] [Indexed: 01/15/2023] Open
Abstract
Inborn cardiac diseases are among the most frequent congenital anomalies and are the main cause of death in infants within the first year of age in industrialized countries when not adequately treated. They can be divided into simple and complex cardiac malformations. The former ones, for instance atrial and ventricular septal defects, valvular or subvalvular stenosis or insufficiency account for up to 80% of cardiac abnormalities. The latter ones, for example transposition of the great vessels, Tetralogy of Fallot or Shone’s anomaly often do not involve only the heart, but also the great vessels and although occurring less frequently, these severe cardiac malformations will become symptomatic within the first months of age and have a high risk of mortality if the patients remain untreated. In the last decade, there is increasing evidence that cardiac gap junction proteins, the connexins (Cx), might have an impact on cardiac anomalies. In the heart, mainly three of them (Cx40, Cx43, and Cx45) are differentially expressed with regard to temporal organogenesis and to their spatial distribution in the heart. These proteins, forming gap junction channels, are most important for a normal electrical conduction and coordinated synchronous heart muscle contraction and also for the normal embryonic development of the heart. Animal and also some human studies revealed that at least in some cardiac malformations alterations in certain gap junction proteins are present but until today no particular gap junction mutation could be assigned to a specific cardiac anomaly. As gap junctions have often been supposed to transmit growth and differentiation signals from cell to cell it is reasonable to assume that they are somehow involved in misdirected growth present in many inborn heart diseases playing a primary or contributory role. This review addresses the potentional role of gap junctions in the development of inborn heart anomalies like the conotruncal heart defects.
Collapse
Affiliation(s)
- Aida Salameh
- Clinic for Pediatric Cardiology, Heart Centre, University of Leipzig Leipzig, Germany
| | | | | |
Collapse
|
94
|
|
95
|
Wacker-Gußmann A, Thriemer M, Yigitbasi M, Berger F, Nagdyman N. Women with congenital heart disease: long-term outcomes after pregnancy. Clin Res Cardiol 2012. [DOI: 10.1007/s00392-012-0522-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
96
|
Dual drainage of the right pulmonary veins: a rare variant of Scimitar syndrome. Clin Res Cardiol 2012; 101:853-5. [DOI: 10.1007/s00392-012-0464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
|
97
|
Eckmann-Scholz C, Hoffmann U, Kramer HH, Schollmeyer T, Schem C, Jonat W, Alkatout I. Perinatal management of pregnancies with severe fetal heart defects and epigenetic aspects. J Matern Fetal Neonatal Med 2012; 25:2542-5. [DOI: 10.3109/14767058.2012.703725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
98
|
Grothoff M, Hoffmann J, Abdul-Khaliq H, Lehmkuhl L, Dähnert I, Berger F, Mende M, Gutberlet M. Right ventricular hypertrophy after atrial switch operation: normal adaptation process or risk factor? A cardiac magnetic resonance study. Clin Res Cardiol 2012; 101:963-71. [PMID: 22714955 PMCID: PMC3501162 DOI: 10.1007/s00392-012-0485-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/08/2012] [Indexed: 11/25/2022]
Abstract
Background Systemic right ventricle (RV) hypertrophy and impaired function occur after atrial switch for dextro-transposition of the great arteries (d-TGA). Echocardiography is limited in its ability to assess the RV. We sought to evaluate systemic RV myocardial-mass index (MMI) and function after atrial switch and to analyse the role of hypertrophy for ventricular function with special consideration of the interventricular septal (IVS) movement. Methods Thirty-seven consecutive patients (median age 22.9 years) after atrial switch were studied using cardiac magnetic resonance imaging (1.5T Intera, Philips) with a dedicated 5-channel phased-array surface cardiac coil. Cine steady-state free-precession sequences were acquired to obtain myocardial masses and function. The systolic movement of the IVS was defined as positive when moving towards the centroid of the RV and was defined as non-positive otherwise. Patient parameters were compared to controls. Results The systemic RVs were significantly larger (p < 0.001) than the left ventricles of the control group, systolic function was significantly impaired (p < 0.001) and MMI including the IVS was comparable (p = n.s.). RV-MMI excluding the IVS and RV ejection fraction (EF) demonstrated a quadratic correlation (r = 0.6, p < 0.001), meaning that patients with RV-MMI ≤29 g/m2 and >68 g/m2 had a reduced level of systolic function. Positive septal movement improved RV function compared with non-positive septal movement (p = 0.024). Conclusions There seems to be a range of beneficial RV hypertrophy after atrial switch in which a sufficient RV-EF can be expected. A positive septal movement, probably the result of hypertrophic septal RV fibres, improves RV function and might be regarded as a beneficial contraction pattern.
Collapse
Affiliation(s)
- Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
99
|
Bedard T, Lowry RB, Sibbald B, Harder JR, Trevenen C, Horobec V, Dyck JD. Congenital heart defect case ascertainment by the Alberta Congenital Anomalies Surveillance System. ACTA ACUST UNITED AC 2012; 94:449-58. [DOI: 10.1002/bdra.23007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/09/2012] [Accepted: 02/10/2012] [Indexed: 11/09/2022]
|