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Kim YH, Lee JH, Cho KW, Lee DW, Kang MJ, Lee KY, Byun JH, Lee YH, Hwang SY, Lee NK. Verification of the Optimal Chest Compression Depth for Children in the 2015 American Heart Association Guidelines: Computed Tomography Study. Pediatr Crit Care Med 2018; 19:e1-e6. [PMID: 29135701 DOI: 10.1097/pcc.0000000000001369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The 2015 American Heart Association guidelines recommended pediatric rescue chest compressions of at least one-third the anteroposterior diameter of the chest, which equates to approximately 5 cm. This study evaluated the appropriateness of these two types by comparing their safeties in chest compression depth simulated by CT. DESIGN Retrospective study with data analysis conducted from January 2005 to June 2015 SETTING:: Regional emergency center in South Korea. PATIENTS Three hundred forty-nine pediatric patients 1-9 years old who had a chest CT scan. INTERVENTIONS Simulation of chest compression depths by CT. MEASUREMENTS AND MAIN RESULTS Internal and external anteroposterior diameter of the chest and residual internal anteroposterior diameter after simulation were measured from CT scans. The safe cutoff levels were differently applied according to age. One-third external anteroposterior diameters were compared with an upper limit of chest compression depth recommended for adults. Primary outcomes were the rates of overcompression to evaluate safety. Overcompression was defined as a negative value of residual internal anteroposterior diameter-age-specific cutoff level. Using a compression of 5-cm depth simulated by chest CT, 16% of all children (55/349) were affected by overcompression. Those 1-3 years old were affected more than those 4-9 years old (p < 0.001). Upon one-third compression of chest anteroposterior depth, only one subject (0.3%) was affected by overcompression. Rate of one-third external anteroposterior diameter greater than 6 cm in children 8 and 9 years old was 16.1% and 33.3%, respectively. CONCLUSIONS A chest compression depth of one-third anteroposterior might be more appropriate than the 5-cm depth chest compression for younger Korean children. But, one-third anteroposterior depth chest compression might induce deep compressions greater than an upper limit of compression depth for adults in older Korean children.
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Affiliation(s)
- Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun Ho Lee
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Kwang Won Cho
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Dong Woo Lee
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Mun Ju Kang
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Kyoung Yul Lee
- Department of Physical Education, Kyungnam University, Changwon, South Korea
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Seong Youn Hwang
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Na Kyoung Lee
- Department of Nursing, Graduate School, Kyung Hee University, Seoul, South Korea
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102
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Dallaire F, Sarkola T. Growth of Cardiovascular Structures from the Fetus to the Young Adult. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:347-360. [PMID: 30051395 DOI: 10.1007/978-3-319-77932-4_22] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The size, hemodynamics, and function of cardiovascular structures change dramatically from the early fetal life to late adolescence. The principal determinants of cardiovascular dimensions are related to the blood flow needed to meet metabolic demands. This demand is in turn tightly related to body size and body composition, keeping in mind that various tissues may have different metabolic rates. There is no simple model that links cardiac dimensions with a single body size measurement. Consequently, despite abundant scientific literature, few studies have proposed pediatric reference values that efficiently and completely account for the effect of body size. Other factors influence cardiovascular size and function in children, including sex. The influence of sex is multifactorial and not fully understood, but differences in body size and body composition play an important role. We will first review the determinants of cardiovascular size and function in children. We then explore the evaluation and normalization of cardiovascular size and function in pediatric cardiology in relation to the growth of cardiovascular structures during childhood, with a particular focus on sex differences.
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Affiliation(s)
| | - Taisto Sarkola
- University of Helsinki, the Helsinki University Central Hospital/Children's Hospital, Helsinki, Finland
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103
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Mathew J, Zahavich L, Lafreniere-Roula M, Wilson J, George K, Benson L, Bowdin S, Mital S. Utility of genetics for risk stratification in pediatric hypertrophic cardiomyopathy. Clin Genet 2017; 93:310-319. [DOI: 10.1111/cge.13157] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/17/2017] [Accepted: 09/27/2017] [Indexed: 12/29/2022]
Affiliation(s)
- J. Mathew
- Cardiology Department; The Royal Children’s Hospital; Melbourne Victoria Australia
| | - L. Zahavich
- Division of Cardiology, Department of Pediatrics; Hospital for Sick Children, University of Toronto; Toronto Ontario Canada
| | - M. Lafreniere-Roula
- Division of Cardiology, Department of Pediatrics; Hospital for Sick Children, University of Toronto; Toronto Ontario Canada
| | - J. Wilson
- Division of Cardiology, Department of Pediatrics; Hospital for Sick Children, University of Toronto; Toronto Ontario Canada
| | - K. George
- Division of Cardiology, Department of Pediatrics; Hospital for Sick Children, University of Toronto; Toronto Ontario Canada
| | - L. Benson
- Division of Cardiology, Department of Pediatrics; Hospital for Sick Children, University of Toronto; Toronto Ontario Canada
| | - S. Bowdin
- Division of Cardiology, Department of Pediatrics; Hospital for Sick Children, University of Toronto; Toronto Ontario Canada
| | - S. Mital
- Division of Cardiology, Department of Pediatrics; Hospital for Sick Children, University of Toronto; Toronto Ontario Canada
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104
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Al-Haidar A, Moula N, Leroux A, Farnir F, Deleuze S, Sandersen C, Amory H. Reference values of two-dimensional and M-mode echocardiographic measurements as a function of body size in various equine breeds and in ponies. J Vet Cardiol 2017; 19:492-501. [DOI: 10.1016/j.jvc.2017.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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105
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Majonga ED, Rehman AM, McHugh G, Mujuru HA, Nathoo K, Patel MS, Munyati S, Odland JO, Kranzer K, Kaski JP, Ferrand RA. Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa. Int J Cardiol 2017; 248:409-413. [PMID: 28711335 PMCID: PMC5627581 DOI: 10.1016/j.ijcard.2017.06.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Echocardiographic reference ranges are important to identify abnormalities of cardiac dimensions. Reference ranges for children in sub-Saharan Africa have not been established. The aim of this study was to establish echocardiographic z-score references for Black children in sub-Saharan Africa. METHODS 282 healthy subjects aged 6-16years (143 [51%] males) with no known history of cardiac disease were enrolled in the study in Harare, Zimbabwe between 2014 and 2016. Standard M-mode echocardiography was performed and nine cardiac chamber dimensions were obtained. Two non-linear statistical models (gamma weighted model and cubic polynomial model) were tested on the data and the best fitting model was used to calculate z-scores of these cardiac chamber measures. The reference ranges are presented on scatter plots against BSA. RESULTS Normative data for the following cardiac measures were obtained and z-scores calculated: right ventricular diameter at end diastole (RVEDD); left ventricular diameter at end diastole (LVEDD) and systole (LVESD); interventricular septal wall thickness at end diastole (IVSd) and systole (IVSs); left ventricular posterior wall thickness at end diastole (LVPWd) and systole (LVPWs); left atrium diameter at end systole (LA) and tricuspid annular plane systolic excursion (TAPSE). Girls had higher values for BMI and heart rate than boys (p=0.048 and p=0.001, respectively). Mean interventricular septal and left ventricular posterior walls thickness was higher than published normal values in predominantly Caucasian populations. CONCLUSION These are the first echocardiographic reference ranges for children from sub Saharan Africa and will allow accurate assessment of cardiac dimensions in clinical practice.
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Affiliation(s)
- Edith D Majonga
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe.
| | - Andrea M Rehman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jon O Odland
- UiT, The Arctic University of Norway, Tromsø, Norway; Department of Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, United Kingdom
| | - Rashida A Ferrand
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe
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106
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Phenotypic expression of a novel desmin gene mutation: hypertrophic cardiomyopathy followed by systemic myopathy. J Hum Genet 2017; 63:249-254. [DOI: 10.1038/s10038-017-0383-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/07/2017] [Accepted: 10/15/2017] [Indexed: 11/08/2022]
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107
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Lopez L, Colan S, Stylianou M, Granger S, Trachtenberg F, Frommelt P, Pearson G, Camarda J, Cnota J, Cohen M, Dragulescu A, Frommelt M, Garuba O, Johnson T, Lai W, Mahgerefteh J, Pignatelli R, Prakash A, Sachdeva R, Soriano B, Soslow J, Spurney C, Srivastava S, Taylor C, Thankavel P, van der Velde M, Minich L. Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database. Circ Cardiovasc Imaging 2017; 10:e006979. [PMID: 29138232 PMCID: PMC5812349 DOI: 10.1161/circimaging.117.006979] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/19/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity. METHODS AND RESULTS Data collected from healthy nonobese children ≤18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSAα) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5% difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as ≥5% difference. Of the 3566 subjects, 90% had measurable images. Appropriate BSA transformations (BSAα) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement. CONCLUSIONS Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.
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Affiliation(s)
- Leo Lopez
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.).
| | - Steven Colan
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Mario Stylianou
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Suzanne Granger
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Felicia Trachtenberg
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Peter Frommelt
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Gail Pearson
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Joseph Camarda
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - James Cnota
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Meryl Cohen
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Andreea Dragulescu
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Michele Frommelt
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Olukayode Garuba
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Tiffanie Johnson
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Wyman Lai
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Joseph Mahgerefteh
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ricardo Pignatelli
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ashwin Prakash
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ritu Sachdeva
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Brian Soriano
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Jonathan Soslow
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Christopher Spurney
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Shubhika Srivastava
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Carolyn Taylor
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Poonam Thankavel
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Mary van der Velde
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - LuAnn Minich
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
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Navarini S, Bellsham-Revell H, Chubb H, Gu H, Sinha MD, Simpson JM. Myocardial Deformation Measured by 3-Dimensional Speckle Tracking in Children and Adolescents With Systemic Arterial Hypertension. Hypertension 2017; 70:1142-1147. [PMID: 29084877 DOI: 10.1161/hypertensionaha.117.09574] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 05/23/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022]
Abstract
Systemic arterial hypertension predisposes children to cardiovascular risk in childhood and adult life. Despite extensive study of left ventricular (LV) hypertrophy, detailed 3-dimensional strain analysis of cardiac function in hypertensive children has not been reported. The aim of this study was to evaluate LV mechanics (strain, twist, and torsion) in young patients with hypertension compared with a healthy control group and assess factors associated with functional measurements. Sixty-three patients (26 hypertension and 37 normotensive) were enrolled (mean age, 14.3 and 11.4 years; 54% men and 41% men, respectively). All children underwent clinical evaluation and echocardiographic examination, including 3-dimensional strain. There was no difference in LV volumes and ejection fraction between the groups. Myocardial deformation was significantly reduced in those with hypertension compared with controls. For hypertensive and normotensive groups, respectively, global longitudinal strain was -15.1±2.3 versus -18.5±1.9 (P<0.0001), global circumferential strain -15.2±3 versus -19.9±3.1 (<0.0001), global radial strain +44.0±11.3 versus 63.4±10.5 (P<0.0001), and global 3-dimensional strain -26.1±3.8 versus -31.5±3.8 (P<0.0001). Basal clockwise rotation, apical counterclockwise rotation, twist, and torsion were not significantly different. After multivariate regression analyses blood pressure, body mass index and LV mass maintained a significant relationship with measures of LV strain. Similar ventricular volumes and ejection fraction were observed in hypertensive and normotensive children, but children with hypertension had significantly lower strain indices. Whether reduced strain might predict future cardiovascular risk merits further longitudinal study.
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Affiliation(s)
- Susanne Navarini
- From the Department of Congenital Heart Disease (S.N., H.B.-R., H.C., J.M.S.) and Department of Pediatric Nephrology (H.G., M.D.S.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom; and Department of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (H.C., J.M.S.)
| | - Hannah Bellsham-Revell
- From the Department of Congenital Heart Disease (S.N., H.B.-R., H.C., J.M.S.) and Department of Pediatric Nephrology (H.G., M.D.S.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom; and Department of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (H.C., J.M.S.)
| | - Henry Chubb
- From the Department of Congenital Heart Disease (S.N., H.B.-R., H.C., J.M.S.) and Department of Pediatric Nephrology (H.G., M.D.S.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom; and Department of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (H.C., J.M.S.)
| | - Haotian Gu
- From the Department of Congenital Heart Disease (S.N., H.B.-R., H.C., J.M.S.) and Department of Pediatric Nephrology (H.G., M.D.S.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom; and Department of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (H.C., J.M.S.)
| | - Manish D Sinha
- From the Department of Congenital Heart Disease (S.N., H.B.-R., H.C., J.M.S.) and Department of Pediatric Nephrology (H.G., M.D.S.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom; and Department of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (H.C., J.M.S.)
| | - John M Simpson
- From the Department of Congenital Heart Disease (S.N., H.B.-R., H.C., J.M.S.) and Department of Pediatric Nephrology (H.G., M.D.S.), Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom; and Department of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (H.C., J.M.S.).
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109
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Longitudinal Analysis of Echocardiographic Abnormalities in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2017; 39:500-505. [PMID: 28859033 DOI: 10.1097/mph.0000000000000930] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cardiac abnormalities have been described in echocardiograms of children with sickle cell disease (SCD). However, longitudinal studies investigating progression of echocardiographic abnormalities across the pediatric age spectrum in SCD are lacking. METHODS A retrospective longitudinal analysis of 829 echocardiograms from pediatric patients with SCD at steady-state was performed. Left heart parameters included left ventricular end-systolic, end-diastolic diameters, fractional shortening, and mass. Right ventricular pressure was estimated by tricuspid regurgitation gradient. Tricuspid regurgitation gradient ≥25 mm Hg, a z-score ≥2 for LV parameters and ≤-2 for left ventricular fractional shortening were considered abnormal. RESULTS Kaplan-Meier analysis revealed that echocardiographic abnormalities were detected by 5 years of age, and the cumulative incidence progressively increased throughout childhood. Age, male gender, HbSS and Sβ thalassemia genotype, white blood cell count, platelet count, total bilirubin, admissions for pain crises and acute chest syndrome were positively, whereas hemoglobin was negatively associated with cardiac abnormalities. CONCLUSION Cardiac abnormalities began early in childhood and progressively increased with age. Our study highlights the high cumulative incidence of cardiac abnormalities in children with SCD, which could represent a marker of disease severity.
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Pediatric echocardiographic nomograms: What has been done and what still needs to be done. Trends Cardiovasc Med 2017; 27:336-349. [DOI: 10.1016/j.tcm.2017.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/29/2022]
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Abstract
UNLABELLED Purpose Sickle cell disease is known to cause various degrees of vasculopathy, including impact on heart function. The aims of this single-centre, retrospective study were to assess cardiac chamber size and function and the relationship with haematological indices such as haemoglobin, aspartate aminotransferase, reticulocytosis and bilirubin, lactate dehydrogenase in sickle cell disease. METHODS Right ventricle and left ventricle diastolic diameters, left ventricle mass estimate, left ventricle shortening fraction, myocardial performance index, and an index of myocardial relaxation (E/E') were calculated and correlated with haematological parameters. RESULTS A total of 110 patients (65% haemoglobin SS, 29% haemoglobin SC) were studied at a mean age of 12.14±5.26 years. Right ventricle dilatation and left ventricle dilatation were present in 61.5 and 42.9%, respectively. Left ventricle mass was abnormal in 21.9%; all patients had normal myocardial performance index, 31.4% had abnormal E/E', and left ventricle shortening fraction was low in 38.1%. Cardiac dilatation was best correlated with haemoglobin, aspartate aminotransferase, reticulocytosis and bilirubin. Best subset regression analysis yielded significant additional prediction for right ventricle or left ventricle dilatation with haemoglobin, bilirubin, and lactate dehydrogenase. Abnormal E/E' was solely predictable with haemoglobin level. Hydroxyurea-treated patients had improved diastolic function. CONCLUSION Right ventricle dilatation was more prevalent than left ventricle dilatation. The long-term consequences of right ventricular dilatation, clinical consequences, and association with pulmonary vasculopathy need to be further determined.
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Sachdeva S, Zhang L, Simpson P, Frommelt PC. Progressive aortic root dilatation in pediatric heart transplant recipients. Echocardiography 2017. [PMID: 28646501 DOI: 10.1111/echo.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To determine prevalence, clinical implication, and risk factors for aortic root dilation (ARD) in pediatric heart transplant recipients. METHODS Serial echocardiograms were reviewed in all pediatric heart transplant recipients from 1999 to 2014 to assess maximal systolic diameter at the aortic annulus, aortic sinus, aortic sino-tubular (ST) junction, and ascending aorta. ARD was defined by a sinus/annulus ratio >1.56, ST junction/annulus ratio >1.28, and/or ascending aorta/annulus ratio >1.35. RESULTS A total of 147 subjects (53% male) were evaluated; 50% had congenital heart disease (CHD). Of the 74 with CHD, 38 had prior aortic arch reconstruction. The median age at transplant was 3 years (7 days-20.3 years) with a median duration of follow-up of 3.88 years (3 months-15 years). Prevalence of ARD significantly increased in the cohort from 15.6% at the initial echocardiogram to 49.6% at later follow-up (P<.0001). The median duration to development of ARD was 7.6 months. There were no significant differences in prevalence of ARD or days to maximum ratio based on the pretransplant diagnosis. Aortic regurgitation was very rare (7 with ≤mild) and did not correlate with ARD or require any interventions. CONCLUSION During intermediate follow-up, ARD commonly develops in children post-heart transplant, and prevalence increases with time after transplant. Within 1 year after transplant, almost 50% had developed abnormalities in aortic root size that were not apparent at the initial posttransplant echocardiogram. Preexisting CHD or need for prior arch reconstruction did not increase the risk of ARD.
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Affiliation(s)
- Shagun Sachdeva
- Children's Hospital of Wisconsin, Milwaukee, WI, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liyun Zhang
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Peter C Frommelt
- Children's Hospital of Wisconsin, Milwaukee, WI, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
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Wang SS, Zhang YQ, Chen SB, Huang GY, Zhang HY, Zhang ZF, Wu LP, Hong WJ, Shen R, Liu YQ, Zhu JX. Regression equations for calculation of z scores for echocardiographic measurements of right heart structures in healthy Han Chinese children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:293-303. [PMID: 28121016 DOI: 10.1002/jcu.22436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/13/2016] [Accepted: 11/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Clinical decision making in children with congenital and acquired heart disease relies on measurements of cardiac structures using two-dimensional echocardiography. We aimed to establish z-score regression equations for right heart structures in healthy Chinese Han children. METHODS Two-dimensional and M-mode echocardiography was performed in 515 patients. We measured the dimensions of the pulmonary valve annulus (PVA), main pulmonary artery (MPA), left pulmonary artery (LPA), right pulmonary artery (RPA), right ventricular outflow tract at end-diastole (RVOTd) and at end-systole (RVOTs), tricuspid valve annulus (TVA), right ventricular inflow tract at end-diastole (RVIDd) and at end-systole (RVIDs), and right atrium (RA). Regression analyses were conducted to relate the measurements of right heart structures to 4body surface area (BSA). Right ventricular outflow-tract fractional shortening (RVOTFS) was also calculated. Several models were used, and the best model was chosen to establish a z-score calculator. RESULTS PVA, MPA, LPA, RPA, RVOTd, RVOTs, TVA, RVIDd, RVIDs, and RA (R2 = 0.786, 0.705, 0.728, 0.701, 0.706, 0.824, 0.804, 0.663, 0.626, and 0.793, respectively) had a cubic polynomial relationship with BSA; specifically, measurement (M) = β0 + β1 × BSA + β2 × BSA2 + β3 × BSA.3 RVOTFS (0.28 ± 0.02) fell within a narrow range (0.12-0.51). CONCLUSIONS Our results provide reference values for z scores and regression equations for right heart structures in Han Chinese children. These data may help interpreting the routine clinical measurement of right heart structures in children with congenital or acquired heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:293-303, 2017.
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Affiliation(s)
- Shan-Shan Wang
- Department of Pediatrics, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, 201204, China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Shu-Bao Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Guo-Ying Huang
- Department of Pediatric Cardiology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Hong-Yan Zhang
- Department of Pediatric Cardiology, Tianjin Children's Hospital, Tianjin, 300204, China
| | - Zhi-Fang Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Wen-Jing Hong
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Rong Shen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Yi-Qing Liu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Jun-Xue Zhu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
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114
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Tony Nengom J, Sap Ngo Um S, Chelo D, Mbono Betoko R, Boombhi J, Mouafo Tambo F, Chiabi A, Kingue S, Koki Ndombo P. Assessment of cardiac function in children with congenital adrenal hyperplasia: a case control study in Cameroon. BMC Pediatr 2017; 17:109. [PMID: 28427378 PMCID: PMC5399398 DOI: 10.1186/s12887-017-0862-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/06/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND High level of androgens found in congenital adrenal hyperplasia (CAH) seems to have a deleterious effect on heart function. We therefore evaluate cardiac function of children with CAH in comparison with a healthy group. METHODS We carried out a case-control study in the single endocrinology unit of the Mother and Child Center of Chantal Biya's Foundation. Cases were matched for age and genotypic sex to 2 healthy controls. We analyzed the ejection fraction (LVEF), fractional shortening and left ventricular mass; output and cardiac index; E and A waves velocities, E/A ratio and the mitral deceleration time and diameter of the left atrium; tricuspid annular plane systolic excursion and pulmonary artery systolic pressure were also measured. RESULTS We included 19 patients with a median age of 6.26 ± 3.75 years and 38 controls stackable distribution. The left ventricular mass of cases was greater than that of controls. A case of reversible cardiomyopathy on hormone replacement therapy was found. For the cases, the average ejection fraction was 71.95 ± 7.88%; the average fractional shortening was 40.67 ± 7.02%. All these values were higher than those of controls, although the difference was not statistically significant. Diastolic left ventricular function was more impaired among the cases. Right ventricular function was similar in both groups. These abnormalities were highly correlated to the late age at diagnosis and duration of treatment. CONCLUSION This study shows an altered cardiac function in CAH compared to healthy control and highlights importance of an early diagnosis of cases, a tight control of androgens levels and a regular monitoring of cardiac function.
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Affiliation(s)
- J Tony Nengom
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.
| | - S Sap Ngo Um
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.,Mother and Child Centre of the Chantal Biya Foundation, Yaounde, Cameroon
| | - D Chelo
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.,Mother and Child Centre of the Chantal Biya Foundation, Yaounde, Cameroon
| | - R Mbono Betoko
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon
| | - J Boombhi
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.,Yaounde General Hospital, Yaounde, Cameroon
| | - F Mouafo Tambo
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.,Yaounde Gyneco Obstetric and Pediatric Hospital, Yaounde, Cameroon
| | - A Chiabi
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.,Yaounde Gyneco Obstetric and Pediatric Hospital, Yaounde, Cameroon
| | - S Kingue
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.,Yaounde General Hospital, Yaounde, Cameroon
| | - P Koki Ndombo
- Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon.,Yaounde General Hospital, Yaounde, Cameroon
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Left ventricular end-diastolic dimension as a predictive factor of outcomes in children with acute myocarditis. Cardiol Young 2017; 27:443-451. [PMID: 27225897 DOI: 10.1017/s1047951116000706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we sought predictors of mortality in children with acute myocarditis and of incomplete recovery in the survivor group. We classified our patients into three groups according to their outcomes at last follow-up: full recovery was classified as group I, incomplete recovery was classified as group II, and death was classified as group III. In total, 55 patients were enrolled in the study: 33 patients in group I, 11 patients in group II, and 11 patients in group III. The initial left ventricular fractional shortening - left ventricular fractional shortening - was significantly lower in group III (p=0.001), and the left ventricular end-diastolic dimension z score was higher in groups II and III compared with group I (p=0.000). A multivariate analysis showed that the left ventricular end-diastolic dimension z score (odds ratio (OR), 1.251; 95% confidence interval (CI), 1.004-1.559), extracorporeal membrane oxygenation (OR, 9.842; 95% CI, 1.044-92.764), and epinephrine infusion (OR, 18.552; 95% CI, 1.759-195.705) were significant predictors of mortality. The left ventricular end-diastolic dimension z score was the only factor that predicted incomplete recovery in the survivor group (OR, 1.360; 95% CI, 1.066-1.734; p=0.013). The receiver operating characteristic curve of the left ventricular end-diastolic dimension z score at admission showed a cut-off level of 3.01 for predicting mortality (95% CI, 0.714-0.948). In conclusion, a high left ventricular end-diastolic dimension z score on admission was a significant predictor of worse outcomes, both regarding mortality and incomplete recovery.
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116
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McClean G, Riding NR, Ardern CL, Farooq A, Pieles GE, Watt V, Adamuz C, George KP, Oxborough D, Wilson MG. Electrical and structural adaptations of the paediatric athlete’s heart: a systematic review with meta-analysis. Br J Sports Med 2017; 52:230. [DOI: 10.1136/bjsports-2016-097052] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 01/27/2023]
Abstract
AimTo describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athlete’s heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.DesignSystematic review with meta-analysis.Data sourcesSix electronic databases were searched to May 2016: MEDLINE, PubMed, EMBASE, Web of Science, CINAHL and SPORTDiscus.Inclusion criteria(1) Male and/or female competitive athletes, (2) participants aged 6–18 years, (3) original research article published in English language.ResultsData from 14 278 athletes and 1668 non-athletes were included for qualitative (43 articles) and quantitative synthesis (40 articles). Paediatric athletes demonstrated a greater prevalence of training-related and training-unrelated ECG changes than non-athletes. Athletes ≥14 years were 15.8 times more likely to have inferolateral T-wave inversion than athletes <14 years. Paediatric black athletes had significantly more training-related and training-unrelated ECG changes than Caucasian athletes. Age was a positive predictor of left ventricular (LV) internal diameter during diastole, interventricular septum thickness during diastole, relative wall thickness and LV mass. When age was accounted for, these parameters remained significantly larger in athletes than non-athletes. Paediatric black athletes presented larger posterior wall thickness during diastole (PWTd) than Caucasian athletes. Paediatric male athletes also presented larger PWTd than females.ConclusionsThe paediatric athlete’s heart undergoes significant remodelling both before and during ‘maturational years’. Paediatric athletes have a greater prevalence of training related and training-unrelated ECG changes than non-athletes, with age, race and sex mediating factors on cardiac electrical and LV structural remodelling.
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Ziółkowska L, Petryka J, Boruc A, Kawalec W. Comparison of echocardiography with tissue Doppler imaging and magnetic resonance imaging with delayed enhancement in the assessment of children with hypertrophic cardiomyopathy. Arch Med Sci 2017; 13:328-336. [PMID: 28261285 PMCID: PMC5332448 DOI: 10.5114/aoms.2016.60404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/19/2015] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION In children with hypertrophic cardiomyopathy (HCM) there often occurs a non-ischemic pattern of myocardial fibrosis, which could be the cause of impaired left ventricular (LV) diastolic function assessed by tissue Doppler imaging (TDI). The aim of the study was to determine the prevalence of myocardial fibrosis in children with HCM, and to evaluate its relationship with echocardiographic parameters including LV diastolic dysfunction. MATERIAL AND METHODS Sixty-three children with HCM, mean age 12.2 ±4.5 years, underwent magnetic resonance imaging (MRI) and echocardiographic study from January 2010 to April 2014. The results of MRI, echocardiography, and TDI velocities were analyzed and compared between children with and without myocardial fibrosis. Moreover, correlations between the results of echocardiography and MRI were assessed. RESULTS Our results showed a significant correlation between magnetic resonance and echocardiographic measurements of septal wall thickness, posterior wall thickness, LV mass and left atrial dimension. Children with myocardial fibrosis (60%) had a significantly thicker interventricular septum (21.3 vs. 1.8 mm; p < 0.0001) and larger left atrial dimension (36.7 vs. 27.8 mm; p = 0.0004) and volume index (42.0 vs. 26.6 ml/m²; p = 0.0011). Tissue Doppler imaging demonstrated significantly decreased lateral E' (9.02 vs. 13.53 cm/s; p < 0.0001) and septal E' (7.05 vs. 9.36 cm/s; p = 0.0082) velocities and a significantly increased transmitral lateral (10.34 vs. 6.68; p = 0.0091) and septal (13.1 vs. 9.8; p = 0.046) E/E' ratio in children with myocardial fibrosis. CONCLUSIONS Myocardial fibrosis in children with hypertrophic cardiomyopathy was associated with markers for disease severity such as larger septum thickness, enlargement of the left atrium as well as impairment of left ventricular diastolic function. Tissue Doppler imaging is a helpful tool to detect the presence of left ventricular diastolic dysfunction in children with hypertrophic cardiomyopathy and myocardial fibrosis.
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Affiliation(s)
- Lidia Ziółkowska
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Joanna Petryka
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Agnieszka Boruc
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Wanda Kawalec
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
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Abdelmohsen G, Abd El Rahman MY, Dohain A, Latif SA, Attia W. Left circumflex coronary artery to coronary sinus fistula diagnosed in infancy. J Cardiol Cases 2017; 15:97-99. [PMID: 30279750 PMCID: PMC6135026 DOI: 10.1016/j.jccase.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/07/2016] [Accepted: 11/25/2016] [Indexed: 01/09/2023] Open
Abstract
Coronary artery fistulas are rare anomalies, their incidence range from 0.1 to 0.2% of congenital heart defects. The left circumflex coronary artery (LCX) fistula draining into the coronary sinus (CS) is a less common form, and most cases described in the literature were adult cases. We are describing this type of fistula in an 8-month-old asymptomatic female presenting with a continuous murmur over the pericordium. Electrocardiogram was normal. Echocardiography revealed a dilated LCX and CS with turbulent flow in CS; 2-D speckle tracking echocardiography revealed normal left ventricular strain with no regional wall abnormalities. Multidetector computed tomography demonstrated the fistula. As the patient was asymptomatic, with no ventricular dilatation or dysfunction, we decided conservatively. .
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Affiliation(s)
- Gaser Abdelmohsen
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Mohamed Youssef Abd El Rahman
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Ahmed Dohain
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | | | - Wael Attia
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
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Panamonta M, Chaikitpinyo A, Lumbiganon P, Panamonta O, Auvichayapat N, Wongswadiwat Y, Thepsuthammarat K, Panthongviriyakul A, Pongchaiyakul C. Historical assessment of diphtheritic myocarditis from a hospital in northeastern Thailand. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0804.316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Although there have been many descriptive studies of diphtheria from resource limited countries, descriptions of the natural history of diphtheritic myocarditis in patients from these countries are scarce.
Objective: To present the natural history of diphtheritic myocarditis from a hospital in northeastern Thailand.
Methods: The clinical features of 38 patients with diphtheria admitted to the Khon Kaen University Hospital in northeastern Thailand between 1983 and 1996 were reviewed.
Results: Of the 38 cases of diphtheria, 10 progressed to diphtheritic myocarditis (26%). Electrocardiographic findings of the 10 patients with myocarditis were myocardial and conduction abnormalities. The presence of a clinically severe (toxic) type (P < 0.001) or a swollen neck (bull neck) (P = 0.001) was a predictor of the occurrence of myocarditis. Five (50%) of the 10 patients with myocarditis had conduction abnormalities (third-degree atrioventricular block 3, left bundle branch block 1, and right bundle branch block 1). Four patients with severe symptomatic bradyarrhythmia (third-degree atrioventricular block 3, and left bundle branch block 1) received ventricular pacing, and 3 patients died after this pacing. Echocardiographic abnormalities of left ventricular dilatation and myocardial hypertrophy were found in all 5 patients with conduction abnormalities. All 6 of 7 survivors of diphtheritic myocarditis had normal 12-lead electrocardiographic results at 1-month follow-up. A patient who was the survivor of third-degree AV block had an electrocardiographic finding of flat T waves, and with a complete echocardiographic normalization of left ventricular dilatation and myocardial hypertrophy.
Conclusion: The present study confirms that increasing diphtheria immunization coverage in the population remains the most important strategy for the control of diphtheria. In resource limited countries, clinical findings, electrocardiography, and sometimes where available, echocardiography are helpful in assessing the severity of diphtheritic myocarditis, decision making of acute management, and predicting fatal outcome.
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Affiliation(s)
- Manat Panamonta
- MD, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | | | | | - Ouyporn Panamonta
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand
| | - Narong Auvichayapat
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand
| | | | | | | | - Choowong Pongchaiyakul
- Echocardiographic Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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120
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Wang C, Takasaki A, Watanabe Ozawa S, Nakaoka H, Okabe M, Miyao N, Saito K, Ibuki K, Hirono K, Yoshimura N, Yu X, Ichida F. Long-Term Prognosis of Patients With Left Ventricular Noncompaction - Comparison Between Infantile and Juvenile Types. Circ J 2017; 81:694-700. [PMID: 28154298 DOI: 10.1253/circj.cj-16-1114] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The natural history of left ventricular noncompaction (LVNC) is largely unsolved, so the aim of the present study was to clarify the clinical features and long-term prognosis of children with LVNC until adulthood.Methods and Results:We conducted a nationwide survey over 20 years and compared the clinical features, anatomical characteristics and long-term prognosis of 205 patients divided into 2 classifications: infantile type (diagnosed at <1 year of age: 108 cases) and juvenile type (diagnosed 1-15 years of age: 97 cases). Most patients diagnosed during infancy had heart failure (HF) at initial presentation (60.19%), while the majority of juvenile cases were asymptomatic (53.61%) but their event-free survival rate decreased gradually, because of later HF, thromboembolism and fatal arrhythmias. The initial LVEF was significantly lower in the infantile type and correlated with the thickness of the compacted layer in the LV posterior wall (LVPWC) and LV end-diastolic dimension (LVDD) Z-score, but not to the noncompacted to compacted layer (N/C) ratio. Survival analysis showed prognosis was similarly poor for both types after 2 decades. The significant risk factors for death, heart transplantation or implantable cardioverter-defibrillator insertion were congestive HF at diagnosis and lower LVPWC Z-score but not age of onset. CONCLUSIONS LVNC of both types showed poor long-term prognosis, therefore ongoing follow-up is recommended into adulthood. HF at diagnosis and LVPWC hypoplasia are major determinants of poor prognosis.
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Affiliation(s)
- Ce Wang
- Department of Pediatrics, Faculty of Medicine, University of Toyama.,Department of Pediatrics, Shengjing Hospital of China Medical University
| | - Asami Takasaki
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | | | - Hideyuki Nakaoka
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Mako Okabe
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Nariaki Miyao
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Kazuyoshi Saito
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Keijiro Ibuki
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Naoki Yoshimura
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Toyama
| | - Xianyi Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University
| | - Fukiko Ichida
- Department of Pediatrics, Faculty of Medicine, University of Toyama
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121
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Aurensanz Clemente E, Ayerza Casas A, Samper Villagrasa P, Ruiz Frontera P, Bueno Lozano G. Evaluación de la función cardiaca en un grupo de niños pequeños para la edad gestacional en edad escolar en tratamiento con hormona de crecimiento. Med Clin (Barc) 2017; 148:101-106. [DOI: 10.1016/j.medcli.2016.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 12/30/2022]
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122
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Borgia F, Pezzullo E, Schiano Lomoriello V, Sorrentino R, Lo Iudice F, Cocozza S, Della Casa R, Parenti G, Strisciuglio P, Trimarco B, Galderisi M. Myocardial deformation in pediatric patients with mucopolysaccharidoses: A two-dimensional speckle tracking echocardiography study. Echocardiography 2017; 34:240-249. [DOI: 10.1111/echo.13444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Francesco Borgia
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Enrica Pezzullo
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | | | - Regina Sorrentino
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Francesco Lo Iudice
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Sara Cocozza
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Roberto Della Casa
- Department of Translational Medical Sciences; Federico II University Hospital; Naples Italy
| | - Giancarlo Parenti
- Department of Translational Medical Sciences; Federico II University Hospital; Naples Italy
| | - Pietro Strisciuglio
- Department of Translational Medical Sciences; Federico II University Hospital; Naples Italy
| | - Bruno Trimarco
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Maurizio Galderisi
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
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Suominen P, Mattila N, Nyblom O, Rautiainen P, Turanlahti M, Rahkonen O. The Hemodynamic Effects and Safety of Repetitive Levosimendan Infusions on Children With Dilated Cardiomyopathy. World J Pediatr Congenit Heart Surg 2016; 8:25-31. [PMID: 28033083 DOI: 10.1177/2150135116674466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited treatment options are available for children with decompensated dilated cardiomyopathy (DCM), while they wait for either functional recovery or heart transplantation. We evaluated the safety of repetitive levosimendan infusions and short-term and long-term impacts of the therapy in this patient population. METHODS Eighty-one repetitive levosimendan infusions administered to 20 patients with DCM at severe or end stage of the disease in the pediatric intensive care unit were analyzed retrospectively. Echocardiographic assessments were reinterpreted by two experienced pediatric cardiologists. The mean follow-up time after therapy was 9.8 ± 3.3 years. RESULTS The median age of the patients at the time of the first levosimendan infusion was 1.1 years (interquartile range: 0.3-2.1). Transient hypotension was reported in 17.3% of the infusions. No significant changes in the mean ejection fraction were detected after repetitive levosimendan infusion (31.6 ± 12.5 vs 33.1 ± 12.4; P = .39) or for the laboratory parameters for the group as a whole. In 7 (35%) of 20 patients, the mean ejection fraction improved from 20% ± 12% to 35% ± 11% ( P = .003). The administration of concomitant medications and time may have contributed to the healing process of these patients. Two patients were removed from the transplantation waiting-list owing to clinical recovery after six months of therapy. The long-term survival rate was 70% (n = 14 of 20). CONCLUSIONS Repetitive levosimendan infusions in children with DCM appeared to be hemodynamically well tolerated without severe adverse events. Although one-third of the children had a good response to repetitive levosimendan infusions, no overall significant improvement in ventricular performance could be found in this heterogenous DCM patient population, which included the patients in end-stage heart failure.
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Affiliation(s)
- Pertti Suominen
- 1 Department of Anaesthesia and Intensive Care, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Niklas Mattila
- 1 Department of Anaesthesia and Intensive Care, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Olle Nyblom
- 2 Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Paula Rautiainen
- 1 Department of Anaesthesia and Intensive Care, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Maila Turanlahti
- 2 Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Otto Rahkonen
- 2 Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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André F, Robbers-Visser D, Helling-Bakki A, Föll A, Voss A, Katus HA, Helbing WA, Buss SJ, Eichhorn JG. Quantification of myocardial deformation in children by cardiovascular magnetic resonance feature tracking: determination of reference values for left ventricular strain and strain rate. J Cardiovasc Magn Reson 2016; 19:8. [PMID: 28103933 PMCID: PMC5248452 DOI: 10.1186/s12968-016-0310-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/30/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective assessment of global and regional cardiac function in children has shown to be clinically relevant but is challenging to conduct. Cardiovascular magnetic resonance (CMR) has emerged as a valuable diagnostic modality especially in patients with cardiomyopathy or congenital heart disease. However, data on the normal cardiac deformation in children assessed by CMR is lacking at present. Thus, the aim of this study was to provide reference values for cardiac strain and strain rate in children and adolescents derived from CMR feature tracking (FT) measurements. METHODS In this binational study, eighty children and adolescents (age 0.4-18.0 years, 41 male, 39 female) free from cardiac diseases from two centers underwent CMR in 1.5 T whole-body scanners in supine position. Global peak radial, circumferential and longitudinal systolic strains as well as the corresponding early peak diastolic strain rates were assessed applying FT on short axis as well as 3- and 4-chamber views of standard cine steady-state free precession images. RESULTS The difference between genders yielded no significance for all assessed strains. Yet, all strains showed a significant parabolic relation to age and an even stronger one to body surface area (BSA). Therefore, BSA-specific reference values were determined using a polynomial regression model. The apical cardiac segments featured significant higher peak circumferential but lower peak radial systolic strains than the midventricular and basal segments (all p < 0.001). CONCLUSIONS The assessment of cardiac deformation by CMR-FT is feasible in children. This is the first CMR study providing specific reference values for FT-derived strain and strain rate in the pediatric age range.
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Affiliation(s)
- Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Daniëlle Robbers-Visser
- Department of Pediatrics, Division of Pediatric Cardiology and Department of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Angela Föll
- Department of General Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - Andreas Voss
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology and Department of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Sebastian J. Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Joachim G. Eichhorn
- Klinikum Leverkusen, Children’s Hospital, Am Gesundheitspark 11, 51375 Leverkusen, Germany
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Van den Berg N, Slieker M, van Beynum I, Bilardo C, de Bruijn D, Clur S, Cornette J, Frohn-Mulder I, Haak M, van Loo-Maurus K, Manten G, Rackowitz A, Rammeloo L, Reimer A, Rijlaarsdam M, Freund M. Fluorinated steroids do not improve outcome of isolated atrioventricular block. Int J Cardiol 2016; 225:167-171. [DOI: 10.1016/j.ijcard.2016.09.119] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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126
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Hayashi T, Inuzuka R, Ono H, Kato H. Echocardiographic assessment of prosthetic mitral valves in children. Echocardiography 2016; 34:94-101. [PMID: 27804157 DOI: 10.1111/echo.13406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/09/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS We studied how Doppler-derived hemodynamic parameters in children change as the relative prosthetic mitral valve (PMV) size decreases with somatic growth and evaluated the diagnostic utility of the parameters for detecting PMV obstruction in children. METHODS AND RESULTS We reviewed 26 echocardiographic examination results of 15 mechanical bileaflet PMVs in 12 children. The median age at echocardiographic examination was 6.6 (0.6-18.1) years. The PMV functioned normally in 24 examinations but was obstructed due to thrombosis in two cases. PMV sizes ranged between 16 and 25 mm, which were standardized to body surface area (BSA) at the examination with z-score calculations. We assessed the peak E velocity, mean pressure gradient (PG), and pressure half time (PHT) of the transprosthetic flow, the velocity-time integral (VTI) ratio of the PMV inflow to the left ventricular outflow, and the BSA-indexed effective orifice area (iEOA) of the PMV calculated with the continuity equation. Linear regression analysis revealed statistically significant correlations between all parameters of normally functioning PMVs and the PMV size z-scores (Pearson correlation coefficients: peak E velocity, -0.68; mean PG, -0.71; PHT, -0.82; VTI ratio, -0.76; iEOA, 0.79). Compared with the predictive values derived from the regression equations, the VTI ratio and iEOA exceeded ± 2 standard errors in both patients with obstructive PMVs. CONCLUSION To assess PMV function in children, Doppler-derived hemodynamic parameters should be compared with their predictive values based on relative PMV sizes. The deviation of the VTI ratio and iEOA from their predictive values may indicate prosthetic obstruction.
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Affiliation(s)
- Taiyu Hayashi
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Kato
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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127
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Van Cauwenberge J, Lovstakken L, Fadnes S, Rodriguez-Morales A, Vierendeels J, Segers P, Swillens A. Assessing the Performance of Ultrafast Vector Flow Imaging in the Neonatal Heart via Multiphysics Modeling and In Vitro Experiments. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2016; 63:1772-1785. [PMID: 27824560 DOI: 10.1109/tuffc.2016.2596804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ultrafast vector flow imaging would benefit newborn patients with congenital heart disorders, but still requires thorough validation before translation to clinical practice. This paper investigates 2-D speckle tracking (ST) of intraventricular blood flow in neonates when transmitting diverging waves at ultrafast frame rate. Computational and in vitro studies enabled us to quantify the performance and identify artifacts related to the flow and the imaging sequence. First, synthetic ultrasound images of a neonate's left ventricular flow pattern were obtained with the ultrasound simulator Field II by propagating point scatterers according to 3-D intraventricular flow fields obtained with computational fluid dynamics (CFD). Noncompounded diverging waves (opening angle of 60°) were transmitted at a pulse repetition frequency of 9 kHz. ST of the B-mode data provided 2-D flow estimates at 180 Hz, which were compared with the CFD flow field. We demonstrated that the diastolic inflow jet showed a strong bias in the lateral velocity estimates at the edges of the jet, as confirmed by additional in vitro tests on a jet flow phantom. Furthermore, ST performance was highly dependent on the cardiac phase with low flows (<5 cm/s), high spatial flow gradients, and out-of-plane flow as deteriorating factors. Despite the observed artifacts, a good overall performance of 2-D ST was obtained with a median magnitude underestimation and angular deviation of, respectively, 28% and 13.5° during systole and 16% and 10.5° during diastole.
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128
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The functional single ventricle: how imaging guides treatment. Clin Imaging 2016; 40:1146-1155. [DOI: 10.1016/j.clinimag.2016.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/06/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
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129
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Mehta A, Saxena A, Juneja R, Ramakrishnan S, Gupta S, Kothari SS. Characteristics and outcomes of Indian children enrolled in a rheumatic heart disease registry. Int J Cardiol 2016; 222:1136-1140. [DOI: 10.1016/j.ijcard.2016.08.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/08/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
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130
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Abadir S, Blanchet C, Fournier A, Mawad W, Shohoudi A, Dahdah N, Khairy P. Characteristics of premature ventricular contractions in healthy children and their impact on left ventricular function. Heart Rhythm 2016; 13:2144-2148. [DOI: 10.1016/j.hrthm.2016.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 11/25/2022]
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131
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Abstract
We aimed to elucidate the relationship between severity of secondary mitral regurgitation and mitral valve geometry in children with dilated cardiomyopathy. The medical records of 16 children with dilated cardiomyopathy (median age, 1.2 years; range, 0.4-12.3 years) were reviewed. Mitral valve geometry was evaluated by measuring coaptation depth using echocardiographic apical four-chamber views at the initial presentation. Patients were dichotomised according to the mitral regurgitation severity: patients with moderate or severe secondary mitral regurgitation (n=6) and those with mild secondary mitral regurgitation (n=10). A total of 58 healthy children were considered as normal controls, and a regression equation to predict coaptation depth by body surface area was derived: coaptation depth [mm]=4.37+1.34×ln (body surface area [m2]) (residual standard error, 0.49; adjusted R2, 0.68; p<0.0001). Compared with patients with mild secondary mitral regurgitation, those with moderate or severe secondary mitral regurgitation had significantly larger coaptation depth z-scores (6.4±2.3 versus 1.9±1.4, p<0.005), larger mitral annulus diameter z-scores (3.6±2.6 versus 0.9±1.8, p<0.05), higher left ventricular sphericity index (0.89±0.07 versus 0.79±0.06, p<0.005), and greater left ventricular fraction shortening (0.15±0.05 versus 0.09±0.05, p<0.05). In conclusion, geometric alteration in the mitral valve and the left ventricle is associated with the severity of secondary mitral regurgitation in paediatric dilated cardiomyopathy, which would provide a theoretical background to surgical intervention for secondary mitral regurgitation in paediatric populations.
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Kampmann C, Abu-Tair T, Gökce S, Lampe C, Reinke J, Mengel E, Hennermann JB, Wiethoff CM. Heart and Cardiovascular Involvement in Patients with Mucopolysaccharidosis Type IVA (Morquio-A Syndrome). PLoS One 2016; 11:e0162612. [PMID: 27610627 PMCID: PMC5017658 DOI: 10.1371/journal.pone.0162612] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/25/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Mucopolysaccharidosis (MPS) IVA is a rare lysosomal storage disorder with multiple skeletal and non-skeletal abnormalities requiring multiple surgical interventions. It is well known that patients with MPS IVA suffer from tachycardia, but cardiac and hemodynamic alterations have not been reported to date. We investigated the cardiovascular and hemodynamic alterations in patients with MPS IVA and developed a possible patho-mechanism for cardiovascular deterioration during anesthesia. MATERIAL AND METHODS In this observational study, serial cardiac examinations were performed in 54 patients with MPS IVA who were followed at the Children's Hospital of the Mainz Medical University (Mainz, Germany) between 1991 and 2014 (follow-up 1-24 years; median 5.8 years). Results were compared with data from a large central European cohort of more than 2000 healthy infants and children. RESULTS None of the patients had arterial hypertension, but 4% had evidence of increased pulmonary artery pressure. Patients developed aortic root extension up to 6.9 standard deviations above normal. Left-sided valve leaflet thickening occurred in 26 patients (five with valve disease). Patients had lower left ventricular dimensions (z: -1.02±0.1), lower stroke volumes (z: -2.3±0.17), lower left ventricular mass (z: -1.5±0.21), but higher wall thickness (z: +0.8±0.16), and higher work index (z: +2.5±0.2) compared to healthy control subjects. Cardiac output was preserved by an increase in heart rate of 21%. Sixty % of patients showed impaired diastolic filling; heart rate (99.0±1.8 vs. 92.0±2.1 bpm), age (18.0±1.8 vs. 14.2±1 years), and cardiothoracic ratio (61.6±3.6% vs. 55±4.2%) of these patients were higher compared to those with normal filling. CONCLUSIONS The results of this study suggest an age-progressive disproportion of the intra-thoracic organs of patients with MPS IVA, which is accompanied by aortic root extension and thickened left ventricles, with reduced stroke volumes, impaired diastolic filling patterns, and increased heart rates.
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Affiliation(s)
- Christoph Kampmann
- Division of Pediatric Cardiology and Congenital Heart Diseases, Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
- * E-mail:
| | - Tariq Abu-Tair
- Division of Pediatric Cardiology and Congenital Heart Diseases, Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
| | - Seyfullah Gökce
- Division of Metabolic Diseases (Villa Metabolica), Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
| | - Christina Lampe
- Division of Metabolic Diseases (Villa Metabolica), Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
| | - Jörg Reinke
- Division of Metabolic Diseases (Villa Metabolica), Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
| | - Eugen Mengel
- Division of Metabolic Diseases (Villa Metabolica), Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
| | - Julia B. Hennermann
- Division of Metabolic Diseases (Villa Metabolica), Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
| | - Christiane M. Wiethoff
- Division of Pediatric Cardiology and Congenital Heart Diseases, Center for Diseases in Childhood and Adolescence, Mainz Medical University, Mainz, Germany
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Rached-D'Astous S, Boukas I, Fournier A, Raboisson MJ, Dahdah N. Coronary Artery Dilatation in Viral Myocarditis Mimics Coronary Artery Findings in Kawasaki Disease. Pediatr Cardiol 2016; 37:1148-52. [PMID: 27233663 DOI: 10.1007/s00246-016-1411-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
Coronary artery (CA) dilatations are typical to Kawasaki disease (KD) in the pediatric population. CA involvement is a useful feature to help establish the diagnosis of KD. Since myocarditis is omnipresent in the acute phase of KD, we sought to investigate whether viral myocarditis may cause CA dilatation. This retrospective study reviewed 14 consecutive patients diagnosed with acute myocarditis at CHU Sainte-Justine, Montreal. KD diagnosis was excluded for all patients. All echocardiography studies were reviewed by an independent experienced echocardiographer for CA size and myocardial function parameters. CA involvement was classified under three categories: definite dilatation (Z-score ≥2.5 in one or more CA), occult dilatation (Z-score variation ≥2 points for the same CA on two different echocardiograms, but maximum Z-score always <2.5), and no dilatation otherwise. Demographics, laboratory values, microbial etiology testing, and diagnostic studies were collected from medical records. Mean age at presentation was 1.67 ± 3.22 years, where 11/14 (78 %) presented with acute and three with subacute myocarditis. Five (36 %) patients had normal CA measurements, six (43 %) had occult dilatation, and three (21 %) had definite dilatation. Maximal CA Z-score was within the first 8 days of presentation. Patients with viral myocarditis can present CA dilatation during the acute phase of the illness. This finding should be taken into account when KD diagnosis is being based on the CA involvement as the two illnesses may present with similar features.
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Affiliation(s)
- Soha Rached-D'Astous
- Division of Pediatric Cardiology (6 - block 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.,Department of Pediatrics, CHU Ste-Justine, University of Montreal, Montréal, Canada
| | - Ibtissama Boukas
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology (6 - block 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Marie-Josée Raboisson
- Division of Pediatric Cardiology (6 - block 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology (6 - block 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
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Curtis AE, Smith TA, Ziganshin BA, Elefteriades JA. The Mystery of the Z-Score. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2016; 4:124-130. [PMID: 28097194 DOI: 10.12945/j.aorta.2016.16.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022]
Abstract
Reliable methods for measuring the thoracic aorta are critical for determining treatment strategies in aneurysmal disease. Z-scores are a pragmatic alternative to raw diameter sizes commonly used in adult medicine. They are particularly valuable in the pediatric population, who undergo rapid changes in physical development. The advantage of the Z-score is its inclusion of body surface area (BSA) in determining whether an aorta is within normal size limits. Therefore, Z-scores allow us to determine whether true pathology exists, which can be challenging in growing children. In addition, Z-scores allow for thoughtful interpretation of aortic size in different genders, ethnicities, and geographical regions. Despite the advantages of using Z-scores, there are limitations. These include intra- and inter-observer bias, measurement error, and variations between alternative Z-score nomograms and BSA equations. Furthermore, it is unclear how Z-scores change in the normal population over time, which is essential when interpreting serial values. Guidelines for measuring aortic parameters have been developed by the American Society of Echocardiography Pediatric and Congenital Heart Disease Council, which may reduce measurement bias when calculating Z-scores for the aortic root. In addition, web-based Z-score calculators have been developed to aid in efficient Z-score calculations. Despite these advances, clinicians must be mindful of the limitations of Z-scores, especially when used to demonstrate beneficial treatment effect. This review looks to unravel the mystery of the Z-score, with a focus on the thoracic aorta. Here, we will discuss how Z-scores are calculated and the limitations of their use.
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Affiliation(s)
- Alexander E Curtis
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tanya A Smith
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
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135
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Recreational scuba diving in patients with congenital heart disease: Time for new guidelines. Arch Cardiovasc Dis 2016; 109:504-10. [PMID: 27364729 DOI: 10.1016/j.acvd.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 01/02/2023]
Abstract
The number of recreational scuba divers is steadily increasing. In its latest recommendations, the French Federation of Undersea Studies and Sports listed congenital heart disease as a formal and final contraindication to scuba diving. On the other hand, with the progress made in their management, the prognosis and quality of life of patients with congenital heart diseases have improved considerably, enabling them to engage in physical and sports endeavours, which are known to confer general health and psychological benefits. As a consequence, the ability of these patients to dive has become a regular and recurrent issue. We review the various types of scuba diving, the physical performance required for its practice, its effects on cardiovascular function and the elements that need to be considered before recommending whether it can be practiced safely at various levels of difficulty. Because of the diversity and broad heterogeneity of congenital heart diseases, a detailed evaluation of each patient's performance based on clinical criteria common to all congenital heart diseases is recommended.
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Abrar S, Ansari MJ, Mittal M, Kushwaha K. Predictors of Mortality in Paediatric Myocarditis. J Clin Diagn Res 2016; 10:SC12-6. [PMID: 27504368 PMCID: PMC4963728 DOI: 10.7860/jcdr/2016/19856.7967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/16/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Paediatric myocarditis can present as mild flu like symptoms to fulminent form. Early identification of the severity of illness and prioritization of intensive care is helpful especially in developing countries with limited resources. AIM To know the factors at admission that can predict mortality in paediatric myocarditis. MATERIALS AND METHODS This was an observational study which enrolled children who presented with fever of acute onset (less than 15 days in duration), and were diagnosed as suspected myocarditis on the basis of clinical features, Troponin I and echocardiography, according to Expanded criteria for myocarditis in Paediatric ward at our institute over a period from August 2014 to December 2015. Their clinical features, cardiac biomarkers and echocardiography findings were compared between survivors and non-survivors. STATISTICAL ANALYSIS All statistical analysis was done using graphpad Prism 5 and SPSS statistical software. A Fisher exact p-value <0.05 was regarded as significant. Multivariate Logistic Regression was carried out to quantify the relationship between cardiac death and other predictor variables. The logistic coefficients for the predictor variables and their exponents, that is, log odds were calculated. Statistical significance of these predictor variables was interpreted by p-values. RESULTS A 17.7% (n=11/62) patients of paediatric myocarditis died in this study. New York Heart Association (NYHA) class IV dyspnea (p=0.0115) and hypotension (p=0.0174) were more in patients who did not survive. The mean value of Troponin I was more in the non-survivor group (0.958 ± 1.13ng/ml); (p=0.0074). More number of patients who died had Brain Natriuretic Peptide (BNP) levels increased in their plasma (p=0.0087) with higher mean value (p=0.0175). LV ejection fraction was decreased markedly in non survivor group with mean value of 37±8.09 % as compared to survivor group with mean value of 46.6±10.5%, (p=0.0115). On multivariate analysis, NYHA class IV dyspnea (p=0.0113), BNP (p=0.015) and ejection fraction (p = 0.0284) independently are the predictors of mortality in our study group. CONCLUSION Children with myocarditis having hypotension, raised Troponin I, BNP and decreased ejection fraction are more prone to die. NYHA IV dyspnea, higher levels of BNP and decreased EF are independently related to worst outcome.
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Affiliation(s)
- Shahla Abrar
- Senior Resident, Department of Paediatrics, B.R.D. Medical College, Gorakhpur, India
| | | | - Mahima Mittal
- Associate Professor, Department of Paediatrics, B.R.D. Medical College, Gorakhpur, India
| | - K.P. Kushwaha
- Professor, Department of Paediatrics, B.R.D. Medical College, Gorakhpur, India
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Lin HY, Chuang CK, Wang CH, Chien YH, Wang YM, Tsai FJ, Chou YY, Lin SJ, Pan HP, Niu DM, Hwu WL, Ke YY, Lin SP. Long-term galsulfase enzyme replacement therapy in Taiwanese mucopolysaccharidosis VI patients: A case series. Mol Genet Metab Rep 2016; 7:63-9. [PMID: 27134829 PMCID: PMC4834679 DOI: 10.1016/j.ymgmr.2016.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/06/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Information regarding the long-term outcome of enzyme replacement therapy (ERT) with recombinant human N-acetylgalactosamine 4-sulfatase (rhASB, galsulfase, Naglazyme®, BioMarin Pharmaceutical Inc.) for Taiwanese patients with mucopolysaccharidosis (MPS) VI is limited. METHODS Nine Taiwanese patients with MPS VI (4 males and 5 females; age range, 1.4 to 21.1 years) treated with weekly intravenous infusions of galsulfase (1.0 mg/kg) in 5 medical centers in Taiwan were reviewed. A set of biochemical and clinical assessments were evaluated annually. RESULTS After 6.2 to 11.2 years of galsulfase treatment, 6 patients experienced improvement over baseline in the 6-minute walk test by a mean of 150 m (59% change over time), and 3 patients also increased the 3-minute stair climb test by a mean of 60 steps (46%). In a manual dexterity test, 3 patients decreased the time required to pick up 10 coins and put the coins into a cup by 15 s (33%). Shoulder range of motion in all 9 patients improved, and Joint Pain and Stiffness Questionnaire scores improved by 0.42 points (21%). Four patients showed improved pulmonary function. Five patients had positive effects on cardiac-wall diameters. Four patients had improved cardiac diastolic function. Liver and spleen sizes as measured by abdominal ultrasonography remained the same or decreased in all 9 patients. However, the severity degree of valvular stenosis or regurgitation did not show improvement despite ERT. A mean overall 69% decrease in urinary glycosaminoglycan (GAG) excretion indicated a satisfactory biomarker response. CONCLUSIONS Long-term ERT was beneficial and safe for Taiwanese patients with MPS VI. This treatment reduced urinary GAG and had positive effects on a wide range of clinical functional assessments including endurance, mobility, joint function, pulmonary function, liver and spleen size, cardiac hypertrophy and diastolic dysfunction.
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Key Words
- 3MSCT, 3-minute stair climb test
- 6MWT, 6-minute walk test
- AC, air conduction
- ASB, N-acetylgalactosamine 4-sulfatase
- BC, bone conduction
- BMD, bone mineral density
- CHAQ, Childhood Health Assessment Questionnaire
- Cardiac hypertrophy
- DXA, dual energy x-ray absorptiometry
- Diastolic dysfunction
- E/A, ratio between early and late (atrial) ventricular filling velocity
- ERT, enzyme replacement therapy
- Enzyme replacement therapy
- FEV1, forced expiratory volume in 1 s
- FVC, Forced vital capacity
- GAG, glycosaminoglycan
- Galsulfase, recombinant human N-acetylgalactosamine 4-sulfatase
- Glycosaminoglycans
- HAQ, Health Assessment Questionnaire
- HAZ, height-for-age
- IVSd, interventricular septum thickness in diastole
- LVM, left ventricular mass
- LVMI, left ventricular mass index
- LVPWd, left ventricular posterior wall thickness in diastole
- MPS, mucopolysaccharidosis
- Mucopolysaccharidosis VI
- PTA, pure-tone audiometry
- Pulmonary function
- Z score, standard deviation score
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Affiliation(s)
- Hsiang-Yu Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Kuang Chuang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Medical College, Fu-Jen Catholic University, Taipei, Taiwan
- Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chung-Hsing Wang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Mei Wang
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Fuu-Jen Tsai
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Yin Chou
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shio Jean Lin
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Hui-Ping Pan
- Genetic Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Dau-Ming Niu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Yuan Ke
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shuan-Pei Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Hauser JA, Demyanets S, Rusai K, Goritschan C, Weber M, Panesar D, Rindler L, Taylor AM, Marculescu R, Burch M, Wojta J, Michel-Behnke I. Diagnostic performance and reference values of novel biomarkers of paediatric heart failure. Heart 2016; 102:1633-9. [PMID: 27220692 DOI: 10.1136/heartjnl-2016-309460] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/03/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Biomarkers play a pivotal role in heart failure (HF) management. Reference values and insights from studies in adults cannot be extrapolated to the paediatric population due to important differences in pathophysiology and compensatory reserve. We assessed the diagnostic utility of four novel biomarkers in paediatric HF. METHODS Midregional (MR) pro-atrial natriuretic peptide (proANP), soluble ST2 (sST2), growth differentiation factor-15 (GDF-15), MR-pro-adrenomedullin (proADM) and N-terminal pro-B natriuretic peptide (NT-proBNP) were measured in 114 patients and 89 controls. HF was defined as the presence of HF symptoms and/or abnormal systolic ventricular function. Receiver-operating characteristics were plotted, and the area under the curve (AUC) was measured. This was repeated for subgroups with cardiomyopathy and congenital heart disease (CHD). Ventricular systolic function was measured by magnetic resonance or echocardiography. Reference values were calculated according to the current guidelines. RESULTS The AUC for diagnosing HF was 0.76 for MR-proANP (CI 0.70 to 0.84) and 0.82 for NT-proBNP (CI 0.75 to 0.88). These parameters performed similarly in the subgroups with CHD and cardiomyopathy. By contrast, MR-proADM, GDF-15 and sST2 performed poorly. When used in conjunction with NT-proBNP, no parameter added significantly to its diagnostic accuracy. NT-proBNP, MR-proANP, GDF-15 and sST2 could accurately discriminate between patients with preserved and patients with poor functional status. In a subset of patients with dilated cardiomyopathy, NT-proBNP, MR-proANP, MR-proADM and GDF-15 were associated with poor LV function. CONCLUSIONS MR-proANP could accurately detect HF in children and adolescents. Its diagnostic performance was comparable with that of NT-proBNP, regardless of the underlying condition. Reference values are presented.
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Affiliation(s)
- Jakob A Hauser
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London, UK Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, UK
| | - Svitlana Demyanets
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Krisztina Rusai
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria
| | - Clara Goritschan
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dilveer Panesar
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London, UK Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, UK
| | - Lisa Rindler
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria
| | - Andrew M Taylor
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London, UK Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, UK
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Burch
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, UK
| | - Johann Wojta
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria Medical University of Vienna, Core Facilities, Vienna, Austria
| | - Ina Michel-Behnke
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Vienna, Austria
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139
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van Gelder CM, Poelman E, Plug I, Hoogeveen-Westerveld M, van der Beek NAME, Reuser AJJ, van der Ploeg AT. Effects of a higher dose of alglucosidase alfa on ventilator-free survival and motor outcome in classic infantile Pompe disease: an open-label single-center study. J Inherit Metab Dis 2016; 39:383-390. [PMID: 26768149 PMCID: PMC4851694 DOI: 10.1007/s10545-015-9912-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Though enzyme-replacement therapy (ERT) with alglucosidase alfa has significantly improved the prospects for patients with classic infantile Pompe disease, some 50 % of treated infants do not survive ventilator-free beyond the age of 3 years. We investigated whether higher and more frequent dosing of alglucosidase alfa improves outcome. METHODS Eight cross-reactive immunological material (CRIM) positive patients were included in the study. All had fully deleterious mutations in both GAA alleles. Four received a dose of 20 mg/kg every other week (eow) and four received 40 mg/kg/week. Survival, ventilator-free survival, left-ventricular mass index (LVMI), motor outcome, infusion-associated reactions (IARs), and antibody formation were evaluated. RESULTS All eight patients were alive at study end, seven of them remained ventilator-free. The patient who became ventilator dependent was treated with 20 mg/kg eow. Three of the four patients receiving 20 mg/kg eow learned to walk; two of them maintained this ability at study end. All four patients receiving 40 mg/kg/week acquired and maintained the ability to walk at study end (ages of 3.3-5.6 years), even though their baseline motor functioning was poorer. There were no apparent differences between the two dose groups with respect to the effect of ERT on LVMI, the number of IARs and antibody formation. CONCLUSIONS Our data may suggest that a dose of 40 mg/kg/week improves outcome of CRIM positive patients over that brought by the currently recommended dose of 20 mg/kg eow. Larger studies are needed to draw definite conclusions.
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Affiliation(s)
- C M van Gelder
- Department of Pediatrics, Division of Metabolic Diseases and Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - E Poelman
- Department of Pediatrics, Division of Metabolic Diseases and Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - I Plug
- Department of Pediatrics, Division of Metabolic Diseases and Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - M Hoogeveen-Westerveld
- Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - N A M E van der Beek
- Department of Pediatrics, Division of Metabolic Diseases and Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A J J Reuser
- Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A T van der Ploeg
- Department of Pediatrics, Division of Metabolic Diseases and Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
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140
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Chen CA, Chang CH, Lin MT, Hua YC, Fang WQ, Wu MH, Lue HC, Wang JK. Six-Minute Walking Test: Normal Reference Values for Taiwanese Children and Adolescents. ACTA CARDIOLOGICA SINICA 2016; 31:193-201. [PMID: 27122870 DOI: 10.6515/acs20140721d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The 6-minute walking test (6MWT) is a simple method used to evaluate exercise capacity in adults and children with cardiac diseases. Normal reference values in pediatric populations have been reported, but significant variations in the walking distance (6MWD) were noted among different studies. We aimed to provide and validate normal reference values of the 6MWD for healthy Taiwanese pediatric population between 7 and 17 years of age. METHODS Healthy children and adolescents were recruited from 13 randomly selected schools in Kaohsiung City. From that recruitment effort, 762 participants (50.1% male) were included, and the 6MWT was conducted using standardized protocols. The main outcome measure utilized was the 6MWD, which was used to construct centile charts and Z score equations. Data from additional 64 healthy volunteers recruited from the National Taiwan University Children's Hospital were used to validate these standards. RESULTS There was an overall linear trend of increase in the 6MWD between 7 and 17 years of age (p < 0.001). Males covered significantly more distance than females after the age of 14 years, when the 6MWD essentially plateaued in female adolescents. Upon multivariate analysis, height was the most significant positive predictor of the 6MWD, while body mass index negatively correlated with the 6MWD. The height-based normal reference values of the 6MWD, derived from the 6MWT conducted in the school settings, were validated by a second cohort who received 6MWT inside the hospital. CONCLUSIONS Normal reference values of the 6MWD in healthy Taiwanese children and adolescents may serve as useful references for future clinical and research studies. KEY WORDS Adolescents; Children; Six-minute walking test; Taiwan.
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Affiliation(s)
| | - Chin-Hao Chang
- National Translational Medicine and Clinical Trial Resource Center; ; Department of Medical Research at National Taiwan University Hospital
| | | | | | - Wei-Quan Fang
- National Translational Medicine and Clinical Trial Resource Center; ; Department of Medical Research at National Taiwan University Hospital
| | - Mei-Hwan Wu
- National Taiwan University Children's Hospital; ; Cardiac Children's Foundation, Taipei, Taiwan
| | - Hung-Chi Lue
- National Taiwan University Children's Hospital; ; Cardiac Children's Foundation, Taipei, Taiwan
| | - Jou-Kou Wang
- National Taiwan University Children's Hospital; ; Cardiac Children's Foundation, Taipei, Taiwan
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141
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Association of Late Gadolinium Enhancement and Degree of Left Ventricular Hypertrophy Assessed on Cardiac Magnetic Resonance Imaging With Ventricular Tachycardia in Children With Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 117:1342-8. [PMID: 26892450 DOI: 10.1016/j.amjcard.2016.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 01/19/2023]
Abstract
There are limited data on the clinical significance of left ventricular (LV) mass and late gadolinium enhancement (LGE) in pediatric hypertrophic cardiomyopathy (HC). We reviewed cardiovascular magnetic resonance (CMR) studies of children with HC to investigate the associations between the extent and distribution of LGE and LV mass with ventricular tachycardia (VT) in children with HC. A blinded observer reviewed CMR studies for the presence and distribution of LV hypertrophy and LGE using a 17-segment model. The primary outcome was VT. LGE was present 17 of 33 subjects (52%). VT was present on outpatient Holter monitor or exercise stress test in 7 patients, of which 5 patients (71%) had LGE. Each additional segment of LGE was associated with an increase in the odds of VT (odds ratio [OR] 1.4, 95% CI 1.1 to 1.9) and fewer than 5 segments with LGE had 93% specificity for the presence or absence of VT (OR 0.06, 95% CI 0.01 to 0.5). VT was more common in patients with LGE in the apical septal (p = 0.03), basal inferoseptal (p <0.01), and basal inferior (p = 0.04) segments, whereas LGE in more commonly involved segments (midanteroseptal and midinferoseptal) was not associated with VT (p = 0.13, 0.26). Patients with VT had greater LV mass index (76.4 ± 40.4 g/m(2.7) vs 50.9 ± 24.3 g/m(2.7); p = 0.03). Each centimeter of increased maximum LV thickness was associated with increased likelihood of VT (OR 2.9, 95% CI 1.2 to 6.8). In conclusion, in pediatric HC, CMR to evaluate the extent and pattern of LGE, LV mass index, and maximum LV thickness may help to identify children with HC at risk of VT.
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142
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Evaluation of the left ventricle longitudinal deformity using myocardial-tracking signals in severely obese adolescents. Cardiol Young 2016. [PMID: 26195022 DOI: 10.1017/s1047951115001298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The global prevalence of obesity in school-age children and adolescents has increased in recent decades. Obesity modifies some aspects of the cardiovascular system in order to preserve the body homoeostasis. Echocardiography to study ventricular function plays an important role in the evaluation of pathological re-modelling associated with left ventricular dysfunction. The aim of this study was to evaluate the left ventricle function and structure with conventional echocardiography and to analyse the longitudinal deformity of the left ventricle using myocardial-tracking signals in a group of severely obese adolescents. Methods and results We carried out a descriptive cross-sectional study. We describe the evaluation of the left ventricle using conventional bi-dimensional echocardiography and the myocardial-tracking signals in severely obese adolescents. There were 34 severely obese adolescents included in our study; 52% had a left ventricular ejection fraction<55%, the left ventricular end-diastolic diameter was increased in 70.5% of patients, and 32.3% had an increase in left ventricular mass. On average, 78.9% had abnormal values of left ventricle longitudinal deformations. The number of segments affected per patient was, on average, 5.8, with the anterior apical segment being the most commonly affected. There was a decrease in global longitudinal deformity in 79.4% of the cases. CONCLUSION More than half of this group of asymptomatic severely obese adolescents showed abnormalities in left ventricular structure and function evaluated using traditional echocardiographic methods, but 100% of the cases showed abnormalities in longitudinal deformation in at least one of the 17 left ventricle segments evaluated using myocardial-tracking signals.
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143
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Lin HY, Chuang CK, Chen MR, Lin SM, Hung CL, Chang CY, Chiu PC, Tsai WH, Niu DM, Tsai FJ, Lin SJ, Hwu WL, Lin JL, Lin SP. Cardiac structure and function and effects of enzyme replacement therapy in patients with mucopolysaccharidoses I, II, IVA and VI. Mol Genet Metab 2016; 117:431-7. [PMID: 26899310 DOI: 10.1016/j.ymgme.2016.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND While enzyme replacement therapy (ERT) has been shown to improve endurance and joint mobility for patients with mucopolysaccharidoses (MPS) I, II, IVA and VI, the impact of ERT on cardiac abnormalities remains uncertain. METHODS Medical records and echocardiograms of 28 Taiwanese MPS patients (9 with MPS I, 7 with MPS II, 7 with MPS IVA, and 5 with MPS VI) treated with ERT for 1-10.8years were retrospectively reviewed. RESULTS At start of ERT, z scores>2 were identified in 46% and 75% for left ventricular mass index (LVMI) and interventricular septum thickness in diastole (IVSd) in these patients, respectively. Twenty-four patients (86%) had valvular heart disease. After ERT, the mean IVSd z score of all patients decreased significantly from 3.87 to 2.57 (p=0.016). For 11 patients starting ERT before 12years of age, z scores for both LVMI and IVSd decreased significantly (p<0.01) after ERT. However, the condition of valve regurgitation or stenosis did not show improvement despite ERT. CONCLUSIONS ERT was shown to be an effective therapy for reducing cardiac hypertrophy, with best results seen when ERT was started at an early age. ERT, however, had little impact on valvular heart disease.
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Affiliation(s)
- Hsiang-Yu Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Kuang Chuang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Medical College, Fu-Jen Catholic University, Taipei, Taiwan; Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Ming-Ren Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Shan-Miao Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chia-Ying Chang
- Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Pao Chin Chiu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Hui Tsai
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Dau-Ming Niu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fuu-Jen Tsai
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Shio Jean Lin
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Wuh-Liang Hwu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ju-Li Lin
- Division of Genetics and Endocrinology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shuan-Pei Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Right to Left Ventricular Diameter Ratio ≥0.42 is the Warning Flag for Suspecting Atrial Septal Defect in Preschool Children: Age- and Body Surface Area-Related Reference Values Determined by M-Mode Echocardiography. Pediatr Cardiol 2016; 37:704-13. [PMID: 26700967 DOI: 10.1007/s00246-015-1334-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
It is not always easy to observe and screen atrial septal defects (ASD) using echocardiography. In addition, there are no established echocardiographic reference indices for screening patients with ASDs. We retrospectively reviewed our database and recruited 151 isolated ASD patients and 2769 healthy subjects. In total, 307 echocardiographic studies were performed for ASD patients. Surgical repairs were done in 75 of the ASD patients. The ratio of right to left ventricular end-diastolic dimensions (RVD/LVD), which was determined by M-mode echocardiography, was used as an index of RV dilatation. After obtaining age- and body surface area (BSA)-related RVD/LVD nomograms in healthy subjects, we calculated the z-scores of RVD/LVD for all subjects and obtained the optimal cut-off values to differentiate patients with ASD from healthy subjects. The optimal cut-off values were high in neonates and gradually decreased with an increase in the age and BSA, but were almost constant in children aged >4 years or whose BSA was >0.65 m(2). The cut-off values of RVD/LVD for suspected ASD were ≥0.42 in children aged >4 years or those whose BSA was >0.65 m(2). Those for an ASD operation were ≥0.46 in those whose BSA > 0.65 m(2). The RVD/LVD determined by M-mode echocardiography is a useful index to evaluate RV dilatation in patients with ASDs. The RVD/LVD ≥ 0.42 is the warning flag for suspecting ASD in preschool children and that ≥0.46 may be a clinical important sign to determine ASD operation.
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145
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Anomalous Left Coronary Artery From the Pulmonary Artery in Infants and Toddlers Misdiagnosed as Myocarditis. Pediatr Emerg Care 2016; 32:232-4. [PMID: 26414630 DOI: 10.1097/pec.0000000000000511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect. Children with this anomaly are usually asymptomatic at birth and develop symptoms later on in life, which may mimic myocarditis. We sought to delineate clinical, laboratory, and epidemiological aspects of this anomaly. METHODS A retrospective analysis of children with ALCAPA evaluated in a tertiary medical center in southern Israel was performed. A computerized search for all patients with the diagnosis of ALCAPA between 2000 and 2011 was performed. The medical records were reviewed; demographic, clinical, and laboratory data were extracted. RESULTS A total of 9 patients were included. In 4 patients, acute deterioration required evaluation in the pediatric emergency medicine department; in all 4, the initial clinical suspicion was myocarditis. Failure to thrive was recorded in 7 (77.7%) of the 9 patients and asthma or wheezing were recorded in 5 (55.5%) of the 9 patients. Normal heart size was recorded in 4 (44.4%) of the 9 patients. Electrocardiographic abnormalities were present in all of the patients (100%). A total of 141,675 births were recorded during the study period, giving an incidence of at least 1 case (0.00635%) per 15,741 births. CONCLUSIONS Children evaluated in the emergency medicine department with suspected myocarditis should be evaluated specifically for ALCAPA. The clinical findings that should raise the suspicion of this anomaly are failure to thrive and either a diagnosis of asthma or recurrent wheezing.
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146
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Restrictive right ventricular performance assessed by cardiac magnetic resonance after balloon valvuloplasty of critical pulmonary valve stenosis. Cardiol Young 2016; 26:556-68. [PMID: 26095337 DOI: 10.1017/s1047951115000724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little data are published about right ventricular diastolic performance in patients with critical pulmonary valve stenosis after balloon pulmonary valvuloplasty thus far. METHODS A total of 44 patients with isolated critical pulmonary valve stenosis who had undergone balloon valvuloplasty with haemodynamic recordings were enrolled to the study; 33 patients who came for follow-up underwent further imaging by echocardiography after 6 months and their right ventricular functional parameters were compared with 33 control patients of the same age and sex. Out of 33 patients, 21 underwent cardiac MRI with late gadolinium enhancement to assess the presence of right ventricular fibrosis. RESULTS The right ventricular systolic pressure (p<0.0001) and right ventricular outflow tract gradient (p<0.0001) decreased acutely (p<0.0001) after balloon valvuloplasty. During follow-up, M-mode left ventricular end diastolic dimension (p<0.001) and end systolic dimension increased (p<0.001), whereas right ventricular end diastolic dimension decreased (p<0.001). Compared with controls, patients (n=33) had significantly reduced tricuspid annular Ea and higher E/Ea (p<0.001). Right ventricular systolic dysfunction was also suggested by reduced tricuspid annular systolic velocity (p<0.001). Late gadolinium enhancement was demonstrated in 13 out of 21 patients with restrictive physiology, which involves the anterior right ventricular outflow tract, anterior wall, and inferior wall. The right ventricular late gadolinium enhancement score correlated positively with age (r=0.7, p<0.001) and right ventricular mass index (r=0.52, p<0.001). CONCLUSION The persistence of right ventricular diastolic dysfunction after relief of chronic pressure overload of critical pulmonary valve stenosis suggests that a factor - other than increase in afterload - is involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.
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147
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Broomfield A, Fletcher J, Davison J, Finnegan N, Fenton M, Chikermane A, Beesley C, Harvey K, Cullen E, Stewart C, Santra S, Vijay S, Champion M, Abulhoul L, Grunewald S, Chakrapani A, Cleary MA, Jones SA, Vellodi A. Response of 33 UK patients with infantile-onset Pompe disease to enzyme replacement therapy. J Inherit Metab Dis 2016; 39:261-71. [PMID: 26497565 DOI: 10.1007/s10545-015-9898-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Enzyme replacement therapy (ERT) for infantile-onset Pompe disease has been commercially available for almost 10 years. We report the experience of its use in a cohort treated at three specialist lysosomal treatment centres in the UK. METHODS A retrospective case-note review was performed, with additional data being gathered from two national audits on all such patients treated with ERT. The impact on the outcome of various characteristics, measured just prior to the initiation of ERT (baseline), was evaluated using logistic regression. RESULTS Thirty-three patients were identified; 13/29 (45%) were cross-reactive immunological material (CRIM) negative, and nine were immunomodulated. At baseline assessment, 79% were in heart failure, 66% had failure to thrive and 70% had radiological signs of focal pulmonary collapse. The overall survival rate was 60%, ventilation-free survival was 40% and 30% of patients were ambulatory. Median follow-up of survivors was 4 years, 1.5 months (range 6 months to 13.5 years). As with previous studies, the CRIM status impacted on all outcome measures. However, in this cohort, baseline failure to thrive was related to death and lack of ambulation, and left ventricular dilatation was a risk factor for non-ventilator-free survival. CONCLUSION The outcome of treated patients remains heterogeneous despite attempts at immunomodulation. Failure to thrive at baseline and left ventricular dilation appear to be associated with poorer outcomes.
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Affiliation(s)
- A Broomfield
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, UK.
| | - J Fletcher
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, UK
| | - J Davison
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N Finnegan
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Fenton
- Cardiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Chikermane
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - C Beesley
- Regional Genetics Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Harvey
- Enzyme Unit, Chemical Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - E Cullen
- Enzyme Unit, Chemical Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - C Stewart
- Department of Inherited Metabolic Disorders, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - S Santra
- Department of Inherited Metabolic Disorders, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - S Vijay
- Department of Inherited Metabolic Disorders, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - M Champion
- Department of Inherited Metabolic Disease, Guy's and St Thomas' NHS Foundation Trusts, Evelina London Children's Hospital, Westminster Bridge Road, London, UK
| | - L Abulhoul
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S Grunewald
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Chakrapani
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M A Cleary
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S A Jones
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, UK
| | - A Vellodi
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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148
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Oxidative Stress Biomarkers and Left Ventricular Hypertrophy in Children with Chronic Kidney Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:7520231. [PMID: 26885251 PMCID: PMC4739446 DOI: 10.1155/2016/7520231] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/28/2015] [Accepted: 12/13/2015] [Indexed: 12/30/2022]
Abstract
Cardiovascular diseases remain the most frequent cause of morbidity and mortality in patients with chronic kidney disease (CKD). The aim of the study was to assess the association between oxidative stress biomarkers and cardiovascular risk factors and left ventricular hypertrophy in children with CKD. Material and Methods. The studied group consisted of 65 patients aged 1.4-18.6 (mean 11.2) years with stages 1 to 5 CKD. Serum oxidized low-density lipoprotein (oxLDL), protein carbonyl group, creatinine, cystatin C, albumin, lipids, high-sensitivity C-reactive protein, intercellular adhesion molecule-1, insulin, plasma renin activity, and aldosterone levels were measured. Patients were divided into groups depending on CKD stage. Anthropometric measurements, ambulatory blood pressure (BP) measurements, and echocardiography with left ventricular mass (LVM) calculation were performed. Results. Serum oxLDL strongly correlated with creatinine (R = 0.246; p = 0.048), cystatin C (R = 0.346; p = 0.006), total cholesterol (R = 0.500; p < 0.001), triglycerides (R = 0.524; p < 0.001), low-density lipoprotein concentrations (R = 0.456; p < 0.001), and 24 hour BP values of systolic (R = 0.492; p = 0.002), diastolic (R = 0.515; p < 0.001), and mean arterial pressure (R = 0.537; p < 0.001). A significant correlation between oxLDL levels and LVM z-scores (R = 0.299; p = 0.016) was found. Conclusions. Hypertension and dyslipidemia correlated with lipid oxidation in children with CKD. oxLDLs seem to be valuable markers of oxidative stress in CKD patients, correlating with left ventricular hypertrophy.
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149
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Ziółkowska L, Turska-Kmieć A, Petryka J, Kawalec W. Predictors of Long-Term Outcome in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2016; 37:448-58. [PMID: 26526335 PMCID: PMC4819755 DOI: 10.1007/s00246-015-1298-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022]
Abstract
To date limited data are available to predict the progression to end-stage heart failure (HF) with subsequent death (non-SCD), need for heart transplantation, or sudden cardiac death (SCD) in children with hypertrophic cardiomyopathy (HCM). We aimed to determine predictors of long-term outcome in children with HCM. A total of 112 children (median 14.1, IQR 7.8-16.6 years) were followed up for the median of 6.5 years for the development of morbidity and mortality, including arrhythmic and HF-related secondary end points. HF end point included HF-related death or heart transplant, and arrhythmic end point included resuscitated cardiac arrest, appropriate ICD discharge, or SCD. Overall, 23 (21 %) patients reached the pre-defined composite primary end point. At 10-year follow-up, the event-free survival rate was 76 %. Thirteen patients (12 %) reached the secondary arrhythmic end point, and 10 patients (9 %) reached the secondary HF end point. In multivariate model, prior cardiac arrest (r = 0.658), QTc dispersion (r = 0.262), and NSVT (r = 0.217) were independent predictors of the arrhythmic secondary end point, while HF (r = 0.440), LV posterior wall thickness (r = 0.258), LA size (r = 0.389), and decreased early transmitral flow velocity (r = 0.202) were all independent predictors of the secondary HF end point. There are differences in the risk factors for SCD and for HF-related death in childhood HCM. Only prior cardiac arrest, QTc dispersion, and NSVT predicted arrhythmic outcome in patients aged <18 years. LA size, LV posterior wall thickness, and decreased early transmitral flow velocity were strong independent predictors of HF-related events.
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Affiliation(s)
- Lidia Ziółkowska
- Department of Pediatric Cardiology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland.
| | - Anna Turska-Kmieć
- Department of Pediatric Cardiology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Joanna Petryka
- Department of Coronary Artery Disease and Structural Heart Disease, Institute of Cardiology, 04-628, Warsaw, Poland
| | - Wanda Kawalec
- Department of Pediatric Cardiology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland
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150
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Tsujii N, Miyazaki A, Sakaguchi H, Kagisaki K, Yamamoto T, Matsuoka M, Shima Y, Ichikawa H, Ohuchi H. High Incidence of Dilated Cardiomyopathy After Right Ventricular Inlet Pacing in Patients With Congenital Complete Atrioventricular Block. Circ J 2016; 80:1251-8. [DOI: 10.1253/circj.cj-15-1122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Nobuyuki Tsujii
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
- Department of Pediatrics, Nara Medical University
| | - Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koji Kagisaki
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tetsuya Yamamoto
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Michio Matsuoka
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yuriko Shima
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Hajime Ichikawa
- Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
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