ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary

Chronic Severe Mitral Regurgitation with Normal Left Ventricular Size - A Case with Coexisting Atrial Septal Defect

Severe chronic mitral regurgitation (MR) is known to cause left ventricular volume overload and subsequently left ventricular dilatation. Here, we present a case of a 68-year-old man with severe chronic MR which happened to coexist with atrial septal defect of secundum type leading to the right ventricular dilatation.

Stroke in Adults With Coarctation of the Aorta: A National Population-Based Study

BACKGROUND

Adults with repaired coarctation of the aorta (CoA) have reduced long-term survival compared with the general population. This study aimed to determine whether CoA is independently associated with premature ischemic and hemorrhagic stroke in the contemporary era.

METHODS AND RESULTS

This was a cross-sectional study utilizing the National Inpatient Sample database from 2005 to 2014. We hypothesized that patients with CoA are hospitalized with ischemic and hemorrhagic stroke at a younger age compared with the general population. To test this hypothesis, we compared the age at stroke in patients with and without a diagnosis of CoA using simple and multivariable weighted linear regression. Among 4 894 582 stroke discharges, 207 had a diagnosis of CoA. Patients with CoA had strokes at significantly younger age compared with patients without CoA: 18.9 years younger for all-cause stroke (P<0.001), 15.9 years younger for ischemic stroke (P<0.001), and 28.5 years younger for hemorrhagic stroke (P<0.001), after adjusting for potential confounders. There was no significant difference in the proportion of ischemic strokes between those with and without CoA (79.2% versus 83.0%, P=0.50). However, CoA patients had a higher proportion of subarachnoid hemorrhage (11.8% versus 4.8%, P=0.039) than those without CoA. Among patients who had a hemorrhagic stroke, the prevalence of unruptured intracranial aneurysms was higher in patients with CoA compared with those without CoA (23.3% versus 2.5%, P=0.002).

CONCLUSIONS

Patients with CoA have both ischemic and hemorrhagic strokes at significantly younger ages compared with the general population.

Late diagnosis of a congenitally corrected transposition of the great arteries discovered at pacemaker implantation in a patient previously diagnosed with dextrocardia and situs solitus

Congenitally corrected transposition of the great arteries (CCTGA) should not be missed in patients with dextrocardia and situs solitus. We report a case of a 56-year-old man with late diagnosis of CCTGA after ventricular lead replacement. Free LV wall pacing may be favorable in these patients so to prevent deterioration of the systemic RV function.

Pulmonary Hypertension and Atrial Septal Defect: Management Dilemma

The decision making in patients with an atrial septal defect (ASD) in setting of pulmonary hypertension is complex. In the era of pulmonary arterial vasodilator therapy, every patient should undergo evaluation by pulmonary hypertension experts especially if defect closure is being considered. Defect closure in the inappropriate group can lead to poor outcomes.

Is Fractional Flow Reserve Useful in Assessing Coronary Artery Fistula: A Case-Based Discussion and Review

We present two cases where fractional flow reserve (FFR) was utilised to guide management of coronary artery fistula (CAF), an approach advocated in recent case studies. CAF is a coronary anomaly that may present with a variety of syndromes though is frequently asymptomatic. When to exclude the fistula (surgically or percutaneously) is not always clear. A way to quantify if the fistula is physiologically meaningful would be advantageous. Our findings suggest FFR may only be assessing the concomitant epicardial coronary artery disease (CAD) rather than the degree of coronary steal and its routine use in this setting is not supported.

Surgical perspective of percutaneous device closure of atrial septal defect

Background Percutaneous device closure of an ostium secundum atrial septal defect is associated with excellent outcomes and cosmetic results but at the cost of occasional serious and sometimes fatal complications as well as lifelong follow-up. Surgical intervention is required in cases of device-related complications, which carries a slightly higher risk compared to primary closure of an atrial septal defect. We present a surgical perspective of device closure of atrial septal defect. Methods Our database was searched over 4 years for complications related to percutaneous device closure of atrial septal defect, which required surgical retrieval of the device and closure of the defect. We identified 14 cases that required surgical intervention. Results The median age of the 14 patients was 18 years (range 4-58 years). The size of the defect ranged from 15 to 40 mm (median 30 mm). Device embolization into any part of the cardiovascular system ( n = 8) was the most common complication, followed by malalignment of the device ( n = 5). One patient had left atrial appendage perforation causing pericardial effusion and cardiac tamponade, and underwent surgical repair. The other 13 patients underwent removal of the device and atrial septal defect closure. One patient developed severe mitral regurgitation requiring mitral valve replacement. There was no mortality. Conclusion Although the incidence of device-related complications may be small, they carry a high risk of death or long-term morbidity, even with a small atrial septal defect, unlike primary surgical closure of isolated atrial septal defect.

Combined use of coils and Onyx for transcatheter closure of coronary artery fistulae

AIMS

The aim of this study was to evaluate the safety and efficacy of combined endovascular coiling and Onyx embolisation in patients with a coronary artery fistula (CAF).

METHODS AND RESULTS

Between September 2014 and September 2016, 26 patients with CAFs were enrolled in our study for attempted combined therapy using coils and Onyx. The mean age of patients was 64.0±9.5 years (range, 44-78 years). CAFs were large in 10 and medium in 16 patients. The mean number of coils used was 3.1±1.2 (range, two to six), and the average volume of Onyx was 0.4±0.1 ml (range, 0.2-0.6 ml). Immediate post-embolisation angiography demonstrated that complete occlusion was achieved in 23 patients (88.5%) and a small residual fistula was achieved in three patients (11.5%). Follow-up imaging (median, 11.5 months; range, nine to 20) revealed stable occlusion of CAF in 21 cases (80.8%), trivial recanalisation in four cases (15.4%), and large recanalisation in only one case (3.8%). Re-closure was performed in the patient with large recanalisation. During the follow-up period, no deaths, severe procedure-related complications, or new symptoms occurred.

CONCLUSIONS

In selected patients with CAF, transcatheter embolisation in combined therapy using coils and Onyx appears to be a valid option, providing a high success rate and low rate of recanalisation.

Interventional Cardiology for Congenital Heart Disease

Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.

Clinical study of prenatal ultrasonography combined with T‑box transcription factor 1 as a biomarker for the diagnosis of congenital heart disease

Congenital heart disease (CHD) seriously threatens fetal health. Therefore, prenatal examination to detect deformity is extremely important. The present study aimed to investigate the clinical application value of prenatal ultrasonography combined with molecular biology methods in the diagnosis of fetal CHD. A total of 1,000 pregnant women who had received fetal ultrasonography to examine fetal CHD were enrolled. Ultrasounds were performed for fetal heart examination and diagnosis, mainly on fetal heart position, size, structure and function, and heart valve morphology and function. These indexes were tested again 2 weeks after birth. Blood samples were collected from pregnant women with fetal CHD. Polymerase chain reaction (PCR) and western blotting were performed to detect the association between heart development and T‑box transcription factor 1 (TBX1) expression. The results revealed that 10 fetuses had CHD (1%), of which ultrasound detected 9 cases. The specificity and sensitivity of ultrasounds were 100 and 90%, respectively. Of the 9 cases were identified by prenatal ultrasound screening, including 2 cases had endocardial cushion defect, 1 case had pulmonary stenosis combined with right ventricular dysplasia, 1 case had tetralogy of Fallot combined with a cleft lip and palate, 2 cases had ventricular septal defect, 1 case had a single ventricle defect, 1 case had Ebstein and 1 case had a triatrial heart. One case of ventricular septal defect was missed prior to delivery. PCR and western blotting demonstrated that TBX1 expression may be associated with CHD. Therefore, ultrasonography combined with laboratory examinations represent efficient, economic and safe methods for fetal CHD detection. These methods may be significant to improve the rate of CHD diagnosis, and require further investigation.

Anesthesia in adults with congenital heart disease

PURPOSE OF REVIEW

The current review focuses on patients with congenital heart disease (CHD) with regard to recent trends in global demographics, healthcare provision for noncardiac surgery, as well as anesthetic and perioperative care for these patients.

RECENT FINDINGS

About 40 years after milestones of surgical innovation in CHD, the number of adults with CHD (ACHD) now surpasses those of children with CHD. This development leads to the fact that even patients with complex CHD managed for noncardiac surgery are not restricted to highly specialized centers. However, preoperative risk assessment for anesthesia in these patients is complex due to underlying cardiac morbidity and substantial CHD-associated noncardiac morbidity. In addition to clinical assessment and echocardiography, biomarker measurement may be a clinically useful tool to estimate severity of heart failure in CHD patients. The high negative predictive value of NT-proBNP makes it particularly valuable as a screening tool. Further, morbidity and mortality in ACHD patients are mainly caused by arrhythmias and therefore are also relevant for perioperative management. Adverse events and perioperative death in ACHD patients in cardiac and noncardiac surgery are frequently related to intraoperative anesthetic care.

SUMMARY

Medical progress in treatment of CHD has shifted morbidity and mortality of these patients largely to adulthood. Future investigations including risk stratification of ACHD patients are necessary to further improve perioperative management, especially for low-risk and high-risk noncardiac management.

Atrial Septal Defect as Unexpected Cause of Pulmonary Artery Hypertension

Methamphetamine abuse is an increasingly prevalent cause of pulmonary artery hypertension in the United States. Conversely, an atrial septal defect rarely presents late as pulmonary artery hypertension. We present the case of a 44-year-old methamphetamine abuser who had a 3-month history of worsening fatigue and near-syncope. She had elevated cardiac enzyme levels and right-sided heart strain. Angiographic findings suggested methamphetamine-induced pulmonary artery hypertension; however, we later heard S₂ irregularities that raised suspicion of an atrial septal defect. Ultimately, the diagnosis was pulmonary artery hypertension and a large secundum atrial septal defect with left-to-right flow. One year after defect closure, the patient was asymptomatic. In addition to discussing this unexpected case of a secundum atrial septal defect masquerading as methamphetamine-induced pulmonary artery hypertension, we briefly review the natural history of atrial septal defects and emphasize the importance of thorough examination in avoiding diagnostic anchoring bias.

Interventional Echocardiography: Field of Advanced Imaging to Support Structural Heart Interventions

Multimodality imaging, particularly echocardiography, is paramount in planning and guiding structural heart disease interventions. Transesophageal echocardiography remains unique in its ability to provide real-time 2D and 3D imaging of valvular heart disease and anatomic cardiac defects, which directly impacts the strategy and outcome of these procedures. This review summarizes the role of transesophageal echocardiography in patients undergoing the most common structural heart disease interventions.

Clinical outcomes of a combined transcatheter and minimally invasive atrial septal defect repair program using a 'Heart Team' approach

Background

Contemporary transcatheter and minimally invasive approaches allow for improved cosmesis and eliminate sternotomy; however, access to a ‘Heart Team’ approach to minimally invasive atrial septal defect (ASD) repair remains limited in Canada.

Methods

Retrospective chart review of all minimally invasive atrial septal defect repairs performed between 2009 and 2017 at a quaternary cardiac care centre were included. We compared residual shunt, functional status, periprocedural complications, and hospital lengths-of-stay between patients undergoing transcatheter and minimally invasive endoscopic ASD repair.

Results

Between 2009 and 2017, 61 consecutive patients underwent ASD repair at a single centre: 28 patients underwent transcatheter closure (64.3% female; median age 57, interquartile range 43–70.5) and 33 patients underwent minimally invasive endoscopic repair (72.7% female; median age 37, interquartile range 24–50). Patient demographics were similar between the two groups with the exception of transcatheter patients having smaller defect size (1.65 cm versus 2.35 cm, p = 0.002). Procedural success was 93% (26/28) and 100% (33/33) for transcatheter and minimally invasive groups (p = 0.21), respectively. Periprocedural complications were similarly low between the two groups with the exception of longer hospital length-of-stay in the surgical patients (5 days vs 1 day, p < 0.0001). Over a follow-up period (transcatheter: 0.5–56.5 months, surgical: 0.25–89 months), there was no difference in residual shunt (14.3% versus 6.1%, p = 0.4) or NYHA I Functional Class (88.5% versus 96.9%, p = 0.21).

Conclusion

Transcatheter and minimally invasive approaches to ASD repair are safe and feasible in selected patients using a ‘Heart Team’ approach and represent attractive alternatives to median sternotomy.

Coarctation of the Aorta Complicated with Intracranial Aneurysm: A Case Report and Literature Review

BACKGROUND

Coarctation of the aorta (CoA) complicated with rupture and hemorrhage of intracranial aneurysms is not commonly seen in clinical practice. Here we report a middle-aged female patient who presented with acute severe headache.

CASE DESCRIPTION

Head computed tomography (CT) demonstrated an extensive subarachnoid hemorrhage. Digital subtraction angiography demonstrated coarctation and occlusion of the proximal thoracic aorta and occlusion of the terminal aortic arch. Aortic-intracranial CT angiography (CTA) confirmed a CoA complicated with an anterior communicating artery aneurysm. Clipping of the anterior communicating artery aneurysm was performed via a left lateral orbital approach. Postoperative intracranial CTA showed complete clipping of the aneurysm. The patient was discharged postoperatively with good recovery.

CONCLUSIONS

The pathophysiological mechanism of CoA complicated with intracranial aneurysm remains unclear, but attention should be given to the relationship between the 2 entities in clinical practice, and effective treatment should be provided according to specific conditions.

Radiation dose management for pediatric cardiac computed tomography: a report from the Image Gently 'Have-A-Heart' campaign

Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease.

Pediatric brain repair from endogenous neural stem cells of the subventricular zone

There is great interest in the regenerative potential of the neural stem cells and progenitors that populate the germinal zones of the immature brain. Studies using animal models of pediatric brain injuries have provided a clearer understanding of the responses of these progenitors to injury. In this review, we have compared and contrasted the responses of the endogenous neural stem cells and progenitors of the subventricular zone in animal models of neonatal cerebral hypoxia-ischemia, neonatal stroke, congenital cardiac disease, and pediatric traumatic brain injury. We have reviewed the dynamic shifts that occur within this germinal zone with injury as well as changes in known signaling molecules that affect these progenitors. Importantly, we have summarized data on the extent to which cell replacement occurs in response to each of these injuries, opportunities available, and obstacles that will need to be overcome to improve neurological outcomes in survivors.

Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery

Background

Native aortic coarctation in young infants can be treated surgically or with balloon angioplasty, although the latter approach remains controversial. We sought to compare midterm outcomes of balloon and surgical coarctoplasty at our center and to review the current practices in literature.

Methods

The study design was a retrospective record review. Patients with coarctation aged <1 year who underwent balloon or surgical coarctoplasty at our center (January 2010-January 2016) with >6-month post-procedure follow-up were studied. Patients with significant arch hypoplasia or interruption, long-segment coarctation, and associated intracardiac lesions were excluded from the study. Clinical, echocardiographic, and procedural details were recorded at initial presentation and follow-up. Need for reintervention was noted.

Results

Out of a total of 75 patients, 28 underwent balloon (Group A) and 47 underwent surgical coarctoplasty (Group B). There were two deaths in Group B (mortality 4.2%) and none in Group A. In neonates, 63.6% of Group A and 17.4% of Group B patients required reintervention (P = 0.007). Beyond the neonatal age, 29.4% of Group A and 41.6% of Group B patients required reintervention (not statistically significant). On univariate analysis, residual coarctation on predischarge echocardiogram was the only significant predictor of reintervention (P = 0.04). On Kaplan-Meier analysis, with neonatal presentation, freedom from reintervention in Group B was significantly higher than Group A (P = 0.028).

Conclusion

In neonates with native aortic coarctation, surgery unequivocally yields better immediate and midterm results and is the preferred treatment modality. In older infants, balloon coarctoplasty has good early and midterm outcomes with acceptable reintervention rates and should be considered a viable alternative to surgery, especially in critical patients with high surgical risk.

Hypertension in Coarctation of the Aorta: Challenges in Diagnosis in Children

Evidence indicates that patients with coarctation of the aorta (COA) suffer from increased cardiovascular morbidity and mortality in later life despite successful repair of COA in childhood. Systolic arterial hypertension is common, presenting in up to one-third of patients, and is regarded as the main driver of premature cardiovascular events in this group of patients. In this review, we discuss the prevalence and pathophysiology of hypertension in children following successful COA repair with no residual arch obstruction. The challenges in accurate blood pressure assessment at this early phase are considered and non-invasive measures of central blood pressure are discussed. Although the pathways for investigations in adults are well defined, we highlight the need to address the issues of cardiovascular surveillance in children and describe techniques which can provide complementary information for cardiovascular assessment in this group of patients such that timely treatment can occur.

Peri-procedural antibiotic prophylaxis in ventricular septal defect: a case study to re-visit guidelines

The current American Heart Association (AHA)/American College of Cardiology (ACC) guidelines do not recommend antibiotic prophylaxis for infective endocarditis (IE) in patients with acyanotic congenital valvular heart disease due to lack of any proven benefit and potential harm associated with antibiotics. As recognized by the guidelines, some acyanotic congenital heart disease, such as ventricular septal defects (VSDs), are associated with a high velocity jet and pose a greater risk of peri-procedural endocarditis. We suggest that an acyanotic congenital heart disease with high velocity jet should be considered for antibiotic prophylaxis for IE.

Reducing sedation for pediatric body MRI using accelerated and abbreviated imaging protocols

Magnetic resonance imaging (MRI) is an established diagnostic imaging tool for investigating pediatric disease. MRI allows assessment of structure, function, and morphology in cardiovascular imaging, as well as tissue characterization in body imaging, without the use of ionizing radiation. For MRI in children, sedation and general anesthesia (GA) are often utilized to suppress patient motion, which can otherwise compromise image quality and diagnostic efficacy. However, evidence is emerging that use of sedation and GA in children might have long-term neurocognitive side effects, in addition to the short-term procedure-related risks. These concerns make risk-benefit assessment of sedation and GA more challenging. Therefore, reducing or eliminating the need for sedation and GA is an important goal of imaging innovation and research in pediatric MRI. In this review, the authors focus on technical and clinical approaches to reducing and eliminating the use of sedation in the pediatric population based on image acquisition acceleration and imaging protocols abbreviation. This paper covers important physiological and technical considerations for pediatric body MR imaging and discusses MRI techniques that offer the potential of recovering diagnostic-quality images from accelerated scans. In this review, the authors also introduce the concept of reporting elements for important indications for pediatric body MRI and use this as a basis for abbreviating the MR protocols. By employing appropriate accelerated and abbreviated approaches based on an understanding of the imaging needs and reporting elements for a given clinical indication, it is possible to reduce sedation and GA for pediatric chest, cardiovascular and abdominal MRI.

Post Mitral Valve Replacement: Paravalvular Leak or Unroofed Coronary Sinus?

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A patient presented with symptoms of heart failure and severe mitral regurgitation.

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On postbypass imaging after MVR a small paravalvular leak appeared to be present.

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Color flow originated from an unroofed CS with predominantly right-to-left shunting.

Radiofrequency Catheter Ablation of Atrial Tachycardias in Congenital Heart Disease

Background

Radiofrequency catheter ablation has become the treatment strategy of choice for atrial tachyarrhythmias in patients with congenital heart disease (CHD). We analyzed results of radiofrequency catheter ablation in a large cohort of patients with CHD with special reference to complexity of underlying anatomy.

Methods and Results

One hundred and forty-four patients with CHD and atrial tachyarrhythmias undergoing radiofrequency catheter ablation were classified according to complexity of underlying CHD: simple CHD, n=18 (12%); moderate CHD, n=53 (37%); and complex CHD, n=73 (51%). Overall acute success was achieved in 81% of the patients. Acute success was lower for tachycardias involving the left atrium compared with right atrial tachycardias. Complexity of CHD was associated with longer procedure duration. Tachycardia recurrence was observed in 54% of the patients after a total follow-up of 7.4 years. 75% of all recurrences occurred within the first year. Recurrence of tachycardia was more likely in patients with complex surgical atrial anatomy (ie, Fontan palliation or atrial switch procedure). Major complications occurred in 4 patients and were related to vascular access.

Conclusions

Acute procedural success of atrial tachycardia ablation in congenital heart patients was not influenced by complexity of CHD. Long-term outcome with regard to tachycardia recurrence was worse in patients with complex surgical atrial anatomy.

Left ventricular dispersion as a parameter for augmented left ventricular stroke volume in patients with atrial septal defect following transcatheter closure

OBJECTIVES

The closure of atrial septal defect (ASD) results in normalized left ventricular (LV) and right ventricular (RV) geometry, and can increase LV stroke volume (LVSV), but the parameters associated with this increase after the closure of ASD remain uncertain.

METHODS

Seventy ASD patients, who underwent transcatheter closure, were studied. Their mean age was 57.80 ± 16.88 years, 42 (60%) were female, and LV ejection fraction (LVEF) was 66.76% ± 7.91% (all ≥55%). Transthoracic echocardiography was performed before and 3 months after the procedure. Global longitudinal strain (GLS) was determined as the average peak speckle tracking strain of 18 segments from the 3 standard apical views, LV dispersion was defined as standard deviation of time-to-peak strain from the same views, and RV systolic function was calculated by averaging the 3-regional peak speckle tracking longitudinal strains from the RV free wall. A significant relative increase in LVSV between before and 3 months after the closure was defined as ∆LVSV ≥15%. Twenty age-, gender-, and LVEF-matched controls served as the control group.

RESULTS

Global longitudinal strain (GLS) and RV free wall strain were similar for ASD patients and controls, but LV dispersion in ASD patients was significantly larger. Global longitudinal strain (GLS) remained unchanged after transcatheter closure, whereas RV free wall strain and LV dispersion decreased significantly. An important finding of the multivariate logistic regression analysis showed that ∆LV dispersion was the only independent determinant of increased LVSV after the closure (OR 1.023; 95% CI 1.001-1.046; P < .01).

CONCLUSIONS

The assessment of LV dispersion may well have clinical implications for better management of ASD patients after transcatheter closure.

Dual-source Computed Tomography for Evaluating Pulmonary Artery and Aorta in Pediatric Patients with Single Ventricle

To explore the accuracy of main pulmonary artery (MPA) and ascending aorta (AAO) image evaluation in pediatric patients with single ventricle (SV) by comparing dual-source computed tomography (DSCT) with echocardiography. Thirty-one children with SV were retrospectively enrolled. The stenosis, dilation, and location of MPA and AAO were independently evaluated by DSCT and echocardiography. The accompanying arterial malformations were also assessed by DSCT. For 17 patients undergoing cardiac catheterization, the DSCT-based diameters of MPA and AAO were correlated with their pressures as measured by catheterization. Referring to the surgical and catheterization findings, DSCT had better diagnostic performance in detecting the stenosis, dilation, and location of MPA and AAO with higher sensitivity than echocardiography (sensitivity, MPA: 88.0% vs. 80.0%, AAO: 100% vs. 66.7%, great arteries location: 95.7% vs. 95.2%). The correlations between diameters of MPA and AAO with their pressures were 0.399 (p = 0.04) and 0.611 (p = 0.01), respectively. In addition, DSCT detected 23 cases with patent ductus arteriosus, 26 systemic-to-pulmonary collaterals, 9 branch pulmonary distortions, and 4 coronary artery anomalies. DSCT is reliable for assessing the anatomic features of pulmonary artery and aorta in SV children, and provides comprehensive information for surgical strategy-making.

Congenital Heart Disease and Neurodevelopment: Clinical Manifestations, Genetics, Mechanisms, and Implications

Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental disorders (NDDs) and psychiatric conditions. These include cognitive, adaptive, motor, speech, behavioural, and executive functioning deficits, as well as autism spectrum disorder and psychiatric conditions. Structural and functional neuroimaging have demonstrated brain abnormalities in young children with CHD before undergoing surgical repair, likely as a result of an in utero developmental insult. Surgical factors do not seem to play a significant role in neurodevelopmental outcomes. Specific genetic abnormalities, particularly copy number variants, have been increasingly implicated in both CHD and NDDs. Variations in genes involved in apolipoprotein E (APOE) production, the Wnt signalling pathway, and histone modification, as well as in the 1q21.1, 16p13.1-11, and 8p23.1 genetic loci, have been associated with CHD and NDDs and are important targets for future research. Understanding these associations is important for risk stratification, disease classification, improved screening, and pharmacologic management of individuals with CHD.