401
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Rajpal S, Raman SV. Congenital cardiovascular computed tomography: Taking the long view. J Cardiovasc Comput Tomogr 2018; 12:267-268. [DOI: 10.1016/j.jcct.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
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402
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Hardy RY, Gurvitz M, Jackson JL, May S, Miller P, Daskalov R, Foster E. College students with congenital heart disease: A critical time for transition. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:324-328. [PMID: 29452064 DOI: 10.1080/07448481.2018.1440583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED As medical and surgical advances improve, more young adults with congenital heart disease (CHD) are attending college. This case study illustrates some of the issues that these young adults may face as they attend college and discusses the role that college health practitioners can play in easing that transition. PARTICIPANTS A case of a male with CHD presenting to the college health clinic with a new onset headache. METHODS The authors discuss some of the unique challenges that college health practitioners may face when caring for students with CHD. In addition, they make recommendations on how best to care for these patients and how best to coordinate care with CHD students other care providers. RESULTS This student with a history of coarctation of the aorta presented with new onset headaches and was found to have high blood pressure. He was diagnosed with recurrent coarctation, underwent percutaneous treatment with stenting and quickly resumed classes. CONCLUSIONS As more students with CHD enter college, college health providers will need to understand some of the health risks that CHD students face. In addition, understanding some of the optimal ways to coordinate care with CHD providers can ease the transition that CHD students face as they enter college.
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Affiliation(s)
- Rose Y Hardy
- a Department of Health Systems , Management and Policy, Colorado School of Public Health , Aurora , Colorado , USA
| | - Michelle Gurvitz
- b Department of Cardiology , Boston Children's Hospital , Boston , Massachusetts , USA
| | - Jamie L Jackson
- c Center for Biobehavioral Health, Nationwide Children's Hospital , Columbus , Ohio , USA
| | - Susan May
- d Congenital Heart Public Health Consortium, American Academy of Pediatrics , Elk Grove Village , Illinois , USA
| | - Paula Miller
- e Adult Congenital Heart Association , Philadelphia , Pennsylvania , USA
| | - Rachel Daskalov
- d Congenital Heart Public Health Consortium, American Academy of Pediatrics , Elk Grove Village , Illinois , USA
| | - Elyse Foster
- f Division of Cardiology, University of California - San Francisco , San Francisco , California , USA
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403
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Xia Y, Yang Y, Huang S, Wu Y, Li P, Zhuang J. Clinical application of chromosomal microarray analysis for the prenatal diagnosis of chromosomal abnormalities and copy number variations in fetuses with congenital heart disease. Prenat Diagn 2018; 38:406-413. [PMID: 29573438 DOI: 10.1002/pd.5249] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 02/17/2018] [Accepted: 03/07/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study aimed to determine chromosomal abnormalities and copy number variations (CNVs) in fetuses with congenital heart disease (CHD) by chromosomal microarray analysis (CMA). METHODS One hundred and ten cases with CHD detected by prenatal echocardiography were enrolled in the study; 27 cases were simple CHDs, and 83 were complex CHDs. Chromosomal microarray analysis was performed on the Affymetrix CytoScan HD platform. All annotated CNVs were validated by quantitative PCR. RESULTS Chromosomal microarray analysis identified 6 cases with chromosomal abnormalities, including 2 cases with trisomy 21, 2 cases with trisomy 18, 1 case with trisomy 13, and 1 unusual case of mosaic trisomy 21. Pathogenic CNVs were detected in 15.5% (17/110) of the fetuses with CHDs, including 13 cases with CHD-associated CNVs. We further identified 10 genes as likely novel CHD candidate genes through gene functional enrichment analysis. We also found that pathogenic CMA results impacted the rate of pregnancy termination. CONCLUSIONS This study shows that CMA is particularly effective for identifying chromosomal abnormalities and CNVs in fetuses with CHDs as well as having an effect on obstetrical outcomes. The elucidation of the genetic basis of CHDs will continue to expand our understanding of the etiology of CHDs.
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Affiliation(s)
- Yu Xia
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Yongchao Yang
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Shufang Huang
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Yueheng Wu
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Ping Li
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
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404
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Thomet C, Moons P, Schwerzmann M, Apers S, Luyckx K, Oechslin EN, Kovacs AH. Self-efficacy as a predictor of patient-reported outcomes in adults with congenital heart disease. Eur J Cardiovasc Nurs 2018; 17:619-626. [DOI: 10.1177/1474515118771017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Self-efficacy is a known predictor of patient-reported outcomes in individuals with acquired diseases. With an overall objective of better understanding patient-reported outcomes in adults with congenital heart disease, this study aimed to: (i) assess self-efficacy in adults with congenital heart disease, (ii) explore potential demographic and medical correlates of self-efficacy and (iii) determine whether self-efficacy explains additional variance in patient-reported outcomes above and beyond known predictors. Methods: As part of a large cross-sectional international multi-site study (APPROACH-IS), we enrolled 454 adults (median age 32 years, range: 18–81) with congenital heart disease in two tertiary care centres in Canada and Switzerland. Self-efficacy was measured using the General Self-Efficacy (GSE) scale, which produces a total score ranging from 10 to 40. Variance in the following patient-reported outcomes was assessed: perceived health status, psychological functioning, health behaviours and quality of life. Hierarchical multivariable linear regression analysis was performed. Results: Patients’ mean GSE score was 30.1 ± 3.3 (range: 10–40). Lower GSE was associated with female sex ( p = 0.025), not having a job ( p = 0.001) and poorer functional class ( p = 0.048). GSE positively predicted health status and quality of life, and negatively predicted symptoms of anxiety and depression, with an additional explained variance up to 13.6%. No associations between self-efficacy and health behaviours were found. Conclusions: GSE adds considerably to our understanding of patient-reported outcomes in adults with congenital heart disease. Given that self-efficacy is a modifiable psychosocial factor, it may be an important focus for interventions targeting congenital heart disease patients’ well-being.
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Affiliation(s)
- Corina Thomet
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Silke Apers
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven – University of Leuven, Belgium
| | - Erwin N Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network and University of Toronto, Canada
| | - Adrienne H Kovacs
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network and University of Toronto, Canada
- The Knight Cardiovascular Institute, Oregon Health & Science University, Portland, USA
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405
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Wong P, Denburg A, Dave M, Levin L, Morinis JO, Suleman S, Wong J, Ford-Jones E, Moore AM. Early life environment and social determinants of cardiac health in children with congenital heart disease. Paediatr Child Health 2018; 23:92-95. [PMID: 29686491 PMCID: PMC5905484 DOI: 10.1093/pch/pxx146] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Congenital heart disease is a significant cause of infant mortality. Epidemiology and social context play a crucial role in conditioning disease burden and modulating outcomes, while diagnosis and treatment remain resource intensive. This review will address the role of social demographics, environmental exposure, epigenetics and nutrition in the aetiology of congenital heart disease. We then discuss the determinant effect of social factors on the provision and outcomes of care for congenital heart disease and implications for practice. It is our hope that enhanced knowledge of the intersection of social determinants of health and congenital heart disease will facilitate effective preventative strategies at the individual and population levels to optimize heart health outcomes across the life course.
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Affiliation(s)
- Peter Wong
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | | | - Malini Dave
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Leo Levin
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Julia Orkin Morinis
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Shazeen Suleman
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Jonathan Wong
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Elizabeth Ford-Jones
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Aideen M Moore
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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406
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Balaguru D. Commentary on "Prevalence of HCV Infection in Adults with Congenital Heart Disease and Treatment with Direct Antiviral Agents". South Med J 2018; 111:142-143. [PMID: 29505647 DOI: 10.14423/smj.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Duraisamy Balaguru
- From the Division of Pediatric Cardiology, University of Texas Houston McGovern Medical School, Houston
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407
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4550] [Impact Index Per Article: 758.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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408
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Lee JW, Ratnayaka K, El-Said HG, Moore JW. Endograft rescue of compromised interposition aortic graft in an adult patient with congenital heart disease. Glob Cardiol Sci Pract 2018; 2018:8. [PMID: 29644235 PMCID: PMC5857065 DOI: 10.21542/gcsp.2018.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In a 19-year-old male with interrupted aortic arch and complex congenital heart disease, we report percutaneous repair of a compromised aortic conduit. The patient had aortic arch repair in childhood utilizing a 12 mm Hemashield Dacron conduit. CT angiography showed multiple segments of this conduit were dilated to 16 mm suggesting conduit degeneration and failure with pseudoaneurysm formation. We utilized a self-expanding aortic endograft supported by internal placement of bare metal stents to repair the conduit. Our repair was guided by 3D rotational angiography. This adult patient with complex congenital heart disease and interrupted aortic arch is an example of patients in whom endograft repair of compromised aortic conduits presents a much lower risk alternative than surgical revision.
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Affiliation(s)
- Jesse W Lee
- Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Diego and Rady Children's Hospital, San Diego CA, USA
| | - Kanishka Ratnayaka
- Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Diego and Rady Children's Hospital, San Diego CA, USA
| | - Howaida G El-Said
- Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Diego and Rady Children's Hospital, San Diego CA, USA
| | - John W Moore
- Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Diego and Rady Children's Hospital, San Diego CA, USA
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409
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Abstract
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.
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410
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Kasparian NA, De Abreu Lourenco R, Winlaw DS, Sholler GF, Viney R, Kirk EPE. Tell me once, tell me soon: parents' preferences for clinical genetics services for congenital heart disease. Genet Med 2018; 20:1387-1395. [PMID: 29493584 DOI: 10.1038/gim.2018.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/18/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE As the molecular basis of congenital heart disease (CHD) comes into sharper focus, cardiac genetics services are likely to play an increasingly important role. This study aimed to identify parents' preferences for, and willingness to participate in, clinical genetics services for CHD. METHODS A discrete choice experiment was developed to assess parents' preferences for pediatric cardiogenetics services based on four attributes: appointment format, health professionals involved, waiting time, and information format. Data were analyzed using a mixed logit model. RESULTS One hundred parents with a living child diagnosed with CHD requiring surgical intervention between 2000 and 2009 completed the discrete choice experiment. Parents expressed a clear preference for cardiac genetics services featuring (i) a single appointment, (ii) the presence of a clinical geneticist and a genetic counselor, (iii) both verbal (oral) and Web-based information about CHD and genetics, and (iv) availability of an appointment within 2 weeks. If offered such conditions, 93% of respondents indicated that they would attend. The choice of service was most strongly influenced by the presence of both a clinical geneticist and a genetic counselor. CONCLUSION Parents of children with CHD favor a single, timely genetics appointment with both a geneticist and a genetic counselor present. If appointments offered match these preferences, uptake is likely to be high.
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Affiliation(s)
- Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia. .,Heart Centre for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David S Winlaw
- Heart Centre for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Edwin P E Kirk
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Medical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
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411
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Nelson JS, Strassle PD. Regional differences in right versus left congenital heart disease diagnoses in neonates in the United States. Birth Defects Res 2018; 110:325-335. [PMID: 29106052 DOI: 10.1002/bdr2.1140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Differences in the prevalence of left and right congenital heart defects (CHD) across the United States are unclear. This study evaluated the overall prevalence and the distribution of right versus left CHD across US regions and divisions in neonates. METHODS Newborns born from 2000 to 2014 diagnosed with CHD were identified using the National Inpatient Sample. Heart defects were stratified into right, left, and "neither" subtypes. The risk of right and left heart diagnoses between US Census regions and divisions was compared using multivariable binomial regression, adjusting for infant, and hospital characteristics. RESULTS Two hundred forty thousand four hundred fifty-five newborns were included and 38,185 (15.9%) were classifiable as having either right or left subtypes. Between 2000 and 2014, the prevalence of right defects increased from 1.65 to 2.88 cases/1,000 live born infants (p < .0001), left defects increased from 0.47 to 0.75 cases/1,000 live born infants (p < .0001), and "neither" defects increased from 10.82 to 20.09 cases/1,000 live born infants (p < .0001). Newborns in the Northeast (RDadj .03, 95% CI .02, .03), Midwest (RDadj .02, 95% CI .02, .03), and South (RDadj .02, 95% CI .02, .02) were significantly more likely to have a right heart defect diagnosis compared to the West. When stratified by division, New England states had a significantly higher prevalence of right defects compared to the Pacific (RDadj .09, 95% CI .06, 0.11). No differences in the prevalence of left defects were seen. CONCLUSIONS The prevalence of CHD diagnoses at birth in the US has increased, and regional differences in the prevalence of right defects appear to exist.
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Affiliation(s)
- Jennifer S Nelson
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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412
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Contemporary Outcomes of Combined Heart-Liver Transplant in Patients With Congenital Heart Disease. Transplantation 2018; 102:e67-e73. [DOI: 10.1097/tp.0000000000001978] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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413
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Phenotype, management and predictors of outcome in a large cohort of adult congenital heart disease patients with heart failure. Int J Cardiol 2018; 252:80-87. [DOI: 10.1016/j.ijcard.2017.10.086] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 11/18/2022]
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414
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NIPBL +/- haploinsufficiency reveals a constellation of transcriptome disruptions in the pluripotent and cardiac states. Sci Rep 2018; 8:1056. [PMID: 29348408 PMCID: PMC5773608 DOI: 10.1038/s41598-018-19173-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/22/2017] [Indexed: 01/08/2023] Open
Abstract
Cornelia de Lange syndrome (CdLS) is a complex disorder with multiple structural and developmental defects caused by mutations in structural and regulatory proteins involved in the cohesin complex. NIPBL, a cohesin regulatory protein, has been identified as a critical protein responsible for the orchestration of transcriptomic regulatory networks necessary for embryonic development. Mutations in NIPBL are responsible for the majority of cases of CdLS. Through RNA-sequencing of human induced pluripotent stem cells and in vitro-derived cardiomyocytes, we identified hundreds of mRNAs, pseudogenes, and non-coding RNAs with altered expression in NIPBL+/− patient-derived cells. We demonstrate that NIPBL haploinsufficiency leads to upregulation of gene sets identified in functions related to nucleosome, chromatin assembly, RNA modification and downregulation of Wnt signaling, cholesterol biosynthesis and vesicular transport in iPSC and cardiomyocytes. Mutations in NIPBL result in the dysregulation of many genes responsible for normal heart development likely resulting in the variety of structural cardiac defects observed in the CdLS population.
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415
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Khan A, Ramsey K, Ballard C, Armstrong E, Burchill LJ, Menashe V, Pantely G, Broberg CS. Limited Accuracy of Administrative Data for the Identification and Classification of Adult Congenital Heart Disease. J Am Heart Assoc 2018; 7:JAHA.117.007378. [PMID: 29330259 PMCID: PMC5850158 DOI: 10.1161/jaha.117.007378] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Administrative data sets utilize billing codes for research and quality assessment. Previous data suggest that such codes can accurately identify adults with congenital heart disease (CHD) in the cardiology clinic, but their use has yet to be validated in a larger population. METHODS AND RESULTS All administrative codes from an entire health system were queried for a single year. Adults with a CHD diagnosis code (International Classification of Diseases, Ninth Revision, (ICD-9) codes 745-747) defined the cohort. A previously validated hierarchical algorithm was used to identify diagnoses and classify patients. All charts were reviewed to determine a gold standard diagnosis, and comparisons were made to determine accuracy. Of 2399 individuals identified, 206 had no CHD by the algorithm or were deemed to have an uncertain diagnosis after provider review. Of the remaining 2193, only 1069 had a confirmed CHD diagnosis, yielding overall accuracy of 48.7% (95% confidence interval, 47-51%). When limited to those with moderate or complex disease (n=484), accuracy was 77% (95% confidence interval, 74-81%). Among those with CHD, misclassification occurred in 23%. The discriminative ability of the hierarchical algorithm (C statistic: 0.79; 95% confidence interval, 0.77-0.80) improved further with the addition of age, encounter type, and provider (C statistic: 0.89; 95% confidence interval, 0.88-0.90). CONCLUSIONS ICD codes from an entire healthcare system were frequently erroneous in detecting and classifying CHD patients. Accuracy was higher for those with moderate or complex disease or when coupled with other data. These findings should be taken into account in future studies utilizing administrative data sets in CHD.
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Affiliation(s)
- Abigail Khan
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Katrina Ramsey
- Division of Biostatistics and Epidemiology, Oregon Health & Science University, Portland, OR
| | - Cody Ballard
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Emily Armstrong
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Luke J Burchill
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Victor Menashe
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR
| | - George Pantely
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Craig S Broberg
- Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
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416
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417
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Rodriguez FH, Ephrem G, Gerardin JF, Raskind-Hood C, Hogue C, Book W. The 745.5 issue in code-based, adult congenital heart disease population studies: Relevance to current and future ICD-9-CM and ICD-10-CM studies. CONGENIT HEART DIS 2017; 13:59-64. [PMID: 29266726 DOI: 10.1111/chd.12563] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although the ICD-9-CM code 745.5 is widely used to indicate the presence of a secundum atrial septal defect (ASD), it is also used for patent foramen ovale (PFO) which is a normal variant and for "rule-out" congenital heart disease (CHD). The ICD-10-CM code Q21.1 perpetuates this issue. The objective of this study was to assess whether code 745.5 in isolation or in combination with unspecified CHD codes 746.9 or 746.89 miscodes for CHD, and if true CHD positives decrease with age. DESIGN Echocardiograms of patients with an ICD-9-CM code of 745.5 in isolation or in combination with unspecified CHD codes 746.9 or 746.89 were reviewed to validate the true incidence of an ASD. This observational, cross-sectional record review included patients between 11 and 64 years of age. RESULTS Medical charts and echocardiograms of 190 patients (47.9% males) were reviewed. The number of falsely coded patients with 745.5 (no ASD) was high (76.3%). Forty-five (23.7%) patients had a true ASD. Among the 145 patients without an ASD, 100 (52.6%) were classified as having a PFO, 37 (19.5%) had a normal non-CHD echocardiogram, and 8 (4.2%) had some other CHD anomaly. The likelihood that 745.5 coded for a true ASD was higher in children aged 11-20 (64.3%) than adults aged 21-64 years (20.6%). CONCLUSIONS This validation study demonstrates that 745.5 performed poorly across all ages. As 745.5 is widely used in population-level investigations and ICD-10-CM perpetuates the problem, future analyses utilizing CHD codes should consider separate analysis of those identified only through code 745.5.
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Affiliation(s)
- Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Sibley Heart Center Cardiology, Atlanta, Georgia, USA
| | - Georges Ephrem
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer F Gerardin
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cheryl Raskind-Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carol Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Wendy Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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418
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Harake DE, Shannon KM, Aboulhosn JA, Moore JP. Transvenous pacemaker implantation after the bidirectional Glenn operation for patients with complex congenital disease. J Cardiovasc Electrophysiol 2017; 29:497-503. [PMID: 29240293 DOI: 10.1111/jce.13404] [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: 08/31/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The bidirectional Glenn operation for congenital heart disease produces anatomical constraints to conventional transvenous pacemaker implantation. An iliac approach, although not previously described in this population, is potentially a preferable alternative to a thoracotomy for epicardial pacing. METHODS AND RESULTS A single-center retrospective review was performed for all patients that underwent transvenous pacemaker implantation following the bidirectional Glenn operation with partial biventricular repair. Follow-up data, implant indications, and techniques were recorded. Five patients underwent a transvenous iliac approach (median age 26.9 years, interquartile range [IQR] 25.8-27.6). Pacing indications included AV block in 3 patients (2 requiring cardiac resychronization therapy) and sinus node dysfunction in 2. Implanted leads were atrial in 4 and ventricular in 3 (1 of the latter was placed in the coronary sinus). In two cases, transvenous leads were tunneled to a preexisting epicardial abdominal generator. Median follow-up was 4.1 years (range 1.0-16.7 years). One patient underwent device revision for lead position-related groin discomfort; a second patient developed atrial lead failure following a Maze operation and underwent lead replacement by the iliac approach. Patients were not routinely anticoagulated postprocedure given lead position in the subpulmonary circulation. At last follow-up, all patients were alive. One patient underwent heart transplantation 6 months after implant with only partial resolution of pacing-induced cardiomyopathy. CONCLUSIONS Trans-iliac pacemaker placement may be an effective alternative to surgery for patients requiring permanent pacing after the Glenn operation.
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Affiliation(s)
- Danielle E Harake
- Division of Pediatric Cardiology, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Kevin M Shannon
- Division of Pediatric Cardiology, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA.,Division of Cardiology, Department of Medicine, Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Jamil A Aboulhosn
- Division of Cardiology, Department of Medicine, Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Jeremy P Moore
- Division of Pediatric Cardiology, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA.,Division of Cardiology, Department of Medicine, Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California, USA
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419
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Adams PS, Zahid M, Khalifa O, Feingold B, Lo CW. Low Nasal NO in Congenital Heart Disease With Systemic Right Ventricle and Postcardiac Transplantation. J Am Heart Assoc 2017; 6:JAHA.117.007447. [PMID: 29212650 PMCID: PMC5779050 DOI: 10.1161/jaha.117.007447] [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] [Indexed: 12/18/2022]
Abstract
Background NO bioavailability has not been systematically examined in congenital heart disease (CHD). To assess NO in patients with CHD, we measured nasal NO (nNO) generated by the nasal epithelia, given blood NO is difficult to measure (half‐life, <2 ms). Given NO's role in hemodynamic regulation and the association of NO bioavailability with heart failure risk, we hypothesized NO levels may differ with varying severity of CHD physiologic characteristics. Methods and Results Six‐hundred eighteen subjects, 483 with CHD and 135 controls, had nNO measured noninvasively via the nares using American Thoracic Society/European Respiratory Society guidelines. Subjects were dichotomized as having low or normal nNO based on age‐specific cutoff values. Prevalence of low nNO was examined by various CHD physiologic feature types. Low nNO was more prevalent with CHD than controls (odds ratio, 2.28; P=0.001). A logistic regression model showed overall significance (P=0.035) for single ventricle, systemic right ventricle, ventricular dysfunction, oxygen desaturation, and heterotaxy predicting low nNO, with systemic right ventricle independently having twice the odds of low nNO (odds ratio, 2.04; P=0.014). Patients with low nNO had a higher risk of experiencing heart transplant or death (hazard ratio, 2.75; P=0.048), and heart transplant recipients (N=16) exhibited 5 times the odds of low nNO (69% versus 30%; odds ratio, 5.1; P=0.001). Conclusions Patients with CHD have increased prevalence of low nNO, with highest odds seen with systemic right ventricle and heart transplant. Further studies are needed to investigate heart failure risks in patients with CHD with left versus right systemic ventricle physiologic characteristics and utility of low nNO for predicting heart failure risk.
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Affiliation(s)
- Phillip S Adams
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maliha Zahid
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Omar Khalifa
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brian Feingold
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Cecilia W Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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420
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Singh S, Kumar R, Roy B, Woo MA, Lewis A, Halnon N, Pike N. Regional brain gray matter changes in adolescents with single ventricle heart disease. Neurosci Lett 2017; 665:156-162. [PMID: 29222023 DOI: 10.1016/j.neulet.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/20/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022]
Abstract
Adolescents with single ventricle heart disease (SVHD) show autonomic, mood, and cognitive deficits, indicating aberrations in brain areas that regulate these functions. However, the gray matter integrity in autonomic, mood, and cognitive control sites is unclear. We examined regional brain gray matter changes, using high-resolution T1-weighted images (3.0-T magnetic resonance scanner) with voxel based morphometry procedures, as well as mood and cognitive functions in SVHD (n=18; age, 15.7±1.1years; male, 10) and controls (n=31; age, 16.0±1.1years; male, 17). High-resolution T1-weighted images were realigned, gray matter tissue type partitioned, normalized to a common space, smoothed, and compared between groups (analysis of covariance; covariates, age and gender). The mood and cognitive scores were compared between groups using independent samples t-tests. SVHD subjects showed significantly altered mood and cognitive functions over controls. Significantly reduced gray matter emerged in multiple brain areas, including the thalamus, caudate nuclei, putamen, insula, prefrontal, post-central and precentral gyrus, occipital gyrus, para-hippocampal gyrus, temporal gyrus, and cerebellar sites in SVHD over controls. SVHD subjects show compromised gray matter integrity in autonomic, mood and cognitive control sites. The findings indicate that frequent deficits found in SVHD subjects have a brain structural basis in the condition.
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Affiliation(s)
- Sadhana Singh
- Department of Anesthesiology, University of California, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California, Los Angeles, CA, USA; Department of Radiological Sciences, University of California, Los Angeles, CA, USA; Department of Bioengineering, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California, Los Angeles, CA, USA.
| | - Bhaswati Roy
- UCLA School of Nursing, University of California, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California, Los Angeles, CA, USA
| | - Alan Lewis
- Division of Pediatric Cardiology, Children's Hospital, Los Angeles, CA, USA
| | - Nancy Halnon
- Division of Pediatric Cardiology, University of California, Los Angeles, CA, USA
| | - Nancy Pike
- UCLA School of Nursing, University of California, Los Angeles, CA, USA.
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421
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Daniels CJ, Bradley EA, Landzberg MJ, Aboulhosn J, Beekman RH, Book W, Gurvitz M, John A, John B, Marelli A, Marino BS, Minich LL, Poterucha JJ, Rand EB, Veldtman GR. Fontan-Associated Liver Disease. J Am Coll Cardiol 2017; 70:3173-3194. [DOI: 10.1016/j.jacc.2017.10.045] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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422
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Bjorkman K, Clancy JF, Elder RW. Old but not forgotten: Creative use of abandoned epicardial leads after more than 2 decades. HeartRhythm Case Rep 2017; 3:559-561. [PMID: 29296574 PMCID: PMC5741798 DOI: 10.1016/j.hrcr.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kurt Bjorkman
- Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Address reprint requests and correspondence: Dr Kurt Bjorkman, 302 LLCI Building, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520-8064.302 LLCI BuildingYale University School of Medicine333 Cedar StNew HavenCT06520-8064
| | - Jude F. Clancy
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Robert W. Elder
- Section of Pediatric Cardiology, Departments of Pediatrics and Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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423
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Sutcliffe DL, Jaquiss RD. Adaptations in pediatric VAD support: Fitting the square peg in the round hole. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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424
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Windsor J, Townsley MM, Briston D, Villablanca PA, Alegria JR, Ramakrishna H. Fontan Palliation for Single-Ventricle Physiology: Perioperative Management for Noncardiac Surgery and Analysis of Outcomes. J Cardiothorac Vasc Anesth 2017; 31:2296-2303. [DOI: 10.1053/j.jvca.2017.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 12/14/2022]
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425
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Akkaya-Hocagil T, Hsu WH, Sommerhalter K, McGarry C, Van Zutphen A. Utility of Capture-Recapture Methodology to Estimate Prevalence of Congenital Heart Defects Among Adolescents in 11 New York State Counties: 2008 to 2010. Birth Defects Res 2017; 109:1423-1429. [PMID: 28802092 DOI: 10.1002/bdr2.1099] [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: 05/08/2017] [Revised: 06/23/2017] [Accepted: 07/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Congenital heart defects (CHDs) are the most common birth defects in the United States, and the population of individuals living with CHDs is growing. Though CHD prevalence in infancy has been well characterized, better prevalence estimates among children and adolescents in the United States are still needed. METHODS We used capture-recapture methods to estimate CHD prevalence among adolescents residing in 11 New York counties. The three data sources used for analysis included Statewide Planning and Research Cooperative System (SPARCS) hospital inpatient records, SPARCS outpatient records, and medical records provided by seven pediatric congenital cardiac clinics from 2008 to 2010. Bayesian log-linear models were fit using the R package Conting to account for dataset dependencies and heterogeneous catchability. RESULTS A total of 2537 adolescent CHD cases were captured in our three data sources. Forty-four cases were identified in all data sources, 283 cases were identified in two of three data sources, and 2210 cases were identified in a single data source. The final model yielded an estimated total adolescent CHD population of 3845, indicating that 66% of the cases in the catchment area were identified in the case-identifying data sources. Based on 2010 Census estimates, we estimated adolescent CHD prevalence as 6.4 CHD cases per 1000 adolescents (95% confidence interval: 6.2-6.6). CONCLUSION We used capture-recapture methodology with a population-based surveillance system in New York to estimate CHD prevalence among adolescents. Future research incorporating additional data sources may improve prevalence estimates in this population. Birth Defects Research 109:1423-1429, 2017.© 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Tugba Akkaya-Hocagil
- New York State Department of Health, Albany, New York.,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
| | | | | | | | - Alissa Van Zutphen
- New York State Department of Health, Albany, New York.,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
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426
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Resheidat A, Quinonez ZA, Mossad EB, Wise-Faberowski L, Mittnacht AJC. Selected 2016 Highlights in Congenital Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2017; 31:1927-1933. [PMID: 29074129 DOI: 10.1053/j.jvca.2017.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ashraf Resheidat
- Division of Cardiovascular Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Zoel A Quinonez
- Division of Cardiovascular Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Emad B Mossad
- Division of Cardiovascular Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Lisa Wise-Faberowski
- Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Alexander J C Mittnacht
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
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427
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Hill KD, Frush DP. Image Gently Have-A-Heart Campaign. J Am Coll Radiol 2017; 15:372-373. [PMID: 28899703 DOI: 10.1016/j.jacr.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
| | - Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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428
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Itani M, Matesan M, Ahuja J, Bermo M, Habib AS, Goiney C, Krieger EV, Vesselle H. The Role of Pulmonary Scintigraphy in the Evaluation of Adults with Congenital Heart Disease. Semin Nucl Med 2017; 47:660-670. [PMID: 28969764 DOI: 10.1053/j.semnuclmed.2017.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adults with congenital heart disease represent a growing population with challenging and complex medical management. Pulmonary scintigraphy can play a valuable role in the evaluation and care of this patient population. We present a review of the variety of clinical scenarios where pulmonary scintigraphy can be helpful in the evaluation of adults with congenital heart disease, along with technical considerations associated with these studies.
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Affiliation(s)
- Malak Itani
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA.
| | - Manuela Matesan
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA
| | - Jitesh Ahuja
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA
| | - Mohamed Bermo
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA
| | - Asma S Habib
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA
| | - Christopher Goiney
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA
| | - Eric V Krieger
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA
| | - Hubert Vesselle
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA
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429
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Hill KD, Frush DP, Han BK, Abbott BG, Armstrong AK, DeKemp RA, Glatz AC, Greenberg SB, Herbert AS, Justino H, Mah D, Mahesh M, Rigsby CK, Slesnick TC, Strauss KJ, Trattner S, Viswanathan MN, Einstein AJ. Radiation Safety in Children With Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization From the Image Gently Alliance. JACC Cardiovasc Imaging 2017; 10:797-818. [PMID: 28514670 PMCID: PMC5542588 DOI: 10.1016/j.jcmg.2017.04.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 02/07/2023]
Abstract
There is a need for consensus recommendations for ionizing radiation dose optimization during multimodality medical imaging in children with congenital and acquired heart disease (CAHD). These children often have complex diseases and may be exposed to a relatively high cumulative burden of ionizing radiation from medical imaging procedures, including cardiac computed tomography, nuclear cardiology studies, and fluoroscopically guided diagnostic and interventional catheterization and electrophysiology procedures. Although these imaging procedures are all essential to the care of children with CAHD and have contributed to meaningfully improved outcomes in these patients, exposure to ionizing radiation is associated with potential risks, including an increased lifetime attributable risk of cancer. The goal of these recommendations is to encourage informed imaging to achieve appropriate study quality at the lowest achievable dose. Other strategies to improve care include a patient-centered approach to imaging, emphasizing education and informed decision making and programmatic approaches to ensure appropriate dose monitoring. Looking ahead, there is a need for standardization of dose metrics across imaging modalities, so as to encourage comparative effectiveness studies across the spectrum of CAHD in children.
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Affiliation(s)
- Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (Image Gently Alliance representative)
| | - Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, North Carolina (Image Gently Alliance and SPR representative)
| | - B Kelly Han
- Department of Pediatric Cardiology, Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota (SCCT representative)
| | - Brian G Abbott
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (ASNC representative)
| | - Aimee K Armstrong
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio (ACC representative)
| | - Robert A DeKemp
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (SNMMI representative)
| | - Andrew C Glatz
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (Image Gently Alliance representative)
| | - S Bruce Greenberg
- Department of Radiology, Arkansas Children's Hospital, Little Rock, Arkansas (NASCI representative)
| | - Alexander Sheldon Herbert
- Department of Radiology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York (ASRT representative)
| | - Henri Justino
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (SCAI representative)
| | - Douglas Mah
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts (PACES representative)
| | - Mahadevappa Mahesh
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland (AAPM representative)
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (ACR representative)
| | - Timothy C Slesnick
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia (AAP representative)
| | - Keith J Strauss
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Image Gently Alliance Representative)
| | - Sigal Trattner
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York (Image Gently Alliance representative)
| | - Mohan N Viswanathan
- Department of Internal Medicine, Stanford University, Stanford, California (HRS representative)
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York (Image Gently Alliance representative).
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430
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431
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Everitt IK, Gerardin JF, Rodriguez FH, Book WM. Improving the quality of transition and transfer of care in young adults with congenital heart disease. CONGENIT HEART DIS 2017; 12:242-250. [DOI: 10.1111/chd.12463] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/15/2017] [Accepted: 03/05/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ian K. Everitt
- Emory University School of Medicine; Atlanta Georgia, USA
| | - Jennifer F. Gerardin
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
| | - Fred H. Rodriguez
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
- Sibley Heart Center Cardiology, Emory University School of Medicine; Atlanta Georgia, USA
| | - Wendy M. Book
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
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432
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Slesnick TC. Role of Computational Modelling in Planning and Executing Interventional Procedures for Congenital Heart Disease. Can J Cardiol 2017; 33:1159-1170. [PMID: 28843327 DOI: 10.1016/j.cjca.2017.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/26/2017] [Accepted: 05/27/2017] [Indexed: 10/19/2022] Open
Abstract
Increasingly, computational modelling and numerical simulations are used to help plan complex surgical and interventional cardiovascular procedures in children and young adults with congenital heart disease. From its origins more than 30 years ago, surgical planning with analysis of flow hemodynamics and energy loss/efficiency has helped design and implement many modifications to existing techniques. On the basis of patient-specific medical imaging, surgical planning allows accurate model production that can then be manipulated in a virtual surgical environment, with the proposed solutions finally tested with advanced computational fluid dynamics to evaluate the results. Applications include a broad range of congenital heart disease, including patients with single-ventricle anatomy undergoing staged palliation, those with arch obstruction, with double outlet right ventricle, or with tetralogy of Fallot. In the present work, we focus on clinical applications of this exciting field. We describe the framework for these techniques, including brief descriptions of the engineering principles applied and the interaction between "benchtop" data with medical decision-making. We highlight some early insights learned from pioneers over the past few decades, including refinements in Fontan baffle geometries and configurations. Finally, we offer a glimpse into exciting advances that are presently being explored, including use of modelling for transcatheter interventions. In this era of personalized medicine, computational modelling and surgical planning allows patient-specific tailoring of interventions to optimize clinical outcomes.
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Affiliation(s)
- Timothy C Slesnick
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
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433
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Chu DI, Tan JM, Mattei P, Costarino AT, Rossano JW, Tasian GE. Mortality and Morbidity after Laparoscopic Surgery in Children with and without Congenital Heart Disease. J Pediatr 2017; 185:88-93.e3. [PMID: 28410089 PMCID: PMC5529241 DOI: 10.1016/j.jpeds.2017.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/15/2016] [Accepted: 02/06/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine the risk of morbidity and mortality after laparoscopic surgery among children with congenital heart disease (CHD). STUDY DESIGN Cohort study using the 2013-2014 National Surgical Quality Improvement Program-Pediatrics, which prospectively collected data at 56 and 64 hospitals in 2013 and 2014, respectively. Primary exposure was CHD. Primary outcome was overall in-hospital postoperative mortality. Secondary outcomes included 30-day mortality and 30-day morbidity (any nondeath adverse event). Among 34?543 children who underwent laparoscopic surgery, 1349, 1106, and 266 had minor, major, and severe CHD, respectively. After propensity score matching within each stratum of CHD severity, morbidity and mortality were compared between children with and without CHD. RESULTS Children with severe CHD had higher overall mortality and 30-day morbidity (OR 12.31, 95% CI 1.59-95.01; OR 2.51, 95% CI 1.57-4.01, respectively), compared with matched controls. Overall mortality and 30-day morbidity were also higher among children with major CHD compared with children without CHD (OR 3.46, 95% CI 1.49-8.06; OR 2.07, 95% CI 1.65-2.61, respectively). Children with minor CHD had similar mortality outcomes, but had higher 30-day morbidity compared with children without CHD (OR 1.71, 95% CI 1.37-2.13). CONCLUSIONS Children with major or severe CHD have higher morbidity and mortality after laparoscopic surgery. Clinicians should consider the increased risks of laparoscopic surgery for these children during medical decision making.
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Affiliation(s)
- David I. Chu
- Department of Surgery, Division of Urology, The Children’s Hospital of Philadelphia Philadelphia, PA
| | - Jonathan M. Tan
- Department of Anesthesia and Critical Care Medicine, Division of General Anesthesiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Peter Mattei
- Department of Surgery, Division of General, Thoracic, and Fetal Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Andrew T. Costarino
- Department of Anesthesia and Critical Care Medicine, Division of Cardiac Critical Care Medicine, The Children’s Hospital of Philadelphia Philadelphia, PA
| | - Joseph W. Rossano
- Department of Cardiology, Cardiac Center, The Children’s Hospital of Philadelphia, Philadelphia, PA,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Gregory E. Tasian
- Department of Surgery, Division of Urology, The Children’s Hospital of Philadelphia Philadelphia, PA,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA,Department of Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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434
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Nicolarsen J. Transition of Adolescents and Young Adults with Congenital Heart Disease: Challenges, Progress, and Future Improvements. Pediatr Ann 2017; 46:e224-e228. [PMID: 28599027 DOI: 10.3928/19382359-20170519-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Congenital heart disease (CHD) is the most common and perhaps most widely variable birth defect. Decades of improved CHD care has resulted in a steady growth in the number and complexity of adults with CHD, and many of these patients require lifelong, specialized follow-up care. This begins with successful transition from pediatric-based to adult-based care. Despite the remarkable advances in this field, many adults with CHD still experience lapses in care that have significant health consequences. This review outlines some of the challenges, progress, and areas for improvement in CHD transition medicine. [Pediatr Ann. 2017;46(6):e224-e228.].
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435
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Touma M, Reemtsen B, Halnon N, Alejos J, Finn JP, Nelson SF, Wang Y. A Path to Implement Precision Child Health Cardiovascular Medicine. Front Cardiovasc Med 2017; 4:36. [PMID: 28620608 PMCID: PMC5451507 DOI: 10.3389/fcvm.2017.00036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/04/2017] [Indexed: 12/17/2022] Open
Abstract
Congenital heart defects (CHDs) affect approximately 1% of live births and are a major source of childhood morbidity and mortality even in countries with advanced healthcare systems. Along with phenotypic heterogeneity, the underlying etiology of CHDs is multifactorial, involving genetic, epigenetic, and/or environmental contributors. Clear dissection of the underlying mechanism is a powerful step to establish individualized therapies. However, the majority of CHDs are yet to be clearly diagnosed for the underlying genetic and environmental factors, and even less with effective therapies. Although the survival rate for CHDs is steadily improving, there is still a significant unmet need for refining diagnostic precision and establishing targeted therapies to optimize life quality and to minimize future complications. In particular, proper identification of disease associated genetic variants in humans has been challenging, and this greatly impedes our ability to delineate gene–environment interactions that contribute to the pathogenesis of CHDs. Implementing a systematic multileveled approach can establish a continuum from phenotypic characterization in the clinic to molecular dissection using combined next-generation sequencing platforms and validation studies in suitable models at the bench. Key elements necessary to advance the field are: first, proper delineation of the phenotypic spectrum of CHDs; second, defining the molecular genotype/phenotype by combining whole-exome sequencing and transcriptome analysis; third, integration of phenotypic, genotypic, and molecular datasets to identify molecular network contributing to CHDs; fourth, generation of relevant disease models and multileveled experimental investigations. In order to achieve all these goals, access to high-quality biological specimens from well-defined patient cohorts is a crucial step. Therefore, establishing a CHD BioCore is an essential infrastructure and a critical step on the path toward precision child health cardiovascular medicine.
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Affiliation(s)
- Marlin Touma
- Department of Pediatrics, Children's Discovery and Innovation Institute, University of California at Los Angeles, Los Angeles, CA, United States.,Cardiovascular Research Laboratory, University of California at Los Angeles, Los Angeles, CA, United States
| | - Brian Reemtsen
- Department of Cardiothoracic Surgery, University of California at Los Angeles, Los Angeles, CA, United States
| | - Nancy Halnon
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA, United States
| | - Juan Alejos
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA, United States
| | - J Paul Finn
- Department of Radiology, Cardiovascular Imaging, University of California at Los Angeles, Los Angeles, CA, United States
| | - Stanley F Nelson
- Department of Human Genetics, University of California at Los Angeles, Los Angeles, CA, United States
| | - Yibin Wang
- Cardiovascular Research Laboratory, University of California at Los Angeles, Los Angeles, CA, United States.,Department of Anesthesiology, Physiology and Medicine, University of California at Los Angeles, Los Angeles, CA, United States
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436
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Bates BA, Richards C, Hall M, Kerut EK, Campbell W, McMullan MR. Evaluation of athletes with complex congenital heart disease. Echocardiography 2017; 34:934-936. [PMID: 28497583 DOI: 10.1111/echo.13562] [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: 11/29/2022] Open
Abstract
As a result of improvements in congenital heart surgery, there are more adults alive today with congenital heart disease (CHD) than children. Individuals with cardiac birth defects may be able to participate in physical activities but require proper cardiovascular evaluation. The American Heart Association and American College of Cardiology released guidelines in 2015 for athletes with cardiovascular abnormalities. The guidelines express that although restriction from competitive athletics may be indicated for some, the majority of individuals with CHD can and should engage in some form of physical activity. This case study demonstrates the importance of combining all aspects of history, physical examination, ECG, and imaging modalities to evaluate cardiac anatomy and function in young athletes with complex CHD.
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Affiliation(s)
- Benjamin A Bates
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Camille Richards
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael Hall
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - William Campbell
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael R McMullan
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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437
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Braley KT, Tang X, Makil ES, Borroughs-Ray D, Collins RT. The impact of body weight on the diagnosis of aortic dilation-misdiagnosis in overweight and underweight groups. Echocardiography 2017; 34:1029-1034. [DOI: 10.1111/echo.13565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Katherine T. Braley
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Xinyu Tang
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Elizabeth S. Makil
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
| | | | - Ronnie T. Collins
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Internal Medicine; University of Arkansas for Medical Sciences; Little Rock AR USA
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438
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Reddy S, Hu DQ, Zhao M, Blay E, Sandeep N, Ong SG, Jung G, Kooiker KB, Coronado M, Fajardo G, Bernstein D. miR-21 is associated with fibrosis and right ventricular failure. JCI Insight 2017; 2:91625. [PMID: 28469078 DOI: 10.1172/jci.insight.91625] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/23/2017] [Indexed: 12/14/2022] Open
Abstract
Combined pulmonary insufficiency (PI) and stenosis (PS) is a common long-term sequela after repair of many forms of congenital heart disease, causing progressive right ventricular (RV) dilation and failure. Little is known of the mechanisms underlying this combination of preload and afterload stressors. We developed a murine model of PI and PS (PI+PS) to identify clinically relevant pathways and biomarkers of disease progression. Diastolic dysfunction was induced (restrictive RV filling, elevated RV end-diastolic pressures) at 1 month after generation of PI+PS and progressed to systolic dysfunction (decreased RV shortening) by 3 months. RV fibrosis progressed from 1 month (4.4% ± 0.4%) to 3 months (9.2% ± 1%), along with TGF-β signaling and tissue expression of profibrotic miR-21. Although plasma miR-21 was upregulated with diastolic dysfunction, it was downregulated with the onset of systolic dysfunction), correlating with RV fibrosis. Plasma miR-21 in children with PI+PS followed a similar pattern. A model of combined RV volume and pressure overload recapitulates the evolution of RV failure unique to patients with prior RV outflow tract surgery. This progression was characterized by enhanced TGF-β and miR-21 signaling. miR-21 may serve as a plasma biomarker of RV failure, with decreased expression heralding the need for valve replacement.
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Affiliation(s)
- Sushma Reddy
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Dong-Qing Hu
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Mingming Zhao
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Eddie Blay
- Department of Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Nefthi Sandeep
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Sang-Ging Ong
- Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Gwanghyun Jung
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Kristina B Kooiker
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Michael Coronado
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Giovanni Fajardo
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
| | - Daniel Bernstein
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA
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439
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Zaidi S, Brueckner M. Genetics and Genomics of Congenital Heart Disease. Circ Res 2017; 120:923-940. [PMID: 28302740 DOI: 10.1161/circresaha.116.309140] [Citation(s) in RCA: 311] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
Congenital heart disease is the most common birth defect, and because of major advances in medical and surgical management, there are now more adults living with congenital heart disease (CHD) than children. Until recently, the cause of the majority of CHD was unknown. Advances in genomic technologies have discovered the genetic causes of a significant fraction of CHD, while at the same time pointing to remarkable complexity in CHD genetics. This review will focus on the evidence for genetic causes underlying CHD and discuss data supporting both monogenic and complex genetic mechanisms underlying CHD. The discoveries from CHD genetic studies draw attention to biological pathways that simultaneously open the door to a better understanding of cardiac development and affect clinical care of patients with CHD. Finally, we address clinical genetic evaluation of patients and families affected by CHD.
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Affiliation(s)
- Samir Zaidi
- From the Departments of Genetics (S.Z.) and Pediatrics and Genetics (M.B.), Yale University School of Medicine, New Haven CT
| | - Martina Brueckner
- From the Departments of Genetics (S.Z.) and Pediatrics and Genetics (M.B.), Yale University School of Medicine, New Haven CT.
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440
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Wei H, Roscigno CI, Swanson KM. Healthcare providers' caring: Nothing is too small for parents and children hospitalized for heart surgery. Heart Lung 2017; 46:166-171. [DOI: 10.1016/j.hrtlng.2017.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/15/2017] [Accepted: 01/20/2017] [Indexed: 11/30/2022]
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441
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Adults with congenital heart disease: a growing population. Challenges of the present and the future. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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442
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Abstract
Twenty years ago, chromosomal abnormalities were the only identifiable genetic causes of a small fraction of congenital heart defects (CHD). Today, a de novo or inherited genetic abnormality can be identified as pathogenic in one-third of cases. We refer to them here as monogenic causes, insofar as the genetic abnormality has a readily detectable, large effect. What explains the other two-thirds? This review considers a complex genetic basis. That is, a combination of genetic mutations or variants that individually may have little or no detectable effect contribute to the pathogenesis of a heart defect. Genes in the embryo that act directly in cardiac developmental pathways have received the most attention, but genes in the mother that establish the gestational milieu via pathways related to metabolism and aging also have an effect. A growing body of evidence highlights the pathogenic significance of genetic interactions in the embryo and maternal effects that have a genetic basis. The investigation of CHD as guided by a complex genetic model could help estimate risk more precisely and logically lead to a means of prevention.
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Affiliation(s)
- Ehiole Akhirome
- Department of Pediatrics, Washington University School of Medicine
| | - Nephi A Walton
- Department of Pediatrics, Washington University School of Medicine
| | - Julie M Nogee
- Department of Pediatrics, Washington University School of Medicine
| | - Patrick Y Jay
- Department of Pediatrics, Washington University School of Medicine
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443
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Deng LX, Gleason LP, Khan AM, Drajpuch D, Fuller S, Goldberg LA, Mascio CE, Partington SL, Tobin L, Kim YY, Kovacs AH. Advance Care Planning in Adults with Congenital Heart Disease: A Patient Priority. Int J Cardiol 2017; 231:105-109. [DOI: 10.1016/j.ijcard.2016.12.185] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/19/2016] [Accepted: 12/31/2016] [Indexed: 01/21/2023]
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444
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Agarwal A, Samad F, Kalvin L, Bush M, Tajik AJ. A great imitator in adult cardiology practice: congenitally corrected transposition of the great arteries. CONGENIT HEART DIS 2017; 12:143-152. [DOI: 10.1111/chd.12453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Anushree Agarwal
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - Fatima Samad
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - Lindsey Kalvin
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - Michelle Bush
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - A. Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
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445
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Eslami B. Correlates of posttraumatic stress disorder in adults with congenital heart disease. CONGENIT HEART DIS 2017; 12:357-363. [PMID: 28217850 DOI: 10.1111/chd.12452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/12/2016] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aims of this study were to compare the level of posttraumatic stress disorder between adults with and without congenital heart disease, and to examine the correlates of posttraumatic stress disorder (e.g., sociodemographics). DESIGN Cross-sectional. SETTING Two university-affiliated heart hospitals in Tehran, Iran. PATIENTS A sample of 347 adults with congenital heart disease aged 18-64 years (52% women), and 353 adults without congenital heart disease matched by sex and age (±2 years) was recruited. OUTCOME MEASURES The PTSD Scale: Self-report version was used to assess the diagnosis and severity of posttraumatic stress disorder. Hierarchical multivariate logistic regression analyses were performed to explore correlates of likely posttraumatic stress disorder diagnosis among each group of participants. RESULTS The posttraumatic stress disorder in the patients was comparable to those of the control group, except for increased arousal (P = .027) which was scored higher among the patients. Over 52% of adults with congenital heart disease met the criteria for a likely posttraumatic stress disorder diagnosis compared with 48% of adults without congenital heart disease. The regression analyses among patients revealed that elevated depressive symptoms (OR = 1.27) and a positive history of cardiac surgery (OR = 2.02) were significantly associated with posttraumatic stress disorder. The model could explain 29% of the variance in posttraumatic stress disorder. CONCLUSIONS The high and comparable prevalence of posttraumatic stress disorder among patients and nonpatients highlight the significance of the context in which adults with congenital heart disease may face other/additional stressors than disease-related ones, an issue that clinicians need also take into account. Furthermore, the association of posttraumatic stress disorder with elevated depressive symptoms warrant a comprehensive psychological assessment and management of adults with congenital heart disease, in particular among those with a history of invasive procedures.
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Affiliation(s)
- Bahareh Eslami
- Division of Public Health Science, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.,Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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446
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Announcement: Congenital Heart Defect Awareness Week - February 7-14, 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:119. [PMID: 28151929 PMCID: PMC5657828 DOI: 10.15585/mmwr.mm6604a7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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447
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Wolterink JM, Leiner T, Viergever MA, Išgum I. Dilated Convolutional Neural Networks for Cardiovascular MR Segmentation in Congenital Heart Disease. RECONSTRUCTION, SEGMENTATION, AND ANALYSIS OF MEDICAL IMAGES 2017. [DOI: 10.1007/978-3-319-52280-7_9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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448
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Refaat MM, Ballout J, Mansour M. Ablation of Atrial Fibrillation in Patients with Congenital Heart Disease. Arrhythm Electrophysiol Rev 2017; 6:191-194. [PMID: 29326834 DOI: 10.15420/2017.2017.15.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With improved surgical techniques and medical management for patients with congenital heart diseases, more patients are living longer and well into adulthood. This improved survival comes with a price of increased morbidity, mainly secondary to increased risk of tachyarrhythmias. One of the major arrhythmias commonly encountered in this subset of cardiac patients is AF. Similar to the general population, the risk of AF increases with advancing age, and is mainly secondary to the abnormal anatomy, abnormal pressure and volume parameters in the hearts of these patients and to the increased scarring and inflammation seen in the left atrium following multiple surgical procedures. Catheter ablation for AF has been shown to be a very effective treatment modality in patients with refractory AF. However, data and guidelines regarding catheter ablation in patients with congenital heart disease are not well established. This review will shed light on the procedural techniques, success rates and complications of AF catheter ablation in patients with different types of CHD, including atrial septal defects, tetralogy of Fallot, persistent left superior vena cava, heterotaxy syndrome and atrial isomerism, and Ebstein anomaly.
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Affiliation(s)
- Marwan M Refaat
- Department of Internal Medicine, Cardiology Division,American University of Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics,American University of Beirut, Lebanon
| | - Jad Ballout
- Department of Internal Medicine, Cardiology Division,American University of Beirut, Lebanon
| | - Moussa Mansour
- Cardiac Arrhythmia Service, Massachusetts General Hospital/Harvard Medical School,Boston, USA
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449
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Design and initial results of a programme for routine standardised longitudinal follow-up after congenital heart surgery. Cardiol Young 2016; 26:1590-1596. [PMID: 28148316 DOI: 10.1017/s1047951116001669] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND With improvements in early survival following congenital heart surgery, it has become increasingly important to understand longer-term outcomes; however, routine collection of these data is challenging and remains very limited. We describe the development and initial results of a collaborative programme incorporating standardised longitudinal follow-up into usual care at the Children's Hospital of Philadelphia (CHOP) and University of Michigan (UM). METHODS We included children undergoing benchmark operations of the Society of Thoracic Surgeons. Considerations regarding personnel, patient/parent engagement, funding, regulatory issues, and annual data collection are described, and initial follow-up rates are reported. RESULTS The present analysis included 1737 eligible patients undergoing surgery at CHOP from January 2007 to December 2014 and 887 UM patients from January 2010 to December 2014. Overall, follow-up data, of any type, were obtained from 90.8% of patients at CHOP (median follow-up 4.3 years, 92.2% survival) and 98.3% at UM (median follow-up 2.8 years, 92.7% survival), with similar rates across operations and institutions. Most patients lost to follow-up at CHOP had undergone surgery before 2010. Standardised questionnaires assessing burden of disease/quality of life were completed by 80.2% (CHOP) and 78.4% (UM) via phone follow-up. In subsequent pilot testing of an automated e-mail system, 53.4% of eligible patients completed the follow-up questionnaire through this system. CONCLUSIONS Standardised follow-up data can be obtained on the majority of children undergoing benchmark operations. Ongoing efforts to support automated electronic systems and integration with registry data may reduce resource needs, facilitate expansion across centres, and support multi-centre efforts to understand and improve long-term outcomes in this population.
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450
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Jay PY, Akhirome E, Magnan RA, Zhang MR, Kang L, Qin Y, Ugwu N, Regmi SD, Nogee JM, Cheverud JM. Transgenerational cardiology: One way to a baby's heart is through the mother. Mol Cell Endocrinol 2016; 435:94-102. [PMID: 27555292 PMCID: PMC5014674 DOI: 10.1016/j.mce.2016.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 12/17/2022]
Abstract
Despite decades of progress, congenital heart disease remains a major cause of mortality and suffering in children and young adults. Prevention would be ideal, but formidable biological and technical hurdles face any intervention that seeks to target the main causes, genetic mutations in the embryo. Other factors, however, significantly modify the total risk in individuals who carry mutations. Investigation of these factors could lead to an alternative approach to prevention. To define the risk modifiers, our group has taken an "experimental epidemiologic" approach via inbred mouse strain crosses. The original intent was to map genes that modify an individual's risk of heart defects caused by an Nkx2-5 mutation. During the analysis of >2000 Nkx2-5(+/-) offspring from one cross we serendipitously discovered a maternal-age associated risk, which also exists in humans. Reciprocal ovarian transplants between young and old mothers indicate that the incidence of heart defects correlates with the age of the mother and not the oocyte, which implicates a maternal pathway as the basis of the risk. The quantitative risk varies between strain backgrounds, so maternal genetic polymorphisms determine the activity of a factor or factors in the pathway. Most strikingly, voluntary exercise by the mother mitigates the risk. Therefore, congenital heart disease can in principle be prevented by targeting a maternal pathway even if the embryo carries a causative mutation. Further mechanistic insight is necessary to develop an intervention that could be implemented on a broad scale, but the physiology of maternal-fetal interactions, aging, and exercise are notoriously complex and undefined. This suggests that an unbiased genetic approach would most efficiently lead to the relevant pathway. A genetic foundation would lay the groundwork for human studies and clinical trials.
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Affiliation(s)
- Patrick Y Jay
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA; Departments of Genetics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA.
| | - Ehiole Akhirome
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Rachel A Magnan
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - M Rebecca Zhang
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Lillian Kang
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Yidan Qin
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Nelson Ugwu
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Suk Dev Regmi
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Julie M Nogee
- Departments of Pediatrics, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - James M Cheverud
- Department of Biology, Loyola University Chicago, Chicago, IL, USA
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