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Dowaikh A, Alsahari A, Khoshhal S, Momenah T. Cardiac care in trisomy 18: A path to improved outcomes (case report). J Taibah Univ Med Sci 2024; 19:545-548. [PMID: 38736899 PMCID: PMC11081794 DOI: 10.1016/j.jtumed.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/25/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024] Open
Abstract
Background Trisomy 18 (also known as Edwards syndrome) is a chromosomal disorder characterized by severe developmental anomalies and cognitive deficits. Cardiac complications are a leading cause of mortality in these patients, and the role of cardiac interventions remains controversial. Case Presentation We report a case of a full-term baby girl with trisomy 18, born via elective cesarean section. The neonate presented with pulmonary atresia and a series of other cardiac abnormalities, necessitating immediate intervention. Despite the initial challenges, including a brief episode of desaturation post-intervention, the patient responded positively to a balloon pulmonary valvuloplasty and emergency patent ductus arteriosus stent insertion, illustrating the potential benefits of cardiac interventions in patients with trisomy 18. Discussion This case highlights the successful application of cardiac interventions in a patient with trisomy 18, challenging the notion of universally denying such treatments to this population. Our findings suggest that selective interventions can improve quality of life and stabilize the condition, supporting the need for further research to establish clear guidelines for treatment in this demographic. Conclusion This case adds to the growing evidence supporting the feasibility and potential benefits of cardiac interventions in patients with trisomy 18, advocating for a more individualized approach to treatment.
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Affiliation(s)
- Abdullghany Dowaikh
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Atif Alsahari
- Structural Heart Interventionist, Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Saad Khoshhal
- Pediatric Cardiology, Medical College, Taibah University, Al-Munawarah, Kingdom of Saudi Arabia
| | - Tarek Momenah
- Structural Heart Interventionist, Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
- Adjunct Associate Professor, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
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2
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Takai A, Yamagishi M, Ikeda K, Sugimoto A, Ichise E, Maeda Y, Teramukai S, Hasegawa T, Oda S, Iehara T. Effectiveness of cardiac palliative surgery for trisomy 18 patients with increased pulmonary blood flow. Am J Med Genet A 2023; 191:2703-2710. [PMID: 37698299 DOI: 10.1002/ajmg.a.63401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/25/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
Congenital heart disease (CHD) is common among patients with trisomy 18 (T18), but cardiac surgery has been rarely indicated for T18 patients due to their short life span. Although the therapeutic effects of aggressive interventions were recently demonstrated for T18 patients, the subjects and factors examined varied, resulting in inconsistent findings. Therefore, the effects of cardiac surgery for T18 remain unclear. We herein investigated the outcomes of cardiac palliative surgery for CHD with increased pulmonary blood flow in T18 patients. 27 patients were examined: 13 (48.1%) underwent cardiac palliative surgery and 14 (51.9%) did not. Median survival times in the no-surgery and surgery groups were 223.0 days (95% confidence interval [CI]: 46-361 days) and 723.0 days (95% CI: 360-1447 days), respectively. The number of patients with pulmonary hypertension significantly differed between the two groups (5 of 14 in the no-surgery group and 0 in the surgery group). Five of 14 patients in the no-surgery group and 10 of 13 in the surgery group were discharged to home care (odds ratio: 10.8 [95% CI: 1.07-110.0]). Therefore, cardiac palliative surgery may be used to treat CHD with increased pulmonary blood flow in T18 patients.
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Affiliation(s)
- Akari Takai
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Pediatrics, Hananoki Medical Welfare Center, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyuki Ikeda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuya Sugimoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Eisuke Ichise
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuji Hasegawa
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinichiro Oda
- Department of Pediatric Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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3
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Jaspersen SL, Bruns DA, Candee MS, Battaglia A, Carey JC, Fishler KP. Seizures in trisomy 18: Prevalence, description, and treatment. Am J Med Genet A 2023; 191:1026-1037. [PMID: 36601988 DOI: 10.1002/ajmg.a.63113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
Changes in medical intervention over the last decade have improved outcomes for individuals with trisomy 18, the second most common human aneuploidy syndrome at birth. As children with trisomy 18 live longer, a shared concern of medical experts and parents is the occurrence and treatment of seizures. Previously published surveillance guidelines for this condition have not addressed seizure management. Using parent-reported data collected as part of the Tracking Rare Incidence Syndromes project, we report on the prevalence, course, and management of seizures in individuals with trisomy 18. Twenty-eight percent (52/186) of individuals diagnosed with trisomy 18 in our retrospective cohort experienced generalized, focal, or mixed seizures at some point in their lifetime. For many individuals, seizures were effectively managed by broad-spectrum anti-seizure medications. Correlation analysis showed that focal and generalized seizures were more likely to occur in individuals who had previously experienced infantile spasms or central apnea. Electroencephalogram testing should be considered as part of a standard screening approach in individuals with trisomy 18 to enable early diagnosis and treatment of seizures. An international registry that incorporates parent-reported and clinical data for patients with trisomy 18 may facilitate ongoing research and recruitment into clinical trials for seizure management.
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Affiliation(s)
- Sue L Jaspersen
- Genetic Counseling Program, Department of Medical Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Deborah A Bruns
- Special Education Program, School of Education, Southern Illinois University Carbondale, Carbondale, Illinois, USA
| | - Meghan S Candee
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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4
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Fick TA, Sexson Tejtel SK. Trisomy 18 Trends over the Last 20 Years. J Pediatr 2021; 239:206-211.e1. [PMID: 34363815 DOI: 10.1016/j.jpeds.2021.07.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the trends in hospitalizations for children with trisomy 18 over time and to determine the rate of invasive procedures on these children, using a large inpatient database. STUDY DESIGN A retrospective analysis using the Kids' Inpatient Database from 1997 to 2016 was performed for trisomy 18. We evaluated survival to discharge as well as the presence of pulmonary, skeletal, neurologic, gastrointestinal, renal, and hematologic/bleeding problems. We also searched for the following interventions, if performed: gastrostomy tube placement, tracheostomy, or cardiac procedure. RESULTS Over this period 10 151 admissions occurred in children with a diagnosis of trisomy 18. Between 1997 and 2016, the number of children admitted annually with trisomy 18 increased 74% from 1036 to 1798. The proportion of patients born prematurely remained stable at 14%-16% throughout the study. Gastrostomy tube placement increased 12-fold during the study period, tracheostomy increased 11-fold, and cardiac intervention increased 5-fold. The overall mortality rate decreased in those with trisomy 18 from 32% in 1997 to 21% in 2016. CONCLUSIONS We highlight a decreased inpatient mortality rate during the study period. The number of children undergoing interventions such as gastrostomy tube and tracheostomy increased, as did the number of children undergoing cardiac intervention. Although the number of procedures has increased with the mortality rate decreasing, it is unclear at present whether the 2 are related.
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5
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Nakai R, Fujioka T, Okamura K, Suzuki T, Nakao A, Kobayashi J, Tsuchiya K. Survival Outcomes of Two-Stage Intracardiac Repair in Large Ventricular Septal Defect and Trisomy 18. Pediatr Cardiol 2021; 42:821-831. [PMID: 33515091 DOI: 10.1007/s00246-021-02546-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical management has not been encouraged in patients with trisomy 18 (T18) and congenital heart diseases due to poor survival. This study aimed to investigate (1) the appropriateness of palliative surgeries followed by intracardiac repair (ICR) (i.e., two-stage ICR) for patients with a large ventricular septal defect (VSD) and T18, and (2) its impact on their long-term outcomes. METHODS Medical charts of patients with VSD and T18 who underwent two-stage ICR at the Japanese Red Cross Medical Center between January 2005 and December 2019 were retrospectively reviewed. Demographic data, timing, and types of palliative surgeries, information related to ICR, peri- and postoperative clinical information, postoperative survival, and cause of death were collected. The long-term prognosis of patients treated with two-stage ICR was compared with that of patients treated with primary ICR and palliative surgery without ICR. RESULTS Overall, 18 (2 male, 16 female) patients underwent two-stage ICR. Pulmonary artery banding was the initial palliative surgery in all patients after a median duration of 19.5 (range 6-194) days of life. The median age and the mean body weight at the time of ICR were 18.2 (7.6-50.7) months and 6.0 ± 1.0 kg, respectively. The mean pulmonary artery pressure and pulmonary vascular resistance index before ICR were 19.1 ± 7.3 mmHg and 3.4 ± 2.0 U m2, respectively. Overall, 17/18 (94%) patients were discharged after ICR. Fourteen (78%) patients were alive during data collection. None of the patients died of cardiac insufficiency, and the median duration of survival was 46.3 (14.3-186.4) months since birth. Most patients required cardiac medications rather than pulmonary vasodilators at the last follow-up. During the study period, three patients underwent primary ICR, and 46 underwent palliative surgery without ICR. Of those who underwent primary ICR, two died in the hospital on the first and 48th day following ICR, and the third died 179 days after the ICR. The Log-rank test revealed a significantly longer survival for the patients treated with two-stage ICR compared with those treated with palliative surgery without ICR (P = 0.003). CONCLUSION Two-stage ICR improves the long-term survival of patients with VSDs and T18. This safe surgical strategy can also prevent pulmonary hypertension in such patients.
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Affiliation(s)
- Ryosuke Nakai
- Department of Pediatrics, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Tao Fujioka
- Department of Pediatrics, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Kenichi Okamura
- Department of Cardiovascular Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Toshihiko Suzuki
- Department of Cardiovascular Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsushi Nakao
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jotaro Kobayashi
- Department of Cardiovascular Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keiji Tsuchiya
- Department of Pediatrics, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
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6
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Kepple JW, Fishler KP, Peeples ES. Surveillance guidelines for children with trisomy 18. Am J Med Genet A 2021; 185:1294-1303. [PMID: 33527722 DOI: 10.1002/ajmg.a.62097] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/31/2022]
Abstract
Trisomy 18 is the second most common aneuploidy syndromes in live born infants. It is associated with high mortality rates, estimated to be 75%-95% in the first year of life, as well as significant morbidity in survivors. The low survival is largely due to the high prevalence of severe congenital anomalies in infants with this diagnosis. However, interventions to repair or palliate those life-threatening anomalies are being performed at a higher rate for these infants, resulting in increased rates of survival beyond the first year of life. While it is well documented that trisomy 18 is associated with several cardiac malformations, these patients also have respiratory, neurological, neoplastic, genitourinary, abdominal, otolaryngologic, and orthopedic complications that can impact their quality of life. The goal of this review is to present a comprehensive description of complications in children with trisomy 18 to aid in the development of monitoring and treatment guidelines for the increasing number of providers who will be caring for these patients throughout their lives. Where the evidence is available, this review presents screening recommendations to allow for more rapid detection and documentation of these complications.
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Affiliation(s)
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
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7
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Carvajal HG, Callahan CP, Miller JR, Rensink BL, Eghtesady P. Cardiac Surgery in Trisomy 13 and 18: A Guide to Clinical Decision-Making. Pediatr Cardiol 2020; 41:1319-1333. [PMID: 32924070 DOI: 10.1007/s00246-020-02444-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
There has been substantial controversy regarding treatment of congenital heart defects in infants with trisomies 13 and 18. Most reports have focused on surgical outcomes versus expectant treatment, and rarely there has been an effort to consolidate existing evidence into a more coherent way to help clinicians with decision-making and counseling families. An extensive review of the existing literature on cardiac surgery in patients with these trisomies was conducted from 2004 to 2020. The effects of preoperative and perioperative factors on in-hospital and long-term mortality were analyzed, as well as possible predictors for postoperative chronic care needs such as tracheostomy and gastrostomy. Patients with minimal or no preoperative pulmonary hypertension and mechanical ventilation undergoing corrective surgery at a weight greater than 2.5 kg suffer from lower postoperative mortality. Infants with lower-complexity cardiac defects are likely to benefit the most from surgery, although their expected mortality is higher than that of infants without trisomy. Omphalocele confers an increased mortality risk regardless of cardiac surgery. Gastrointestinal comorbidities increased the risk of gastrostomy tube placement, while those with prolonged mechanical ventilation and respiratory comorbidities are more likely to require tracheostomy. Cardiac surgery is feasible in children with trisomies 13 and 18 and can provide improved long-term results. However, this is a clinically complex population, and both physicians and caretakers should be aware of the long-term challenges these patients face following surgery when discussing treatment options.
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Affiliation(s)
- Horacio G Carvajal
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA
| | - Connor P Callahan
- Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA
| | - Jacob R Miller
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA
| | - Bethany L Rensink
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis/St. Louis Children's Hospital, Saint Louis, MO, USA.
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8
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Janvier A, Farlow B, Barrington KJ, Bourque CJ, Brazg T, Wilfond B. Building trust and improving communication with parents of children with Trisomy 13 and 18: A mixed-methods study. Palliat Med 2020; 34:262-271. [PMID: 31280664 DOI: 10.1177/0269216319860662] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trisomy 13 and trisomy 18 are common life-limiting conditions associated with major disabilities. Many parents have described conflictual relationships with clinicians, but positive and adverse experiences of families with healthcare providers have not been well described. AIM (1) To investigate parental experiences with clinicians and (2) to provide practical recommendations and behaviors clinicians could emulate to avoid conflict. DESIGN Participants were asked to describe their best and worse experiences, as well as supportive clinicians they met. The results were analyzed using mixed methods. SETTING/PARTICIPANTS Parents of children with trisomy 13 and 18 who were part of online social support networks. A total of 503 invitations were sent, and 332 parents completed the questionnaire about 272 children. RESULTS The majority of parents (72%) had met a supportive clinician. When describing clinicians who changed their lives, the overarching theme, present in 88% of answers, was trust. Parents trusted clinicians when they felt he or she cared and valued their child, their family, and made them feel like good parents (69%), had appropriate knowledge (66%), and supported them and gave them realistic hope (42%). Many (42%) parents did not want to make-or be part of-life-and-death decisions. Parents gave specific examples of supportive behaviors that can be adopted by clinicians. Parents also described adverse experiences, generally leading to conflicts and lack of trust. CONCLUSION Realistic and compassionate support of parents living with children with trisomy 13 and 18 is possible. Adversarial interactions that lead to distrust and conflicts can be avoided. Many supportive behaviors that inspire trust can be emulated.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada.,Neonatology, Sainte-Justine Hospital, Montreal, QC, Canada.,Clinical Ethics Unit and Palliative Care Unit, Sainte-Justine Hospital, Montreal, QC, Canada.,Unité de Recherche en Éthique Clinique et Partenariat Famille, Centre de Recherche, Hôpital Sainte-Justine, Montréal, QC, Canada
| | - Barbara Farlow
- The deVeber Institute for Bioethics and Social Research, North York, ON, Canada.,Patients for Patient Safety Canada, Edmonton, AB, Canada
| | - Keith J Barrington
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada.,Neonatology, Sainte-Justine Hospital, Montreal, QC, Canada
| | - Claude Julie Bourque
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada.,Unité de Recherche en Éthique Clinique et Partenariat Famille, Centre de Recherche, Hôpital Sainte-Justine, Montréal, QC, Canada
| | - Tracy Brazg
- Ethics Consultation Service, University of Washington Medical Center, Washington, DC, USA
| | - Benjamin Wilfond
- Truman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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9
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Applications of Genome Editing Technology in Research on Chromosome Aneuploidy Disorders. Cells 2020; 9:cells9010239. [PMID: 31963583 PMCID: PMC7016705 DOI: 10.3390/cells9010239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022] Open
Abstract
Chromosomal segregation errors in germ cells and early embryonic development underlie aneuploidies, which are numerical chromosomal abnormalities causing fetal absorption, developmental anomalies, and carcinogenesis. It has been considered that human aneuploidy disorders cannot be resolved by radical treatment. However, recent studies have demonstrated that aneuploidies can be rescued to a normal diploid state using genetic engineering in cultured cells. Here, we summarize a series of studies mainly applying genome editing to eliminate an extra copy of human chromosome 21, the cause of the most common constitutional aneuploidy disorder Down syndrome. We also present findings on induced pluripotent stem cell reprogramming, which has been shown to be one of the most promising technologies for converting aneuploidies into normal diploidy without the risk of genetic alterations such as genome editing-mediated off-target effects.
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10
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Ferreira de Souza LM, Galvão E Brito Medeiros A, Júnior JPR, de Melo AN, Dias SAMM. Long Survival of a Patient with Trisomy 18 and Dandy-Walker Syndrome. ACTA ACUST UNITED AC 2019; 55:medicina55070352. [PMID: 31288482 PMCID: PMC6681329 DOI: 10.3390/medicina55070352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022]
Abstract
Trisomy 18 is a genetic disease resulting from an extra chromosome 18, characterized by a broad clinical spectrum, poor prognosis and low rates of survival. This is the case of a 12 year-old girl diagnosed with full trisomy 18, and multiple malformations, including Dandy-Walker Syndrome and congenital heart defects on long term survival. At nine months, a new echocardiogram showed a double outlet right ventricle, significant pulmonary stenosis, patent ductus arteriosus and ventricular septal defect. Cardiac surgery was performed at one year and seven months. Early surgical intervention and multidisciplinary follow-up may change the clinical outcome of the disease. Further studies are required to evaluate the benefit of invasive procedures such as cardiac surgery on survival of patients with trisomy 18.
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Affiliation(s)
| | | | | | - Aurea Nogueira de Melo
- Department of Pediatric of Federal, University of Rio Grande do Norte, Natal 58051-900, Brazil.
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11
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Kato E, Kitase Y, Tachibana T, Hattori T, Saito A, Muramatsu Y, Takemoto K, Yamamoto H, Hayashi S, Yasuda A, Kato Y, Ieda K, Oshiro M, Sato Y, Hayakawa M. Factors related to survival discharge in trisomy 18: A retrospective multicenter study. Am J Med Genet A 2019; 179:1253-1259. [DOI: 10.1002/ajmg.a.61146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/26/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Eiko Kato
- Department of PediatricsTosei General Hospital Aichi Japan
| | - Yuma Kitase
- Division of Neonatology, Center for Maternal–Neonatal CareNagoya University Hospital Nagoya Japan
| | | | | | - Akiko Saito
- Division of Neonatology, Center for Maternal–Neonatal CareNagoya University Hospital Nagoya Japan
| | - Yukako Muramatsu
- Department of PediatricsCentral Hospital, Aichi Human Service Center Aichi Japan
| | - Koji Takemoto
- Department of PediatricsKonan Kosei Hospital Aichi Japan
| | - Hikaru Yamamoto
- Department of PediatricsToyota Memorial Hospital Aichi Japan
| | - Seiji Hayashi
- Department of PediatricsOkazaki City Hospital Aichi Japan
| | - Ayako Yasuda
- Department of NeonatologyJapanese Red Cross Nagoya Daiichi Hospital Nagoya Japan
| | - Yuichi Kato
- Department of PediatricsAnjo Kosei Hospital Aichi Japan
| | - Kuniko Ieda
- Department of PediatricsTosei General Hospital Aichi Japan
| | - Makoto Oshiro
- Department of NeonatologyJapanese Red Cross Nagoya Daiichi Hospital Nagoya Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal–Neonatal CareNagoya University Hospital Nagoya Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal–Neonatal CareNagoya University Hospital Nagoya Japan
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12
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Mullin J, Wolfe J, Bluebond-Langner M, Craig F. Experiences of children with trisomy 18 referred to pediatric palliative care services on two continents. Am J Med Genet A 2019; 179:903-907. [PMID: 30932336 PMCID: PMC6766889 DOI: 10.1002/ajmg.a.61149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/11/2022]
Abstract
Children with trisomy 18 that survive beyond the neonatal period have multiple congenital anomalies, neurodevelopmental disability, and high mortality rates. The experience of children with trisomy 18 who receive pediatric palliative care services is largely unknown. We conducted a retrospective review of children with trisomy 18 receiving pediatric palliative care services at both Boston Children's Hospital, USA and Great Ormond Street Hospital, UK from January 1, 2004 to January 1, 2015. Fifty-eight children with trisomy 18 were referred to pediatric palliative care, 38 in the United Kingdom, 20 in the United States. Median age at referral was 19 days (2-89) in the United Kingdom, and 25 days (1-463) in the United States. Median length of time being followed by pediatric palliative care was 32 days (1-1,637) in the United Kingdom and 67 days (3-2,442) in the United States. The only significant difference in the two cohorts (p = .001) was in likelihood of receiving cardiac surgical intervention-37% in the United States, 0% the United Kingdom. Children with trisomy 18 receive pediatric palliative care services, with variable age at referral and for a variable length of time. Further research is needed to understand the experience of children with trisomy 18 and their families receiving pediatric palliative care services.
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Affiliation(s)
- Jonathan Mullin
- Department of Pediatrics, Washington University in St Louis, St. Louis, Missouri
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Myra Bluebond-Langner
- Faculty of Population Health Sciences, Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Finella Craig
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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13
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Domingo L, Carey JC, Eckhauser A, Wilkes J, Menon SC. Mortality and Resource Use Following Cardiac Interventions in Children with Trisomy 13 and Trisomy 18 and Congenital Heart Disease. Pediatr Cardiol 2019; 40:349-356. [PMID: 30291384 DOI: 10.1007/s00246-018-2001-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Abstract
We sought to evaluate the mortality, risk factors for mortality, and resource utilization following cardiac interventions in trisomy 13 (T13) and 18 (T18) children. All T13 and T18 children who underwent a cardiac intervention from January 1999 to March 2015 were identified from the Pediatric Health Information System database. Data collected included demographics, type of congenital heart disease (CHD), cardiac interventions, comorbidities, length of stay (LOS), hospital charges, and deaths (within 30 days). Logistic regression analysis was used to determine factors associated with mortality. There were 49 (47% females) T13 and 140 (67% females) T18 subjects. The two cohorts were similar in distribution for race, geographic region, insurance type, and median household income. The most common CHD in both groups was a shunt lesion followed by conotruncal defects. Compared to T18, the T13 cohort had higher mortality (29% vs. 12%), tracheostomies (12% vs. 4%), gastrostomies (18% vs. 6%), and overall resource use (P < 0.05 for all). White race (OR 0.23, 95% CI 0.06-0.81) in T13 and older age (in weeks) at surgery in T18 (OR 0.75, 95% CI 0.64-0.86) were associated with lower mortality. A select group of T13 and T18 CHD patients can undergo successful cardiac interventions, albeit with a higher mortality and resource use. T13 patients have higher mortality and resource use compared to T18. In T13 and T18 patients, interventions for CHD may be an acceptable and ethical option following a careful individualized selection and counseling by a team of experts.
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Affiliation(s)
- Liezl Domingo
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
- Division of Pediatric Cardiology, Augusta University, 1120 15th Street BA, 8300, Augusta, GA, 30909, USA.
| | - John C Carey
- Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | - Aaron Eckhauser
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jacob Wilkes
- Pediatric Specialties Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
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14
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Shitara Y, Naruse Y, Matsushita R. Concerns About the Study "Congenital Heart Surgery on In-Hospital Mortality in Trisomy 13 and 18". Pediatrics 2018; 141:peds.2018-0400A. [PMID: 29712761 DOI: 10.1542/peds.2018-0400a] [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: 11/24/2022] Open
Affiliation(s)
- Yoshihiko Shitara
- Neonatologist, Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Sumida, Tokyo, Japan
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15
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Fruhman G, Miller C, Amon E, Raible D, Bradshaw R, Martin K. Obstetricians' views on the ethics of cardiac surgery for newborns with common aneuploidies. Prenat Diagn 2018; 38:303-309. [DOI: 10.1002/pd.5225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/21/2018] [Accepted: 01/25/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Gary Fruhman
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
- Northwell Health, Department of Obstetrics and Gynecology; Staten Island University Hospital; Staten Island NY USA
| | - Collin Miller
- Division of Research, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Erol Amon
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Darbey Raible
- Department of Pediatrics; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Rachael Bradshaw
- Department of Pediatrics; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Kimberly Martin
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
- Natera Inc.; San Carlos CA USA
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16
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Peterson R, Calamur N, Fiore A, Huddleston C, Spence K. Factors Influencing Outcomes After Cardiac Intervention in Infants with Trisomy 13 and 18. Pediatr Cardiol 2018; 39:140-147. [PMID: 28948390 DOI: 10.1007/s00246-017-1738-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
Cardiac intervention remains controversial in patients with trisomy 13 and 18 and little is known about factors that may affect outcomes. The goal of this study was to evaluate preoperative factors and surgical approach with respect to outcomes in these patients. Patients with congenital heart disease and trisomy 13 or 18 presenting to our institution from 2004 through 2015 were retrospectively reviewed. Patients were grouped into complete intervention, palliated intervention, and non-intervention. Pre-intervention variables, timing and type of intervention, post-intervention outcomes, and survival were recorded and comparisons were made between the groups. Of 34 patients, 18 cardiac interventions were performed. Complete repair was performed in 11(61%) and palliation in 7(39%). Median age for complete repair was 9.2 vs. 1.7 months in palliated patients (p < 0.001) and palliated patients were smaller (median 2.5 vs. 5.2 kg, p < 0.001). All patients who underwent complete repair survived to discharge compared to only 57% of patients that were palliated (p = 0.04). Palliated patients had longer intubation and time to discharge (p < 0.05). Survival at last follow-up was greater in the complete repair group compared with palliated patients and non-intervention patients (72, 14, and 18%, p = 0.009) with a longer median length of survival in the complete repair group (p = 0.002). In our group of trisomy 13 and 18 patients, those able to undergo complete repair had improved outcomes. Patients undergoing complete repair were older and bigger; this suggests that delaying intervention and optimizing the likelihood of complete repair may be beneficial.
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Affiliation(s)
- Renuka Peterson
- Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Medical Center, 1465 S. Grand Boulevard, Saint Louis, MO, 63104, USA.
| | - Nandini Calamur
- Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Medical Center, 1465 S. Grand Boulevard, Saint Louis, MO, 63104, USA
| | - Andrew Fiore
- Department of Surgery, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Medical Center, Saint Louis, MO, USA
| | - Charles Huddleston
- Department of Surgery, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Medical Center, Saint Louis, MO, USA
| | - Kimberly Spence
- Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Medical Center, 1465 S. Grand Boulevard, Saint Louis, MO, 63104, USA
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17
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Carey JC, Kosho T. Perspectives on the care and advances in the management of children with trisomy 13 and 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 172:249-50. [PMID: 27643592 DOI: 10.1002/ajmg.c.31527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The trisomy 13 and trisomy 18 syndromes are important and relatively common chromosome conditions each consisting of a recognizable pattern of multiple congenital anomalies, an increased neonatal and infant mortality, and a marked cognitive and motor disability in older children. Because of the medically serious nature of the outcomes, the traditional approach to management in the newborn and early infancy periods has been to withhold technological support and surgery. In the last decade a rich dialogue has emerged in the literature; one view makes the case for pure comfort care for the benefit of the child while the other view supports full intervention in appropriate situations. The principal aim of the series of articles in this issue of the Seminars in Medical Genetics is to enrich and continue this emerging dialogue. The papers include review articles, original research, and commentaries that discuss perspectives on the care and advances in the management of children with the trisomy 13 and 18 syndromes. © 2016 Wiley Periodicals, Inc.
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18
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Janvier A, Farlow B, Barrington KJ. Parental hopes, interventions, and survival of neonates with trisomy 13 and trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:279-87. [DOI: 10.1002/ajmg.c.31526] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Josephsen JB, Armbrecht ES, Braddock SR, Cibulskis CC. Procedures in the 1st year of life for children with trisomy 13 and trisomy 18, a 25-year, single-center review. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:264-71. [DOI: 10.1002/ajmg.c.31525] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Donovan JH, Krigbaum G, Bruns DA. Medical interventions and survival by gender of children with trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:272-8. [DOI: 10.1002/ajmg.c.31522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Roberts W, Zurada A, Zurada-ZieliŃSka A, Gielecki J, Loukas M. Anatomy of trisomy 18. Clin Anat 2016; 29:628-32. [DOI: 10.1002/ca.22725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Wallisa Roberts
- Department of Anatomical Sciences; St George's University; Grenada
| | - Anna Zurada
- Department of Anatomy; Varmia and Mazury Medical School; Olsztyn Poland
| | | | - Jerzy Gielecki
- Department of Anatomy; Varmia and Mazury Medical School; Olsztyn Poland
| | - Marios Loukas
- Department of Anatomical Sciences; St George's University; Grenada
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22
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Kosho T, Carey JC. Does medical intervention affect outcome in infants with trisomy 18 or trisomy 13? Am J Med Genet A 2016; 170A:847-9. [DOI: 10.1002/ajmg.a.37610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Tomoki Kosho
- Department of Medical Genetics; Shinshu University School of Medicine; Matsumoto Japan
| | - John C. Carey
- Department of Pediatrics; University of Utah Health Sciences Center; Salt Lake City Utah
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