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Majani NG, Koster JR, Kalezi ZE, Letara N, Nkya D, Mongela S, Kubhoja S, Sharau G, Mlawi V, Grobbee DE, Slieker MG, Chillo P, Janabi M, Kisenge P. Spectrum of Heart Diseases in Children in a National Cardiac Referral Center Tanzania, Eastern Africa: A Six-Year Overview. Glob Heart 2024; 19:61. [PMID: 39100942 PMCID: PMC11295910 DOI: 10.5334/gh.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background While communicable diseases have long been the primary focus of healthcare in Africa, the rising impact of paediatric and congenital heart disease (CHD) cannot be overlooked. This research aimed to estimate the frequency and pattern of heart diseases in children who underwent their first echocardiography at a national cardiac referral hospital in Tanzania. Methods A retrospective observational study was conducted on children aged 0 to 18 years referred for first-time cardiological evaluation from January 2017 to December 2022. Retrieval of social and echocardiogram data and descriptive analysis were performed. Results There were 6,058 children with complete reports. Of these, 52.8% (3,198) had heart disease, of whom 2,559 (80%) had CHD, while (340/639; 53.2%) with acquired heart disease (AHD) had rheumatic heart disease (RHD). Children with CHD had a median age 1.0 years (IQR: 0.3-3.5) and were predominantly 51.2% male. Children with RHD had a median age 9.7 years (IQR: 3.2-13.8) with equal gender distribution. Shunt lesions were common in 1,487 (58.1%), mainly VSD 19.3%, PDA 19.1%, ASD 15.1%, and atrioventricular septal defect (AVSD) 4.6%. Pulmonary valve stenosis was in 97 (3.8%). Around 35% (718) had cyanotic CHD, with TOF being most common (13.3%), followed by double outlet right ventricle (DORV) (3.6%). Compared to global average truncus arteriosus was higher in 69 (2.3%) children. In contrast, TGA and hypoplastic left heart syndrome (HLHS) were lower than the estimated global average seen in 2.3% and 0.5% of the cases, respectively. Atresia of the right-side valves was more common (174 vs. 24), and approximately 40% of the patients referred for first-time echocardiographic evaluation required hospitalization. Conclusion Congenital heart disease is the primary cause of heart disease in children presenting at a national referral hospital, surpassing RHD. With its distinct distribution pattern, acyanotic lesions are more frequent than cyanotic heart diseases. The observed late referral tendencies suggest improving the referral system, enhancing CHD awareness among healthcare professionals, and instituting nationwide screening programs.
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Affiliation(s)
- Naizihijwa G. Majani
- Department of Pediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
- Julius Global Health, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Joëlle R. Koster
- Faculty of Medicine, University of Utrecht, Utrecht, The Netherlands
| | - Zawadi E. Kalezi
- Department of Pediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Nuru Letara
- Department of Pediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Deogratias Nkya
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella Mongela
- Department of Pediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Sulende Kubhoja
- Department of Pediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Godwin Sharau
- Department of Pediatric Cardiac Surgery, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Vivienne Mlawi
- Department of Pediatric Cardiac Surgery, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Martijn. G. Slieker
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Rakha S. Initiating a Fetal Cardiac Program from Scratch in Low- and Middle-Income Countries: Structure, Challenges, and Hopes for Solutions. Pediatr Cardiol 2024:10.1007/s00246-024-03479-9. [PMID: 38639814 DOI: 10.1007/s00246-024-03479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
Although fetal cardiac programs are well established in developed countries, establishing an efficient program in low- and middle-income countries (LMICs) is still considered a significant challenge. Substantial obstacles usually face the initiation of fetal cardiac service from scratch in LMICs. The primary structural frame of a successful fetal cardiac program is described in detail, emphasizing the required team members. The potential challenges for starting fetal cardiac services in LMICs include financial, awareness-related, prenatal obstetric screening, sociocultural, psychosocial, and social support factors. These challenges could be solved by addressing these barriers, such as collecting funds for financial support, raising awareness among families and health care providers, telemedicine, building international health partnerships, modifying training protocols for fetal cardiologists and sonographers, and initiating support groups and social services for families with confirmed fetal cardiac disease. Initiating a successful fetal cardiac program requires multi-aspect structural planning. The challenges for program initiation require diverse efforts, from modified training and promoting awareness of care providers and the community to governmental and nonprofit organizations' collaborations for proper building and utilization of program resources.
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Affiliation(s)
- Shaimaa Rakha
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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3
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Searchinger C, Nalubwama H, Pulle J, Mehta R, Tumwbaze H, Kyarimpa R, Mwima R, Atukunda E, Bua B, Sarnacki R, Sherman MG, Oketcho M, Zimmerman M, Nakitto M, Longenecker CT, Webel A, Scheel A, Lwabi PS, Sable CA. Quality of Life in Ugandan Children and Young Adults After Surgery for Congenital Heart Disease: Mixed Methods Approach. Glob Heart 2024; 19:36. [PMID: 38638125 PMCID: PMC11025577 DOI: 10.5334/gh.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
Background Health-related quality of life (HRQOL) is a critical issue for patients undergoing surgery for congenital heart disease (CHD) but has never been assessed in a low-income country. We conducted a cross-sectional mixed methods study with age-matched healthy siblings serving as controls at the Uganda Heart Institute. Methods One-hundred fifteen CHD pediatric and young adult patients and sibling control participants were recruited. Health-related quality of life was assessed using the Pediatric Quality of Life Inventory Version 4.0 in participants ages 5-17 and 36-Item Short Form Survey for young adults aged 18-25. A subset of 27 participants completed face-to-face interviews to supplement quantitative findings. Results Eighty-six pediatric (age 5-17) sibling and parent pairs completed Peds QOL surveys, and 29 young adult (age 18-25) sibling pairs completed SF-36 surveys. One third of patients had surgery in Uganda. Ventricular septal defects and tetralogy of Fallot were the most common diagnoses. Health-related quality of life scores in patients were lower across all domains compared to control participants in children. Reductions in physical and emotional domains of HRQOL were also statistically significant for young adults. Variables associated with lower HRQOL score on multivariate analysis in pediatric patients were younger age in the physical and emotional domains, greater number of surgeries in the physical domain and surgery outside Uganda in the school domain. The only predictor of lower HRQOL score in young adults was surgery outside Uganda in the social domain. Qualitative interviews identified a number of themes that correlated with survey results including abandonment by family, isolation from peers and community, financial hardship and social stigmatization. Conclusion Health-related quality of life was lower in Ugandan patients after CHD surgery than siblings. Younger patients and those who had surgery outside of Uganda had lower HRQOL. These data have important implications for patients undergoing CHD surgery in LMIC and have potential to inform interventions.
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Affiliation(s)
- Chloe Searchinger
- Princeton University, Princeton, NJ, USA
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | - Rittal Mehta
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | | | | | | | - Rachel Sarnacki
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | - Meredith G. Sherman
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
| | | | | | | | - Chris T. Longenecker
- Division of Cardiology and Department of Global Health University of Washington School of Medicine, Seattle WA, USA
| | - Allison Webel
- University of Washington School of Nursing, Seattle WA, USA
| | - Amy Scheel
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Craig A. Sable
- Division of Cardiology and Global Health Initiative, Children’s National Hospital, Washington, DC, USA
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4
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Alkhodari M, Hadjileontiadis LJ, Khandoker AH. Identification of Congenital Valvular Murmurs in Young Patients Using Deep Learning-Based Attention Transformers and Phonocardiograms. IEEE J Biomed Health Inform 2024; 28:1803-1814. [PMID: 38261492 DOI: 10.1109/jbhi.2024.3357506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
One in every four newborns suffers from congenital heart disease (CHD) that causes defects in the heart structure. The current gold-standard assessment technique, echocardiography, causes delays in the diagnosis owing to the need for experts who vary markedly in their ability to detect and interpret pathological patterns. Moreover, echo is still causing cost difficulties for low- and middle-income countries. Here, we developed a deep learning-based attention transformer model to automate the detection of heart murmurs caused by CHD at an early stage of life using cost-effective and widely available phonocardiography (PCG). PCG recordings were obtained from 942 young patients at four major auscultation locations, including the aortic valve (AV), mitral valve (MV), pulmonary valve (PV), and tricuspid valve (TV), and they were annotated by experts as absent, present, or unknown murmurs. A transformation to wavelet features was performed to reduce the dimensionality before the deep learning stage for inferring the medical condition. The performance was validated through 10-fold cross-validation and yielded an average accuracy and sensitivity of 90.23 % and 72.41 %, respectively. The accuracy of discriminating between murmurs' absence and presence reached 76.10 % when evaluated on unseen data. The model had accuracies of 70 %, 88 %, and 86 % in predicting murmur presence in infants, children, and adolescents, respectively. The interpretation of the model revealed proper discrimination between the learned attributes, and AV channel was found important (score 0.75) for the murmur absence predictions while MV and TV were more important for murmur presence predictions. The findings potentiate deep learning as a powerful front-line tool for inferring CHD status in PCG recordings leveraging early detection of heart anomalies in young people. It is suggested as a tool that can be used independently from high-cost machinery or expert assessment.
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5
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Feng W, Zhang M, Hou J, Die X, Wang Y, Liu R. Clinical characteristics of congenital heart defects in mild congenital anorectal malformation: single-centre experience. BMC Pediatr 2024; 24:71. [PMID: 38245711 PMCID: PMC10799376 DOI: 10.1186/s12887-023-04518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/29/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To analyze the clinical characteristics and types of congenital heart defect (CHD) in mild congenital anorectal malformation (CARM), namely the rectoperineal and rectovestibular fistulas. METHODS The retrospective study of 183 patients with mild CARM was conducted with assessments of demographic information, color Doppler echocardiography results, and follow-up data. We performed an analysis of the clinical characteristics of CHD, grouping them based on sex and type of mild CARM. RESULTS Of the 183 patients, rectoperineal fistula occurred in 133 patients (72.7%), while the frequency of CHD was 79.8% (146/183). Ventricular septal defects (VSDs) occur more frequently in patients with rectoperineal fistula compared to those with rectovestibular fistula (1.5% vs. 10%), while the opposite trend was observed for patent ductus arteriosus (PDAs) (39.8% vs. 22.0%). Additionally, males presented higher frequency of PDA (42.7% vs. 26.4%) and self-healing (6 months: 87.2% vs. 42.6%; 12 months: 91.0% vs. 63.2%) than females. However, males had a lower rate of undergoing cardiac surgery (6.4% vs. 17.6%) and a younger median diagnosis age (1 day vs. 9 days). CONCLUSION Our study indicates that there is a necessity for meticulous cardiac assessment and follow-up in neonates diagnosed with mild CARM.
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Affiliation(s)
- Wei Feng
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Minjie Zhang
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Jinping Hou
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xiaohong Die
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yi Wang
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
| | - Rong Liu
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
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Makkar JS, Milasinovic G, Ching CK. Complementary role of governments, non-governmental organizations, industry, and medical societies in expanding bradycardia therapy access. Eur Heart J Suppl 2023; 25:H22-H26. [PMID: 38046889 PMCID: PMC10689899 DOI: 10.1093/eurheartjsupp/suad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
As the aging population continues to grow, so has the incidence of cardiovascular diseases, including bradycardia, with much of the burden falling on low- and middle-income countries (LMICs). Pacemaker therapy remains the only guideline-recommended therapy for symptomatic bradycardia, but due to the cost and expertise required for pacemaker implants, patients in LMICs have less access to pacemaker therapies. However, with the concerted effort of organizations (governments, non-governmental organizations, industry, and medical societies) strides can continue to be made in improving access to care. Governments play a role in extending health coverage to its citizens and improving their physical and digital healthcare infrastructure. Non-governmental organizations promote access and awareness through charity and advocacy programs. Industries can continue innovating technology that is both affordable and accessible. Medical societies provide guidelines for treatment and necessary educational and networking opportunities for physicians who serve in LMICs. All of these organizations have individual responsibilities and goals in expanding access to bradycardia therapy, which can be more easily realized by their continued collaboration.
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Affiliation(s)
| | - Goran Milasinovic
- Referral Pacemaker Center, Clinical Center of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
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Song H, Li X, Lu J, Song J, Wang T, Gao M, Zhang X, Ma M, Shi Y, Fang J, Fu H, Wang H, Duo L, Tang M, Pang L. The 'Ironclad friendship' of China-Cambodia, lays the first step in the foundation of early diagnosis and treatment of asymptomatic congenital heart Defects- A multi-national screening and intervention project, 2017-2020. BMC Cardiovasc Disord 2023; 23:288. [PMID: 37286959 DOI: 10.1186/s12872-023-03314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is the leading cause of mortality in childhood worldwide. However, a large number of children with CHD are not diagnosed promptly in low- and middle-income regions, due to limited healthcare resources and lack the ability of prenatal and postnatal ultrasound examinations. The research on asymptomatic CHD in the community is still blank, resulting in a large number of children with asymptomatic CHD can not be found and treated in time. Through the China-Cambodia collaborative health care initiative, the project team conducted research, screened children's CHD through a sampling survey in China and Cambodia, collected relevant data, and retrospectively analyzed the data of all eligible patients. OBJECTIVES The project aimed to evaluate the prevalence of asymptomatic CHD in a sample population of 3-18years old and effects on their growth status and treatment outcomes. METHODS We examined the prevalence of 'asymptomatic CHD' among 3-18years old children and adolescents at the township/county levels in the two participating. A total of eight provinces in China and five provinces in Cambodia were analyzed from 2017 to 2020. During 1 year follow-up after treatment, the differences in heights and weights of the treated and control groups were evaluated. RESULTS Among the 3,068,075 participants screened from 2017 to 2020, 3967 patients with asymptomatic CHD requiring treatment were identified [0.130%, 95% confidence interval (CI) 0.126 -0.134%]. The prevalence rate of CHD ranged from 0.02 to 0.88%, and was negatively related to local per capita GDP (p = 0.028). The average height of 3310 treated CHD patients were 2.23% (95% CI: -2.51%~-1.9%) lower than that of the standard group and the average weight was - 6.41% (95% CI: -7.17%~-5.65%) lower, the developmental gap widening with advancing age. One year after treatment, the relative height difference remained comparable while that, in weight was reduced by 5.68% (95% CI: 4.27% ~7.09%). CONCLUSIONS Asymptomatic CHD now is often overlooked and is an emerging public health challenge. Early detection and treatment are essential to lower the potential burden of heart diseases in children and adolescents.
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Affiliation(s)
- Honglin Song
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
- School of Public Health, Kunming Medical University, Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Central China Subcenter of the National Center for Cardiovascular Diseases, Zhengzhou, China
| | - Jiang Lu
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Junjie Song
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Teng Wang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Min Gao
- School of Public Health, Chongqing Medical University, Jinyun Campus, Huxi Town, Shapingba District, Chongqing, China
| | - Xingyi Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Min Ma
- School of Public Health, Kunming Medical University, Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Yi Shi
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Jiayu Fang
- School of Public Health, Kunming Medical University, Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Hongchen Fu
- School of Public Health, Kunming Medical University, Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Huadan Wang
- School of Public Health, Kunming Medical University, Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China
| | - Lin Duo
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Mingjing Tang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China.
| | - Linhong Pang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China.
- School of Public Health, Kunming Medical University, Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, China.
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8
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Hasan BS, Bhatti A, Mohsin S, Barach P, Ahmed E, Ali S, Amanullah M, Ansong A, Banu T, Beaton A, Bolman RM, Borim BC, Breinholt JP, Callus E, Caputo M, Cardarelli M, Hernandez TC, Croti UA, Ejigu YM, Fenton K, Gomanju A, Harahsheh AS, Hesslein P, Hugo-Hamman C, Khan S, Kpodonu J, Kumar RK, Jenkins KJ, Lakhoo K, Malik M, Nichani S, Novick WM, Overman D, Quenot APM, Patton Bolman C, Pearson D, Raju V, Ross S, Sandoval NF, Sholler G, Sharma R, Shidhika F, Sivalingam S, Verstappen A, Vervoort D, Zühlke LJ, Zheleva B. Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries: a public health framework. BMJ Glob Health 2023; 8:e012049. [PMID: 37142298 PMCID: PMC10163477 DOI: 10.1136/bmjgh-2023-012049] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
The global burden of paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children's Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and standards of care and builds on a consensus process about the competencies needed at each step of the care continuum. We recommend a tier-based framework for PCHD care integrated within existing health systems. Each level of care is expected to meet minimum benchmarks and ensure high-quality and family centred care. We propose that cardiac surgery capabilities should only be developed at the more advanced levels on hospitals that have an established foundation of cardiology and cardiac surgery services, including screening, diagnostics, inpatient and outpatient care, postoperative care and cardiac catheterisation. This approach requires a quality control system and close collaboration between the different levels of care to facilitate the journey and care of every child with heart disease. This effort was designed to guide readers and leaders in taking action, strengthening capacity, evaluating impact, advancing policy and engaging in partnerships to guide facilities providing PCHD care in LMICs.
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Affiliation(s)
- Babar S Hasan
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Areesh Bhatti
- Medical College, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shazia Mohsin
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Paul Barach
- Department of Public Health and Anesthesiology, Thomas Jefferson School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Sigmund Freud University, Vienna, Austria
| | | | - Sulafa Ali
- Department of Pediatrics and Child Health, University of Khartoum, Khartoum, Sudan
- Department of Pediatrics and Child Health, Sudan Heart Center, Khartoum, Sudan
| | - Muneer Amanullah
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Annette Ansong
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Tahmina Banu
- Department of Pediatric Surgery, Chittagong Research Institute for Children, Chittagong, Bangladesh
| | - Andrea Beaton
- The Heart Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ralph Morton Bolman
- University of Minnesota, Minneapolis, Minnesota, USA
- Team Heart Inc, Newton Highlands, Massachusetts, USA
| | - Bruna Cury Borim
- Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil
| | - John P Breinholt
- Division Chief, Pediatric Cardiology, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Danato, San Donato Milanese, Lombardia, Italy
- Department of Biomedical Sciences, University of Milan, Milan, Italy
| | - Massimo Caputo
- Translational Health Science, University of Bristol, Bristol, UK
| | | | | | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil
| | - Yayehyirad M Ejigu
- Department of Cardiothoracic Surgery, King Faisal Hospital, Kigali, Rwanda
| | - Kathleen Fenton
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
- NIH, Bethesda, Maryland, USA
| | - Anu Gomanju
- Kathmandu Institute of Child Health, Kathmandu, Nepal
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | - Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | | | - Christopher Hugo-Hamman
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Sohail Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Kathy J Jenkins
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Mahim Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Punjab, Pakistan
| | - Sanjiv Nichani
- Leicester Children's Hospital, Leicester, East Midlands, UK
- Healing Little Hearts Global Foundation, Leicester, UK
| | - William M Novick
- University of Tennessee Health Science Center-Global Surgery Institute, Memphis, Tennessee, USA
- William Novick Global Cardiac Alliance, Memphis, Tennessee, USA
| | - David Overman
- Division of Cardiac Surgery, The Children's Heart Clinic, Children's Minnesota, Minneapolis, Minnesota, USA
- Division of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota, USA
| | | | | | - Dorothy Pearson
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | | | - Shelagh Ross
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | - Nestor F Sandoval
- Department of Cardiac Surgery, Fundacion cardioinfantil -la Cardio.Instituto de cardiopatías Congenitas, Universidad del Rosario, Bogota, Colombia
| | - Gary Sholler
- Heart Center for Children, Sydney Children's Hospital Network, University of Sydney, Sydney, New South Wales, Australia
| | | | - Fenny Shidhika
- Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Amy Verstappen
- President, Global Alliance for Rheumatic and Congenital Hearts, Memphis, Tennessee, USA
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Liesl J Zühlke
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, SAMRC Francie Van Zil Drive Parow, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics Red Cross War Memorial Hospital, University of Cape Town, Cape Town, South Africa
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9
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Qu P, Zhao D, Yan M, Liu D, Zhang R, Li S, Pei L, Yan H, Zeng L, Dang S. Maternal exposure to housing renovation during the periconceptional period and the risk of offspring with isolated congenital heart disease: a case-control study. Environ Health 2023; 22:37. [PMID: 37072765 PMCID: PMC10111801 DOI: 10.1186/s12940-023-00990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most prevalent birth defect in recent decades. The aim of this research was to examine the association between maternal housing renovation exposure during the periconceptional period and isolated congenital heart disease (CHD) in their offspring. METHODS A multi-hospitals case-control study was conducted from six tertiary A hospitals in Xi'an, Shaanxi, Northwest China based on questionnaires and interviews to address this question. The cases included fetuses or newborns diagnosed with CHD. Controls consisted of healthy newborns without birth defects. In total, 587 cases and 1180 controls were enrolled in this study. The association between maternal periconceptional housing renovation exposure and isolated CHD for offspring was assessed by estimating odds ratios (OR) with multivariate logistic regression models. RESULTS After adjusting for potential confounding variables, it was found that maternal exposure to home improvement projects was associated with a higher probability of isolated CHD in offspring (adjusted OR: 1.77, 95% CI: 1.34, 2.33). Additionally, the risk of the ventricular septal defect (VSD) and patent ductus arteriosus (PDA) for CHD types was significantly associated with maternal exposure to housing renovations (VSD: adjusted OR = 1.56, 95% CI: 1.01, 2.41; PDA: adjusted OR = 2.50, 95% CI: 1.41, 4.45). CONCLUSIONS Our study suggests that maternal exposure to housing renovation during the periconceptional period was associated with an increased risk of isolated CHD in offspring. Consequently, it would be beneficial to avoid living in a renovated home from 12 months before pregnancy through the first trimester to lower isolated CHD in infants.
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Affiliation(s)
- Pengfei Qu
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, 710061 China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
| | - Doudou Zhao
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, 710061 China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
| | - Mingxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
| | - Danmeng Liu
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, 710061 China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
| | - Ruo Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 China
| | - Shanshan Li
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117 China
| | - Leilei Pei
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 China
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10
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Sable C, Li JS, Tristani‐Firouzi M, Fagerlin A, Silver RM, Yandel M, Yost HJ, Beaton A, Dale J, Engel ME, Watkins D, Spurney C, Skinner AC, Armstrong SC, Shah SH, Allen N, Davis M, Hou L, Van Horn L, Labarthe D, Lloyd‐Jones D, Marino B. American Heart Association's Children's Strategically Focused Research Network Experience. J Am Heart Assoc 2023; 12:e028356. [PMID: 36974754 PMCID: PMC10122897 DOI: 10.1161/jaha.122.028356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The American Heart Association's Strategically Focused Children's Research Network started in July 2017 with 4 unique programs at Children's National Hospital in Washington, DC; Duke University in Durham, North Carolina; University of Utah in Salt Lake City, Utah; and Lurie Children's Hospital/Northwestern University in Chicago, Illinois. The overarching goal of the Children's National center was to develop evidence-based strategies to strengthen the health system response to rheumatic heart disease through synergistic basic, clinical, and population science research. The overall goals of the Duke center were to determine risk factors for obesity and response to treatment including those that might work on a larger scale in communities across the country. The integrating theme of the Utah center focused on leveraging big data-science approaches to improve the quality of care and outcomes for children with congenital heart defects, within the context of the patient and their family. The overarching hypothesis of the Northwestern center is that the early course of change in cardiovascular health, from birth onward, reflects factors that result in either subsequent development of cardiovascular risk or preservation of lifetime favorable cardiovascular health. All 4 centers exceeded the original goals of research productivity, fellow training, and collaboration. This article describes details of these accomplishments and highlights challenges, especially around the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Norrina Allen
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Matthew Davis
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Lifang Hou
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Linda Van Horn
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Darwin Labarthe
- Northwestern University Feinberg School of MedicineChicagoILUSA
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11
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Patient-reported outcome measures in congenital heart surgery: a systematic review. Cardiol Young 2023; 33:337-341. [PMID: 36650739 DOI: 10.1017/s1047951123000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patient-reported outcome measures are commonly used to evaluate the effectiveness of treatments. CHD remains the most common congenital malformation. There has been a gradual shift in evaluating the outcome of surgery for CHD from mortality to morbidity and now to self-reported outcomes. AIMS We aimed to review studies assessing patient-reported outcome measures as a useful marker of outcome for patients, both children and adults, who underwent surgery for CHD. METHODS A systematic database search was conducted of original articles that explored the application of patient-reported outcome measures in the CHD surgical setting in PubMed and SCOPUS from inception to February 2022. RESULTS Our search yielded 1511 papers, of which six studies were included in this review after screening abstract and full-text, with a total sample size of 5734 patients. The main areas of discussion were the utility of patient-reported outcome measures, determinants of patient-reported outcome measures, and the need for a congenital cardiac surgery-specific patient-reported outcome measure for paediatric patients and their parents/guardians and adult patients. CONCLUSION This systematic review reports the use of patient-reported outcome measures to be a useful indicator to gain insight into the patients' perspective to provide holistic and patient-centred management. However, further studies are required to assess the utility of patient-reported outcome measures in a congenital cardiac surgical setting.
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12
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Dopke C, Connor J, Zheleva B, Gauvreau K, Bakalcheva B, Bina N, Calvimontes G, Cerovic I, Majani N, Oketcho M, Pechilkov D, Shidhika F, Shiryaev T, Jenkins K. Effects of COVID-19 on paediatric cardiac centres in low-income and middle-income countries: a mixed-methods study. BMJ Open 2022; 12:e065031. [PMID: 36418128 PMCID: PMC9684279 DOI: 10.1136/bmjopen-2022-065031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to understand the effects of the COVID-19 pandemic on paediatric cardiac services in critical access centres in low-income and middle-income countries. DESIGN A mixed-methods approach was used. SETTING Critical access sites that participate in the International Quality Improvement Collaborative (IQIC) for congenital heart disease (CHD) were identified. PARTICIPANTS Eight IQIC sites in low-income and middle-income countries agreed to participate. OUTCOME MEASURES Differences in volume and casemix before and during the pandemic were identified, and semistructured interviews were conducted with programme representatives and analysed by two individuals using NVivo software. The qualitative component of this study contributed to a better understanding of the centres' experiences and to identify themes that were common across centres. RESULTS In aggregate, among the seven critical access sites that reported data in both 2019 and 2020, there was a 20% reduction in case volume, though the reduction varied among programmes. Qualitative analysis identified a universal impact for all programmes related to Access to Care/Clinical Services, Financial Stability and Professional/Personal Issues for healthcare providers. CONCLUSIONS Our study identified and quantified a significant impact of the COVID-19 pandemic on critical access to CHD surgery in low-income and middle-income countries, as well as a significant adverse impact on both the skilled workforce needed to treat CHD and on the institutions in which care is delivered. These findings suggest that the COVID-19 pandemic has been a major threat to access to care for children with CHD in resource-constrained environments and that this effect may be long-lasting beyond the global emergency. Efforts are needed to preserve vulnerable CHD programmes even during unprecedented pandemic situations.
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Affiliation(s)
- Campbell Dopke
- Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
- Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Jean Connor
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Najeebullah Bina
- Department of Cardiology, French Medical Institute for Children (FMIC), Kabul, Afghanistan
| | - Gonzalo Calvimontes
- Department of Cardiology, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Ivana Cerovic
- Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia
| | - Naizihijwa Majani
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania, United Republic of
| | - Michael Oketcho
- Department of Paediatric Cardiac Surgery, Uganda Heart Institute, Kampala, Uganda
| | - Dimitar Pechilkov
- Department of Paediatric Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Fenny Shidhika
- Department of Paediatric Cardiology, Windhoek Central Hospital, Windhoek, Namibia
| | - Tengiz Shiryaev
- Congenital Cardiac Surgery Department, JoAnn McGowan Paediatric Cardiac Surgery Center, Tbilisi, Georgia
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Paediatrics, Harvard Medical School, Boston, Massachusetts, USA
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13
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Minja NW, Nakagaayi D, Aliku T, Zhang W, Ssinabulya I, Nabaale J, Amutuhaire W, de Loizaga SR, Ndagire E, Rwebembera J, Okello E, Kayima J. Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward. Front Cardiovasc Med 2022; 9:1008335. [PMID: 36440012 PMCID: PMC9686438 DOI: 10.3389/fcvm.2022.1008335] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.
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Affiliation(s)
- Neema W. Minja
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Doreen Nakagaayi
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Twalib Aliku
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Wanzhu Zhang
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nabaale
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Willington Amutuhaire
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Sarah R. de Loizaga
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Emma Ndagire
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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14
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Arvanitaki A, Gatzoulis MA, Opotowsky AR, Khairy P, Dimopoulos K, Diller GP, Giannakoulas G, Brida M, Griselli M, Grünig E, Montanaro C, Alexander PD, Ameduri R, Mulder BJM, D'Alto M. Eisenmenger Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:1183-1198. [PMID: 35331414 DOI: 10.1016/j.jacc.2022.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
Abstract
Although major breakthroughs in the field of pediatric cardiology, cardiac surgery, intervention, and overall care improved the outlook of congenital heart disease, Eisenmenger syndrome (ES) is still encountered and remains a complex clinical entity with multisystem involvement, including secondary erythrocytosis, increased thrombotic and bleeding diathesis, high arrhythmogenic risk, progressive heart failure, and premature death. Clearly, care for ES is best delivered in multidisciplinary expert centers. In this review, we discuss the considerable recent progress in understanding the complex pathophysiology of ES, means of prognostication, and improvement in clinical outcomes achieved with pulmonary arterial hypertension-targeted therapies. Additionally, we delineate areas of uncertainty in various aspects of care, discuss gaps in current evidence, and review current status in less privileged countries and propose initiatives to reduce disease burden. Finally, we propose the application of emerging technologies to enhance the delivery and quality of health care related to ES and beyond.
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Affiliation(s)
- Alexandra Arvanitaki
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom; First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom.
| | - Alexander R Opotowsky
- The Cincinnati Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
| | - Gerhard-Paul Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Margarita Brida
- Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Massimo Griselli
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom; Pediatric Cardiac Surgery and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, and German Center of Lung Research (DZL), TLRC Heidelberg, Heidelberg, Germany
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
| | - Peter David Alexander
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
| | - Rebecca Ameduri
- Pediatric Cardiac Surgery and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - "L. Vanvitelli" University, Naples, Italy.
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15
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Keepanasseril A, Pfaller B, Metcalfe A, Siu SC, Davis MB, Silversides CK. Cardiovascular Deaths in Pregnancy: Growing Concerns and Preventive Strategies. Can J Cardiol 2021; 37:1969-1978. [PMID: 34600086 DOI: 10.1016/j.cjca.2021.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022] Open
Abstract
There has been an increase in maternal deaths from cardiovascular disease in many countries. In high-income countries, cardiovascular deaths secondary to cardiomyopathies, ischemic heart disease, sudden arrhythmic deaths, aortic dissection, and valve disease are responsible for up to one-third of all pregnancy-related maternal deaths. In low- and middle-income countries, rheumatic heart disease is a much more common cause of cardiac death during pregnancy. Although deaths occur in women with known heart conditions or cardiovascular risk factors such as hypertension, many women present for the first time in pregnancy with unrecognised heart disease or with de novo cardiovascular conditions such as preeclampsia, peripartum cardiomyopathy, spontaneous coronary artery dissection. Not only has maternal cardiovascular mortality increased, but serious cardiac morbidity, or "near misses," during pregnancy also have increased in frequency. Although maternal morbidity and mortality are often preventable, many health professionals remain unaware of the impact of cardiovascular disease in this population, and the lack of awareness contributes to inappropriate care and preventable deaths. In this review, we discuss the maternal mortality from cardiovascular causes in both high- and low- and middle-income countries and strategies to improve outcomes.
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Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | - Birgit Pfaller
- Department of Internal Medicine 1, University Hospital of St Pölten, Karl Landsteiner University of Health Sciences, Karl Landsteiner Institute for Nephrology, St Pölten, Austria
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samuel C Siu
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, University of Western Ontario, London, Ontario, Canada
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Candice K Silversides
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, University of Toronto, Toronto, Ontario, Canada.
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16
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Nonmedical Determinants of Congenital Heart Diseases in Children from the Perspective of Mothers: A Qualitative Study in Iran. Cardiol Res Pract 2021; 2021:6647260. [PMID: 34447593 PMCID: PMC8384533 DOI: 10.1155/2021/6647260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/17/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. The objective of present study was to identify nonmedical determinants related to this abnormality from the mother's perspectives. Methods This research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. Results Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. Conclusions Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers' prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.
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17
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Post-operative fever (POF) after cardiac surgery in a low- and middle-income-country: 7-year institutional experience. Cardiol Young 2021; 31:352-357. [PMID: 33558001 DOI: 10.1017/s1047951121000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Post-operative fever (POF) after cardiac surgery in a developing country is of great concern because of the associated morbidity and mortality. In our country, we experience this complication more because of a high rate of malaria infestations, gastroenteritis, and malnutrition. We also experience a low yield of positive diagnostic tests when POF develops; this is partly due to expense and the prioritisation of other essential items in our poorly equipped cardiac ICU. AIMS/OBJECTIVE To assess the causes of POF after cardiac surgery and determine its impact on the outcome on patients. MATERIALS AND METHODS International Cardiac Surgery Mission teams visited our centre for 7 years (2013-2019). During this period, a significant number of cardiac surgeries were performed. A retrospective study of patients with POF was performed with data from our hospital's database, and included standard demographics; types of surgery performed, and management protocols being used in the peri-operative care. RESULTS A total of 242 patients were treated during the study period and underwent 266 surgeries. Of these, 151 (56.8%) and 115 (43.2%) were adult and paediatric cases respectively. Ages ranged between 0 and 90 years; 34 (14.1%) had POF. When we evaluated the clinical and associated laboratory findings, pyrexia (temp >38.0 °C) and elevated white blood cell count with differential neutrophilia were present in 10 patients (29.4%). The time of onset and duration of POF were between <24 and >144 hours. In the invasive procedure related to POF, sternotomy infections were present in seven patients (18.4%). Malaria infestations and breach in sterility protocol were predominant. CONCLUSION The management of POF in the cardiac ICU was complicated by the requirement of co-operation from a larger number of specialties than is usually required in advanced centres with special expertise in malaria confirmation. We, therefore, introduced structured clinical, laboratory, and appropriate interventions to treat POF more aggressively. We found that more careful attention to peri-operative details to ensure strict observation of sterility protocol with anti-malaria prophylaxis led to improvements in our centre's outcomes.
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18
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Choi S, Shin H, Heo J, Gedlu E, Nega B, Moges T, Bezabih A, Park J, Kim WH. How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia? BMC Health Serv Res 2021; 21:110. [PMID: 33526022 PMCID: PMC7852139 DOI: 10.1186/s12913-021-06083-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery. METHODS A qualitative study was conducted at a teaching hospital in Ethiopia. We conducted semi-structured interviews with 13 caregivers of 10 patients with CHD who underwent cardiac surgery. We additionally conducted chart reviews for triangulation and verification. Interviews were conducted in Amharic and then translated into English. Data were analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework. RESULTS The following four observations emerged from the interviews: (a) most patients were diagnosed with CHD at birth if they were born at a health care facility, but for those born at home, CHD was discovered much later (b) many patients experienced misdiagnoses before seeking care at a large hospital, (c) after diagnosis, patients were waiting for the surgery for more than a year, (d) caregivers felt anxious and optimistic once they were able to schedule the surgical date. During the care-seeking journey, caregivers encountered financial constraints, struggled in a fragmented delivery system, and experienced poor service quality. CONCLUSIONS Delayed access to care was largely due to the lack of early CHD recognition and financial hardships, related to the inefficient and disorganized health care system. Fee waivers were available to assist low-income children in gaining access to health services or medications, but application information was not readily available. Indirect costs like long-distance travel contributed to this challenge. Overall, improvements must be made for district-level screening and the health care workforce.
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Affiliation(s)
- Sugy Choi
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heesu Shin
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Jongho Heo
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- National Assembly Futures Institute, Seoul, Republic of Korea.
| | - Etsegenet Gedlu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhanu Nega
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamirat Moges
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bezabih
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jayoung Park
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woong-Han Kim
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Keepanasseril A, Raj A, Plakkal N, Satheesh S, Pillai AA, Kundra P. Maternal and perinatal outcomes of pregnant women with tetralogy of Fallot: a tertiary center experience from south-India. J Matern Fetal Neonatal Med 2020; 35:3483-3488. [PMID: 32954868 DOI: 10.1080/14767058.2020.1822315] [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: 10/23/2022]
Abstract
BACKGROUND Women with tetralogy of Fallot especially uncorrected are at increased risk of adverse maternal and perinatal outcomes. METHOD We reviewed the maternal complications and pregnancy outcomes of women with tetralogy of Fallot (ToF), having corrected or uncorrected lesion during the period from 2011 to 2019 attending a south-Indian tertiary care center. Data regarding demographics, clinical course, and medications received and echocardiographic diagnosis regarding ToF, labor and delivery details, and postpartum follow-up was collected from the records. For each case, four women matched for age (±2 years), without a diagnosis of heart disease, were included as controls. We compared the outcomes in pregnant women with ToF and controls as well between those who have undergone repair with those without repair and also with the controls. RESULTS There were 27 pregnancies in 19 patients with ToF, including eight pregnancies in seven women with uncorrected lesions. There was no maternal death or occurrence of infective endocarditis. Women with uncorrected lesion had significantly higher rates of fetal growth restriction (37.5% vs 6.7%), preterm birth (50% vs. 13.3%) resulting in lower birth weight (1907.5 g vs. 2607.3 g)) compared to those with a corrected lesion. Women with corrected lesion had similar outcomes to the controls (p > .5). CONCLUSION Women with uncorrected ToF are at increased risk of perinatal complications compared to those with corrected lesion and require care under a multidisciplinary team, with an individualized plan for delivery to optimize the outcomes.
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Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ashwini Raj
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
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Kruszka P, Beaton A. The state of congenital heart disease. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:5-6. [PMID: 32083375 DOI: 10.1002/ajmg.c.31776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/22/2022]
Abstract
In this special issue of the American Journal of Medical Genetics Part C, we focus on the "State of Congenital Heart Disease." We anticipate that after viewing this journal, the reader will be up-to-date on the epidemiology of congenital heart disease (CHD), the genetic basis of CHD, ethical concerns, and the global impact of CHD. And most importantly, we are confident that this special issue conveys the message that CHD is complex and that much work is still needed in genetic and genomic research.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrea Beaton
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio.,University of Cincinnati School of Medicine, Cincinnati, Ohio
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