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Walter A, Herberg U, Calite E, Geipel A, Recker F, Strizek B, Berg C, Gembruch U. Association of right aortic arch and agenesis of ductus arteriosus in prenatal tetralogy of Fallot spectrum and its clinical implications. Prenat Diagn 2024; 44:899-906. [PMID: 38797960 DOI: 10.1002/pd.6611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE In our center, we observed an increased frequency of right aortic arch (RAA) with an agenesis of the ductus arteriosus (ADA) in prenatally diagnosed tetralogy of Fallot (ToF) and its variations. This study aimed to determine whether there is an association of RAA and ADA in fetuses with ToF. Distribution of genetic anomalies and impact on postnatal outcome were further evaluated. METHOD Single-center retrospective observational study including pregnancies with prenatal diagnosis of ToF from 2010 to 2023. All cases were subdivided into ToF with pulmonary stenosis (PS) and pulmonary atresia (PA). Clinical and echocardiographic databases were reviewed for pregnancy outcome, genetic anomalies, and postnatal course. RESULTS The cohort included 169 cases, 124 (73.4%) with ToF/PS and 45(26.6%) with ToF/PA. Agenesis of the ductus arteriosus was significantly associated with RAA in both subtypes of ToF (p = 0.001) compared to left aortic arch and found in 82.5% (33/40) versus 10.7% (9/84) of fetuses with ToF/PS and in 57.1% (8/14) versus 12.9% (4/31) of fetuses with ToF/PA. In both ToF/PS and ToF/PA, RAA/ADA versus RAA/patent DA revealed a significantly higher risk for the presence of genetic abnormalities, especially microdeletion 22q11.2, major aorto-pulmonary collateral arteries and a shorter time to complete surgical repair. CONCLUSION We demonstrated a significantly increased frequency of RAA/ADA in patients with prenatally diagnosed ToF. Although this association revealed no significant impact on overall survival, the prenatal detection of RAA/ADA has implications for counseling, genetic evaluation and postnatal management.
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Affiliation(s)
- Adeline Walter
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Elina Calite
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Başar EZ, Doğan Y, Şaşmazel A, Babaoğlu K. Rare association of absent pulmonary valve syndrome, complete atrioventricular canal defect, double outlet right ventricle, right aortic arch, and aberrant right subclavian artery in a fetal case. Echocardiography 2022; 39:1359-1362. [PMID: 36126337 DOI: 10.1111/echo.15446] [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: 03/22/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac anomaly. It is often associated with TOF, but may also be associated with an intact ventricular septum or, more rarely, with tricuspid atresia. It's combination with a complete atrioventricular septal defects and double outlet right ventricle has been reported extremely rare, even in the postnatal period. Herein, we report a 20-week-old fetus with a right aortic arch and an aberrant left subclavian artery with this rare combination. We report a case of a 20-week fetus diagnosed having this rare combination of right aortic arch and aberrant left subclavian artery. The APVS with complete atrioventricular septal defects may represent another type of APVS.
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Affiliation(s)
- Eviç Zeynep Başar
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yasemin Doğan
- Department of Perinatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ahmet Şaşmazel
- Department of Pediatric Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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3
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Recker F, Weber EC, Strizek B, Geipel A, Berg C, Gembruch U. Management and outcome of prenatal absent pulmonary valve syndrome. Arch Gynecol Obstet 2022; 306:1449-1454. [PMID: 35043273 PMCID: PMC9519727 DOI: 10.1007/s00404-022-06397-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022]
Abstract
Objective The purpose of this study was to explore the outcome in fetuses with prenatal diagnosis of absent pulmonary valve syndrome (APVS) on ultrasound imaging. Methods A manual web scraping technique was utilized, where MEDLINE and EMBASE were searched along the combination with other relevant medical subject headings such as “absent pulmonary valve syndrome”, “prenatal APVS” and “APVS/outcome”. The observed outcomes encompassed the rate of chromosomal abnormalities, associations and malformations linked to APVS and fetuses with APVS. A quality assessment of the included studies was also performed. We used meta-analyses of proportions to combine data and fixed or random-effects models according to the heterogeneity of the results. Results Seven studies including 199 fetuses with APVS were included in the analysis. The median gestational age at referral to the tertiary center was 24.8 weeks. An association to tetralogy of Fallot (TOF) could be seen in 84.4% of all cases. In total 140 out of 199 cases underwent invasive testing, with a total number of 55 abnormal karyotypes [39.3% (95% CI 31.1–47.9%)]. 35.2% of the patients opted for termination of pregnancy (95% CI 28.5–42.3%). Conclusion The analysis underlines the distribution of fetuses with APVS, with 84.4% of cases presenting with TOF/APVS and only 12.6% having APVS/intact ventricular septum (IVS). Larger and more prospective study analyses is now needed, especially focusing on long-term follow-up periods of fetuses and children with APVS. Particularly as the postnatal course shows great variety depending on prenatal diagnosis.
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Inamura N, Takada N, Marutani S. The prenatal diagnosis of a rare circular shunt with absent pulmonary valve syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:86-89. [PMID: 34137049 DOI: 10.1002/jcu.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 06/12/2023]
Abstract
Absent pulmonary valve syndrome (APVS) with tricuspid atresia is very rare. We report a case of APVS in which the fetus died due to severe hydrops fetalis. In addition to weakened cardiac contraction due to left ventricular noncompaction cardiomyopathy, a circular shunt through a ventricular septal defect exacerbated heart failure. Although APVS with tricuspid valve atresia is not supposed to cause a circular shunt, we herein present the echocardiographic demonstration of a case of circular shunt.
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Affiliation(s)
- Noboru Inamura
- Department of Pediatrics, Kindai University, Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Nori Takada
- Department of Pediatrics, Kindai University, Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Satoshi Marutani
- Department of Pediatrics, Kindai University, Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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5
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Torok K, Brettle E, Desai T, Miller P, Khan N, Stickey J, Nagakumar P, Seale A. Long-term outcomes in children with absent pulmonary valve syndrome: it is not just fixing the heart. Arch Dis Child 2021; 106:877-881. [PMID: 33632783 DOI: 10.1136/archdischild-2020-320219] [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: 07/21/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Absent pulmonary valve syndrome (APV) is a rare condition usually associated with tetralogy of Fallot (TOF). Some infants develop respiratory failure from bronchial compression and the long-term neurodevelopmental outcome is unknown. We aimed to investigate the outcomes of APV and the need for long-term ventilation (LTV). DESIGN, PATIENTS AND SETTING Retrospective single-centre review of patients diagnosed with APV between 2007 and 2017. OUTCOME MEASURES Survival, neurological disability and postoperative LTV (≥3 months of non-invasive or invasive respiratory support). RESULTS Thirty patients were identified, 22 (73%) of whom were prenatally diagnosed. Pregnancy was discontinued in one patient, while in utero death occurred in three. One was lost to follow-up. Of the remaining 25 liveborn, 21 had the classic TOF/APV. One baby died immediately after birth, while two patients had palliative care due to severe airway compression and inability to wean ventilation support. Surgical repair was performed in 21 of the 25 (84%) liveborn, with one awaiting surgery. Of those undergoing surgery, two patients died: one during surgery and the other due to severe airway malacia 5 months postsurgery. In the surgical group survival from birth at 1 and 5 years was 89% (95% CI 75% to 100%). Six (30%) patients required LTV postoperatively; all had surgery within the first 6 months of life. Learning and/or other physical difficulties were evident in 63%. CONCLUSIONS Majority of patients with APV are diagnosed antenatally. A third of those operated required LTV and over half had learning and/or other physical difficulties. Prospective studies are needed to identify prenatal factors that predict postnatal outcomes so parents can be counselled appropriately.
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Affiliation(s)
- Katalin Torok
- Department of Cardiology and Cardiovascular Surgery, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Brettle
- Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Tarak Desai
- Department of Cardiology and Cardiovascular Surgery, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Paul Miller
- Department of Cardiology and Cardiovascular Surgery, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Natasha Khan
- Department of Cardiology and Cardiovascular Surgery, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - John Stickey
- Department of Cardiology and Cardiovascular Surgery, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Prasad Nagakumar
- Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, West Midlands, UK
| | - Anna Seale
- Department of Cardiology and Cardiovascular Surgery, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK .,College of Medical and Dental Science, Institute of Cardiovascular Sciences, Congenital Heart Disease Research Group, University of Birmingham, Birmingham, West Midlands, UK
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6
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Weichert J, Weichert A. A 'holistic' sonographic view on congenital heart disease - How automatic reconstruction using fetal intelligent navigation echocardiography (FINE) eases the unveiling of abnormal cardiac anatomy part I: Right heart anomalies. Echocardiography 2021; 38:1430-1445. [PMID: 34232534 DOI: 10.1111/echo.15134] [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: 09/18/2020] [Revised: 04/18/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022] Open
Abstract
Attempting a comprehensive examination of the fetal heart remains challenging for unexperienced operators as it emphasizes the acquisition and documentation of sequential cross-sectional and sagittal views and inevitably results in diminished detection rates of fetuses affected by congenital heart disease. The introduction of four-dimensional spatio-temporal image correlation (4D STIC) technology facilitated a volumetric approach for thorough cardiac anatomic evaluation by the acquisition of cardiac 4D datasets. By analyzing and re-arranging of numerous frames according to their temporal event within the heart cycle, STIC allows visualization of cardiac structures as an endless cine loop sequence of a complete single cardiac cycle in motion. However, post-analysis with manipulation and repeated slicing of the volume usually requires experience and in-depth anatomic knowledge, which limits the widespread application of this advanced technique in clinical care and unfortunately leads to the underestimation of its diagnostic value to date. Fetal intelligent navigation echocardiography (FINE), a novel method that automatically generates and displays nine standard fetal echocardiographic views in normal hearts, has shown to be able to overcome these limitations. Very recent data on the detection of congenital heart defects (CHDs) using the FINE method revealed a high sensitivity and specificity of 98% and 93%, respectively. In this two-part manuscript, we focused on the performance of FINE in delineating abnormal anatomy of typical right and left heart lesions and thereby emphasized the educational potential of this technology for more than just teaching purposes. We further discussed recent findings in a pathophysiological and/or functional context.
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Affiliation(s)
- Jan Weichert
- Department of Gynecology & Obstetrics, Division of Prenatal Medicine, Campus Luebeck, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany
| | - Alexander Weichert
- Elbe Center of Prenatal Medicine and Human Genetics, Hamburg, Germany.,Department of Obstetrics, Charité-Universitätsmedizin Berlin - CCM, Berlin, Germany.,Prenatal Medicine Bergmannstrasse, Berlin, Germany
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7
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Chelliah A, Moon-Grady AJ, Peyvandi S, Chiu JS, Bost JE, Schidlow D, Carroll SJ, Davey B, Divanovic A, Hornberger L, Howley LW, Kavanaugh-McHugh A, Kovalchin JP, Levasseur SM, Lindblade CL, Morris SA, Ngwezi D, Pruetz JD, Puchalski MD, Rychik J, Samai C, Tacy TA, Tworetzky W, Vernon MM, Yeh J, Donofrio MT. Contemporary Outcomes in Tetralogy of Fallot With Absent Pulmonary Valve After Fetal Diagnosis. J Am Heart Assoc 2021; 10:e019713. [PMID: 34098741 PMCID: PMC8477871 DOI: 10.1161/jaha.120.019713] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Tetralogy of Fallot with absent pulmonary valve is associated with high mortality, but it remains difficult to predict outcomes prenatally. We aimed to identify risk factors for mortality in a large multicenter cohort. Methods and Results Fetal echocardiograms and clinical data from 19 centers over a 10‐year period were collected. Primary outcome measures included fetal demise and overall mortality. Of 100 fetuses, pregnancy termination/postnatal nonintervention was elected in 22. Of 78 with intention to treat, 7 (9%) died in utero and 21 (27%) died postnatally. With median follow‐up of 32.9 months, no deaths occurred after 13 months. Of 80 fetuses with genetic testing, 46% had chromosomal abnormalities, with 22q11.2 deletion in 35%. On last fetal echocardiogram, at a median of 34.6 weeks, left ventricular dysfunction independently predicted fetal demise (odds ratio [OR], 7.4; 95% CI 1.3, 43.0; P=0.026). Right ventricular dysfunction independently predicted overall mortality in multivariate analysis (OR, 7.9; 95% CI 2.1–30.0; P=0.002). Earlier gestational age at delivery, mediastinal shift, left ventricular/right ventricular dilation, left ventricular dysfunction, tricuspid regurgitation, and Doppler abnormalities were associated with fetal and postnatal mortality, although few tended to progress throughout gestation on serial evaluation. Pulmonary artery diameters did not correlate with outcomes. Conclusions Perinatal mortality in tetralogy of Fallot with absent pulmonary valve remains high, with overall survival of 64% in fetuses with intention to treat. Right ventricular dysfunction independently predicts overall mortality. Left ventricular dysfunction predicts fetal mortality and may influence prenatal management and delivery planning. Mediastinal shift may reflect secondary effects of airway obstruction and abnormal lung development and is associated with increased mortality.
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Affiliation(s)
- Anjali Chelliah
- Division of Cardiology Department of Pediatrics Morgan Stanley Children's Hospital of New York-PresbyterianColumbia University Irving Medical Center New York NY
| | - Anita J Moon-Grady
- Division of Cardiology Department of Pediatrics UCSF Benioff Children's HospitalUniversity of California-San Francisco School of Medicine San Francisco CA
| | - Shabnam Peyvandi
- Division of Cardiology Department of Pediatrics UCSF Benioff Children's HospitalUniversity of California-San Francisco School of Medicine San Francisco CA
| | - Joanne S Chiu
- Division of Cardiology Department of Pediatrics Massachusetts General HospitalHarvard Medical School Boston MA
| | - James E Bost
- Center for Translational Research Children's Research InstituteChildren's National HospitalGeorge Washington University School of Medicine and Health Sciences Washington DC
| | - David Schidlow
- Department of Cardiology Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston MA
| | - Sheila J Carroll
- Division of Cardiology Department of Pediatrics Komansky Children's Hospital of New York-PresbyterianWeill Cornell Medicine New York NY
| | - Brooke Davey
- Division of Cardiology Department of Pediatrics Connecticut Children's Medical Center University of Connecticut Health Center Hartford CT
| | - Allison Divanovic
- Department of Pediatrics The Heart InstituteCincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of Medicine Cincinnati OH
| | - Lisa Hornberger
- Division of Cardiology Department of Pediatrics Stollery Children's HospitalUniversity of Alberta Edmonton AB Canada
| | - Lisa W Howley
- Division of Cardiology Department of Pediatrics Heart InstituteChildren's Hospital ColoradoUniversity of Colorado School of Medicine Denver CO
| | - Ann Kavanaugh-McHugh
- Division of Cardiology Department of Pediatrics Monroe Carell Jr. Children's HospitalVanderbilt University School of Medicine Nashville TN
| | - John P Kovalchin
- Division of Cardiology Department of Pediatrics Nationwide Children's HospitalThe Ohio State University College of Medicine Columbus OH
| | - Stephanie M Levasseur
- Division of Cardiology Department of Pediatrics Morgan Stanley Children's Hospital of New York-PresbyterianColumbia University Irving Medical Center New York NY
| | - Christopher L Lindblade
- Division of Cardiology Department of Pediatrics Phoenix Children's HospitalUniversity of Arizona College of Medicine Phoenix AZ
| | - Shaine A Morris
- Division of Cardiology Department of Pediatrics Texas Children's HospitalBaylor School of Medicine Houston TX
| | - Deliwe Ngwezi
- Division of Cardiology Department of Pediatrics Stollery Children's HospitalUniversity of Alberta Edmonton AB Canada
| | - Jay D Pruetz
- Division of Cardiology Department of Pediatrics Children's Hospital of Los AngelesKeck School of Medicine of USC Los Angeles CA
| | - Michael D Puchalski
- Division of Cardiology Department of Pediatrics Johns Hopkins All Children's Hospital St. Petersburg FL
| | - Jack Rychik
- Division of Cardiology Department of Pediatrics Children's Hospital of PhiladelphiaPerelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Cyrus Samai
- Division of Cardiology Department of Pediatrics Children's Healthcare of AtlantaEmory University School of Medicine Atlanta GA
| | - Theresa A Tacy
- Division of Cardiology Department of Pediatrics Lucile Packard Children's HospitalStanford School of Medicine Palo Alto CA
| | - Wayne Tworetzky
- Department of Cardiology Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston MA
| | - Margaret M Vernon
- Division of Cardiology Department of Pediatrics Seattle Children's HospitalUniversity of Washington Seattle WA
| | - Jay Yeh
- Division of Cardiology Department of Pediatrics University of California Davis Medical Center Sacramento CA
| | - Mary T Donofrio
- Division of Cardiology Children's National HospitalDepartment of PediatricsGeorge Washington University School of Medicine and Health Sciences Washington DC
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Kawasaki Y, Murakami Y, Fujino M, Sasaki T, Nakamura K, Yoshida Y, Suzuki T, Nishigaki K, Ehara E. Absent pulmonary valve with tricuspid atresia/stenosis: literature review with new three long-term cases. Heart Vessels 2021; 37:142-151. [PMID: 34089363 DOI: 10.1007/s00380-021-01887-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
Absent pulmonary valve (APV) syndrome with tricuspid atresia or tricuspid stenosis (TA/TS) is an extremely rare malformation recently reported as a variant of APV with intact ventricular septum (VS). The condition, however, has univentricular physiology and unique structural and clinical features. The purpose of this study was to update the current knowledge about this condition by describing long-term outcomes of three new cases and reviewing the available literatures. A systematic literature search was performed to collect clinical and anatomical data of APV with TA/TS. Institutional medical records were retrospectively reviewed to identify APV with TA/TS patients. In a total of 62 (59 reported and 3 new) cases, patent ductus arteriosus was present in 98% of APV patients with TA/TS. A large ventricular septal defect, dilatation of the pulmonary arteries, which is typically found in APV with tetralogy of Fallot, and respiratory distress at birth were rarely reported. Most of the recent cases were successfully managed by the Glenn or Fontan procedure. Coronary artery anomaly and ventricular arrhythmia were more frequently reported as the cause of death or severe neurological sequelae (9/16 and 3/8, respectively). Additional surgical intervention was required in the mid/long-term period in three cases due to left-ventricular outflow obstruction and in two due to aortic dilatation. The Fontan and Glenn procedures improved the survival in the last two decades. In addition to coronary artery anomaly and ventricular arrhythmia, left-ventricular outflow tract obstruction and aortic dilatation should be carefully monitored.
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Affiliation(s)
- Yuki Kawasaki
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan.
- Department of Pediatric Cardiology, Osaka City General Hospital Pediatric Medical Center, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.
| | - Yosuke Murakami
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Mitsuhiro Fujino
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Sasaki
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Kae Nakamura
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yoko Yoshida
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Osaka, Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Osaka, Japan
| | - Kyoichi Nishigaki
- Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
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Sivakumar K, Mohakud AR, Agarwal R. Unusual association of isolation of right pulmonary artery in absent pulmonary valve syndrome. Asian Cardiovasc Thorac Ann 2021; 30:335-338. [PMID: 33789442 DOI: 10.1177/02184923211006309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Absence of arterial duct, a sixth aortic arch derivative, plays an important etiologic role in Tetralogy of Fallot with absent pulmonary valve syndrome. When fetal ductus is absent, the large right ventricular stroke volume dilates the pulmonary trunk leading to pulmonary regurgitation. A proximal extension of the embryonic insult to the entire left sixth arch causes absence of the left pulmonary artery, a common association of absent pulmonary valve syndrome. On the contrary, absence of right pulmonary artery is not reported in absent pulmonary valve syndrome. A rare combination of tetralogy, absent pulmonary valve syndrome and isolation of a hypoplastic right pulmonary artery offered challenges to diagnosis and management.
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Affiliation(s)
| | | | - Ravi Agarwal
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India
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10
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Moleiro ML, Guedes-Martins L. Prenatal diagnosis of absent pulmonary valve syndrome. BMJ Case Rep 2021; 14:14/1/e240567. [PMID: 33414127 PMCID: PMC7797262 DOI: 10.1136/bcr-2020-240567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Maria Lúcia Moleiro
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
| | - Luís Guedes-Martins
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
- Department of Experimental Biology, University of Porto, Porto, Portugal
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11
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Wolter A, Gebert M, Enzensberger C, Kawecki A, Stessig R, Degenhardt J, Ritgen J, Thul J, Khalil M, Herrmann J, Axt-Fliedner R. Outcome and Associated Findings in Individuals with Pre- and Postnatal Diagnosis of Tetralogy of Fallot (TOF) and Prediction of Early Postnatal Intervention. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:504-513. [PMID: 30453353 DOI: 10.1055/a-0753-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The aim of our retrospective evaluation was to compare the outcome of patients with prenatal and postnatal diagnosis of Tetralogy of Fallot (TOF) and to analyze prenatal echocardiographic parameters predicting intervention within 30 days postnatal. MATERIALS AND METHODS We evaluated 142 patients in our pediatric heart center and prenatal diagnosis center and prenatal practice Praenatal plus in Cologne between 01/08-06/16. RESULTS Within the prenatal diagnosis group, 6/74 fetuses (8.1 %) had TOF with pulmonary atresia (TOF-PA), and 6 (8.1 %) had absent pulmonary valve syndrome (TOF-APVS). 14 (18.9 %) had an abnormal karyotype including 9/14 (64.3 %) with microdeletion 22q11.2. 25 (33.8 %) had extracardiac malformation. 4 (5.4 %) had agenesis of ductus arteriosus (DA), 22 (29.7 %) had right aortic arch (RAA) and 9 (12.2 %) had major aortopulmonary collateral arteries (MAPCAs). Within the postnatal diagnosis group, no patient had TOF-PA, 4/68 (5.9 %) had TOF-APVS. 12 (17.6 %) had extracardiac malformations, 9 (13.2 %) had an abnormal karyotype including 2/9 with microdeletion 22q11.2. 10 (14.7 %) had RAA, 9 (13.2 %) had MAPCAs. There were no cases with agenesis of DA. Increasing z-score values of the left/right pulmonary artery (LPA/RPA) prenatally were associated with a lower probability for early postnatal intervention (RPA: p = 0.017; LPA: p = 0.013). Within the prenatal diagnosis group, 12 of 41 (29.3 %) live-born patients with follow-up and intention to treat needed early intervention versus 7 (10.3 %) in the postnatal diagnosis group (p = 0.02). Within the postnatal diagnosis group, there were no deaths, while 2 (4.9 %) post-intervention deaths occurred in the prenatal diagnosis group. CONCLUSION There are no significant differences concerning post-intervention survival in the prenatal diagnosis group versus the postnatal diagnosis group. Complex cases may be underrepresented in the postnatal diagnosis group. Smaller RPA/LPA values prenatally seem to be associated with early postnatal intervention.
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Affiliation(s)
- Aline Wolter
- Department of OB&GYN, Justus-Liebig-University and UKGM, Division of Prenatal Medicine, Giessen, Germany
| | - Marie Gebert
- Department of OB&GYN, Justus-Liebig-University and UKGM, Division of Prenatal Medicine, Giessen, Germany
| | - Christian Enzensberger
- Department of OB&GYN, Justus-Liebig-University and UKGM, Division of Prenatal Medicine, Giessen, Germany
| | - Andrea Kawecki
- Department of OB&GYN, Justus-Liebig-University and UKGM, Division of Prenatal Medicine, Giessen, Germany
| | | | | | | | - Josef Thul
- Department of Paediatric Cardiology, Justus-Liebig-University and UKGM, Giessen, Germany
| | - Markus Khalil
- Department of Paediatric Cardiology, Justus-Liebig-University and UKGM, Giessen, Germany
| | | | - Roland Axt-Fliedner
- Department of OB&GYN, Justus-Liebig-University and UKGM, Division of Prenatal Medicine, Giessen, Germany
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Ataíde Silva R, Martins D, Teixeira A, Anjos R. Tetralogy of Fallot with absent pulmonary valve: main differences with classic Fallot are crucial for an accurate prenatal diagnosis and counselling. BMJ Case Rep 2020; 13:13/4/e233592. [PMID: 32276999 DOI: 10.1136/bcr-2019-233592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rita Ataíde Silva
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
| | - Duarte Martins
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
| | - Ana Teixeira
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
| | - Rui Anjos
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
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Rakha S, Alkhushi N. Fetal diagnosis of isolated absent pulmonary valve with intact interventricular septum: How to counsel the parents? Ann Pediatr Cardiol 2020; 13:136-140. [PMID: 32641885 PMCID: PMC7331835 DOI: 10.4103/apc.apc_101_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/15/2019] [Accepted: 02/21/2020] [Indexed: 11/25/2022] Open
Abstract
Isolated absent pulmonary valve syndrome with an intact ventricular septum (APVS/IVS) is an extremely rare lesion. The prenatal diagnosis was described in a few reports. In the current work, we report a unique fetal case with this rare anomaly. The family counseling for isolated APVS/IVS is a different challenging process than with fetal Fallot type diagnosis. Moreover, 22q11 deletion has never been found as an association. Parents must also be aware of the expected early heart failure in cases with large patent ductus arteriosus and the need for its closure as early as possible.
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Affiliation(s)
- Shaimaa Rakha
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Pediatric Cardiology Unit, Department of Pediatrics, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Naif Alkhushi
- Pediatric Cardiology Unit, Department of Pediatrics, King Abdul-Aziz University, Jeddah, Saudi Arabia
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Saito M, Ishii T, Hamamichi Y. Unusually abnormal vessels in tetralogy of Fallot with absent pulmonary valve. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:417-419. [PMID: 31240812 DOI: 10.1002/uog.20384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/06/2019] [Accepted: 06/14/2019] [Indexed: 06/09/2023]
Affiliation(s)
- M Saito
- Pediatric Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - T Ishii
- Pediatric Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Y Hamamichi
- Pediatric Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Greene CL, Mainwaring RD, Sidell D, Palmon M, Hanley FL. Lecompte Procedure for Relief of Severe Airway Compression in Children With Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2019; 10:558-564. [PMID: 31496414 DOI: 10.1177/2150135119860466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Children with congenital heart disease may present with severe airway compression prior to any surgical procedure or may develop airway compression following their surgical procedure. This combination of congenital heart defect and airway compression poses a significant management challenge. The purpose of this study was to review our experience with the Lecompte procedure for relief of severe airway compression. METHODS This was a retrospective review of ten patients who underwent a Lecompte procedure for relief of severe airway compression over the past nine years (2010-2018). Three patients with absent pulmonary valve syndrome presented with severe symptoms prior to any surgical procedure. Seven patients presented with symptoms of airway compression following repair of their congenital heart defects (one with absent pulmonary valve syndrome, three patients had repair of pulmonary atresia with ventricular septal defect, and three patients had undergone aortic arch surgery). The median age at presentation was two years (range: one day to seven years). RESULTS The ten patients underwent a Lecompte procedure without any significant complications or operative mortality. The median interval between the surgical procedure and extubation was 9.5 days. No patients have required any further interventions for relief of airway obstruction. CONCLUSIONS The Lecompte procedure is a surgical option for young children who present with severe airway compression. The patients in this series responded well to the Lecompte procedure as evidenced by clinical relief of airway compression.
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Affiliation(s)
- Christina L Greene
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Douglas Sidell
- Division of Pediatric Otorhinolaryngology, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Michal Palmon
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
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Yang Z, Zhou L. Right aortic arch with mirror image branching accompanied by absent pulmonary valve syndrome and tricuspid stenosis: Prenatal echocardiographic diagnosis of an unusual congenital heart defect. Echocardiography 2019; 36:1952-1955. [PMID: 31471981 DOI: 10.1111/echo.14466] [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: 02/08/2019] [Revised: 07/04/2019] [Accepted: 08/08/2019] [Indexed: 11/26/2022] Open
Abstract
Right aortic arch (RAA) with mirror image branching (RAMI) accompanied by absent pulmonary valve syndrome (APVS), tricuspid stenosis, and hypoplastic right ventricle is an extremely rare combination of congenital heart anomalies. This combination might result in severe cardiac failure and respiratory compromise, indicating a poor prognosis. Here, we describe a detailed prenatal echocardiographic diagnosis of RAMI accompanied by APVS and tricuspid stenosis. These anomalies were further confirmed by autopsy. This case could be helpful in improving our understanding of this abnormal combination and the development of an early therapeutic strategy.
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Affiliation(s)
- Zexuan Yang
- Department of Ultrasound, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
| | - Liuying Zhou
- Department of Ultrasound, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
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Zych-Krekora K, Krekora M, Kopala M, Respondek-Libserska M. Absent Pulmonary Valve Syndrome – Special Prenatal Care and Early Surgery in Obstetric/Cardiac Center - A New Hope for Postnatal Survivors? PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2017-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: APVS (Absent Pulmonary Valve Syndrome) is a rare congenital heart disease. Its incidence according to The Polish National Registry of Fetal Cardiac Pathology in years 2004 - 2016 was 0.6%.This disease is caused by the absence or the residual pulmonary artery valve resulting in significant dilation of the pulmonary trunk and its branches. In utero deaths are reported. After birth the major problem is respiratory failure and high preoperative and postoperative mortality. Material and methods: In 1995 to 2016, 11 fetuses with APVS were diagnosed in our unit, at the average 27,5 weeks of gestation (min. 18.5- max 37.1 weeks of gestation). Two groups were analysed in this series of cases: “Old one” by 2011 (n = 6) and “New one” since 2011 (n = 5) and perinatal care as well as survival were compared. We analysed the fetal echo results, perinatal care including transplacental digoxin and steroids treatment in NEW group, the longevity of the pregnancy and neonatal/infants outcome. Results: In Old group the average day of cardiac surgery was day 91st after birth (max. 161) and the survival was 50% . In the New group the average surgery day was 41st day and the postoperative survival was 60%, however there was no statistical significance ( p > 0,05). Conclusions: There is no single parameter from prenatal life in foetuses with APVS which may allow to predict the positive outcome meaning neonatal survival. However optimal perinatal care (early detection of defect, transplacental digoxin at least 3-4 weeks, steroids, no preterm delivery, on-time delivery, postnatal care in tertiary center) and relatively early cardiac surgery may have combined impact on the improvement of survival after prenatal diagnosis of APVS, however more data are necessary to prove this hypothesis.
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Affiliation(s)
- Katarzyna Zych-Krekora
- Prenatal Cardiology Department Research Institute Polish Mother’s Memorial Hospital in Łódź, Łódź , Poland
| | - Michał Krekora
- Obstetrics and Gynecology Department, Research Institute Polish Mother’s Memorial Hospital in Łódź, Łódź , Poland
| | - Marek Kopala
- Cardiosurgery Department , Research Institute Polish Mother’s Memorial Hospital in Łódź, Łódź , Poland
| | - Maria Respondek-Libserska
- Prenatal Cardiology Department Research Institute Polish Mother’s Memorial Hospital in Łódź, Łódź , Poland
- Fetal Malformations Department, Medical University of Lodz, Lodz , Poland
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