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Poelmann RE, Jongbloed MRM, DeRuiter MC. Total Anomalous Pulmonary Venous Connections, Human Genetics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1441:593-598. [PMID: 38884735 DOI: 10.1007/978-3-031-44087-8_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Partial anomalous pulmonary venous connections (PAVC) have been found after abnormal gene expressions involving several syndromes. Total anomalous pulmonary venous connection (TAPVC) is found in conjunction with heterotaxia syndrome as well as several other syndromes. It has been reported with an autosomal dominance with variable expression and incomplete penetrance. The occurrence is also related to environmental factors which may superimpose on a familial susceptibility for TAPVC. Many pathways are involved in the normal development of the pulmonary venous connections and as a consequence disturbance of many genetic and epigenetic pathways lead to partial or total pulmonary venous misconnections. In this chapter, an overview of current knowledge regarding human genetics of anomalous venous connections is provided.
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Affiliation(s)
- R E Poelmann
- Institute of Biology Leiden, Leiden University, Leiden, The Netherlands
| | - M R M Jongbloed
- Department Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - M C DeRuiter
- Department Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
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2
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Gujja S, Prajapati M, Chuada TR, Gandhi H, Arora V, Kaul V, Patel S. Outcome of obstructed total anamalous pulmonary venous connection (TAPVC) repair patients with milrinone versus milrinone and inhaled nitric oxide (INO): A prospective randomized observational study. Ann Card Anaesth 2023; 26:177-182. [PMID: 37706383 PMCID: PMC10284474 DOI: 10.4103/aca.aca_56_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/10/2022] [Accepted: 10/07/2022] [Indexed: 09/15/2023] Open
Abstract
Background Obstructed total anomalous pulmonary venous connection (TAPVC) typically present with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. Milrinone and inhaled nitric oxide (iNO) efficiently reduce pulmonary artery pressure (PAP) and help to improve the outcome. The aim was to determine the outcome of patients with high PAP with milrinone alone and a combination of iNO and milrinone. Material and Method After ethical committee approval, the study was conducted over a period of 3 years in 80 patients with obstructed TAPVC repair. A total of 80 patients having severe PAH (supra systemic arterial pressure) randomly divided into two groups with 40 patients in each (M & MN). Group M (milrinone) patients received milrinone and Group MN (milrinone & iNO) patients received both milrinone (after opening aortic cross clamp) and iNO (post operative ICU). Ventilation time, hospital stay, ICU stay, complications, in hospital mortality were compared between both groups. Result Ventilation time, Intensive Care Unit (ICU) stay, hospital stay for group M was 8.02 ± 5.74 days, 11.25 ± 7.33 day, 14.92 ± 8.55 days, respectively, and for group MN was 5.02 ± 1.78 days, 8.27 ± 3.24 days, 10.3 ± 3.18 days, respectively. In hospital mortality for group M and MN was 10% and 2.5%, respectively. P value for each variable was significant < 0.05 (except mortality). Conclusion Most of the patients with obstructed TAPVC had severe PAH. Management of severe PAH with a combination of milrinone with iNO had a better outcome than milrinone alone.
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Affiliation(s)
- Srikanth Gujja
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Mrugesh Prajapati
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Tanya R Chuada
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Hemang Gandhi
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Varun Arora
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Vivek Kaul
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Sanjay Patel
- Department of Research, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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Shammout R, Alkhadraa D, Alkadi S, Al‐Dairy A. Surgical repair of an obstructed mixed-type total anomalous pulmonary venous connection. Clin Case Rep 2022; 10:e6747. [PMID: 36545552 PMCID: PMC9760782 DOI: 10.1002/ccr3.6747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/16/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Total anomalous pulmonary venous connection is a rare congenital anomaly and has four anatomical subtypes of which the mixed type represents diagnostic and therapeutic challenge. When associated with obstruction, however, urgent surgical repair is needed. Herein, we present a rare case of obstructed mixed type total anomalous pulmonary venous connection with successful surgical repair.
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Affiliation(s)
- Reem Shammout
- Medical student at Faculty of MedicineDamascus UniversityDamascusSyria
| | - Doaa Alkhadraa
- Medical student at Faculty of MedicineDamascus UniversityDamascusSyria
| | - Sidra Alkadi
- Medical student at Faculty of MedicineDamascus UniversityDamascusSyria
| | - Alwaleed Al‐Dairy
- Cardiac Surgery at Faculty of MedicineDamascus UniversityDamascusSyria
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Azab B, Aburizeg D, Ji W, Jeffries L, Isbeih NJ, Al-Akily AS, Mohammad H, Osba YA, Shahin MA, Dardas Z, Hatmal MM, Al-Ammouri I, Lakhani S. TBX5 variant with the novel phenotype of mixed‑type total anomalous pulmonary venous return in Holt‑Oram Syndrome and variable intrafamilial heart defects. Mol Med Rep 2022; 25:210. [PMID: 35514310 PMCID: PMC9133962 DOI: 10.3892/mmr.2022.12726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/07/2022] [Indexed: 12/04/2022] Open
Abstract
Variants in T‑box transcription factor 5 (TBX5) can result in a wide phenotypic spectrum, specifically in the heart and the limbs. TBX5 has been implicated in causing non‑syndromic cardiac defects and Holt‑Oram syndrome (HOS). The present study investigated the underlying molecular etiology of a family with heterogeneous heart defects. The proband had mixed‑type total anomalous pulmonary venous return (mixed‑type TAPVR), whereas her mother had an atrial septal defect. Genetic testing through trio‑based whole‑exome sequencing was used to reveal the molecular etiology. A nonsense variant was identified in TBX5 (c.577G>T; p.Gly193*) initially showing co‑segregation with a presumably non‑syndromic presentation of congenital heart disease. Subsequent genetic investigations and more complete phenotyping led to the correct diagnosis of HOS, documenting the novel association of mixed‑type TAPVR with HOS. Finally, protein modeling of the mutant TBX5 protein that harbored this pathogenic nonsense variant (p.Gly193*) revealed a substantial drop in the quantity of non‑covalent bonds. The decrease in the number of non‑covalent bonds suggested that the resultant mutant dimer was less stable compared with the wild‑type protein, consequently affecting the protein's ability to bind DNA. The present findings extended the phenotypic cardiac defects associated with HOS; to the best of our knowledge, this is the first association of mixed‑type TAPVR with TBX5. Prior to the current analysis, the molecular association of TAPVR with HOS had never been documented; hence, this is the first genetic investigation to report the association between TAPVR and HOS. Furthermore, it was demonstrated that the null‑variants reported in the T‑box domain of TBX5 were associated with a wide range of cardiac and/or skeletal anomalies on both the inter‑and intrafamilial levels. In conclusion, genetic testing was highlighted as a potentially powerful approach in the prognostication of the proper diagnosis.
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Affiliation(s)
- Bilal Azab
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pathology and Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Correspondence to: Dr Bilal Azab, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 3959 Broadway, New York, NY 10032, USA, E-mail:
| | - Dunia Aburizeg
- Department of Pathology and Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Weizhen Ji
- Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06504, USA
| | - Lauren Jeffries
- Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06504, USA
| | - Nooredeen Jamal Isbeih
- Department of Pathology and Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Amal Saleh Al-Akily
- Department of Pathology and Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Hashim Mohammad
- Department of Pathology and Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Yousef Abu Osba
- Department of Pathology and Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mohammad A. Shahin
- Department of Pathology and Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Zain Dardas
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ma'mon M. Hatmal
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan
| | - Iyad Al-Ammouri
- Department of Pediatrics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Saquib Lakhani
- Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06504, USA
- Dr Saquib Lakhani, Pediatric Genomics Discovery Program, Department of Pediatrics, Yale University School of Medicine, 1 Park Street, Wing West Pavilion, New Haven, CT 06504, USA, E-mail:
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Salehi F, Darmiani K, Nakhaee S, Zadeh AA, Javadmoosavi SY, Faghihi V, Mehrpour O. Comparison of Blood Lead Concentrations in Mothers of Children with Congenital Heart Disease and Mothers of Healthy Children. Biol Trace Elem Res 2022; 200:2001-2007. [PMID: 34231195 DOI: 10.1007/s12011-021-02813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/28/2021] [Indexed: 12/11/2022]
Abstract
Congenital heart disease (CHD) is the most prevalent congenital defect that causes several problems for patients and their families and medical specialists. It is important to investigate CHD risk factors due to their significantly destructive load on society. This study aims to determine the association between maternal lead exposure and conceiving a child with CHD. This case-control study was performed on a total of 246 mothers in the pediatric clinic of Vali-e-Asr Hospital in Birjand, Iran. One hundred forty-six mothers with CHD children were defined as the case group, and 100 age-matched mothers with healthy children were considered the control group. All the mothers were between 20 and 40 years old, and their children were under the age of 6 months. Demographic data was collected from mothers using a well-designed questionnaire. In addition, all mothers were referred to the laboratory for measuring blood lead concentrations. The mean blood lead concentration (BLC) of mothers in the group of children with heart problems was 4.11 ± 10.02 with a median of 2.50 μg/dL and in the control group was 2.66 ± 2.06 with a median of 2.30 μg/dL. The Mann-Whitney test results showed that mothers' lead concentration in the group of children with heart problems was significantly higher than the control group (z = 2.13, p = 0.03). The chi-square test results showed that lead concentrations in the two groups were significantly different from each other (χ2 = 9.11, p = 0.01). The results of our study showed that mothers of children with CHD had higher blood concentrations than mothers of healthy children.
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Affiliation(s)
- Forod Salehi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Kimia Darmiani
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Sameneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadi Zadeh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Vahideh Faghihi
- Islamic Azad University, Science and Research Branch, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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6
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Van Praagh R. Pulmonary Venous Anomalies. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Parović V, Parezanović V. Prenatal diagnosis of infracardiac type of total anomalous pulmonary venous connection with dilatation of portal vein. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:133-135. [PMID: 34225384 DOI: 10.1002/uog.23731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Affiliation(s)
- V Parović
- Office for Prenatal Diagnosis, Pancevo, Serbia
| | - V Parezanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Children's Hospital, Belgrade, Serbia
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Katewa A, Sahu B, Gajpal S, Anderson RH. Total Anomalous Pulmonary Venous Connection and Aortopulmonary Window: Successful Management of a Rare Association. World J Pediatr Congenit Heart Surg 2021; 12:785-787. [PMID: 33966539 DOI: 10.1177/2150135120957947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association of total anomalous pulmonary venous connection (TAPVC) with aortopulmonary window (APW) is extremely rare. The coexistence of these two anomalies will have implications on clinical presentation, diagnosis, and pathophysiology. The lungs are exposed to pulmonary venous hypertension due to obstructed TAPVC as well as pulmonary arterial hypertension due to unrestrictive APW. We describe successful management of this unusual association in a three-month-old child.
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Affiliation(s)
- Ashish Katewa
- Department of Paediatric Cardiac Sciences, Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | - Balswaroop Sahu
- Department of Paediatric Cardiac Sciences, Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | - Shivani Gajpal
- Department of Paediatric Cardiac Sciences, Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | - Robert H Anderson
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Piroddi N, Pesce P, Scellini B, Manzini S, Ganzetti GS, Badi I, Menegollo M, Cora V, Tiso S, Cinquetti R, Monti L, Chiesa G, Bleyl SB, Busnelli M, Dellera F, Bruno D, Caicci F, Grimaldi A, Taramelli R, Manni L, Sacerdoti D, Tesi C, Poggesi C, Ausoni S, Acquati F, Campione M. Myocardial overexpression of ANKRD1 causes sinus venosus defects and progressive diastolic dysfunction. Cardiovasc Res 2021; 116:1458-1472. [PMID: 31688894 DOI: 10.1093/cvr/cvz291] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/26/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Increased Ankyrin Repeat Domain 1 (ANKRD1) levels linked to gain of function mutations have been associated to total anomalous pulmonary venous return and adult cardiomyopathy occurrence in humans. The link between increased ANKRD1 level and cardiac structural and functional disease is not understood. To get insight into this problem, we have generated a gain of function ANKRD1 mouse model by overexpressing ANKRD1 in the myocardium. METHODS AND RESULTS Ankrd1 is expressed non-homogeneously in the embryonic myocardium, with a dynamic nucleo-sarcomeric localization in developing cardiomyocytes. ANKRD1 transgenic mice present sinus venosus defect, which originates during development by impaired remodelling of early embryonic heart. Adult transgenic hearts develop diastolic dysfunction with preserved ejection fraction, which progressively evolves into heart failure, as shown histologically and haemodynamically. Transgenic cardiomyocyte structure, sarcomeric assembly, and stability are progressively impaired from embryonic to adult life. Postnatal transgenic myofibrils also present characteristic functional alterations: impaired compliance at neonatal stage and impaired lusitropism in adult hearts. Altogether, our combined analyses suggest that impaired embryonic remodelling and adult heart dysfunction in ANKRD1 transgenic mice present a common ground of initial cardiomyocyte defects, which are exacerbated postnatally. Molecular analysis showed transient activation of GATA4-Nkx2.5 transcription in early transgenic embryos and subsequent dynamic transcriptional modulation within titin gene. CONCLUSIONS ANKRD1 is a fine mediator of cardiomyocyte response to haemodynamic load in the developing and adult heart. Increased ANKRD1 levels are sufficient to initiate an altered cellular phenotype, which is progressively exacerbated into a pathological organ response by the high ventricular workload during postnatal life. Our study defines for the first time a unifying picture for ANKRD1 role in heart development and disease and provides the first mechanistic link between ANKRD1 overexpression and cardiac disease onset.
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Affiliation(s)
- Nicoletta Piroddi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Paola Pesce
- Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Beatrice Scellini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Stefano Manzini
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Giulia S Ganzetti
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Ileana Badi
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Michela Menegollo
- Department of Biomedical Sciences, University of Padua, 35121 Padua, Italy
| | - Virginia Cora
- Department of Biomedical Sciences, University of Padua, 35121 Padua, Italy
| | - Simone Tiso
- Department of Biomedical Sciences, University of Padua, 35121 Padua, Italy
| | - Raffaella Cinquetti
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Laura Monti
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Giulia Chiesa
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Steven B Bleyl
- Department of Pediatrics, University of Utah, Salt Lake City, 84132 UT, USA
| | - Marco Busnelli
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Federica Dellera
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Daniele Bruno
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Federico Caicci
- Department of Biology, University of Padua, 35121 Padua, Italy
| | - Annalisa Grimaldi
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Roberto Taramelli
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Lucia Manni
- Department of Biology, University of Padua, 35121 Padua, Italy
| | - David Sacerdoti
- Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Chiara Tesi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Corrado Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, 35121 Padua, Italy
| | - Francesco Acquati
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Marina Campione
- Department of Biomedical Sciences, University of Padua, 35121 Padua, Italy.,CNR-Neuroscience Institute, 35121 Padua, Italy
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Shi X, Lu Y, Sun K. Research Progress in Pathogenesis of Total Anomalous Pulmonary Venous Connection. Methods Mol Biol 2020; 2204:173-178. [PMID: 32710324 DOI: 10.1007/978-1-0716-0904-0_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Congenital heart defect (CHD) is one of the most common birth defects and the leading course of infant mortality. Total anomalous pulmonary venous connection (TAPVC) is a rare type of cyanotic which accounting for approximately 1-3% of congenital heart disease cases. Based on where the anomalous veins drain, TAPVC can be divided into four subtypes: supracardiac, cardiac, infracardiac, and mixed. In TAPVC, all pulmonary veins fail to link to the left atrium correctly but make abnormal connections to the right atrium or systemic venous system. The mortality of TAPVC patients without proper intervention is nearly 80% in the first year of life and 50% of them died within 3 months after birth. However, the pathogenesis and mechanism of TAPVC remains elusive. In this chapter, we systematically review the epidemiology, anatomy, and pathophysiology of TAPVC and give an overview of the research progress of TAPVC pathogenesis.
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Affiliation(s)
- Xin Shi
- Department of Pediatric Cardiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanan Lu
- Department of Pediatric Cardiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Kun Sun
- Department of Pediatric Cardiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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11
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Surgical ductal stent implantation in total anomalous pulmonary venous connection to vena porta with right pulmonary sequestration in a mature newborn. Ann Med Surg (Lond) 2019; 45:33-35. [PMID: 31360457 PMCID: PMC6639658 DOI: 10.1016/j.amsu.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
In many cases of total anomalous pulmonary venous connection (TAPVC), the four pulmonary veins (PV) join together behind the left atrium, where they form a collector. This collector can drain into the right atrium directly through the innominate vein into the superior vena cava (SVC), into the coronary sinus (CS), or through the diaphragm to the venous structures of the abdomen. In our case, a mature newborn had TAPVC draining into the vena porta along with severe pulmonary hypertension. Additionally, there were right pulmonary sequestration, dextrocardia, transposition of the great arteries, severe pulmonary stenosis, and single ventricular pathology in echocardiographic examination. Clinical signs manifested in the first 7 days of life. Diagnostic tools used were echocardiography and angiography. A ductal stent was surgically implanted into the ductus arteriosus by angiography. TAPVC was found to be nonobstructive. Therefore, we would like to emphasize the rareness and hardness to perform the surgical ductal implant technique in our particular case of TAPVC with pulmonary sequestration draining into the vena porta. The prognosis in TAPVC is poor and related mainly to the existence of pulmonary venous obstruction.
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12
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Sondhi S, Negi PC, Asotra S, Mehta A. Snowman heart. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2019. [DOI: 10.4103/jpcs.jpcs_27_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Liu Z, He C, Chen M, Yang S, Li J, Lin Y, Deng Y, Li N, Guo Y, Yu P, Li X. The effects of lead and aluminum exposure on congenital heart disease and the mechanism of oxidative stress. Reprod Toxicol 2018; 81:93-98. [PMID: 30031113 DOI: 10.1016/j.reprotox.2018.07.081] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aimed to analyze the association between fetal lead or aluminum exposure and congenital heart disease (CHD) occurrence as well as to explore the mechanism of oxidative stress in heart development. METHODS Lead and aluminum concentrations were measured by ICP-MS in umbilical serum. The oxidative stress statuses were analyzed by measuring SOD, GPx and MDA with colorimetric assays. RESULTS Higher concentrations of Al were seen in the CHD groups compared to the controls. The risk of CHD occurrence increased markedly in the highly elevated Al group (aOR 2.08, 95%CI 1.11-3.88). With increasing Al and Pb levels, the activity of SOD decreased, and the level of MDA increased. Significantly decreased activity of SOD and GPx were found in the CHD groups (P < 0.05). CONCLUSION Fetal aluminum exposure may contribute to CHD occurrence. Oxidative stress was related to the concentration of Pb and Al, which may be involved in the occurrence of CHD.
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Affiliation(s)
- Zhen Liu
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Chunhua He
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Chen
- Department of Ultrasound, Harbin Red Cross Central Hospital, Harbin, Heilongjiang, China
| | - Shuihua Yang
- Department of Ultrasound, Maternal and Child Healthcare Hospital of Guangxi, Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jun Li
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Yuan Lin
- Department of Obstetrics & Gynecology, Fujian Provincial Maternal and Child Healthcare Hospital, Fuzhou, Fujian, China
| | - Ying Deng
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Nana Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yixiong Guo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ping Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Xiaohong Li
- National Center for Birth Defect Monitoring, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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14
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Li J, Yang S, Pu Z, Dai J, Jiang T, Du F, Jiang Z, Cheng Y, Dai G, Wang J, Qi J, Cao L, Cheng X, Ren C, Li X, Qin Y. Whole-exome sequencing identifies SGCD and ACVRL1 mutations associated with total anomalous pulmonary venous return (TAPVR) in Chinese population. Oncotarget 2018; 8:27812-27819. [PMID: 28412737 PMCID: PMC5438610 DOI: 10.18632/oncotarget.15434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/06/2017] [Indexed: 12/30/2022] Open
Abstract
As a rare type of Congenital Heart Defects (CHD), the genetic mechanism of Total Anomalous Pulmonary Venous Return (TAPVR) remains unknown, although previous studies have revealed potential disease-driving regions/genes. Blood samples collected from the 6 sporadic TAPVR cases and 81 non-TAPVR controls were subjected to whole exome sequencing. All detected variations were confirmed by direct Sanger sequencing. Here, we identified 2 non-synonymous missense mutations: c.C652T, p.R218W in activin A receptor type II-like 1 (ACVRL1), c.C717G, p.D239E in sarcoglycan delta (SGCD). Our results offered the landscape of mutations for TAPVR in Chinese population firstly and are valuable in the mutation-based pre- and post-natal screening and genetic diagnosis for TAPVR.
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Affiliation(s)
- Jun Li
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Zhening Pu
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Juncheng Dai
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Tao Jiang
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Fangzhi Du
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhu Jiang
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yue Cheng
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Genyin Dai
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Jun Wang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Jirong Qi
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Liming Cao
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Xueying Cheng
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Cong Ren
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yuming Qin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
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15
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Vanderlaan RD, Caldarone CA. Surgical Approaches to Total Anomalous Pulmonary Venous Connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018; 21:83-91. [PMID: 29425529 DOI: 10.1053/j.pcsu.2017.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/14/2017] [Indexed: 06/08/2023]
Abstract
Total anomalous pulmonary venous connection (TAPVC) constitutes a spectrum of congenital lesions whereby the pulmonary veins remain connected to systemic venous vessels or aberrantly connect to the right atrium. Definitive management requires surgical intervention and, in patients with obstruction to pulmonary venous flow, urgent operation is required. Use of temporizing catheter-based interventions allow for optimization in hemodynamically unstable neonates. Overall, survival has significantly improved over the past decades through better perioperative management and evolution of surgical approaches to minimize post-repair pulmonary vein stenosis, which persists as a major determinant of long-term outcomes.
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Affiliation(s)
- Rachel D Vanderlaan
- University of Toronto, Division of Cardiac Surgery, Toronto, Ontario, Canada
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16
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Onbas O, Koplay M, Kandis H, Besir FH, Erdogmus B. Total Anomalous Pulmonary Venous Connection Draining into the Portal Vein in a 2-Month-Old Infant: Multidetector Computed Tomography Angiography Diagnosis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac anomaly in which the pulmonary veins fail to connect with the left atrium and connect directly to the right atrium or to one of the systemic veins. Early diagnosis and surgical correction is highly important for survival. In the evaluation of TAPVC, imaging methods such as echocardiography, computed tomography (CT) angiography, magnetic resonance (MR) angiography, and catheter angiography have been used. We reported a rare case of infracardiac type of TAPVC draining into the portal vein at 2-mounth-old infant who was admitted to the hospital with shortness of breath and mild cyanosis. The images demonstrating TAPVC between the portal vein and the pulmonary veins with multidetector computed tomography (MDCT) angiography were also shown.
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Affiliation(s)
| | - M Koplay
- Selcuk University School of Selcuklu Medicine, Department of Radiology, Konya, Turkey
| | - H Kandis
- Duzce University School of Medicine, Department of Emergency, Duzce, Turkey
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17
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Sun X, Zhang Y, Fan M, Wang Y, Wang M, Siddiqui FA, Sun W, Sun F, Zhang D, Lei W, Hu G. Role of four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation in detecting fetal pulmonary veins. Echocardiography 2017; 34:906-914. [PMID: 28401632 DOI: 10.1111/echo.13543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Xue Sun
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Ying Zhang
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Miao Fan
- Department of Radiology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Yu Wang
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Meilian Wang
- Department of Microbiology and Parasitology; College of Basic Medical Sciences; China Medical University; Shenyang China
- Department of Entomology; The Pennsylvania State University; University Park PA USA
| | - Faiza Amber Siddiqui
- Department of Entomology; The Pennsylvania State University; University Park PA USA
| | - Wei Sun
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Feifei Sun
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Dongyu Zhang
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Wenjia Lei
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
| | - Guyue Hu
- Department of Sonography; Shengjing Hospital of China Medical University; Shenyang China
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18
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Muntean I, Mărginean C, Stanca R, Togănel R, Pop M, Gozar L. Prenatal diagnoses of an uncommon isolated obstructed supracardiac total anomalous pulmonary venous connection: Case report and review of the literature (CARE compliant). Medicine (Baltimore) 2017; 96:e6061. [PMID: 28151919 PMCID: PMC5293482 DOI: 10.1097/md.0000000000006061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Total anomalous pulmonary venous connection is an uncommon congenital heart disease. Four types are described based on the site of pulmonary venous drainage: supracardiac, cardiac, infradiaphragmathic, and mixed connection. In most cases of supracardiac type, the common venous confluence drains through an ascending left vertical vein into the brachiocephalic vein, right superior vena cava, and then into the right atrium. Anomalous connection of the pulmonary venous confluence directly to the right SVC, especially the obstructed form is an unusual and severe supracardiac variant. The prenatal diagnosis is challenging. PATIENT CONCERNS We present a case report of a fetus diagnosed with TAPVC at 23 gestational weeks. DIAGNOSIS INTERVENTIONS The 4-chamber view showed a small left atrium, with a "smooth" posterior wall and the absence of pulmonary vein connection. This is the first case of prenatally diagnosed isolated, obstructed supracardiac type with drainage directly into the right superior vena cava. CONCLUSION The obstetrician and fetal cardiologist should be cautious at the direct and indirect echocardiographic signs of this condition. A prenatal diagnose of isolated, obstructed form is important for adequate planning of delivery and postnatal surgery in a tertiary center.
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Affiliation(s)
- Iolanda Muntean
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
| | - Claudiu Mărginean
- Department of Obstetric and Gynecology I, University of Medicine and Pharmacy, Tirgu-Mures
| | | | - Rodica Togănel
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
| | - Marian Pop
- County Emergency Hospital, Tîrgu-Mureş, România
| | - Liliana Gozar
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
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Files MD, Morray B. Total Anomalous Pulmonary Venous Connection: Preoperative Anatomy, Physiology, Imaging, and Interventional Management of Postoperative Pulmonary Venous Obstruction. Semin Cardiothorac Vasc Anesth 2016; 21:123-131. [PMID: 27831520 DOI: 10.1177/1089253216672442] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Total anomalous pulmonary venous connection refers to a spectrum of cardiac anomalies where the pulmonary veins fail to return to the left atrium and the pulmonary venous blood returns through a systemic vein or directly to the right atrium. There is a wide anatomical variety of venous connections and degrees of pulmonary venous obstruction that affect the presentation, surgical repair, and outcomes. In this review, we explore the preoperative physiology, echocardiographic diagnosis, and approach to postoperative complications.
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20
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Dong DY, Binongo JN, Kancherla V. Maternal Chlamydia Infection During Pregnancy and Risk of Cyanotic Congenital Heart Defects in the Offspring. Matern Child Health J 2016; 20:66-76. [PMID: 26156829 DOI: 10.1007/s10995-015-1804-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Genital Chlamydia is a common bacterial sexually-transmitted infection among reproductive aged women, particularly younger populations. Cyanotic congenital heart defects (CCHDs) constitute about one quarter of all cardiac malformations at birth, and are associated with high rate of morbidity and mortality. Epidemiological research on the association between maternal Chlamydia during pregnancy and CCHDs in the offspring is lacking. METHODS Using data from the 2012 United States birth certificates, we examined the association between CCHDs and prenatal exposure to Chlamydia among live singleton births with CCHDs (n = 2487) and unaffected singleton births (n = 3,334,424). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using unconditional logistic regression analysis for all CCHDs combined, and isolated CCHDs (without other major congenital malformations). RESULTS Overall 1.7% of case and 1.7% of control women reported having Chlamydia during their pregnancies. After controlling for potential confounders, we found a weak positive association between maternal Chlamydia during pregnancy and all CCHDs combined (aOR = 1.39; 95% CI 1.02-1.90). The positive association persisted for isolated CCHD cases, but with marginal significance (aOR = 1.34; 95% CI 0.96-1.74). Subgroup analyses for younger women showed an increased risk for CCHDs; however, the associations were not statistically significant. CONCLUSIONS Maternal exposure to Chlamydia during pregnancy was weakly associated with a higher risk of CCHDs in the offspring. The finding should be interpreted with caution due to limitations of birth certificate data. Future studies using more robust data sources are warranted to further study the association between maternal Chlamydia during pregnancy and CCHDs in the offspring.
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Affiliation(s)
- Diane Y Dong
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, USA.,Department of Veterans Affairs, Center for Medication Safety, Hines, IL, USA
| | - José N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, USA.
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21
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Olsen R, Doyle Z, Levy D, Anton T, Molkara D, Tarsa M, Sklansky M, Pretorius DH. Anomalous Pulmonary Venous Return: Insights Into Prenatal Detection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1193-1206. [PMID: 27126401 DOI: 10.7863/ultra.15.04041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To review all cases of total anomalous pulmonary venous return (TAPVR) or partial anomalous pulmonary venous return (PAPVR) identified prenatally or postnatally at a single institution and to identify factors that may lead to a correct or missed diagnosis in both high- and low-risk fetuses on screening examinations. METHODS Fetal images from 16 cases of prenatally or postnatally diagnosed T/PAPVR were retrospectively reviewed to analyze factors that influenced interpretations and diagnoses. RESULTS Sixteen diagnoses of T/PAPVR were made, with a final number of 10 confirmed cases, 1 of which was PAPVR. Ten fetuses with a presumptive diagnosis of T/PAPVR before delivery were at an average gestational age of 24.7 weeks, with 5 cases diagnosed postnatally. None of the diagnoses of isolated TAPVR were made during a screening examination. Twelve of the pregnancies were complicated by complex cardiac defects, including 6 with heterotaxy syndromes. Of the 5 abnormal cases identified in the postpartum period, 3 had isolated TAPVR. In the 3 patients with isolated defects, prenatal echocardiography was not performed; the anatomy scan interpretations were confounded by multiple factors. In retrospect, there was no obvious sonographic evidence of TAPVR in these patients; however, color flow Doppler imaging of the pulmonary veins was not performed on any of them. CONCLUSIONS Although fetal echocardiography has improved the overall detection of TAPVR or PAPVR, this abnormality continues to elude prenatal diagnosis during screening in both low- and high-risk patients. We hypothesize that the use of color flow Doppler imaging in the 4-chamber view may assist in diagnosing TAPVR in screening low-risk patients, especially in those with difficult scans.
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Affiliation(s)
- Richelle Olsen
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA
| | - Zoe Doyle
- University of California San Diego Medical School, La Jolla, California USA
| | - Denis Levy
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADivision of Cardiology, Department of Pediatrics, Southern California Permanente Medical Group, Kaiser Permanente, San Diego, California USA
| | - Tracy Anton
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA
| | - Delaram Molkara
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Pediatrics, University of California San Diego, San Diego, California USA
| | - Maryam Tarsa
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA
| | - Mark Sklansky
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California USA
| | - Dolores H Pretorius
- Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Radiology, University of California San Diego, San Diego, California USA
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22
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Rocheleau CM, Bertke SJ, Lawson CC, Romitti PA, Sanderson WT, Malik S, Lupo PJ, Desrosiers TA, Bell E, Druschel C, Correa A, Reefhuis J. Maternal occupational pesticide exposure and risk of congenital heart defects in the National Birth Defects Prevention Study. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2015; 103:823-33. [PMID: 26033688 PMCID: PMC4607631 DOI: 10.1002/bdra.23351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital heart defects (CHDs) are common birth defects, affecting approximately 1% of live births. Pesticide exposure has been suggested as an etiologic factor for CHDs, but previous results were inconsistent. METHODS We examined maternal occupational exposure to fungicides, insecticides, and herbicides for 3328 infants with CHDs and 2988 unaffected control infants of employed mothers using data for 1997 through 2002 births from the National Birth Defects Prevention Study, a population-based multisite case-control study. Potential pesticide exposure from 1 month before conception through the first trimester of pregnancy was assigned by an expert-guided task-exposure matrix and job history details self-reported by mothers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. RESULTS Maternal occupational exposure to pesticides was not associated with CHDs overall. In examining specific CHD subtypes compared with controls, some novel associations were observed with higher estimated pesticide exposure: insecticides only and secundum atrial septal defect (OR = 1.8; 95% CI, 1.3-2.7, 40 exposed cases); both insecticides and herbicides and hypoplastic left heart syndrome (OR = 5.1; 95% CI, 1.7-15.3, 4 exposed cases), as well as pulmonary valve stenosis (OR = 3.6; 95% CI, 1.3-10.1, 5 exposed cases); and insecticides, herbicides, and fungicides and tetralogy of Fallot (TOF) (OR = 2.2; 95% CI, 1.2-4.0, 13 exposed cases). CONCLUSION Broad pesticide exposure categories were not associated with CHDs overall, but examining specific CHD subtypes revealed some increased odds ratios. These results highlight the importance of examining specific CHDs separately. Because of multiple comparisons, additional work is needed to verify these associations.
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Affiliation(s)
- Carissa M. Rocheleau
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Stephen J. Bertke
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Christina C. Lawson
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | | | - Sadia Malik
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Philip J. Lupo
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Tania A. Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Erin Bell
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York
| | - Charlotte Druschel
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York
- Center for Environmental Health, New York State Department of Health, Albany, New York
| | - Adolfo Correa
- Departments of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennita Reefhuis
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
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23
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Nash D, Arrington CB, Kennedy BJ, Yandell M, Wu W, Zhang W, Ware S, Jorde LB, Gruber PJ, Yost HJ, Bowles NE, Bleyl SB. Shared Segment Analysis and Next-Generation Sequencing Implicates the Retinoic Acid Signaling Pathway in Total Anomalous Pulmonary Venous Return (TAPVR). PLoS One 2015; 10:e0131514. [PMID: 26121141 PMCID: PMC4485409 DOI: 10.1371/journal.pone.0131514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 06/03/2015] [Indexed: 11/19/2022] Open
Abstract
Most isolated congenital heart defects are thought to be sporadic and are often ascribed to multifactorial mechanisms with poorly understood genetics. Total Anomalous Pulmonary Venous Return (TAPVR) occurs in 1 in 15,000 live-born infants and occurs either in isolation or as part of a syndrome involving aberrant left-right development. Previously, we reported causative links between TAVPR and the PDGFRA gene. TAPVR has also been linked to the ANKRD1/CARP genes. However, these genes only explain a small fraction of the heritability of the condition. By examination of phased single nucleotide polymorphism genotype data from 5 distantly related TAPVR patients we identified a single 25 cM shared, Identical by Descent genomic segment on the short arm of chromosome 12 shared by 3 of the patients and their obligate-carrier parents. Whole genome sequence (WGS) analysis identified a non-synonymous variant within the shared segment in the retinol binding protein 5 (RBP5) gene. The RBP5 variant is predicted to be deleterious and is overrepresented in the TAPVR population. Gene expression and functional analysis of the zebrafish orthologue, rbp7, supports the notion that RBP5 is a TAPVR susceptibility gene. Additional sequence analysis also uncovered deleterious variants in genes associated with retinoic acid signaling, including NODAL and retinol dehydrogenase 10. These data indicate that genetic variation in the retinoic acid signaling pathway confers, in part, susceptibility to TAPVR.
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Affiliation(s)
- Dustin Nash
- Department of Pediatrics (Division of Cardiology), University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Cammon B. Arrington
- Department of Pediatrics (Division of Cardiology), University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Brett J. Kennedy
- Department of Human Genetics, University of Utah, Salt Lake City, UT, United States of America
| | - Mark Yandell
- Department of Human Genetics, University of Utah, Salt Lake City, UT, United States of America
- USTAR Center for Genetic Discovery, Salt Lake City, UT, United States of America
| | - Wilfred Wu
- Department of Human Genetics, University of Utah, Salt Lake City, UT, United States of America
| | - Wenying Zhang
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Stephanie Ware
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Lynn B. Jorde
- Department of Human Genetics, University of Utah, Salt Lake City, UT, United States of America
| | - Peter J. Gruber
- Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - H. Joseph Yost
- Neurobiology and Anatomy, University of Utah, Salt Lake City, UT, United States of America
| | - Neil E. Bowles
- Department of Pediatrics (Division of Cardiology), University of Utah School of Medicine, Salt Lake City, UT, United States of America
- * E-mail: (NEB); (SBB)
| | - Steven B. Bleyl
- Department of Pediatrics (Division of Cardiology), University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Clinical Genetic Institute, Intermountain Healthcare, Salt Lake City, UT, United States of America
- * E-mail: (NEB); (SBB)
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24
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Byard RW, Gilbert JD. Total anomalous pulmonary venous connection : Autopsy considerations. Forensic Sci Med Pathol 2015; 1:215-20. [PMID: 25870050 DOI: 10.1385/fsmp:1:3:215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2005] [Indexed: 11/11/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC), where the pulmonary venous circulation drains into the systemic venous circulation rather than into the left atrium, may present a number of problems at autopsy. A 5-week-old infant is reported who died suddenly and unexpectedly who was found at autopsy to have infradiaphragmatic TAPVC into the portal vein. The only associated anomalies were a tri-lobed left lung, a patent ductus arteriosus, and drainage of the inferior vena cava into the both the right and left atria. This case demonstrates particular features that may lead to difficulties in establishing the diagnosis of TAPVC. Sudden death in the absence of symptoms in this age group raises the possibilities of sudden infant death syndrome (SIDS) and inflicted injury, both of which were discounted in this case. An autopsy approach is outlined to maximize chances of diagnosing this entity that includes meticulous inspection and dissection of cardiac vascular connections before evisceration, with photographic documentation of findings. Concurrent cardiovascular abnormalities, including valve atresias, septal defects, and left heart hypoplasia are likely in the presence of asplenia/polysplenia syndrome. Extracardiac anomalies may be present in the form of Holt-Oram, Ellis-van Creveld, and cat eye syndromes. Careful examination of the common draining vein for obstructive features is an important part of the postmortem assessment. The possibility of heritable cases requires referral of the family for genetic evaluation.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA and University of Adelaide, Adelaide, Australia,
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25
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Kim HS, Jeong K, Cho HJ, Choi WY, Choi YE, Ma JS, Cho YK. Total anomalous pulmonary venous return in siblings. J Cardiovasc Ultrasound 2014; 22:213-9. [PMID: 25580197 PMCID: PMC4286644 DOI: 10.4250/jcu.2014.22.4.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/12/2014] [Accepted: 11/27/2014] [Indexed: 12/03/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR) is a rare and critical congenital vascular anomaly that requires an early operation. However, initial symptoms of TAPVR may be non-specific, and cardiovascular findings may be minimal. The heart may not be enlarged and there is often no cardiac murmur. Without cardiac murmur, these symptoms are similar to those of respiratory distress syndrome in newborns. Therefore, a high degree of suspicion and an early diagnosis of TAPVR are important. This condition generally occurs without a family history and has a low recurrence rate, but several familial cases, including siblings, have been reported worldwide. Additionally, several chromosomal or gene abnormalities associated with TAPVR have been reported. In the case presented here, two brothers with a 6-year age gap were diagnosed with TAPVR. Surgery was performed without cardiac or neurological complications. This is the first report on TAPVR in siblings in Korea.
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Affiliation(s)
- Ho-Sung Kim
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kumi Jeong
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Hwa-Jin Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Woo-Yeon Choi
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Earl Choi
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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Liu Z, Yu Y, Li X, Wu A, Mu M, Li N, Deng Y, Jin X, Li S, Lin Y, Chen X, Wang F, Zhu J. Maternal lead exposure and risk of congenital heart defects occurrence in offspring. Reprod Toxicol 2014; 51:1-6. [PMID: 25462788 DOI: 10.1016/j.reprotox.2014.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
Maternal lead exposure may be harmful to fetal development. However, sufficient evidence was lacked about the risk on cardiac development in offspring. To explore the association between maternal lead exposure and risks of congenital heart defects (CHDs) occurrence in fetuses, a case-control study was adopted during pregnant women making antenatal examinations. The maternal hair lead levels were measured by using inductively coupled plasma mass spectrometry (ICP-MS), and logistic regression analysis was used to calculate the odds ratio (OR). Three hundred and sixteen cases and 348 controls were eligible to the study. The median level of lead in maternal hair of case (0.670ng/mg) was significantly higher (AOR 3.07, 95% CI 2.00-4.72) than that of the control (0.461ng/mg), including the CHD cases with or without extracardiac malformations (AOR 3.55, 2.94, respectively). Maternal lead exposure is associated with the risk of some subtypes of CHDs occurrence in offspring. The potential dose-response relationship is also presented.
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Affiliation(s)
- Zhen Liu
- National Centre for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Yu
- Department of Nutrition, Research Center for Nutrition and Health, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Public Health, Zhejiang University, Hangzhou 310058, China; Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Xiaohong Li
- National Centre for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Aimin Wu
- Department of Nutrition, Research Center for Nutrition and Health, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Mingdao Mu
- Department of Nutrition, Research Center for Nutrition and Health, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Nana Li
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Ying Deng
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xi Jin
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Shengli Li
- Department of Ultrasound, Shenzhen Maternity & Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen 518028, China
| | - Yuan Lin
- Department of Obstetrics and Gynecology, Fujian provincial Maternal and Child Healthcare Hospital, Fuzhou 350005, China
| | - Xinlin Chen
- Department of Ultrasound, Hubei provincial Maternal and Child Healthcare Hospital, Wuhan 430071, China
| | - Fudi Wang
- Department of Nutrition, Research Center for Nutrition and Health, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Jun Zhu
- National Centre for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
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Carmichael SL, Yang W, Roberts E, Kegley SE, Padula AM, English PB, Lammer EJ, Shaw GM. Residential agricultural pesticide exposures and risk of selected congenital heart defects among offspring in the San Joaquin Valley of California. ENVIRONMENTAL RESEARCH 2014; 135:133-8. [PMID: 25262086 PMCID: PMC5525322 DOI: 10.1016/j.envres.2014.08.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/20/2014] [Accepted: 08/23/2014] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pesticide exposures are ubiquitous and of substantial public concern. We examined the potential association of congenital heart defects with residential proximity to commercial agricultural pesticide applications in the San Joaquin Valley, California. METHODS Study subjects included 569 heart defect cases and 785 non-malformed controls born from 1997 to 2006 whose mothers participated in a population-based case-control study. Associations with any versus no exposure to physicochemical groups of pesticides and specific chemicals were assessed using logistic regression adjusted for relevant covariates, for 8 heart defect phenotypes that included ≥ 50 cases and pesticide exposures with ≥ 5 exposed cases and controls, which resulted in 235 comparisons. RESULTS 38% of cases and controls were classified as exposed to pesticides within a 500 m radius of mother's address during a 3-month periconceptional window. Adjusted odds ratios (AORs) with 95% CIs excluding 1.0 were observed for 18 comparisons; all were >1 and ranged from 1.9 to 7.1. They included tetralogy of Fallot (n=101 cases) and neonicotinoids; hypoplastic left heart syndrome (n=59) and strobins; coarctation of the aorta (n=74) and pyridazinones; pulmonary valve stenosis (n=53) and bipyridyliums and organophosphates; ventricular septal defects (n=93) and avermectins and pyrethroids; and atrial septal defects (n=132) and dichlorphenoxy acid or esters, organophosphates, organotins, and pyrethroids. No AORs met both of these criteria for d-transposition of the great arteries (n=58) or heterotaxia (n=53). CONCLUSIONS Most pesticides were not associated with increased risk of specific heart defect phenotypes. For the few that were associated, results should be interpreted with caution until replicated in other study populations.
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Affiliation(s)
- Suzan L Carmichael
- Department of Pediatrics, Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, USA.
| | - Wei Yang
- Department of Pediatrics, Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, USA
| | | | | | - Amy M Padula
- Department of Pediatrics, Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, USA
| | - Paul B English
- California Department of Public Health, Richmond, CA, USA
| | - Edward J Lammer
- Children׳s Hospital Oakland Research Institute, Oakland, CA, USA
| | - Gary M Shaw
- Department of Pediatrics, Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, USA
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Aihara N, Horiuchi N, Hikichi N, Ochiai M, Ishikawa Y, Oishi K. Total anomalous pulmonary venous connection in a chicken. Avian Dis 2013; 57:140-2. [PMID: 23678743 DOI: 10.1637/10210-041712-case.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This report describes a case of total anomalous pulmonary venous connection (TAPVC) in a 5-wk-old male white leghorn chicken that presented with growth retardation. This chicken was a specific-pathogen-free chicken bred in an isolator. At 5 wk of age, the chicken was euthanatized and autopsied. Macroscopically, the right ventricle and right atrium were significantly enlarged whereas the left atrium was small and blind-ending with no connection to the pulmonary veins. The pulmonary veins were connected directly to the right atrium. The above abnormality was accompanied by an ostium secundum-type atrial septal defect. No other malformations were observed. TAPVC is a very rare congenital cardiac abnormality that has not been reported in avian species to date.
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Affiliation(s)
- Naoyuki Aihara
- National Veterinary Assay Laboratory, Ministry of Agriculture, Forestry and Fisheries, 1-15-1 Tokura, Kokubunji, Tokyo 185-8511, Japan
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Ghanim M, Rossignol S, Delobel B, Irving M, Miller O, Devisme L, Plennevaux JL, Lucidarme-Rossi S, Manouvrier S, Salah A, Chivu O, Netchine I, Vincent-Delorme C. Possible association between complex congenital heart defects and 11p15 hypomethylation in three patients with severe Silver-Russell syndrome. Am J Med Genet A 2013; 161A:572-7. [PMID: 23401077 DOI: 10.1002/ajmg.a.35691] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 08/23/2012] [Indexed: 11/08/2022]
Abstract
Silver-Russell syndrome (SRS) is characterized by pre- and post-natal growth restriction that spares head growth, feeding difficulties, and variable dysmorphic facial features without major malformations. Hypomethylation of the paternal 11p15 imprinting control region 1 (ICR1) and maternal uniparental disomy of chromosome 7 are found in 50-60% and in 5-10% of SRS patients, respectively. We report on the pre- and post-natal features of three unrelated SRS patients with unusual congenital heart defects (CHDs). Two patients born prematurely had total anomalous pulmonary venous return and died shortly after birth, and a third patient, now 4 years old, had cor triatriatum sinistrum, which was surgically corrected. In all three patients, the underlying molecular defect was 11p15 ICR1 hypomethylation. Based on a large cohort with molecularly proven SRS, the prevalence of CHD in SRS is estimated at 5.5%. We suggest that the occurrence of CHD in SRS with 11p15 ICR1 hypomethylation is not coincidental, but specific to this genotype.
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Affiliation(s)
- Mustafa Ghanim
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs Nord de France, CHRU Lille, France.
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Ashfaq A, Shah N, Khan MZ, Atiq M, Amanullah MM. Successful surgical intervention of total anomalous pulmonary venous drainage in the third decade of life. Ann Med Surg (Lond) 2013; 2:60-2. [PMID: 25628887 PMCID: PMC4306058 DOI: 10.1016/s2049-0801(13)70039-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 02/17/2013] [Indexed: 12/02/2022] Open
Abstract
Total anomalous pulmonary venous drainage (TAPVD) accounts for approximately 1.5% of all congenital heart diseases. It is usually diagnosed in the neonatal period and is rarely seen in adults. We report an unusual case of a patient with TAPVD who was successfully treated at the age of 28 years. We believe that this is the oldest person in the South Asian literature to undergo surgical correction of TAPVD.
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Affiliation(s)
- Awais Ashfaq
- Department of Surgery, Mayo Clinic Arizona, Arizona, United States of America
| | - Nilay Shah
- Department of Surgery, Mayo Clinic Arizona, Arizona, United States of America
| | - Mubashir Z Khan
- Division of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Pakistan
| | - Mehnaz Atiq
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Muhammad M Amanullah
- Division of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Pakistan
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Seale AN, Carvalho JS, Gardiner HM, Mellander M, Roughton M, Simpson J, Tometzki A, Uzun O, Webber SA, Daubeney PEF. Total anomalous pulmonary venous connection: impact of prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:310-318. [PMID: 22262371 DOI: 10.1002/uog.11093] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To investigate whether prenatal screening is effective in the detection of total anomalous pulmonary venous connection (TAPVC) and to identify common prenatal features. METHODS This was a retrospective collaborative study involving 19 pediatric cardiac centers in the UK, Ireland and Sweden. Cases with TAPVC born between January 1, 1998 and December 31, 2004, and prenatally diagnosed cases whose estimated dates of delivery were within this time frame, were identified. Cases with functionally univentricular circulation or atrial isomerism were excluded. All available data and stored images were reviewed. RESULTS Four-hundred and twenty-four cases with TAPVC were identified prenatally or postnatally, of whom eight (1.9%) had a prenatal diagnosis of TAPVC. Median gestational age at fetal diagnosis was 26 + 6 (range, 22 + 4 to 32 + 0) weeks. Six further fetuses with TAPVC had an abnormality diagnosed on prenatal ultrasound, but not the TAPVC. This included other congenital heart defects (four cases) and isolated pleural effusion (two cases). Seventeen (4.0%) of the 422 liveborn infants had a first-degree relative with congenital heart disease; and six of 17 had a sibling with TAPVC. Two died in utero. Of the liveborn infants diagnosed prenatally with TAPVC, none required urgent intervention for pulmonary venous obstruction and all were alive and well at a median of 2.3 (range, 1.0-7.0) years after surgical repair. CONCLUSION Prenatal diagnosis of TAPVC is infrequent using current screening methods. Where there is a family history of TAPVC, specialized fetal echocardiography at 20 and 28 weeks' gestation may be indicated.
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Gilboa SM, Desrosiers TA, Lawson C, Lupo PJ, Riehle-Colarusso TJ, Stewart PA, van Wijngaarden E, Waters MA, Correa A. Association between maternal occupational exposure to organic solvents and congenital heart defects, National Birth Defects Prevention Study, 1997-2002. Occup Environ Med 2012; 69:628-35. [PMID: 22811060 DOI: 10.1136/oemed-2011-100536] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the relation between congenital heart defects (CHDs) in offspring and estimated maternal occupational exposure to chlorinated solvents, aromatic solvents and Stoddard solvent during the period from 1 month before conception through the first trimester. METHODS The study population included mothers of infants with simple isolated CHDs and mothers of control infants who delivered from 1997 through 2002 and participated in the National Birth Defects Prevention Study. Two methods to assess occupational solvent exposure were employed: an expert consensus-based approach and a literature-based approach. Multiple logistic regression was used to calculate adjusted ORs and 95% CIs for the association between solvent classes and CHDs. RESULTS 2951 control mothers and 2047 CHD case mothers were included. Using the consensus-based approach, associations were observed for exposure to any solvent and any chlorinated solvent with perimembranous ventricular septal defects (OR 1.6, 95% CI 1.0 to 2.6 and OR 1.7, 95% CI 1.0 to 2.8, respectively). Using the literature-based approach, associations were observed for: any solvent exposure with aortic stenosis (OR 2.1, 95% CI 1.1 to 4.1) and Stoddard solvent exposure with d-transposition of the great arteries (OR 2.0, 95% CI 1.0 to 4.2), right ventricular outflow tract obstruction defects (OR 1.9, 95% CI 1.1 to 3.3) and pulmonary valve stenosis (OR 2.1, 95% CI 1.1 to 3.8). CONCLUSIONS The authors found evidence of associations between occupational exposure to solvents and several types of CHDs. These results should be interpreted in light of the potential for misclassification of exposure.
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Affiliation(s)
- Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Abstract
Familial recurrence of congenital heart disease (CHD), in particular, d-transposition of great arteries (d-TGA) is rare. However, there have been several reports in the literature of sibling recurrence of total anomalous pulmonary venous return (TAPVR). This is the first case report in the literature, describing mother to offspring recurrence of d-TGA. We describe two cases of non-syndromic CHD with mother to offspring and sibling recurrence. The first case is an antenatally diagnosed d-TGA on fetal echocardiogram at 25 weeks of gestational age in the offspring of a 30-year-old mother with d-TGA. The second case is a sibling reoccurrence of TAPVR diagnosed antenatally at 30 weeks of gestational age, with supradiaphragmatic TAPVR on fetal echocardiogram in a mother, whose first child was diagnosed with infradiaphragmatic TAPVR in infancy.
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Normal and abnormal development of pulmonary veins: State of the art and correlation with clinical entities. Int J Cardiol 2011; 147:13-24. [DOI: 10.1016/j.ijcard.2010.07.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/17/2010] [Accepted: 07/04/2010] [Indexed: 11/19/2022]
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Seale AN, Uemura H, Webber SA, Partridge J, Roughton M, Ho SY, McCarthy KP, Jones S, Shaughnessy L, Sunnegardh J, Hanseus K, Berggren H, Johansson S, Rigby ML, Keeton BR, Daubeney PE. Total Anomalous Pulmonary Venous Connection. Circulation 2010; 122:2718-26. [DOI: 10.1161/circulationaha.110.940825] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Late mortality after repair of total anomalous pulmonary venous connection is frequently associated with pulmonary venous obstruction (PVO). We aimed to describe the morphological spectrum of total anomalous pulmonary venous connection and identify risk factors for death and postoperative PVO.
Methods and Results—
We conducted a retrospective, international, collaborative, population-based study involving all 19 pediatric cardiac centers in the United Kingdom, Ireland, and Sweden. All infants with total anomalous pulmonary venous connection born between 1998 and 2004 were identified. Cases with functionally univentricular circulations or atrial isomerism were excluded. All available data and imaging were reviewed. Of 422 live-born cases, 205 (48.6%) had supracardiac, 110 (26.1%) had infracardiac, 67 (15.9%) had cardiac, and 37 (8.8%) had mixed connections. There were 2 cases (0.5%) of common pulmonary vein atresia. Some patients had extremely hypoplastic veins or, rarely, discrete stenosis of the individual veins. Sixty (14.2%) had associated cardiac anomalies. Sixteen died before intervention. Three-year survival for surgically treated patients was 85.2% (95% confidence interval 81.3% to 88.4%). Risk factors for death in multivariable analysis comprised earlier age at surgery, hypoplastic/stenotic pulmonary veins, associated complex cardiac lesions, postoperative pulmonary hypertension, and postoperative PVO. Sixty (14.8%) of the 406 patients undergoing total anomalous pulmonary venous connection repair had postoperative PVO that required reintervention. Three-year survival after initial surgery for patients with postoperative PVO was 58.7% (95% confidence interval 46.2% to 69.2%). Risk factors for postoperative PVO comprised preoperative hypoplastic/stenotic pulmonary veins and absence of a common confluence.
Conclusions—
Preoperative clinical and morphological features are important risk factors for postoperative PVO and survival.
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Affiliation(s)
- Anna N. Seale
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Hideki Uemura
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Steven A. Webber
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - John Partridge
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Michael Roughton
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Siew Y. Ho
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Karen P. McCarthy
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Sheila Jones
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Lynda Shaughnessy
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Jan Sunnegardh
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Katarina Hanseus
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Hakan Berggren
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Sune Johansson
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Michael L. Rigby
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Barry R. Keeton
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
| | - Piers E.F. Daubeney
- From the Royal Brompton Hospital (A.N.S., H.U., J.P., M.R., S.Y.H., K.P.M., S.J., L.S., M.L.R., P.E.F.D.) London, United Kingdom; National Heart and Lung Institute (A.N.S., H.U., S.Y.H., K.P.M., P.E.F.D.), Imperial College, London, United Kingdom; Queen Charlotte's and Chelsea Hospital (A.N.S.), London, United Kingdom; Children's Hospital of Pittsburgh (S.A.W.), Pittsburgh, Pa; Queen Silvia Children's Hospital (J.S., H.B.), Gothenburg, Sweden; Lund University Hospital (K.H., S.J.), Lund, Sweden; and
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Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:93-111. [PMID: 20205158 DOI: 10.1002/uog.7622] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The human fetal venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise.
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Affiliation(s)
- S Yagel
- Obstetrics and Gynecology Ultrasound Center, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Kuehl K, Loffredo C, Lammer EJ, Iovannisci DM, Shaw GM. Association of congenital cardiovascular malformations with 33 single nucleotide polymorphisms of selected cardiovascular disease-related genes. ACTA ACUST UNITED AC 2010; 88:101-10. [PMID: 19764075 DOI: 10.1002/bdra.20630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Clark (1996) proposed that abnormal blood flow is related to some congenital cardiovascular malformations (CCVMs), particularly CCVM with obstruction to blood flow. Our hypothesis is that CCVMs may relate to genes that affect blood coagulation or flow. We studied whether polymorphisms of such genes are related to CCVMs; previous association of these SNPs to conotruncal CCVMs is described. METHODS We assessed risk of pulmonary stenosis (PS, N = 120), atrial septal defect (ASD, N = 108), aortic stenosis (AS, N = 36), and coarctation of the aorta (CoAo, N = 64), associated with 33 candidate genes, selected for their relationship to blood flow affected by homocysteine metabolism, coagulation, cell-cell interaction, inflammation, or blood pressure regulation. RESULTS Effects were specific to cardiac phenotype and race. CoAo was associated with MTHFR (-667) C>T (odds ratio [OR] for TT 3.5, 95% confidence limits [CI] 1.4-8.6). AS was associated with a polymorphism of SERPINE1, G5>G4, OR = 5.6 for the homozygote with 95% CI 1.4-22.9. Unique polymorphisms were associated with increased risk of ASD and PS: NPPA 664G>A with ASD (OR of 2.4, 95%CI 1.3-4.4) and NOS3 (-690) C>T with PS (OR 6.1; 95% CI 1.6-22.6 in the African American population only). For ASD, the NPPA (-664) G>A SNP there was increased risk from the variant genotype only in maternal smokers (OR 2.6; 95% CI 1.0-7.2). CONCLUSIONS Genes affecting vascular function and coagulation appear to be promising candidates for the etiology of cardiac malformations and warrant further study.
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Affiliation(s)
- Karen Kuehl
- Children's National Heart Institute, Washington, DC 20010, USA.
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Bleyl SB, Saijoh Y, Bax NAM, Gittenberger-de Groot AC, Wisse LJ, Chapman SC, Hunter J, Shiratori H, Hamada H, Yamada S, Shiota K, Klewer SE, Leppert MF, Schoenwolf GC. Dysregulation of the PDGFRA gene causes inflow tract anomalies including TAPVR: integrating evidence from human genetics and model organisms. Hum Mol Genet 2010; 19:1286-301. [PMID: 20071345 DOI: 10.1093/hmg/ddq005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR) is a congenital heart defect inherited via complex genetic and/or environmental factors. We report detailed mapping in extended TAPVR kindreds and mutation analysis in TAPVR patients that implicate the PDGFRA gene in the development of TAPVR. Gene expression studies in mouse and chick embryos for both the Pdgfra receptor and its ligand Pdgf-a show temporal and spatial patterns consistent with a role in pulmonary vein (PV) development. We used an in ovo function blocking assay in chick and a conditional knockout approach in mouse to knock down Pdgfra expression in the developing venous pole during the period of PV formation. We observed that loss of PDGFRA function in both organisms causes TAPVR with low penetrance (approximately 7%) reminiscent of that observed in our human TAPVR kindreds. Intermediate inflow tract anomalies occurred in a higher percentage of embryos (approximately 30%), suggesting that TAPVR occurs at one end of a spectrum of defects. We show that the anomalous pulmonary venous connection seen in chick and mouse is highly similar to TAPVR discovered in an abnormal early stage embryo from the Kyoto human embryo collection. Whereas the embryology of the normal venous pole and PV is becoming understood, little is known about the embryogenesis or molecular pathogenesis of TAPVR. These models of TAPVR provide important insight into the pathogenesis of PV defects. Taken together, these data from human genetics and animal models support a role for PDGF-signaling in normal PV development, and in the pathogenesis of TAPVR.
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Affiliation(s)
- Steven B Bleyl
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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Shaheen F, Gojwari TA, Andrabi M, Sofi S, Singh M. 64-slice CT imaging in a case of total anomalous pulmonary venous circulation. Indian J Radiol Imaging 2009; 19:54-6. [PMID: 19774141 PMCID: PMC2747419 DOI: 10.4103/0971-3026.45346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For long, catheter angiography has been the investigation of choice for the diagnosis of congenital anomalies of the heart such as total anomalous pulmonary venous circulation (TAPVC). In the last few years, MRI and multislice CT scan have also been introduced for this purpose. We report a case where 64-slice CT scan was found very useful in the evaluation of TAPVC.
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Badi I, Cinquetti R, Frascoli M, Parolini C, Chiesa G, Taramelli R, Acquati F. Intracellular ANKRD1 protein levels are regulated by 26S proteasome-mediated degradation. FEBS Lett 2009; 583:2486-92. [PMID: 19589340 DOI: 10.1016/j.febslet.2009.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 06/29/2009] [Accepted: 07/01/2009] [Indexed: 12/01/2022]
Abstract
The ANKRD1/CARP gene encodes a muscle-specific protein which has been implicated in transcriptional regulation and myofibrillar assembly. Several features at both the mRNA and protein levels define ANKRD1 as a gene whose expression is tightly regulated, and deregulated expression of this protein has been recently associated to human congenital heart disease. It is therefore crucial to define the intracellular pathways that regulate the ANKRD1 protein's steady-state levels. Here, we show that ANKRD1 is a short-lived protein whose levels are tightly regulated by the 26S proteasome. In addition, a critical role for a putative PEST motif was established, although other degrons within the ANKRD1 protein are likely implicated in the control of its intracellular levels.
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Affiliation(s)
- Ileana Badi
- Dipartimento di Biotecnologie e Scienze Molecolari, Università degli Studi dell'Insubria, Varese, Italy
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Modi A, Vohra HA, Brown I, Langley SM. Successful surgical correction of total anomalous pulmonary venous drainage in the sixth decade. Ann Thorac Surg 2008; 86:1684-6. [PMID: 19049779 DOI: 10.1016/j.athoracsur.2008.04.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 03/08/2008] [Accepted: 04/25/2008] [Indexed: 11/25/2022]
Abstract
We report an unusual case of total anomalous pulmonary venous drainage (TAPVD), who was successfully treated by surgery at the age of 56 years. We believe that this is the oldest person in the English literature to undergo surgical correction of TAPVD. The pathophysiology and factors for prolonged survival are further discussed.
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Affiliation(s)
- Amit Modi
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, United Kingdom
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Wigle DT, Arbuckle TE, Turner MC, Bérubé A, Yang Q, Liu S, Krewski D. Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2008; 11:373-517. [PMID: 18074303 DOI: 10.1080/10937400801921320] [Citation(s) in RCA: 281] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.
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Affiliation(s)
- Donald T Wigle
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada.
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Cinquetti R, Badi I, Campione M, Bortoletto E, Chiesa G, Parolini C, Camesasca C, Russo A, Taramelli R, Acquati F. Transcriptional deregulation and a missense mutation define ANKRD1 as a candidate gene for total anomalous pulmonary venous return. Hum Mutat 2008; 29:468-74. [PMID: 18273862 DOI: 10.1002/humu.20711] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Total anomalous pulmonary venous return (TAPVR) is a congenital heart defect in which the pulmonary veins fail to enter the left atrium and drain instead into the right atrium or one of its venous tributaries. Although a genetic basis for TAPVR has long been recognized, no single gene involved in the pathogenesis of this disease has been identified to date. We previously reported a TAPVR patient bearing a de novo 10;21 balanced translocation. In this work, we cloned both translocation breakpoints from this patient and mapped the ANKRD1 gene, encoding a cardiac transcriptional regulator, 130 kb proximally to the breakpoint on chromosome 10. In situ hybridization analysis performed on murine embryos showed ANKRD1 expression in the developing pulmonary veins, suggesting a possible role for this gene in TAPVR pathogenesis. Moreover, ANKRD1 expression levels were found to be highly increased in lymphoblastoid cell lines derived from both the translocation-bearing proband and a second independent sporadic TAPVR patient, suggesting that disruption of the normal ANKRD1 expression pattern is associated with TAPVR. Finally, a nonconservative missense mutation in the ANKRD1 gene was found in a third sporadic TAPVR patient. In vitro calpain-mediated degradation assays, coupled to reporter gene analysis in transfected HeLa cells, strongly suggested that this mutation enhances both the stability of the ANKRD1/CARP protein and its transcriptional repression activity upon the cardiac-specific atrial natriuretic factor (ANF) promoter. Taken together, these results define ANKRD1 as a possible candidate gene for TAPVR pathogenesis.
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Affiliation(s)
- Raffaella Cinquetti
- Department of Biotechnology and Molecular Sciences, University of Insubria, Varese, Italy
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Volpe P, Campobasso G, De Robertis V, Di Paolo S, Caruso G, Stanziano A, Volpe N, Gentile M. Two- and four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation in prenatal diagnosis of isolated total anomalous pulmonary venous connection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:830-7. [PMID: 17914751 DOI: 10.1002/uog.5145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To explore whether the use of four dimensional (4D) ultrasound examination with B-flow imaging and spatiotemporal image correlation (STIC) can supply additional information with respect to two-dimensional (2D) gray-scale and color Doppler echocardiography in the prenatal characterization of isolated total anomalous pulmonary venous connection (TAPVC). METHODS The study population comprised a group of three TAPVC fetuses that had been examined exclusively by conventional echocardiography, and a group of four additional cases initially identified by conventional echocardiography and examined further by 4D ultrasonography; a thorough postnatal work-up was available for all fetuses. RESULTS At our center, isolated TAPVC was found in seven of 1040 fetuses with cardiac defects (0.67%). Anomalous drainage was supracardiac to the innominate vein in three cases, cardiac to the coronary sinus in two, and infracardiac to the portal vein in the remaining two cases. An evident asymmetry between left heart and right heart structures was observed in 4/7 cases. The confluence of the anomalous pulmonary veins (PVs) was visualized in 4/7 cases and the connecting vertical vein was identified in 3/5 cases at 2D echocardiography. 4D ultrasound imaging with B-flow imaging and STIC clearly visualized the anomalous PV confluence and the draining vertical vein in all four cases examined. CONCLUSION 2D and color Doppler echocardiography appears to diagnose reliably TAPVC, albeit with some limitations in thorough assessment of the pathology, depending on the anatomy of the defect, on the technical adequacy of the equipment used and on the experience of the operator. 4D ultrasound examination with B-flow imaging and STIC is apparently able to facilitate identification of the anatomical features of TAPVC, thus supplying additional information over that provided by 2D fetal sonography.
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Affiliation(s)
- P Volpe
- Department of Obstetrics and Gynecology, Hospital Di Venere, Bari, Italy.
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Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL. Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation 2007; 115:2995-3014. [PMID: 17519397 DOI: 10.1161/circulationaha.106.183216] [Citation(s) in RCA: 532] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prevention of congenital cardiovascular defects has been hampered by a lack of information about modifiable risk factors for abnormalities in cardiac development. Over the past decade, there have been major breakthroughs in the understanding of inherited causes of congenital heart disease, including the identification of specific genetic abnormalities for some types of malformations. Although relatively less information has been available on noninherited modifiable factors that may have an adverse effect on the fetal heart, there is a growing body of epidemiological literature on this topic. This statement summarizes the currently available literature on potential fetal exposures that might alter risk for cardiovascular defects. Information is summarized for periconceptional multivitamin or folic acid intake, which may reduce the risk of cardiac disease in the fetus, and for additional types of potential exposures that may increase the risk, including maternal illnesses, maternal therapeutic and nontherapeutic drug exposures, environmental exposures, and paternal exposures. Information is highlighted regarding definitive risk factors such as maternal rubella; phenylketonuria; pregestational diabetes; exposure to thalidomide, vitamin A cogeners, or retinoids; and indomethacin tocolysis. Caveats regarding interpretation of possible exposure-outcome relationships from case-control studies are given because this type of study has provided most of the available information. Guidelines for prospective parents that could reduce the likelihood that their child will have a major cardiac malformation are given. Issues related to pregnancy monitoring are discussed. Knowledge gaps and future sources of new information on risk factors are described.
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Abstract
Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect in which there is no connection between the pulmonary veins and the left atrium. An anomalous connection is established that allows the pulmonary veins to deliver pulmonary venous blood to the right side of the heart rather than to the left side. A patent foramen ovale or an atrial septal defect develops in utero, allowing a right-to-left shunting of blood without which the infant would die. This article describes normal embryology, abnormal embryology that results in TAPVC, types of anomalous connections, how TAPVC is diagnosed, surgical correction, and nursing interventions when caring for patients with TAPVC and dealing with the concerns of their family members.
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Correa A, Min YI, Stewart PA, Lees PSJ, Breysse P, Dosemeci M, Jackson LW. Inter-rater agreement of assessed prenatal maternal occupational exposures to lead. ACTA ACUST UNITED AC 2007; 76:811-24. [PMID: 17044050 DOI: 10.1002/bdra.20311] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Industrial hygienists' assessments of prenatal occupational exposures based on parental job histories is a promising approach for population-based case-control studies of birth defects and other perinatal outcomes. However, evaluations of inter-rater agreement of such assessments have been limited. METHODS We examined inter-rater agreement of occupational lead exposure assessments of maternal job reports by industrial hygienists in a population-based case-control study of parental occupational lead exposure and low birth weight. A total of 178 jobs with potential exposure to lead during the 6 months before pregnancy to the end of pregnancy were examined. Three industrial hygienists evaluated these jobs independently for exposure to lead including probability of exposure, type of exposure, route of entry, exposure frequency, duration, and intensity. Inter-rater agreement of these assessments beyond chance was evaluated using the kappa statistic (kappa). RESULTS In general, inter-rater agreement was greater for assessment of direct exposures than assessment of indirect exposures. However, inter-rater agreement varied with the lead exposure metric under consideration, being: 1) fair to good for type of direct exposure (i.e., inorganic or organic), respiratory exposure and frequency of exposure to direct inorganic lead, hours per day of direct (i.e., inorganic or organic), and intensity of direct inorganic exposure; 2) poor for probability and type of indirect exposure (inorganic or organic); and 3) indeterminate for frequency of direct organic exposure, frequency of indirect exposures (organic or inorganic), and intensity of direct exposures (organic or inorganic). CONCLUSION Retrospective assessment of maternal prenatal exposures to lead by industrial hygienists can provide some reliable metrics of exposure for studies of perinatal outcomes. Reliability studies of such exposure assessments may be useful for: quantifying the reliability of derived exposure metrics; identifying exposure metrics for exposure-outcome analyses; and determining the reliability of prenatal occupational exposures to other agents of interest.
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Affiliation(s)
- Adolfo Correa
- Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA.
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Weselak M, Arbuckle TE, Foster W. Pesticide exposures and developmental outcomes: the epidemiological evidence. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2007; 10:41-80. [PMID: 18074304 DOI: 10.1080/10937400601034571] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Since the advent of DDT as an insecticide in the late 1930s, billions of kilograms of pesticide active ingredient have been sold in North America and around the world. In recent years, there has been a heightened public awareness of pesticides and child health and a number of epidemiologic studies linked pre- and postnatal exposures to pesticides to a number of adverse developmental outcomes, including fetal death, intrauterine growth restriction, preterm birth, and birth defects. Given this, it was felt prudent to critically appraise the evidence for periconceptual pesticide exposures and developmental outcomes. The epidemiological evidence for specific pesticide classes, families, and active ingredients were examined and summarized and recommendations were made for how to improve future studies in order to address the current pitfalls and gaps in the studies in this area. Many of the studies suffered from poor exposure estimation, relying on job title only and/or the exposure category "any pesticide" as a measure of exposure, and there was limited or inadequate evidence to support causality for all associations examined.
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Affiliation(s)
- M Weselak
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontaria.
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Bretveld RW, Thomas CMG, Scheepers PTJ, Zielhuis GA, Roeleveld N. Pesticide exposure: the hormonal function of the female reproductive system disrupted? Reprod Biol Endocrinol 2006; 4:30. [PMID: 16737536 PMCID: PMC1524969 DOI: 10.1186/1477-7827-4-30] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 05/31/2006] [Indexed: 11/24/2022] Open
Abstract
Some pesticides may interfere with the female hormonal function, which may lead to negative effects on the reproductive system through disruption of the hormonal balance necessary for proper functioning. Previous studies primarily focused on interference with the estrogen and/or androgen receptor, but the hormonal function may be disrupted in many more ways through pesticide exposure. The aim of this review is to give an overview of the various ways in which pesticides may disrupt the hormonal function of the female reproductive system and in particular the ovarian cycle. Disruption can occur in all stages of hormonal regulation: 1. hormone synthesis; 2. hormone release and storage; 3. hormone transport and clearance; 4. hormone receptor recognition and binding; 5. hormone postreceptor activation; 6. the thyroid function; and 7. the central nervous system. These mechanisms are described for effects of pesticide exposure in vitro and on experimental animals in vivo. For the latter, potential effects of endocrine disrupting pesticides on the female reproductive system, i.e. modulation of hormone concentrations, ovarian cycle irregularities, and impaired fertility, are also reviewed. In epidemiological studies, exposure to pesticides has been associated with menstrual cycle disturbances, reduced fertility, prolonged time-to-pregnancy, spontaneous abortion, stillbirths, and developmental defects, which may or may not be due to disruption of the female hormonal function. Because pesticides comprise a large number of distinct substances with dissimilar structures and diverse toxicity, it is most likely that several of the above-mentioned mechanisms are involved in the pathophysiological pathways explaining the role of pesticide exposure in ovarian cycle disturbances, ultimately leading to fertility problems and other reproductive effects. In future research, information on the ways in which pesticides may disrupt the hormonal function as described in this review, can be used to generate specific hypotheses for studies on the effects of pesticides on the ovarian cycle, both in toxicological and epidemiological settings.
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Affiliation(s)
- Reini W Bretveld
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Chris MG Thomas
- Chemical Endocrinology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Paul TJ Scheepers
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Gerhard A Zielhuis
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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