1
|
Akhtar S, Wasif M, Afzal Y, Shahab I, Dhanani R, Shaikh AR. Syndromic Piere Robbin Sequence- A Rare Presentation in Association with Multiple Heart Defects and Type III Stickler Syndrome. Indian J Otolaryngol Head Neck Surg 2024; 76:1325-1327. [PMID: 38440550 PMCID: PMC10909042 DOI: 10.1007/s12070-023-04307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 03/06/2024] Open
Abstract
Pierre Robin Sequence (PRS), a rare congenital disorder, is a triad of micrognathia, glossoptosis, and tongue based airway obstruction (TBSO). It may occur as isolated anomaly (iPRS) or as a part of a syndrome (sPRS), like that seen in association with Stickler Syndrome. Approximately 20% of children with PRS have congenital heart diseases. To the best of our knowledge this case of a one-day old infant is the first one to be reported as having two heart defects; patent ductus arteriosus and patent foramen ovale in Pierre Robbin Sequence child.
Collapse
Affiliation(s)
| | | | - Yumna Afzal
- Dr Ziauddin University hospital, Karachi, Pakistan
| | - Iqra Shahab
- Dr Ziauddin University hospital, Karachi, Pakistan
| | | | | |
Collapse
|
2
|
Eerdekens GJ, Van Beersel D, Rex S, Gewillig M, Schrijvers A, Al Tmimi L. The patient with congenital heart disease in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:421-436. [PMID: 37938087 DOI: 10.1016/j.bpa.2022.11.006] [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: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
The number of patients with congenital heart disease (CHD) undergoing ambulatory surgery is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists' Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator. Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.
Collapse
Affiliation(s)
- Gert-Jan Eerdekens
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Dieter Van Beersel
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - An Schrijvers
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Layth Al Tmimi
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
| |
Collapse
|
3
|
Pierre Robin sequence: A comprehensive narrative review of the literature over time. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:419-428. [DOI: 10.1016/j.jormas.2018.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022]
|
4
|
Logjes RJH, Haasnoot M, Lemmers PMA, Nicolaije MFA, van den Boogaard MJH, Mink van der Molen AB, Breugem CC. Mortality in Robin sequence: identification of risk factors. Eur J Pediatr 2018; 177:781-789. [PMID: 29492661 PMCID: PMC5899115 DOI: 10.1007/s00431-018-3111-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED Although Robin sequence (RS) is a well-known phenomenon, it is still associated with considerable morbidity and even mortality. The purposes of this study were to gain greater insight into the mortality rate and identify risk factors associated with mortality in RS. We retrospectively reviewed all RS infants followed at the Wilhelmina Children's Hospital from 1995 to 2016. Outcome measurements were death and causes of death. The authors identified 103 consecutive RS infants with a median follow-up of 8.6 years (range 0.1-21.9 years). Ten of the 103 infants (10%) died at a median age of 0.8 years (range 0.1-5.9 years). Nine of these ten infants (90%) were diagnosed with an associated syndrome. Of these, seven infants died of respiratory insufficiency due to various causes (two related to upper airway obstruction). The other two syndromic RS infants died of arrhythmia due to hypernatremia and of West syndrome with status epilepticus. One isolated RS infant died of brain ischemia after MDO surgery. Cardiac anomalies were observed in 41% and neurological anomalies in 36%. The presence of a neurological anomaly was associated with a mortality rate of 40% versus 7% in infants with no neurological anomaly (p = 0.016), with an odds ratio of 8.3 (95% CI 1.4-49.0) for neurological anomaly versus no neurological anomaly. Mortality was 15% in infants with syndromic RS versus 2% in infants with isolated RS (p = 0.044). Mortality was not significantly associated with the presence of a cardiac anomaly, surgical treatment for severe respiratory distress in the neonatal period, or prematurity. CONCLUSION RS represents a heterogeneous patient population and is associated with a high level of underlying syndromes. The present study reports a mortality rate of 10% significantly associated with syndromic RS and the presence of neurological anomalies. A multidisciplinary approach in all infants born with RS, including genetic testing and examination of neurological anomalies in a standardized way, is crucial to identify infants with underlying syndromes potentially associated with increased mortality. What is Known: • Reported mortality rates in Robin sequence vary from 2% to 26%. • Clinicians mainly focus on the morbidity of Robin sequence that includes respiratory complications due to upper airway obstruction in the period after birth. • Robin sequence represents a heterogeneous patient population and is associated with a high level of underlying syndromes. What is New: • The present study reports a mortality rate of 10% significantly associated with syndromic Robin sequence and the presence of neurological anomalies. • A multidisciplinary approach in all infants born with Robin sequence, including genetic evaluation and standardized workup for neurological anomalies, is crucial to identify infants with underlying syndromes potentially associated with increased mortality.
Collapse
Affiliation(s)
- Robrecht J. H. Logjes
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Maartje Haasnoot
- Department of Pediatrics, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Petra M. A. Lemmers
- Department of Pediatrics, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Mike F. A. Nicolaije
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Marie-José H. van den Boogaard
- Department of Clinical Genetics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Aebele B. Mink van der Molen
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| |
Collapse
|
5
|
Fitz-James Antoine I, Carullo V, Hernandez CK, Tepper O. Anatomic Approach to Airway Management of the Syndromic Child. Int Anesthesiol Clin 2016; 55:52-64. [PMID: 27941366 DOI: 10.1097/aia.0000000000000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ingrid Fitz-James Antoine
- *Department of Anesthesiology, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York †Department of Plastic Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
| | | | | | | |
Collapse
|
6
|
Andrews S, Sam M, Krishnan R, Ramesh M, Kunjappan SM. Surgical management of a large cleft palate in a Pierre Robin sequence: A case report and review of literature. J Pharm Bioallied Sci 2015; 7:S718-20. [PMID: 26538951 PMCID: PMC4606693 DOI: 10.4103/0975-7406.163498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pierre Robin syndrome or Pierre Robin sequence (PRS) is a congenital etiologically heterogeneous condition presenting with various malformations. Here we are reporting the surgical management of an 18-month-old female baby who was referred from Department of Pediatrics with a complaint of a large cleft palate. She was taken up for palatoplasty with consent for elective tracheostomy. After genetic evaluation, the authors conclude that the presented case was a PRS in isolation with mild cardiac anomalies and an inferiorly placed hypoplastic epiglottis. Patient should be followed up and growth modifications of the jaws should be done.
Collapse
Affiliation(s)
- Sherry Andrews
- Department of Oral and Maxillofacial Surgery, Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia
| | - Mathew Sam
- Department of Oral and Maxillofacial Surgery, Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia
| | - Ramesh Krishnan
- Department of Pedodontics, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India
| | - Maya Ramesh
- Department of Oral Pathology, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India
| | - Shiji M Kunjappan
- Department of Orthodontics, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India
| |
Collapse
|
7
|
|
8
|
Aypar E, Sert A, Gokmen Z, Aslan E, Odabas D. Isolated left ventricular noncompaction in a newborn with Pierre-Robin sequence. Pediatr Cardiol 2013; 34:452-4. [PMID: 22447382 DOI: 10.1007/s00246-012-0294-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/29/2012] [Indexed: 11/29/2022]
Abstract
Pierre-Robin sequence or syndrome (PRS) (OMIM #261800) is characterized by a small mandible (micrognathia), posterior displacement/retraction of the tongue (glossoptosis), and upper airway obstruction. It has an incidence varying from 1 in 8,500 to 1 in 30,000 births. Congenital heart defects (CHDs) occur in 20 % of the patients with PRS. Ventricular septal defect, patent ductus arteriosus, and atrial septal defects are the most common lesions. Noncompaction of the ventricular myocardium is a rare cardiomyopathy characterized by a pattern of prominent trabecular meshwork and deep intertrabecular recesses. It is thought to be caused by arrest of the normal endomyocardial morphogenesis. Isolated left ventricular noncompaction (LVNC) in patients with PRS has not been reported previously. This report describes a newborn with PRS and isolated LVNC. Previously, LVNC has been reported in association with mitochondrial disorders, Barth syndrome hypertrophic cardiomyopathy, zaspopathy, muscular dystrophy type 1, 1p36 deletion, Turner syndrome, Ohtahara syndrome, distal 5q deletion, mosaic trisomy 22, trisomy 13, DiGeorge syndrome, and 1q43 deletion with decreasing frequency. Karyotype analysis of the reported patient showed normal chromosomes (46, XX), and a fluorescent in situ hybridization study did not show chromosome 22q11.2 deletion. This is the first clinical report of a patient with isolated LVNC and PRS. Noncompaction of the ventricular myocardium is a rare and unique disorder with characteristic morphologic features that can be identified by echocardiography. Long-term follow-up evaluation for development of progressive LV dysfunction and cardiac arrhythmias is indicated for these patients.
Collapse
Affiliation(s)
- Ebru Aypar
- Department of Pediatric Cardiology, Konya Training and Research Hospital, Meram yeniyol street, 42080 Konya, Turkey.
| | | | | | | | | |
Collapse
|
9
|
Berry JG, Graham RJ, Roberson DW, Rhein L, Graham DA, Zhou J, O’Brien J, Putney H, Goldmann DA. Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child 2010; 95:703-10. [PMID: 20522454 PMCID: PMC3118570 DOI: 10.1136/adc.2009.180836] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify children at risk for in-hospital mortality following tracheotomy. DESIGN Retrospective cohort study. SETTING 25 746 876 US hospitalisations for children within the Kids' Inpatient Database 1997, 2000, 2003 and 2006. PARTICIPANTS 18 806 hospitalisations of children ages 0-18 years undergoing tracheotomy, identified from ICD-9-CM tracheotomy procedure codes. MAIN OUTCOME MEASURE Mortality during the initial hospitalisation when tracheotomy was performed in relation to patient demographic and clinical characteristics (neuromuscular impairment (NI), chronic lung disease, upper airway anomaly, prematurity, congenital heart disease, upper airway infection and trauma) identified with ICD-9-CM codes. RESULTS Between 1997 and 2006, mortality following tracheotomy ranged from 7.7% to 8.5%. In each year, higher mortality was observed in children undergoing tracheotomy who were aged <1 year compared with children aged 1-4 years (mortality range: 10.2-13.1% vs 1.1-4.2%); in children with congenital heart disease, compared with children without congenital heart disease (13.1-18.7% vs 6.2-7.1%) and in children with prematurity, compared with children who were not premature (13.0-19.4% vs 6.8-7.3%). Lower mortality was observed in children with an upper airway anomaly compared with children without an upper airway anomaly (1.5-5.1% vs 9.1-10.3%). In 2006, the highest mortality (40.0%) was observed in premature children with NI and congenital heart disease, who did not have an upper airway anomaly. CONCLUSIONS Congenital heart disease, prematurity, the absence of an upper airway anomaly and age <1 year were characteristics associated with higher mortality in children following tracheotomy. These findings may assist provider communication with children and families regarding early prognosis following tracheotomy.
Collapse
Affiliation(s)
| | - Robert J Graham
- Division of Critical Care Medicine, Children’s Hospital, Boston, Massachusetts, USA
| | - David W Roberson
- Program for Patient Safety and Quality, Children’s Hospital, Boston, Massachusetts, USA, Department of Otolaryngology and Communication Enhancement, Children’s Hospital, Boston, Massachusetts, USA
| | - Lawrence Rhein
- Division of Newborn Medicine and Division of Respiratory Diseases, Children’s Hospital, Boston, Massachusetts, USA
| | - Dionne A Graham
- Clinical Research Program, Children’s Hospital, Boston, Massachusetts, USA
| | - Jing Zhou
- Clinical Research Program, Children’s Hospital, Boston, Massachusetts, USA
| | - Jane O’Brien
- Complex Care Service, Division of General Pediatrics, Children’s Hospital, Boston, Massachusetts, USA
| | - Heather Putney
- Institute for Community Inclusion, Boston, Massachusetts, USA
| | - Donald A Goldmann
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA, Division of Infectious Diseases and Pediatric Health Services Research, Children’s Hospital, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Management of difficult airway in pediatric patients with right ventricular outflow tract obstruction. J Anesth 2009; 23:281-3. [PMID: 19444572 DOI: 10.1007/s00540-008-0729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 12/07/2008] [Indexed: 10/20/2022]
Abstract
We present two cases of difficult airway management for patients with Pierre Robin syndrome and right ventricular outflow tract obstruction in infants. To prevent the exacerbation of right ventricular outflow tract obstruction, adequate oxygenation and ventilation are mandatory in this population. This rule needs to be followed even while dealing with a difficult airway. Depending on the prediction of mask ventilation capability, we took two different approaches to difficult airway. In the first case, we fiberoptically intubated the patient while allowing him to breathe spontaneously with the aid of a nasopharyngeal airway under deep sedation. In the second case, we fiberoptically intubated the patient through a laryngeal mask airway while controlling ventilation. Through both cases, we highlight options of difficult airway management in the pediatric population. Although we can approach a difficult airway with or without spontaneous breathing, the important point is how we will prepare the methods to oxygenate and ventilate patients throughout the procedure. Patients with difficult airway and right ventricular outflow tract obstruction are good examples to make us realize this point.
Collapse
|
11
|
Waters ET, Oberman JP, Biswas AK. Pierre Robin sequence and double aortic arch: a case report. Int J Pediatr Otorhinolaryngol 2005; 69:105-10. [PMID: 15627457 DOI: 10.1016/j.ijporl.2004.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2004] [Revised: 07/16/2004] [Accepted: 07/17/2004] [Indexed: 10/26/2022]
Abstract
We present an 8-day-old female with two admissions for respiratory failure. On the first admission, the diagnosis of Pierre Robin sequence (PRS) and laryngomalacia was made after assessment with chest radiography, echocardiography, and flexible fiberoptic laryngoscopy. Four days after discharge, the child presented with stridor and respiratory distress, and a new cardiac murmur was noted after admission. Repeat echocardiography, with confirmatory direct laryngobronchoscopy, revealed a double aortic arch (DAA) with distal tracheal compression. This case illustrates the necessity of a complete otolaryngic evaluation, including direct laryngobronchoscopy, to search for a synchronous airway lesion in any neonate with severe respiratory distress associated with stridor.
Collapse
Affiliation(s)
- Edward T Waters
- Department of Pediatrics, Naval Hospital Beaufort, One Pinckney Blvd., Beaufort, SC 29902, USA.
| | | | | |
Collapse
|
12
|
Goldberg R, Motzkin B, Marion R, Scambler PJ, Shprintzen RJ. Velo-cardio-facial syndrome: a review of 120 patients. AMERICAN JOURNAL OF MEDICAL GENETICS 1993; 45:313-9. [PMID: 8434617 DOI: 10.1002/ajmg.1320450307] [Citation(s) in RCA: 313] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A series of earlier reports has described the velo-cardio-facial syndrome (VCFS), a syndrome of multiple anomalies including cleft palate, heart malformations, facial characteristics, and learning disabilities. The patients reported previously were primarily ascertained from a craniofacial program at a large tertiary medical center. Recent reports, including a companion paper in this issue, suggest that this common syndrome of clefting is also a common syndrome of congenital heart defect (CHD) which is expressed as familial examples of DiGeorge sequence. Appreciation of more severely affected cases of VCFS and the detection of mild expressions have led to a broadening of the phenotypic spectrum of the syndrome. The purpose of this report is to describe the full spectrum of VCFS, including several new manifestations and to compare the VCFS phenotype with published cases of "familial DiGeorge sequence" which are now thought to represent examples of VCFS.
Collapse
Affiliation(s)
- R Goldberg
- Department of Plastic Surgery, Montefiore Medical Center, Bronx, NY 10467
| | | | | | | | | |
Collapse
|
13
|
Abstract
Robin sequence is now understood to be a grouping of clinical findings that does not represent a distinct multiple anomaly syndrome. Previously known as the "Pierre Robin syndrome," this fairly common association of micrognathia with cleft palate and upper airway obstruction was initially thought to be a specific disease, and entire treatment regimens were established to deal with presumed problems. Until recently, the management of Robin has not been excellent and mortality has been high. It is only a better understanding of the basic mechanisms leading to this sequence that has resulted in better care. This article reviews the history of the delineation of Robin sequence and how the perception of Robin has led directly to management decisions.
Collapse
Affiliation(s)
- V L Sadewitz
- Center for Craniofacial Disorders, Montefiore Medical Center, Bronx, NY 10467
| |
Collapse
|
14
|
Abstract
Eight patients (aged 8 to 22 years) with the Pierre Robin syndrome underwent sleep studies. Seven demonstrated significant although minor degrees of increased sleep disturbances and apneas, and less time spent in the rapid-eye-movement (REM) stage of sleep. One patient who had previously undergone mandibular corrective surgery had major sleep abnormalities (central apnea index of 81.7 although an obstructive sleep apnea index of only 1.9). The patients had small mandibles, as demonstrated by lateral cephalometric roentgenography, and mildly increased right ventricular diastolic dimensions, as shown by M-mode echocardiography. Snoring was present in all of these patients and in 13 of 22 patients questioned from our Pierre Robin clinic. We conclude that minor abnormalities in sleep, mandibular size, and right ventricular size persist well into adolescence in the majority of patients with Pierre Robin syndrome. These appear to be clinically insignificant; however, a small percentage of such patients may continue to have major sleep disturbances.
Collapse
|