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Wick M, Kliemt R, Poshtiban A, Kossack N, Diller GP, Soudani S, Bangert M, Kramer R, Damm O. Respiratory syncytial virus immunization patterns in Germany, 2015-2020. Hum Vaccin Immunother 2024; 20:2380110. [PMID: 39118394 PMCID: PMC11318726 DOI: 10.1080/21645515.2024.2380110] [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: 05/02/2024] [Revised: 06/28/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in infants and young children worldwide. Using routine statutory health insurance claims data including patients from all regions of Germany, we investigated the health-care resource use and costs associated with RSV prophylaxis with palivizumab in Germany. In the database, infants from the birth cohorts 2015-2019 eligible for palivizumab immunization were identified using codes of the 10th revision of the International Classification of Diseases (ICD-10). Health-care resource use and costs related to immunization were determined by inpatient and outpatient administrations. Over the study period, only 1.3% of infants received at least one dose of palivizumab in their first year of life. The mean number of doses per immunized infant was 4.6. From a third-party payer perspective, the mean costs of palivizumab per infant who received at least one dose in the first year of life was €5,435 in the birth cohorts 2015-2019. Despite the substantial risk of severe RSV infection, we found low rates of palivizumab utilization. Novel preventive interventions, featuring broader indications and single-dose administration per season, contribute to mitigating the burden of RSV disease across a more extensive infant population.
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Affiliation(s)
- Moritz Wick
- Evidence-based Medicine / Health Economics & Outcomes Research, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Roman Kliemt
- Health Services Research and Health Economics, WIG2 GmbH, Leipzig, Germany
| | - Anahita Poshtiban
- Evidence-based Medicine / Health Economics & Outcomes Research, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Nils Kossack
- Health Services Research and Health Economics, WIG2 GmbH, Leipzig, Germany
| | - Gerhard-Paul Diller
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
- Competence Network for Congenital Heart Defects, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Samira Soudani
- Health Economics & Value Assessment Vaccines, Sanofi Vaccines, Lyon, France
| | - Mathieu Bangert
- Health Economics & Value Assessment Vaccines, Sanofi Vaccines, Lyon, France
| | - Rolf Kramer
- Health Economics & Value Assessment Vaccines, Sanofi Vaccines, Lyon, France
| | - Oliver Damm
- Evidence-based Medicine / Health Economics & Outcomes Research, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
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Georgiev YH, Neunhoeffer F, Hofbeck M, Michel J. Assessment of accuracy of two pulse oximeters in infants with cyanotic and acyanotic congenital heart diseases. Paediatr Anaesth 2024. [PMID: 39365291 DOI: 10.1111/pan.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 09/09/2024] [Accepted: 09/23/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Peripherally measured oxygen saturation (SpO2) may often differ from arterial oxygen saturation (SaO2), measured by co-oximetry, especially within the lower range of oxygen saturations. This can potentially impact clinical decisions and therapy in children with congenital heart disease, as critical hypoxemia might remain unnoticed. AIMS Our aim was to investigate the accuracy of two different pulse oximeters compared to SaO2 in infants with congenital heart diseases. METHODS Simultaneous recordings of SpO2, measured by two different pulse oximeters (Philips IntelliVue X3 Monitor and Nellcor™ OxiMax™), were compared to SaO2 obtained by arterial blood gas analysis. RESULTS A total of 153 measurements were performed in 44 infants with arterial oxygen saturation between 70 and 100%. We divided the measurements into 3 subgroups: group 1-SaO2 70.0%-85.0%, group 2-SaO2 85.1%-94.0%, group 3-SaO2 >94.1%. For Philipps, the median bias was 5.3 (IQR: 2.6-8.7) %, 2.3 (IQR: 0.9-6.0) % and 1.1 (IQR: -0.8-2.4) % in group 1, 2 and 3, respectively. For OxiMax™, the median bias was 2.7 (IQR: 0.5-5.1) %, 0.2 (IQR: -0.9-2.6) % and -0.5 (IQR: -1.3-0.6) % in group 1, 2 and 3, respectively. Regarding the accuracy of these oximeters, as evaluated with the Accuracy root mean squared index (Arms), it was 9.8 versus 4.5% in group 1, 4.5 versus 2.9% in group 2 and 2.4 versus 1.9% in group 3 for Philipps and OxiMax™, respectively. CONCLUSIONS In lower range saturations between 70% and 85% the accuracy of both pulse oximeters exceeded the threshold of ≤3% recommended by the Food and Drug Administration (FDA). Therefore, peripheral pulse oximetry within the lower range of oxygen saturations should be interpreted with caution in infants with congenital heart diseases, taking into consideration its limitations. Direct co-oximetry should be the preferred method to support clinical decisions in children with cyanotic congenital heart diseases.
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Affiliation(s)
- Yordan Hristov Georgiev
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
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Blixenkrone-Møller E, Dannesbo S, Dehn AM, Pihl CA, Sillesen AS, Vøgg ROB, Raja AA, Colan S, Mertens L, Vejlstrup N, Bundgaard H, Iversen K. Interatrial Communications: Prevalence and Subtypes in 12,385 Newborns-a Copenhagen Baby Heart Study. Pediatr Cardiol 2024:10.1007/s00246-024-03571-0. [PMID: 39003423 DOI: 10.1007/s00246-024-03571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
The prevalence of interatrial communications in newborns, i.e., patent foramen ovale or atrial septal defect, was previously reported to be between 24 and 92%, but the area has been impeded by lack of a universal classification method. A recently published novel echocardiographic diagnostic algorithm for systematic classification of interatrial communications had inter-and intraobserver agreements superior to standard expert assessment. This study aimed to determine the prevalence of subtypes of interatrial communications on transthoracic echocardiography in newborns. Echocardiograms of newborns aged 0-30 days were prospectively collected in the population-based cohort study Copenhagen Baby Heart Study in 2017-2018 and analyzed according to the new diagnostic algorithm, classifying interatrial communications into three subtypes of patent foramen ovale and three subtypes of atrial septal defects. Echocardiograms from 15,801 newborns were analyzed; 3416 (21.6%) were excluded due to suboptimal image quality or severe structural heart disease (n = 3), leaving 12,385 newborns (aged 12 [interquartile range 8; 15] days, 48.2% female) included in the study. An interatrial communication was detected in 9766 (78.9%) newborns. According to the algorithm, 9029 (72.9%) had a patent foramen ovale, while 737 (6.0%) fulfilled criteria for an atrial septal defect, further divided into subtypes. An interatrial communication was seen on echocardiography in almost 80% of newborns aged 0-30 days. Patent foramen ovale was 12 times more frequent than atrial septal defects. The observed prevalence of atrial septal defects was higher than previously reported. Follow up studies could distinguish which interatrial communications require follow-up or intervention. ClinicalTrial.gov, NCT02753348, posted April 27, 2016, [ https://classic.clinicaltrials.gov/ct2/show/NCT02753348 ].
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Affiliation(s)
- Elisabeth Blixenkrone-Møller
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sofie Dannesbo
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anna Maria Dehn
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian A Pihl
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Steven Colan
- Department of Cardiology, Boston Children's Hospital, Boston, USA
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Niels Vejlstrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Fillies B, Stapel B, Lemke LH, Löffler F, Bauersachs J, Kahl KG, Westhoff-Bleck M. Remission from depression is associated with improved quality of life and preserved exercise capacity in adults with congenital heart disease. Front Cardiovasc Med 2024; 11:1418342. [PMID: 39022619 PMCID: PMC11251921 DOI: 10.3389/fcvm.2024.1418342] [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: 04/16/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Aims Improved long-term survival has widened the treatment goals for adults with congenital heart disease (ACHD) by addressing parameters that impact mental well-being and exercise capacity. Depression, a frequent co-morbidity in ACHD, is linked to both. Whether successful treatment of depression also affects cardiac parameters is a matter of debate. Methods This prospective, cross-sectional, longitudinal study included N = 150 ACHD (mean age 35.2 ± 11.3 years, 57% male) at baseline (t0) and N = 114 at follow-up (mean follow-up: 4.8 ± 0.6 years; t1). Patients were interviewed using a structured clinical interview, and severity of depression was assessed using the Montgomery-Asperg Depression Scale (MADRS). Additional testing was performed using self-rating questionnaires concerning depression, anxiety and quality of life (QoL). Exercise capacity (VO2max) was assessed by symptom limited exercise testing. Results Of N = 33 patients diagnosed with depression at t0, N = 18 patients remitted and N = 15 were non-remitters. Remitters displayed significantly decreased anxiety (P = 0.013), improved global QoL (P = 0.002), and preserved VO2max (P = 0.958) at t1 compared to t0. This was associated with favourable health behaviour at t1 and stable body-mass-index. Contrarily, non-remitters reported further increased anxiety (P = 0.021) and no significant improvement in QoL (P = 0.405). VO2max declined significantly (P = 0.006) and body-mass-index increased (P = 0.004). Never-depressed patients showed no significant changes in anxiety (P = 0.415) or QoL (P = 0.211). VO2max decreased significantly (P < 0.001). Conclusion In ACHD, remission from depression is associated with better physical functioning, mental health, and QoL. The assessment and treatment of depression in ACHD emerges as an important clinical goal that should be included in a comprehensive multimodal treatment plan.
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Affiliation(s)
- Brit Fillies
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Lars H. Lemke
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Janzing P, Nourkami-Tutdibi N, Tutdibi E, Freundt P, von Ostrowski T, Langer M, Zemlin M, Steinhard J. Controlled prospective study on ultrasound simulation training in fetal echocardiography: FESIM II. Arch Gynecol Obstet 2024; 309:2505-2513. [PMID: 37454353 PMCID: PMC11147821 DOI: 10.1007/s00404-023-07133-2] [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: 05/01/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To analyze the learning curves of ultrasound novices in fetal echocardiography during structured simulation-based ultrasound training (SIM-UT) including a virtual, randomly moving fetus. METHODS 11 medical students with minimal (< 10 h) prior obstetric ultrasound experience underwent 12 h of structured fetal echocardiography SIM-UT in individual hands-on sessions during a 6-week training program. Their learning progress was assessed with standardized tests after 2, 4, and 6 weeks of SIM-UT. Participants were asked to obtain 11 fetal echocardiography standard planes (in accordance with ISUOG and AHA guidelines) as quickly as possible. All tests were carried out under real life, examination-like conditions on a healthy, randomly moving fetus. Subsequently, we analyzed the rate of correctly obtained images and the total time to completion (TTC). As reference groups, 10 Ob/Gyn physicians (median of 750 previously performed Ob/Gyn scans) and 10 fetal echocardiography experts (median of 15,000 previously performed Ob/Gyn scans) were examined with the same standardized tests. RESULTS The students showed a consistent and steady improvement of their ultrasound performance during the training program. After 2 weeks, they were able to obtain > 95% of the standard planes correctly. After 6 weeks, they were significantly faster than the physician group (p < 0.001) and no longer significantly slower than the expert group (p = 0.944). CONCLUSION SIM-UT is highly effective to learn fetal echocardiography. Regarding the acquisition of the AHA/ISUOG fetal echocardiography standard planes, the students were able to reach the same skill level as the expert group within 6 weeks.
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Affiliation(s)
- Paul Janzing
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany.
| | - Nasenien Nourkami-Tutdibi
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Erol Tutdibi
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Paula Freundt
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | | | - Martin Langer
- LARA-Praxis für Frauengesundheit, Bocholt, NRW, Germany
| | - Michael Zemlin
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Johannes Steinhard
- Fetal Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
- Prenatal Medicine Center Münster, Münster, NRW, Germany
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Abdul-Khaliq H, Gomes D, Meyer S, von Kries R, Wagenpfeil S, Pfeifer J, Poryo M. Trends of mortality rate in patients with congenital heart defects in Germany-analysis of nationwide data of the Federal Statistical Office of Germany. Clin Res Cardiol 2024; 113:750-760. [PMID: 38436738 PMCID: PMC11026207 DOI: 10.1007/s00392-023-02370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Congenital heart defects (CHD) are still associated with an increased morbidity and mortality. The aim of this study was to analyze trends of mortality rates in patients with CHD between 1998 and 2018 in Germany. METHODS Data of registered deaths with an underlying diagnosis of CHD were used to evaluate annual mortality between 1998 and 2018. Polynomial regressions were performed to assess annual changes in CHD-associated mortality rates by age groups. RESULTS During the 21-year study period, a total of 11,314 deaths were attributed to CHD with 50.9% of deaths in infants (age < 1 year) and 28.2% in neonates (age ≤ 28 days). The most frequent underlying CHDs associated with death were hypoplastic left heart syndrome (n = 1498, 13.2%), left ventricular outflow tract obstruction (n = 1009, 8.9%), atrial septal defects (n = 771, 6.8%), ventricular septal defects (n = 697, 6.2%), and tetralogy of Fallot (n = 673, 5.9%), and others (n = 6666, 58.9%). Among all patients, annual CHD-related mortality rates declined significantly between 1998 and 2010 (p < 0.0001), followed by a significant annual increase until 2018 (p < 0.0001). However, mortality rates in 2018 in all ages were significantly lower than in 1998. CONCLUSION Mortality in CHD patients decreased significantly between 1998 and 2010, but a substantial number of deaths still occurred and even significantly increased in the last 3 years of the observation period particularly in neonates and infants. This renewed slight increase in mortality rate during the last years was influenced mainly by high-risk neonates and infants. Assessment of factors influencing the mortality rate trends in association with CHD in Germany is urgently needed. Obligatory nationwide registration of death cases in relation to surgical and catheter interventions in CHD patients is necessary to provide additional valuable data on the outcome of CHD.
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Affiliation(s)
- Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany.
- Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
| | - Delphina Gomes
- Institute of Social Pediatrics and Adolescent Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sascha Meyer
- Department of Pediatrics and Neonatology, Section of Intensive Care, Saarland University Medical Center, Homburg/Saar, Germany
| | - Rüdiger von Kries
- Institute of Social Pediatrics and Adolescent Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg/Saar, Germany
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Bremer SJ, Boxnick A, Glau L, Biermann D, Joosse SA, Thiele F, Billeb E, May J, Kolster M, Hackbusch R, Fortmann MI, Kozlik-Feldmann R, Hübler M, Tolosa E, Sachweh JS, Gieras A. Thymic Atrophy and Immune Dysregulation in Infants with Complex Congenital Heart Disease. J Clin Immunol 2024; 44:69. [PMID: 38393459 PMCID: PMC10891212 DOI: 10.1007/s10875-024-01662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Congenital heart disease (CHD) is the most common birth defect, and up to 50% of infants with CHD require cardiovascular surgery early in life. Current clinical practice often involves thymus resection during cardiac surgery, detrimentally affecting T-cell immunity. However, epidemiological data indicate that CHD patients face an elevated risk for infections and immune-mediated diseases, independent of thymectomy. Hence, we examined whether the cardiac defect impacts thymus function in individuals with CHD. We investigated thymocyte development in 58 infants categorized by CHD complexity. To assess the relationship between CHD complexity and thymic function, we analyzed T-cell development, thymic output, and biomarkers linked to cardiac defects, stress, or inflammation. Patients with highly complex CHD exhibit thymic atrophy, resulting in low frequencies of recent thymic emigrants in peripheral blood, even prior to thymectomy. Elevated plasma cortisol levels were detected in all CHD patients, while high NT-proBNP and IL-6 levels were associated with thymic atrophy. Our findings reveal an association between complex CHD and thymic atrophy, resulting in reduced thymic output. Consequently, thymus preservation during cardiovascular surgery could significantly enhance immune function and the long-term health of CHD patients.
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Affiliation(s)
- Sarah-Jolan Bremer
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Boxnick
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Glau
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Biermann
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Simon A Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Thiele
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Elena Billeb
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
- University Children's Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonathan May
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Manuela Kolster
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Romy Hackbusch
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | | | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hübler
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Eva Tolosa
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörg Siegmar Sachweh
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Anna Gieras
- Department of Immunology, University Medical Center Hamburg-Eppendorf, N27, Martinistraße 52, 20246, Hamburg, Germany.
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Yuan X, Chen R, Luo G, Sun P, Song X, Ma J, Sun R, Yu T, Jiang Z. Role and mechanism of miR-871-3p/Megf8 in regulating formaldehyde-induced cardiomyocyte inflammation and congenital heart disease. Int Immunopharmacol 2024; 126:111297. [PMID: 38039718 DOI: 10.1016/j.intimp.2023.111297] [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: 08/17/2023] [Revised: 11/02/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE AND DESIGN We aimed to investigate the molecular mechanism underlying formaldehyde (FA)-induced congenital heart disease (CHD) using in vitro and in vivo models. MATERIALS AND SUBJECTS Neonatal rat heart tissues and H9C2 cells were used for in vitro studies, while FA-exposed new-born rats were used for in vivo studies. TREATMENT H9C2 cells were exposed to FA concentrations of 0, 50, 100 and 150 μM/mL for 24 h. METHODS Whole transcriptome gene sequencing identified differentially expressed miRNAs in neonatal rat heart tissues, while Real-time quantitative PCR (RT-qPCR) assessed miR-871-3p and Megf8 expression. RNA pull-down and dual-luciferase reporter assays determined miR-871-3p and Megf8 relationships. Inflammatory cytokine expression was assessed by western blotting. A FA-induced CHD model was used to validate miR-871-3p regulatory effects in vivo. RESULTS We identified 89 differentially expressed miRNAs, with 28 up-regulated and 61 down-regulated (fold change ≥ 2.0, P < 0.05). Inflammation (interleukin) and signalling pathways were found to control FA-induced cardiac dysplasia. miR-871-3p was upregulated in FA-exposed heart tissues, modulated inflammation, and directly targeted Megf8. In vivo experiments showed miR-871-3p knockdown inhibited FA-induced inflammation and CHD. CONCLUSION We demonstrated miR-871-3p's role in FA-induced CHD by targeting Megf8, providing potential targets for CHD intervention and improved diagnosis and treatment strategies.
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Affiliation(s)
- Xiaoli Yuan
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao 266100, Shandong Province, People's Republic of China
| | - Rui Chen
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao 266034, Shandong Province, People's Republic of China
| | - Gang Luo
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao 266034, Shandong Province, People's Republic of China
| | - Pin Sun
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao 266100, Shandong Province, People's Republic of China
| | - Xiaoxia Song
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao 266100, Shandong Province, People's Republic of China
| | - Jianmin Ma
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao 266100, Shandong Province, People's Republic of China
| | - Ruicong Sun
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao 266100, Shandong Province, People's Republic of China
| | - Tao Yu
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao 266100, Shandong Province, People's Republic of China; Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, Qingdao 266021, Shandong Province, People's Republic of China.
| | - Zhirong Jiang
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao 266100, Shandong Province, People's Republic of China.
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Rottermann K, Doll U, Pfenning S, Reichenbach M, Fey D, Dobler A, Siauw C, Reif F, Gnibl J, Cesnjevar R, Dittrich S. The Congenital Cardiology Cloud - optimizing long-term care by connecting ambulatory and hospital medical attendance via telemedicine. KLINISCHE PADIATRIE 2024; 236:16-23. [PMID: 37683668 PMCID: PMC10803177 DOI: 10.1055/a-2154-6659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Patients with complex congenital heart disease frequently undergo a life-long ambulatory therapy with the need for repeated hospital interventions. To optimize this manifold interplay, we designed and implemented a tele-medical service, the Congenital Cardiology Cloud (CCC). This study aims to analyse the requirements for its implementation through the comprehensive assessment of design, installation and impact on patient´s care. METHODS CCC's development comprised the analysis of historically raised admission and discharge management and the definition of technical and organizational requirements. Elaboration of procedural flow charts, description of data formats and technical processes as well as distribution of patient structure formed part of this process. RESULTS Analysis of existing workflows uncovered a need for the rebuilding of admission and discharge process and decision making for further treatment. The CCC reduces conference-meetings in general and repetitive meetings up to less than a third. Real-time dispatch of discharge documents guarantees an instantaneous access to patient-related data. Comparative analyses show a more complex patient group to be involved in tele-medical services. CONCLUSIONS The CCC enables the sharing of complex clinical information by overcoming sectoral barriers and improves mutual patient advice. Implementation of a tele-medical network requires willingness, perseverance and professional engagement. Future application analysis and possible introduction of refinancing concepts will show its long-term feasibility.
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Affiliation(s)
| | - Ulrike Doll
- Department of Pediatric Cardiology, FAU, Erlangen,
Germany
| | - Simon Pfenning
- Department of Computer Science, Chair for Computer Architecture, FAU,
Erlangen, Germany
| | - Marc Reichenbach
- Department of Computer Science, Chair for Computer Architecture, FAU,
Erlangen, Germany
| | - Dietmar Fey
- Department of Computer Science, Chair for Computer Architecture, FAU,
Erlangen, Germany
| | | | - Céline Siauw
- Department of Pediatrics, University Hospital Würzburg,
Würzburg, Germany
| | - Fabian Reif
- Practice for Pediatric Cardiology, Ambulatory Practice, Nuremberg,
Germany
| | - Julia Gnibl
- Chair of Education with a Focus on Organizational Education, FAU,
Erlangen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Heart Surgery, University of Zurich, Zurich,
Switzerland
| | - Sven Dittrich
- Department of Pediatric Cardiology, FAU, Erlangen,
Germany
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10
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Freundt P, Nourkami-Tutdibi N, Tutdibi E, Janzing P, von Ostrowski T, Langer M, Zemlin M, Steinhard J. Controlled Prospective Study on the Use of Systematic Simulator-Based Training with a Virtual, Moving Fetus for Learning Second-Trimester Scan: FESIM III. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e199-e205. [PMID: 36882110 PMCID: PMC10411095 DOI: 10.1055/a-1984-8320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/16/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To analyze the feasibility of structured ultrasound simulation training (SIM-UT) in teaching second-trimester ultrasound screening using a high-end simulator with a randomly moving fetus. METHODS This was a prospective, controlled trial. A trial group of 11 medical students with minimal obstetric ultrasound experience underwent 12 hours of structured SIM-UT in individual hands-on sessions within 6 weeks. Learning progress was assessed with standardized tests. Performance after 2, 4, and 6 weeks of SIM-UT was compared with two reference groups ((A) Ob/Gyn residents and consultants, and (B) highly skilled DEGUM experts). Participants were asked to acquire 23 2nd trimester planes according to ISUOG guidelines in a realistic simulation B-mode with a randomly moving fetus as quickly as possible within a 30-minute time frame. All tests were analyzed regarding the rate of appropriately obtained images and the total time to completion (TTC). RESULTS During the study, novices were able to improve their ultrasound skills significantly, reaching the physician level of the reference group (A) after 8 hours of training. After 12 hours of SIM-UT, the trial group performed significantly faster than the physician group (TTC: 621±189 vs. 1036±389 sec., p=0.011). Novices obtained 20 out of 23 2nd trimester standard planes without a significant time difference when compared to experts. TTC of the DEGUM reference group remained significantly faster (p<0.001) though. CONCLUSION SIM-UT on a simulator with a virtual, randomly moving fetus is highly effective. Novices can obtain standard plane acquisition skills close to expert level within 12 hours of self-training.
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Affiliation(s)
- Paula Freundt
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Nasenien Nourkami-Tutdibi
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Erol Tutdibi
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Paul Janzing
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | | | - Martin Langer
- Practice for Gynecology and Women Health, LARA, Bocholt, Germany
| | - Michael Zemlin
- Hospital for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Johannes Steinhard
- Fetal Cardiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
- Prenatal Medical Center Münster, Münster, Germany
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11
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Zhang Y, Wang J, Zhao J, Huang G, Liu K, Pan W, Sun L, Li J, Xu W, He C, Zhang Y, Li S, Zhang H, Zhu J, He Y. Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:479-489. [PMID: 37301215 DOI: 10.1016/s2352-4642(23)00051-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/12/2023]
Abstract
Congenital heart disease (CHD), a wide spectrum of diseases with varied outcomes, is the most common congenital malformation worldwide. In this Series of three papers, we describe the burden of CHD in China; the development of screening, diagnosis, treatment, and follow-up strategies; and challenges associated with the disease. We also propose solutions and recommendations for policies and actions to improve the outcomes of CHD. In the first paper in this Series, we focus on prenatal and neonatal screening, diagnosis, and management of CHD. Based on advanced international knowledge, the Chinese Government has developed a network system comprising prenatal screening, diagnosis of CHD subtypes, specialist consultation appointments, and treatment centres for CHD. A new professional discipline, fetal cardiology, has been formed and rapidly developed. Consequently, the overall coverage of prenatal and neonatal screening and the accuracy of CHD diagnoses have gradually improved, and the neonatal CHD mortality rate has decreased substantially. However, China still faces several challenges in the prevention and treatment of CHD, such as insufficient diagnostic capabilities and unqualified consultation services in some regions and rural areas. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yingying Zhang
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China; Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China; School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jingyi Wang
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China; Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China
| | - Jianxin Zhao
- National Office for Maternal and Child Health Surveillance of China, National Centre for Birth Defect Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Guoying Huang
- Pediatric Heart Centre, Children's Hospital of Fudan University, Shanghai, China
| | - Kaibo Liu
- Department of Perinatal Health, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China; Department of Perinatal Health, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Wei Pan
- Department of Maternal-Fetal Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Luming Sun
- Department of Fetal Medicine & Prenatal Diagnosis Centre, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun Li
- Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - Wenli Xu
- National Office for Maternal and Child Health Surveillance of China, National Centre for Birth Defect Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chunhua He
- National Office for Maternal and Child Health Surveillance of China, National Centre for Birth Defect Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yunting Zhang
- Child Health Advocacy Institute, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center and State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease and Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, National Centre for Birth Defect Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, and Sichuan Birth Defects Clinical Research Centre, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yihua He
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China; Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China.
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12
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Pijpers AGH, Eeftinck Schattenkerk LD, de Vries R, Broers CJM, Straver B, van Heurn ELW, Musters GD, Gorter RR, Derikx JPM. Cardiac anomalies in children with congenital duodenal obstruction: a systematic review with meta-analysis. Pediatr Surg Int 2023; 39:160. [PMID: 36967411 PMCID: PMC10040397 DOI: 10.1007/s00383-023-05449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Cardiac anomalies occur frequently in patients with congenital duodenal obstruction (DO). However, the exact occurrence and the type of associated anomalies remain unknown. Therefore, the aim of this systematic review is to aggregate the available literatures on cardiac anomalies in patients with DO. METHODS In July 2022, a search was performed in PubMed and Embase.com. Studies describing cardiac anomalies in patients with congenital DO were considered eligible. Primary outcome was the pooled percentage of cardiac anomalies in patients with DO. Secondary outcomes were the pooled percentages of the types of cardiac anomalies, type of DO, and trisomy 21. A meta-analysis was performed to pool the reported data. RESULTS In total, 99 publications met our eligibility data, representing 6725 patients. The pooled percentage of cardiac anomalies was 29% (95% CI 0.26-0.32). The most common cardiac anomalies were persistent foramen ovale 35% (95% CI 0.20-0.54), ventricular septal defect 33% (95% CI 0.24-0.43), and atrial septal defect 33% (95% CI 0.26-0.41). The most prevalent type of obstruction was type 3 (complete atresias), with a pooled percentage of 54% (95% CI 0.48-0.60). The pooled percentage of Trisomy 21 in patients with DO was 28% (95% CI 0.26-0.31). CONCLUSION This review shows cardiac anomalies are found in one-third of the patients with DO regardless of the presence of trisomy 21. Therefore, we recommend that patients with DO should receive preoperative cardiac screening. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Adinda G H Pijpers
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands.
| | - Laurens D Eeftinck Schattenkerk
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Chantal J M Broers
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bart Straver
- Department of Pediatric Cardiology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Gijsbert D Musters
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
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13
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Siaplaouras J, Jahn A, Helm P, Hanssen K, Bauer U, Apitz C, Niessner C. Physical Self-Concept and Physical Activity in Children with Congenital Heart Defects-Can We Point Out Differences to Healthy Children to Promote Physical Activity? CHILDREN (BASEL, SWITZERLAND) 2023; 10:478. [PMID: 36980036 PMCID: PMC10047027 DOI: 10.3390/children10030478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Children with congenital heart defects (CHD) are at high risk for cardiovascular disease in addition to their congenital disease, so it is important to motivate this group of patients to live a physically active lifestyle. A potential influencing determinant of younger children's physical performance is the physical self-concept. The objective of the present study was first to evaluate the correlation between the physical self-concept (PSC) and the participation in physical activities (PA) of a representative group of children with congenital heart disease (CHD), and second to point out differences in comparison to their healthy peer group. METHODS Using the database of PA of the S-BAHn-Study we focused on physical self-concept assessed by the German version of the Physical Self-Description Questionnaire. We compare the obtained data of children with CHD to a representative age-matched sample of 3.385 participants of the Motorik Modul Study. RESULTS N = 1.198 complete datasets could be included in the analyses. The mean age of patients was 11.6 ± 3.1 years. For the total cohort of patients with CHD and the reference group, PA correlated significantly with a positive PSC (p < 0.001). PA was significantly reduced in all groups of patients despite the severity of their heart defect (p < 0.001). Remarkably, PSC did not differ statistically significantly in patients with simple CHD from the reference collective (p > 0.24). CONCLUSIONS According to this representative survey, there is a clear relation between PA and PSC in the cohort of healthy children and the group of children with CHD throughout the severity of their heart defects. Although PSC did not differ in patients with simple CHD and their healthy peer group, PA was significantly reduced. This gap invites us to reflect on how we could break new ground to promote a physically active lifestyle in children with CHD regardless of the severity of their cardiac defects.
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Affiliation(s)
| | - Annika Jahn
- Division of Pediatric Cardiology, Children’s Hospital, University of Ulm, 89073 Ulm, Germany
| | - Paul Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
| | - Kerstin Hanssen
- Institute for Sport and Sport Science, Karlsruhe Institute for Technology, 76131 Karlsruhe, Germany
| | - Ulrike Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
| | - Christian Apitz
- Division of Pediatric Cardiology, Children’s Hospital, University of Ulm, 89073 Ulm, Germany
| | - Claudia Niessner
- Institute for Sport and Sport Science, Karlsruhe Institute for Technology, 76131 Karlsruhe, Germany
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14
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Ditkivskyy IO, Voloshyn DL, Yermolovych YV, Perepeka IA, Lazoryshynets VV. Endovascular Closure of Secondary Septal Defect in Children with Low Body Weight. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/dv061-5358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim. To assess the effectiveness and safety of transcatheter closure of a secondary atrial septal defect (ASD) using an occluder in symptomatic children weighing ≤10 kg.
Materials and methods. In the period from November 2014 to June 2021, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, closure of secondary ASD using an occluder was performed in 18 patients, among them 13 women (72.2%) and 5 men (27.8%). Th e mean age of the patients was 18.94±9.44 months (the youngest patient was 12 months, the oldest was 4 years). The mean weight was 9.294±1.170 kg (6.4 kg to 10 kg), the mean Z-score was -1.7±1.5 (-4.6 to 0.46), the mean height was 80 cm (71 cm to 88 cm). According to the measurements by transesophageal echocardiography (TEE), the average size of the defects was 13.7 mm±3.6mm (the largest 18.0 mm, the smallest 6.0 mm).
Results and discussion. In our publication, the effectiveness of the method was 100% (18/18), while the world statistics show 94-95%. Th e frequency of complications was 5.6% (n=1). We suggest that this is associated with the use of a sizing balloon and careful selection of the device.
When choosing treatment tactics for symptomatic children weighing ≤10 kg, the decisive factor was the determination of the presence of edges and the size of the defect. Defects were considered suitable for closure, according to TEE data, when all margins of the defect were ≥4 mm, except for the aortic margin. Although the total length of the interatrial membrane was taken into account, it was not of decisive importance, since for most occluders with the presence of all edges, the fields of the implant could not interfere with the work of the anatomical structures of the heart. To determine the real size of the defect, we recommend a measuring balloon under TEE control.
The following devices were used to close the defect: MemoPart ASD occluder, Amplatzer Septal Occluder, LifeTech HeartR Occluder, LifeTech HeartR Multi-Fenestrated Atrial Septal Defect (MF-ASD) Occluder.
Conclusion. After the study, we are convinced that the endovascular method of closing a hemodynamically significant secondary ASD for the treatment of children with a body weight of ≤10 kg has proven to be an effective method, with successful implantation of the occluder in 100% of cases.
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15
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Sandoval Boburg R, Schlensak C, Hofbeck M, Magunia H, Berger R, Jost W, Mustafi M. Routine Detachment of the Anterior and Septal Tricuspid Leaflets Simplifies VSD Closure and Improves the Outcomes. Medicina (B Aires) 2022; 58:medicina58121849. [PMID: 36557051 PMCID: PMC9787562 DOI: 10.3390/medicina58121849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives: The closure of perimembranous ventricular septal defects (VSDs) is one of the most common surgeries performed in infancy. The technique of detachment of the anterior and septal leaflets of the tricuspid valve (TV) with subsequent leaflet augmentation is frequently used for isolated as well as non-isolated VSD closure. In this study, we compared the incidence of tricuspid regurgitation (TR) in patients who underwent a VSD repair with and without detachment of the TV in the short- and long-term follow-up. Materials and Methods: A retrospective study that included 140 patients who underwent perimembranous VSD closure at our center from 2011-2016, where 102 of these patients underwent the procedure with detachment of the TV, was performed. The follow-up data were obtained from postoperative echocardiography performed in the follow-up visits. A total of 62 patients underwent follow-up at our center, where the follow-up time ranged from 1 to 9 years, with a mean of 71 ± 2.47 months. Results: Regarding patients who underwent a VSD repair with a detachment of the TV, 98.1% of the patients had none to mild TR, compared to 94.7% in patients without intraoperative TV detachment at the time of discharge. There were no reported cases of moderate to severe TR, atrioventricular blocks, aortic insufficiency, or deaths. A total of 98.1% of patients who underwent follow-up at our center with a TV detachment had none to mild TR compared to 94.7% in the group without TV detachment. Conclusion: TV detachment with leaflet augmentation for VSD closure is safe and effective and does not increase the incidence of TR in the short- and long-term follow-up.
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Affiliation(s)
- Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-(0)7071-29-68185
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Rafal Berger
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Walter Jost
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
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16
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Bet BB, De Vries JM, Limpens J, Van Wely M, Van Leeuwen E, Clur SA, Pajkrt E. Implications of fetal premature atrial contractions: systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:721-730. [PMID: 35763619 PMCID: PMC10107702 DOI: 10.1002/uog.26017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Fetal heart-rate irregularities occur in 1-2% of pregnancies and are usually caused by premature atrial contractions (PAC). Although PAC are considered benign, they may be associated with cardiac defects and tachyarrhythmia. We aimed to determine the incidence of congenital heart defects (CHDs) and complications in fetuses with PAC. METHODS This was a systematic review and meta-analysis conducted in accordance with the PRISMA statement for reporting items for systematic reviews and meta-analyses. MEDLINE and EMBASE were searched from 1990 to June 2021 to identify studies on fetuses with PAC. The primary outcome was CHD; secondary outcomes were complications using the endpoints supraventricular tachyarrhythmia (SVT), cardiac failure and intrauterine fetal demise. Meta-analysis of proportions was performed, subdivided into high-risk and low-risk populations based on reason for referral. Pooled incidences with 95% CIs were calculated. RESULTS Of 2443 unique articles identified, 19 cohort studies including 2260 fetuses were included. The pooled incidence of CHD in fetuses with PAC was 2.8% (95% CI, 1.5-4.1%), when 0.6% is the incidence expected in the general population. The pooled incidence of CHD was 7.2% (95% CI, 3.5-10.9%) in the high-risk population and 0.9% (95% CI, 0.0-2.0%) in the low-risk population. SVT occurred in 1.4% (95% CI, 0.6-3.4%) of fetuses diagnosed with PAC. Cardiac failure was described in 16 fetuses (1.4% (95% CI, 0.5-3.5%)), of which eight were CHD-related. Intrauterine fetal demise occurred in four fetuses (0.9% (95% CI, 0.5-1.7%)) and was related to CHD in two cases. CONCLUSIONS Our findings suggest that the risk of CHD in fetuses with PAC is 4-5 times higher than that in the general population. CHD was present more frequently in the high-risk population. Consequently, an advanced ultrasound examination to diagnose PAC correctly and exclude CHD is recommended. Complications of PAC are rare but can result in fetal demise, thus weekly fetal heart-rate monitoring remains advisable to enable early detection of SVT and to prevent cardiac failure. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B. B. Bet
- Department of Obstetrics and Gynaecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - J. M. De Vries
- Department of Obstetrics and Gynaecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - J. Limpens
- Medical Library, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
| | - M. Van Wely
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
| | - E. Van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - S. A. Clur
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
- Department of Pediatric Cardiology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
| | - E. Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam UMC locationUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
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17
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Vollbrecht TM, Luetkens JA. [Cardiac MRI of congenital heart disease : From fetus to adult]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:933-940. [PMID: 35976404 DOI: 10.1007/s00117-022-01062-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is an important diagnostic tool for initial diagnostic workup and follow-up of patients with congenital heart disease (CHD) of different age groups. OBJECTIVES This review provides an overview of clinically applied MRI sequences for the assessment of CHD, highlights technical developments, and demonstrates key aspects of reporting in specific heart defects. MATERIALS AND METHODS Presentation of epidemiologic data, summary of studies on MRI sequences and their clinical application, and demonstration of clinical examples. RESULTS The broad spectrum of congenital heart defects requires the use of various sequences, which can be modified depending on patient age or treatment status. Cine imaging can be used to assess cardiac function and volumes, phase contrast flow measurements allow for the assessment of vessel hemodynamics, and various techniques of MR angiography allow visualization of the thoracic vessels with high spatiotemporal resolution. New developments allow high-resolution vascular imaging without the need for contrast agents, assessment of additional hemodynamic parameters, or fetal cardiac MRI. CONCLUSION Cardiac MRI can be employed in children as well as in adults with CHD. By using different sequences and considering the treatment status and surgery-related complications, the vast majority of clinical questions can be answered.
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Affiliation(s)
- Thomas M Vollbrecht
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Deutschland
| | - Julian A Luetkens
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Deutschland.
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18
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FAIRifizierung von Real World Data für die Gesundheitsforschung. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2022. [PMCID: PMC9516507 DOI: 10.1007/s11553-022-00973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hintergrund Die Bereitstellung von Real-World-Daten im Sinne der FAIR-Prinzipien ist die Voraussetzung einer effizienten Ausschöpfung des Potenzials von Gesundheitsdaten für Prävention und Versorgung. Ziel der Arbeit Möglichkeiten und Limitationen der Nachnutzung und Verknüpfung von Gesundheitsdaten in Deutschland werden dargestellt. Material und Methoden Es werden Initiativen zur Schaffung einer verbesserten Forschungsdateninfrastruktur vorgestellt und an einem Beispiel die Einschränkungen illustriert, die das Record Linkage personenbezogener Gesundheitsdaten behindern. Ergebnisse In der Regel erfüllen Gesundheitsdaten in Deutschland nicht die Anforderungen der FAIR-Prinzipien. Ihre Auffindbarkeit scheitert bereits daran, dass entweder keine Metadaten zur Verfügung stehen oder diese nicht standardisiert in suchbare Repositorien eingestellt werden. Die Verknüpfung von personenbezogenen Gesundheitsdaten ist durch restriktive Datenschutzbestimmungen und das Fehlen eines sog. Unique Identifiers extrem eingeschränkt. Datenschutzkonforme Lösungen für die Verknüpfung von Gesundheitsdaten, die in europäischen Nachbarländern erfolgreich praktiziert werden, könnten hier als Vorbild dienen. Schlussfolgerung Die Schaffung einer Nationalen Forschungsdateninfrastruktur (NFDI), insbesondere für personenbezogene Gesundheitsdaten (NFDI4Health), ist nur mit erheblichen Anstrengungen und Gesetzesänderungen realisierbar. Bereits vorliegende Strukturen und Standards, wie sie z. B. durch die Medizininformatik-Initiative und das Netzwerk Universitätsmedizin geschaffen wurden, sowie internationale Initiativen wie z. B. die European Open Science Cloud müssen dabei berücksichtigt werden.
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19
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Zhang Y, Yang Y, Ju H, He X, Sun P, Tian Y, Yang P, Song XX, Yu T, Jiang Z. Comprehensive profile of circRNAs in formaldehyde induced heart development. Food Chem Toxicol 2022; 162:112899. [PMID: 35231573 DOI: 10.1016/j.fct.2022.112899] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/17/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023]
Abstract
Circular RNAs (circRNAs) are a novel type of long non-coding RNAs that can regulate gene expression in heart development and heart disease. However, the expression pattern of circRNAs in congenital heart disease (CHD) induced by formaldehyde exposure is still unknown. We detected circRNAs expression profiles in heart tissue taken from six neonatal rat pups with formaldehyde exposure group and normal group using RNA-sequencing. Results revealed that a total of 54 circRNAs were dysregulated in the formaldehyde exposure group compared to the normal group. Among them, 31 were upregulated and 23 were downregulated (fold change = 2.0, p < 0.0 5). The qRT-qPCR results showed that expressions of 12:628708|632694, 18:77477060|77520779, 5:167486001|167526275 were significantly upregulated, while that of 7:41167312|4116775 and 20:50659751|5068786 were notably downregulated; the expression pattern was consistent with the RNA sequencing data. Bioinformatics analysis shows that the pathogenesis of formaldehyde exposure-induced CHD may involve Hippo-YAP pathway、Notch signaling pathway and other pathways. A key miRNA (rno-miR-665) was identified by constructing a circRNA-miRNA-mRNA co-expression network. In summary, the study illustrated that circRNAs differentially expressed in fetal heart tissues during formaldehyde exposure has potential biological functions and may be a biomarker or therapeutic target for CHD.
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Affiliation(s)
- Ying Zhang
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China
| | - Yanyan Yang
- Department of Immunology, Basic Medicine School, Qingdao University, No. 308 Ningxia Road, Qingdao, 266071, People's Republic of China
| | - Hui Ju
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Road No. 16 Jiangsu, Qingdao, 266000, Shandong, People's Republic of China
| | - Xiangqin He
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China
| | - Pin Sun
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China
| | - Yu Tian
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China
| | - Panyu Yang
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China
| | - Xiao-Xia Song
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China
| | - Tao Yu
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China; Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Road No. 38 Dengzhou, Qingdao, 266021, People's Republic of China.
| | - Zhirong Jiang
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Road No. 59 Haier, Qingdao, 266100, Shandong, People's Republic of China.
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20
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Grünwald A, Korte J, Wilmanns N, Winkler C, Linden K, Herberg U, Groß-Hardt S, Steinseifer U, Neidlin M. Intraventricular Flow Simulations in Singular Right Ventricles Reveal Deteriorated Washout and Low Vortex Formation. Cardiovasc Eng Technol 2021; 13:495-503. [PMID: 34850371 PMCID: PMC9197806 DOI: 10.1007/s13239-021-00598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
Purpose Patients with a functionally univentricular heart represent one of the most common severe cardiac lesions with a prevalence of 3 per 10,000 live births. Hemodynamics of the singular ventricle is a major research topic in cardiology and there exists a relationship between fluid dynamical features and cardiac behavior in health and disease. The aim of the present work was to compare intraventricular flow in single right ventricle (SRV) patients and subjects with healthy left hearts (LV) through patient-specific CFD simulations. Methods Three-dimensional real-time echocardiographic images were obtained for five SRV patients and two healthy subjects and CFD simulations with a moving mesh methodology were performed. Intraventricular vortex formation and vortex formation time (VFT) as well as the turbulent kinetic energy (TKE) and ventricular washout were evaluated. Results The results show significantly lower values for the VFT and the TKE in SRV patients compared with healthy LV subjects. Furthermore, vortex formation does not progress to the apex in SRV patients. These findings were confirmed by a significantly lower washout in SRV patients. Conclusions The study pinpoints the intriguing role of intraventricular flows to characterize performance of SRVs that goes beyond standard clinical metrics such as ejection fraction. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00598-9.
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Affiliation(s)
- Anna Grünwald
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jana Korte
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nadja Wilmanns
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Christian Winkler
- Department of Pediatric Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Katharina Linden
- Department of Pediatric Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Sascha Groß-Hardt
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany.
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21
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Lammers AE, Diller GP, Lober R, Möllers M, Schmidt R, Radke RM, De-Torres-Alba F, Kaleschke G, Marschall U, Bauer UM, Gerß J, Enders D, Baumgartner H. Maternal and neonatal complications in women with congenital heart disease: a nationwide analysis. Eur Heart J 2021; 42:4252-4260. [PMID: 34638134 DOI: 10.1093/eurheartj/ehab571] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 01/27/2023] Open
Abstract
AIMS The aim of this study was to provide population-based data on maternal and neonatal complications and outcome in the pregnancies of women with congenital heart disease (CHD). METHODS AND RESULTS Based on administrative data from one of the largest German Health Insurance Companies (BARMER GEK, ∼9 million members representative for Germany), all pregnancies in women with CHD between 2005 and 2018 were analysed. In addition, an age-matched non-CHD control group was included for comparison and the association between adult CHD (ACHD) and maternal or neonatal outcomes investigated. Overall, 7512 pregnancies occurred in 4015 women with CHD. The matched non-CHD control group included 6502 women with 11 225 pregnancies. Caesarean deliveries were more common in CHD patients (40.5% vs. 31.5% in the control group; P < 0.001). There was no excess mortality. Although the maternal complication rate was low in absolute terms, women with CHD had a significantly higher rate of stroke, heart failure and cardiac arrhythmias during pregnancy (P < 0.001 for all). Neonatal mortality was low but also significantly higher in the ACHD group (0.83% vs. 0.22%; P = 0.001) and neonates to CHD mothers had low/extremely low birth weight or extreme immaturity (<0.001) or required resuscitation and mechanical ventilation more often compared to non-CHD offspring (P < 0.001 for both). On multivariate logistic regression maternal defect complexity, arterial hypertension, heart failure, prior fertility treatment, and anticoagulation with vitamin K antagonists emerged as significant predictors of adverse neonatal outcome (P < 0.05 for all). Recurrence of CHD was 6.1 times higher in infants to ACHD mothers compared to controls (P < 0.0001). CONCLUSIONS This population-based study illustrates a reassuringly low maternal mortality rate in a highly developed healthcare system. Nevertheless, maternal morbidity and neonatal morbidity/mortality were significantly increased in women with ACHD and their offspring compared to non-ACHD controls highlighting the need of specialized care and pre-pregnancy counselling.
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Affiliation(s)
- Astrid Elisabeth Lammers
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.,Department of Paediatric Cardiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Gerhard-Paul Diller
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.,National Register for Congenital Heart Disease, Berlin, Germany
| | - Rieke Lober
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Mareike Möllers
- Department of Gynecology and Obstetrics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Renate Schmidt
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Robert M Radke
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Fernando De-Torres-Alba
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Gerrit Kaleschke
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Health Insurance, Wuppertal, Germany
| | - Ulrike M Bauer
- National Register for Congenital Heart Disease, Berlin, Germany.,DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Berlin, Germany
| | - Joachim Gerß
- Department for Biostatistics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Dominic Enders
- Department for Biostatistics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.,National Register for Congenital Heart Disease, Berlin, Germany
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22
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Parvez MA, Das D. Transcatheter device closure of perimembranous ventricular septal defect associated with indirect Gerbode defect: A retrospective study. Ann Pediatr Cardiol 2021; 14:397-400. [PMID: 34667415 PMCID: PMC8457281 DOI: 10.4103/apc.apc_143_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/18/2020] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
Perimembranous ventricular septal defect (pmVSD) is a common congenital heart disease that is sometimes associated with indirect left ventricle (LV) to right atrium (RA) shunt (indirect Gerbode defect). This defect has a rare chance of spontaneous closure and therefore was usually closed surgically in the past, but more recently transcatheter closure has been reported by a few authors. In our study, we have described a series of 14 children (age ranging from 1.2 to 12 years and weight ranging from 7.2 to 25.5 kg) with the above-mentioned defect which were closed by various interventional devices. The procedures were successful in complete elimination of pmVSD and immediate reduction of indirect LV-RA shunts with negligible residual tricuspid regurgitation on follow-up. In our midterm experience, the judicious use of double-disc devices is efficacious for occluding pmVSD associated with indirect Gerbode defect.
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Affiliation(s)
- Md Afaque Parvez
- Department of Pediatric Cardiology, AMRI Hospitals Ltd., Kolkata, West Bengal, India
| | - Dhritabrata Das
- Department of Pediatric Cardiology, AMRI Hospitals Ltd., Kolkata, West Bengal, India
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23
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Movileanu I, Harpa M, Al Hussein H, Harceaga L, Chertes A, Al Hussein H, Lutter G, Puehler T, Preda T, Sircuta C, Cotoi O, Nistor D, Man A, Cordos B, Deac R, Suciu H, Brinzaniuc K, Casco M, Sierad L, Bruce M, Simionescu D, Simionescu A. Preclinical Testing of Living Tissue-Engineered Heart Valves for Pediatric Patients, Challenges and Opportunities. Front Cardiovasc Med 2021; 8:707892. [PMID: 34490371 PMCID: PMC8416773 DOI: 10.3389/fcvm.2021.707892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Pediatric patients with cardiac congenital diseases require heart valve implants that can grow with their natural somatic increase in size. Current artificial valves perform poorly in children and cannot grow; thus, living-tissue-engineered valves capable of sustaining matrix homeostasis could overcome the current drawbacks of artificial prostheses and minimize the need for repeat surgeries. Materials and Methods: To prepare living-tissue-engineered valves, we produced completely acellular ovine pulmonary valves by perfusion. We then collected autologous adipose tissue, isolated stem cells, and differentiated them into fibroblasts and separately into endothelial cells. We seeded the fibroblasts in the cusp interstitium and onto the root adventitia and the endothelial cells inside the lumen, conditioned the living valves in dedicated pulmonary heart valve bioreactors, and pursued orthotopic implantation of autologous cell-seeded valves with 6 months follow-up. Unseeded valves served as controls. Results: Perfusion decellularization yielded acellular pulmonary valves that were stable, no degradable in vivo, cell friendly and biocompatible, had excellent hemodynamics, were not immunogenic or inflammatory, non thrombogenic, did not calcify in juvenile sheep, and served as substrates for cell repopulation. Autologous adipose-derived stem cells were easy to isolate and differentiate into fibroblasts and endothelial-like cells. Cell-seeded valves exhibited preserved viability after progressive bioreactor conditioning and functioned well in vivo for 6 months. At explantation, the implants and anastomoses were intact, and the valve root was well integrated into host tissues; valve leaflets were unchanged in size, non fibrotic, supple, and functional. Numerous cells positive for a-smooth muscle cell actin were found mostly in the sinus, base, and the fibrosa of the leaflets, and most surfaces were covered by endothelial cells, indicating a strong potential for repopulation of the scaffold. Conclusions: Tissue-engineered living valves can be generated in vitro using the approach described here. The technology is not trivial and can provide numerous challenges and opportunities, which are discussed in detail in this paper. Overall, we concluded that cell seeding did not negatively affect tissue-engineered heart valve (TEHV) performance as they exhibited as good hemodynamic performance as acellular valves in this model. Further understanding of cell fate after implantation and the timeline of repopulation of acellular scaffolds will help us evaluate the translational potential of this technology.
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Affiliation(s)
- Ionela Movileanu
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
- Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
| | - Marius Harpa
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
- Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
| | - Hussam Al Hussein
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
- Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
| | - Lucian Harceaga
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Alexandru Chertes
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Hamida Al Hussein
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Georg Lutter
- Department for Experimental Cardiac Surgery and Heart Valve Replacement, School of Medicine, University of Kiel, Kiel, Germany
| | - Thomas Puehler
- Department for Experimental Cardiac Surgery and Heart Valve Replacement, School of Medicine, University of Kiel, Kiel, Germany
| | - Terezia Preda
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Carmen Sircuta
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Ovidiu Cotoi
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Dan Nistor
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
- Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
| | - Adrian Man
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Bogdan Cordos
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Radu Deac
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
| | - Horatiu Suciu
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
- Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
| | - Klara Brinzaniuc
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
- Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
| | - Megan Casco
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, United States
| | | | - Margarita Bruce
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Dan Simionescu
- Regenerative Medicine Laboratory, University of Medicine, Pharmacy, Science and Technology “George Emil Palade”, Târgu Mureş, Romania
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Agneta Simionescu
- Tissue Engineering Laboratory, Department of Bioengineering, Clemson University, Clemson, SC, United States
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Lammers AE, Helm PC, Bauer UM, van Huelsen AK, Schneider H, Baumgartner H, Diller GP. Optimizing Care for Adults with Congenital Heart Disease: Results of a Conjoint Analysis Based on a Nationwide Sample of Patients Included in the German National Register. J Clin Med 2021; 10:jcm10163483. [PMID: 34441779 PMCID: PMC8396998 DOI: 10.3390/jcm10163483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Congenital heart disease (CHD) requires lifelong specialized care. Failure to follow up and gaps in care are common in this group and lead to increased morbidity/mortality. We evaluated patients’ perceived needs and expectations regarding specialized care using state-of-the-art statistical and market research techniques based on a nationwide sample of CHD patients. (2) Methods: A random sample of adults with CHD registered in the German National Register for Congenital Heart Defects were invited to answer an adaptive online questionnaire based on the conjoint analysis (CA) technique. CA determines the relative importance of various aspects of health care provision and allows individuals to trade between characteristics, thus recognizing limited resources. (3) Results: 637 patients participated (mean age 33.8 ± 12.6 years; 55.6% female; disease complexity: simple defect 12.6%, moderate complexity 40.3%, complex CHD 40.2%) in the analysis. Patients assigned the highest relative importance to aspects of patient–physician communication, physician qualifications, waiting time, medical care, and medical equipment. Comfort-related aspects such as driving time or hotel aspects of care received much lower scores. We identified four well-defined clusters of patients with differing expectation patterns: (i) time sensitive patients; (ii) excellence seeking patients; (iii) continuity seekers, and (iv) support seeking patients. (4) Conclusions: Adult CHD patients rank effective patient–physician interaction and communication as the most important factors. As we identified significant heterogeneity between CHD patients, centers should cater for individual preferences and integrate individual needs into treatment plans to prevent failure to follow up and ensure patient compliance.
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Affiliation(s)
- Astrid E. Lammers
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Münster, Germany;
- Department of Paediatric Cardiology, University Hospital Münster, 48149 Münster, Germany
- Correspondence: (A.E.L.); (G.-P.D.); Tel.: +49-251-8346110 (A.E.L. & G.-P.D.)
| | - Paul C. Helm
- National Register for Congenital Heart Defects, Augustenburger Platz 1, 13353 Berlin, Germany; (P.C.H.); (U.M.B.)
| | - Ulrike M. Bauer
- National Register for Congenital Heart Defects, Augustenburger Platz 1, 13353 Berlin, Germany; (P.C.H.); (U.M.B.)
- DZHK (German Centre for Cardiovascular Research), Potsdamer Straße 58, 10785 Berlin, Germany
| | | | - Helmut Schneider
- Department of Marketing, Steinbeis-Hochschule, Ernst-Augustin-Straße 15, 12489 Berlin, Germany;
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Münster, Germany;
| | - Gerhard-Paul Diller
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Münster, Germany;
- National Register for Congenital Heart Defects, Augustenburger Platz 1, 13353 Berlin, Germany; (P.C.H.); (U.M.B.)
- Correspondence: (A.E.L.); (G.-P.D.); Tel.: +49-251-8346110 (A.E.L. & G.-P.D.)
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25
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Niemitz M, Tutus D, Hövels-Gürich HH, Fegert J, Rassenhofer M. Angeborene Herzfehler und gesundheitsbezogene Lebensqualität. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Rossi E, Frigo AC, Reffo E, Cabrelle G, Castaldi B, Di Salvo G, Vida VL, Padalino MA. The presence of an additional ventricular chamber does not change the outcome of Fontan circulation: a comparative study. Eur J Cardiothorac Surg 2021; 60:1074-1081. [PMID: 33963841 DOI: 10.1093/ejcts/ezab194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The role of an additional ventricle in patients with a functional single ventricle undergoing the Fontan operation has been debated due to conflicting data. Our goal was to report our experience with Fontan circulation for complex congenital heart disease, with a focus on the influence that an additional ventricular chamber may have on early and long-term clinical outcomes. METHODS We performed a retrospective clinical study including all patients undergoing the Fontan procedure between 1978 and 2019. Clinical data were retrieved from our institutional database. A 'biventricular' Fontan (BVF) was defined as that performed in a patient with single ventricle anomaly where an additional diminutive ventricular cavity was present at echocardiographic evaluation. RESULTS A total of 210 consecutive patients with functional single ventricle were included. Among these, 46 had BVF (21.9%). Early complications occurred in 42 patients (20.0%; 11 in BVF vs 31 in univentricular Fontan; P = 0.53) There were 18 early deaths (8.6%) with no difference between the groups. At a median follow-up of 12.7 years (interquartile range 5.4-20.7), there were no significant differences in late mortality, whereas cardiac rhythm disturbances resulted more frequently in univentricular Fontan (P = 0.018). Statistical analysis showed an equal distribution of BVF across time (P = 0.620), and there were no significant differences in terms of early and late survival (P = 0.53 and P = 0.72, respectively) or morbidity (P = 0.45 and P = 0.80, respectively). CONCLUSIONS A secondary ventricle in Fontan circulation is not significantly related to any clinical disadvantage in terms of survival or onset of complications. However, the immediate postoperative course may be influenced negatively by the presence of an additional secondary ventricle.
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Affiliation(s)
- Elena Rossi
- Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Elena Reffo
- Pediatric Cardiology, Department of Woman and Child's Health, University of Padua, Padua, Italy
| | - Giulio Cabrelle
- Pediatric Cardiology, Department of Woman and Child's Health, University of Padua, Padua, Italy
| | - Biagio Castaldi
- Pediatric Cardiology, Department of Woman and Child's Health, University of Padua, Padua, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Woman and Child's Health, University of Padua, Padua, Italy
| | - Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo A Padalino
- Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Neidenbach R, Achenbach S, Andonian C, Bauer UMM, Ewert P, Freilinger S, Gundlach U, Kaemmerer AS, Nagdyman N, Nebel K, Oberhoffer R, Pieper L, Reinhard W, Sanftenberg L, von Scheidt F, Schelling J, Seidel L, Weyand M, Kaemmerer H. Systematic assessment of health care perception in adults with congenital heart disease in Germany. Cardiovasc Diagn Ther 2021; 11:481-491. [PMID: 33968627 PMCID: PMC8102265 DOI: 10.21037/cdt-20-825] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The number of adults with congenital heart disease (ACHD) is steadily rising due to increased survival rate and improved medical resources. Accordingly, more than 330,000 ACHD are currently living in Germany. Almost all of them require lifelong specialized medical follow-up for their chronic heart disease, often accompanied by residua, sequelae, or comorbidities. Primary care physicians (PCPs) are a crucial factor in directing patients to ACHD specialists or specialized institutions, but despite all efforts, the number of ACHD under specialized care is low, the lost-to-follow-up rate is high, and the morbidity and mortality is substantial. The present cross-sectional study was designed to systematically characterize the health care of ACHD from a patient perspective, including (I) use of medical care by ACHD, (II) medical counselling needs, and (III) perceived satisfaction with health care. METHODS The German-wide analysis was based on a 25-item questionnaire designed to address different aspects of medical status and health issues of ACHD from their own perspective, performed between May of 2017 and July of 2020. RESULTS A total of 4,008 ACHD (52% female; mean age 41.9±17.2 years) completed the questionnaire. The majority of ACHD (3,524, 87.9%) reported, that they consulted their PCP for non-cardiac health problems, and 49.7% (n=1,991) consulted their PCP also for medical problems associated with the underlying CHD. Almost all ACHD reported a need for medical advice concerning exercise capacity and daily life activities, occupational skills, pregnancy, rehabilitation, genetic counselling, insurance, and retirement. A total of 1,840 (45.9%) patients were not aware of the existence of certified ACHD specialists or centers. Moreover, 2,552 (67.6%) of those surveyed were uninformed about patient organizations for ACHD. CONCLUSIONS The present study demonstrates that ACHD are largely uninformed about the ACHD care structures available nationwide, although the patients have a great need for specialized follow-up, advice, and care.
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Affiliation(s)
- Rhoia Neidenbach
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
- Department of Sports Medicine, Exercise Physiology and Prevention, Institute of Sport Science, University of Vienna, Austria
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Caroline Andonian
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Ulrike M. M. Bauer
- Competence Network for Congenital Heart Defects, National Register for Congenital Heart Defects, Berlin, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Ulrike Gundlach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Ann-Sophie Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Kathrin Nebel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Renate Oberhoffer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
- Department of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Lars Pieper
- Department of Behavioral Epidemiology, Technical University of Dresden, Germany
| | - Wibke Reinhard
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Germany
| | - Linda Sanftenberg
- Institute of General Practice, Ludwig-Maximilians-University Munich, Germany
| | - Fabian von Scheidt
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | | | - Lavinia Seidel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
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Zhang X, He S, Liu Y, Zhong J, Sun Y, Zheng M, Gui J, Wang R, Feng B, Mo J, Jian M, Liu C, Liang Y. The significance of an integrated management mode of prenatal diagnosis-postnatal treatment for critical congenital heart disease in newborns. Cardiovasc Diagn Ther 2021; 11:447-456. [PMID: 33968622 DOI: 10.21037/cdt-20-892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Congenital heart disease (CHD) is the most common congenital defect in human beings. The purpose of this article is to investigate impact of an integrated management mode of 'prenatal diagnosis-postnatal treatment' on birth, surgery, prognosis and complications associated with critical CHD (CCHD) in newborns. Methods A retrospective analysis of the medical records of newborns diagnosed with CCHD were divided into two groups: prenatal diagnosis and postnatal diagnosis. The demographics, clinical characteristics, surgical status, prognosis and complications of the two groups were compared and the differences identified. Results Among the 290 newborns with CCHD, 97 (33.4%) were prenatally diagnosed and 193 (66.6%) were postnatally diagnosed. Newborns in the prenatal diagnostic group were hospitalized immediately after birth, whereas the median age of admission was 6.00 (3.00-12.00) days in postnatal diagnostic group, P=0.000. In terms of postnatal symptoms and signs, the incidence of anhelation, cyanosis and cardiac murmur was higher in the postnatal diagnostic group. The rates of preoperative intubation, postoperative open chest exploration and treatment abandonment were higher in the postnatal diagnostic group. The postnatal diagnostic group was more prone to postoperative complications, such as pneumonia and hypoxic-ischemic brain damage. The preoperative mortality [0 (0.0%) vs. 12 (6.2%), P=0.028] in the prenatal diagnostic group was lower than that in the postnatal diagnostic group. And the one-year survival rate of the prenatal diagnostic group was higher (log-rank test P=0.034). Conclusions The integrated management mode of prenatal diagnosis-postnatal treatment can improve postnatal symptoms, reduces complications, reduces preoperative mortality and increases one-year survival rates in newborns with CCHD.
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Affiliation(s)
- Xiaohui Zhang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaoru He
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Yumei Liu
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Zhong
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunxia Sun
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Manli Zheng
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juan Gui
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixi Wang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bowen Feng
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianling Mo
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Minqiao Jian
- Department of NICU, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Caisheng Liu
- Department of NICU, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yijing Liang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Evaluation of the Effectiveness of an Interdisciplinary Preventive Oral Hygiene Program for Children with Congenital Heart Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073497. [PMID: 33800550 PMCID: PMC8036511 DOI: 10.3390/ijerph18073497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/22/2022]
Abstract
It is recognized that children with congenital heart disease (CHD) are predisposed to having poorer oral health. Therefore, the purpose of this study was to evaluate the effectiveness of an interdisciplinary preventive oral hygiene program (POHP) for children with CHD. The aim was the reduction of the incidence of dental caries, as well as improvement of oral hygiene. The total number of participants in this study was 107 children with CHD aged between two to six years. At baseline, these children were compared to a healthy control group (HCG) of 101 children of similar age from five preschools in Giessen, Germany. All examinations were carried out before the introduction of a standardized POHP. The Quigley/Hein Plaque- (QHI), Silness/Loe Gingival- (GI) and Gingival Hyperplasia Index (GHI) were determined. Starting with baseline, the described procedures were repeated in the CHD group during two follow-ups after three and six months. In the first examination, compared to controls, CHD children showed a significantly (p < 0.05) poorer oral hygiene (QHI: 2.6; GI: 0.3; GHI: 0.2). All oral hygiene parameters (QHI, GI, GHI) of the CHD group improved significantly over the whole period of the preventive program (p < 0.05). These results demonstrated an improvement in CHD children involved in a standardized POHP. The data with regard to the general health of these risk patients, including prevention of endocarditis, demonstrate the necessity of an interdisciplinary approach between pediatric cardiologists, pediatricians and dentists.
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Natural history of pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS) and prediction of outcome. Arch Gynecol Obstet 2021; 304:81-90. [PMID: 33585987 PMCID: PMC8164597 DOI: 10.1007/s00404-020-05929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022]
Abstract
Objectives To analyse prenatal parameters predicting biventricular (BV) outcome in pulmonary atresia with intact ventricular septum/critical pulmonary stenosis (PAIVS/CPS). Methods We evaluated 82 foetuses from 01/08 to 10/18 in 3 centres in intervals 1 (< 24 weeks), 2 (24–30 weeks) and 3 (> 30 weeks). Results 61/82 (74.4%) were livebirths, 5 (8.2%) lost for follow-up, 3 (4.9%) had compassionate care leaving 53 (64.6% of the whole cohort and 86.9% of livebirths) with intention to treat. 9 died, 44/53 (83.0%) survived. 24/38 (63.2%) with information on postnatal outcome had BV outcome, 14 (36.8%) non-BV outcome (2 × 1.5 circulation). One with BV outcome had prenatal valvuloplasty. Best single parameter for BV outcome was tricuspid/mitral valve (TV/MV) ratio (AUC 0.93) in intervals 2 and 3 (AUC 0.92). Ventriculo-coronary-arterial communications (VCAC) were present in 11 (78.6%) in non-BV outcome group vs. 2 (8.3%) in BV outcome group (p < 0.001). Tricuspid insufficiency (TI)-Vmax > 2.5 m/s was present in BV outcome group in75.0% (18/24) vs. 14.3% (2/14) in non-BV outcome group. Including the most predictive markers (VCAC presence, TI- Vmax < 2.5 m/s, TV/MV ratio < cutoff) to a score, non-BV outcome was correctly predicted when > 1 criterion was fulfilled in all cases. After recently published criteria for foetal intervention, only 4/9 (44.4%) and 5/14 (35.7%) in our interval 2 + 3 with predicted non-BV outcome would have been candidates for intervention. Two (1 × intrauterine intervention) in interval 2, two in interval 3 reached BV outcome and one 1.5 circulation without intervention. Conclusion TV/MV ratio as simple parameter has high predictive value. After our score, non-BV outcome was correctly predicted in all cases. Criteria for foetal intervention must further be evaluated.
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van Kalsbeek R, Krings G, Molenschot M, Breur J. Early and midterm outcomes of bare metal stenting in small children with recurrent aortic coarctation. EUROINTERVENTION 2021; 16:e1281-e1287. [PMID: 31566574 PMCID: PMC9724864 DOI: 10.4244/eij-d-19-00157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to report our experience with the Cook Formula stent in the treatment of (recurrent) coarctation of the aorta in children below 12 kg. METHODS AND RESULTS In vitro study of the Cook Formula 418 (8 mm) and 535 (8 and 10 mm) stents demonstrated successful down-crimping on smaller balloons and predictable fracturing patterns. Between November 2012 and January 2019, one patient with native, one patient with post-interventional and thirteen patients with post-surgical coarctation of the aorta underwent implantation of a Cook Formula stent. Patient and procedural characteristics were obtained as well as procedural success, complications, and follow-up. Median age was 4.3 months and median weight 5.5 kg. Arterial sheath size ranged from 5 to 7 Fr. In-stent diameters of 3.7 to 8.8 mm were obtained with a median residual gradient of 0 mmHg. Major complications consisted of periprocedural haemodynamic instability (n=1), dissection of the iliac artery (n=1) and non-deployment with surgical removal (n=1). Re-dilations were performed after a median interval of 24.3 months. Median follow-up was 31.7 months. CONCLUSIONS The bare metal Cook Formula stent provides a durable and effective alternative to reoperation and balloon dilatation for native as well as post-surgical aortic coarctation in children below 12 kg.
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Affiliation(s)
- Rebecca van Kalsbeek
- University Medical Centre Utrecht/Wilhelmina Children’s Hospital, Lundlaan 6, KG.01.319.0, Post Office Box 85090, 3508 AB Utrecht, the Netherlands
| | - Gregor Krings
- Paediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | - Mirella Molenschot
- Paediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | - Johannes Breur
- Paediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
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Linden K, Winkler C, Breuer J, Herberg U. Assessment of pressure-volume relations in univentricular hearts: Comparison of obtainment by real-time 3D echocardiography and mini pressure-wire with conductance technology. PLoS One 2021; 16:e0246031. [PMID: 33524066 PMCID: PMC7850469 DOI: 10.1371/journal.pone.0246031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives The gold standard to obtain pressure-volume relations (PVR) of the heart, the conductance technology (PVRCond), is rarely used in children. PVR can also be obtained by 3D-echocardiography volume data combined with simultaneously measured pressure data by a mini pressure-wire (PVR3DE). We sought to investigate the feasibility of both methods in patients with univentricular hearts and to compare them, including hemodynamic changes. Methods We studied 19 patients (age 2–29 years). PVR3DE and PVRCond were assessed under baseline conditions and stimulation with dobutamine. Results Obtaining PVR3DE was successful in all patients. Obtaining PVRCond was possible in 15 patients during baseline (79%) and in 12 patients under dobutamine (63%). Both methods showed that end-systolic elastance (Ees) and arterial elastance (Ea) increased under dobutamine and that Tau showed a statistically significant decrease. Intraclass correlation (95% confidence interval) showed moderate to good agreement between methods: Ees: 0.873 (0.711–0.945), Ea: 0.709 (0.336–0.873), Tau: 0.867 (0.697–0.942). Bland-Altman analyses showed an acceptable bias with wider limits of agreement: Ees: 1.63 mmHg/ml (-3.83–7.08 mmHg/ml), Ea: 0.53 mmHg/ml (-5.23–6.28 mmHg/ml), Tau: -0,76 ms (-10.73–9.21 ms). Conclusion Changes of PVR-specific parameters under dobutamine stimulation were reflected in the same way by both methods. However, the absolute values for these parameters could vary between methods and, therefore, methods are not interchangeable. Obtaining PVR3DE in a single ventricle was easier, faster and more successful than PVRCond. PVR3DE provides a promising and needed alternative to the conductance technology for the assessment of cardiac function in univentricular hearts.
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Affiliation(s)
- Katharina Linden
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Christian Winkler
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, Children’s Hospital, University Hospital Bonn, Bonn, Germany
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Baehner T, Kiefer N, Ghamari S, Graeff I, Huett C, Pflugradt S, Sendzik B, Heinze I, Mueller M, Schindler E, Duerr GD, Ellerkmann R, Velten M. A National Survey: Current Clinical Practice in Pediatric Anesthesia for Congenital Heart Surgery. World J Pediatr Congenit Heart Surg 2021; 11:257-264. [PMID: 32294007 DOI: 10.1177/2150135120902122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Providing anesthesia for pediatric patients undergoing congenital cardiac surgery is complex and requires profound knowledge and clinical experience. Prospective studies on best anesthetic management are missing, partially due to different standards. The aim of the present study was to survey the current standard practice in anesthetic management in pediatric cardiac surgical centers in Germany. METHODS All 78 cardiac surgical centers in Germany were reviewed for a congenital cardiac surgery program. Centers with an active program for congenital cardiac surgery were interviewed to participate in the present online questionnaire to assess their current anesthetic practice. RESULTS Twenty-seven German centers running an active program for congenital heart surgery were identified, covering more than 3,000 pediatric cardiac surgeries annually. Of these centers, 96.3% (26/27) participated in our survey. Standard induction agents were etomidate in 26.9% (7/26), propofol in 19.2% (5/26), a combination of benzodiazepines and ketamine in 19.2% (5/26), and barbiturates in 11.5% (3/26). General anesthesia was preferentially maintained using volatile agents, 61.5% (16/26), with sevoflurane being the most common volatile agent within this group, 81.2% (13/16). Intraoperative first-choice/first-line inotropic drug was epinephrine, 53.8% (14/26), followed by milrinone, 23.1% (6/26), and dobutamine 15.4% (4/26). Fast-track programs performing on-table extubation depending on the type of surgical procedure were established at 61.5% (16/26) of the centers. CONCLUSION This study highlights the diversity of clinical standards in pediatric cardiac anesthesia for congenital cardiac surgery in Germany.
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Affiliation(s)
- Torsten Baehner
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Nicholas Kiefer
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Shahab Ghamari
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Ingo Graeff
- Emergency Department, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Christopher Huett
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Stefan Pflugradt
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Bjoern Sendzik
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Matthias Mueller
- Pediatric Heart Centre, Justus-Liebig University, Giessen, Germany
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiac Surgery, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
| | - Richard Ellerkmann
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany.,Department of Anesthesiology, Klinikum Dortmund, Dortmund, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany
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Mismatch between self-estimated and objectively assessed exercise capacity in patients with congenital heart disease varies in regard to complexity of cardiac defects. Cardiol Young 2021; 31:77-83. [PMID: 33081857 DOI: 10.1017/s1047951120003406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Regular evaluation of physical capacity takes a crucial part in long-term follow-up in patients with congenital heart disease (CHD). This study aims to examine the accuracy of self-estimated exercise capacity compared to objective assessments by cardiopulmonary exercise testing in patients with CHD of various complexity. METHODS We conducted a single centre, cross-sectional study with retrospective analysis on 382 patients aged 8-68 years with various CHD who completed cardiopulmonary exercise tests. Peak oxygen uptake was measured. Additionally, questionnaires covering self-estimation of exercise capacity were completed. Peak oxygen uptake was compared to patient's self-estimated exercise capacity with focus on differences between complex and non-complex defects. RESULTS Peak oxygen uptake was 25.5 ± 7.9 ml/minute/kg, corresponding to 75.1 ± 18.8% of age- and sex-specific reference values. Higher values of peak oxygen uptake were seen in patients with higher subjective rating of exercise capacity. However, oxygen uptake in patients rating their exercise capacity as good (mean oxygen uptake 78.5 ± 1.6%) or very good (mean oxygen uptake 84.8 ± 4.8%) was on average still reduced compared to normal. In patients with non-complex cardiac defects, we saw a significant correlation between peak oxygen uptake and self-estimated exercise capacity (spearman-rho -0.30, p < 0.001), whereas in patients with complex cardiac defects, no correlation was found (spearman-rho -0.11, p < 0.255). CONCLUSION The mismatch between self-estimated and objectively assessed exercise capacity is most prominent in patients with complex CHD.Registration number at Charité Universitätsmedizin Berlin Ethics Committee: EA2/106/14.
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Evertz R, Reinders M, Houck C, Ten Cate T, Duijnhouwer AL, Beukema R, Westra S, Vernooy K, de Groot NMS. Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy. Open Heart 2020; 7:openhrt-2020-001298. [PMID: 32817255 PMCID: PMC7437693 DOI: 10.1136/openhrt-2020-001298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Currently, consensus is lacking on the relation between closure of atrial septal defect (ASD) and the incidence of atrial fibrillation (AF), which is a known complication in ASD patients. More importantly, studies reporting on the treatment applied for AF in ASD patients are scarce. The aims of this study were (1) to assess the incidence of AF in ASD patients, (2) to study the relation between closure and AF and (3) to evaluate applied treatment strategies. Methods A single-centre retrospective study in 173 patients with an ASD was performed. We analysed the incidence of AF, the relation of AF with closure, method of closure and the treatment success of therapies applied. Results Almost 20% of patients with an ASD developed AF, with a mean age of 59 (±14) years at first presentation of AF during a median clinical follow-up of 43 (29–59) years. Older age (OR 1.072; p<0.001) and a dilated left atrium (OR 3.727; p=0.009) were independently associated with new-onset AF. Closure itself was not independently associated with AF. First applied treatment strategy was rhythm control in 77%. Of the 18 patients treated with antiarrhythmic drugs 50% had at least 1 recurrence of AF. Conclusion No clear relation between closure of the ASD and AF could be assessed. This is the first study describing applied therapy for AF in ASD patients of which medical rhythm control was the most applied strategy with a disappointing efficacy.
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Affiliation(s)
- Reinder Evertz
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon Reinders
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charlotte Houck
- Cardiology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Tim Ten Cate
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Rypko Beukema
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sjoerd Westra
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kevin Vernooy
- Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Prenatal diagnosis, associated findings and postnatal outcome in fetuses with congenitally corrected transposition of the great arteries. Arch Gynecol Obstet 2020; 303:1469-1481. [PMID: 33219483 PMCID: PMC8087597 DOI: 10.1007/s00404-020-05886-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/05/2020] [Indexed: 01/03/2023]
Abstract
Purpose To analyze anatomic features and associated malformations in 37 prenatally detected cases of congenitally corrected transposition of the great arteries (ccTGA) and to evaluate the prenatal course, neonatal outcome and mid-term follow-up. Methods Retrospective analysis of prenatal ultrasound of 37 patients with ccTGA in two tertiary centers between 1999 and 2019. All fetuses received fetal echocardiography and a detailed anomaly scan. Postnatal outcome and follow-up data were retrieved from pediatric reports. Results Isolated ccTGA without associated cardiac anomalies was found in 13.5% (5/37), in all other fetuses additional defects such as VSD (73.0%), pulmonary obstruction (35.1%), tricuspid valve anomalies (18.9%), aortic arch anomalies (13.5%), ventricular hypoplasia (5.4%) or atrioventricular block (5.4%) were present. The rate of extracardiac malformations or chromosomal aberrations was low. There were 91.9% (34/37) live births and postnatal survival rates reached 91.2% in a mean follow-up time of 4.98 years. The prenatal diagnosis of ccTGA was confirmed postnatally in all but one documented live birth and the prenatal counselling regarding the expected treatment after birth (uni- versus biventricular repair) was reassured in the majority of cases. The postnatal intervention rate was high, 64.7% (22/34) received surgery, the intervention-free survival was 36.7%, 35.0% and 25.0% at 1 month, 1 year and 10 years, respectively. Conclusions ccTGA is a rare heart defect often associated with additional heterogeneous cardiac anomalies that can be diagnosed prenatally. The presented study demonstrates a favorable outcome in most cases but the majority of patients require surgical treatment early in life.
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Schulz-Weidner N, Bulski JC, Siahi-Benlarbi R, Bauer J, Logeswaran T, Jux C, Wetzel WE, Krämer N. Symptom-orientated oral hygiene for children after heart transplantation: Effectiveness of a standardized prophylactic program. Pediatr Transplant 2020; 24:e13845. [PMID: 32997421 DOI: 10.1111/petr.13845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Children with CHD, especially heart-transplanted patients, are predisposed to have caries lesions, gingivitis and other oral findings like gingival hyperplasia. The aim of the study was the implementation of a specific oral hygiene program in these patients and its effect on the improvement of oral health, especially gingival overgrowth. For this, we used a newly developed systematic GHI to evaluate and describe this gingival alteration. Thirty-three children, aged 6 to 15 years with cardiac transplants (9 girls, 24 boys), were examined and introduced into a specific oral hygiene program. Each child showed evidence of gingival hyperplasia. They were randomly divided into three groups with the following oral care measurements: Group ZZ tooth brushing, Group ZZS tooth brushing and mouth rinsing, Group ZZSS tooth brushing, mouth rinsing and the use of an additional single and sulcus toothbrush. A significant decline of all oral health parameters could be proven in all groups. Gingival hyperplasia (GHI) improved as well as plaque accumulation (QHI). The children who used in addition to toothbrushing rinsing solutions and/or additional miniature toothbrushes showed better parameters of the gingival hygiene indexes from the baseline examination until the end of the study. The results show that any infant with cardiac transplant has to be introduced into an individualized oral hygiene program underlining the need of comprehensive dental care in cooperation with pediatric cardiology.
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Affiliation(s)
- Nelly Schulz-Weidner
- Department of Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig University, Giessen, Germany
| | - Julia C Bulski
- Department of Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig University, Giessen, Germany
| | - Rachida Siahi-Benlarbi
- Department of Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig University, Giessen, Germany
| | - Jürgen Bauer
- Pediatric Heart Centre, Justus Liebig University, Giessen, Germany
| | | | - Christian Jux
- Pediatric Heart Centre, Justus Liebig University, Giessen, Germany
| | - Willi-Eckhard Wetzel
- Department of Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig University, Giessen, Germany
| | - Norbert Krämer
- Department of Pediatric Dentistry, Medical Centre of Odontology, Justus Liebig University, Giessen, Germany
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Trenk L, Lammers AE, Radke R, Baumgartner H, Wort SJ, Gatzoulis MA, Diller GP, Kempny A. Neurological complications in aortic coarctation: Results of a Nationwide analysis based on 11,907 patients. Int J Cardiol 2020; 322:114-120. [PMID: 32798628 DOI: 10.1016/j.ijcard.2020.08.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/25/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with coarctation of the aorta (CoA) are at increased risk of periprocedural and late neurological complications. Based on a nationwide inpatient dataset, we assessed the prevalence and risk factors for neurological complications in this cohort. METHOD AND RESULTS We included all CoA patients hospitalized in England between 1997 and 2015. The risk for procedural complications, subarachnoid bleeding and ischemic stroke were quantified, and risk factors investigated. Overall, 11,907 patients (60% male) with CoA were identified. The median age at first presentation was 0.6 years with a median follow-up period of 14.4 years. Throughout the study period, 8456 surgical or interventional procedures were performed in 6796 patients. The neurological complication rate for primary surgical or interventional repair in patients born after 1997 was 0.05% and 0.2%, respectively. During a total follow-up period of 146,295 patient-years, late neurological complications such as subarachnoid bleeding and cerebral infarction occurred in 225 patients (0.15%/patient-year). The median age for subarachnoid bleeding was 29 years and 57 years for ischemic stroke. While, arterial hypertension (p = .0014), current smoking (p = .02), dyslipidaemia (p = .007) and diabetes (p = .037) were significantly related to the risk of ischemic stroke, only arterial hypertension emerged as significant risk factor for subarachnoid bleeding. CONCLUSIONS Neurological complication during primary CoA repair are extremely rare in the current era. In contrast, many CoA patients are afflicted by late complications such as subarachnoid bleeding and ischemic stroke at a relatively young age, emphasizing the need for meticulous and pro-active blood pressure control and reduction of cardiovascular risk factors.
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Affiliation(s)
- Lukas Trenk
- Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK
| | | | - Robert Radke
- Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK
| | - Helmut Baumgartner
- Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK; Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Stephen J Wort
- Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, UK
| | - Gerhard-Paul Diller
- Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK; Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany; Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
| | - Aleksander Kempny
- Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, UK
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Siaplaouras J, Niessner C, Helm PC, Jahn A, Flemming M, Urschitz MS, Sticker E, Abdul-Khaliq H, Bauer UM, Apitz C. Physical Activity Among Children With Congenital Heart Defects in Germany: A Nationwide Survey. Front Pediatr 2020; 8:170. [PMID: 32426306 PMCID: PMC7203217 DOI: 10.3389/fped.2020.00170] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: In children with congenital heart defects (CHD), a sedentary lifestyle should be avoided and usually WHO recommendations on physical activity (PA) are supposed to be followed. In order to obtain representative data of the actual amount of PA (and potential influencing factors) in children with CHD we performed a nationwide online survey. Methods: All patients aged 6-17 years registered in the German National Register for CHD were contacted by email and asked to participate in the survey using the comprehensive questionnaire of the "Motorik-Modul" from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), thus allowing the comparison with a representative age-matched subset of 3.385 participants of the KiGGS study. The questionnaire for CHD-patients was amended by specific questions regarding medical care, sports recommendations and PA restrictions. Results: Complete datasets of 1.198 patients (mean age of 11.6 ± 3.1 years) were available for evaluation. Compared to the reference group, CHD patients significantly less frequently reached the WHO recommended level of 60 min of daily PA (8.8 vs. 12%; p < 0.001). Enjoyment in sports was almost equally distributed across CHD and reference groups, and strongly correlated with the level of PA (r = 0.41; p < 0.001). Remarkably, 49.2% of children with complex CHD, 31.7% with moderate, and even 13.1% with simple CHD were advised by their physician to restrict PA. Conclusions: According to this nationwide survey, PA is markedly reduced in children with CHD. An important reason for this might be an unexpected high rate of physician-recommended restrictions on levels of PA.
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Affiliation(s)
- Jannos Siaplaouras
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | - Claudia Niessner
- Institute of Sports and Sports Science, Institute of Technology, Karlsruhe, Germany
| | - Paul C. Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Annika Jahn
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
| | | | - Michael S. Urschitz
- Abteilung für Pädiatrische Epidemiologie, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Elisabeth Sticker
- Department Psychology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Hashim Abdul-Khaliq
- Klinik für Pädiatrische Kardiologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Ulrike M. Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Christian Apitz
- Division of Pediatric Cardiology, Children's Hospital, University of Ulm, Ulm, Germany
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Maran S, Ee R, Faten SA, Sy Bing C, Khaw KY, Erin Lim SH, Lai KS, Wan Ibrahim WP, Mohd Zain MR, Chan KG, Gan SH, Tan HL. Mutations in the tail domain of MYH3 contributes to atrial septal defect. PLoS One 2020; 15:e0230982. [PMID: 32315303 PMCID: PMC7173802 DOI: 10.1371/journal.pone.0230982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
Atrial septal defect (ASD) is one of the most common congenital heart defects diagnosed in children. Sarcomeric genes has been attributed to ASD and knockdown of MYH3 functionally homologues gene in chick models indicated abnormal atrial septal development. Here, we report for the first time, a case-control study investigating the role of MYH3 among non-syndromic ASD patients in contributing to septal development. Four amplicons which will amplifies the 40 kb MYH3 were designed and amplified using long range-PCR. The amplicons were then sequenced using indexed paired-end libraries on the MiSeq platform. The STREGA guidelines were applied for planning and reporting. The non-synonymous c. 3574G>A (p.Ala1192Thr) [p = 0.001, OR = 2.30 (1.36-3.87)] located within the tail domain indicated a highly conserved protein region. The mutant model of c. 3574G>A (p.Ala1192Thr) showed high root mean square deviation (RMSD) values compared to the wild model. To our knowledge, this is the first study to provide compelling evidence on the pathogenesis of MYH3 variants towards ASD hence, suggesting the crucial role of non-synonymous variants in the tail domain of MYH3 towards atrial septal development. It is hoped that this gene can be used as panel for diagnosis of ASD in future.
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Affiliation(s)
- Sathiya Maran
- School of Pharmacy, Monash University, Sunway, Selangor, Malaysia
- Human Genome Centre, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- * E-mail:
| | - Robson Ee
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Aisyah Faten
- Human Genome Centre, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Choi Sy Bing
- School of Data Sciences, Perdana University, Selangor, Malaysia
| | - Kooi Yeong Khaw
- School of Pharmacy, Monash University, Sunway, Selangor, Malaysia
| | - Swee-Hua Erin Lim
- Health Sciences Division, Abu Dhabi Women's College, Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
| | - Kok-Song Lai
- Health Sciences Division, Abu Dhabi Women's College, Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
| | - Wan Pauzi Wan Ibrahim
- Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Mohd Rizal Mohd Zain
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Kok Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- International Genome Centre, Jiangsu University, Zhenjiang, China
| | - Siew Hua Gan
- School of Pharmacy, Monash University, Sunway, Selangor, Malaysia
| | - Huay Lin Tan
- Human Genome Centre, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Bano S, Akhtar S, Khan U. Pediatric congenital heart diseases: Patterns of presentation to the emergency department of a tertiary care hospital. Pak J Med Sci 2020; 36:333-337. [PMID: 32292429 PMCID: PMC7150392 DOI: 10.12669/pjms.36.3.1592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan. Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as a separate encounter. Results: Out of 133 children, 44 (33.5%) were diagnosed congenital cardiac disease for the first time (Group-1) in ED, while 89 (66.5%) children were diagnosed cases of congenital heart disease (Group-2). Among Group-1; main reasons for ED visits were cyanosis, cardiac failure, murmur evaluation and cardiogenic shock where as in Group-2; main presentations were cardiac failure, hyper cyanotic spells, gastroenteritis, lower respiratory tract infection, and post-operative issues. There were total 13 deaths. Conclusion: High index of suspicion is necessary for early diagnosis and management of children with congenital heart disease in the pediatric emergency department.
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Affiliation(s)
- Surraiya Bano
- Dr. Surraiya Bano, MBBS, MCPS, FCPS (Peds). Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saleem Akhtar
- Dr. Saleem Akhtar, MBBS, MCPS, FCPS (Peds), FCPS (Peds Cardiology) Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Uzma Khan
- Dr. Uzma Khan, MBBS. Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Abstract
BACKGROUND Color Doppler echocardiography greatly facilitates the diagnosis of isolated muscular ventricular septal defect with a small shunt. DATA SOURCES Original research articles were collected from database, including PubMed and Google scholar. Relevant articles about muscular ventricular septal defect were included. RESULTS The frequency of isolated muscular ventricular septal defect is 5.7% in preterm infants and 1.1-5.3% in term infants. Spontaneous closure in muscular ventricular septal defect occurs with higher frequency and earlier than in perimembranous ventricular septal defect. Approximately 80-90% of isolated muscular ventricular septal defect closes spontaneously by 12 months of age. Midventricular muscular ventricular septal defect is spontaneously closed earlier in the short term, but no site difference is found in the long term. The spontaneous closure mechanism is regarded as aposition of the muscle tissue or fibrous tissue formation in the right ventricular side, but in rare cases involves aneurysm formation of the fibrous tissue. Regarding spontaneous closure of isolated muscular ventricular septal defect diagnosed for the fetus, further studies are needed. Chromosomal microarray analysis of fetuses with isolated muscular ventricular septal defect has revealed that it is not a severe risk factor of chromosomal abnormalities. CONCLUSIONS This paper presents a review of the history of the diagnosis and frequency of ventricular septal defect, with discussion of its natural history from the fetal period to after birth in patients with isolated muscular ventricular septal defect.
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Affiliation(s)
- Toshiharu Miyake
- Department of Pediatrics, Kindai University Nara Hospital, 1248-1, Otoda, Ikoma, Nara, 630-0293, Japan.
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Bride P, Kaestner M, Radermacher M, Vitanova K, von Scheidt F, Scharnbeck D, Apitz C. Spontaneous Closure of Perimembranous Ventricular Septal Defects: A Janus-Faced Condition. CASE (PHILADELPHIA, PA.) 2020; 4:103-105. [PMID: 32337401 PMCID: PMC7175755 DOI: 10.1016/j.case.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
•Large perimembranous VSDs can occasionally close spontaneously by a septal aneurysm. •Complications of aneurysmatic VSD closure include RVOT obstruction. •The use of multimodal imaging allows accurate diagnosis of RVOT obstruction. •RVOT obstruction due to septal aneurysm is preferably treated by surgical excision. •Patients with aneurysmatic closure of perimembranous VSD need life-long observation.
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Affiliation(s)
- Peter Bride
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
| | - Michael Kaestner
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
| | - Michael Radermacher
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany
| | - Fabian von Scheidt
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
| | - Dominik Scharnbeck
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Christian Apitz
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
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Pressurized Perfusion System for Obtaining Completely Acellular Pulmonary Valve Scaffolds for Tissue Engineering. ARS MEDICA TOMITANA 2020. [DOI: 10.2478/arsm-2019-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Xenogeneic tissues decellularization represents the obtaining process of extracellular matrix derived scaffolds. Most antigens being cell based, non-immunogenicity is obtained by cells removal. Scaffolds are temporary structures with biologic and mechanical role. Scaffolds, stem cells and bioreactors represent premise of regenerative medicine, aiming towards the ideal valvular substitute. In previous studies, we decellularized pulmonary valves root by immersion histology revealing cellular residue, requiring a more efficient approach. We hypothesized that immersion is insufficient and thus a pressure gradient was added.
Material and Method. This is part of a grant approved by the UMFTS. Eleven porcine pulmonary valves were included in the study: n=6 underwent immersion decellularization and n=5 were cyclically perfused with a 20-25mmHg pressure gradient during a 10-day protocol. The acellular valves obtained underwent a quality control using DAPI (4′,6-diamidino-2-phenylindol) nuclear staining, histological Haematoxylin-Eosin, DNA extraction and quantification, harvested from different structural levels: arterial wall, sinus, cusp.
Results. Histological assessments highlighted integrity of extracellular matrix in both groups and overall cells absence at the different levels of valvular structures analyzed. Immersion decellularized valves exhibited DAPI positive structures identified as potential residual nucleic material. Comparatively, the perfusion decellularized valves, lacked in those structures, result confirmed by DNA extraction and quantitation procedure.
Conclusions. Perfusion decellularization represents a feasible approach to obtain acellular cardiac valvular scaffolds derived from the extracellular matrix, being superior to immersion decellularization method. Their nonimmunogenic potential is underlined by total absence of nuclei. The process is fast, allowing production of an abundant number of valvular biomaterials in a short time.
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P wave dispersion in assessment of dysrhythmia risk in patients with secundum type atrial septal defect and the effect of transcatheter or surgical closure. Cardiol Young 2020; 30:263-270. [PMID: 31854289 DOI: 10.1017/s1047951119002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial dysrhythmia is an important cause of mortality and morbidity in patients with atrial septal defect. Increased P wave duration can predict the risk of atrial dysrhythmia. The aim of this study is to evaluate the risk of atrial dysrhythmia by measuring P wave dispersion, and to observe the effect of surgical and transcatheter closure. Sixty-one patients and 30 controls were investigated. In patient group, before and after closure and in control group at the time of presentation, 12-lead electrocardiography records were evaluated. P wave duration and amplitude, P wave axis, PR interval, P wave dispersion, QRS axis, corrected QT interval, and QT dispersion were calculated. The measurements in patient and control groups, measurements before and after closure, and measurements of surgical and transcatheter group were compared. There were 27 patients in surgical group and 34 patients in transcatheter group. In patient group, signs of right heart volume overload were apparent but there was no significant difference in terms of P wave dispersion between two groups. We compared patient group in itself and found that while the use of medication, cardiothoracic index, ratio of right ventricular dilation, and paradoxical movement in interventricular septum were increased, mean age of closure was younger in surgical group. While P wave dispersion decreased in transcatheter group after closure, it increased in surgical group (p = 0.021). In conclusion, atrial septal defects may cause atrial repolarisation abnormalities and this effect persists even after surgical closure. Transcatheter closure in childhood may decrease dysrhythmia risk in long-term follow-up.
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
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Evertz R, Houck CA, Ten Cate T, Duijnhouwer AL, Beukema R, Westra S, Vernooy K, de Groot NMS. Concomitant pulmonary vein isolation and percutaneous closure of atrial septal defects: A pilot project. CONGENIT HEART DIS 2019; 14:1123-1129. [PMID: 31692272 PMCID: PMC7003759 DOI: 10.1111/chd.12859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/04/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022]
Abstract
Background Patients with an atrial septal defect (ASD) are at increased risk of developing atrial fibrillation (AF). Currently percutaneous ASD closure is the preferred therapeutic strategy and although pulmonary vein isolation (PVI) for AF is feasible after ASD closure, the transseptal puncture can be technically challenging and probably increases the perioperative risk. A staged approach, with PVI several months before ASD closure, has been recommended for patients already scheduled for closure, but no data are available on combined procedures. Purpose This pilot study evaluates the feasibility of a combined procedure of PVI and ASD closure in patients with a hemodynamic important ASD and documented AF. Methods In one procedure, PVI was performed prior to placement of the ASD closure device. Transseptal access for PVI was obtained via wire passage through the ASD in all patients. Patients were followed with 5‐day‐holter monitoring at 3, 6, and 12 months. Recurrence of AF was defined as a documented, symptomatic episode of AF. Results The study population consisted of five patients (four females, mean age: 58 (±3) years). Acute PVI was achieved in all patients. Only one patient had a small residual ASD after closure. Besides a small groin hematoma in two patients, no complications occurred. After 12‐month follow‐up, three patients were free of AF recurrence (60%). Conclusion This study shows that a combined PVI with ASD closure is feasible with an acceptable success rate of AF free survival. These preliminary results in a small patient group warrants a larger trial.
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Affiliation(s)
- Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Charlotte A Houck
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tim Ten Cate
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rypko Beukema
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjoerd Westra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Runte K, Brosien K, Salcher-Konrad M, Schubert C, Goubergrits L, Kelle S, Schubert S, Berger F, Kuehne T, Kelm M. Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients-A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2019; 6:43. [PMID: 31024935 PMCID: PMC6467940 DOI: 10.3389/fcvm.2019.00043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/22/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction: Exercise testing has become a diagnostic standard in the evaluation and management of heart disease. While different methods of exercise and pharmacological stress testing exist, only little is known about their comparability. We aimed to assess hemodynamic changes during dynamic exercise, isometric exercise, and dobutamine stress testing at different stress intensities in healthy subjects and patients with aortic stenosis (AS) and aortic coarctation (CoA). Methods: A systematic literature search (PROSPERO 2017:CRD42017078608) in MEDLINE of interventional trials was conducted to identify eligible studies providing evidence of changes in hemodynamic parameters under different stress conditions acquired by MRI or echocardiography. A random effects model was used to estimate pooled mean changes in hemodynamics. Results: One hundred and twenty-eight study arms with a total of 3,139 stress-examinations were included. In healthy subjects/(where available) in AS, pooled mean changes (95% CIs) during light dynamic stress were 31.78 (27.82–35.74) bpm in heart rate (HR) and 6.59 (2.58–10.61) ml in stroke volume (SV). Changes during light pharmacological stress were 13.71 (7.87–19.56)/14.0 (9.82–18.18) bpm in HR, and 5.47 (0.3–10.63)/8.0 (3.82–12.18) ml in SV. Changes during light isometric stress were 18.44 (10.74–26.14)/5.0 (−1.17–11.17) bpm in HR and −4.17 (−14.37–6.03)/−4.0 (−16.43–8.43) ml in SV. Changes during moderate dynamic stress were 49.57 (40.03–59.1)/46.45 (42.63–50.27) bpm in HR and 11.64 (5.87–17.42) ml in SV. During moderate pharmacological stress, changes in HR were 42.83 (36.94–48.72)/18.66 (2.38–34.93) bpm and in SV 6.29 (−2.0–14.58)/13.11 (7.99–18.23) ml. During high intensity dynamic stress changes in HR were 89.31 (81.46–97.17)/55.32 (47.31–63.33) bpm and in SV 21.31 (13.42–29.21)/−0.96 (−5.27–3.35) ml. During high pharmacological stress, changes in HR were 53.58 (36.53–70.64)/42.52 (32.77–52.28) bpm, and in SV 0.98 (−9.32–11.27)/14.06 (−1.62–29.74) ml. HR increase and age were inversely correlated at high stress intensities. In CoA, evidence was limited to single studies. Conclusion: This systematic review and meta-analysis presents pooled hemodynamic changes under light, moderate and high intensity exercise and pharmacological stress, while considering the potential influence of age. Despite limited availability of comparative studies, the reference values presented in this review allow estimation of the expected individual range of a circulatory response in healthy individuals and patients with AS and may contribute to future study planning and patient-specific models even when stress testing is contraindicated.
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Affiliation(s)
- Kilian Runte
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Kay Brosien
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Salcher-Konrad
- Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom.,LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Charlotte Schubert
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Marcus Kelm
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
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50
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Massoth C, Zarbock A, Wenk M. [Non-cardiac surgery in adults with congenital heart defects : Most important parameters in anesthesia management]. Anaesthesist 2019; 68:245-258. [PMID: 30911773 DOI: 10.1007/s00101-019-0575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with congenital heart disease (CHD) represent an increasing proportion of patients undergoing non-cardiac surgery. OBJECTIVE To identify the most important parameters for management of anesthesia. MATERIAL AND METHODS Evaluation and discussion of the current original research and guideline recommendations. RESULTS There are approximately 300,000 patients with CHD living in Germany. The preoperative evaluation is an important influencing factor affecting perioperative morbidity and mortality. Echocardiography is the key instrument for identifying cardiac conditions predisposing to adverse events. The subdivision of CHD into lesions with left-to-right shunt, obstructive lesions and complex congenital heart diseases facilitates the classification of the pathophysiology. CONCLUSION Decisive for the perioperative outcome of patients with CHD are the identification of high-risk patients, understanding of the individual situation with respect to the underlying pathophysiology and the intraoperative maintenance of cardiac output.
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Affiliation(s)
| | | | - M Wenk
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland.
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