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Downey C, Metry D, Garzon MC, Morales LK, Baselga E. Cutis marmorata telangiectatica congenita: Incidence of extracutaneous manifestations and a proposed clinical definition. Pediatr Dermatol 2023; 40:820-828. [PMID: 37442634 DOI: 10.1111/pde.15377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND/OBJECTIVES Cutis marmorata telangiectatica congenita (CMTC) is a capillary malformation characterized by congenital, reticulated, well-demarcated dark blue, red-purple, or violaceous macules or plaques, with a coarse fixed livedo pattern. Nearly always, contiguous areas of skin atrophy and/or ulceration are present. CMTC is usually localized but may rarely be generalized. Such generalized cases may be a feature of Adams-Oliver syndrome (AOS). The nosologic confusion surrounding the term CMTC and uncertainty about the risk of associated abnormalities hinders the appropriate workup of patients and prognostic counseling for families. We hypothesized that the risk of associated anomalies in children with localized CMTC is very low. METHODS We performed a literature review and retrospective review of patients with CMTC to propose a more precise clinical definition and ascertain the risk of associated anomalies. RESULTS We included 78 patients determined to have a diagnosis of CMTC based on consensus. The majority of patients had localized CMTC. Most patients with generalized CMTC met the criteria for the diagnosis of AOS. The associations found in patients with localized CMTC were mostly dermatological, with atrophy, ulcerations, or erosions present in 71%. Extracutaneous findings were present in 34.4% of patients and consisted mainly of extremity asymmetry (24.5%) that improved over time. CONCLUSION Our study showed a very low frequency of extracutaneous anomalies among patients with localized CTMC, ipsilateral limb discrepancy being the most common. We did not find a strong association with any other visceral anomalies that would justify routine evaluation in patients with localized CMTC.
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Affiliation(s)
- Camila Downey
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Dermatology, Hospital Luis Calvo Mackenna, Facultad de Medicina Universidad de Chile, Santiago, Chile
- Department of Dermatology, Clínica Alemana de Santiago, Santiago, Chile
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Garzon
- Departments of Dermatology and Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Luz Karem Morales
- Department of Dermatology, Clínica Marly JCG Chía, Cundinamarca, Colombia
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain
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Okamoto M, Tsuruno Y, Fukuzawa H. Axillary skin crease incision versus conventional posterolateral incision in open repair of patent ductus arteriosus for extremely low birth weight infants: a retrospective study. BMC Surg 2023; 23:168. [PMID: 37349731 DOI: 10.1186/s12893-023-02081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Thoracotomy with posterolateral incision (PLI) is commonly used for surgical repair of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Some reports have described thoracotomy for PDA using an axillary skin crease incision (ASCI) in consideration of cosmetic problems such as surgical wounds and thoracic deformities, but the details remain unclear. METHODS In this study, we performed clipping ligation by thoracotomy with ASCI for ELBW infants with PDA from 2011 to 2015 for the purpose of improving cosmetic results, and retrospectively compared the results with those for conventional PLI cases performed from 2016 to 2020. RESULTS ASCI was found to be associated with serious surgical complications and showed a significant difference in outcome parameters only for surgery time, suggesting a safety problem for ASCI. Considering these results, PLI allows clipping of the nearby PDA from the thoracotomy wound while looking straight ahead, whereas the PDA in ASCI is positioned deep and oblique to the thoracotomy wound, so the clipping angle is limited and accurate completion of the procedure is difficult. CONCLUSIONS Regarding PDA repair in ELBW infants, ASCI shows a high risk of serious surgical complications. Conventional PLI remains preferable for safe and accurate results.
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Affiliation(s)
- Mitsumasa Okamoto
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan.
| | - Yudai Tsuruno
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
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Zhang X, Hou XD, Wang WX, Yi K, Wang XK, Ding F, Li XX, You T. Different interventions for the treatment of patent ductus arteriosus in children: a protocol for a network meta-analysis. Syst Rev 2023; 12:29. [PMID: 36864458 PMCID: PMC9979466 DOI: 10.1186/s13643-023-02195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/16/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. Once the PDA is diagnosed, it needs to be dealt with in time. At present, main methods include pharmacological treatment, surgical closure, and interventional closure for treatment of PDA. However, the effect of different interventions in PDA management is still controversial. Thus, our study aims to assess the effectiveness of different interventions together and estimate the sequence of these therapies for PDA children. Meanwhile, it is necessary to conduct a Bayesian network meta-analysis to compare the safety of different interventions comprehensively. METHODS AND ANALYSIS To the best of our knowledge, this is the first Bayesian network meta-analysis comparing the efficacy and safety of different interventions for the treatment of PDA. PubMed, Embase, Cochrane Library, Web of Science, gray literature, and trial registry databases were searched from inception to December 2022. We will extract and report data according to methodological guidelines for Bayesian network meta-analysis by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Primary PDA closure, overall PDA closure, technical success, surgical success rate, mortality during hospital stay, operation time, intensive care unit stay, intraoperative radiation dose, radiation exposure time, total postoperative complication rate, and postoperative major complication rate will be defined as the outcomes. The quality of all random studies will be assessed using ROB, and quality of evidence for all outcomes will be judged by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). ETHICS AND DISSEMINATION The results will be disseminated through peer-reviewed publication. Since no private and confidential patient data will be contained in the reporting, there are no ethical considerations associated with this protocol. SYSTEMATIC REVIEW REGISTRATION INPLASY2020110067.
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Affiliation(s)
- Xin Zhang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Xiao-Dong Hou
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Wen-Xin Wang
- The First School of Clinical Medicine of Gansu University of Chinese Medicine, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Kang Yi
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Xin-Kuan Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Fan Ding
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Xin-Xin Li
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Tao You
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China. .,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China.
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Application of robot-assisted endoscopic technique in the treatment of patent ductus arteriosus in 106 children. J Robot Surg 2023:10.1007/s11701-023-01537-7. [PMID: 36646967 PMCID: PMC10374795 DOI: 10.1007/s11701-023-01537-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
The objective is to evaluate and apply the robot-assisted endoscopic surgical technique for treatment of patent ductus arteriosus (PDA) in children. Clinical data of 106 children with PDA who underwent robot-assisted endoscopic operation were retrospectively analyzed from August, 2020 to March, 2022. Demographic and preoperative data were collected, including the patient's age, weight, diameter of the ductus arteriosus, operation time, length of postoperative hospital stay, postoperative complications and hospitalization cost. The age ranged from 6 months to 12 years with median age of 2.5 years. In addition, the weight ranged from 6.6 kg (kg) to 51.6 kg with median weight of 12.5 kg. Patients who received transcatheter PDA closure were also enrolled during the same period. Clinical features and perioperative data were compared between the two groups. All the 106 cases underwent robotically assisted surgery for PDA ligation. No one was converted to thoracotomy. The length of operation time was 15-84 min, with an average of 39.4 min. There was no obvious bleeding during the operation. The length of postoperative hospital stays were 1-3 days, with an average of 1.1 ± 0.2 days, which was significantly shorter than that of patients underwent transcatheter approach PDA closure (2.2 ± 0.2 days) (p < 0.05). The average hospitalization costs were US$ 8180 in the 106 patients, which were more expensive than that of ones who received transcatheter procedure (US$ 5076 ± 406) (p < 0.05). Only one case was found to have residual ductus shunt during early postoperative follow-up. One case was found with recurrent laryngeal nerve injury. The two cases recovered after 3 months of follow-up. The median duration of follow-up was 12 (1-20) months. No other short-term complications occurred during the follow-up period. Robotic surgical technique for PDA ligation in children is a safe, effective and reliable surgical method with less trauma, faster recovery and fewer surgical risks. This approach should be considered as an option in children patients requiring PDA ligation.
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Kılıç Y, Irdem AK, Doyurgan O, Özlem G, Balik H, Bıcak EA, Salik F, Aldudak B. Ligation of patent ductus arteriosus through left anterior mini-thoracotomy in preterm infants. Cardiol Young 2022; 33:1-6. [PMID: 35611831 DOI: 10.1017/s1047951122001603] [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
OBJECTIVE Patent ductus arteriosus is an important cause of morbidity and mortality, especially in very low birth weight infants. The aim of the study is to report our single-centre short-term results of preterm patients who underwent ligation through left anterior mini-thoracotomy . METHODS Data of 27 preterm infants operated by the same surgeon who underwent Patent ductus arteriosus (PDA) closure with left anterior mini-thoracotomy technique between November 2020 and January 2022 at a single institution were reviewed. The patients were divided into two groups according to their weight at the time of surgery. Data on early postoperative outcomes and survival rates after discharge were collected. RESULTS Twenty-seven patients with a mean (±SD) gestational age of 25.8 (±2.0) weeks and a mean birth weight of 1027 (±423) g were operated using left anterior mini-thoracotomy technique. The lowest body weight was 480 g. Complications such as bleeding, abnormal healing of incision, or pneumothorax were not seen. There were 8 mortalities after the operation (29,6 %). The causes of the deaths were sepsis, necrotising enterocolitis, hydrops fetalis, hepatoblastoma, and intracranial bleeding. There was no statistically significant difference in the rates of complication between the groups. CONCLUSIONS Left anterior mini-thoracotomy technique can be performed as the first choice when transcatheter intervention cannot be applied in preterm infants. It provides easy access to the PDA, a good exposure, minimal contact with the lungs, good cosmetic results in early and mid-term and shortens the operation time, especially in very low birth weight preterm babies. However, early ligation may be helpful to minimise the complications related to PDA.
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Affiliation(s)
- Yiğit Kılıç
- Department of Pediatric Cardiac Surgery, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ahmet Kuddusi Irdem
- Department of Pediatric Cardiac Surgery, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Onur Doyurgan
- Department of Pediatric Cardiac Surgery, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Gül Özlem
- Department of Pediatric Cardiology, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Hasan Balik
- Department of Pediatric Cardiology, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Esra Aktiz Bıcak
- Department of Anesthesiology and Reanimation, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Fikret Salik
- Department of Anesthesiology and Reanimation, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Bedri Aldudak
- Department of Pediatric Cardiology, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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Ligation of patent ductus arteriosus through anterior thoracotomy in preterm infants: a 10-year experience. Cardiol Young 2021; 31:985-991. [PMID: 33504380 DOI: 10.1017/s1047951121000032] [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: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to report on the short-term and mid-term outcomes of preterm infants who underwent patent ductus arteriosus ligation through anterior mini-thoracotomy. METHODS Data for 103 preterm infants who underwent patent ductus arteriosus clipping through an anterior mini-thoracotomy at the 2nd intercostal space between 2009 and 2019 were retrospectively reviewed. The patients were divided into two groups according to their weight at the time of surgery. The complications, morbidity, and mortality rates of each group were compared at postoperative day 30 and at the end of 1 year after surgery. RESULTS During the operation, the median weight of the patients was 900 g (IQR 800-1125 g), the median age was 21 days (IQR 14.5-29 days). The lowest body weight was 460 g. In three patients (3%), there was intraoperative bleeding from the patent ductus arteriosus that required transition to median sternotomy. In one patient (1%) a residual patent ductus arteriosus that required reoperation was observed. Twelve patients (12%) died in the first 30 days postoperatively. Six patients (6%) died between the postoperative day 30 and 1 year. There was no statistically significant difference in the rates of mortality, morbidity, and complication between the groups. CONCLUSIONS Based on our observations of over a hundred preterm infants with patent ductus arteriosus over a decade, ligation through anterior mini-thoracotomy is the main surgical procedure of choice for this patient group in our clinic. Our findings demonstrate the safety of this approach and we believe that it can be successfully replicated in other institutions.
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A. Karatza A, Sinopidis X. Patent Arterial Duct. CONGENIT HEART DIS 2018. [DOI: 10.5772/intechopen.79956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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