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Donthula R, Li W, Duvvada A, Dyer D, Uppu SC. Normative computed tomography angiography values of the aortic root, aorta, and aortic arch in children. Eur J Pediatr 2024:10.1007/s00431-024-05818-7. [PMID: 39417839 DOI: 10.1007/s00431-024-05818-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/21/2024] [Accepted: 10/08/2024] [Indexed: 10/19/2024]
Abstract
Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data is not currently available for ECG-gated computed tomography angiography (CTA). We sought to establish ECG-gated CTA-derived normative values for the aortic root, aorta, and aortic arch in children. Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 and December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface areaAE (BSAAE) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements. CONCLUSION Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta, and aortic arch in children. WHAT IS KNOWN • Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity. WHAT IS NEW • Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the aortic root, aorta and aortic arch in children.
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Affiliation(s)
- Rakesh Donthula
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, the University of Texas McGovern Medical School at Houston, Houston, TX, 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | | | - Dan Dyer
- Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Santosh C Uppu
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA.
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Muiño-Mosquera L, Cervi E, De Groote K, Dewals W, Fejzic Z, Kazamia K, Mathur S, Milleron O, Mir TS, Nielsen DG, Odermarsky M, Sabate-Rotes A, van der Hulst A, Valenzuela I, Jondeau G. Management of aortic disease in children with FBN1-related Marfan syndrome. Eur Heart J 2024; 45:4156-4169. [PMID: 39250726 PMCID: PMC11472455 DOI: 10.1093/eurheartj/ehae526] [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: 12/19/2023] [Revised: 05/14/2024] [Accepted: 07/31/2024] [Indexed: 09/11/2024] Open
Abstract
Marfan syndrome (MFS) is a hereditary connective tissue disorder with an estimated prevalence of 1:5000-1:10 000 individuals. It is a pleiotropic disease characterized by specific ocular, cardiovascular, and skeletal features. The most common cardiovascular complication is aortic root dilatation which untreated can lead to life-threatening aortic root dissection, mainly occurring in adult patients. Prompt diagnosis, appropriate follow-up, and timely treatment can prevent aortic events. Currently there are no specific recommendations for treatment of children with MFS, and management is greatly based on adult guidelines. Furthermore, due to the scarcity of studies including children, there is a lack of uniform treatment across different centres. This consensus document aims at bridging these gaps of knowledge. This work is a joint collaboration between the paediatric subgroup of the European Network of Vascular Diseases (VASCERN, Heritable Thoracic Aortic Disease Working Group) and the Association for European Paediatric and Congenital Cardiology (AEPC). A group of experts from 12 different centres and 8 different countries participated in this effort. This document reviews four main subjects, namely, (i) imaging of the aorta at diagnosis and follow-up, (ii) recommendations on medical treatment, (iii) recommendations on surgical treatment, and (iv) recommendations on sport participation.
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Affiliation(s)
- Laura Muiño-Mosquera
- Department of Paediatrics, division of Paediatric Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Elena Cervi
- Inherited Cardiovascular Diseases Centre, Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | - Katya De Groote
- Department of Paediatrics, division of Paediatric Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Wendy Dewals
- Department of Paediatrics, division of Paediatric Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Zina Fejzic
- Department of Paediatrics, division of Paediatric Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kalliopi Kazamia
- Department of Paediatric Cardiology, Stockholm-Uppsala, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Sujeev Mathur
- Department of Cardiovascular Imaging, Guy’s and St Thomas Hospital, London, United Kingdom
| | - Olivier Milleron
- Centre de réference pour le syndrome de Marfan et apparentés, Department of Cardiology, Bichat Claude Bernard Hospital, Université Paris Cité, INSERM U1148, Paris, France
| | - Thomas S Mir
- Childrens Heart Centre, Paediatric Cardiology, University Clinics Hamburg, Hamburg, Germany
| | - Dorte G Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anna Sabate-Rotes
- Department of Paediatric Cardiology, Hospital Vall D’Hebron, Barcelona, Spain
| | - Annelies van der Hulst
- Department of Paediatrics, Division of Paediatric Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Irene Valenzuela
- Department of Clinical and Molecular Genetics, Hospital Vall d’Hebron, Barcelona, Spain
| | - Guillaume Jondeau
- Centre de réference pour le syndrome de Marfan et apparentés, Department of Cardiology, Bichat Claude Bernard Hospital, Université Paris Cité, INSERM U1148, Paris, France
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Făgărășan A, Săsăran MO, Gozar L, Toma D, Șuteu C, Ghiragosian-Rusu S, Al-Akel FC, Szabo B, Huțanu A. Circulating Matrix Metalloproteinases for Prediction of Aortic Dilatation in Children with Bicuspid Aortic Valve: A Single-Center, Observational Study. Int J Mol Sci 2024; 25:10538. [PMID: 39408865 PMCID: PMC11476682 DOI: 10.3390/ijms251910538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 09/19/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
Circulating biomarkers have been proposed for early identification of aortic dilatation progression associated with bicuspid aortic valve (BAV), but matrix metalloproteinases (MMPs) are distinguished as signatures of increased extracellular matrix degradation, a landmark of aneurysm formation. The current study aims to identify the role of MMP-1, MMP-2, MMP-9, and the MMP inhibitor, TIMP-1, in identifying aortic dilation in children with BAV. We conducted a study on 73 children divided into two study groups, depending on the presence of aortic dilatation (group 1-43 BAV controls and group 2-30 children with BAV and aortic dilatation). Each patient underwent a cardiac ultrasound and, in each case, serum MMP-1, MMP-2, MMP-9, and TIMP-1 were quantified using xMAP technology. Comparison of the MMPs between the two study groups revealed significantly higher values only in the case of TIMP-1, among BAV controls. Moreover, the same TIMP-1 inversely correlated with aortic annulus absolute size and z score, as well as with ascending aorta z score. No particular correlation between the aortic phenotype and the presence of aortic dilatation was found. Future longitudinal research starting at pediatric ages could show the significance of MMPs screening in BAV individuals as predictors of aortic aneurysm formation.
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Affiliation(s)
- Amalia Făgărășan
- Department of Pediatrics III, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (A.F.); (L.G.); (D.T.); (C.Ș.); (S.G.-R.)
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, Gheorghe Marinescu Street No 50, 540136 Târgu Mureș, Romania; (F.C.A.-A.); (B.S.)
| | - Maria Oana Săsăran
- Department of Pediatrics III, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540142 Târgu Mureș, Romania
| | - Liliana Gozar
- Department of Pediatrics III, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (A.F.); (L.G.); (D.T.); (C.Ș.); (S.G.-R.)
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, Gheorghe Marinescu Street No 50, 540136 Târgu Mureș, Romania; (F.C.A.-A.); (B.S.)
| | - Daniela Toma
- Department of Pediatrics III, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (A.F.); (L.G.); (D.T.); (C.Ș.); (S.G.-R.)
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, Gheorghe Marinescu Street No 50, 540136 Târgu Mureș, Romania; (F.C.A.-A.); (B.S.)
| | - Carmen Șuteu
- Department of Pediatrics III, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (A.F.); (L.G.); (D.T.); (C.Ș.); (S.G.-R.)
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, Gheorghe Marinescu Street No 50, 540136 Târgu Mureș, Romania; (F.C.A.-A.); (B.S.)
| | - Simina Ghiragosian-Rusu
- Department of Pediatrics III, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (A.F.); (L.G.); (D.T.); (C.Ș.); (S.G.-R.)
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, Gheorghe Marinescu Street No 50, 540136 Târgu Mureș, Romania; (F.C.A.-A.); (B.S.)
| | - Flavia Cristina Al-Akel
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, Gheorghe Marinescu Street No 50, 540136 Târgu Mureș, Romania; (F.C.A.-A.); (B.S.)
- Pathophysiology Department, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania
| | - Boglarka Szabo
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, Gheorghe Marinescu Street No 50, 540136 Târgu Mureș, Romania; (F.C.A.-A.); (B.S.)
| | - Adina Huțanu
- Department of Laboratory Medicine, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania;
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Karaoglan M, Nacarkahya G, Aytac EH, Keskin M. Genotype and clinical phenotype of children with Marfan syndrome in Southeastern Anatolia. Eur J Pediatr 2024; 183:3219-3232. [PMID: 38700693 PMCID: PMC11263224 DOI: 10.1007/s00431-024-05579-3] [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: 01/28/2024] [Revised: 03/19/2024] [Accepted: 04/19/2024] [Indexed: 07/23/2024]
Abstract
The cardinal phenotypic hallmarks of Marfan syndrome (MFS) include cardiac, ocular, and skeletal abnormalities. Since the clinical phenotype of MFS is highly heterogeneous, with certain symptoms appearing as children age, the diagnostic process and establishing a genotype-phenotype association in childhood MFS can be challenging. The lack of sufficient childhood studies also makes it difficult to interpret the subject. This study aims to evaluate the relationship between clinical symptoms used as diagnostic criteria and FBN1 variations in children with MFS. This study investigated the relationships between genotypes and phenotypes in 131 children suspected of having Marfan syndrome (MFS). Diagnosis of MFS was made according to the revised Ghent nosology. FBN1 variants were categorized based on exon regions, type of variant, and pathogenicity classes. These FBN1 variants were then correlated with the clinical manifestations including cardiovascular, ocular, facial, and skeletal abnormalities. Out of the children, 43 were diagnosed with MFS. FBN1 variant was identified in 32 (74.4%) of the MFS children. MFS diagnosis could not be made in five (15.6%) FBN1 variant-positive children. The most common cardinal finding is cardiac anomalies n = 38 (88.3%). The most common FBN1 pathogenic variant was c.1786 T > C/p.Cys596Arg n = 4 (12.5%). The distribution of pathogenic variants was as follows: 29 (90.6%) missense, 2 (6.3%) frameshift, and 1 (3.1%) nonsense. The numbers of AD and EL of the variant-positive children were 16 (50%) and 14 (43.7%), respectively. Ocular abnormalities were more common in children with FBN1-positive MFS (p = 0.009). There was no difference in the number of cardiac abnormalities between FBN1-positive and FBN1-negative MFS patients (p = 0.139). Conclusion: This study examines the relationship between FBN1 variants and clinical features used as diagnostic criteria in MFS children. The findings emphasize the importance of long-term monitoring of heterogeneous clinical phenotypes and bioinformatic reanalysis in determining the genotype-phenotype relationship in children, as MFS symptoms can vary with age. What is Known: • Marfan syndrome has highly variable phenotypic heterogeneity. • The genotype-phenotype relationship in childhood Marfan syndrome is not clear enough due to the variation in the time of onset of the findings. What is New: • This article provides regional data for the field of research on genotype-phenotype relationships in childhood Marfan syndrome. • Long-term follow-up of clinical findings and bioinformatics reanalysis is an important requirement for a well-established genotype-phenotype relationship in childhood Marfan syndrome.
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Affiliation(s)
- Murat Karaoglan
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Turkey.
| | - Gulper Nacarkahya
- Department of Molecular Biology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Emel Hatun Aytac
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Keskin
- Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep University, Gaziantep, Turkey
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Pfeifer J, Rentzsch A, Poryo M, Abdul-Khaliq H. Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle. J Cardiovasc Dev Dis 2024; 11:156. [PMID: 38786978 PMCID: PMC11122585 DOI: 10.3390/jcdd11050156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Congenital critical aortic valve stenosis (CAVS) is a life-threatening disease requiring urgent treatment. First-line therapy is still controversial. The aim of our study was (1) to analyze retrospectively the patients of our institution who underwent balloon aortic valvuloplasty (BAV) due to CAVS and (2) describe the techniques for improved feasibility of intervention using microcatheters and retrieval loops. Twelve patients underwent 23 BAVs: 1 BAV was performed in 3 patients, 2 BAVs were performed in 7 patients, and 3 BAVs were performed in 2 patients. The peak trans-valvular pressure gradient (Δp) and left ventricular shortening fraction (LVSF) improved significantly in the first two interventions. In the first BAV, Δp decreased from 73.7 ± 34.5 mmHg to 39.8 ± 11.9 mmHg (p = 0.003), and the LVSF improved from 22.3 ± 13.5% to 31.6 ± 10.2% (p = 0.001). In the second BAV, Δp decreased from 73.2 ± 33.3 mmHg to 35.0 ± 20.2 mmHg (p < 0.001), and the LVSF increased from 26.7 ± 9.6% to 33.3 ± 7.4% (p = 0.004). Cardiac surgery during the neonatal period was avoided for all children. The median time to valve surgery was 5.75 years. Few complications occurred, namely mild-to-moderate aortic regurgitation, one remediable air embolism, and one intimal injury to the ascending aorta. We conclude that BAV is a successful emergency treatment for CAVS, resulting in left ventricular relief, clinical stabilization, and a time gain until cardiac surgery.
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Affiliation(s)
- Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany
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6
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Donthula R, Li W, Duvvada A, Dyer D, Uppu SC. Normative Computed Tomography Angiography Values of the Aortic Root, Aorta and Aortic arch in Children. RESEARCH SQUARE 2024:rs.3.rs-4406785. [PMID: 38798643 PMCID: PMC11118707 DOI: 10.21203/rs.3.rs-4406785/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Purpose Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data are not currently available for ECG-gated Computed Tomography Angiography (CTA). We sought to establish ECG-gated CTA derived normative values for the aortic root, aorta and aortic arch in children. Methods and Results Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface areaAE (BSAAE) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements. Conclusion Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta and aortic arch in children.
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Affiliation(s)
| | - Wen Li
- the University of Texas McGovern Medical School at Houston
| | | | | | - Santosh C Uppu
- The University of Texas Health Science Center at Houston
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Kwon HW, Song MK, Lee SY, Kim GB, Kwak JG, Cho S, Kim WH, Bae EJ. Risk Factors for Coronary Artery Complications After Prosthetic Pulmonary Valve Implantation in Patients With Congenital Heart Disease. Circ J 2024; 88:652-662. [PMID: 38325847 DOI: 10.1253/circj.cj-23-0752] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND Coronary artery complications (CACs) in patients who undergoing prosthetic pulmonary valve implantation for congenital heart disease can lead to fetal outcomes. However, the incidence of and risk factors for CACs in these patients remain unknown. METHODS AND RESULTS A retrospective cohort study was conducted on patients who underwent cardiac computed tomography or invasive coronary angiography after prosthetic pulmonary valve implantation at Seoul National University Hospital from June 1986 to May 2021. Among 341 patients, 25 (7.3%) were identified with CACs, and 2 of them died. Among the patients with CACs, congenital coronary anomalies and an interarterial course of the coronary artery were identified in 11 (44%) and 18 (72%) patients, respectively. Interarterial and intramural courses of the coronary artery were associated with a 4.4- and 10.6-fold increased risk of CACs, respectively. Among patients with tetralogy of Fallot and pulmonary atresia, the aortic root was rotated further clockwise in patients with coronary artery compression compared to those without it (mean [±SD] 128.0±19.9° vs. 113.5±23.7°; P=0.024). The cut-off rotation angle of the aorta for predicting the occurrence of coronary artery compression was 133°. CONCLUSIONS Perioperative coronary artery evaluation and prevention of CACs are required in patients undergoing prosthetic pulmonary valve implantation, particularly in those with coronary artery anomalies or severe clockwise rotation of the aortic root.
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Affiliation(s)
- Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
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Donthula R, Li W, Kaur H, Adebo DA, Uppu SC. Normative computed tomography angiography values of the main and branch pulmonary arteries in children. Eur J Pediatr 2024; 183:1183-1193. [PMID: 38078969 DOI: 10.1007/s00431-023-05363-9] [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] [Received: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
Non-invasive cardiac imaging like echocardiogram, cardiac magnetic resonance imaging (CMR), and computed tomography angiography (CTA) play a key role in the diagnosis, aid in management and follow-up of congenital heart disease patients. Normative data for intracardiac and extracardiac vascular structures in children are currently available for echocardiogram, CMR, and non-gated CTA. We sought to establish systolic and diastolic normative data for main and branch pulmonary arteries in children using electrocardiogram (ECG)-gated CTA. Diameters and cross-sectional areas of the main and branch pulmonary arteries were measured in systole and diastole based on the aortic valve position (open versus closed) in 100 subjects who had ECG-gated cardiac CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface area (BSAAE) was established using the previously described methods. A total of 100 children aged 0-18 years were analyzed; mean age was 5.3 years (SD, 6.1 years). Z-score curves were plotted in relation to the BSA for the mean, maximum, and minimum diameters and cross-sectional area of the main and branch pulmonary arteries for systole and diastole. Conclusion: We report systolic and diastolic mean, maximum, and minimum diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children derived using ECG-gated cardiac CTA. We believe our results can help identify abnormally sized main and branch pulmonary arteries. What is Known: • Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity. What is New: • Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children.
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Affiliation(s)
- Rakesh Donthula
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, the University of Texas McGovern Medical School at Houston, Houston, TX, 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Harmanpreet Kaur
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Dilachew A Adebo
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Santosh C Uppu
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA.
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Lopez L, Saurers DL, Barker PCA, Cohen MS, Colan SD, Dwyer J, Forsha D, Friedberg MK, Lai WW, Printz BF, Sachdeva R, Soni-Patel NR, Truong DT, Young LT, Altman CA. Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:119-170. [PMID: 38309834 DOI: 10.1016/j.echo.2023.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Echocardiography is a fundamental component of pediatric cardiology, and appropriate indications have been established for its use in the setting of suspected, congenital, or acquired heart disease in children. Since the publication of guidelines for pediatric transthoracic echocardiography in 2006 and 2010, advances in knowledge and technology have expanded the scope of practice beyond the use of traditional modalities such as two-dimensional, M-mode, and Doppler echocardiography to evaluate the cardiac segmental structures and their function. Adjunct modalities such as contrast, three-dimensional, and speckle-tracking echocardiography are now used routinely at many pediatric centers. Guidelines and recommendations for the use of traditional and newer adjunct modalities in children are described in detail in this document. In addition, suggested protocols related to standard operations, infection control, sedation, and quality assurance and improvement are included to provide an organizational structure for centers performing pediatric transthoracic echocardiograms.
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Affiliation(s)
- Leo Lopez
- Department of Pediatrics Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, California.
| | - Daniel L Saurers
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Piers C A Barker
- Duke Children's Hospital & Health Center, Duke University, Durham, North Carolina
| | - Meryl S Cohen
- Cardiac Center and Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeanine Dwyer
- Pediatric Heart Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Daniel Forsha
- Ward Family Heart Center, Children's Mercy Kansas City Hospital, Kansas City, Missouri
| | - Mark K Friedberg
- Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wyman W Lai
- Division of Pediatric Cardiology, University of California School of Medicine, Irvine, California; Department of Pediatrics, Children's Hospital of Orange County, Orange, California
| | - Beth F Printz
- Rady Children's Hospital San Diego and University of California, San Diego, San Diego, California
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Neha R Soni-Patel
- Pediatric & Adult Congenital Heart Center, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Dongngan T Truong
- University of Utah and Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah
| | - Luciana T Young
- Seattle Children's Hospital and Pediatric Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A Altman
- Baylor College of Medicine and Texas Children's Heart Center, Texas Children's Hospital, Houston, Texas
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Cantinotti M, Jani V, Kutty S, Marchese P, Franchi E, Pizzuto A, Viacava C, Assanta N, Santoro G, Giordano R. Neonates and Infants with Left Heart Obstruction and Borderline Left Ventricle Undergoing Biventricular Repair: What Do We Know about Long-Term Outcomes? A Critical Review. Healthcare (Basel) 2024; 12:348. [PMID: 38338232 PMCID: PMC10855671 DOI: 10.3390/healthcare12030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The decision to perform biventricular repair (BVR) in neonates and infants presenting with either single or multiple left ventricle outflow obstructions (LVOTOs) and a borderline left ventricle (BLV) is subject to extensive discussion, and limited information is known regarding the long-term outcomes. As a result, the objective of this study is to critically assess and summarize the available data regarding the prognosis of neonates and infants with LVOTO and BLV who underwent BVR. METHODS In February 2023, we conducted a review study with three different medical search engines (the National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings and free text terms including "congenital heart disease", "outcome", and "borderline left ventricle". The search was refined by adding keywords for "Shone's complex", "complex LVOT obstruction", "hypoplastic left heart syndrome/complex", and "critical aortic stenosis". RESULTS Out of a total of 51 studies, 15 studies were included in the final analysis. The authors utilized heterogeneous definitions to characterize BLV, resulting in considerable variation in inclusion criteria among studies. Three distinct categories of studies were identified, encompassing those specifically designed to evaluate BLV, those focused on Shone's complex, and finally those on aortic stenosis. Despite the challenges associated with comparing data originating from slightly different cardiac defects and from different eras, our results indicate a favorable survival rate and clinical outcome following BVR. However, the incidence of reintervention remains high, and concerns persist regarding residual pulmonary hypertension, which has been inadequately investigated. CONCLUSIONS The available data concerning neonates and infants with LVOTO and BLV who undergo BVR are inadequate and fragmented. Consequently, large-scale studies are necessary to fully ascertain the long-term outcome of these complex defects.
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Affiliation(s)
- Massimiliano Cantinotti
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Vivek Jani
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Pietro Marchese
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Eliana Franchi
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Alessandra Pizzuto
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Cecilia Viacava
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Nadia Assanta
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Giuseppe Santoro
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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11
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Recco DP, Kizilski SB, Ghosh RM, Piekarski B, Prakash A, Hoganson DM. Aortic growth after arch reconstruction with patch augmentation: a 2-decade experience. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad210. [PMID: 38134426 PMCID: PMC10752579 DOI: 10.1093/icvts/ivad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Optimal aortic sizing during aortic arch reconstruction remains unknown. Negative effects of arch under- or oversizing are well-published. We aimed to characterize longitudinal aortic growth after patch-augmented arch reconstruction to identify the initial reconstructed arch size that results in normal mid-term arch dimensions. METHODS Single-centre, retrospective review of infants undergoing Damus-Kaye-Stansel (DKS) or non-DKS patch-augmented aortic arch reconstruction between 2000 and 2021. Ascending aorta, proximal and distal transverse arch, aortic isthmus (AIsth) and descending aorta dimensions were measured in postoperative echocardiograms (<3 months from index operation) and cross-sectional imaging (>12 months). Longitudinal changes to aortic dimensions and z-scores were analysed. Secondary outcomes included reintervention, valve and ventricular function, mortality and transplantation. RESULTS Fifty-four patients (16 DKS, 38 non-DKS) were included. At 6.3 [2.2, 12.0]-year follow-up, all aortic segments grew significantly in both groups, while z-scores remained unchanged except for non-DKS proximal and distal transverse arch z-scores, which significantly increased (P < 0.05 each). When stratified by initial postoperative z-score (z < -1, -1 ≤ z ≤ 1, z > 1), non-DKS patients with initial AIsth z-score <-1 had a final z-score significantly smaller than both the targeted z-score zero (P = 0.014) and final z-score in a group with initial postoperative z-score ±1 (P = 0.009). Valve and ventricular function remained stable. Eighteen patients required reintervention, 1 died and 1 underwent transplant. CONCLUSIONS Over mid-term follow-up, aortic growth after arch reconstruction with patch augmentation was proportional when repaired to normal z-score dimensions, aside from proximal transverse arch, which disproportionately dilated. AIsth undersizing prevailed mid-term and trended towards a higher reintervention rate. Initial reconstruction between z-score 0 and +1 resulted in maintenance of that z-score size at mid-term follow-up. Overall, it is crucial to achieve targeted aortic sizing at index operation to maintain appropriate aortic dimensions over time and reduce reintervention risk with specific focus on the AIsth.
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Affiliation(s)
- Dominic P Recco
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shannen B Kizilski
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Reena M Ghosh
- Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Breanna Piekarski
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ashwin Prakash
- Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - David M Hoganson
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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12
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Xu Q, Hou K, Lv B, Xing Q, Chen R. Application of Foley balloon catheter in palliative surgery for pulmonary atresia with an intact ventricular septem, with additional cases of pulmonary atresia with ventricular septal defect and tetralogy of Fallot. BMC Cardiovasc Disord 2023; 23:547. [PMID: 37940877 PMCID: PMC10634058 DOI: 10.1186/s12872-023-03587-z] [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: 04/07/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Pulmonary atresia and tetralogy of Fallot can require palliative surgery in the neonatal period due to severe hypoxia; however, limitations of established techniques include high failure rate and need for cardiopulmonary bypass. Herein, right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter is described. METHODS A retrospective review of patients who underwent right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter at our institution between September 2018 and March 2022 was completed. During the procedure, a Foley balloon catheter was used to occlude the blood from the right ventricular inflow tract. RESULTS Eight patients with pulmonary atresia and intact ventricular septum underwent an off-pump right ventricular outflow tract reconstruction. One patient with pulmonary atresia and ventricular septal defect, and two patients with tetralogy of Fallot underwent an on-pump right ventricular outflow tract reconstruction on a beating heart. The procedures were successful in all patients. Patent ductus arteriosus ligation without modified Blalock-Taussig shunt placement was performed in three patients with pulmonary atresia with intact ventricular septum and two patients with tetralogy of Fallot, ductus arteriosus was left open in four patients with pulmonary atresia with intact ventricular septum. All patients remained clinically well without serious complications. CONCLUSIONS Right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter for pulmonary atresia and tetralogy of Fallot is a feasible alternative to catheter-based interventions or traditional surgical treatment, especially in patients with muscular infundibular stenosis or hypoplastic pulmonary annulus. Further studies with more cases are needed to verify feasibility and superiority of this approach.
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Affiliation(s)
- Qiteng Xu
- Medical College, Qingdao University, Qingdao, China
| | - Kefeng Hou
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Bei Lv
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Quansheng Xing
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Rui Chen
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China.
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Crago M, Winlaw DS, Farajikhah S, Dehghani F, Naficy S. Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies. Bioeng Transl Med 2023; 8:e10501. [PMID: 37476058 PMCID: PMC10354783 DOI: 10.1002/btm2.10501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 03/06/2023] Open
Abstract
Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growth-accommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.
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Affiliation(s)
- Matthew Crago
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - David S. Winlaw
- Department of Cardiothoracic SurgeryHeart Institute, Cincinnati Children's HospitalCincinnatiOHUSA
| | - Syamak Farajikhah
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Fariba Dehghani
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Sina Naficy
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
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HTAD patient pathway: Strategy for diagnostic work-up of patients and families with (suspected) heritable thoracic aortic diseases (HTAD). A statement from the HTAD working group of VASCERN. Eur J Med Genet 2022; 66:104673. [PMID: 36460281 DOI: 10.1016/j.ejmg.2022.104673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
Heritable thoracic aortic diseases (HTAD) are rare pathologies associated with thoracic aortic aneurysms and dissection, which can be syndromic or non-syndromic. They may result from genetic defects. Associated genes identified to date are classified into those encoding components of the (a) extracellular matrix (b) TGFβ pathway and (c) smooth muscle contractile mechanism. Timely diagnosis allows for prompt aortic surveillance and prophylactic surgery, hence improving life expectancy and reducing maternal complications as well as providing reassurance to family members when a diagnosis is ruled out. This document is an expert opinion reflecting strategies put forward by medical experts and patient representatives involved in the HTAD Rare Disease Working Group of VASCERN. It aims to provide a patient pathway that improves patient care by diminishing time to diagnosis, facilitating the establishment of a correct diagnosis using molecular genetics when possible, excluding the diagnosis in unaffected persons through appropriate family screening and avoiding overuse of resources. It is being recommended that patients are referred to an expert centre for further evaluation if they meet at least one of the following criteria: (1) thoracic aortic dissection (<70 years if hypertensive; all ages if non-hypertensive), (2) thoracic aortic aneurysm (all adults with Z score >3.5 or 2.5-3.5 if non-hypertensive or hypertensive and <60 years; all children with Z score >3), (3) family history of HTAD with/without a pathogenic variant in a gene linked to HTAD, (4) ectopia lentis without other obvious explanation and (5) a systemic score of >5 in adults and >3 in children. Aortic imaging primarily relies on transthoracic echocardiography with magnetic resonance imaging or computed tomography as needed. Genetic testing should be considered in those with a high suspicion of underlying genetic aortopathy. Though panels vary among centers, for patients with thoracic aortic aneurysm or dissection or systemic features these should include genes with a definitive or strong association to HTAD. Genetic cascade screening and serial aortic imaging should be considered for family screening and follow-up. In conclusion, the implementation of these strategies should help standardise the diagnostic work-up and follow-up of patients with suspected HTAD and the screening of their relatives.
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Outcome of truncus arteriosus repair: 20 years of single-center experience comparing early versus late surgical repair. Cardiol Young 2022; 32:1289-1295. [PMID: 34666851 DOI: 10.1017/s104795112100408x] [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: 11/07/2022]
Abstract
BACKGROUND Truncus arteriosus is a rare CHD. Neonatal and early infancy repair is recommended though some cases may present late. The aim of our study is to investigate the current results of truncus arteriosus repair and to analyse the differences in outcome and reintervention need between early versus late truncus arteriosus surgical repair. MATERIAL AND METHODS In this cohort study, we reviewed all children who underwent truncus arteriosus repair from 2001 till 2021. We divided patients into two groups; early repair group including patients repaired at age less than 3 months and late repair group including patients who had repair at 3 months of age and later. We compared both groups for outcome variables. RESULTS Sixty-four children had truncus arteriosus repair including 48(75%) patients in early repair and 16(25%) patients in late repair groups. Peri-operative course was comparable between both groups. Post-surgery, we observed pulmonary hypertension in 6(12%) patients in early repair group comparing with 11(69%) patients in late repair group (p = 0.0001). In the last follow-up visit, pulmonary hypertension resolved in all early repair group patients while 6(37.5%) patients in late repair group continued to have pulmonary hypertension (p = 0.0001). Twenty-three(36%) patients required reintervention including 22(48%) in early repair group versus 1(6%) in late repair group (p = 0.007). CONCLUSION In general, the outcome of early truncus arteriosus repair is excellent with resolution of pulmonary hypertension following early repair. Late repair caries higher risk of persistent pulmonary hypertension (37.5%). About one-third of the patients who had truncus arteriosus repair will require re-intervention within 38±38.4 months after initial surgery.
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Schweintzger S, Kurath-Koller S, Burmas A, Grangl G, Fandl A, Noessler N, Avian A, Gamillscheg A, Chouvarine P, Hansmann G, Koestenberger M. Normal Echocardiographic Reference Values of the Right Ventricular to Left Ventricular Endsystolic Diameter Ratio and the Left Ventricular Endsystolic Eccentricity Index in Healthy Children and in Children With Pulmonary Hypertension. Front Cardiovasc Med 2022; 9:950765. [PMID: 35911557 PMCID: PMC9332913 DOI: 10.3389/fcvm.2022.950765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAn accurate assessment of the right and left ventricle and their interaction is important in pediatric pulmonary hypertension (PH). Our objective was to provide normal reference values for the right ventricular to left ventricular endsystolic (RV/LVes) ratio and the LV endsystolic eccentricity index (LVes EI) in healthy children and in children with PH.MethodsWe conducted an echocardiographic study in 769 healthy children (median age: 3.36 years; range: 1 day—18 years) and validated abnormal values in 44 children with PH (median age: 2.1 years; range: 0.1 months—17.7 years). We determined the effects of gender, age, body length, body weight, and body surface area (BSA) on RV/LVes ratio and LVes EI values. The RV/LVes ratio and LVes EI were measured from the parasternal short axis view between papillary muscle from the endocardial to endocardial surfaces.ResultsBoth, the RV/LVes ratio and the LVes EI were highly age-dependent: (i) neonates RV/LVes ratio [median 0.83 (range 0.53–1.37)], LVes EI [1.21 (0.92–1.45)]; (ii) 12–24 months old: RV/LVes ratio: [0.55 (0.35–0.80)], LVes EI: [1.0 (0.88–1.13)]; iii) 18th year of life RV/LVes ratio: [0.53 (0.32–0.74)], LVes EI: [1.0 (0.97–1.07)]. Healthy neonates had high LVes EI and RV/LVes ratios, both gradually decreased within the first year of life and until BSA values of about 0.5 m2, body weight to about 15 kg and body length to about 75 cm, but were almost constant thereafter. Children (>1 year) and adolescents with PH had significantly higher RV/LVes ratio (no PH: median 0.55, IQR 0.49–0.60; PH: 1.02, 0.87–1.26; p < 0.001) and higher LVes EI values (no PH: 1.00, 0.98–1.00; PH: 1.53, 1.26–1.71; p < 0.001) compared to those without PH. To predict the presence of PH in children > 1 year, we found the following best cutoff values: RV/LVes ratio ≥ 0.67 (sensitivity: 1.00, specificity: 0.95) and LVes EI ≥ 1.06 (sensitivity: 1.00, specificity: 0.97).ConclusionWe provide normal echocardiographic reference values of the RV/LVes ratio and LVes EI in healthy children, as well as statistically determined cutoffs for the increased values in children with PH.
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Affiliation(s)
- Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
- *Correspondence: Sabrina Schweintzger,
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Andrea Fandl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Nathalie Noessler
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andreas Gamillscheg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Philippe Chouvarine
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hanover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hanover, Germany
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
- European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
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Prominent prolapsing Chiari network: presentation and prognosis in paediatric patients. Cardiol Young 2022; 32:1071-1076. [PMID: 34494516 DOI: 10.1017/s1047951121003668] [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: 11/07/2022]
Abstract
Chiari network is an infrequently visualized web-like structure in the right atrium that is usually thin and small. Rarely, it can be prominent and elongated with protrusion into the right ventricle during diastole and complications have been reported. Thirty-eight patients (median age 2.5 years) with prolapsing Chiari network were identified and associated cardiac abnormalities documented. Echocardiographic right and left heart parameters were measured and compared to normative data. At presentation, the extent of Chiari network prolapse below the tricuspid annulus was 9.1 ± 3.5 mm (mean ± standard deviation), mean pulmonary valve annulus diameter z-value was reduced (-0.91 ± 0.64), and mean aortic valve z-value was enlarged (+0.97 ± 0.87). Fourteen patients exhibited no other cardiac abnormality. Eight were noted to have atrial septal defects, eight demonstrated supraventricular dysrhythmias, six had mild to moderate tricuspid valve regurgitation, and one patient each had an atrial septal aneurysm, severe pulmonic valve stenosis, small perimembranous ventricular septal defect, bicuspid aortic valve, and mild right upper pulmonary vein stenosis. Fourteen patients (37%) were seen in follow-up from 1 to 8.5 years later (median 3.2 years). During that time, the magnitude of prolapse across the tricuspid valve decreased by up to 7 mm (median 2 mm). Interventions were required in three patients, but many associated cardiac abnormalities resolved spontaneously with growth. Thus, the presence of a prolapsing Chiari network has a substantial risk of associated CHDs. However, the extent of Chiari network prolapse gradually decreases and many related abnormalities resolve during growth.
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Kocher MR, Waltz J, Collins H, Schoepf UJ, Tran T, Guruvadoo K, Lehew H, Kabakus IM, Akkaya S, McBee MP, Gregg D, Zahergivar A, Burt JR. Normative Values of Pediatric Thoracic Aortic Diameters Indexed to Body Surface Area Using Computed Tomography. J Thorac Imaging 2022; 37:231-238. [PMID: 34710892 DOI: 10.1097/rti.0000000000000623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to establish normative values for the thoracic aorta diameter in pediatric patients from birth to 18 years of age using computed tomography (CT) measurements and to create nomograms related to body surface area (BSA). METHODS A total of 623 pediatric patients without cardiovascular disease (42.1% females; from 3 d to 18 y old) with high-quality, non-electrocardiogram-gated, contrast-enhanced CT imaging of the chest were retrospectively evaluated. Systematic measurements of the aortic diameter at predetermined levels were recorded, and demographic data including age, sex, ethnicity, and BSA were collected. Reference graphs plotting BSA over aortic diameter included the mean and Z -3 to Z +3, where Z represents SDs from the mean. RESULTS The study population was divided into 2 groups (below 2 and greater than or equal to 2 y old). There were no significant differences in average aortic measurements between males and females. Both age groups exhibited significant positive correlations among all size-related metrics (all P <0.001) with BSA having the highest correlation. For both groups, the average orthogonal thoracic aortic diameters at each level of the thoracic aorta were used to create nomograms. CONCLUSION This study establishes clinically applicable, BSA-specific reference values of the normal thoracic aorta for the pediatric population from CT imaging.
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Affiliation(s)
- Madison R Kocher
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Jeffrey Waltz
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Heather Collins
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - U Joseph Schoepf
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Tri Tran
- Department of Radiology, AdventHealth Orlando, Orlando, FL
| | | | - Haley Lehew
- Department of Radiology, AdventHealth Orlando, Orlando, FL
| | - Ismail M Kabakus
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Selcuk Akkaya
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Morgan P McBee
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - David Gregg
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Aryan Zahergivar
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
| | - Jeremy R Burt
- Department of Radiology or Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC
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Comparability of different Z-score equations for aortic root dimensions in children with Marfan syndrome. Cardiol Young 2021; 31:1962-1968. [PMID: 33843540 DOI: 10.1017/s1047951121001311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Aortic root dilation is a major complication of Marfan syndrome and is one of the most important criteria in establishing the diagnosis. Currently, different echocardiographic nomograms are used to calculate aortic root Z-scores. The aim of the present study was to assess the potential differences in aortic root measurements when aortic root Z-scores were obtained in a cohort of paediatric Marfan patients using several published nomograms. METHODS In a cohort of 100 children with Marfan syndrome, Z-scores for aortic root dimensions were calculated according to the nomograms of Pettersen et al, Gautier et al, Colan et al, and Lopez et al. Bland-Altman plots were used to estimate mean differences in Z-scores and to establish limits of agreement. RESULTS The mean Z-score of the sinus of Valsalva for Lopez et al was significantly higher compared to Gautier et al (p < 0.01) and Pettersen et al (p = 0.03). The nomogram of Lopez et al resulted in substantially higher Z-scores in patients with a large sinus of Valsalva diameter. Thirty-five percentage of the studied patients would have a Z-score ≥ 2 using Lopez et al compared to 20% for Pettersen et al, 21% for Gautier et al, and 33% for Colan et al. CONCLUSION The currently available nomograms for calculating Z-scores of aortic dilation in children with Marfan syndrome lead to clinically relevant differences in Z-scores, especially in children with a relative large aortic root diameter. This could have impact on both the diagnosis and treatment of patients with Marfan syndrome.
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Plante V, Gobeil L, Xiong WT, Touré M, Dahdah N, Greenway SC, Drolet C, Wong KK, Mackie AS, Bradley TJ, Mertens L, Cavallé-Garrido T, Penslar J, Wong D, Dallaire F. Alternative to body surface area as a solution to correct systematic bias in pediatric echocardiography Z scores. Can J Cardiol 2021; 37:1790-1797. [PMID: 34216742 DOI: 10.1016/j.cjca.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Z scores are the method of choice to report dimensions in pediatric echocardiography. Z scores based on body surface area (BSA) have been shown to cause systematic biases in overweight and obese children. Using aortic valve (AoV) diameters as a paradigm, the aims of this study were to assess the magnitude of Z score underestimation in children with increased body mass index Z score (BMI-Z) and to determine if a predicting model with height and weight as independent predictors would minimize this bias. METHODS In this multicenter, retrospective, cross-sectional study, 15,006 normal echocardiograms in healthy children 1-18 years old were analyzed. Residual associations with body size were assessed for previously published Z score. BSA-based and alternative prediction models based on height and weight were developed and validated in separate training and validation samples. RESULTS Existing BSA-based Z scores incompletely adjusted for weight, BSA and BMI-Z and led to an underestimation of >0.8 Z score units in subjects with higher BMI-Z, compared to lean subjects. BSA-based models led to overestimation of predicted AoV diameters with increasing weight or BMI-Z. Models using height and weight as independent predictors improved adjustment with body size, including in children with higher BMI-Z. CONCLUSIONS BSA-based models result in underestimation of Z scores in patients with high BMI-Z. Prediction models using height and weight as independent predictors minimize residual associations with body size and generate well-fitted predicted values that could apply to all children, including those with low or high BMI-Z.
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Affiliation(s)
- Virginie Plante
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Laurence Gobeil
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Wei Ting Xiong
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moustapha Touré
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte-Justine University Hospital, Université de Montréal, Montreal, QC, Canada
| | - Steven C Greenway
- Departments of Pediatrics, Cardiac Sciences and Biochemistry & Molecular Biology, Alberta Children's Hospital Research Institute and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christian Drolet
- Centre Hospitalier de l'Université Laval, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Kenny K Wong
- IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Timothy J Bradley
- Division of Cardiology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Luc Mertens
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tiscar Cavallé-Garrido
- Division of Cardiology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Joshua Penslar
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Derek Wong
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Frédéric Dallaire
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada.
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21
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Hofferberth SC, Saeed MY, Tomholt L, Fernandes MC, Payne CJ, Price K, Marx GR, Esch JJ, Brown DW, Brown J, Hammer PE, Bianco RW, Weaver JC, Edelman ER, Del Nido PJ. A geometrically adaptable heart valve replacement. Sci Transl Med 2021; 12:12/531/eaay4006. [PMID: 32075944 DOI: 10.1126/scitranslmed.aay4006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022]
Abstract
Congenital heart valve disease has life-threatening consequences that warrant early valve replacement; however, the development of a growth-accommodating prosthetic valve has remained elusive. Thousands of children continue to face multiple high-risk open-heart operations to replace valves that they have outgrown. Here, we demonstrate a biomimetic prosthetic valve that is geometrically adaptable to accommodate somatic growth and structural asymmetries within the heart. Inspired by the human venous valve, whose geometry is optimized to preserve functionality across a wide range of constantly varying volume loads and diameters, our balloon-expandable synthetic bileaflet valve analog exhibits similar adaptability to dimensional and shape changes. Benchtop and acute in vivo experiments validated design functionality, and in vivo survival studies in growing sheep demonstrated that mechanical valve expansion accommodated growth. As illustrated in this work, dynamic size adaptability with preservation of unidirectional flow in prosthetic valves thus offers a paradigm shift in the treatment of heart valve disease.
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Affiliation(s)
- Sophie C Hofferberth
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Mossab Y Saeed
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Lara Tomholt
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA.,Harvard Graduate School of Design, Harvard University, Cambridge, MA 02138, USA
| | - Matheus C Fernandes
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA.,John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Christopher J Payne
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Karl Price
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jesse J Esch
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jonathan Brown
- Biomedical Engineering Center, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Peter E Hammer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Richard W Bianco
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - James C Weaver
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA
| | - Elazer R Edelman
- Biomedical Engineering Center, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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22
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Siurana JM, Sabaté-Rotés A, Ayerza A, Jimenez L, Figueras-Coll M, Gonzalez MA. Adolescents with bicuspid aortic valve: Which criteria should we use for aortic dilatation? Int J Cardiol 2021; 333:90-93. [PMID: 33757790 DOI: 10.1016/j.ijcard.2021.03.041] [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] [Received: 01/19/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Criteria to define aortic dilatation in bicuspid aortic valve (BAV) patients are different for children and adults. The objective of this study was to find the best reference tool to define dilation of the aortic root (AR) and the ascending aorta (AA) in BAV adolescents with an adult body surface area (BSA). METHODS Patients recruited were ≥10-years-old with a BSA ≥1.5 m2. Three measurements of the AR and AA were compared: z-score, the BSA-indexed value (BSA-IV) and the absolute value (AV), with thresholds in +2/+3, 21 mm/m2 and 40 mm, respectively. RESULTS 231 subjects were collected from the Pediatric REVAB database, with a median age and BSA of 14-year-old and 1.67 m2. Significant differences were reported in the AA: 109 (47%) patients had a z-score ≥2 and 67 (29%) a Z ≥ 3, but only 9 (3%) a BSA-IV ≥21 mm/m2 (p < 0.01 and p < 0.01) and 2 (0.9%) an AV ≥40 mm (p = 0.22 and p = 0.08). CONCLUSION Our results indicate that in the AA there are a significant number of patients in which it would be recommendable changing to BSA-IV when children are older than 10-year-old and BSA ≥1.5 m2. Regarding the AR, criteria for dilatation seems not to be influenced by the reference chosen.
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Affiliation(s)
- Jose M Siurana
- Hospital HM Nens. HM Hospitales, Spain; Universitat Autònoma de Barcelona, Spain
| | - Anna Sabaté-Rotés
- Universitat Autònoma de Barcelona, Spain; Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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23
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Lopez L, Frommelt PC, Colan SD, Trachtenberg FL, Gongwer R, Stylianou M, Bhat A, Burns KM, Cohen MS, Dragulescu A, Freud LR, Frommelt MA, Lytrivi ID, Mahgerefteh J, McCrindle BW, Pignatelli R, Prakash A, Sachdeva R, Soslow JH, Spurney C, Taylor CL, Thankavel PP, Thorsson T, Tretter JT, Young LT, LuAnn Minich L. Pediatric Heart Network Echocardiographic Z Scores: Comparison with Other Published Models. J Am Soc Echocardiogr 2021; 34:185-192. [PMID: 33189460 PMCID: PMC7870534 DOI: 10.1016/j.echo.2020.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Different methods have resulted in variable Z scores for echocardiographic measurements. Using the measurements from 3,215 healthy North American children in the Pediatric Heart Network (PHN) echocardiographic Z score database, the authors compared the PHN model with previously published Z score models. METHODS Z scores were derived for cardiovascular measurements using four models (PHN, Boston, Italy, and Detroit). Model comparisons were performed by evaluating (1) overlaid graphs of measurement versus body surface area with curves at Z = -2, 0, and +2; (2) scatterplots of PHN versus other Z scores with correlation coefficients; (3) Bland-Altman plots of PHN versus other Z scores; and (4) comparison of median Z scores for each model. RESULTS For most measurements, PHN Z score curves were similar to Boston and Italian curves but diverged from Detroit curves at high body surface areas. Correlation coefficients were high when comparing the PHN model with the others, highest with Boston (mean, 0.99) and lowest with Detroit (mean, 0.90). Scatterplots suggested systematic differences despite high correlations. Bland-Altman plots also revealed poor agreement at both extremes of size and a systematic bias for most when comparing PHN against Italian and Detroit Z scores. There were statistically significant differences when comparing median Z scores between the PHN and other models. CONCLUSIONS Z scores from the multicenter PHN model correlated well with previous single-center models, especially the Boston model, which also had a large sample size and similar methodology. The Detroit Z scores diverged from the PHN Z scores at high body surface area, possibly because there were more subjects in this category in the PHN database. Despite excellent correlation, significant differences in Z scores between the PHN model and others were seen for many measurements. This is important when comparing publications using different models and for clinical care, particularly when Z score thresholds are used to guide diagnosis and management.
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Affiliation(s)
- Leo Lopez
- Stanford University School of Medicine, Palo Alto, California.
| | | | | | | | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Aarti Bhat
- Seattle Children's Hospital, Seattle, Washington
| | - Kristin M Burns
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | - Carolyn L Taylor
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | - Luciana T Young
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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24
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A statistical comparison of reproducibility in current pediatric two-dimensional echocardiographic nomograms. Pediatr Res 2021; 89:579-590. [PMID: 32330930 DOI: 10.1038/s41390-020-0900-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study is to compare new pediatric nomograms for clinical parameters from 2D echocardiography. METHODS 2D pediatric echocardiographic parameters from four recent nomograms were used for statistical analysis. To assess the accuracy of the predictive models from each study, namely multivariate, linear, and nonlinear regression, mean values and 5th and 95th percentiles (μ ± 1.65σ) were calculated. A Z-score calculator was created. RESULTS Mean values and 5th and 95th percentiles have been provided for a range of BSA (0.15-2.20 m2) for each nomogram assessed in this study. Moreover, plots of Z-scores over the same range of BSA have been generated to assess trends among different studies. For most measurements from the two most recent nomograms, namely Lopez et al. and Cantinotti et al., differences were within a Z-score of 0.5 (Z-score range: 0.001-1.26). Measurements from Sluysmans and Colan and Pettersen et al. were observed to diverge from Lopez et al. at the upper extremities of BSA. Differences among various nomograms emerged at lower extremes of BSA. CONCLUSIONS The two most recent echocardiographic nomograms were observed to have the most statistically similar ranges of normality. Significant deviations in ranges of normality were observed at extremes of BSA. IMPACT Echocardiographic nomograms for pediatric age are discordant. Comparison of current pediatric echocardiographic nomograms. A Z-score calculator was created. Clinical relevance of differences among nomograms is highlighted.
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25
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Cha SG, Baek JS, Yu JJ, Kim YH, Kwon BS, Choi ES, Park CS, Yun TJ. Growth Pattern of the Neo-Aorta after Arterial Switch Operation during Childhood. Korean Circ J 2020; 51:83-93. [PMID: 33164353 PMCID: PMC7779819 DOI: 10.4070/kcj.2020.0249] [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: 06/08/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives Neo-aortic root dilatation (ARD) and annular dilatation (AAD) tend to develop after arterial switch operation (ASO). However, the trend of neo-aortic growth has not been well established. This paper aims to identify this trend, its associated factors, and predictors of neo-aortic dilatation after ASO. Methods We analyzed the growth trend of the neo-aortic root, annulus, and sinotubular junction (STJ) z-scores using random coefficients model and the risk factors affecting neo-aortic dilatation in 163 patients who underwent ASO from 2006 to 2015. Results Among 163 patients, 41 had a ventricular septal defect, and 11 had Taussig-Bing (TB) anomaly. The median follow-up duration was 6.61 years. The increased in the neo-aortic root z-score was different between the trapdoor and non-trapdoor coronary artery transfer techniques (0.149/year, p<0.001 vs. 0.311/year, p<0.001). Moreover, the neo-aortic annulus and STJ z-score significantly increased over time after ASO (0.067/year, p<0.001; 0.309/year, p<0.001). Pulmonary artery banding (PAB) was rather a negative affecting factor. The probabilities of freedom from ARD, AAD, and neo-aortic STJ dilatation at 10 years after ASO were 33.4%, 53.9%, and 65.4%. Neo- aortic regurgitation within 1 year was the predictor of ARD, AAD, and neo-aortic STJ dilatation. TB anomaly, PAB, and native pulmonary sinus z-score were other predictors for ARD. Conclusion The growth of neo-aortic root, annulus, and STJ after ASO was greater than somatic growth during childhood. The coronary artery transfer technique affected the growth pattern of the neo-aortic root.
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Affiliation(s)
- Seul Gi Cha
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jeong Jin Yu
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hwue Kim
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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26
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Wozniak-Mielczarek L, Sabiniewicz R, Nowak R, Gilis-Malinowska N, Osowicka M, Mielczarek M. New Screening Tool for Aortic Root Dilation in Children with Marfan Syndrome and Marfan-Like Disorders. Pediatr Cardiol 2020; 41:632-641. [PMID: 32006082 PMCID: PMC7170831 DOI: 10.1007/s00246-020-02307-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
One of the roles of a pediatric cardiologist who suspects or diagnoses a genetically determined connective tissue disease (e.g., Marfan, Ehlers-Danlos, and Loeys-Dietz syndromes) is to assess whether the aortic root is dilated. The aortic root diameter is affected by the patient's age, sex, and body surface area. Therefore, the aortic root diameter needs to be determined and expressed as a z-score. Calculation of the z-score is time-consuming and problematic if used infrequently. This study aimed to introduce a simple screening method for identifying aortic root dilation in children. The study population consisted of 190 children who were diagnosed with Marfan syndrome or Marfan-like disorders. The aortic root ratio (ARr) was formulated. The value of the ARr was compared in each patient with the results in z-scores, which were obtained using on-line calculators based on the most widespread nomograms. The optimal cut-off value of the ARr was ≥ 18.7. At this cut-off point, the sensitivity of the ARr ranged from 88.3% to 100% and the specificity ranged from 94% to 97.8%. All of the patients in whom the ARr failed to identify aortic root dilation were also divergently classified by different nomograms. At the ARr cut-off point of ≥ 18.0, a sensitivity of 100% was achieved for all nomograms with minimal reduction in specificity. The ARr allows for rapid and precise screening for aortic root dilation in children. Unlike classic analysis, the ARr does not require nomograms or on-line calculations.
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Affiliation(s)
- Lidia Wozniak-Mielczarek
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, 7 Debinki Street, 80-211, Gdansk, Poland.
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, 7 Debinki Street, 80-211, Gdansk, Poland
| | - Radosław Nowak
- 2nd Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | | | - Michalina Osowicka
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, 7 Debinki Street, 80-211, Gdansk, Poland
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27
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Vida VL, Triglia LT, Zanotto L, Zanotto L, Bertelli F, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Cleuziou J, Myers PO, Prêtre R, Poncelet AJ, Meyns B, Van den Bossche K, Accord RE, Gil-Jaurena JM, Sakurai T, Stellin G. Late management of the aortic root after repair of tetralogy of Fallot: A European multicentre study. J Card Surg 2019; 35:40-47. [PMID: 31899837 DOI: 10.1111/jocs.14316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to determine the indications, type, and outcomes of reoperations on the aortic root after repair of tetralogy of Fallot (TOF). METHODS Eleven centers belonging to the European Congenital Heart Surgeons Association contributed to the data collection process. We included 36 patients who underwent surgical procedures on the aortic root, including surgery on the aortic valve and ascending aorta, between January 1975 and December 2017. Original diagnoses included TOF-pulmonary stenosis (n = 18) and TOF-pulmonary atresia (n = 18). The main indications for reoperation were aortic insufficiency (n = 19, 53%), aortic insufficiency and dilatation of the ascending aorta (n = 10, 28%), aortic root dilatation (n = 4, 11%), and ascending aorta dilatation (n = 3, 8%). RESULTS The median age at reoperation was 30.4 years (interquartile range 20.3-45.3 years), and mechanical aortic valve replacement was the most common procedure performed. Five patients died early after reoperation (14%), and larger ascending aorta diameters were associated with early mortality (P = .04). The median age at the last follow-up was 41.4 years (interquartile range 24.5-51.6 years). Late death occurred in five patients (5/31, 16%). Most survivors (15/26, 58%) were asymptomatic at the last clinical examination (New York Heart Association, NYHA class I). The remaining patients were NYHA class II (n = 7) and III (n = 3). The most common symptoms were fatigue (n = 5), dyspnea (n = 4), and exercise intolerance (n = 3). CONCLUSIONS Reoperations on the aortic root are infrequent but may become necessary late after TOF repair. The main indications for reoperation are aortic insufficiency, either isolated or associated with a dilatation of the ascending aorta. The surgical risk at reoperation was high and the presence of ascending aorta dilation is related to higher mortality.
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Affiliation(s)
- Vladimiro L Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Laura Torlai Triglia
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Francesco Bertelli
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Massimo Padalino
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - George Sarris
- Athens Heart Surgery Institute and Department of Paediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Eleftherios Protopapas
- Athens Heart Surgery Institute and Department of Paediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Carol Prospero
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Julie Cleuziou
- Department of Congenital and Paediatric Cardiac Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Patrick O Myers
- Division of Cardiovascular Surgery, University of Geneva, Geneva, Switzerland
| | - René Prêtre
- Cardiac Surgery Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, Lausanne, Switzerland
| | - Alain J Poncelet
- Cardio-Vascular Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Bart Meyns
- Cardiac Surgery - UZ Leuven, Leuven, Belgium
| | | | - Ryan E Accord
- Pediatric and Congenital Cardio-Thoracic Surgery Unit, University Medical Center Groningen, Groningen, Netherlands
| | | | - Takahisa Sakurai
- Department of Cardiovascular Surgery, Chukyo Hospital, Nagoya, Japan
| | - Giovanni Stellin
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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28
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Frommelt PC, Minich LL, Trachtenberg FL, Altmann K, Camarda J, Cohen MS, Colan SD, Dragulescu A, Frommelt MA, Johnson TR, Kovalchin JP, Lin L, Mahgerefteh J, Nutting A, Parra DA, Pearson GD, Pignatelli R, Sachdeva R, Soriano BD, Spurney C, Srivastava S, Statile CJ, Stelter J, Stylianou M, Thankavel PP, Tierney ES, van der Velde ME, Lopez L. Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database. J Am Soc Echocardiogr 2019; 32:1331-1338.e1. [PMID: 31351792 DOI: 10.1016/j.echo.2019.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The reliability of left ventricular (LV) systolic functional indices calculated from blinded echocardiographic measurements of LV size has not been tested in a large cohort of healthy children. The objective of this study was to estimate interobserver variability in standard measurements of LV size and systolic function in children with normal cardiac anatomy and qualitatively normal function. METHODS The Pediatric Heart Network Normal Echocardiogram Database collected normal echocardiograms from healthy children ≤18 years old distributed equally by age, gender, and race. A core lab used two-dimensional echocardiograms to measure LV dimensions from which a separate data coordinating center calculated LV volumes and systolic functional indices. To evaluate interobserver variability, two independent expert pediatric echocardiographic observers remeasured LV dimensions on a subset of studies, while blinded to calculated volumes and functional indices. RESULTS Of 3,215 subjects with measurable images, 552 (17%) had a calculated LV shortening fraction (SF) < 25% and/or LV ejection fraction (EF) < 50%; the subjects were significantly younger and smaller than those with normal values. When the core lab and independent observer measurements were compared, individual LV size parameter intraclass correlation coefficients were high (0.81-0.99), indicating high reproducibility. The intraclass correlation coefficients were lower for SF (0.24) and EF (0.56). Comparing reviewers, 40/56 (71%) of those with an abnormal SF and 36/104 (35%) of those with a normal SF based on core lab measurements were calculated as abnormal from at least one independent observer. In contrast, an abnormal EF was less commonly calculated from the independent observers' repeat measures; only 9/47 (19%) of those with an abnormal EF and 8/113 (7%) of those with a normal EF based on core lab measurements were calculated as abnormal by at least one independent observer. CONCLUSIONS Although blinded measurements of LV size show good reproducibility in healthy children, subsequently calculated LV functional indices reveal significant variability despite qualitatively normal systolic function. This suggests that, in clinical practice, abnormal SF/EF values may result in repeat measures of LV size to match the subjective assessment of function. Abnormal LV functional indices were more prevalent in younger, smaller children.
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Affiliation(s)
| | | | | | - Karen Altmann
- Columbia University Medical Center, New York, New York
| | | | - Meryl S Cohen
- Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Lina Lin
- New England Research Institute, Boston, Massachusetts
| | | | - Arni Nutting
- Medical University of South Carolina, Charleston, South Carolina
| | - David A Parra
- Vanderbilt Medical Center (D.A.P.), Nashville, Tennessee
| | - Gail D Pearson
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Ritu Sachdeva
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Mario Stylianou
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Leo Lopez
- Stanford University, Palo Alto, California
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Lopez L, Colan SD. How Well Does the Neonatal Heart Measure Up? J Am Soc Echocardiogr 2019; 32:906-908. [DOI: 10.1016/j.echo.2019.04.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/17/2022]
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Ahmadipour S, Mohsenzadeh A, Soleimaninejad M. Echocardiographic Evaluation in Neonates with Heart Murmurs. J Pediatr Intensive Care 2019; 7:81-85. [PMID: 31073475 DOI: 10.1055/s-0037-1612614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/02/2017] [Indexed: 12/29/2022] Open
Abstract
Auscultation of the heart is one of the most important tools of physical examination in neonates, which is very helpful in the diagnosis or rejection of congenital heart diseases (CHDs). The aim of this study is to investigate the causes of heart murmur in neonates hospitalized in neonatal unit in Imam Reza Hospital, Kermanshah, Iran. This cross-sectional study was conducted within the period of 18 months on neonates hospitalized in neonatal unit whose heart murmur, diagnosed through examination, and echocardiography was conducted to investigate the existence of CHD. In 62.1% of the cases, murmuring was auscultated within the first week after birth. Among 172 neonates with heart murmur, 25 subjects (14.5%) had normal echocardiogram, and others had abnormal echocardiogram in which ventricular septal defect (31.4%) was the most common CHD. Patent ductus arteriosus (23.3%) was the second common CHD found. Other defects were atrial septal defect, persistent foramen ovale, pulmonary stenosis, and tricuspid regurgitation. Among the neonates with CHD, 55 subjects were females and 92 cases were males. There was CHD history in previous siblings in 10 cases. In 73 neonates with CHD, the mother had not taken folic acid in the first trimester of pregnancy. A total of 14.5% of the hospitalized neonates suffered from innocent murmur, and the rest with heart murmur had abnormal echocardiography and suffered from CHD (85.5%). Heart murmur in neonates could be a symptom of CHD, and timely echocardiography is very important in diagnosing the type of disease.
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Affiliation(s)
- Shokoufeh Ahmadipour
- Department of Pediatrics, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Pediatrics Gastroenterology and Hepatology Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Mohsenzadeh
- Department of Pediatrics, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Soleimaninejad
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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31
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Díaz A, Zócalo Y, Bia D. Percentile curves for left ventricle structural, functional and haemodynamic parameters obtained in healthy children and adolescents from echocardiography-derived data. J Echocardiogr 2019; 18:16-43. [PMID: 30927161 DOI: 10.1007/s12574-019-00425-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/24/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transthoracic echocardiography is the most common non-invasive technique for the study of the left ventricle (LV) and the proximal aorta. Despite the clinical value, there is scarcity of data about reference intervals (RIs) and percentiles for thoracic aorta dimension and LV structural and functional parameters, obtained from population-based studies in children and adolescents. The aim was to generate RIs for LV, haemodynamic and thoracic aorta parameters obtained from transthoracic echocardiography in healthy children, adolescents and young adults from a South-American population. METHODS One thousand ninety-five healthy subjects (5-24 years) were studied (M-mode, B-mode and Doppler echocardiography). RESULTS RIs for LV structural (diameters, volumes and wall thickness) and functional (stroke volume, cardiac output, cardiac index, transmitral E and A flow waves velocities) parameters; systemic vascular resistance and aortic root diameter were obtained using parametric regression analyzes based on fractional polynomials. Covariate analysis (i.e., adjusting for age, body surface) showed that specific sex-specific RIs were necessary. Then, age, body height (BH), body weight (BW), body surface area (BSA), and sex-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th and 99th percentiles were obtained. Our results were in agreement with and complimentary to available international databases. CONCLUSION This study provides RIs for echocardiography-derived haemodynamic, LV (structural and functional) and aortic parameters in children, adolescents and young adults considering data obtained from the largest Argentinean database. In early stages of life an adequate interpretation of echocardiography-derived LV and aortic parameters requires considering age, BH, BW, BSA and/or sex-specific RIs.
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Affiliation(s)
- Alejandro Díaz
- Instituto de Investigación en Ciencias de La Salud, UNICEN-CONICET, 4 de Abril 618, 7000, Tandil, Buenos Aires Province, Argentina.
| | - Yanina Zócalo
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay
| | - Daniel Bia
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay
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How should we determine normal echocardiographic right ventricle function reference values in pediatrics? Int J Cardiovasc Imaging 2018; 35:259-265. [PMID: 30269294 DOI: 10.1007/s10554-018-1462-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
Several models have been used to establish pediatric Z-scores for echocardiographic right ventricle (RV) variables. This study aimed to determine the most appropriate mathematical model for RV function reference values in pediatrics. Prospective cross-sectional study among 314 healthy children ages 2 days to 18 years (46% female, 88 infants, 26 neonates, 226 children). RV parameters (S', E', A' waves, TEI index, TAPSE) were modelized with four explanatory variables: age, height, weight and body surface area. Four mathematical models were applied: a linear model, a polynomial model of degree 2, a linear regression model by spline with free knot, and a polynomial regression model of degree 2 by spline with a free knot. The choice of the best method used the adjusted coefficient of determination (aR2). The modelization of RV variables did not follow a linear model. A single explanatory variable could not determine all Z-scores, as specific and independent variables were required for each parameter. The quadratic spline model best adjusted the modelization of RV variables. The S' wave was best modelized by the spline model with the weight (knot at 6.86 kg). The E' wave was best modelized by the spline model with the age (knot at 0.29 years). The A' wave was best modelized by the model with the height (knot at 81 cm). The TAPSE was best modelized by the spline model with the weight (knot at 9.04 kg). The spline regression models best applies to echocardiographic RV reference values in pediatrics.
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Hirsig LE, Sharma PG, Verma N, Rajderkar DA. Congenital Pulmonary Artery Anomalies: A Review and Approach to Classification. J Clin Imaging Sci 2018; 8:29. [PMID: 30147993 PMCID: PMC6085843 DOI: 10.4103/jcis.jcis_9_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/02/2018] [Indexed: 12/04/2022] Open
Abstract
Congenital pulmonary artery anomalies are infrequent but given improved prenatal diagnosis and care, and neonatal surgical advances, over the past two decades are not uncommonly encountered by cardiothoracic imagers. An understanding of their etiology, classifications, associated anomalies, and surgical management can be helpful to avoid under or overdiagnosis. Timely diagnosis assisted by familiarity with imaging findings across modalities and recognition of surgical findings allows for medical management and surgical planning for these patients, with more patients reaching adulthood than ever before.
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Affiliation(s)
- Leslie E Hirsig
- Department of Radiology, Division of Pediatric Imaging, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Priya G Sharma
- Department of Radiology, Division of Pediatric Imaging, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Nupur Verma
- Department of Radiology, Division of Cardiac Imaging, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Dhanashree A Rajderkar
- Department of Radiology, Division of Pediatric Imaging, Medical University of South Carolina, Charleston, SC 29425, USA
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34
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van Ark AE, Molenschot MC, Wesseling MH, de Vries WB, Strengers JLM, Adams A, Breur JMPJ. Cardiac Valve Annulus Diameters in Extremely Preterm Infants: A Cross-Sectional Echocardiographic Study. Neonatology 2018; 114:198-204. [PMID: 29940560 PMCID: PMC6191879 DOI: 10.1159/000488387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND With the increasing incidence of births of very preterm very-low-birth-weight infants, there is a demand for echocardiographic reference values of cardiac dimensions. OBJECTIVES The aim of this study was to provide reference values of cardiac valve annulus diameters in a cohort of extremely preterm very-low-birth-weight neonates and to correlate these with patient characteristics. METHODS Valve diameters of 376 infants of < 32 weeks' gestation and with a birth weight of ≤2,000 g were measured using 2-dimensional echocardiography. Correlations between valve diameters and patient characteristics (birth length/weight, body surface area, gestational age, and sex) were assessed. Birth weight was used to establish linear regression models. Inter- and intraobserver agreement was assessed through intraclass correlation coefficient (ICC) analysis. RESULTS Substantial variability was found (aortic valve mean [standard deviation; range]: 5.0 mm [0.6; 3.7-6.5]; pulmonic valve: 5.8 mm [0.8; 3.4-7.9]; mitral valve: 8.0 mm [1.0; 5.5-10.5]; tricuspid valve: 7.6 mm [1.2; 4.9-10.6]). There was a moderate correlation between birth weight and valve diameter (R2 aortic valve: 0.36; pulmonic valve: 0.20; mitral valve: 0.24; tricuspid valve: 0.24). Adequate intraobserver (ICC range 0.74-0.91) and interobserver agreement (ICC range 0.77-0.89) was found. CONCLUSIONS Our study provides ready-to-use reference values for cardiac valve annulus diameters for extremely preterm infants.
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Affiliation(s)
- Allard E van Ark
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mirella C Molenschot
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maria H Wesseling
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem B de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan L M Strengers
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arthur Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Dallaire F, Sarkola T. Growth of Cardiovascular Structures from the Fetus to the Young Adult. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:347-360. [PMID: 30051395 DOI: 10.1007/978-3-319-77932-4_22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The size, hemodynamics, and function of cardiovascular structures change dramatically from the early fetal life to late adolescence. The principal determinants of cardiovascular dimensions are related to the blood flow needed to meet metabolic demands. This demand is in turn tightly related to body size and body composition, keeping in mind that various tissues may have different metabolic rates. There is no simple model that links cardiac dimensions with a single body size measurement. Consequently, despite abundant scientific literature, few studies have proposed pediatric reference values that efficiently and completely account for the effect of body size. Other factors influence cardiovascular size and function in children, including sex. The influence of sex is multifactorial and not fully understood, but differences in body size and body composition play an important role. We will first review the determinants of cardiovascular size and function in children. We then explore the evaluation and normalization of cardiovascular size and function in pediatric cardiology in relation to the growth of cardiovascular structures during childhood, with a particular focus on sex differences.
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Affiliation(s)
| | - Taisto Sarkola
- University of Helsinki, the Helsinki University Central Hospital/Children's Hospital, Helsinki, Finland
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36
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Cantinotti M, Giordano R, Corsini I, Dani C, Scalese M, Murzi B, Assanta N, Spadoni I, Molinaro S, Kutty S, Iervasi G, Franchi E. Echocardiographic nomograms for upper abdominal aorta Doppler systolic wave values and systo-diastolic diameters variations in children. J Cardiol 2017; 71:394-400. [PMID: 29129395 DOI: 10.1016/j.jjcc.2017.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Abdominal aorta pulsatility and blood flow patterns are important diagnostic indicators in congenital heart disease. Reference values for these indexes are lacking. METHODS We prospectively studied abdominal aorta pulsed-wave Doppler systolic peak velocity, deceleration time, and wave duration, and two-dimensional vessel diameters in systole and diastole in healthy Caucasian children. Heteroscedasticity was accounted for by White or Breusch-Pagan test. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Structured Z-scores were then computed. RESULTS In all, 853 subjects (age 0 days to 17 years; 45% females; BSA 0.12-2.12m2) were studied. The predicted values and Z-score boundaries are presented. Data are also presented as mean±2 SDs for a given BSA. CONCLUSIONS We report paediatric echocardiographic nomograms for multiple proximal abdominal aorta parameters including pulsed-wave Doppler systolic velocities, deceleration time, wave duration, and two-dimensional vessel diameter variations. Significant variations in these functional indexes with age were found that should be taken into account in clinical practice. At lower ages, steeper and shorter pulsed-wave Doppler peak velocity and limited pulsatility should be expected as physiologic findings.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Carlo Dani
- University of Florence, Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Italy
| | | | - Bruno Murzi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Isabella Spadoni
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
| | - Giorgio Iervasi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
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Cantinotti M, Giordano R, Scalese M, Franchi E, Corana G, Assanta N, Maura C, Marco M, Molinaro S, Koestenberger M, Iervasi G. Nomograms for echocardiographic right ventricular sub-costal view dimensions in healthy Caucasian children: A new approach to measure the right ventricle. J Cardiol 2017; 71:181-186. [PMID: 28893427 DOI: 10.1016/j.jjcc.2017.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/03/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The sub-costal examination of the heart is part of routine examination in pediatric echocardiography, and has the advantage to visualize also the infundibulum part of the right ventricle (RV). Despite this fact, currently nomograms for sub-costal RV dimensions are lacking. METHODS We prospectively studied healthy Caucasian Italian children by two-dimensional echocardiography. Measurements included: sub-costal end diastolic basal-apical and latero-lateral diameters, end diastolic and end systolic area, 4 chamber end diastolic and end systolic area and length, end diastolic basal (RV1) and mid-cavity (RV2) diameters. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Structured Z scores were then computed. Agreement of RV diameters and areas in subcostal view and 4-chamber view were investigated. RESULTS 732 subjects (age 0 days-17 years; 48% female; BSA 0.12-2.12 m2) were studied. The Haycock formula was used when presenting data as predicted values (mean ± 2 SDs) for a given BSA and within equations relating echocardiographic measurements to BSA. The predicted values and Z-score boundaries for all measurements are presented. Excellent correlations were found among two-dimensional diameters and area calculated in sub-costal view with those evaluated in 4-chamber view. CONCLUSIONS We report echocardiographic nomograms for RV diameters and areas measured in the sub-costal view. Our data may implement normative data for 2D echocardiography evaluation of the RV in children.
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Affiliation(s)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | | | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Giulia Corana
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Crocetti Maura
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Marotta Marco
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | - Giorgio Iervasi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
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