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Silberberg A, Castro Méndez J, Torres SF, Fraire R, Siaba Serrate A, Kreutzer C, López Daneri M, Iolster T. Experiences of parents of children with hypoplastic left heart syndrome during their treatment: a qualitative study. Cardiol Young 2023; 33:2553-2558. [PMID: 37009758 DOI: 10.1017/s1047951123000677] [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: 04/04/2023]
Abstract
AIM To investigate the opinion and personal experience of parents of children born with Hypoplastic Left Heart Syndrome and what advice they would give to other parents who have to decide between treatment options. METHODS We conducted a qualitative, descriptive and retrospective study by means of a survey directed to parents of children born with Hypoplastic Left Heart Syndrome in a tertiary hospital in Buenos Aires (Argentina). Their answers and data regarding medical procedures were analysed. RESULTS Parents of thirteen out of sixteen patients with Hypoplastic Left Heart Syndrome were surveyed. Norwood surgery had been performed in all the patients, many had received other procedures, and five had died. In relation to the decision-making process, sixty-one percent of parents would recommend other parents to remain at peace after having done everything possible and 54% would suggest to not feel guilt despite the final result. None of the parents would recommend rejecting surgical treatment and choosing comfort care. CONCLUSION The majority of parents of children with Hypoplastic Left Heart Syndrome would recommend continuing with the therapeutic effort in order to feel at peace and reduce feelings of guilt.
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Affiliation(s)
| | | | - Silvio F Torres
- Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Rafael Fraire
- Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | | | | | | | - Thomas Iolster
- Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
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Gabriel GC, Yagi H, Xu X, Lo CW. Novel Insights into the Etiology, Genetics, and Embryology of Hypoplastic Left Heart Syndrome. World J Pediatr Congenit Heart Surg 2022; 13:565-570. [PMID: 36053093 PMCID: PMC10010598 DOI: 10.1177/21501351221102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) is a relatively rare severe congenital heart defect (CHD) closely linked to other left ventricular outflow tract (LVOT) lesions including bicuspid aortic valve (BAV), one of the most common heart defects. While HLHS, BAV, and other LVOT lesions have a strong genetic underpinning, their genetic etiology remains poorly understood. Findings from a large-scale mouse mutagenesis screen showed HLHS has a multigenic etiology and is genetically heterogenous, explaining difficulties in identifying the genetic causes of HLHS. In Ohia mice, HLHS shows incomplete penetrance. Some mice exhibited small LV with normal aorta, and others a normal LV with hypoplastic aorta, indicating the LV hypoplasia is not hemodynamically driven. In Ohia mutants, HLHS was found to have a digenic modular construction, with mutation in a chromatin modifier causing the small LV phenotype and mutation in Pcdha9 causing the aorta/aortic valve hypoplasia. The Pcdha9 mutation alone can cause BAV, and in the human genome two common deletion copy number variants spanning PCDHA7-10 are associated with BAV. Hence the digenic etiology of HLHS can account for the close association of HLHS, a rare CHD, with BAV, one of the most common CHD. Functional analysis of Ohia HLHS heart tissue showed severe mitochondrial dysfunction in the small LV, while the normal size RV is also affected but milder, suggesting possible role in vulnerability of surgically palliated HLHS patients to heart failure. These findings suggest insights into the genetics of HLHS may yield new therapies for improving outcome for patients with HLHS.
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Affiliation(s)
- George C Gabriel
- Department of Developmental Biology, 6614University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hisato Yagi
- Department of Developmental Biology, 6614University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Xinxiu Xu
- Department of Developmental Biology, 6614University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cecilia W Lo
- Department of Developmental Biology, 6614University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Wu FM, Kogon B, Earing MG, Aboulhosn JA, Broberg CS, John AS, Harmon A, Sainani NI, Hill AJ, Odze RD, Johncilla ME, Ukomadu C, Gauvreau K, Valente AM, Landzberg MJ. Liver health in adults with Fontan circulation: A multicenter cross-sectional study. J Thorac Cardiovasc Surg 2016; 153:656-664. [PMID: 27955914 DOI: 10.1016/j.jtcvs.2016.10.060] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/19/2016] [Accepted: 10/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Liver disease is an important contributor to morbidity and mortality in patients after Fontan surgery. There has been no large-scale survey of liver health in this population. We sought to explore the prevalence and predictors of liver disease in a multicenter cohort of adults with Fontan physiology. METHODS Subjects were recruited from 6 adult congenital heart centers. Demographics; clinical history; and laboratory, imaging, and histopathology data were obtained. RESULTS Of 241 subjects (median age 25.8 years [11.8-59.4], median time since Fontan 20.3 years [5.4-34.5]), more than 94% of those who underwent testing (208 of 221) had at least 1 abnormal liver-related finding. All hepatic imaging (n = 54) and liver histology (n = 68) was abnormal. Subjects with abnormal laboratory values had higher sinusoidal fibrosis stage (2 vs 1, P = .007) and higher portal fibrosis stage (3 vs 1, P = .003) compared with those with all normal values. Low albumin correlated with lower sinusoidal fibrosis stage (1 vs 2; P = .02) and portal fibrosis stage (0 vs 3, P = .002); no other liver studies correlated with fibrosis. Regenerative nodules were seen on 33% of histology specimens. CONCLUSIONS Regardless of modality, findings of liver disease are common among adults with Fontan circulation, even those appearing clinically well. Cirrhosis is present in up to one-third of subjects. Correlations between hepatic fibrosis stage and clinical history or findings on noninvasive testing are few. Further research is needed to identify patients at risk for more severe liver disease and to determine the best methods for assessing liver health in this population.
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Affiliation(s)
- Fred M Wu
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Brian Kogon
- Division of Cardiothoracic Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Michael G Earing
- Department of Pediatric Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, Calif
| | - Craig S Broberg
- Department of Cardiology, Oregon Health and Science University, Portland, Ore
| | - Anitha S John
- Division of Cardiology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Amy Harmon
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Nisha I Sainani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Andrew J Hill
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Robert D Odze
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Melanie E Johncilla
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Chinweike Ukomadu
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Michael J Landzberg
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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