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Landsem L, Brown N, Cox R, Ross F. Perioperative and Anesthetic Considerations in Shone's Complex. Semin Cardiothorac Vasc Anesth 2024; 28:28-37. [PMID: 38134942 DOI: 10.1177/10892532231223840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Shone's complex is a congenital cardiac disease consisting of the following four lesions: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and aortic coarctation. Though not all components are required for a diagnosis, the end result is both left ventricular inflow and outflow obstruction, which typically present in patients as congestive heart failure. The complex pathology requires careful management and surgical decision-making to ensure an optimal outcome. This review will focus on the anatomy, physiology, and perioperative anesthetic management of patients with Shone's complex.
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Affiliation(s)
- Leah Landsem
- Division of Paediatric Cardiac Anesthesiology, Department of Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Nicholas Brown
- Department of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Ryan Cox
- Department of Anesthesiology, University of Washington, Seattle, WA, USA
| | - Faith Ross
- Division of Paediatric Cardiac Anesthesiology, Department of Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
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Haines D, Kertai MD, Abrams B, Huang J. Understanding Physiology and Using Technology to Care for Challenging Patients. Semin Cardiothorac Vasc Anesth 2024; 28:5-7. [PMID: 38378200 DOI: 10.1177/10892532241233106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Daniel Haines
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
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Seaback JC, Masneri DA, Schoeneck JH. Shone Complex: A Case Report of Congenital Heart Disease Detected Using Point-of-care Ultrasound. Clin Pract Cases Emerg Med 2023; 7:189-192. [PMID: 37595300 PMCID: PMC10438940 DOI: 10.5811/cpcem.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/06/2023] [Accepted: 06/30/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Undiagnosed congenital heart disease and management of pediatric cardiogenic shock presents a diagnostic challenge for the emergency clinician. These diagnoses are rare and require a high index of suspicion given the overlap with more common pediatric pathology. Point-of-care ultrasound can assist in differentiating these presentations. We present a case of neonatal cardiogenic shock secondary to a previously undiagnosed congenital heart disease, specifically Shone complex, detected using point-of-care ultrasound. CASE REPORT A six-week-old female presented with severe respiratory distress and was found to be in cardiogenic shock secondary to a previously undiagnosed congenital heart defect. CONCLUSION Initial diagnosis of congenital heart disease is uncommon in the emergency department, but it should be recognized by clinicians given the high associated morbidity and mortality. Point-of-care ultrasound is a powerful tool to assist in evaluating for cardiac abnormalities as an etiology for undifferentiated shock in the pediatric population.
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Affiliation(s)
- Jordan C Seaback
- Atrium Health Wake Forest Baptist, Department of Emergency Medicine, Winston Salem, North Carolina
| | - David A Masneri
- Atrium Health Wake Forest Baptist, Department of Emergency Medicine, Winston Salem, North Carolina
| | - Jacob H Schoeneck
- Atrium Health Wake Forest Baptist, Department of Emergency Medicine, Winston Salem, North Carolina
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Mahmoudian R, Hali R, Sharifkazemi M, Anvari L. A Rare Case of Intramitral Valve Ring in the Setting of Shone Complex Diagnosed by Echocardiography. J Cardiovasc Echogr 2023; 33:155-157. [PMID: 38161777 PMCID: PMC10756313 DOI: 10.4103/jcecho.jcecho_68_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Roshanak Mahmoudian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hali
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Leila Anvari
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Sinfield S, Ranasinghe S, Wang S, Mendoza F, Khoynezhad A. Shone's complex and aortic dissection: case report and review of a rare, underdiagnosed congenital heart disease. J Cardiothorac Surg 2022; 17:21. [PMID: 35197098 PMCID: PMC8864782 DOI: 10.1186/s13019-022-01768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shone's complex is a rare congenital heart disease consisting of a variety of left ventricular inflow and outflow tract lesions. Patients typically present in childhood requiring early surgical intervention; however, with improved surgical techniques, these patients are surviving later into adulthood. This increased survival comes with a new set of medical complications that providers need to be aware of. CASE PRESENTATION A 27 year old man with a complex cardiac history including an incomplete Shone's complex and persistent symptomatic atrial flutter presented with sharp chest pain radiating to his back. He was found to have type A aortic dissection on imaging in the setting of severe patient-prosthesis mismatch. He had multiple valvular surgeries in childhood. The patient was being followed-up as an outpatient for an enlarging chronic aortic aneurysm and was non-compliant with his medications. He was taken emergently to the operating room for a skirted Bentall procedure, aortic valve replacement, and right sided MAZE. CONCLUSIONS Shone's complex is a rare congenital heart disease associated with significant morbidities including atrial flutter, patient-prosthesis mismatch, and aortic dissection. As patients continue to live longer into adulthood with this disease, it is important to raise awareness of this rare syndrome for providers and highlight its potential complications. Further research is needed to determine appropriate guidelines for when to intervene on aortopathy-associated CHD.
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Affiliation(s)
- Steven Sinfield
- Department of Medicine, University of California, Irvine, 333 The City Blvd. West, Suite 400, Orange, CA, 92868, USA.
| | - Sachini Ranasinghe
- Department of Medicine, University of California, Irvine, 333 The City Blvd. West, Suite 400, Orange, CA, 92868, USA
| | - Stephani Wang
- Department of Medicine, Division of Cardiology, University of California, Irvine, Irvine, USA
| | - Fernando Mendoza
- Memorial Care Heart and Vascular Institute, MemorialCare Long Beach Medical Center, Long Beach, USA
| | - Ali Khoynezhad
- Memorial Care Heart and Vascular Institute, MemorialCare Long Beach Medical Center, Long Beach, USA
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Zhang X, Ma G, Zheng L, Zhang H, Sun Y, Li J, Ma N. Echocardiographic diagnosis of Shone's syndrome. Echocardiography 2020; 37:2139-2143. [PMID: 33070402 DOI: 10.1111/echo.14899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023] Open
Abstract
Shone's syndrome is a rare congenital heart disease that includes 4 cardiovascular anomalies: supravalvular mitral ring, parachute mitral valve, subaortic stenosis, and coarctation of the aorta. Early diagnosis and treatment result in better outcomes. Echocardiography plays an important role in the diagnosis and is the optimal examination for detecting this disease. Pressure gradients are often unreliable and inaccurate; thus, careful anatomical observation of the left ventricular inflow and outflow tracts, particularly the mitral valve, is vital for accurate diagnosis and planning appropriate management. Herein, we describe 9 cases of Shone's syndrome, diagnosed with echocardiography and treated surgically.
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Affiliation(s)
- Xin Zhang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guiqin Ma
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin Zheng
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hongju Zhang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Sun
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jingya Li
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ning Ma
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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