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Liu J, Cao H, Cui L, Zhang Y, Song X, Ma J, Shi J, Zhang L, Hong L, Xie M. The Association of Pulmonary Flow Characteristics With Cardiac Function in Tricuspid Valve Malformation Fetuses: Study With Two-Dimensional Speckle Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1791-1805. [PMID: 34726794 DOI: 10.1002/jum.15862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To explore the relationship between cardiac function and pulmonary flow characteristics in tricuspid valve malformation (TVM) fetuses by conventional and speckle tracking echocardiography. METHODS Eighty-eight TVM fetuses were retrospectively included and compared with 80 normal controls. TVM fetuses in each trimester were divided into two subgroups according to pulmonary flow characteristics: those with normal pulmonary flow (TVM-N) and those with reduced or absent pulmonary flow (TVM-R/A). Cardiac measurements, Celermajer index, and Simpson-Andrews-Sharland (SAS) score were obtained. Speckle tracking echocardiography was used to compute ventricular deformation parameters. RESULTS TVM fetuses demonstrated significantly lower global longitudinal strain (GLS) and strain rate for both ventricles than controls (all P < .05). When compared with TVM-N, left ventricular (LV) ejection fraction, LV fractional area change, right ventricular (RV) fractional area change, LVGLS, and RVGLS were significantly reduced (all P < .05), while the RV diameter Z-score, RV/LV diameter, SAS score, and Celermajer index were obviously increased in TVM-R/A in both trimesters (all P < .05). Both LVGLS and RVGLS correlated with cardiothoracic circumference ratio, RV diameter Z-score, RV/LV diameter, Celermajer index, and SAS score (all P < .01). There was a slow decline for LVGLS and RVGLS in TVM-N fetuses throughout the gestation. Conversely, these two parameters worsened rapidly in TVM-R/A group. CONCLUSIONS TVM fetuses present biventricular dysfunction by deformation analysis in the second and third trimester of pregnancy. TVM fetuses with reduced or absent pulmonary flow exhibit significantly greater impairment and more rapid deterioration of cardiac function, which may contribute to poor outcomes.
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Affiliation(s)
- Juanjuan Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Haiyan Cao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Cui
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yi Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoyan Song
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Ma
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiawei Shi
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Liu Hong
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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2
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Lubaua I, Teraudkalna M. Ebstein Anomaly and Right Aortic Arch in Patient with Charge Syndrome. Medicina (B Aires) 2021; 57:medicina57111239. [PMID: 34833458 PMCID: PMC8619708 DOI: 10.3390/medicina57111239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Ebstein anomaly is a rare congenital heart disease characterized by a varying degree of anatomical and functional abnormalities of tricuspid valve and right ventricle. It often coexists with other congenital cardiac malformations. Up to 79–89% of patients with Ebstein anomaly have interatrial communication in the form of patent oval foramen or atrial septal defect and more than one-third has other types of cardiac malformations. Association between Ebstein anomaly and right aortic arch is extremely rare and only few cases have been described in the literature so far. Much rarer than with other cardiac malformations, Ebstein anomaly is associated with non-cardiac malformations or genetic syndromes. Several cases of association between Ebstein anomaly and Charge syndrome have been reported, nevertheless, Ebstein anomaly accounts for less than 1% of cardiac defects seen in patients with Charge syndrome. In this case report, we present a unique case of a patient with Charge syndrome where both Ebstein anomaly and right aortic arch are present. The diagnosis of Ebstein anomaly and right aortic arch was established prenatally. In the first years of life, the patient did not exhibit any remarkable symptoms. However, over time, deterioration of right ventricle function and increased tricuspid regurgitation were observed, requiring consideration of surgical treatment at the age of five. In addition, delay in physical, motor, and mental development was observed and thus, at the age of five, the patient was consulted by a medical geneticist and a gene panel to test for structural heart defects was ordered. The test showed a mutation in chromodomain helicase DNA binding protein 7 (CHD7) gene, which, along with clinical features, allowed to establish a diagnosis of Charge syndrome. To the best of the authors’ knowledge, this is the first case report of a patient with Charge syndrome, Ebstein anomaly, and right aortic arch that has been described in the literature.
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Affiliation(s)
- Inguna Lubaua
- Department of Pediatrics, Riga Stradins University, LV-1007 Riga, Latvia;
- Clinic for Pediatric Cardiology and Cardiac Surgery, Children’s Clinical University Hospital, LV-1004 Riga, Latvia
- Correspondence:
| | - Madara Teraudkalna
- Department of Pediatrics, Riga Stradins University, LV-1007 Riga, Latvia;
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3
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Weichert J, Weichert A. A 'holistic' sonographic view on congenital heart disease - How automatic reconstruction using fetal intelligent navigation echocardiography (FINE) eases the unveiling of abnormal cardiac anatomy part I: Right heart anomalies. Echocardiography 2021; 38:1430-1445. [PMID: 34232534 DOI: 10.1111/echo.15134] [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: 09/18/2020] [Revised: 04/18/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022] Open
Abstract
Attempting a comprehensive examination of the fetal heart remains challenging for unexperienced operators as it emphasizes the acquisition and documentation of sequential cross-sectional and sagittal views and inevitably results in diminished detection rates of fetuses affected by congenital heart disease. The introduction of four-dimensional spatio-temporal image correlation (4D STIC) technology facilitated a volumetric approach for thorough cardiac anatomic evaluation by the acquisition of cardiac 4D datasets. By analyzing and re-arranging of numerous frames according to their temporal event within the heart cycle, STIC allows visualization of cardiac structures as an endless cine loop sequence of a complete single cardiac cycle in motion. However, post-analysis with manipulation and repeated slicing of the volume usually requires experience and in-depth anatomic knowledge, which limits the widespread application of this advanced technique in clinical care and unfortunately leads to the underestimation of its diagnostic value to date. Fetal intelligent navigation echocardiography (FINE), a novel method that automatically generates and displays nine standard fetal echocardiographic views in normal hearts, has shown to be able to overcome these limitations. Very recent data on the detection of congenital heart defects (CHDs) using the FINE method revealed a high sensitivity and specificity of 98% and 93%, respectively. In this two-part manuscript, we focused on the performance of FINE in delineating abnormal anatomy of typical right and left heart lesions and thereby emphasized the educational potential of this technology for more than just teaching purposes. We further discussed recent findings in a pathophysiological and/or functional context.
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Affiliation(s)
- Jan Weichert
- Department of Gynecology & Obstetrics, Division of Prenatal Medicine, Campus Luebeck, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany
| | - Alexander Weichert
- Elbe Center of Prenatal Medicine and Human Genetics, Hamburg, Germany.,Department of Obstetrics, Charité-Universitätsmedizin Berlin - CCM, Berlin, Germany.,Prenatal Medicine Bergmannstrasse, Berlin, Germany
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4
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Abu-Halima M, Wagner V, Becker LS, Ayesh BM, Abd El-Rahman M, Fischer U, Meese E, Abdul-Khaliq H. Integrated microRNA and mRNA Expression Profiling Identifies Novel Targets and Networks Associated with Ebstein's Anomaly. Cells 2021; 10:cells10051066. [PMID: 33946378 PMCID: PMC8146150 DOI: 10.3390/cells10051066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
Little is known about abundance level changes of circulating microRNAs (miRNAs) and messenger RNAs (mRNA) in patients with Ebstein’s anomaly (EA). Here, we performed an integrated analysis to identify the differentially abundant miRNAs and mRNA targets and to identify the potential therapeutic targets that might be involved in the mechanisms underlying EA. A large panel of human miRNA and mRNA microarrays were conducted to determine the genome-wide expression profiles in the blood of 16 EA patients and 16 age and gender-matched healthy control volunteers (HVs). Differential abundance level of single miRNA and mRNA was validated by Real-Time quantitative PCR (RT-qPCR). Enrichment analyses of altered miRNA and mRNA abundance levels were identified using bioinformatics tools. Altered miRNA and mRNA abundance levels were observed between EA patients and HVs. Among the deregulated miRNAs and mRNAs, 76 miRNAs (49 lower abundance and 27 higher abundance, fold-change of ≥2) and 29 mRNAs (25 higher abundance and 4 lower abundance, fold-change of ≥1.5) were identified in EA patients compared to HVs. Bioinformatics analysis identified 37 pairs of putative miRNA-mRNA interactions. The majority of the correlations were detected between the lower abundance level of miRNA and higher abundance level of mRNA, except for let-7b-5p, which showed a higher abundance level and their target gene, SCRN3, showed a lower abundance level. Pathway enrichment analysis of the deregulated mRNAs identified 35 significant pathways that are mostly involved in signal transduction and cellular interaction pathways. Our findings provide new insights into a potential molecular biomarker(s) for the EA that may guide the development of novel targeting therapies.
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Affiliation(s)
- Masood Abu-Halima
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany; (M.A.E.-R.); (H.A.-K.)
- Correspondence:
| | - Viktoria Wagner
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
- Center for Clinical Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
| | - Lea Simone Becker
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
| | - Basim M. Ayesh
- Department of Laboratory Medical Sciences, Alaqsa University, Gaza 4051, Palestine;
| | - Mohammed Abd El-Rahman
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany; (M.A.E.-R.); (H.A.-K.)
| | - Ulrike Fischer
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
| | - Eckart Meese
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany; (M.A.E.-R.); (H.A.-K.)
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Nozari A, Aghaei-Moghadam E, Zeinaloo A, Alavi A, Ghasemi Firouzabdi S, Minaee S, Eskandari Hesari M, Behjati F. A Pathogenic Homozygous Mutation in The Pleckstrin Homology Domain of RASA1 Is Responsible for Familial Tricuspid Atresia in An Iranian Consanguineous Family. CELL JOURNAL 2018; 21:70-77. [PMID: 30507091 PMCID: PMC6275424 DOI: 10.22074/cellj.2019.5734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/21/2018] [Indexed: 11/28/2022]
Abstract
Objective Tricuspid atresia (TA) is a rare life-threatening form of congenital heart defect (CHD). The genetic
mechanisms underlying TA are not clearly understood. According to previous studies, the endocardial cushioning event,
as the primary sign of cardiac valvulogenesis, is governed by several overlapping signaling pathways including Ras/
ERK pathway. RASA1, a regulator of cardiovascular development, is involved in this pathway and its haploinsufficiency
(due to heterozygous mutations) has been identified as the underlying etiology of the autosomal dominant capillary
malformation/arteriovenous malformation (CM/AVM).
Materials and Methods In this prospective study, we used whole exome sequencing (WES) followed by serial
bioinformatics filtering steps for two siblings with TA and early onset CM. Their parents were consanguineous which
had a history of recurrent abortions. Patients were carefully assessed to exclude extra-cardiac anomalies.
Results We identified a homozygous RASA1 germline mutation, c.1583A>G (p.Tyr528Cys) in the family. This mutation
lies in the pleckstrin homology (PH) domain of the gene. The parents who were heterozygous for this variant displayed
CM.
Conclusion This is the first study reporting an adverse phenotypic outcome of a RASA1 homozygous mutation.
Here, we propose that the phenotypic consequence of the homozygous RASA1 p.Tyr528Cys mutation is more serious
than the heterozygous type. This could be responsible for the TA pathogenesis in our patients. We strongly suggest
that parents with CM/AVM should be investigated for RASA1 heterozygous mutations. Prenatal diagnosis and fetal
echocardiography should also be carried out in the event of pregnancy in heterozygous parents.
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Affiliation(s)
- Ahoura Nozari
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ehsan Aghaei-Moghadam
- Department of Pediatrics Cardiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Zeinaloo
- Department of Pediatrics Cardiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Afagh Alavi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Shohre Minaee
- Department of Pediatrics Cardiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Eskandari Hesari
- Department of Pediatrics Cardiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farkhondeh Behjati
- Department of Pediatrics Cardiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic Address:
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Abstract
Abstract
Ebstein anomaly (EA) is a rare congenital tricuspid valve malformation, characterized by downward displacement of the septal leaflet and an atrialized right ventricle. About 80% of cases of EA are non-syndromic; in the other 20%, the anomaly is associated with a chromosomal or Mendelian syndrome. The prevalence of EA is estimated at about 1 per 20,000 live births, and accounts for less than 1% of all congenital heart defects. EA has autosomal dominant inheritance. Likely causative genes are: NKX2-5, MYH7 and TPM1. This Utility Gene Test was developed on the basis of an analysis of the literature and existing diagnostic protocols. It is useful for confirming diagnosis, as well as for differential diagnosis, potential risk assessment and access to clinical trials.
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Geerdink LM, Delhaas T, Helbing WA, du Marchie Sarvaas GJ, Heide HT, Rozendaal L, de Korte CL, Peer PGM, Kuipers IM, Kapusta L. Paediatric Ebstein's anomaly: how clinical presentation predicts mortality. Arch Dis Child 2018; 103:859-863. [PMID: 29567665 DOI: 10.1136/archdischild-2017-313482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 02/20/2018] [Accepted: 02/24/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Forecasting the prognosis of a child when diagnosed with Ebstein's anomaly is difficult. We, therefore, studied which factors at the time of diagnosis are associated with death during childhood. METHODS All consecutive patients (0-18 years) diagnosed with Ebstein's anomaly in the Netherlands between 1980 and 2014 were included. Survival curves were obtained using the Kaplan-Meier method. By using the Cox proportional hazard model, we analysed the factors (at diagnosis) that were associated with death. RESULTS We included 176 patients. Thirty-one patients (18%) died before the age of 18 years. The 1-year survival was 84% and remained stable at 82% from 35 months after diagnosis and onwards. Modified Ross Heart Failure Class 4 at the time of diagnosis was the most important risk factor for death during childhood (HR 12.5, 95% CI 4.4 to 35.9). Furthermore, diagnosis in the neonatal period (HR 4.2, 95% CI 1.5 to 12.0), severe tricuspid valve regurgitation (HR 2.4, 95% CI 1.2 to 5.0), severe right ventricular outflow tract obstruction (HR 3.7, 95% CI 1.8 to 7.7) and a patent ductus arteriosus (HR 2.8, 95% CI 1.3 to 6.0) at the time of diagnosis were univariately associated with death. Multivariable analysis showed that presentation with Heart Failure Class 4 and a ventricular septal defect is the strongest predictor of death in childhood and adolescence. CONCLUSION Patients with Ebstein's anomaly presenting with Heart Failure Class 4 and a ventricular septal defect have a high risk of death during childhood.
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Affiliation(s)
- Lianne M Geerdink
- Department of Paediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Paediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Tammo Delhaas
- Department of Paediatric Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Willem A Helbing
- Department of Paediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gideon J du Marchie Sarvaas
- Centre for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henriette Ter Heide
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lieke Rozendaal
- Department of Paediatric Cardiology, Willem Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Centre, Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Petronella G M Peer
- Department of Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Irene M Kuipers
- Department of Paediatric Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Livia Kapusta
- Department of Paediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Paediatrics, Paediatric Cardiology Unit, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Navarro-Cubas X, Palermo V, French A, Sanchis-Mora S, Culshaw G. Tricuspid valve dysplasia: A retrospective study of clinical features and outcome in dogs in the UK. Open Vet J 2017; 7:349-359. [PMID: 29296595 PMCID: PMC5738889 DOI: 10.4314/ovj.v7i4.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/19/2017] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to determine the demographic, clinical and survival characteristics and to identify risk factors for mortality due to tricuspid valve dysplasia in UK dogs. Records of client-owned dogs diagnosed with tricuspid valve dysplasia at a referral centre were retrospectively reviewed. Only dogs diagnosed with tricuspid valve dysplasia based on the presence of a right-sided heart murmur identified prior to one year of age, and confirmed with Doppler echocardiography, were included. Dogs with concomitant cardiac diseases, pulmonary hypertension and/or trivial tricuspid regurgitation were excluded. Analysed data included signalment, reason for presentation, clinical signs, electrocardiographic and echocardiographic features, survival status and cause of death. Survival times and risk factors for mortality were evaluated using Kaplan-Meier curves and Cox regression. Eighteen dogs met inclusion criteria. Border collies were over-represented (p= 0.014). Dogs were most frequently referred for investigation of heart murmur. The most common arrhythmia was atrial fibrillation (n=3). Median survival time from diagnosis of tricuspid valve dysplasia was 2775 days (range 1-3696 days; 95% CI 1542.41-4007.59) and from onset of right-sided congestive heart failure was 181 days (range 1-2130 days; 95% CI 0-455.59). Syncope was the sole risk factor for cardiac death. In this population of UK dogs, tricuspid valve dysplasia was uncommon but, when severe, frequently led to right-sided congestive heart failure. Prognosis was favourable for mild and moderate tricuspid dysplasia. Survival time was reduced with right-sided congestive heart failure but varied widely. Risk of cardiac death was significantly increased if syncope had occurred.
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Affiliation(s)
- Xavier Navarro-Cubas
- University of Liverpool, Small Animal Teaching Hospital, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, UK
| | - Valentina Palermo
- Anderson and Moores Veterinary Specialists, The Granary, Bunstead Barns, Poles Lane, Hursley, Winchester, Hampshire, SO21 2LL, UK
| | - Anne French
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Bearsden Road, Bearsden, Glasgow, G61 1QH, UK
| | - Sandra Sanchis-Mora
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Geoff Culshaw
- R(D)SVS Hospital for Small Animals, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian, EH25 9RG, UK
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DeVore GR, Tabsh K, Polanco B, Satou G, Sklansky M. Fetal Heart Size: A Comparison Between the Point-to-Point Trace and Automated Ellipse Methods Between 20 and 40 Weeks' Gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2543-2562. [PMID: 27738291 DOI: 10.7863/ultra.16.02019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/13/2016] [Accepted: 03/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate whether the global area and circumference of the heart varies between two measurement techniques: the point-to-point trace and the electronic ellipse methods. METHODS The epicardial border of the 4-chamber view was measured in 200 fetuses between 20 and 40 weeks' gestation, from which the area and circumference using the point-to-point trace and electronic ellipse were measured. Analysis of variance, correlation, and regression analysis using fractional polynomials and 7 independent variables (head circumference, biparietal diameter, abdominal circumference, femur length, estimated fetal weight, mean ultrasound gestational age, and last menstrual period gestational age) were performed. RESULTS The correlation between the mean ultrasound gestational age and last menstrual period gestational age was 0.9880 (5% confidence limit, 0.9716; 95% confidence limit, 0.9880), with an R2 of 0.9762. The R2 value for the 7 independent variables regressed against the area and circumference using the point-to-point trace and electronic ellipse methods ranged between 0.885 and 0.965. Comparison of Z scores between this study and previous publications demonstrated that there were differences and similarities, depending on whether the area or circumference was measured. CONCLUSIONS This study shows high R2 values when comparing measurements of the area and circumference against 7 independent variables, irrespective of whether the point-to-point trace or the electronic ellipse method was used to obtain the measurements. A calculator to evaluate the area and circumference is provided, using 7 independent variables from which Z scores and percentiles for individual measurements can be computed.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Kareem Tabsh
- Department of Obstetrics and Gynecology, Kern Medical Center, Bakersfield, California USA
| | - Bardo Polanco
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
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10
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Ross FJ, Latham GJ, Richards M, Geiduschek J, Thompson D, Joffe D. Perioperative and Anesthetic Considerations in Ebstein’s Anomaly. Semin Cardiothorac Vasc Anesth 2015; 20:82-92. [DOI: 10.1177/1089253215605390] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ebstein’s anomaly is a complex and heterogeneous form of congenital heart disease characterized by malformation and apical displacement of the tricuspid valve leaflets. Patients may present at any time from the neonatal period to adulthood with symptoms ranging from cardiac failure and cyanosis to paroxysmal arrhythmias. Depending on the timing of presentation, various surgical options are available for the management of symptomatic patients. This review will discuss the perioperative and anesthetic management of patients with Ebstein’s anomaly with reference to the more common surgical approaches.
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Affiliation(s)
- Faith J. Ross
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Gregory J. Latham
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael Richards
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeremy Geiduschek
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas Thompson
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Denise Joffe
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
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11
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Ebstein's anomaly in children: A single-center study in Angola. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Manuel V, Morais H, Magalhães MP, Nunes MAS, Leon G, Ferreira M, Filipe Júnior AP. Ebstein's anomaly in children: a single-center study in Angola. Rev Port Cardiol 2015; 34:607-12. [PMID: 26391845 DOI: 10.1016/j.repc.2015.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Ebstein's anomaly is a rare complex congenital heart defect of the tricuspid valve. We aimed to describe the frequency, clinical profile, and early and short-term post-operative results in patients under the age of 18 years operated for this anomaly in a tertiary center in Angola. METHODS A retrospective cross-sectional study was conducted over a period of 37 months. We analyzed all patients diagnosed with congenital heart defects. RESULTS Of the 1362 patients studied, eight (0.6%) had Ebstein's anomaly; six patients (75%) were female. Mean age was 69±59 months. Five patients were in NYHA functional class III or IV. Mean cardiothoracic index was 0.72. Seven patients (87.5%) had severe tricuspid regurgitation and five (62.5%) had another associated congenital heart defect. All patients were operated: two had complications and one (12.5%) died in the early post-operative period. The mean follow-up time was 1.22±0.6 years, and mortality during follow-up was 12.5% (n=1). At the end of the study, of the five patients in whom cone reconstruction was performed, four (80%) were in functional class I. Mean cardiothoracic index decreased to 0.64. Three patients had mild and two had moderate tricuspid regurgitation. The patient who underwent cone reconstruction and a Glenn procedure was in functional class I. CONCLUSION The frequency of Ebstein's anomaly was similar to that in other centers. Cone reconstruction was viable in the majority of patients, with good early and short-term results.
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Affiliation(s)
- Valdano Manuel
- Cardio-Thoracic Center, Clinica Girassol, Luanda, Angola.
| | - Humberto Morais
- Cardiology Department, Hospital Militar Principal/Instituto Superior, Luanda, Angola
| | - Manuel Pedro Magalhães
- Cardio-Thoracic Center, Clinica Girassol, Luanda, Angola; Hospital Cruz Vermelha, Lisbon, Portugal
| | | | - Gilberto Leon
- Cardio-Thoracic Center, Clinica Girassol, Luanda, Angola
| | - Manuel Ferreira
- Cardio-Thoracic Center, Clinica Girassol, Luanda, Angola; Hospital Cruz Vermelha, Lisbon, Portugal
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Luu Q, Choudhary P, Jackson D, Canniffe C, McGuire M, Chard R, Celermajer DS. Ebstein's anomaly in those surviving to adult life - a single centre experience. Heart Lung Circ 2015; 24:996-1001. [PMID: 25911143 DOI: 10.1016/j.hlc.2015.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/15/2015] [Accepted: 03/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ebstein's anomaly (EA) occurs in about one to five per 200 000 live births. Long-term follow-up data of adults with EA is scarce due to the relatively low frequency of the disease and the variation of its anatomic and haemodynamic severity. METHODS Since 1995, in our adult congenital heart disease (ACHD) centre, we have practised a uniform approach to management of adults with EA, with surgery reserved for those with refractory arrhythmia (failed medical and/or catheter-based treatment) or worsening symptoms of breathlessness. A retrospective review of medical records of all such patients with EA and normal cardiac connections was performed. RESULTS Fifty-one EA patients (17 males) were identified. Mean age at diagnosis was 21+/-21 years and mean follow-up time at our centre was 21±14 years. During this time, 18 patients (35%) had documented supraventricular arrhythmia. Sixteen patients (30%) underwent ablation therapy with long-term relief from arrhythmia in nine (56%). Nine patients (18%) underwent tricuspid valve (TV) surgery (four repair and five replacement), with seven patients having undergone a tricuspid valve surgery prior to referral to our unit. Three patients died, one of cardiogenic shock after redo surgery (58 years), one of progressive heart failure (45 years) and one with malignancy. Overall survival was 100% to age 40 years, 95% to age 50 years and 81% to age 60 years. CONCLUSIONS Ebstein's Anomaly in adulthood often has severe morphological abnormalities but is compatible with good medium-term survival, with a generally symptom driven approach to the indications for interventions.
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Affiliation(s)
- Queenie Luu
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Preeti Choudhary
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, Australia
| | - Dan Jackson
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Carla Canniffe
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mark McGuire
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Richard Chard
- Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, Australia.
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Abstract
Ebstein's anomaly is a complex congenital disorder of the tricuspid valve. Presentation in neonatal life and (early) childhood is common. Disease severity and clinical features vary widely and require a patient-tailored treatment. In this review, we describe the natural history of children and adolescents with Ebstein's anomaly, including symptoms and signs presenting at diagnosis. Current classification strategies of Ebstein's anomaly are discussed. We report on diagnostic methods for establishing the severity of disease that might enhance decision on the timing of surgical intervention. Furthermore, we describe different surgical options for severely ill neonates and multiple surgical interventions after infancy. Only with ample knowledge and understanding of the above, this complex and diverse group of patients can be correctly treated in order to improve not only duration, but also quality of life.
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Barre E, Durand I, Hazelzet T, David N. Ebstein's anomaly and tricuspid valve dysplasia: prognosis after diagnosis in utero. Pediatr Cardiol 2012; 33:1391-6. [PMID: 22639000 DOI: 10.1007/s00246-012-0355-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/27/2012] [Indexed: 11/29/2022]
Abstract
Tricuspid valve malformation is a rare congenital heart disease. Prenatal diagnosis of Ebstein's anomaly (EA) and tricuspid valve dysplasia (TVD) is associated with high mortality. There are conflicting reports concerning accurate prognostication after diagnosis in utero. The aim of our study was to assess prognostic factors based on our experience. We reviewed 37 fetuses between 1984 and June 2010 comprising 26 cases of EA and 11 cases of TVD. There were 10 terminations, 5 intrauterine deaths, 8 neonatal deaths, and 14 survivors. We found that the major prognostic factor for outcome was the flow pattern through the pulmonary valve on the first echocardiogram. Retrograde flow was strongly correlated with fetal or neonatal death (p = 8 × 10(-5)), and anterograde flow predicted good outcome (p = 8 × 10(-5)). In contrast, cardiothoracic indexes, right to left-ventricular ratio, and Celermajer index were not useful prognostic markers. The Simpson Andrews Sharland score, which was more complex, was well correlated with our series. Flow through the pulmonary valve on the first echocardiogram is a simple and excellent prognostic factor when major tricuspid valve disease is diagnosed in utero. Fetuses should be monitored throughout pregnancy, particularly those with retrograde ductus arteriosus, because several hemodynamic factors may worsen the prognosis.
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Affiliation(s)
- E Barre
- Department of Congenital Cardiology, Rouen University Hospital, 1 Rue de Germont, 76031, Rouen, France.
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Complications Associated With the Use of Left Ventricular Assist Device Therapy in an Adult Patient With Ebstein's Anomaly. Ann Thorac Surg 2012; 93:297-9. [DOI: 10.1016/j.athoracsur.2011.06.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 04/28/2011] [Accepted: 06/16/2011] [Indexed: 11/21/2022]
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Epidemiology of Ebstein anomaly: Prevalence and patterns in Texas, 1999-2005. Am J Med Genet A 2011; 155A:1007-14. [DOI: 10.1002/ajmg.a.33883] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 12/10/2010] [Indexed: 11/07/2022]
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Jadaon JE, Haddad S, Mukary M, Ben-Shlomo I, Ben-Ami M. Evaluation of normal fetal atrio-ventricular septum dimensions during pregnancy. Prenat Diagn 2011; 31:167-70. [DOI: 10.1002/pd.2670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 10/31/2010] [Accepted: 11/04/2010] [Indexed: 11/11/2022]
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Hidaka N, Sugitani M, Fujita Y, Fukushima K, Tsukimori K, Wake N. Preload index of the inferior vena cava as a possible predictive marker of hydropic changes in fetuses with Ebstein anomaly. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1369-1374. [PMID: 19778884 DOI: 10.7863/jum.2009.28.10.1369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE We aimed to investigate whether the preload index of the inferior vena cava (PLI-IVC) is of diagnostic value in predicting hydropic changes in fetuses with Ebstein anomaly. METHODS Five cases of prenatally diagnosed Ebstein anomaly, which were managed at our institution between 1999 and 2008, were retrospectively reviewed. The PLI-IVC was calculated as the ratio between the reversed flow velocity from the right atrium and the forward velocity of the IVC. RESULTS The PLI-IVC was high in all the cases. In 2 cases, PLI-IVC values tended to increase gradually before hydropic changes were recognized. In the cases without hydrops, PLI-IVC values exhibited a nonlinear trend throughout gestation and did not show any apparent increase. CONCLUSIONS The upward trend of the PLI-IVC rather than the maintenance of a high value can be considered a sign of cardiac failure. The blood flow pattern in the IVC should be carefully monitored in fetuses with Ebstein anomaly for the early identification of fetal impairment.
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Affiliation(s)
- Nobuhiro Hidaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Higashiku, Fukuoka, Japan.
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Cantinotti M, Bell A, Razavi R. Role of magnetic resonance imaging in different ways of presentation of Ebsteinʼs anomaly. J Cardiovasc Med (Hagerstown) 2008; 9:628-30. [DOI: 10.2459/jcm.0b013e3282f21654] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Andrews RE, Tibby SM, Sharland GK, Simpson JM. Prediction of outcome of tricuspid valve malformations diagnosed during fetal life. Am J Cardiol 2008; 101:1046-50. [PMID: 18359329 DOI: 10.1016/j.amjcard.2007.11.049] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 11/21/2007] [Accepted: 11/21/2007] [Indexed: 11/18/2022]
Abstract
There are conflicting reports on the prenatal validity of echocardiographic indexes used to assess tricuspid valve malformations (TVM) in postnatal life. The aim of this study was to determine which echocardiographic factors are of most prognostic significance in prenatally-diagnosed TVM and to develop a clinically-based prognostic scoring system to better inform prenatal counseling. From a prospective database, 44 fetuses with isolated TVM were identified from 1995 to 2004, inclusive. Prenatal echocardiographic findings were correlated with known outcome in 43. Tricuspid valve dyplasia was diagnosed in 22, Ebstein's anomaly in 21, and unguarded tricuspid valve orifice in 1. There were 19 terminations, 9 intrauterine deaths, 5 neonatal deaths, and 10 survivors >1 month. Survival was 35% at birth and 23% at 1 month, or 63% and 42% respectively on an intention-to-treat basis. There was no significant change to termination or overall survival rates over time, but there was a significant improvement in survival for live-born babies in the second 5 years compared with the first (p = 0.02). Factors significantly associated with increased mortality included increased cardiothoracic ratio (p <0.001), Celermajer index (p <0.001), and right-left ventricular ratio (p = 0.02); reduced/absent pulmonary valve flow (p = 0.02), and retrograde duct flow (p = 0.003). These factors were combined to give a prognostic score (SAS score) with good predictive value. In conclusion, the prenatal echocardiographic factors of most prognostic significance in TVM are similar to those used postnatally. The SAS score is a useful clinical tool that may be used to inform counseling in affected pregnancies.
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Affiliation(s)
- Rachel E Andrews
- Department of Fetal Cardiology, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Abstract
Ebstein's anomaly of the tricuspid valve is a rare lesion comprising less than 1% of patients with congenital heart disease. Among congenital heart lesions, Ebstein's anomaly is one of the most diverse in presentation, severity, and management. In its most severe form, it is also one of the most lethal. In this article we present a case of a patient who developed cardiac symptoms in adulthood. We follow this with a review of the pathology, clinical presentation, evaluation, and management of Ebstein's anomaly.
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Affiliation(s)
- Michelle Gurvitz
- Division of Cardiology, University of Washington, Box 356422, 1959 NE Pacific, Seattle, WA 98105, USA.
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Abstract
EBSTEIN’S ANOMALY IS A RARE congenital heart defect characterized by displacement of the tricuspid valve leaflets into the right ventricle.1The defect was first described by Wilhelm Ebstein in 1866.2This anomaly of the tricuspid valve causes the right atrium to thin and become enlarged, resulting in a wide range of clinical presentations.3Clinical presentation depends on the severity of the pathologic findings, which vary considerably from patient to patient. Some infants may present with cyanosis, respiratory distress, heart failure, and even death, whereas others may not present with mild symptoms until adolescence or adulthood.
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Affiliation(s)
- Sarah E Pashia
- NICU, St. John's Mercy Medical Center, St. Louis, Missouri, USA.
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Chauvaud SM, Hernigou AC, Mousseaux ER, Sidi D, Hébert JL. Ventricular Volumes in Ebstein’s Anomaly: X-Ray Multislice Computed Tomography Before and After Repair. Ann Thorac Surg 2006; 81:1443-9. [PMID: 16564290 DOI: 10.1016/j.athoracsur.2005.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2005] [Revised: 10/04/2005] [Accepted: 10/04/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study was performed to measure right and left ventricular volumes in Ebstein's anomaly before and after operation. METHODS Twenty-six consecutive patients were operated on with tricuspid valve repair and plication of the atrialized right ventricle, associated with a bidirectional cavopulmonary shunt in 15 patients. Right ventricular (RV) and left ventricular end-diastolic and end-systolic volume indexes were measured by x-ray computerized tomography before and after surgical repair. Left ventricular stroke index and ejection fraction were calculated. RESULTS Before surgery, the mean stroke index of the atrialized RV was 36 +/- 33 mL/m2, with severe reduction in 9 patients and aneurysmal aspect in 2 patients. After surgery, the atrialized RV was no longer identifiable. Both RV end-diastolic volume index and stroke index of the remaining effective RV were reduced. Bidirectional cavopulmonary shunt was a determinant factor of decrease in the effective RV end-diastolic volume index after repair. Conversely, left ventricular ejection fraction and stroke index increased significantly after surgery. CONCLUSIONS The atrialized RV with dyskinesia seems a good indication for a plication. RV end-diastolic volume index of the effective RV decreased after surgery. In severe cases, bidirectional cavopulmonary shunt was useful by decreasing RV end-diastolic volume, thus preventing further RV dilation. In all cases left ventricular ejection fraction and stroke volume index increased after surgery.
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Affiliation(s)
- Sylvain M Chauvaud
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France.
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