1
|
Ling Y, Li T, An Q. Infant With Cyanosis. Ann Emerg Med 2022; 80:e17-e18. [PMID: 35870873 DOI: 10.1016/j.annemergmed.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tiange Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| |
Collapse
|
2
|
Goo HW. Diagnostic imaging for absent pulmonary valve syndrome: an update with an emphasis on cardiothoracic computed tomography. Pediatr Radiol 2022; 52:1167-1174. [PMID: 35039934 DOI: 10.1007/s00247-021-05254-x] [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: 12/22/2020] [Revised: 06/11/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Absent pulmonary valve syndrome is a rare congenital heart disease characterized by partial or complete absence of pulmonary valve cusps which commonly presents with respiratory difficulty during infancy. Because central airway compression by dilated central pulmonary arteries is a key pathology of this syndrome responsible for clinical presentation, severity, and outcome, cardiothoracic computed tomography (CT) is currently regarded as the imaging modality of choice before and after treatment. In addition, tracheobronchomalacia frequently responsible for persistent respiratory problems can be accurately evaluated with conventional two-dimensional cine CT or four-dimensional CT. In this pictorial review, various diagnostic imaging methods used to evaluate absent pulmonary valve syndrome are comprehensively illustrated with an emphasis on a recently spotlighted role of cardiothoracic CT.
Collapse
Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
3
|
Cappuccio G, Brunetti-Pierri N, Clift P, Learn C, Dykes JC, Mercer CL, Callewaert B, Meerschaut I, Spinelli AM, Bruno I, Gillespie MJ, Dorfman AT, Grimberg A, Lindsay ME, Lin AE. Expanded cardiovascular phenotype of Myhre syndrome includes tetralogy of Fallot suggesting a role for SMAD4 in human neural crest defects. Am J Med Genet A 2022; 188:1384-1395. [PMID: 35025139 DOI: 10.1002/ajmg.a.62645] [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: 08/26/2021] [Revised: 11/16/2021] [Accepted: 12/11/2021] [Indexed: 11/08/2022]
Abstract
Tetralogy of Fallot (ToF) can be associated with a wide range of extracardiac anomalies, with an underlying etiology identified in approximately 10% of cases. Individuals affected with Myhre syndrome due to recurrent SMAD4 mutations frequently have cardiovascular anomalies, including congenital heart defects. In addition to two patients in the literature with ToF, we describe five additional individuals with Myhre syndrome and classic ToF, ToF with pulmonary atresia and multiple aorto-pulmonary collaterals, and ToF with absent pulmonary valve. Aorta hypoplasia was documented in one patient and suspected in another two. In half of these individuals, postoperative cardiac dysfunction was thought to be more severe than classic postoperative ToF repair. There may be an increase in right ventricular pressure, and right ventricular dysfunction due to free pulmonic regurgitation. Noncardiac developmental abnormalities in our series and the literature, including corectopia, heterochromia iridis, and congenital miosis suggest an underlying defect of neural crest cell migration in Myhre syndrome. We advise clinicians that Myhre syndrome should be considered in the genetic evaluation of a child with ToF, short stature, unusual facial features, and developmental delay, as these children may be at risk for increased postoperative morbidity. Additional research is needed to investigate the hypothesis that postoperative hemodynamics in these patients may be consistent with restrictive myocardial physiology.
Collapse
Affiliation(s)
- Gerarda Cappuccio
- Department of Translational Medicine, Section of Pediatrics, Federico II University, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli (Naples), Italy
| | - Nicola Brunetti-Pierri
- Department of Translational Medicine, Section of Pediatrics, Federico II University, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli (Naples), Italy
| | - Paul Clift
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, UK
| | - Christopher Learn
- Adult Congenital Heart Disease Program, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John C Dykes
- Departments of Pediatrics, Stanford, California, USA
| | - Catherine L Mercer
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, UK
| | - Bert Callewaert
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.,Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Ilse Meerschaut
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Irene Bruno
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aaron T Dorfman
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adda Grimberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mark E Lindsay
- Department of Pediatrics, Division of Pediatric Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Angela E Lin
- Genetics Unit, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Spaziani G, Bennati E, Marrone C, Lucà F, Iorio A, Rao CM, Di Fusco SA, Russo MG, Colivicchi F, Gabrielli D, Santoro G, Favilli S, Gulizia MM. Pathophysiology and clinical presentation of paediatric heart failure related to congenital heart disease. Acta Paediatr 2021; 110:2336-2343. [PMID: 33948967 DOI: 10.1111/apa.15904] [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: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Congenital heart disease (CHD) and cardiomyopathies represent the two most important causes of paediatric heart failure (HF) in developed countries. We made a review of the literature on pathophysiology and clinical presentation of paediatric HF in children with CHD. Two main pathophysiologic models can be identified: the 'over-circulation failure', characterised by signs and symptoms of congestion or hypoperfusion, due respectively to volume or pressure overload, and the 'pump failure'. CONCLUSIONS: The comprehension of the HF pathophysiology in paediatric patients with CHD is of paramount importance for the optimal management and for addressing the best therapeutic choices.
Collapse
Affiliation(s)
- Gaia Spaziani
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
| | - Elena Bennati
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
| | - Chiara Marrone
- Pediatric Cardiology Fondazione G. Monasterio CNR‐Regione Toscana Massa Italy
| | - Fabiana Lucà
- Division of Cardiology Big Metropolitan Hospital Reggio Calabria Italy
| | - Annamaria Iorio
- Division of Cardiology Azienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | | | | | - Maria Giovanna Russo
- Pediatric Cardiology Department of Cardiology Monaldi Hospital, “L. Vanvitelli” University Naples Italy
| | - Furio Colivicchi
- UOC Cardiologia Clinica e Riabilitativa San Filippo Neri Hospital Rome Italy
| | | | - Giuseppe Santoro
- Pediatric Cardiology Fondazione G. Monasterio CNR‐Regione Toscana Massa Italy
| | - Silvia Favilli
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
| | | | | |
Collapse
|
5
|
Saef JM, Ghobrial J. Valvular heart disease in congenital heart disease: a narrative review. Cardiovasc Diagn Ther 2021; 11:818-839. [PMID: 34295708 DOI: 10.21037/cdt-19-693-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/29/2021] [Indexed: 12/29/2022]
Abstract
Patients with congenital heart disease (CHD) are one of the fastest growing populations in cardiology, and valvular pathology is at the center of many congenital lesions. Derangements in valvular embryology lead to several anomalies prone to dysfunction, each with hemodynamic effects that require appropriate surveillance and management. Surgical innovation has provided new treatments that have improved survival in this population, though has also contributed to esotericism in patients who already have unique anatomic and physiologic considerations. Conduit and prosthesis durability are often monitored collaboratively with general and specialized congenital-focused cardiologists. As such, general cardiologists must become familiar with valvular disease with CHD for appropriate care and referral practices. In this review, we summarize the embryology of the semilunar and atrioventricular (AV) valves as a foundation for understanding the origins of valvular CHD and describe the mechanisms that account for heterogeneity in disease. We then highlight the categories of pathology from the simple (e.g., bicuspid aortic valve, isolated pulmonic stenosis) to the more complex (e.g., Ebstein's anomaly, AV valvular disease in single ventricle circulations) with details on natural history, diagnosis, and contemporary therapeutic approaches. Care for CHD patients requires collaborative effort between providers, both CHD-specialized and not, to achieve optimal patient outcomes.
Collapse
Affiliation(s)
- Joshua M Saef
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joanna Ghobrial
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
6
|
Verma M, Pandey NN, Ojha V, Jagia P, Kumar S, Kothari SS, Saxena A. Evaluation of cardiovascular morphology and airway-related abnormalities in tetralogy of fallot with absent pulmonary valve syndrome on multidetector computed tomography angiography. J Card Surg 2021; 36:2697-2704. [PMID: 33993521 DOI: 10.1111/jocs.15639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/10/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the cardiovascular, tracheobronchial and pulmonary abnormalities associated with tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) on multidetector computed tomograpgy (MDCT) angiography. MATERIALS AND METHODS We conducted a retrospective review of our electronic database from January, 2014 to December, 2020 to identify pediatric patients diagnosed with TOF-APVS on MDCT angiography. Pulmonary anatomy, associated tracheobronchial and coronary compression, compression of intrapulmonary bronchi, lung parenchymal changes and other associated cardiovascular abnormalities were evaluated. RESULTS Forty-seven patients with TOF-APVS were included in the study. Compression of the airways was observed at multiple levels; 4 (8.5%) patients had carinal compression while right main bronchus and left main bronchus compression was seen in 12 (25.5%) and 16 (34.0%) patients, respectively. Forty-three (91.5%) patients showed abnormal pulmonary arterial branching at the segmental level and compression at the level of intrapulmonary bronchi was seen in 24 (51.1%) patients. Some degree of air trapping was seen in 35 (74.5%) patients whereas atelectasis was observed in 15 (31.9%) patients. Mild coronary arterial compression was seen in 3 (6.4%) patients. CONCLUSION TOF-APVS is characterized by aneurysmal dilatation of pulmonary arteries leading to a varying degree of airway compression. However, even in the absence of compression of the trachea and main bronchi, there can be distal bronchial compression secondary to abnormal pulmonary arterial branching resulting in lung abnormalities in the majority of these patients. This study highlights the importance of dedicated airway assessment in addition to cardiovascular morphological assessment by MDCT angiography, before planning surgery.
Collapse
Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Song Y, Zou YF, Ru YH, Qiu J, Yin H. Absent pulmonary valve syndrome with tetralogy of fallot and patent ductus arteriosus at 14 weeks of gestation and follow-up 2 weeks later: Case report and review of literature. Echocardiography 2021; 38:484-487. [PMID: 33544401 DOI: 10.1111/echo.14936] [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: 06/28/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022] Open
Abstract
Classical absent pulmonary valve syndrome (APVS) with tetralogy of fallot (TOF) is a rare congenital cardiac anomaly commonly associated with the absence of patent ductus arteriosus (PDA), which is mostly diagnosed after 20 weeks of gestation by fetal echocardiography. This case of APVS with TOF was suspected at 13 weeks of gestation and diagnosed at 14 weeks of gestation with an obvious PDA. The pulmonary arterial trunk and the branches did not dilate obviously. Fifteen days later, the PDA narrowed down with the discovery of pulmonary artery ectasia at the same time. This progress indicated that the absence of PDA is not necessary for the survival of APVS with TOF in utero, in contrast, the absence or restriction of PDA may be nothing less than adaptation to the disease. Fetal autopsy confirmed the accuracy of fetal echocardiography. Chromosome microarray analysis (CMA) showed 20p12 deletion in this fetus, which is rare among TOF cases.
Collapse
Affiliation(s)
- Yan Song
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Hospital, Jinan, China
| | - Yu-Fen Zou
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Hospital, Jinan, China
| | - Yan-Hui Ru
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Hospital, Jinan, China
| | - Jing Qiu
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Hospital, Jinan, China
| | - Hong Yin
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Hospital, Jinan, China
| |
Collapse
|
8
|
Desai DB, Mathur NP, Marik A. Fallot type of absent pulmonary valve syndrome - A case report. Indian J Radiol Imaging 2020; 30:240-243. [PMID: 33100698 PMCID: PMC7546300 DOI: 10.4103/ijri.ijri_508_19] [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] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/13/2020] [Accepted: 07/19/2020] [Indexed: 11/04/2022] Open
Abstract
Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac malformation characterized by absent, dysplastic, or rudimentary pulmonary valve leaflets in association with other cardiac anomalies. It has an incidence of 3-6% in cases of tetralogy of Fallot (TOF) and 0.2-0.4% of live-born infants with congenital heart disease (CHD). Absent pulmonary valve leads to dilated main pulmonary artery; presenting as a pulsatile, paracardiac cystic lesion on antenatal ultrasound (USG). We report a case of this rare anomaly in association with ventricular septal defect (VSD), TOF, and left axis deviation of heart detected at 23 weeks of gestation.
Collapse
Affiliation(s)
- Divya B Desai
- Department of Radiodiagnosis, D Y Patil Hospital and Research Center, Sector-5, Nerul, Navi Mumbai, Maharashtra, India
| | - Neeti P Mathur
- Department of Radiodiagnosis, D Y Patil Hospital and Research Center, Sector-5, Nerul, Navi Mumbai, Maharashtra, India
| | - Arnab Marik
- Department of Radiodiagnosis, D Y Patil Hospital and Research Center, Sector-5, Nerul, Navi Mumbai, Maharashtra, India
| |
Collapse
|
9
|
Rare association of absent pulmonary valve with intact ventricular septum and patent ductus arteriosus: Assessment in a newborn with CT Angiography. J Cardiovasc Comput Tomogr 2020; 15:e1-e2. [PMID: 32807704 DOI: 10.1016/j.jcct.2020.07.001] [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: 04/09/2020] [Revised: 06/12/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022]
|
10
|
Averkin II, Grehov EV, Pervunina TM, Komlichenko EV, Vasichkina ES, Zaverza VM, Nikiforov VG, Latipova ML, Govorov IE, Kozyrev IA, Komlichenko EE, Ricci A, Biccari E, Tsibizova VI. 3D-printing in preoperative planning in neonates with complex congenital heart defects. J Matern Fetal Neonatal Med 2020; 35:2020-2024. [PMID: 32552076 DOI: 10.1080/14767058.2020.1771691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The application of the 3D printing approach in medicine is currently becoming increasingly popular. The management of fetuses and newborns with congenital heart defects is often difficult, primarily due to the complexity of the anatomy. Here we report a newborn with a complex congenital malformation (absent pulmonary valve syndrome associated with tetralogy of Fallot), which could be clinically interpreted in different ways. 3D printing allowed to elucidate the exact anatomy more precisely and direct the cardiosurgeon to a definitive treatment.
Collapse
Affiliation(s)
- Igor I Averkin
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Evgeny V Grehov
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Tat'yana M Pervunina
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Eduard V Komlichenko
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Elena S Vasichkina
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Viktoriya M Zaverza
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Vladimir G Nikiforov
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Marina L Latipova
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Igor E Govorov
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Ivan A Kozyrev
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - E E Komlichenko
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| | - Alessandro Ricci
- 3DIFIC and Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - E Biccari
- 3DIFIC and Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Valentina I Tsibizova
- Almazov National Medical Research Centre, Institute of Perinatology and Pediatrics, Saint-Petersburg, Russian Federation
| |
Collapse
|
11
|
Zhou WY, Li YY, He XQ, Wang YB. Absent Pulmonary Valve Syndrome in a Fetus: A Case Report and Literature Review. Fetal Pediatr Pathol 2019; 38:57-62. [PMID: 30661433 DOI: 10.1080/15513815.2018.1529066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The main characteristics of absent pulmonary valve syndrome (APVS) include the absence or hypoplasia of the pulmonary valve, stenosis of the pulmonary valve annulus, and aneurysmal dilatation of the pulmonary trunk and its branches. In the more common type 1, the tetralogy of Fallot-like type, there is a ventricular septal defect, overriding aorta, pulmonary arterial dilatation, and absence of ductus arteriosus, The second type has an intact ventricular septum, less pulmonary artery dilatation, and a patent ductus arteriosus, with or without tricuspid atresia. CASE REPORT This APVS had an intact ventricular septum with an absent ductus arteriosus. CONCLUSION The APVS with intact ventricular septum with an absent ductus arteriosus may represent a third type of APVS.
Collapse
Affiliation(s)
| | - Yue-Yi Li
- a Loudi Central Hospital , Loudi , China
| | - Xiao-Qin He
- b Department of Ultrasound , Xiamen Maternity and Child Care Hospital , Xiamen , China
| | - Yi-Bin Wang
- c Department of Medical Ultrasound , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| |
Collapse
|
12
|
Swaminathan S, Agarwal A, Infante JC, Rosenkranz E. Tetralogy of Fallot With Absent Pulmonary Valve and Nonconfluent Pulmonary Arteries: A Management Conundrum. World J Pediatr Congenit Heart Surg 2018; 11:NP168-NP171. [PMID: 30148690 DOI: 10.1177/2150135118775661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tetralogy of Fallot with absent pulmonary valve syndrome is a rare form of congenital heart disease. Among the different variations with this rare anomaly is nonconfluent pulmonary artery branches with anomalous origin of the left pulmonary artery from the ductus arteriosus. The authors present one such case which was diagnosed prenatally to have tetralogy of Fallot with absent pulmonary valve and identified postnatally to have nonconfluent pulmonary artery branches in addition. We discuss the conundrum of respiratory management in this patient pre- and postoperatively due to a unique ventilation perfusion mismatch problem, which varies between the two lungs.
Collapse
Affiliation(s)
- Sethuraman Swaminathan
- Division of Pediatric Cardiology, Department of Pediatrics, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arpit Agarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan C Infante
- Department of Radiology, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eliot Rosenkranz
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Holtz Children's Hospital, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
13
|
Significance of lung anomalies in fetuses affected by tetralogy of Fallot with absent pulmonary valve syndrome. Cardiol Young 2017; 27:1740-1747. [PMID: 28673366 DOI: 10.1017/s1047951117001147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Tetralogy of Fallot with absent pulmonary valve syndrome is a rare form of tetralogy of Fallot with dilatation of large pulmonary arteries. Prognosis is related to the severity of the cardiac malformation and to bronchial tree compression by dilated pulmonary arteries. This study analyses the prenatal echographic lung appearance in fetuses with tetralogy of Fallot with absent pulmonary valve and discusses its significance. METHODS We carried out a retrospective review of fetal and postnatal files of nine fetuses diagnosed with tetralogy of Fallot with absent pulmonary valve syndrome in our institution. Correlations of prenatal ultrasound and cardiac imaging findings were obtained with outcome. RESULTS Abnormal heterogeneous fetal lung echogenicity was detected in eight cases out of nine, always associated with significant lobar arterial dilatation. This aspect was well correlated with postnatal imaging and outcome in the four neonatal cases. The only fetus with normal lung echogenicity also had lower degree of pulmonary artery dilatation in the series. CONCLUSIONS This study demonstrates that a heterogeneous ultrasound appearance of the fetal lungs can be detected in utero in the most severe cases. This aspect suggests an already significant compression of the fetal bronchial tree by the dilated arteries that may have prognostic implications.
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Our review is intended to provide readers with an overview of disease processes involving the pulmonic valve, highlighting recent outcome studies and guideline-based recommendations; with focus on the two most common interventions for treating pulmonic valve disease, balloon pulmonary valvuloplasty and pulmonic valve replacement. RECENT FINDINGS The main long-term sequelae of balloon pulmonary valvuloplasty, the gold standard treatment for pulmonic stenosis, remain pulmonic regurgitation and valvular restenosis. The balloon:annulus ratio is a major contributor to both, with high ratios resulting in greater degrees of regurgitation, and small ratios increasing risk for restenosis. Recent studies suggest that a ratio of approximately 1.2 may provide the most optimal results. Pulmonic valve replacement is currently the procedure of choice for patients with severe pulmonic regurgitation and hemodynamic sequelae or symptoms, yet it remains uncertain how it impacts long-term survival. Transcatheter pulmonic valve replacement is a rapidly evolving field and recent outcome studies suggest short and mid-term results at least equivalent to surgery. The Melody valve® was FDA approved for failing pulmonary surgical conduits in 2010 and for failing bioprosthetic surgical pulmonic valves in 2017 and has been extensively studied, whereas the Sapien XT valve®, offering larger diameters, was approved for failing pulmonary conduits in 2016 and has been less extensively studied. Patients with pulmonic valve disease deserve lifelong surveillance for complications. Transcatheter pulmonic valve replacement is a novel and attractive therapeutic option, but is currently only FDA approved for patients with failing pulmonary conduits or dysfunctional surgical bioprosthetic valves. New advances will undoubtedly increase the utilization of this rapidly expanding technology.
Collapse
|
15
|
Abstract
RATIONALE Absent pulmonary valve syndrome (APVS) is a rare congenital heart disease that is often associated with tetralogy of Fallot (TOF). Here, we report 2 cases of APVS associated with TOF diagnosed via fetal echocardiography and discuss their specific ultrasonographic characteristics. PATIENT CONCERNS Two pregnant women with suspicion of fetal heart anomaly were referred from their local hospitals to our hospital for fetal malformation screening and detailed fetal echocardiography. Color and spectral Doppler flow imaging were utilized to evaluate the axis, size, situs, cardiac chambers, and both inflow and outflow tracts of the heart as well as the great arteries. Both cases had a severe dilatation of the pulmonary trunk and its branches and an absence or dysplasia of the pulmonary valve, which was associated with subaortic ventricular septal defect (VSD) with an overriding aorta. In addition, the fetus in case 1 showed a patent ductus arteriosus, and the fetus in case 2 showed arterial duct agenesis. Furthermore, color Doppler flow imaging showed a bi-directional multicolored flow signal in the pulmonary valve ring. DIAGNOSES Both fetuses were diagnosed with APVS associated with TOF. INTERVENTIONS No therapeutic intervention was performed. OUTCOMES On the request of the pregnant women and their families, both fetuses were aborted. LESSONS Although APVS is a rare congenital heart disease and often associated with TOF, it has an overall poor prognosis. Nowadays, it can be easily diagnosed via ultrasonography because of its typical ultrasonographic features, such as aneurysmal dilatation of pulmonary artery, massive regurgitation of the pulmonary valve, VSD, and an overriding aorta. Therefore, early fetal echocardiography screening should be performed for every fetus.
Collapse
|
16
|
Yamazaki S, Yamagishi M, Nishida K, Tamura S, Monta O, Numata S, Tsutsumi Y, Ohashi H. Congenital Absence of One Pulmonary Valve Cusp With Other Hypoplastic Cusps. Ann Thorac Surg 2015; 100:1450-2. [PMID: 26434444 DOI: 10.1016/j.athoracsur.2014.12.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
Abstract
Congenital absence of a single pulmonary valve cusp is extremely rare. We report a case of a 38-year-old woman with a confirmed congenital absence of a single pulmonary valve cusp associated with dextrocardia. The other 2 leaflets were moderately hypoplastic, and transthoracic echocardiography showed severe pulmonary regurgitation. This combination of lesions has not been reported previously. Pulmonary valve replacement using a composite biologic valved conduit was performed with an excellent outcome.
Collapse
Affiliation(s)
- Sachiko Yamazaki
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan.
| | - Masaaki Yamagishi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan; Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kouichi Nishida
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Satoshi Tamura
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Yasushi Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Hirokazu Ohashi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| |
Collapse
|
17
|
Qureshi MY, Burkhart HM, Julsrud P, Cetta F. Importance of absent ductus arteriosus in tetralogy of Fallot with absent pulmonary valve syndrome. Tex Heart Inst J 2014; 41:664-7. [PMID: 25593538 DOI: 10.14503/thij-13-3674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Tetralogy of Fallot without pulmonary valve syndrome is almost always associated with an absent ductus arteriosus. Patients with right aortic arch and retroesophageal left subclavian artery have a vascular ring if the left ductus arteriosus or its remnant and the Kommerell diverticulum are present. We report the cases of 2 infants in whom the role of an absent ductus arteriosus or its remnant is noteworthy. Both patients had a combination of tetralogy of Fallot with absent pulmonary valve syndrome and right aortic arch with retroesophageal left subclavian artery without a vascular ring. The absence of the ductus arteriosus has a role in the pathogenesis of tetralogy of Fallot with absent pulmonary valve syndrome. The absence of a ductus arteriosus in the right aortic arch with retroesophageal left subclavian artery precludes a vascular ring.
Collapse
|
18
|
Avsar MK, Demir T, Demir HB. Absence of Left Pulmonary Artery in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome. J Card Surg 2014; 30:104-7. [DOI: 10.1111/jocs.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mustafa Kemal Avsar
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
| | - Tolga Demir
- Department of Cardiovascular Surgery; Beylikduzu Kolan Hospital; Istanbul Turkey
| | - Hale Bolgi Demir
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
| |
Collapse
|
19
|
Zhong YM, Jaffe RB, Liu JF, Sun AM, Gao W, Wang Q, Zhu M, Qiu HS, Berdon WE. Multi-slice computed tomography assessment of bronchial compression with absent pulmonary valve. Pediatr Radiol 2014; 44:803-9. [PMID: 24706163 PMCID: PMC4061480 DOI: 10.1007/s00247-014-2898-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 12/12/2013] [Accepted: 01/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression. OBJECTIVE To demonstrate the advantage of multi-slice CT in diagnosing tracheobronchial compression, its severity as related to the adjacent dilated pulmonary arteries, and associated lung and cardiac lesions. MATERIALS AND METHODS We included children with absent pulmonary valve who were reviewed by multi-slice CT during a 17-year period. The number and locations of stenoses and lung lesions were noted and the severity of stenosis was categorized. The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated. RESULTS Thirty-one children (14 girls and 17 boys) were included. Of these, 29 had ventricular septal defect and 2 had an intact ventricular septum. Twenty-nine children (94%) had tracheobronchial compression, judged to be mild in nine children (31%), moderate in 10 (34%) and severe in 10 (34%). The different locations of the stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. And the number and location of lung lesions demonstrated that the right middle and left upper and lower lobes were often affected. The diameter of the pulmonary artery in these children was well above normal published values, and Spearman rank correlation analysis showed a correlation between the size of the pulmonary artery and the severity of the tracheobronchial stenosis. Nineteen children (61%) underwent surgery and 4 of these children had a multi-slice CT post-operative follow-up study. CONCLUSION Absent pulmonary valve can cause significant morbidity and mortality in children. Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon.
Collapse
Affiliation(s)
- Yu-Min Zhong
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Richard B. Jaffe
- Department of Medical Imaging, Primary Children’s Medical Center, Salt Lake City, UT USA
| | - Jin-Fen Liu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, No.1678 Dong Fang Road, Shanghai, 200127 China
| | - Ai-Min Sun
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Wei Gao
- Department of Cardiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Qian Wang
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Hai-Sheng Qiu
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Walter E. Berdon
- Department of Radiology, Children’s Hospital of New York, New York, NY USA
| |
Collapse
|
20
|
Wertaschnigg D, Jaeggi M, Chitayat D, Shannon P, Ryan G, Thompson M, Yoo SJ, Jaeggi E. Prenatal diagnosis and outcome of absent pulmonary valve syndrome: contemporary single-center experience and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:162-167. [PMID: 22605612 DOI: 10.1002/uog.11193] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To review the anomaly spectrum of prenatally detected absent pulmonary valve syndrome (APVS) and the outcome after diagnosis. Previous fetal studies reported survival rates of ≤ 25% for patients with intended postnatal care. METHODS Clinical data and echocardiograms of 12 cases with a fetal diagnosis of APVS between 2000 and 2010 were analyzed in this retrospective single-center study. Collected parameters included: gestational age at referral, associated fetal abnormalities, cardiothoracic ratio, maximum diameters of pulmonary annulus and main and branch pulmonary arteries, ventricular dimensions and function as well as ventricular Doppler flows. Karyotyping included fluorescence in-situ hybridization (FISH) analysis for microdeletion 22q11.2. RESULTS Median gestational age at diagnosis was 24 weeks. Three subtypes of APVS were observed: (1) with tetralogy of Fallot (TOF) and no arterial duct (n = 10; 83%); (2) isolated, with a large arterial duct (n = 1; 8%); and (3) with tricuspid atresia, right ventricular dysplasia and a restricted duct (n = 1; 8%). The cardiothoracic ratio and pulmonary artery dimensions were increased in all cases. The karyotype was abnormal in 70% of fetuses with TOF and their mortality rate was significantly higher due to pregnancy termination (n = 3) or perinatal demise (n = 2) (hazard ratio, 5; 95% CI, 0.87-28.9; P = 0.015). Of seven live births with active postnatal care, six children (86%) were alive without residual respiratory symptoms at a median follow-up of 4.7 (range, 2.1-10.6) years. CONCLUSION Outcome after fetal diagnosis of APVS was significantly better in this study compared with those of previous fetal series, with a low mortality rate for actively managed patients.
Collapse
Affiliation(s)
- D Wertaschnigg
- Fetal Cardiac Program, Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Vivek G, Shetty RK, Nayak SS, Girisha KM, Naha K. Prenatal diagnosis of absent pulmonary valve confirmed by autopsy. BMJ Case Rep 2013; 2013:bcr2012007997. [PMID: 23371040 PMCID: PMC3618538 DOI: 10.1136/bcr-2012-007997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac anomaly. This syndrome is comprised of subtotal or total absence of pulmonary valve leaflets, stenosis of the pulmonary artery orifice, aneurysmal dilation of the main pulmonary artery and ventricular septal defect. We report a case of APVS with neural tube defect detected prenatally at 22 weeks of gestation by echocardiography, and subsequently confirmed by autopsy of the still born fetus. The common presentations, means of diagnosis and variants of APVS are discussed in brief.
Collapse
Affiliation(s)
- G Vivek
- Department of Cardiology, Kasturba Medical College, Manipal, Karnataka, India.
| | | | | | | | | |
Collapse
|
22
|
Vincenti M, Jacquot A, Guillaumont S, Milési C, Saguintaah M, Pidoux O, Kreitmann B, Rideau A, Cambonie G. Thoracic computed tomography in absent pulmonary valve syndrome management. Pediatr Int 2012; 54:938-41. [PMID: 23279028 DOI: 10.1111/j.1442-200x.2012.03595.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A neonate with absent pulmonary valve syndrome (APVS) and features of tetralogy of Fallot presented respiratory distress. The prolonged need for mechanical ventilation was an indication for surgical repair. Preoperative thoracic CT imaging showed nearly complete closure of the distal trachea, compressed by the aneurysmal dilatation of the pulmonary arteries, and its reopening after ventilator pressure was increased. Management of APVS may require high-pressure ventilation to prevent bronchial collapse due to compression by the pulmonary arteries. In this context, thoracic CT imaging is very useful for adjusting ventilation support so that surgical repair can be performed in optimal conditions.
Collapse
Affiliation(s)
- Marie Vincenti
- Neonatal Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier, France
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Absent pulmonary valve syndrome with tetralogy of Fallot detected at an early gestational age of 27 weeks - a case report. Indian Heart J 2012; 65:191-3. [PMID: 23647900 DOI: 10.1016/j.ihj.2012.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/28/2012] [Accepted: 10/23/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Absent pulmonary valve syndrome (APVS) is a rare congenital anomaly, usually seen in association with a ventricular septal defect. It has been reported to occur in 3-6% of cases of tetralogy of Fallot (TOF). In this case report we discuss a case of absent pulmonary valve syndrome with tetralogy of Fallot that was detected in utero by fetal echocardiography at 27 weeks of gestation. CASE A 20-year-old pregnant woman at 27 weeks of gestation referred to our Institute. She has no consanguineous history. We diagnosed the case as tetralogy of Fallot with absent pulmonary valves in fetal echocardiographic study. CONCLUSION We conclude that when a paracardiac cystic, pulsatile lesion with dilated pulmonary arteries are seen in the fetus in utero then other features associated with the syndrome, such as TOF and the presence or absence of the ductus arteriosus should be looked for. In our case there was no ductus arteriosus.
Collapse
|
24
|
Bharati AH, Naware A, Merchant SA. Absent pulmonary valve syndrome with tetralogy of Fallot and associated dextrocardia detected at an early gestational age of 26 weeks. Indian J Radiol Imaging 2011; 18:352-4. [PMID: 19774197 PMCID: PMC2747463 DOI: 10.4103/0971-3026.43841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Absent pulmonary valve syndrome is a rare congenital anomaly, usually seen in association with a ventricular septal defect. It has been reported to occur in 3–6% of cases of tetralogy of Fallot. Absence of the pulmonary valve results in a dilated main pulmonary artery, which can be seen as a cystic, pulsatile, paracardiac lesion on antenatal USG. Such a lesion, though rare, can easily be detected. We report a case of this rare anomaly which was present in association with a ventricular septal defect, tetralogy of Fallot, and dextrocardia. The case was detected at 26 weeks of gestation.
Collapse
Affiliation(s)
- Alpa H Bharati
- Department of Radiology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | | | | |
Collapse
|
25
|
Te CC, Bauer CE, Abu-Fadel MS, Peyton M, Sivaram CA. Prolonged postsurgical survival without a pulmonic valve: case report and review of the literature. Clin Cardiol 2010; 33:E1-5. [PMID: 20552586 DOI: 10.1002/clc.20699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Pulmonic valve stenosis is usually congenital and causes right-sided heart failure secondary to pressure overload. We report the case of a 56-year-old male with congenital pulmonary valve stenosis who presented with severe right heart failure 32 years after pulmonary valvectomy. He subsequently underwent pulmonary valve replacement and did well. Pulmonary valvectomy is an uncommon treatment for pulmonary stenosis and this is the longest documented survival of a patient without a pulmonic valve.
Collapse
Affiliation(s)
- Charles C Te
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA.
| | | | | | | | | |
Collapse
|
26
|
Conotruncal cardiac defects: a clinical imaging perspective. Pediatr Cardiol 2010; 31:430-7. [PMID: 20165841 DOI: 10.1007/s00246-010-9668-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 01/26/2010] [Indexed: 02/08/2023]
Abstract
Conotruncal cardiac defects make up a significant portion of congenital heart disease. For proper diagnosis and subsequent care of patients with these defects, different and sometimes multiple imaging modalities are needed at various stages of care. This article reviews the characteristics of some of the most common conotruncal defects and the imaging options available along with the advantages and disadvantages of each. Intricate knowledge of the capabilities of each modality will aid the practitioner in making optimal clinical decisions.
Collapse
|
27
|
Karimi A, Peiravian F, Amirghofran AA, Kariminejad A. Absent pulmonary valve, intact interventricular septum, rudimentary aortic non-coronary cusp and ascending aortic aneurysm in a single patient. Interact Cardiovasc Thorac Surg 2010; 10:636-8. [PMID: 20118119 DOI: 10.1510/icvts.2009.225508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Absent pulmonary valve (APV) is a relatively rare congenital heart disease, and is mostly associated with tetralogy of Fallot phenotype or ventricular septal defect. APV with intact interventricular septum (IVS) is even less common with case reports or very small series in the literature. Congenital aortic regurgitation with a rudimentary non-coronary cusp is also by itself a rare congenital anomaly and to our knowledge this is the first report of the combination of APV, intact IVS, abnormal aortic valve and ascending aortic aneurysm. The clinical course, possible etiologies and management are discussed.
Collapse
Affiliation(s)
- Ashkan Karimi
- Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | |
Collapse
|
28
|
Favilli S, Lapi E, Pollini I, Calabri GB, Bini RM. Prenatal diagnosis and postnatal outcome in patients with absent pulmonary valve syndrome not associated with tetralogy of Fallot: report of one case and review of the literature. J Cardiovasc Med (Hagerstown) 2009; 9:1127-9. [PMID: 18852585 DOI: 10.2459/jcm.0b013e3283100eb1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Echocardiographic diagnosis of absent pulmonary valve syndrome and muscular ventricular septal defect was made in a fetus of gestational age 25 weeks referred for marked dilation of the right ventricle at obstetric ultrasound examination. Delivery was planned in a tertiary-level center. The neonate became severely symptomatic for respiratory distress and heart failure during the second day of life. His clinical condition dramatically improved after surgical closure of a large ductus arteriosus. The child is still asymptomatic 30 months later. In the minority of cases with absent pulmonary valve not associated with tetralogy of Fallot, irrespective of the presence of muscular ventricular septal defect, early closure of the ductus may be crucial to improve hemodynamic conditions and postpone surgical correction.
Collapse
Affiliation(s)
- Silvia Favilli
- Paediatric Cardiology, Italy bMedical Genetics Unit, A.Meyer Paediatric Hospital, Firenze, Italy.
| | | | | | | | | |
Collapse
|
29
|
Hayashi Y, Barron GJ, Almeida AA. Operative timing for absent pulmonary valve with obstructive sleep apnea. Asian Cardiovasc Thorac Ann 2008; 16:e52-4. [PMID: 18984746 DOI: 10.1177/021849230801600624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital absence of the pulmonary valve appears to have a prolonged fate, despite substantial regurgitation, thus the optimal timing of surgical correction remains unclear. A 53-year-old man with isolated pulmonary regurgitation accompanied by obstructive sleep apnea developed progressive heart failure after reopening of the foramen ovale. Closure of the interatrial shunt and pulmonary valve replacement with a 25-mm mechanical prosthesis relieved his refractory left heart failure.
Collapse
Affiliation(s)
- Yoshitaka Hayashi
- Department of Surgery, Monash Medical Center, Monash University, Clayton, Australia.
| | | | | |
Collapse
|
30
|
So-called "absence" of the leaflets of the pulmonary valve. Cardiol Young 2008; 18:535-6. [PMID: 18588731 DOI: 10.1017/s1047951108002503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
31
|
Jeewa A, Mann GS, Hosking MCK. Tetralogy of Fallot with absent pulmonary valve and obstructed totally anomalous pulmonary venous connection. Cardiol Young 2007; 17:551-3. [PMID: 17578588 DOI: 10.1017/s1047951107000571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe a combination, unique as far as we are aware, of tetralogy of Fallot with so-called "absent" pulmonary valve and supracardiac totally anomalous pulmonary venous connection. The vertical vein was obstructed in a neonate born at term who presented with respiratory compromise.
Collapse
Affiliation(s)
- Aamir Jeewa
- Division of Cardiology, British Columbia Children's Hospital and Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | | | | |
Collapse
|
32
|
Oosterhof T, Vriend JWJ, Spijkerboer AM, Mulder BJM. Cardiovascular magnetic resonance in a pregnant patient with absent pulmonary valve syndrome. Int J Cardiovasc Imaging 2006; 23:249-52. [PMID: 16972143 DOI: 10.1007/s10554-006-9150-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
We present a 22 year old Moroccan woman with chronic severe pulmonary regurgitation, who becomes symptomatic in her fourth month of pregnancy. Cardiovascular magnetic resonance, during pregnancy, revealed a large pulmonary aneurysm and turbulent blood flow in the pulmonary trunk with severe pulmonary regurgitation. After gestation, the branch pulmonary arteries were assessed with magnetic resonance angiography and the severely dilated pulmonary arterial trunk and valve were replaced by a pulmonary homograft. We briefly review this rare syndrome, the management of pulmonary regurgitation during pregnancy and the role of CMR during pregnancy.
Collapse
Affiliation(s)
- Thomas Oosterhof
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
33
|
Taragin BH, Berdon WE, Printz B. MRI assessment of bronchial compression in absent pulmonary valve syndrome and review of the syndrome. Pediatr Radiol 2006; 36:71-5. [PMID: 16283289 DOI: 10.1007/s00247-005-0018-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 08/16/2005] [Accepted: 08/25/2005] [Indexed: 11/30/2022]
Abstract
Absent pulmonary valve syndrome (APVS) is a rare cardiac malformation with massive pulmonary insufficiency that presents with short-term and long-term respiratory problems secondary to severe bronchial compression from enlarged central and hilar pulmonary arteries. Association with chromosome 22.Q11 deletions and DiGeorge syndrome is common. This historical review illustrates the airway disease with emphasis on assessment of the bronchial compression in patients with persistent respiratory difficulties post-valvular repair. Cases that had MRI for cardiac assessment are used to illustrate the pattern of airway disease.
Collapse
Affiliation(s)
- Benjamin H Taragin
- Department of Radiology, Children's Hospital of New York, 3959 Broadway CHN-3, New York, NY 10032, USA.
| | | | | |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW We provide an overview of the past year's literature on congenital heart surgery. RECENT FINDINGS This review focuses on selected disease entities, operative techniques, perioperative management strategies, and quality of care. SUMMARY Congenital heart surgery is an evolving field.
Collapse
Affiliation(s)
- Karl F Welke
- Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
| | | | | | | |
Collapse
|