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Ahmed HS, Jayaram PR, Gupta D. Clinical presentation and surgical outcomes in patients with Shone's complex: a systematic review. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02067-1. [PMID: 39090433 DOI: 10.1007/s11748-024-02067-1] [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: 06/16/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Shone's complex comprises of a combination of congenital cardiac anomalies causing obstructions in the left ventricle's inflow and outflow tracts. This systematic review aims to evaluate the clinical features and surgical outcomes of Shone's complex. METHODS An electronic literature search of PubMed and Scopus was performed to identify relevant studies related to the presentation, management, and outcomes of Shone's complex. Two reviewers independently performed selection. Data on study characteristics, participant demographics, interventions, outcomes, and follow-up durations were extracted and analyzed. RESULTS A total of 691 papers were identified, with 18 studies included in the final analysis. The majority of the studies (n = 12) focused on the pediatric age group. The most common clinical presentations were coarctation of the aorta (n = 17) and mitral stenosis (n = 12). Surgical interventions often involved staged approaches, prioritizing outflow before inflow obstructions. Mitral valve repair was preferred over replacement due to better long-term outcomes (n = 8). Biventricular repair was recommended due to improved postoperative outcomes, but often needed reoperations. Reoperations were common, primarily due to recurrent coarctation (n = 10), subaortic stenosis (n = 8), and mitral valve dysfunction (n = 7). Pulmonary hypertension (n = 10) and arrhythmias (n = 11) were significant complications. Most patients were in modified Ross/NYHA functional class 1 on follow-up. Mortality rates ranged from 4 to 28%, with better outcomes associated with early and strategic surgical interventions. CONCLUSION Early diagnosis and biventricular repair were associated with better outcomes while transplantation was often an eventuality. Standardized diagnostic criteria, long-term follow-up, and consensus guidelines are needed to improve the management of this congenital heart disease.
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Affiliation(s)
- H Shafeeq Ahmed
- Department of Medicine, Bangalore Medical College and Research Institute, K.R Road, Bangalore, 560002, Karnataka, India.
| | - Purva Reddy Jayaram
- Department of Medicine, Bangalore Medical College and Research Institute, K.R Road, Bangalore, 560002, Karnataka, India
| | - Deeksha Gupta
- Department of Medicine, Bangalore Medical College and Research Institute, K.R Road, Bangalore, 560002, Karnataka, India
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2
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Cantinotti M, Jani V, Kutty S, Marchese P, Franchi E, Pizzuto A, Viacava C, Assanta N, Santoro G, Giordano R. Neonates and Infants with Left Heart Obstruction and Borderline Left Ventricle Undergoing Biventricular Repair: What Do We Know about Long-Term Outcomes? A Critical Review. Healthcare (Basel) 2024; 12:348. [PMID: 38338232 PMCID: PMC10855671 DOI: 10.3390/healthcare12030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The decision to perform biventricular repair (BVR) in neonates and infants presenting with either single or multiple left ventricle outflow obstructions (LVOTOs) and a borderline left ventricle (BLV) is subject to extensive discussion, and limited information is known regarding the long-term outcomes. As a result, the objective of this study is to critically assess and summarize the available data regarding the prognosis of neonates and infants with LVOTO and BLV who underwent BVR. METHODS In February 2023, we conducted a review study with three different medical search engines (the National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings and free text terms including "congenital heart disease", "outcome", and "borderline left ventricle". The search was refined by adding keywords for "Shone's complex", "complex LVOT obstruction", "hypoplastic left heart syndrome/complex", and "critical aortic stenosis". RESULTS Out of a total of 51 studies, 15 studies were included in the final analysis. The authors utilized heterogeneous definitions to characterize BLV, resulting in considerable variation in inclusion criteria among studies. Three distinct categories of studies were identified, encompassing those specifically designed to evaluate BLV, those focused on Shone's complex, and finally those on aortic stenosis. Despite the challenges associated with comparing data originating from slightly different cardiac defects and from different eras, our results indicate a favorable survival rate and clinical outcome following BVR. However, the incidence of reintervention remains high, and concerns persist regarding residual pulmonary hypertension, which has been inadequately investigated. CONCLUSIONS The available data concerning neonates and infants with LVOTO and BLV who undergo BVR are inadequate and fragmented. Consequently, large-scale studies are necessary to fully ascertain the long-term outcome of these complex defects.
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Affiliation(s)
- Massimiliano Cantinotti
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Vivek Jani
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Pietro Marchese
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Eliana Franchi
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Alessandra Pizzuto
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Cecilia Viacava
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Nadia Assanta
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Giuseppe Santoro
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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3
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Damlakhy A, Messina Alvarez AA, Martin RH, Hakim AH, Rajagopal R. Non-syndromic Parachute Mitral Valve "When the Valve Dives in": Case Report and Review of the Literature. Cureus 2024; 16:e52805. [PMID: 38389617 PMCID: PMC10883408 DOI: 10.7759/cureus.52805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
A parachute mitral valve (PMV) is a congenital mitral valve anomaly diagnosed in infancy, and it can also be discovered in adults during echocardiography. Surgical management is common in infants to prevent complications from left-heart obstructions. In adults, PMV may be found independently or with other cardiac defects. Prophylactic antibiotics are recommended for certain congenital heart anomalies before dental procedures. A study suggests reconsidering guidelines to include anomalies like bicuspid aortic valve and MVP for antibiotic prophylaxis. PMV, with transvalvular blood flow turbulence, may increase the risk of infective endocarditis, as seen in a reported case with a parachute-like mitral valve. Here, we present the case of a 62-year-old female incidentally found to have a PMV during an echocardiogram.
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Affiliation(s)
- Ahmad Damlakhy
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | - Angelo A Messina Alvarez
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | | | - Arif H Hakim
- Cardiology, Detroit Medical Center, Detroit, USA
| | - Ramegowda Rajagopal
- Cardiology, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
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4
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Rooke DA, Kertai MD, Abrams B. Advancing the Role of the Anesthesiologist in Perioperative Medicine. Semin Cardiothorac Vasc Anesth 2023; 27:249-251. [PMID: 37909211 DOI: 10.1177/10892532231212593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Douglas A Rooke
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
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5
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Yang R, Greene CL. Surgical Considerations in Shone Complex. Semin Cardiothorac Vasc Anesth 2023; 27:260-272. [PMID: 37750051 DOI: 10.1177/10892532231203372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Shone complex is defined by 4 anomalies: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and coarctation of the aorta. Establishing a clear definition is one of the principal challenges in the study of Shone complex as not all patients have all lesions. The essential feature of Shone complex is multilevel left-sided obstruction involving both the left ventricular inflow and outflow. This anatomic variability is reflected in the clinical presentation as signs of left ventricular inflow obstruction are often masked by outflow obstruction and the multilevel nature of the condition is thus underappreciated. Surgical treatment is often stepwise addressing the outflow obstruction first. In this review, geared to the pediatric cardiac anesthesiologist, we review the pathophysiology, diagnosis, treatment, and outcomes of Shone complex.
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Affiliation(s)
- Roderick Yang
- Congenital Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Christina L Greene
- Congenital Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, USA
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6
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Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension 2023; 80:1970-1979. [PMID: 37476999 PMCID: PMC10530495 DOI: 10.1161/hypertensionaha.123.19454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
While coarctation of the aorta varies greatly in both severity and age at presentation, all patients are at increased risk of hypertension both before and after repair. Despite advances in knowledge about genetic etiologies, pathophysiologic mechanisms, and optimal repair strategies, patients with repaired coarctation of the aorta remain at increased risk of acquired cardiovascular disease. The aims of this review are to describe the management of coarctation of the aorta at all ages before and after repair, highlight pathophysiologic mechanisms of hypertension, and review long-term follow-up considerations.
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Affiliation(s)
- Katherine B Salciccioli
- Section of Pediatric Cardiology, Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston TX USA
| | - Justin P Zachariah
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston TX USA
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Lee LJ, Tucker DL, Gupta S, Shaheen N, Rajeswaran J, Karamlou T. Characterizing the anatomic spectrum, surgical treatment, and long-term clinical outcomes for patients with Shone's syndrome. J Thorac Cardiovasc Surg 2023; 165:1224-1234.e9. [PMID: 35798609 DOI: 10.1016/j.jtcvs.2022.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Shone's syndrome (SS) has a varied anatomic spectrum without consensus on need and timing for mitral valve intervention (MVI). We sought to (1) characterize the anatomic spectrum and treatment pathways; (2) describe long-term outcomes and their determinants; and (3) define the impact of MVI timing on survival. METHODS In total, 121 patients with SS who underwent operation at Cleveland Clinic between 1956 and 2021 were reviewed. Multivariable parametric hazard analyses including time-varying covariables, and modulated renewal to account for repeated events, were performed. End points included time-related survival and reintervention. RESULTS Median follow-up was 9.9 years. Mitral stenosis (MS) (98%), coarctation (80%), and aortic stenosis (70%) predominated. The most common combination was MS + aortic stenosis + coarctation (26%). Median initial mean mitral and aortic gradients were 3.6 (15th/85th percentiles: 2.0/6.8) and 9.0 (2.1/46) mm Hg, respectively. Median initial surgery age was 0.041 (0.011/3.2) years. Initial surgeries included coarctation repair (43%), arch repair (18%), and staged biventricular repair (18%). Overall survival was 92% at 20 years. Freedom from reoperation was 66% and 24% at 1 and 20 years. Patients with no MVI or initial MVI (N = 7) tended to be associated with better early survival compared with those with MVI at subsequent operation (N = 29) (P = .06). Risk factors for early reintervention included initial Norwood operation, with younger age and arch hypoplasia increasing later reintervention. CONCLUSIONS Despite excellent long-term survival, reoperation in SS is frequent and occurs most commonly on left ventricular outflow tract and mitral valve. Although MS is present in most, few require MVI. Delaying MVI may compromise early survival.
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Affiliation(s)
- Leah J Lee
- Department of Thoracic and Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Dominique L Tucker
- Department of Thoracic and Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sohini Gupta
- Department of Thoracic and Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Naseeb Shaheen
- Department of Thoracic and Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Tara Karamlou
- Division of Pediatric Cardiac Surgery and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Altin FH, Korun O, Yurdakok O, Cicek M, Kilic Y, Selcuk A, Bulut O, Yilmaz EH, Ergin SO, Sasmazel A, Aydemir NA. Evaluation of midterm outcomes after Shone's complex surgery: Analysis of reoperation and mortality risk factors. J Card Surg 2022; 37:5153-5161. [PMID: 36595965 DOI: 10.1111/jocs.17163] [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: 08/12/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The midterm results of patients who underwent biventricular repair surgery for Shone's complex were examined, and mortality and reoperation risk factors were evaluated. METHODS This retrospective study included 34 patients with Shone's complex who underwent mitral valve (MV) surgery between 2005 and 2020. RESULTS A total of 19 patients (56%) had coarctation, 10 (29%) patients had subaortic stenosis, 9 (26.5%) patients had a hypoplastic aortic arch (AA), and 9 (26.5%) patients had aortic valve (AV) stenosis. Twenty-four (70.6%) patients had bileaflet AV. Associated left-sided in-flow stenotic lesions included parachute MV in 19 (56%) patients and supramitral ring in 18 (53%) patients. The estimated freedom from reoperation rate on the 6th month, 1 year and 2 years after surgery was 84.4%, 79.5%, and 71.5%, respectively. The overall mortality rate was 20.6% (seven patients) with a median follow-up of 10 months (0-41). The estimated survival rate on the 6th month, 1 year, and 3 years after surgery was 83.8%, 79.4%, and 79.4 respectively. Bicuspid aortic valve (p = .017) (HR (95% CI) = 0.130 (0.025-0.695) and hammock mitral valve (p = .038) (HR (95% CI) = 11,008 (1,146->100) were associated with mortality. CONCLUSION The presence of a bicuspid aortic valve hammock mitral valve might have an effect on negative effect on the outcome.
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Affiliation(s)
- Firat Husnu Altin
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Oktay Korun
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Yurdakok
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Cicek
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yigit Kilic
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Arif Selcuk
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Orhan Bulut
- Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emine Hekim Yilmaz
- Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selma Oktay Ergin
- Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Sasmazel
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan Ali Aydemir
- Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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9
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Moras P, Pasquini L, Rizzo G, Campanale CM, Masci M, Di Chiara L, Falasconi G, Bagolan P, Toscano A. Prenatal prediction of Shone's complex. The role of the degree of ventricular disproportion and speckle-tracking analysis. J Perinat Med 2022; 51:550-558. [PMID: 36420537 DOI: 10.1515/jpm-2022-0379] [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: 08/04/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Shone's complex (SC) is characterized by sequential obstructions of left ventricular (LV) inflow and outflow. It can be associated with poor long-term prognosis when compared to Simple-Aortic Coarctation (S-CoA). We aimed to assess whether the degree of ventricular disproportion and 2D-speckle-tracking echocardiography (2D-STE) could improve the accuracy of prenatal prediction of SC. METHODS 75 consecutive fetuses were retrospectively enrolled from January 2010 to June 2021. Fetuses were divided into 4 groups (Group 1: SC; Group 2: S-CoA; Group 3: False Positive-Coarctation of the Aorta [FP-CoA]; group 4: controls). Comparisons for echocardiographic measures and myocardial deformation indices were performed. A receiver operating characteristic (ROC) analysis was performed on the MV/TV (mitral valve/tricuspid valve ratio) and LV GLS (global longitudinal strain) values to identify cut-offs to separate group 1 and 2 fetuses. RESULTS SC fetuses showed a significant reduction in MV/TV when compared to S-CoA and FP-CoA fetuses (p<0.001). LV GLS in SC fetuses was significantly reduced compared to S-CoA fetuses (-13.3 ± 2.1% vs. -17.0 ± 2.2%, p=0.001). A cut-off value of 0.59 for MV/TV and -15.35% for LV GLS yielded a sensitivity of 76 and 82% and a specificity of 71 and 83% respectively in separating SC vs. S-CoA fetuses. CONCLUSIONS SC fetuses showed a more severe degree of ventricular disproportion and a lower LV GLS compared to S-CoA, FP-CoA and control fetuses. MV/TV and GLS are both predictors of SC. These findings may improve the quality of prenatal parental counselling.
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Affiliation(s)
- Patrizio Moras
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy.,Pediatric Department, University of Tor Vergata, Rome, Italy
| | - Luciano Pasquini
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università Roma Tor Vergata, Rome, Italy
| | - Cosimo Marco Campanale
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Masci
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luca Di Chiara
- Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Department of Medical and Surgical for Fetus-Neonate, Bambino Gesù Children's Hospital, Rome, Italy
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Tan-Recep BZ, Hatemi AC, Yavuz Y, Yildirim AI, Ceyran H. Comparison of early-stage stenosis and regurgitation results among patients who underwent aortic valve repair. Cardiol Young 2022; 33:1-6. [PMID: 35712756 DOI: 10.1017/s1047951122001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION This study aimed to analyse the results of paediatric aortic valve repairs in our institution. METHOD The data of 57 patients under 18 years of age who underwent aortic valve repair between 2014 and 2019 were retrospectively analysed. Early postoperative reoperation and hospital mortality rates were evaluated based on the ages of the patients, their preoperative diagnoses, and the surgical techniques used. Survival curves for groups of patients were calculated by Kaplan-Meier analysis. RESULTS The rate of reoperation was 14% (n = 8), and there were no significant differences regarding valve pathologies and preoperative diagnoses (p > 0.05). Among the repair techniques, tricuspidisation was considered to be a risk factor for reoperation (p < 0.05). Augmentation, the material used (0.1 PTFE or pericardium), and the number of cusps were not found to have significant effects on reoperation or mortality. The mean follow-up period was 29.86 ± 21.30 months. The survival rates of the patients were 88%, 100%, and 88.2% for those with aortic stenosis, aortic insufficiency, and mixed disease, respectively, and no significant difference was found when these rates were evaluated with the log-rank test (p > 0.05). The mortality rate was 8.8% (n = 5), and undergoing surgery before the age of 1 year was found to be significant in terms of mortality (p = 0.032, p < 0.05). The bicuspid aortic valve group had the lowest mortality risk, while the Shone complex group had the highest. CONCLUSION With its acceptable reoperation and mortality rates, aortic valve repair should be the first choice of treatment in the paediatric age group. Early results were satisfactory in all groups.
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Affiliation(s)
- Berra Zumrut Tan-Recep
- Department of Pediatric Cardiac Surgery, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Ali Can Hatemi
- Department of Pediatric Cardiac Surgery, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Yasemin Yavuz
- Department of Anesthesiology and Reanimation, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Ayse Inci Yildirim
- Department of Pediatric Cardiology, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Hakan Ceyran
- Department of Pediatric Cardiac Surgery, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
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11
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Li YD, Meng H, Pang KJ, Li MZ, Xu N, Wang H, Li SJ, Yan J. Echocardiography in the diagnosis of Shone’s complex and analysis of the causes for missed diagnosis and misdiagnosis. World J Clin Cases 2022; 10:3369-3378. [PMID: 35611202 PMCID: PMC9048561 DOI: 10.12998/wjcc.v10.i11.3369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shone’s complex is a rare syndrome characterized by congenital left heart defects that can differ among the patients.
AIM To use echocardiography in the diagnosis of Shone’s complex and analyze the causes of missed diagnosis and misdiagnosis.
METHODS This was a retrospective study of patients who underwent echocardiography and repair surgery from February 14, 2008, to November 22, 2019. The patients were followed once a year at the outpatient clinic after surgery.
RESULTS Sixty-six patients were included. The patients were 2.7 (0.8-5.6) years of age, and 54.5% were male. Ten (15.2%) had a history of heart surgery. The most common heart defect was the Annulo-Leaflet mitral ring (ALMR) (50/66, 75.8%), followed by coarctation of the aorta (CoA) (43/66, 65.2%). The patients had a variety of combinations of defects. Only two (3.0%) patients had all four defects. None of the patients had a family history of congenital heart disease. The preoperative echocardiographic findings were examined against the intraoperative findings. Echocardiography missed an ALMR in 31 patients (47.0%), a parachute mitral valve (PMV) in one patient (1.5%), subaortic stenosis in one patient (1.5%), and CoA in two patients (3.0%).
CONCLUSION Echocardiography is an effective method to diagnose the Shone’s complex. Due to this disease’s complexity and interindividual variability, Improving the understanding of the disease can reduce misdiagnosis and missed diagnosis.
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Affiliation(s)
- Ye-Dan Li
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Hong Meng
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Kun-Jing Pang
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Mu-Zi Li
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Nan Xu
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital, Beijing 100037, China
| | - Shou-Jun Li
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing 100037, China
| | - Jun Yan
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing 100037, China
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12
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Sinfield S, Ranasinghe S, Wang S, Mendoza F, Khoynezhad A. Shone's complex and aortic dissection: case report and review of a rare, underdiagnosed congenital heart disease. J Cardiothorac Surg 2022; 17:21. [PMID: 35197098 PMCID: PMC8864782 DOI: 10.1186/s13019-022-01768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shone's complex is a rare congenital heart disease consisting of a variety of left ventricular inflow and outflow tract lesions. Patients typically present in childhood requiring early surgical intervention; however, with improved surgical techniques, these patients are surviving later into adulthood. This increased survival comes with a new set of medical complications that providers need to be aware of. CASE PRESENTATION A 27 year old man with a complex cardiac history including an incomplete Shone's complex and persistent symptomatic atrial flutter presented with sharp chest pain radiating to his back. He was found to have type A aortic dissection on imaging in the setting of severe patient-prosthesis mismatch. He had multiple valvular surgeries in childhood. The patient was being followed-up as an outpatient for an enlarging chronic aortic aneurysm and was non-compliant with his medications. He was taken emergently to the operating room for a skirted Bentall procedure, aortic valve replacement, and right sided MAZE. CONCLUSIONS Shone's complex is a rare congenital heart disease associated with significant morbidities including atrial flutter, patient-prosthesis mismatch, and aortic dissection. As patients continue to live longer into adulthood with this disease, it is important to raise awareness of this rare syndrome for providers and highlight its potential complications. Further research is needed to determine appropriate guidelines for when to intervene on aortopathy-associated CHD.
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Affiliation(s)
- Steven Sinfield
- Department of Medicine, University of California, Irvine, 333 The City Blvd. West, Suite 400, Orange, CA, 92868, USA.
| | - Sachini Ranasinghe
- Department of Medicine, University of California, Irvine, 333 The City Blvd. West, Suite 400, Orange, CA, 92868, USA
| | - Stephani Wang
- Department of Medicine, Division of Cardiology, University of California, Irvine, Irvine, USA
| | - Fernando Mendoza
- Memorial Care Heart and Vascular Institute, MemorialCare Long Beach Medical Center, Long Beach, USA
| | - Ali Khoynezhad
- Memorial Care Heart and Vascular Institute, MemorialCare Long Beach Medical Center, Long Beach, USA
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13
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Dalton TJ, Johnson WK, Kuhn EM, Goot BH, Woods RK, Mitchell ME, Hraska V. Outcomes Following Surgery to Address Shone Syndrome in Children. World J Pediatr Congenit Heart Surg 2021; 12:360-366. [PMID: 33942685 DOI: 10.1177/2150135121994083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shone syndrome is characterized by coincident mitral valve stenosis and left ventricular outflow tract obstruction. Although first described in 1963, little research has expounded surgical outcomes. We sought to evaluate our experience with this cohort, emphasizing outcomes including mortality, morbidity, and cardiac function. METHODS A retrospective chart review of 46 patients who underwent operation for Shone syndrome between 1990 and May 2018 was conducted. Index operations included 32 repairs of the left ventricular outflow tract, four mitral valve repair/replacements, nine combined repairs, and one non-Shone's repair. Median age at index procedure was 22 days (2 days-10 years). Mean follow-up was 9.1 years (2 months-21 years), and 70 additional operations (51 reoperations) were required. Three patients were lost to follow-up. RESULTS Overall survival was 95.7% with two late deaths. Freedom from death or transplant was 93.5%. Thirteen (28.3%) patients remained free from reoperation. Thirty-three patients required 51 reoperations of the left ventricle outflow tract (n = 12), mitral valve (n = 16), combined repairs (n = 21), and transplant (n = 1). At most recent follow-up, patients exhibited mitral stenosis (n = 21), aortic stenosis (n = 7), and diminished LV function (n = 2). CONCLUSION Surgical correction of Shone's offers excellent survival benefit, but reoperation burden is high, with >70% of patients requiring reintervention in the follow-up period. A total of 65% of patients developed recurrent obstruction of left ventricular inflow or outflow, however, ventricular function is preserved in the majority of patients. All but one patient had no functional deficits, classified as New York Heart Association I with > 60% requiring no medication.
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Affiliation(s)
- Tyler J Dalton
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Herma Heart Institute, 5506Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - William K Johnson
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Herma Heart Institute, 5506Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Evelyn M Kuhn
- Department of Analytics, Business Intelligence & Data Warehousing, Children's Wisconsin, Milwaukee, WI, USA
| | - Benjamin H Goot
- Division of Cardiology, Department of Pediatrics, 5506Medical College of Wisconsin, Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| | - Ronald K Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Herma Heart Institute, 5506Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Herma Heart Institute, 5506Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Viktor Hraska
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Herma Heart Institute, 5506Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
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14
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Yichen QMD, Ya YMD, Jinjie XMD, Rongjuan LMD, Han ZMD, Li SMD, Yueli WMD, Jing LMD. Incomplete Shone’s Complex with BAV and VSD in Adult Diagnosed by Echocardiography. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.200017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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Zhang X, Ma G, Zheng L, Zhang H, Sun Y, Li J, Ma N. Echocardiographic diagnosis of Shone's syndrome. Echocardiography 2020; 37:2139-2143. [PMID: 33070402 DOI: 10.1111/echo.14899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023] Open
Abstract
Shone's syndrome is a rare congenital heart disease that includes 4 cardiovascular anomalies: supravalvular mitral ring, parachute mitral valve, subaortic stenosis, and coarctation of the aorta. Early diagnosis and treatment result in better outcomes. Echocardiography plays an important role in the diagnosis and is the optimal examination for detecting this disease. Pressure gradients are often unreliable and inaccurate; thus, careful anatomical observation of the left ventricular inflow and outflow tracts, particularly the mitral valve, is vital for accurate diagnosis and planning appropriate management. Herein, we describe 9 cases of Shone's syndrome, diagnosed with echocardiography and treated surgically.
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Affiliation(s)
- Xin Zhang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guiqin Ma
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin Zheng
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hongju Zhang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Sun
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jingya Li
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ning Ma
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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16
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Elmahrouk AF, Ismail MF, Arafat AA, Dohain AM, Helal AM, Hamouda TE, Galal M, Edrees AM, Al-Radi OO, Jamjoom AA. Outcomes of biventricular repair for shone's complex. J Card Surg 2020; 36:12-20. [PMID: 33032391 DOI: 10.1111/jocs.15090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shone's complex is a rare lesion affecting the mitral valve (MV) and left ventricular outflow tract (LVOT). The objective of this study is to report the outcomes after Shone's complex repair, the growth of mitral and aortic valve and LVOT, and long-term survival. METHODS This retrospective study included all patients diagnosed with Shone's complex, who underwent biventricular repair. Data including patients' characteristics, type of the MV lesion and the associated lesions were collected. Patients were followed up regularly with echocardiography, and the changes in mitral and aortic valve z-score and LVOT z-score were recorded. RESULTS Thirty-seven patients were included in the study, the median age was 3.4 months, and 11 patients (30.6%) had pulmonary hypertension. The main procedure performed during the first surgical intervention was coarctation repair in 26 patients (70%). Twelve patients had MV repair, and five had MV replacement. Operative mortality occurred in 1 patient (2.7%), median follow up was 52 (25-75th percentile: 22-84) months. Survival at 1, 5, and 10 years was 94.4%, 90%, and 76.9%, respectively. Reoperation was required in 13 patients, mainly for LVOT repair (n = 8). Reoperation was significantly associated with associated aortic valve lesion (p = .044). The growth of the MV z-score was 0.35 per year; p < .001, aortic valve z-score 0.086 per year; p = 0.422, and the LVOT z-score was 0.53 per year; p = .01. CONCLUSION Biventricular repair of Shone's complex has good outcomes. Reoperation is frequently encountered, especially with low aortic valve z-score. The MV and LVOT have significant growth following Shone's complex repair.
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Affiliation(s)
- Ahmed F Elmahrouk
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Mohamed F Ismail
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Mansoura University, Mansoura, Egypt
| | - Amr A Arafat
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Ahmed M Dohain
- Department of Pediatric Cardiology, Cairo University, Giza, Egypt.,Department of Pediatric Cardiology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdelmonem M Helal
- Department of Pediatric Cardiology, Cairo University, Giza, Egypt.,Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Tamer E Hamouda
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Benha University, Benha, Egypt
| | - Mohamed Galal
- Department of Cardiac Surgery, Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Azzahra M Edrees
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Cardiac Surgery Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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17
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Jain CC, Warnes CA, Egbe AC, Cetta F, DuBrock HM, Connolly HM, Miranda WR. Hemodynamics in Adults With the Shone Complex. Am J Cardiol 2020; 130:137-142. [PMID: 32703525 DOI: 10.1016/j.amjcard.2020.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
Patients with Shone complex (SC) have multiple left-sided obstructive lesions and thus are at risk for left ventricular (LV) remodeling, LV diastolic dysfunction and pulmonary hypertension. Yet, to date, there has been no description of hemodynamics in adults with SC. Retrospective chart review of 25 patients with SC who underwent cardiac catheterization at Mayo Clinic, MN between 2002 and 2019 was performed. SC was defined as multiple left-sided obstructive lesions in the presence of an anatomically abnormal mitral valve. Median age was 32 years (22.5, 42) and 15 patients (60%) were female. The majority of patients (84%) had history of coarctation of the aorta, 10 (40%) had subaortic stenosis, 11 (44%) had prior aortic valve replacement, and 10 (40%) had prior mitral valve replacement. Structural disease at the time of catheterization which warranted intervention within the next year was present in 13 patients (52%). The mean LV end-diastolic pressure was 21.3 ± 9.0 mm Hg (>15 mm Hg in 71%), pulmonary artery peak systolic pressure was 55.4 ± 13.4 mm Hg, and the pulmonary artery mean pressure was 37.0 ± 9.4 mm Hg (>20 mm Hg in 96%). During a mean follow-up of 8.3 ± 4.4 years, there were 7 deaths (28%) and 3 additional patients (12%) underwent cardiac transplantation. In conclusion, adults with SC who underwent catheterization showed significant left-sided heart and pulmonary vascular remodeling. Elevated LV end-diastolic pressure and pulmonary artery pressures were highly prevalent. There were high mortality and cardiac transplant rates in our cohort.
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Affiliation(s)
- C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Minnesota
| | - Carole A Warnes
- Department of Cardiovascular Medicine, Mayo Clinic, Minnesota
| | | | - Frank Cetta
- Department of Cardiovascular Medicine, Mayo Clinic, Minnesota; Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Minnesota
| | - Hilary M DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
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18
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Perrier SL, Jadhav M, d’Udekem Y, Brink J, Konstantinov IE, Zannino D, Cheung MM, Brizard CP. Multiple left-sided stenotic lesions: outcomes after mitral valve surgery. Arguments for abandoning the eponym ‘Shone syndrome’. Eur J Cardiothorac Surg 2020; 58:567-573. [DOI: 10.1093/ejcts/ezaa057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Management of patients with left ventricular inflow and outflow stenotic lesions can be challenging. Our purpose was to characterize such patients and review the long-term outcomes of those requiring mitral valve (MV) surgery.
METHODS
We performed a retrospective study of 40 patients with subaortic, aortic and/or arch stenotic lesion(s) who underwent MV surgery between 1985 and 2016.
RESULTS
Associated left-sided stenotic lesions included aortic valve stenosis in 20 patients (50%), subaortic stenosis in 19 (47.5%) patients, coarctation in 23 (57.5%) patients and hypoplastic aortic arch in 16 (40%) patients. Nineteen patients (47.5%) had a supravalvular mitral ring and 15 (37.5%) patients had a parachute MV. The overall mortality rate was 32.5% (13 patients) with a mean follow-up of 16.3 ± 1.8 years. Being <6 months of age at the time of MV surgery (P = 0.02) and having had previous neonatal aortic valve and/or arch surgery (P = 0.01) were associated with death. The incidence of reoperation (95% confidence interval) at 1, 5, 10 and 15 years was 38% (23–53%), 54% (38–70%), 68% (53–84%) and 85% (72–98%), respectively.
CONCLUSIONS
Results after MV surgery for children with associated left-sided stenotic lesions are closely age-related. The need for mitral intervention shortly after the initial aortic valve and/or arch intervention was a predictor of dismal outcomes
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Affiliation(s)
- Stephanie L Perrier
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Mangesh Jadhav
- Department of Cardiology, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Heart Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Johann Brink
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Heart Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Michael M Cheung
- Department of Cardiology, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Heart Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Heart Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
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19
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Williams T, Lluri G, Boyd EK, Kratzert WB. Perioperative Echocardiography in the Adult With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2020; 34:1292-1308. [PMID: 32001150 DOI: 10.1053/j.jvca.2019.11.036] [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: 05/15/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023]
Abstract
Survival of patients with congenital heart disease has significantly improved over the last 2 decades, confronting interventionalists, surgeons, anesthesiologists, cardiologists, and intensivists with often unfamiliar complex pathophysiology in the perioperative setting. Aside from cardiac catheterization, echocardiography has become the main imaging modality in the hospitalized adult with congenital heart disease. The great variety of congenital lesions and their prior surgical management challenges practitioners to generate optimal imaging, reporting, and interpretation of these complex anatomic structures. Standardization of echocardiographic studies can not only provide significant benefits in the surveillance of these patients, but also facilitate understanding of pathophysiologic mechanism and assist clinical management in the perioperative setting. Knowledge in obtaining and interpreting uniform imaging protocols is essential for the perioperative clinician. In this publication, the authors review current international consensus recommendations on echocardiographic imaging of adults with congenital heart disease and describe the fundamental components by specific lesion. The authors will emphasize key aspects pertinent to the clinical management when imaging these patients in the perioperative setting. The goal of this review is to familiarize the perioperative physician on how to structure and standardize echocardiographic image acquisition of congenital heart disease anatomy for optimal clinical management.
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Affiliation(s)
- Tiffany Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gentian Lluri
- Ahmanson/UCLA ACHD Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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20
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Ganigara M, Doshi A, Naimi I, Mahadevaiah GP, Buddhe S, Chikkabyrappa SM. Preoperative Physiology, Imaging, and Management of Coarctation of Aorta in Children. Semin Cardiothorac Vasc Anesth 2019; 23:379-386. [PMID: 31535945 DOI: 10.1177/1089253219873004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Coarctation of the aorta (CoA) is a narrowing of the proximal thoracic aorta typically located at the junction of the aorta with the ductus arteriosus. While it is a simple lesion to understand, considerable variation exists in the anatomy and pathophysiology, leading to varied clinical presentation, management options, and prognosis. On the one hand critical CoA manifests in the neonatal period as a duct-dependent lesion, while less severe forms of obstruction present later in childhood or adulthood as hypertension or incidentally noted precordial murmurs. While transthoracic echocardiography is usually adequate, older children and adults may need more advanced imaging modalities like computed tomography and magnetic resonance imaging prior to intervention. Depending on the type of lesion, management options currently available include surgery and percutaneous balloon angioplasty and stenting. Even after successful interventions, these patients need life-long surveillance for residual aortic obstruction and systemic hypertension with variable long-term clinical outcomes.
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Affiliation(s)
- Madhusudan Ganigara
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Arpan Doshi
- Children's Mercy Hospitals and Clinics, Wichita, KS, USA
| | - Iman Naimi
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Sujatha Buddhe
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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21
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Rajiah P, MacNamara J, Chaturvedi A, Ashwath R, Fulton NL, Goerne H. Bands in the Heart: Multimodality Imaging Review. Radiographics 2019; 39:1238-1263. [DOI: 10.1148/rg.2019180176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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22
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Krieger EV, Stout KK, Grosse-Wortmann L. How to Image Congenital Left Heart Obstruction in Adults. Circ Cardiovasc Imaging 2019; 10:CIRCIMAGING.116.004271. [PMID: 28495822 DOI: 10.1161/circimaging.116.004271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Eric V Krieger
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.)
| | - Karen K Stout
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.)
| | - Lars Grosse-Wortmann
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.).
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23
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d'Udekem Y, Tweddell JS, Karl TR. The great debate series: surgical treatment of aortic valve abnormalities in children. Eur J Cardiothorac Surg 2019; 53:919-931. [PMID: 29668975 DOI: 10.1093/ejcts/ezy069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
This article is the latest in an EJCTS series entitled 'The Great Debates'. We have chosen the topic of aortic valve (AoV) surgery in children, with a focus on infants and neonates. The topic was selected due to the significant challenges that AoV problems in the young may present to the surgical team. There are many areas of active controversy, despite the vast accumulated world experience. We have tried to incorporate many of these issues in the questions posed, not claiming to be all-inclusive. The individuals invited to this debate are experts in paediatric valve surgery, with broad and successful clinical experiences on multiple continents. We hope that the facts and opinions presented in this debate will generate interest and discussion and perhaps prove useful in decision-making for future complex valve cases.
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Affiliation(s)
- Yves d'Udekem
- Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, VIC, Australia
| | - James S Tweddell
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Tom R Karl
- Johns Hopkins All Children's Heart Institute, St. Petersburg, FL, USA.,European Journal of Cardio-Thoracic Surgery
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24
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Ahmed M, Aziz H, Jiang L. Severe aortic complications in a patient with variant Shone's complex and bicuspid aortic valve. BMJ Case Rep 2017; 2017:bcr-2017-221348. [PMID: 28790051 DOI: 10.1136/bcr-2017-221348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Mashrafi Ahmed
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Hany Aziz
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Leng Jiang
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
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25
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Opotowsky AR, Webb GD. Evolving Understanding of Shone Complex Through the Lifespan: What's in an Eponym? Can J Cardiol 2017; 33:214-215. [DOI: 10.1016/j.cjca.2016.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 11/24/2016] [Accepted: 11/24/2016] [Indexed: 12/14/2022] Open
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