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Najm H, Gupta S, Weingarten N, Stewart R, Ahmad M, Lane J, Amdani S, Karamlou T. Infant Ross-Konno, Endocardial Fibroelastosis Resection and Mitral Valve Repair. World J Pediatr Congenit Heart Surg 2021; 13:389-392. [PMID: 34775844 DOI: 10.1177/21501351211054380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Optimal management of critical aortic stenosis (AS) in infants depends on the left ventricle's (LV's) ability to maintain adequate output. Determining feasibility of biventricular repair may be difficult, particularly in those with mitral disease, endocardial fibroelastosis (EFE), multi-level obstruction, and uncertain physiologic capacity. We report a case of a three-month-old with critical AS, severely reduced LV function, EFE, and moderate mitral regurgitation (MR), who underwent a Ross-Konno procedure with concomitant EFE resection and mitral valve repair. Although the technical sequence is challenging, definitive surgery completely relieved multi-level obstruction and MR with markedly improved LV function.
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Affiliation(s)
- Hani Najm
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland
| | - Sohini Gupta
- 2546Case Western Reserve University School of Medicine, Cleveland
| | | | - Robert Stewart
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland.,1079Akron Children's Hospital, Akron
| | - Munir Ahmad
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland
| | - John Lane
- 1079Akron Children's Hospital, Akron
| | | | - Tara Karamlou
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland
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Kido T, Guariento A, Doulamis IP, Porras D, Baird CW, Del Nido PJ, Nathan M. Aortic Valve Surgery After Neonatal Balloon Aortic Valvuloplasty in Congenital Aortic Stenosis. Circ Cardiovasc Interv 2021; 14:e009933. [PMID: 34092095 DOI: 10.1161/circinterventions.120.009933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Takashi Kido
- Department of Cardiac Surgery (T.K., A.G., I.P.D., C.W.B., P.J.d.N., M.N.), Boston Children's Hospital, Harvard Medical School, MA
| | - Alvise Guariento
- Department of Cardiac Surgery (T.K., A.G., I.P.D., C.W.B., P.J.d.N., M.N.), Boston Children's Hospital, Harvard Medical School, MA
| | - Ilias P Doulamis
- Department of Cardiac Surgery (T.K., A.G., I.P.D., C.W.B., P.J.d.N., M.N.), Boston Children's Hospital, Harvard Medical School, MA
| | - Diego Porras
- Department of Cardiology (D.P.), Boston Children's Hospital, Harvard Medical School, MA
| | - Christopher W Baird
- Department of Cardiac Surgery (T.K., A.G., I.P.D., C.W.B., P.J.d.N., M.N.), Boston Children's Hospital, Harvard Medical School, MA
| | - Pedro J Del Nido
- Department of Cardiac Surgery (T.K., A.G., I.P.D., C.W.B., P.J.d.N., M.N.), Boston Children's Hospital, Harvard Medical School, MA
| | - Meena Nathan
- Department of Cardiac Surgery (T.K., A.G., I.P.D., C.W.B., P.J.d.N., M.N.), Boston Children's Hospital, Harvard Medical School, MA
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Kovacevic A, Öhman A, Tulzer G, Herberg U, Dangel J, Carvalho JS, Fesslova V, Jicinska H, Sarkola T, Pedroza C, Averiss IE, Mellander M, Gardiner HM. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:221-229. [PMID: 28976617 DOI: 10.1002/uog.18913] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/15/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Fetal aortic stenosis may progress to hypoplastic left heart syndrome. Fetal valvuloplasty (FV) has been proposed to improve left heart hemodynamics and maintain biventricular (BV) circulation. The aim of this study was to assess FV efficacy by comparing survival and postnatal circulation between fetuses that underwent FV and those that did not. METHODS This was a retrospective multicenter study of fetuses with aortic stenosis that underwent FV between 2005 and 2012, compared with contemporaneously enrolled natural history (NH) cases sharing similar characteristics at presentation but not undergoing FV. Main outcome measures were overall survival, BV-circulation survival and survival after birth. Secondary outcomes were hemodynamic change and left heart growth. A propensity score model was created including 54/67 FV and 60/147 NH fetuses. Analyses were performed using logistic, Cox or linear regression models with inverse probability of treatment weighting (IPTW) restricted to fetuses with a propensity score of 0.14-0.9, to create a final cohort for analysis of 42 FV and 29 NH cases. RESULTS FV was technically successful in 59/67 fetuses at a median age of 26 (21-34) weeks. There were 7/72 (10%) procedure-related losses, and 22/53 (42%) FV babies were delivered at < 37 weeks. IPTW demonstrated improved survival of liveborn infants following FV (hazard ratio, 0.38; 95% CI, 0.23-0.64; P = 0.0001), after adjusting for circulation and postnatal surgical center. Similar proportions had BV circulation (36% for the FV cohort and 38% for the NH cohort) and survival was similar between final circulations. Successful FV cases showed improved hemodynamic response and less deterioration of left heart growth compared with NH cases (P ≤ 0.01). CONCLUSIONS We report improvements in fetal hemodynamics and preservation of left heart growth following successful FV compared with NH. While the proportion of those achieving a BV circulation outcome was similar in both cohorts, FV survivors showed improved survival independent of final circulation to 10 years' follow-up. However, FV is associated with a 10% procedure-related loss and increased prematurity compared with the NH cohort, and therefore the risk-to-benefit ratio remains uncertain. We recommend a carefully designed trial incorporating appropriate and integrated fetal and postnatal management strategies to account for center-specific practices, so that the benefits achieved by fetal therapy vs surgical strategy can be demonstrated clearly. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Kovacevic
- Royal Brompton NHS Foundation Trust, London, UK; and Department of General Paediatrics, Neonatology and Paediatric Cardiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - A Öhman
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Tulzer
- Department of Paediatric Cardiology, Children's Heart Center Linz, Kepler University Hospital, Linz, Austria
| | - U Herberg
- Department of Paediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - J Dangel
- Perinatal Cardiology Department, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - J S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton NHS Foundation Trust, London, UK; and Fetal Medicine Unit, St George's University Hospital NHS Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - V Fesslova
- Center of Fetal Cardiology, Policlinico San Donato IRCSS, Milan, Italy
| | - H Jicinska
- University Hospital Brno, Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - T Sarkola
- University of Helsinki and Helsinki University Central Hospital/Children's Hospital, Helsinki, Finland
| | - C Pedroza
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - I E Averiss
- The Fetal Center, McGovern Medical School at University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - M Mellander
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H M Gardiner
- The Fetal Center, McGovern Medical School at University of Texas Health Sciences Center at Houston, Houston, TX, USA
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Peeling the left ventricle as treatment for endocardial fibroelastosis: An exceptional surgical procedure in adults. J Thorac Cardiovasc Surg 2017; 154:e85-e86. [PMID: 28732708 DOI: 10.1016/j.jtcvs.2017.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 11/20/2022]
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Gardiner HM, Kovacevic A, Tulzer G, Sarkola T, Herberg U, Dangel J, Öhman A, Bartrons J, Carvalho JS, Jicinska H, Fesslova V, Averiss I, Mellander M. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:373-381. [PMID: 26843026 DOI: 10.1002/uog.15876] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/22/2016] [Accepted: 01/30/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS), which results in postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life remains poorly defined. The primary aim of this study was to describe the natural history of fetal aortic stenosis, and a secondary aim was to test previously published criteria designed to identify cases of emerging HLHS with the potential for a biventricular (BV) outcome after FV. METHODS From a European multicenter retrospective study of 214 fetuses with aortic stenosis (2005-2012), 107 fetuses in ongoing pregnancies that did not undergo FV were included in this study and their natural history was reported. We examined longitudinal changes in Z-scores of aortic and mitral valve and left ventricular dimensions and documented direction of flow across the foramen ovale and aortic arch, and mitral valve inflow pattern and any gestational changes. Data were used to identify fetuses satisfying the Boston criteria for emerging HLHS and estimate the proportion of these that would have been ideal FV candidates. We applied the threshold score whereby a score of 1 was assigned to fetuses for each Z-score meeting the following criteria: left ventricular length and width > 0; mitral valve diameter > -2; aortic valve diameter > -3.5; and pressure gradient across either the mitral or aortic valve > 20 mmHg. We compared the predicted circulation with known survival and final postnatal circulation (BV, UV or conversion from BV to UV). RESULTS Among the 107 ongoing pregnancies there were eight spontaneous fetal deaths and 99 livebirths. Five were lost to follow-up, five had comfort care and four had mild aortic stenosis not requiring intervention. There was intention-to-treat in these 85 newborns but five died prior to surgery, before circulation could be determined, and thus 80 underwent postnatal procedures with 44 BV, 29 UV and seven BV-to-UV circulatory outcomes. Of newborns with intention-to-treat, 69/85 (81%) survived ≥ 30 days. Survival at median 6 years was superior in cases with BV circulation (P = 0.041). Those with a postnatal UV circulation showed a trend towards smaller aortic valve diameters at first scan than did the BV cohort (P = 0.076), but aortic valve growth velocities were similar in both cohorts to term. In contrast, the mitral valve diameter was significantly smaller at first scan in those with postnatal UV outcomes (P = 0.004) and its growth velocity (P = 0.008), in common with the left ventricular inlet length (P = 0.004) and width (P = 0.002), were reduced significantly by term in fetuses with UV compared with BV outcome. Fetal data, recorded before 30 completed gestational weeks, from 70 treated neonates were evaluated to identify emerging HLHS. Forty-four had moderate or severe left ventricular depression and 38 of these had retrograde flow in the aortic arch and two had left-to-right flow at atrial level and reversed a-waves in the pulmonary veins. Thus 40 neonates met the criteria for emerging HLHS and BV circulation was documented in 13 (33%). Of these 40 cases, 12 (30%) had a threshold score of 4 or 5, of which five (42%) had BV circulation without fetal intervention. CONCLUSIONS The natural history in our cohort of fetuses with aortic stenosis and known outcomes shows that a substantial proportion of fetuses meeting the criteria for emerging HLHS, with or without favorable selection criteria for FV, had a sustained BV circulation without fetal intervention. This indicates that further work is needed to refine the selection criteria to offer appropriate therapy to fetuses with aortic stenosis. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H M Gardiner
- The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - A Kovacevic
- Department of Paediatric and Congenital Cardiology, University of Heidelberg, Heidelberg, Germany
| | - G Tulzer
- Department of Paediatric Cardiology, Children's Heart Centre, Linz, Austria
| | - T Sarkola
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - U Herberg
- Department of Paediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - J Dangel
- Perinatal Cardiology Clinic, 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - A Öhman
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Bartrons
- Department of Paediatric Cardiology, Sant Joan de Déu, Barcelona, Spain
| | - J S Carvalho
- Department of Paediatric and Congenital Cardiology, Royal Brompton and Harefield Hospital, NHS Trust, and Fetal Medicine Unit, St George's Hospital NHS Trust, London, UK
| | - H Jicinska
- University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - V Fesslova
- Center of Fetal Cardiology, Policlinico San Donato IRCSS, Milan, Italy
| | - I Averiss
- The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - M Mellander
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bouquet de la Jolinière J, Fadhlaoui A, Dubuisson JB, Feki A. Gynecology and Obstetrics has Entered Modern Times: Perspectives and Challenges. Front Surg 2015; 1:19. [PMID: 25593943 PMCID: PMC4287019 DOI: 10.3389/fsurg.2014.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Anis Fadhlaoui
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland
| | - Jean-Bernard Dubuisson
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland
| | - Anis Feki
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland
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