1
|
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.
Collapse
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
| |
Collapse
|
2
|
Abu-Hilal LH, Njoum Y, Barghouthi DI, Khatib H, Mtour S, Adwan B. An Undiagnosed Shone Complex in a 52-Year-Old Female: A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096231218636. [PMID: 38288715 PMCID: PMC10829487 DOI: 10.1177/23247096231218636] [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] [Received: 09/03/2023] [Revised: 11/08/2023] [Accepted: 11/18/2023] [Indexed: 02/01/2024] Open
Abstract
Shone complex (SC) is a rare congenital heart disease characterized by four obstructive anomalies, including parachute mitral valve (PMV), left atrial supra-valvular ring, subaortic stenosis, and coarctation of the aorta. Typically, SC manifests early in life. However, we encountered a 52-year-old female with a history of hypertension diagnosed at 26 years and left-sided weakness poststroke. She presented with worsening dyspnea and palpitations, prompting a thorough investigation. Echocardiography revealed a heavily calcified bicuspid aortic valve with severe aortic stenosis and parachute mitral valve with severe mitral stenosis and preserved ejection fraction, raising suspicions regarding the presence of SC. Cardiac catheterization, aortic-angiography, and noncontrast chest computed tomography (CT) revealed abrupt occlusion of the postductal aorta, giving a picture of aortic coarctation with well-established collateral vessels including prominent right and left internal mammary arteries. So, she was diagnosed with an incomplete SC at the age of 52. Shone complex is a rare congenital heart disease that typically presents in early childhood, but late presentations due to misdiagnosis or incomplete work up are possible. This case emphasizes the rarity of late presentations of SC and highlights the importance of early diagnosis and intervention to improve outcomes. An incomplete SC should be considered in adult patients presenting with left-sided obstructive lesions.
Collapse
Affiliation(s)
| | | | | | - Hasan Khatib
- Al-Makassed Charitable Hospital, Jerusalem, Palestine
| | - Sameer Mtour
- Al-Makassed Charitable Hospital, Jerusalem, Palestine
| | - Bilal Adwan
- Al-Makassed Charitable Hospital, Jerusalem, Palestine
| |
Collapse
|
3
|
Kaneko T, Miyazaki S, Koike T, Murata A, Morimoto R, Hirose K, Takamura K, Endo D, Amano A, Minamino T. Atypical Shone's Complex Diagnosed at 70 Years Old: Presenting with Double-orifice Mitral Valve, Bicuspid Aortic Valve, and Aortic Coarctation. Intern Med 2022; 61:1367-1370. [PMID: 34670894 PMCID: PMC9152849 DOI: 10.2169/internalmedicine.8176-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Atypical Shone's complex is a rare congenital anomaly involving a left-sided obstructive lesion of two or three cardiovascular levels. A 70-year-old man with dyspnea on exertion was diagnosed with severe aortic stenosis (AS) with a bicuspid valve, complicated by severe aortic coarctation (CoA) and a double-orifice mitral valve. He underwent surgery for AS and CoA in one session. It is important to search for complicated malformations, even in cases of bicuspid aortic valve found in old age.
Collapse
Affiliation(s)
- Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Takuma Koike
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Azusa Murata
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Japan
| | - Ryoko Morimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Japan
| | - Kuniaki Hirose
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Japan
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Parachute mitral valve: Morphology and surgical management. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:219-226. [PMID: 32175169 DOI: 10.5606/tgkdc.dergisi.2020.18041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
Background This review aims to discuss morphology and surgical management of parachute mitral valve. Methods A total of 62 articles in the English language with 330 parachute mitral valve patients were retrieved from the PubMed, HighWire Press, and Cochrane Library databases using specific MeSH terms and keywords between January 2000 and December 2018. In these articles, morphology of parachute mitral valve and surgical treatment options were investigated. Results A non-syndromic parachute mitral valve was present in 287 patients (87.0%) and a syndromic parachute mitral valve was present in 43 patients (13.0%). A higher number of patients with a non-syndromic parachute mitral valve presented with congestive heart failure compared to syndromic ones. The patients with a non-syndromic parachute mitral valve often had mitral regurgitation, while syndromic parachute mitral valve patients often had mitral stenosis. Conclusion Parachute mitral valves are usually not an isolated lesion and are often characterized by a constellation of pathological changes of the mitral valve leaflets, annulus, commissures, subvalvular apparatus, and supravalvular mitral ring. Therefore, the majority of the patients need one or more surgical operations. The incidence of adverse events such as reintervention, postoperative complete heart block, and mortality is high in these patients.
Collapse
|
6
|
True A, Baidya M, Lui C, Kilimnik G, Sadler M. Computed tomography imaging characteristics of shone syndrome. Radiol Case Rep 2018; 14:164-167. [PMID: 30416637 PMCID: PMC6223228 DOI: 10.1016/j.radcr.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/13/2018] [Indexed: 11/15/2022] Open
Abstract
Shone syndrome was first described in 1963 by Dr JD Shone. It is a constellation of congenital abnormalities compromising approximately 0.6% of all cases of congenital cardiac abnormalities. Shone syndrome is also known as Shone complex, involving several characteristic cardiac abnormalities: coarctation of the aorta, subaortic stenosis, supravalvular mitral ring, and a parachute mitral valve. Given the uncommon nature of the disease, we present this case to illustrate potential postsurgical appearances of Shone syndrome, specifically on computed tomography imaging.
Collapse
|
7
|
Aslam S, Khairy P, Shohoudi A, Mercier LA, Dore A, Marcotte F, Miró J, Avila-Alonso P, Ibrahim R, Asgar A, Poirier N, Mongeon FP. Shone Complex: An Under-recognized Congenital Heart Disease With Substantial Morbidity in Adulthood. Can J Cardiol 2016; 33:253-259. [PMID: 27956040 DOI: 10.1016/j.cjca.2016.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/09/2016] [Accepted: 09/26/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Shone complex consists of a constellation of left-sided, usually obstructive, cardiac lesions, including supravalvar mitral ring, parachute mitral valve, subaortic stenosis, and aortic coarctation. Incomplete Shone complex consists of a mitral valve anomaly associated with lesions involving the subaortic region, aortic valve, or thoracic aorta. There is a paucity of data regarding long-term outcomes in adults with Shone complex. METHODS We reviewed records of adults with complete or incomplete Shone complex followed at the Montreal Heart Institute between 1982 and 2014. RESULTS Among 4189 adults with congenital heart disease, 28 (0.67%) patients (mean age, 35 ± 11 years; 50% women) had complete or incomplete Shone complex and were followed for a median of 8 years. Only 39% were previously diagnosed as having Shone complex. The most common defects were congenital mitral stenosis (93%), aortic coarctation (75%), and bicuspid aortic valve (71%). Heart transplantation was required in 2 patients (7.1%) at age 22 and 28 years, respectively. Overall, 48% had cardiovascular hospitalizations during adulthood, predominantly for arrhythmias or heart failure. Freedom from cardiovascular intervention was 55%, 18%, and 8% at 10, 20, and 30 years of age, respectively. Although aortic coarctation was the most common indication for initial intervention (61%), adult interventions occurred predominantly for aortic valve/left ventricular outflow tract (60%) and mitral valve (33%) lesions. CONCLUSIONS Shone complex is an under-recognized entity associated with relatively low mortality in adulthood but substantial morbidity related to arrhythmias, heart failure, and interventions. Increased awareness of this condition and associated complications may allow for more tailored follow-up.
Collapse
Affiliation(s)
- Sajid Aslam
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Manchester Royal Infirmary, Manchester, United Kingdom
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Azadeh Shohoudi
- Biostatistics Department, Montreal Health Innovation Coordinating Center, Montréal, Québec, Canada
| | - Lise-Andrée Mercier
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Annie Dore
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - François Marcotte
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Joaquim Miró
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Pablo Avila-Alonso
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Department of Cardiology, Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Réda Ibrahim
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Anita Asgar
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Nancy Poirier
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
| |
Collapse
|
8
|
Ganju NK, Kandoria A, Thakur S, Ganju SA. A Constellation of Cardiac Anomalies: Beyond Shone's Complex. Heart Views 2016; 17:23-6. [PMID: 27293526 PMCID: PMC4879801 DOI: 10.4103/1995-705x.182643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Shone's anomaly is a very rare congenital cardiac malformation characterized by four serial obstructive lesions of the left side of the heart (i) Supravalvular mitral membrane (ii) parachute mitral valve (iii) muscular or membranous subaortic stenosis and (iv) coarctation of aorta. We report a unique presentation of Shone's complex in a 14-year-old adolescent male. In addition to the four characteristic lesions the patient had bicuspid aortic valve, aneurysm of sinus of valsalva, patent ductus arteriosus, ventricular septal defect, persistent left superior vena cava opening into coronary sinus and severe pulmonary artery hypertension. This case report highlights the importance of a strong clinical suspicion of the coexistence of multiple congenital cardiac anomalies in Shone's complex and the significance of a careful comprehensive echocardiography.
Collapse
Affiliation(s)
- Neeraj K Ganju
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Arvind Kandoria
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Suresh Thakur
- Department of Radiodiagnosis and Imaging, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sunite A Ganju
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| |
Collapse
|
9
|
Naz A, Dasgupta S, Bandyopadhyay BK, Shirazee HH. Graded epidural anaesthesia for Caesarean section in a parturient with Shone’s syndrome: a case study. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2015.1111676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Aherrera JAM, Abola MTB, Magno JDA, Sta. Maria MHF, Abrahan LL, Tiongco RHP, Anonuevo JC. Coarctation of the Aorta and a Parachute Mitral Valve in an Adult With Differential Cyanosis. Cardiol Res 2015; 6:232-235. [PMID: 28197231 PMCID: PMC5295559 DOI: 10.14740/cr378w] [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] [Accepted: 02/24/2015] [Indexed: 12/02/2022] Open
Abstract
Differential cyanosis may occur in Eisenmenger physiology in the presence of a patent ductus arteriosus (PDA). We present a unique case of a 22-year-old male manifesting as cyanosis of the left upper extremity and both lower extremities, but with preservation of the right upper extremity. Work-up revealed multiple congenital defects, reminiscent of the Shone's complex. Survival into adulthood is presumed to be due to a PDA, at the expense of a right-to-left shunt. This report highlights the interplay of multiple anomalies documented on echocardiography and MRI, wherein diagnosis was made non-invasively.
Collapse
Affiliation(s)
- Jaime Alfonso M. Aherrera
- Section of Cardiology, Department of Medicine, University of the Philippines, Philippine General Hospital, Philippine
| | - Ma. Teresa B. Abola
- Section of Cardiology, Department of Medicine, University of the Philippines, Philippine General Hospital, Philippine
| | - Jose Donato A. Magno
- Section of Cardiology, Department of Medicine, University of the Philippines, Philippine General Hospital, Philippine
| | | | - Lauro L. Abrahan
- Section of Cardiology, Department of Medicine, University of the Philippines, Philippine General Hospital, Philippine
| | - Richard Henry P. Tiongco
- Section of Cardiology, Department of Medicine, University of the Philippines, Philippine General Hospital, Philippine
| | - John C. Anonuevo
- Section of Cardiology, Department of Medicine, University of the Philippines, Philippine General Hospital, Philippine
| |
Collapse
|
11
|
Nkoke C, Lekoubou A, Yonta EW, Dzudie A, Kengne AP. Shone's anomaly: a report of one case in sub-Saharan Africa. Cardiovasc Diagn Ther 2015; 4:495-8. [PMID: 25610807 DOI: 10.3978/j.issn.2223-3652.2014.12.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/02/2014] [Indexed: 12/26/2022]
Abstract
Shone's anomaly is a rare congenital cardiac malformation consisting of four obstructive lesions of the left heart and the aortic arch: a supramitral membrane; parachute mitral valve; subaortic stenosis; and coarctation of the aorta which occurs most commonly in its incomplete form. We report on a 17-year-old male Cameroonian with a variant of shone anomaly consisting of sub-valvular aortic stenosis, coarctation of the aorta and parachute mitral valve. He was referred for the investigation of a cardiac murmur after he presented with shortness of breath preceded by flu like syndrome. He underwent successful management abroad consisting of aortic coarctation treatment by percutaneous angioplasty and resection of the subaortic ring by traditional surgical approach without any mitral valve repair. Shone's anomaly is a rare congenital heart disease that can be missed in low resource settings. This case raises awareness about this syndrome, highlights the importance of cardiac ultrasonography in resource limited settings and illustrates the need for comprehensive service frameworks to improve access and level of care and services for patients in the African context.
Collapse
Affiliation(s)
- Clovis Nkoke
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde1, Cameroon ; 2 Department of neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Street, Ste 301 CSB, Charleston, South Carolina, USA ; 3 Department of Internal Medicine, Douala General Hospital, Cameroon ; 4 Non-Communicable Diseases Research Unit, South African Medical Research Council 7505 Cape Town, South Africa ; 5 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Alain Lekoubou
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde1, Cameroon ; 2 Department of neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Street, Ste 301 CSB, Charleston, South Carolina, USA ; 3 Department of Internal Medicine, Douala General Hospital, Cameroon ; 4 Non-Communicable Diseases Research Unit, South African Medical Research Council 7505 Cape Town, South Africa ; 5 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Edvine Wawo Yonta
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde1, Cameroon ; 2 Department of neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Street, Ste 301 CSB, Charleston, South Carolina, USA ; 3 Department of Internal Medicine, Douala General Hospital, Cameroon ; 4 Non-Communicable Diseases Research Unit, South African Medical Research Council 7505 Cape Town, South Africa ; 5 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Anastase Dzudie
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde1, Cameroon ; 2 Department of neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Street, Ste 301 CSB, Charleston, South Carolina, USA ; 3 Department of Internal Medicine, Douala General Hospital, Cameroon ; 4 Non-Communicable Diseases Research Unit, South African Medical Research Council 7505 Cape Town, South Africa ; 5 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde1, Cameroon ; 2 Department of neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Street, Ste 301 CSB, Charleston, South Carolina, USA ; 3 Department of Internal Medicine, Douala General Hospital, Cameroon ; 4 Non-Communicable Diseases Research Unit, South African Medical Research Council 7505 Cape Town, South Africa ; 5 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| |
Collapse
|
12
|
|
13
|
Escárcega RO, Michelena HI, Bove AA. Bicuspid aortic valve: a neglected feature of Shone’s complex? Pediatr Cardiol 2014; 35:186-7. [PMID: 24078196 DOI: 10.1007/s00246-013-0804-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/14/2013] [Indexed: 12/18/2022]
|
14
|
Intervention and Management of Congenital Left Heart Obstructive Lesions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:632-45. [DOI: 10.1007/s11936-013-0260-7] [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] [Indexed: 12/18/2022]
|
15
|
Grimaldi A, Vermi AC, Ho SY, Pappalardo F, Castiglioni A, Benussi S, Zangrillo A, Alfieri O. Surgical outcome of partial Shone complex. Interact Cardiovasc Thorac Surg 2012; 14:440-4. [PMID: 22279117 DOI: 10.1093/icvts/ivr169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Partial forms of Shone complex are rare. Surgical outcomes of the complete forms have generally been poor, whereas there is a lack of data on long-term follow-up of surgically treated adult partial complex. Between 2001 and 2011, nine patients (age: 38 ± 8 years; six males, 67%) were referred for valvular heart disease. Transthoracic and transoesophageal echocardiography was performed. Data were confirmed by intra-operative findings and reports. Patients were diagnosed as partial Shone complex and presented with mitral stenosis (MS) (45%) or mitral regurgitation (22%) or aortic regurgitation (22%). All but one patient (89%) reported previous surgery: coarctation of the aorta repair (87.5%) and aortic valvulotomy (12.5%). Redo intervention included: mitral valve replacement (25%), mitral repair (25%), aortic valve replacement (37.5%) and subvalvular aortic ridge resection (25%). One patient refused surgery. Patients surgically treated before the age of 5 (87.5%) showed favourable outcome (survival rate: 100%) and a 23.6 (± 4.6)-year follow-up free from events. The patient who underwent first intervention at the age of 50 and the patient with MS who refused surgery showed a 45 (± 7)-year follow-up free from major morbidity. Patients with partial Shone complex, properly diagnosed and treated, show favourable surgical outcome free from major clinical events.
Collapse
Affiliation(s)
- Antonio Grimaldi
- Cardiovascular and Thoracic Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Ma XJ, Huang GY, Liang XC, Liu XQ, Jia B. Atypical Shone's complex diagnosed by echocardiography. Pediatr Cardiol 2011; 32:442-8. [PMID: 21279339 DOI: 10.1007/s00246-011-9886-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 12/14/2022]
Abstract
Shone's complex is a rare and severe type of congenital left-sided obstructive lesion of multiple cardiovascular levels. This report aims to present the authors' experience diagnosing atypical Shone's complex using echocardiography. Atypical Shone's complex was diagnosed for 38 consecutive patients (18 boys and 20 girls, ages 1 day to 15 years) using echocardiography. All the diagnoses were confirmed by cardioangiography, surgery, or both. Among the congenital left-sided obstructive lesions, four levels of obstruction coexisted in 3 cases (7.9%), three levels in 10 cases (26.3%), and two levels in 25 cases (65.8%). Supra-annular mitral stenosis caused by a supravalvular mitral ring was diagnosed in 1 case. Mitral valvular stenosis was diagnosed in 24 cases including a parachute mitral valve (4 cases), a double-orifice mitral valve (1 case), and partly fused thickened mitral valvular leaflets (19 cases). Subaortic stenosis was diagnosed in 10 cases including circumferential membranous subaortic stenosis (1 case), tunnel-type subaortic narrowing (2 cases), and asymmetric obstructive fibrous ridge below the aortic valve (7 cases). Aortic stenosis was diagnosed in 25 cases including the bicuspid aortic valve (12 cases), the hypoplasia aortic annulus (3 cases), and partly fused or thickened tri-leaflet aortic valves (10 cases). Supra-aortic stenosis was diagnosed in 6 cases including the localized type (4 cases) and the diffused type (2 cases). Coarctation of the aorta was diagnosed in 26 cases. Of these, focal coarctation was described in 15 cases, long segment coarctation in 7 cases, and dysplastic isthmus and/or descending aorta in 4 cases. Secondary changes in Shone's complex manifested as left atrial dilation (26 cases), left ventricular hypertrophy (26 cases), and pulmonary hypertension (19 cases). Echocardiography plays an important role in the diagnosis of atypical Shone's complex, in comprehensive evaluation of the number, position, morphology, and severity of left-sided obstructions.
Collapse
Affiliation(s)
- Xiao-jing Ma
- Children's Hospital of Fudan University, Shanghai, China, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | | | | | | | | |
Collapse
|
17
|
|
18
|
Misra S, Koshy T, Dash PK. Diagnosis of Shone's anomaly by intraoperative transesophageal echocardiography in an adult patient undergoing repair of coarctation of the aorta. J Cardiothorac Vasc Anesth 2010; 25:838-40. [PMID: 20728379 DOI: 10.1053/j.jvca.2010.06.018] [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: 03/26/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Satyajeet Misra
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala,
| | | | | |
Collapse
|