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Nydegger C, Corno AF, von Segesser LK, Beghetti M, Samaja M, Milano G. Effects of PDE-5 Inhibition on the Cardiopulmonary System After 2 or 4 Weeks of Chronic Hypoxia. Cardiovasc Drugs Ther 2020; 33:407-414. [PMID: 31264002 PMCID: PMC6689028 DOI: 10.1007/s10557-019-06887-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose In pulmonary hypertension (PH), hypoxia represents both an outcome and a cause of exacerbation. We addressed the question whether hypoxia adaptation might affect the mechanisms underlying PH alleviation through phosphodiesterase-5 (PDE5) inhibition. Methods Eight-week-old male Sprague-Dawley rats were divided into two groups depending on treatment (placebo or sildenafil, a drug inhibiting PDE5) and were exposed to hypoxia (10% O2) for 0 (t0, n = 9/10), 2 (t2, n = 5/5) or 4 (t4, n = 5/5) weeks. The rats were treated (0.3 mL i.p.) with either saline or sildenafil (1.4 mg/Kg per day). Results Two-week hypoxia changed the body weight (− 31% vs. − 27%, respectively, P = NS), blood hemoglobin (+ 25% vs. + 27%, P = NS) and nitrates+nitrites (+ 175% vs. + 261%, P = 0.007), right ventricle fibrosis (+ 814% vs. + 317%, P < 0.0001), right ventricle hypertrophy (+ 84% vs. + 49%, P = 0.007) and systolic pressure (+ 108% vs. + 41%, P = 0.001), pulmonary vessel density (+ 61% vs. + 46%, P = NS), and the frequency of small (< 50 µm wall thickness) vessels (+ 35% vs. + 13%, P = 0.0001). Most of these changes were maintained for 4-week hypoxia, except blood hemoglobin and right ventricle hypertrophy that continued increasing (+ 52% vs. + 42%, P = NS; and + 104% vs. + 83%, P = 0.04). To further assess these observations, small vessel frequency was found to be linearly related with the right ventricle-developed pressure independent of hypoxia duration. Conclusions Thus, although hypoxia adaptation is not yet accomplished after 4 weeks, PH alleviation by PDE5 inhibition might nevertheless provide an efficient strategy for the management of this disease.
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Affiliation(s)
- Coline Nydegger
- Department Cœur-Vaisseaux, Cardiac Surgery center, University Hospital of Lausanne, Lausanne, Switzerland
| | - Antonio F Corno
- Cardiovascular Research Center, University of Leicester, Leicester, UK
| | - Ludwig K von Segesser
- Cardiovascular Research Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, University of Geneva, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Children's University Hospitals, Geneva and Lausanne, Lausanne, Switzerland
| | - Michele Samaja
- Department of Health Science, University of Milan, Milan, Italy
| | - Giuseppina Milano
- Department Cœur-Vaisseaux, Cardiac Surgery center, University Hospital of Lausanne, Lausanne, Switzerland.
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Corno AF. Pulmonary Valve Regurgitation: Neither Interventional Nor Surgery Fits All. Front Pediatr 2018; 6:169. [PMID: 29951475 PMCID: PMC6008531 DOI: 10.3389/fped.2018.00169] [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: 03/14/2018] [Accepted: 05/22/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction: PV implantation is indicated for severe PV regurgitation after surgery for congenital heart defects, but debates accompany the following issues: timing of PV implantation; choice of the approach, percutaneous interventional vs. surgical PV implantation, and choice of the most suitable valve. Timing of pulmonary valve implantation: The presence of symptoms is class I evidence indication for PV implantation. In asymptomatic patients indication is agreed for any of the following criteria: PV regurgitation > 20%, indexed end-diastolic right ventricular volume > 120-150 ml/m2 BSA, and indexed end-systolic right ventricular volume > 80-90 ml/m2 BSA. Choice of the approach: percutaneous interventional vs. surgical: The choice of the approach depends upon the morphology and the size of the right ventricular outflow tract, the morphology and the size of the pulmonary arteries, the presence of residual intra-cardiac defects and the presence of extremely dilated right ventricle. Choice of the most suitable valve for surgical implantation: Biological valves are first choice in most of the reported studies. A relatively large size of the biological prosthesis presents the advantage of avoiding a right ventricular outflow tract obstruction, and also of allowing for future percutaneous valve-in-valve implantation. Alternatively, biological valved conduits can be implanted between the right ventricle and pulmonary artery, particularly when a reconstruction of the main pulmonary artery and/or its branches is required. Hybrid options: combination of interventional and surgical: Many progresses extended the implantation of a PV with combined hybrid interventional and surgical approaches. Major efforts have been made to overcome the current limits of percutaneous PV implantation, namely the excessive size of a dilated right ventricular outflow tract and the absence of a cylindrical geometry of the right ventricular outflow tract as a suitable landing for a percutaneous PV implantation. Conclusion: Despite tremendous progress obtained with modern technologies, and the endless fantasy of researchers trying to explore new forms of treatment, it is too early to say that either the interventional or the surgical approach to implant a PV can fit all patients with good long-term results.
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Affiliation(s)
- Antonio F. Corno
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, United Kingdom
- Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom
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Gregory SH, Zoller JK, Shahanavaz S, Chilson KL, Ridley CH. Anesthetic Considerations for Transcatheter Pulmonary Valve Replacement. J Cardiothorac Vasc Anesth 2018; 32:402-411. [DOI: 10.1053/j.jvca.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 12/27/2022]
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Corno AF, Dawson AG, Bolger AP, Mimic B, Shebani SO, Skinner GJ, Speggiorin S. Trifecta St. Jude medical® aortic valve in pulmonary position. NANO REVIEWS & EXPERIMENTS 2017; 8:1299900. [PMID: 30410702 PMCID: PMC6167870 DOI: 10.1080/20022727.2017.1299900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/01/2017] [Accepted: 02/21/2017] [Indexed: 12/29/2022]
Abstract
Introduction: To evaluate an aortic pericardial valve for pulmonary valve (PV) regurgitation after repair of congenital heart defects. Methods: From July 2012 to June 2016 71 patients, mean age 24 ± 13 years (four to years) underwent PV implantation of aortic pericardial valve, mean interval after previous repair = 21 ± 10 years (two to 47 years). Previous surgery at mean age 3.2 ± 7.2 years (one day to 49 years): tetralogy of Fallot repair in 83% (59/71), pulmonary valvotomy in 11% (8/71), relief of right ventricular outflow tract (RVOT) obstruction in 6% (4/71). Pre-operative echocardiography and MRI showed severe PV regurgitation in 97% (69/71), moderate in 3% (2/71) with associated RVOT obstruction. MRI and knowledge-based reconstruction 3D volumetry (KBR-3D-volumetry) showed mean PV regurgitation = 42 ± 9% (20–58%), mean indexed RV end-diastolic volume = 169 ± 33 (130–265) ml m–2 BSA and mean ejection fraction (EF) = 46 ± 8% (33–61%). Cardio-pulmonary exercise showed mean peak O2/uptake = 24 ± 8 ml kg–1 min–1 (14–45 ml kg–1 min–1), predicted max O2/uptake 66 ± 17% (26–97%). Pre-operative NYHA class was I in 17% (12/71) patients, II in 70% (50/71) and III in 13% (9/71). Results: Mean cardio-pulmonary bypass duration was 95 ± 30ʹ (38–190ʹ), mean aortic cross-clamp in 23% (16/71) 46 ± 31ʹ (8–95ʹ), with 77% (55/71) implantations without aortic cross-clamp. Size of implanted PV: 21 mm in seven patients, 23 mm in 33, 25 mm in 23, and 27 mm in eight. The z-score of the implanted PV was −0.16 ± 0.80 (−1.6 to 2.5), effective orifice area indexed (for BSA) of native PV was 1.5 ± 0.2 (1.2 to –2.1) vs. implanted PV 1.2 ± 0.3 (0.76 to –2.5) (p = ns). In 76% (54/71) patients surgical RV modelling was associated. Mean duration of mechanical ventilation was 6 ± 5 h (0–26 h), mean ICU stay 21 ± 11 h (12–64 h), mean hospital stay 6 ± 3 days (three to 19 days). In mean follow-up = 25 ± 14 months (six to 53 months) there were no early/late deaths, no need for cardiac intervention/re-operation, no valve-related complications, thrombosis or endocarditis. Last echocardiography showed absent PV regurgitation in 87.3% (62/71) patients, trivial/mild degree in 11.3% (8/71), moderate degree in 1.45% (1/71), mean max peak velocity through RVOT 1.6 ± 0.4 (1.0–2.4) m s–1. Mean indexed RV end-diastolic volume at MRI/KBR-3D-volumetry was 96 ± 20 (63–151) ml m–2 BSA, lower than pre-operatively (p < 0.001), and mean EF = 55 ± 4% (49–61%), higher than pre-operatively (p < 0.05). Almost all patients (99% = 70/71) remain in NYHA class I, 1.45% = 1/71 in class II. Conclusion: (a) Aortic pericardial valve is implantable in PV position with an easy and reproducible surgical technique; (b) valve size adequate for patient BSA can be implanted with simultaneous RV remodelling; (c) medium-term outcomes are good with maintained PV function, RV dimensions significantly reduced and EF significantly improved; (d) adequate valve size will allow later percutaneous valve-in-valve implantation.
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Affiliation(s)
- Antonio F Corno
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Alan G Dawson
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Aidan P Bolger
- Service of Adult Congenital Cardiology, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Branco Mimic
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Suhair O Shebani
- Service of Paediatric Cardiology, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Gregory J Skinner
- Service of Paediatric Cardiology, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Simone Speggiorin
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
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Schubmehl HB, Swartz MF, Atallah-Yunes N, Wittlieb-Weber C, Pratt RE, Alfieris GM. Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement. World J Pediatr Congenit Heart Surg 2016; 8:39-47. [DOI: 10.1177/2150135116670632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The goals following pulmonary valve replacement (PVR) are to optimize right ventricular hemodynamics and minimize the need for subsequent reoperations on the right ventricular outflow tract. We hypothesized PVR using a xenograft valved conduit would result in superior freedom from reoperation with sustained improvement in right ventricular chamber dimensions. Methods: Xenograft valved conduits placed in patients aged >16 years were reviewed from 2000 to 2010 to allow for a 5-year minimum follow-up. Preoperative, one-year, and the most recent echocardiograms quantified right ventricular chamber dimensions, corresponding Z scores, and prosthetic valve function. Magnetic resonance imaging (MRI) studies compared preoperative and follow-up right ventricular volumes. Results: A total of 100 patients underwent PVR at 24 (19-34) years. Freedom from reintervention was 100% at 10 years. At most recent follow-up, only one patient had greater than mild pulmonary insufficiency. The one-year (17.3 ± 7.2 mm Hg; P < .01) and most recent follow-up (18.6 ± 9.8 mm Hg; P < .01) Doppler-derived right ventricular outflow tract gradients remained significantly lower than preoperative measurements (36.7 ± 27.0 mm Hg). Similarly, right ventricular basal diameter, basal longitudinal diameter, and the corresponding Z scores remained lower at one year and follow-up from preoperative measurements. From 34 MRI studies, the right ventricular end-diastolic indexed volume (161.7 ± 58.5 vs 102.9 ± 38.3; P < .01) and pulmonary regurgitant fraction (38.0% ± 15.9% vs 0.8% ± 3.3%; P < .01) were significantly lower at 7.1 ± 3.4 years compared to the preoperative levels. Conclusion: Use of a xenograft valved conduit for PVR results in excellent freedom from reoperation with sustained improvement in right ventricular dimensions at an intermediate-term follow-up.
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Affiliation(s)
| | - Michael F. Swartz
- University of Rochester Medical Center, Rochester, NY, USA
- Pediatric Cardiac Consortium of Upstate, New York, NY, USA
| | - Nader Atallah-Yunes
- University of Rochester Medical Center, Rochester, NY, USA
- Pediatric Cardiac Consortium of Upstate, New York, NY, USA
| | - Carol Wittlieb-Weber
- University of Rochester Medical Center, Rochester, NY, USA
- Pediatric Cardiac Consortium of Upstate, New York, NY, USA
| | - Rebecca E. Pratt
- University of Rochester Medical Center, Rochester, NY, USA
- Pediatric Cardiac Consortium of Upstate, New York, NY, USA
| | - George M. Alfieris
- University of Rochester Medical Center, Rochester, NY, USA
- Pediatric Cardiac Consortium of Upstate, New York, NY, USA
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Dawson AG, Corno AF. Pulmonary Valve Replacement: What Did We Learn? Ann Thorac Surg 2016; 100:2418-9. [PMID: 26652562 DOI: 10.1016/j.athoracsur.2015.06.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 06/09/2015] [Accepted: 06/19/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Alan G Dawson
- Pediatric Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, LE39QP, United Kingdom
| | - Antonio F Corno
- Pediatric Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, LE39QP, United Kingdom.
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Wolff D, van Melle JP, Dijkstra H, Bartelds B, Willems TP, Hillege H, van den Berg AP, Ebels T, Sijens PE, Berger RMF. The Fontan circulation and the liver: A magnetic resonance diffusion-weighted imaging study. Int J Cardiol 2015; 202:595-600. [PMID: 26447669 DOI: 10.1016/j.ijcard.2015.09.088] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/10/2015] [Accepted: 09/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with a Fontan circulation tend to develop liver fibrosis, liver cirrhosis and even hepatocellular carcinoma. The aim of this study is to use the magnetic resonance technique diffusing-weighted imaging (DWI) for detecting liver fibrosis/cirrhosis in Fontan patients and to establish whether DWI results are associated with functional aspects of the Fontan circulation. METHODS In a cross-sectional study, 59 Fontan patients were evaluated by liver DWI. The association between apparent diffusion coefficients (ADC) and patient characteristics, laboratory measurements and functional aspects of the Fontan circulation (NYHA class, maximum oxygen uptake during exercise and cardiac index) was assessed. RESULTS Liver ADC values were low (0.82×10(-3)±0.11×10(-3) mm2/s) compared with literature values for healthy volunteers and correlated negatively with calculated liver fibrosis/cirrhosis scores (Fib-4 score, p=0.019; AST/ALT ratio, p=0.009) and gamma-glutamyl transferase (p=0.001). Furthermore, ADC values correlated negatively with follow-up duration (p<0.001) and positively with cardiac index (p=0.019). No correlation between ADC values and exercise tests was found. In multivariable analysis, the ADC values were independently correlated with follow-up duration after Fontan completion. CONCLUSIONS The results of the current study suggest that progressive liver damage due to chronic congestion and potential hypoperfusion is reflected in the liver ADC values in Fontan patients. This study highlights that liver damage in the context of the Fontan circulation might be far more common than previously thought, and that the implementation of liver assessment in the routine follow-up of Fontan patients is recommendable.
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Affiliation(s)
- Djoeke Wolff
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology/Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, The Netherlands.
| | - Joost P van Melle
- Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Hildebrand Dijkstra
- Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology/Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Tineke P Willems
- Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Hans Hillege
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Tjark Ebels
- Center for Congenital Heart Diseases, Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Paul E Sijens
- Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology/Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, The Netherlands
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Fraisse A, Aldebert P, Malekzadeh-Milani S, Thambo JB, Piéchaud JF, Aucoururier P, Chatelier G, Bonnet D, Iserin L, Bonello B, Assaidi A, Kammache I, Boudjemline Y. Melody ® transcatheter pulmonary valve implantation: results from a French registry. Arch Cardiovasc Dis 2014; 107:607-14. [PMID: 25453718 DOI: 10.1016/j.acvd.2014.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Percutaneous implantation of pulmonary valves has recently been introduced into clinical practice. AIM To analyse data of patients treated in France between April 2008 and December 2010. METHODS Prospective, observational, multi-centric survey by means of a database registry of the Filiale de cardiologie pédiatrique et congénitale. RESULTS Sixty-four patients were included, with a median (range) age of 21.4 (10.5-77.3) years. The majority (60.9%) of the patients were New York Heart Association (NYHA) class II. The most common congenital heart disease was tetralogy of Fallot with or without pulmonary atresia (50%). Indication for valve implantation was stenosis in 21.9%, regurgitation in 10.9% and association of stenosis and regurgitation in 67.2%. Implantation was successful in all patients. Pre-stenting was performed in 96.9% of cases. Median (range) procedure time was 92.5 (25-250) minutes. No significant regurgitation was recorded after the procedure, and the trans-pulmonary gradient was significantly reduced. Early minor complications occurred in five cases (7.8%). Three patients died during a median follow-up of 4.6 (0.2-5.2) years, two from infectious endocarditis and one from end-stage cardiac failure. Surgical reintervention was required in three patients. Follow-up with magnetic resonance imaging demonstrated significant improvements in right ventricular volumes and pulmonary regurgitation in mixed and regurgitant lesions. CONCLUSIONS Transcatheter pulmonary valve implantation is highly feasible and mid-term follow-up demonstrates sustained improvement of right ventricular function. Late endocarditis is of concern, therefore longer follow-up in more patients is urgently needed to better assess long-term outcome. CLINICAL TRIAL REGISTRATION NCT01250327.
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Affiliation(s)
- Alain Fraisse
- Cardiologie Pédiatrique, hôpital de la Timone-Enfants, 13385 Marseille, France
| | - Philippe Aldebert
- Cardiologie Pédiatrique, hôpital de la Timone-Enfants, 13385 Marseille, France
| | - Sophie Malekzadeh-Milani
- Pediatric Cardiology, unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence malformations cardiaques congénitales complexes-M3C, Necker Hospital for Sick Children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Unit for adults with congenital heart defects, centre de référence malformations cardiaques congénitales complexes-M3C, George-Pompidou European Hospital, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - Jean-Benoit Thambo
- Unit for children and adults with congenital heart defects, hospital Bordeaux, 33604 Bordeaux, France
| | | | - Pascaline Aucoururier
- Unit of Clinical Research (URC), George-Pompidou European Hospital, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - Gilles Chatelier
- Unit of Clinical Research (URC), George-Pompidou European Hospital, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - Damien Bonnet
- Pediatric Cardiology, unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence malformations cardiaques congénitales complexes-M3C, Necker Hospital for Sick Children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris-Descartes, Sorbonne Paris-Cité, 75008 Paris, France
| | - Laurence Iserin
- Unit for adults with congenital heart defects, centre de référence malformations cardiaques congénitales complexes-M3C, George-Pompidou European Hospital, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - Béatrice Bonello
- Cardiologie Pédiatrique, hôpital de la Timone-Enfants, 13385 Marseille, France
| | - Anass Assaidi
- Cardiologie Pédiatrique, hôpital de la Timone-Enfants, 13385 Marseille, France
| | - Issam Kammache
- Cardiologie Pédiatrique, hôpital de la Timone-Enfants, 13385 Marseille, France
| | - Younes Boudjemline
- Pediatric Cardiology, unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence malformations cardiaques congénitales complexes-M3C, Necker Hospital for Sick Children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Unit for adults with congenital heart defects, centre de référence malformations cardiaques congénitales complexes-M3C, George-Pompidou European Hospital, Assistance publique des Hôpitaux de Paris, 75015 Paris, France; Université Paris-Descartes, Sorbonne Paris-Cité, 75008 Paris, France.
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