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Paessler A, Forman C, Minhas K, Patel PA, Carmichael J, Smith L, Jaradat F, Assia-Zamora S, Arslan Z, Calder F, Ray S, Kessaris N, Stojanovic J. 3D printing: a useful tool for safe clinical practice in children with complex vasculature. Arch Dis Child 2024; 109:497-502. [PMID: 38627026 DOI: 10.1136/archdischild-2023-326201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/06/2023] [Indexed: 05/19/2024]
Abstract
BACKGROUND 3D printing has been used in different medical contexts, although it is underutilised in paediatrics. We present the first use of 3D printing in the management of three paediatric patients with complex renovascular disease. METHODS Patient-specific 3D models were produced from conventional 2D imaging and manufactured using 3D polyjet printing technology. All three patients had different underlying pathologies, but all underwent multiple endovascular interventions (renal artery balloon angioplasty) prior to 3D printing and subsequent vascular surgery. The models were verified by an expert radiologist and then presented to the multidisciplinary team to aid with surgical planning. RESULTS Following evaluation of the 3D-printed models, all patients underwent successful uni/bilateral renal auto-transplants and aortic bypass surgery. The 3D models allowed more detailed preoperative discussions and more focused planning of surgical approach, therefore enhancing safer surgical planning. It influenced clinical decision-making and shortened general anaesthetic time. The families and the patients reported that they had a significantly improved understanding of the patient's condition and had more confidence in understanding proposed surgical intervention, thereby contributing to obtaining good-quality informed consent. CONCLUSION 3D printing has a great potential to improve both surgical safety and decision-making as well as patient understanding in the field of paediatrics and may be considered in wider surgical areas.
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Affiliation(s)
- Alicia Paessler
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Colin Forman
- Vascular Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Kishore Minhas
- Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Premal Amrishkumar Patel
- Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - James Carmichael
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Luke Smith
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Fayyad Jaradat
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sergio Assia-Zamora
- Transplant Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Zainab Arslan
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London Institute of Child Health, London, UK
| | - Francis Calder
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Transplant Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Samiran Ray
- Paediatric Intensive Care Unit, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Nicos Kessaris
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Transplantation, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Jelena Stojanovic
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London Institute of Child Health, London, UK
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Redhead ECG, Paessler A, Arslan Z, Patel P, Minhas K, Forman C, Hollis P, Lava S, Ionescu F, Manuel D, Ray S, Kessaris N, Giardini A, Ratnamma V, Dobby N, Tullus K, Simmonds J, Stojanovic J. Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions. Pediatr Nephrol 2024; 39:521-530. [PMID: 37658875 PMCID: PMC10728245 DOI: 10.1007/s00467-023-06123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Renovascular hypertension (RenoVH) is a cause of hypertension in children. A common cause of RenoVH is renal artery stenosis which acts by reducing blood supply to renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This longitudinal observational study aims to describe occurrence of cardiovascular changes secondary to RenoVH and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention. METHODS All patients with RenoVH referred to our centre, who received ≥ 1 endovascular intervention (some had also undergone surgical interventions) were included. Data were collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure and eight echocardiographic parameters pre- and post-intervention. RESULTS One hundred fifty-two patients met inclusion criteria and had on average two endovascular interventions; of these children, six presented in heart failure. Blood pressure (BP) control was achieved by 54.4% of patients post-intervention. Average z-scores improved in interventricular septal thickness in diastole (IVSD), posterior Wall thickness in diastole (PWD) and fractional shortening (FS); left ventricular mass index (LVMI) and relative wall thickness (RWT) also improved. PWD saw the greatest reduction in mean difference in children with abnormal (z-score reduction 0.25, p < 0.001) and severely abnormal (z-score reduction 0.23, p < 0.001) z-scores between pre- and post-intervention echocardiograms. Almost half (45.9%) had reduction in prescribed antihypertensive medications, and 21.3% could discontinue all antihypertensive therapy. CONCLUSIONS Our study reports improvement in cardiac outcomes after endovascular + / - surgical interventions. This is evidenced by BP control, and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters. A higher resolution version of the Graphical abstract is available as Supplementary information. SUPPLEMENTARY INFORMATION
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Affiliation(s)
- Emily C G Redhead
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Alicia Paessler
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Zainab Arslan
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Premal Patel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kishore Minhas
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Colin Forman
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Paolo Hollis
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Sebastiano Lava
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Florin Ionescu
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Devi Manuel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Samiran Ray
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nicos Kessaris
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Alessandro Giardini
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Vineetha Ratnamma
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nadine Dobby
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kjell Tullus
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jacob Simmonds
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jelena Stojanovic
- University College London Great Ormond Street Institute of Child Health, London, UK.
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK.
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Lazea C, Al-Khzouz C, Sufana C, Miclea D, Asavoaie C, Filimon I, Fufezan O. Diagnosis and Management of Genetic Causes of Middle Aortic Syndrome in Children: A Comprehensive Literature Review. Ther Clin Risk Manag 2022; 18:233-248. [PMID: 35330917 PMCID: PMC8938167 DOI: 10.2147/tcrm.s348366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cecilia Lazea
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Correspondence: Cecilia Lazea, Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, 68, Motilor Street, Cluj-Napoca, 400370, Romania, Tel +40 744353764, Email ;
| | - Camelia Al-Khzouz
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Crina Sufana
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Diana Miclea
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Ioana Filimon
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
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Kim SS, Stein DR, Ferguson MA, Porras D, Chaudry G, Singh MN, Smoot L, Kim HB, Vakili K. Surgical management of pediatric renovascular hypertension and midaortic syndrome at a single-center multidisciplinary program. J Vasc Surg 2020; 74:79-89.e2. [PMID: 33340698 DOI: 10.1016/j.jvs.2020.12.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the outcomes of various surgical approaches in the treatment of renovascular hypertension and midaortic syndrome (MAS) in children. METHODS We performed a retrospective medical record review of patients who had undergone surgery for renovascular hypertension from 2010 to 2018 at our center under the care of a multidisciplinary team. The operative interventions included mesenteric artery growth improves circulation (MAGIC), tissue expander-stimulated lengthening of arteries (TESLA), aortic bypass using polytetrafluorethylene, renal artery reimplantation, and autotransplantation. The MAGIC procedure uses the meandering mesenteric artery as a free conduit for aortic bypass. The TESLA procedure is based on lengthening the normal distal aorta and iliac arteries by gradual filling of a retroaortic tissue expander for several weeks, followed by resection of the stenotic aorta and subsequent primary reconstruction. RESULTS A total of 39 patients were identified, 10 with isolated renal artery stenosis, 26 with MAS, and 3 with systemic inflammatory vasculitis. The median age at presentation and surgery was 6.4 years (range, 0-16.3 years) and 9.3 years (range, 0-9.2 years), respectively. The MAS-associated syndromes included neurofibromatosis type 1 (15.4%) and Williams syndrome (5.1%), although most cases were idiopathic. At surgery, 33.3% had had stage 1 hypertension (HTN), 53.8% stage 2 HTN, and 12.8% normal blood pressure with a median of three antihypertensive medications. Follow-up of 37 patients at a median of 2.5 years demonstrated normal blood pressure in 86.1%, stage 1 HTN in 8.3%, and stage 2 HTN in 5.6%, with a median of one antihypertensive medication for the entire cohort. CONCLUSIONS The patterns of vascular involvement leading to renovascular hypertension in children are variable and complex, requiring thoughtful multidisciplinary planning and surgical decision-making. The MAGIC and TESLA procedures provide feasible approaches for aortic bypass and reconstruction using autologous tissues and will result in normalization of blood pressure in 85% of children 2.5 years after surgery.
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Affiliation(s)
- Stephanie S Kim
- Department of Surgery, Boston Children's Hospital, Boston, Mass
| | - Deborah R Stein
- Division of Nephrology, Boston Children's Hospital, Boston, Mass
| | | | - Diego Porras
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Gulraiz Chaudry
- Division of Interventional Radiology, Boston Children's Hospital, Boston, Mass
| | - Michael N Singh
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Leslie Smoot
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, Boston, Mass
| | - Khashayar Vakili
- Department of Surgery, Boston Children's Hospital, Boston, Mass.
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