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Strengths, Limitations, and Geographical Discrepancies in the Eligibility Criteria for Sport Participation in Young Patients With Congenital Heart Disease. Clin J Sport Med 2018; 28:540-560. [PMID: 28742603 DOI: 10.1097/jsm.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Benefits of physical activity has been shown in children with congenital heart disease (CHD). In several forms of CHD, the risk of sudden death remains a major concern both for parents and clinicians, who in turn will have to consider the risk-benefit ratio of sport participation versus restriction. DATA SOURCE A literature search was performed within the National Library of Medicine using the keywords: Sport, CHD, and Eligibility. The search was further refined by adding the keywords: Children, Adult, and Criteria. MAIN RESULTS Fifteen published studies evaluating sport eligibility criteria in CHD were included. Seven documents from various scientific societies have been published in the past decade but which of them should be adopted remains unclear. Our research highlighted accuracy and consistency of the latest documents; however, differences have emerged between the US and European recommendations. Eligibility criteria were consistent between countries for simple congenital heart defects, whereas there are discrepancies for borderline conditions including moderate valvular lesions and mild or moderate residual defects after CHD repair. Furthermore, some of the more severe defects were not evaluated. Multiple recommendations have been made for the same CHD, and cut-off values used to define disease severity have varied. Published eligibility criteria have mainly focused on competitive sports. Little attention was paid to recreational activities, and the psychosocial consequences of activity restriction were seldom evaluated. CONCLUSIONS Comprehensive consensus recommendations for sport eligibility evaluating all CHD types and stages of repair are needed. These should include competitive and recreational activities, use standardized classifications to grade disease severity, and address the consequences of restriction.
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Shiraishi S, Takahashi M, Sugimoto A, Tsuchida M. Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient. J Thorac Dis 2018; 9:5112-5119. [PMID: 29312717 DOI: 10.21037/jtd.2017.11.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To determine potential predictors of ventricular tachyarrhythmia and sudden cardiac death (SCD) occurring late after repair of tetralogy of Fallot (TOF). Methods Since 1964, 415 patients had undergone total repair for TOF at Niigata University Hospital. Of these, 89 patients who were followed for more than 10 years at our institute were retrospectively reviewed. Results The mean follow-up period was 24.3 years. During the study period, one patient died of cerebral bleeding, and two patients had SCD. The overall survival rates at 20, 30, and 40 years were 100%, 94.6%, and 94.6%, respectively. Eight (9.0%) patients required re-intervention during the late period associated with right ventricular outflow (n=4), tricuspid valve (n=3), aortic valve (n=2), and others (n=2). Ten (11.2%) patients had a history of ventricular tachycardia (VT) or ventricular fibrillation (VF), and six underwent implantation of an implantable cardiac defibrillator. Multivariate analysis selected the change rate of QRS duration [ms/year; odds ratio (OR), 2.44; 95% confidence interval (CI): 1.28-4.65; P=0.007] and the pressure gradient at tricuspid valve regurgitation on echocardiography (OR, 1.12; 95% CI: 1.02-1.22; P=0.017) as risk factors for VT/VF or SCD. Trans-annular patch (TAP) repair was not an independent risk factor for ventricular arrhythmia. Conclusions The combination of rapid change rate of QRS duration and higher-pressure gradient at tricuspid regurgitation were risk factors for ventricular tachyarrhythmia late after TOF repair. Adequate surgical or catheter intervention for pressure and volume load in the right ventricle might decrease the prevalence of VT/VF and SCD.
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Affiliation(s)
- Shuichi Shiraishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masashi Takahashi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ai Sugimoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Dobson RJ, Mordi I, Danton MH, Walker NL, Walker HA, Tzemos N. Late gadolinium enhancement and adverse outcomes in a contemporary cohort of adult survivors of tetralogy of Fallot. CONGENIT HEART DIS 2016; 12:58-66. [DOI: 10.1111/chd.12403] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/19/2016] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Richard J. Dobson
- Scottish Adult Congenital Cardiac Service; Golden Jubilee National Hospital, Clydebank; Dunbartonshire United Kingdom
| | - Ify Mordi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow; Glasgow United Kingdom
| | - Mark H. Danton
- Scottish Adult Congenital Cardiac Service; Golden Jubilee National Hospital, Clydebank; Dunbartonshire United Kingdom
| | - Niki L. Walker
- Scottish Adult Congenital Cardiac Service; Golden Jubilee National Hospital, Clydebank; Dunbartonshire United Kingdom
| | - Hamish A. Walker
- Scottish Adult Congenital Cardiac Service; Golden Jubilee National Hospital, Clydebank; Dunbartonshire United Kingdom
| | - Nikolaos Tzemos
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow; Glasgow United Kingdom
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Mazurek B, Szydlowski L, Mazurek M, Markiewicz-Loskot G, Pajak J, Morka A. Comparison of the Degree of Exercise Tolerance in Children After Surgical Treatment of Complex Cardiac Defects, Assessed Using Ergospirometry and the Level of Brain Natriuretic Peptide. Medicine (Baltimore) 2016; 95:e2619. [PMID: 26937900 PMCID: PMC4778997 DOI: 10.1097/md.0000000000002619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/26/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
Children who underwent surgery for complex congenital heart defects present worse exercise capacity than their healthy peers. In adults and adolescents, heart failure is assessed on the basis of clinical symptoms using the New York Heart Association (NYHA) score, while in an infant Ross scale; heart failure can also be evaluated by other parameters. The purpose of this study was to compare the degree of exercise tolerance in children after surgery for complex heart defects, assessed by the ratio of maximum oxygen uptake (VO2max) and the brain natriuretic peptide (N-terminal fragment of the prohormone brain-type natriuretic peptide [NT-proBNP]) concentration.The study group consisted of 42 children, ages 9 to 17 years (mean 14.00 ± 2.72). Among them there were 22 children with tetralogy of Fallot (ToF) after total correction, 18 children with transposition of the great arteries (d-TGA) after the arterial switch operation, and 2 children with single ventricle (SV) after the Fontan operation. All but 1 child were in NYHA class I. The control group consisted of 20 healthy children. Outcomes of interest were the ratio of VO2max, determined during ergospirometry, and the level of NT-proBNP. The statistical analysis was performed and the groups were considered significantly different for P < 0.05.There was no statistically significant correlation between NT-proBNP and maximum oxygen uptake (VO2) kg min in the study group compared with the control group.The VO2max in the test group had a mean value less (34.6 ± 8.0) than controls (38.4 ± 7.7), and the differences were statistically significant (P = 0.041). In contrast, the average concentration of NT-proBNP in the study group was higher than controls (117.9 ± 74.3 vs 18.0 ± 24.5), and these differences were statistically significant (P < 0.001).After operations for complex heart defects (ToF, TGA, and SV), children have worse heart function parameters and exercise capacity than the healthy population. To control this, we recommend postoperative ergospirometry and determination of NT-proBNP concentrations.
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Affiliation(s)
- Boguslaw Mazurek
- From the Department of Pediatrics Cardiology, School of Medicine (BM, LS, JP) and Department of Nursing and Social Medical Problems Chair of Nursing, School of Health Sciences (GM-L), Medical University of Silesia, Katowice, Poland; Upper Silesian Center of Children's Health, Katowice (MM); Department of Pediatric Cardiosurgery and Cardiosurgical Intensive Care University Children Hospital, Faculty of Medicine and Faculty of Health Sciences Jagiellonian University Medical College, Krakow, Poland (AM); and Faculty of Medicine, Department of Pediatric Cardiosurgery, Polish-American Institute of Pediatrics, and Faculty of Health Sciences, Jagiellonian University Medical College (AM), Krakow, Poland
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Ono S, Ohuchi H, Miyazaki A, Abe T, Kiso K, Yamada O. Heterogeneity of Ventricular Sympathetic Nervous Activity is Associated with Clinically Relevant Ventricular Arrhythmia in Postoperative Patients with Tetralogy of Fallot. Pediatr Cardiol 2015; 36:1515-22. [PMID: 25981565 DOI: 10.1007/s00246-015-1195-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/06/2015] [Indexed: 12/29/2022]
Abstract
This study aimed to clarify whether there is an association between ventricular sympathetic nervous activity (SNA) and clinically relevant ventricular arrhythmia (a run of ≥ 3 consecutive ventricular beats, RVA) in postoperative patients with tetralogy of Fallot (TOF). We performed a retrospective study in a national referral center of pediatric cardiology in Japan. Twenty-four postoperative TOF patients (13 males, median age 17 years) undergoing myocardial (123)I metaiodobenzylguanidine (MIBG) scintigraphy were included. We measured the heart-to-mediastinum ratio (HMR) and washout ratio (WR) from planar MIBG myocardial scintigraphy. Tomographic images and polar maps were generated with 20 segments. The standard deviation of percentage uptake of 20 segments (SD-uptake) as an index of heterogeneous MIBG uptake to the ventricular myocardium was calculated. We compared these MIBG-derived variables with the patients' clinical profiles, including ECG findings and hemodynamics. Eight of 24 patients had RVA (RVA group), and the other 16 did not have RVA (non-RVA group). There were no significant differences in the HMR (1.9 ± 0.5 vs. 2.2 ± 0.4) and WR (50 ± 5 vs. 42 ± 10) between the two groups. SD-uptake was significantly higher in the RVA group than in the non-RVA group (15 ± 3 vs. 12 ± 3, p = 0.03). QT dispersion (ms) was also higher in the RVA group than in the non-RVA group (53 ± 23 vs. 44 ± 18, p = 0.04). Multivariate logistic regression showed that SD-uptake and QT dispersion were independent predictors in the RVA group (p = 0.02, p = 0.03). In addition to greater QT dispersion, heterogeneous SNA is associated with RVA in TOF patients postoperatively.
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Affiliation(s)
- Shin Ono
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
| | - Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Tadaaki Abe
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Keisuke Kiso
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Osamu Yamada
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
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Gao Y, Jacot JG. Stem Cells and Progenitor Cells for Tissue-Engineered Solutions to Congenital Heart Defects. Biomark Insights 2015; 10:139-46. [PMID: 26379417 PMCID: PMC4554358 DOI: 10.4137/bmi.s20058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/01/2015] [Accepted: 03/04/2015] [Indexed: 02/06/2023] Open
Abstract
Synthetic patches and fixed grafts currently used in the repair of congenital heart defects are nonliving, noncontractile, and not electrically responsive, leading to increased risk of complication, reoperation, and sudden cardiac death. Studies suggest that tissue-engineered patches made from living, functional cells could grow with the patient, facilitate healing, and help recover cardiac function. In this paper, we review the research into possible sources of cardiomyocytes and other cardiac cells, including embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells, adipose-derived stem cells, umbilical cord blood cells, amniotic fluid-derived stem cells, and cardiac progenitor cells. Each cell source has advantages, but also has technical hurdles to overcome, including heterogeneity, functional maturity, immunogenicity, and pathogenicity. Additionally, biomaterials used as patch materials will need to attract and support desired cells and induce minimal immune responses.
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Affiliation(s)
- Yang Gao
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Jeffrey G Jacot
- Department of Bioengineering, Rice University, Houston, TX, USA
- Congenital Heart Surgery Services, Texas Children’s Hospital, Houston, TX, USA
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Gao Y, Connell JP, Wadhwa L, Ruano R, Jacot JG. Amniotic fluid-derived stem cells demonstrated cardiogenic potential in indirect co-culture with human cardiac cells. Ann Biomed Eng 2014; 42:2490-500. [PMID: 25266932 PMCID: PMC4241123 DOI: 10.1007/s10439-014-1114-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/05/2014] [Indexed: 01/15/2023]
Abstract
Amniotic fluid-derived stem cells (AFSC) have been shown to be broadly multipotent and non-tumorogenic. Previous studies of direct mixing of AFSC and neonatal rat ventricle myocytes indicated evidence of AFSC cardiogenesis. In this study, we examined human AFSC cardiogenic potential in indirect co-culture with human cardiac cells in conditions that eliminated the possibility of cell fusion. Human AFSC in contact with human cardiac cells showed expression of cardiac troponin T (cTnT) in immunohistochemistry, and no evidence of cell fusion was found through fluorescent in situ hybridization. When indirectly co-cultured with cardiac cells, human AFSC in contact with cardiac cells across a thin porous membrane showed a statistically significant increase in cTnT expression compared to non-contact conditions but lacked upregulation of calcium modulating proteins and did not have functional or morphological characteristics of mature cardiomyocytes. This suggests that contact is a necessary but not sufficient condition for AFSC cardiac differentiation in co-culture with cardiac cells.
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Affiliation(s)
- Yang Gao
- Department of Bioengineering, Rice University, Houston, Texas
| | | | - Lalita Wadhwa
- Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, Texas
| | - Rodrigo Ruano
- Fetal Center, Pavilion for Women, Texas Children’s Hospital, Houston, Texas
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G. Jacot
- Department of Bioengineering, Rice University, Houston, Texas
- Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, Texas
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Gu Q, Chen XT, Xiao YB, Chen L, Wang XF, Fang J, Chen BC, Hao J. Identification of differently expressed genes and small molecule drugs for Tetralogy of Fallot by bioinformatics strategy. Pediatr Cardiol 2014; 35:863-9. [PMID: 24463614 DOI: 10.1007/s00246-014-0868-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/03/2014] [Indexed: 12/20/2022]
Abstract
This study aimed to screen out differentially expressed genes (DEGs) and explore small molecule drugs for Tetralogy of Fallot (TOF). The gene expression profile of TOF GSE26125 was downloaded from the Gene Expression Omnibus database, including 16 idiopathic TOF samples and five healthy controls. The DEGs were identified by the Limma package in R language and underwent functional enrichment analysis via Database for Annotation, Visualization and Integrated Discovery tools. A protein-protein interaction (PPI) network of DEGs was then constructed and the significant clusters were selected for functional analysis. In addition, the DEGs were mapped to the connectivity map (CMap) database to identify potential small-molecule drugs. As a result, a total of 499 DEGs were selected between TOF and healthy controls. Meanwhile, the functional changes of DEGs related to TOF were mainly associated with cellular respiration and energy metabolism. Furthermore, in the PPI network, two clusters were identified via cluster 1 analysis. And only cluster 1 was significantly enriched into gene ontology terms, including respiratory chain, electron transport chain, and oxidation reduction. The hub gene of cluster 1 was NDUFAB1. Additionally, small molecules, such as harmine, solanine, and testosterone, may have the potential to repair the disordered metabolic pathways of TOF.
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Affiliation(s)
- Qiang Gu
- Institute of Cardiovascular Surgery, Second Affiliated Hospital of Third Military, Medical University, No.183 Xinqiao Street, Shapingba District, Chongqing, 400037, People's Republic of China,
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Niu MC, Morris SA, Morales DLS, Fraser CD, Kim JJ. Low incidence of arrhythmias in the right ventricular infundibulum sparing approach to tetralogy of Fallot repair. Pediatr Cardiol 2014; 35:261-9. [PMID: 23921493 DOI: 10.1007/s00246-013-0767-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 07/19/2013] [Indexed: 11/29/2022]
Abstract
To improve outcomes, including arrhythmia incidence, for patients with tetralogy of Fallot (TOF), the authors' institution adopted an approach that minimizes or avoids transmural incision of the right ventricular outflow tract. When pulmonary blood flow is insufficient during the neonatal period, placement of an aortopulmonary artery shunt is preferred, followed by complete repair later in infancy. This study reviewed the perioperative and mid-term arrhythmia outcomes at the authors' institution using this approach. Patients who underwent TOF repair from 1995 to 2008 were included in the study. Patient demographics and surgical history were collected. The primary end points of the study included documented perioperative arrhythmias and arrhythmias at the 10-year follow-up assessment. Of the 298 patients who underwent TOF repair, 50 (17 %) had undergone prior placement of a systemic-to-pulmonary artery shunt. The median age at repair was 9.7 months (interquartile range, 6.3-16.2 months). Clinically significant perioperative arrhythmias were found in 12 patients (4 %) including 6 junctional tachycardias, 4 atrial tachycardias, and 1 temporary complete heart block. No patients were receiving antiarrhythmic medications more than 24 months after surgery. Of the 298 patients, 86 (29 %) had a follow-up period of 10 years or longer (median, 12.2 years). No patients experienced new arrhythmias, received antiarrhythmic therapy, experienced post-discharge ventricular tachycardia, had atrioventricular block, or required a pacemaker or defibrillator. The right ventricular infundibulum sparing approach is associated with an extremely low incidence of perioperative and midterm arrhythmias. The perioperative and mid-term outcomes compare favorably with existing data from programs favoring neonatal repair. Long-term follow-up evaluation is essential to determine whether this strategy can effectively alter late pathophysiology and minimize late-term arrhythmias and associated mortality.
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Affiliation(s)
- Mary C Niu
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA,
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Piazza L, Chessa M, Giamberti A, Bussadori CM, Butera G, Negura DG, Micheletti A, Callus E, Carminati M. Timing of pulmonary valve replacement after tetralogy of Fallot repair. Expert Rev Cardiovasc Ther 2014; 10:917-23. [DOI: 10.1586/erc.12.67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aburawi EH, Souid AK, Liuba P, Zoubeidi T, Pesonen E. Early changes in myocardial repolarization and coronary perfusion after cardiopulmonary bypass surgery for ASD repair in children. BMC Cardiovasc Disord 2013; 13:67. [PMID: 24015980 PMCID: PMC3846500 DOI: 10.1186/1471-2261-13-67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 09/03/2013] [Indexed: 11/25/2022] Open
Abstract
Background In adults, impaired myocardial repolarization and increased risk of arrhythmia are known consequences of open heart surgery. Little is known, however, about post-operative consequences of cardiopulmonary bypass surgery in children. The aim of this study was to assess ventricular repolarization and coronary perfusion after bypass surgery for atrial septal defect (ASD) repair in children. Methods Twelve patients with ASD were assessed one day before and 5–6 days after ASD repair. Myocardial repolarization (corrected QT interval, QTc, QT dispersion, QTd, and PQ interval) was determined on 12-lead electrocardiograms. Coronary flow in proximal left anterior descending artery (peak flow velocity in diastole, PFVd) was assessed by transthoracic Doppler echocardiography. Results Ten of the 12 (83%) children had normal myocardial repolarization before and after surgery. After surgery, QTc increased 1-9% in 5 (42%) patients, decreased 2-11% in 5 (42%) patients and did not change in 2 (16%) patients. Post-op QTc positively correlated with bypass time (R=0.686, p=0.014) and changes in PFVd (R=0.741, p=0.006). After surgery, QTd increased 33-67% in 4 (33%) patients, decreased 25-50% in 6 patients (50%) and did not change in 2 (16%) patients. After surgery, PQ interval increased 5-30% in 4 (33%) patients, decreased 4-29% in 6 (50%) patients and did not change in 1 (8%) patient. Post-op PQ positively correlated with bypass time (R=0.636, p=0.027). As previously reported, PFVd significantly increased after surgery (p<0.001). Conclusions Changes in QTc, PQ and PFVd are common in young children undergoing surgery for ASD repair. Post-op QTc significantly correlates with bypass time, suggesting prolonged cardiopulmonary bypass may impair ventricular repolarization. Post-op QTc significantly correlates with PFVd changes, suggesting increased coronary flow may also impair ventricular repolarization. The clinical significance and reversibility of these alternations require further investigations.
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Affiliation(s)
- Elhadi H Aburawi
- Pediatric Department, Section of Pediatric Cardiology, Skane University Hospital, Lund University, Lund, Sweden.
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Hauser M, Eicken A, Kuehn A, Hess J, Fratz S, Ewert P, Kaemmerer H. Managing the right ventricular outflow tract for pulmonary regurgitation after tetralogy of Fallot repair. HEART ASIA 2013; 5:106-11. [PMID: 27326099 DOI: 10.1136/heartasia-2013-010319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/27/2013] [Accepted: 06/02/2013] [Indexed: 01/08/2023]
Abstract
The long-term outcome of patients with tetralogy of Fallot (TOF) with reconstruction of the right ventricular (RV) outflow tract is often complicated by the sequelae of severe pulmonary regurgitation. Progressive enlargement of the right ventricle, biventricular dysfunction and arrhythmia are apparent in more than 50% of the patients in the fourth decade of life. Pathophysiologic implications, clinical assessment and diagnostic modalities are discussed, whereas CMR imaging seems to be the procedure of choice. Therapeutical options for rereconstruction of the RV outflow tract are mentioned, surgical and interventional procedures are explained in detail. The optimal timing of reoperation for significant pulmonary regurgitation after TOF repair is still a matter of controversy given the limited runtime of the lately implanted prostheses and the risk of further reoperation. Early surgery is recommended in these patients before symptoms develop, or RV function has declined. Today we believe that waiting for the patient to become symptomatic is too late. All in all, pulmonary valve replacement is at least indicated in patients developing symptoms due to severe pulmonary regurgitation, particularly if associated with substantial or progressive RV dilatation, tricuspid regurgitation and/or supraventricular or ventricular arrhythmias.
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Affiliation(s)
- Michael Hauser
- Department of Pediatric Cardiology and Congenital heart Disease , Deutsches Herzzentrum München, Technische Universität München , Munich , Germany
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital heart Disease , Deutsches Herzzentrum München, Technische Universität München , Munich , Germany
| | - Andreas Kuehn
- Department of Pediatric Cardiology and Congenital heart Disease , Deutsches Herzzentrum München, Technische Universität München , Munich , Germany
| | - John Hess
- Department of Pediatric Cardiology and Congenital heart Disease , Deutsches Herzzentrum München, Technische Universität München , Munich , Germany
| | - Sohrab Fratz
- Department of Pediatric Cardiology and Congenital heart Disease , Deutsches Herzzentrum München, Technische Universität München , Munich , Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital heart Disease , Deutsches Herzzentrum München, Technische Universität München , Munich , Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital heart Disease , Deutsches Herzzentrum München, Technische Universität München , Munich , Germany
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QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview. ISRN CARDIOLOGY 2013; 2013:782508. [PMID: 23509638 PMCID: PMC3590565 DOI: 10.1155/2013/782508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 01/16/2013] [Indexed: 12/01/2022]
Abstract
Tetralogy of Fallot (TOF) is a congenital heart disease frequently treated by surgical repair to relieve symptoms and improve survival. However, despite the performing of an optimal surgical repair, TOF patients are at times characterized by a poor long-term survival rate, likely due to cardiac causes such as ventricular arrhythmias, with subsequent sudden death. In the 80s it was irrefutably demonstrated that QRS prolongation ≥180 msec at basal electrocardiogram is a strong predictor for refining risk stratification for ventricular tachycardia in these patients. The aim of this research was to undertake a review of all studies conducted to assess the impact of QRS duration on the development of life-threatening ventricular arrhythmias in repaired TOF subjects.
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Takken T, Giardini A, Reybrouck T, Gewillig M, Hövels-Gürich HH, Longmuir PE, McCrindle BW, Paridon SM, Hager A. Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the Exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology. Eur J Prev Cardiol 2011; 19:1034-65. [DOI: 10.1177/1741826711420000] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- T Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - A Giardini
- Cardiorespiratory Unit, Great Ormond Street Hospital For Children – UCL Institute of Child Health, London, UK
| | - T Reybrouck
- Department of Cardiovascular Rehabilitation University Hospitals Leuven (campus Gasthuisberg); Department Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - M Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven (campus Gasthuisberg), Leuven, Belgium
| | - HH Hövels-Gürich
- Department of Paediatric Cardiology, Children's Heart Centre, University Hospital, Aachen University of Technology, Aachen, Germany
| | - PE Longmuir
- Hospital for Sick Children (Labatt Family Heart Centre), Toronto, Ontario, Canda; University of Toronto (Department of Physical Therapy) Toronto, Ontario Canada, Children's Hospital of Eastern Ontario (Healthy Active Living and Obesity Research Unit), Ottawa, Ontario, Canada
| | - BW McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - SM Paridon
- Cardiology Division, The Children's Hospital of Philadelphia Professor of Pediatrics The Perlman School of Medicine The University of Pennsylvania
| | - A Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, Bella PD, Hindricks G, Jais P, Josephson ME, Kautzner J, Kay GN, Kuck KH, Lerman BB, Marchlinski F, Reddy V, Schalij MJ, Schilling R, Soejima K, Wilber D. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace 2009; 11:771-817. [DOI: 10.1093/europace/eup098] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Semeraro O, Scott B, Vermeersch P. Surgical correction of tetralogy of Fallot in a seventy-five year old patient. Int J Cardiol 2008; 128:e98-100. [PMID: 17707101 DOI: 10.1016/j.ijcard.2007.05.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 05/26/2007] [Indexed: 10/22/2022]
Abstract
Tetralogy of Fallot is a congenital heart disease which is mostly diagnosed and treated in infancy. In the literature there are some cases where the diagnosis was made in adults. This report describes the case of a seventy-five year old man who presents with a dilated and severely hypertrophic right ventricle, a ventricular septum defect, an overriding aorta and a severe infundibular stenosis in the right ventricular outflow tract. The diagnosis of an unrepaired Tetralogy of Fallot was made. A full surgical correction of the Tetralogy was performed and the patient received an implantable defibrillator, making him the oldest patient repaired for Tetralogy of Fallot.
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Cross KP, Santucci KA. Transitional medicine: will emergency medicine physicians be ready for the growing population of adults with congenital heart disease? Pediatr Emerg Care 2006; 22:775-81. [PMID: 17198208 DOI: 10.1097/01.pec.0000245178.13418.4f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Currently, approximately 85% of children with significant congenital heart problems survive to adolescence and adulthood. This survival rate represents a dramatic improvement in the medical and surgical care of congenital heart disease (CHD) during the last 35 years. Nevertheless, these patients remain at increased risk for significant cardiac problems long after primary interventions are completed. They are more likely than the general population to seek urgent medical care, often in an emergency department setting. They represent a new and growing population of emergency department patients with a specialized set of problems not traditionally part of the training for emergency medicine (EM) physicians. OBJECTIVE We investigated the current scope and status of training for EM physicians in the immediate management of CHD patients as they grow to adolescence and adulthood. METHODS We conducted 2 cross-sectional surveys to assess the current training environment for 2 specific groups: (1) US general EM (GEM) residency programs, and (2) US and Canadian pediatric EM (PEM) fellowship programs. Surveys were mailed to program directors during the summer of 2005. A total of 198 surveys were sent out: 134 to GEM residency directors and 64 to PEM fellowship directors. RESULTS The response rate overall was 68%, with a 64% response rate from the GEM residency directors and 77% from the PEM fellowship directors. Across all programs, 43% (56/130 respondents) were "unsure" about the existence or location of an adult CHD (ACHD) clinic in their area. When asked to rate the importance of ACHD as a training topic, 40 (85%) of 47 PEM fellowship directors and 62 (74%) of 84 GEM residency directors ranked it as "low priority" or "unnecessary." However, 70 (55%) of 127 respondents were "unsure," "uncomfortable," or "worried" about the ACHD training their trainees receive (PEM, 59%; GEM, 53%). In addition, most program directors (75%) estimated that their trainees care for 5 or fewer ACHD patients annually. CONCLUSIONS There seems to be a mismatch between the growing need for ACHD emergency care and the current state of this topic in both GEM residency and PEM fellowship training programs.
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Affiliation(s)
- Keith P Cross
- Yale-New Haven Children's Hospital, 20 York Street, Room WP-143, New Haven, CT 06520, USA.
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Herold SE, Young TW, Ge D, Snieder H, Lovrekovic GZ. Sleep disordered breathing in pediatric patients with tetralogy of Fallot. Pediatr Cardiol 2006; 27:243-9. [PMID: 16235013 DOI: 10.1007/s00246-005-1168-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adverse effects on the pulmonary circulation in obstructive sleep disordered breathing (SDB) may place children with heart lesions affecting the right ventricle at increased risk for morbidity and mortality. We examined the distribution and effects of SDB in pediatric patients with tetralogy of Fallot (TOF). Families of 37 pediatric patients with TOF completed a survey of cardiac symptoms and school performance as well as a Pediatric Sleep Questionnaire (PSQ), a validated questionnaire for the screening of SDB in children 2-18 years of age. Medical records were reviewed for growth parameters, medical history, and most recent electrocardiogram (ECG) findings. Data from patients with SDB (PSQ score > or = 8, n = 14) were compared to data from patients without SDB (PSQ score < 8; n = 23). The prevalence of SDB in this population (38%) was significantly higher than the published prevalence of 5% in a healthy general pediatric population (p < 0.001). No significant difference was found in age, gender, or age and sex standardized body mass index between patients with or without SDB. No difference was seen in medication use or timing of surgical repair, whether primary or palliative. Patients with SDB had a significantly higher cardiac symptom score (p = 0.01) and increasing PSQ scores correlated with worsening cardiac symptom scores (p = 0.006). Increasing PSQ scores also correlated with worsening school performance (p = 0.001). No differences were seen in ECG data. The screened prevalence of SDB in the pediatric population with TOF is higher than in the general population; patients with TOF and SDB are more likely to have worse cardiac symptoms and poor school performance.
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Affiliation(s)
- S E Herold
- Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912, USA.
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Abstract
Sudden cardiac death is often due to a ventricular arrhythmia. When a patient presents with a malignant arrhythmia unrelated to a transient reversible cause, there is a high probability of recurrent arrhythmia and sudden death. Clinical trials have shown a uniform survival benefit from implantable cardioverter-defibrillator (ICD) therapy in survivors of a malignant arrhythmia when compared with drug therapy. However, only 1% to 5% of patients survive an out-of-hospital cardiac arrest, emphasizing the need for primary prevention of sudden death. Clinical trial data available in this regard are largely limited to patients with coronary artery disease (CAD). Mortality can be reduced by the ICD in patients with CAD and depressed left ventricular ejection fraction (LVEF) less than 30%. If left ventricular function is only moderately depressed (LVEF between 30% and 40%), the presence of nonsustained ventricular tachycardia with inducible ventricular arrhythmia at electrophysiologic testing identifies patients who benefit from an ICD. The role of the ICD in primary prevention of sudden death in patients with nonischemic dilated cardiomyopathy is less clear at this time. Preliminary data indicate that the presence of heart failure symptoms in this population increases risk of sudden death that can be prevented by an ICD. Antiarrhythmic drugs have little role in prevention of sudden death; however, drugs that block the effects of beta-adrenergic stimulation, angiotensin, and aldosterone reduce mortality partly through their salutary effects on sudden death. Finally, a number of inherited defects of genes coding for ion channels, contractile sarcomeric proteins, and cell-to-cell junction proteins can result in primary electrical abnormalities and sudden death. The ICD is effective for secondary prevention, but its role in primary prevention is controversial and should be based on individual risk factors.
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Bhat AH, Sahn DJ. Congenital heart disease never goes away, even when it has been 'treated': the adult with congenital heart disease. Curr Opin Pediatr 2004; 16:500-7. [PMID: 15367842 DOI: 10.1097/01.mop.0000140996.24408.1a] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW As the specialties of pediatrics and pediatric cardiology continue to forge ahead with better diagnoses, medical care, and surgical results, an expanding population of patients with congenital heart disease (CHD) outgrows the pediatric age group, yet does not quite graduate to routine adult cardiology or general medicine. The adult with congenital heart disease (ACHD) faces medical, surgical, and psychosocial issues that are unique to this population and must be addressed as such. This review attempts to discuss and highlight some of the important advances and controversies brought up in the past year, in the care and management of these patients. RECENT FINDINGS The past five to 10 years have seen dynamic interest in understanding sequelae of corrected, uncorrected, or palliated congenital heart disease. The search for the ideal surgery, optimal prosthesis, and a smooth transition to adult care continues and is reflected in the vast amount of academic work and publications in this field. Of particular interest, conduit reoperations and single ventricle pathway modifications are still an art and a science in evolution. SUMMARY While all are agreed that there is a pressing need to focus on the delivery of care to the adult with congenital heart disease, this essentially requires a clearer understanding of late sequelae of CHD. The sheer heterogeneity of anatomy, age, surgery, and institutional management protocols can make it difficult to develop clear guidelines. This review attempts to give an up-to-date perspective on some of the new findings related to the more common lesions and problems faced in this group.
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Affiliation(s)
- Aarti Hejmadi Bhat
- The Clinical Care Center for Congenital Heart Disease, Oregon Health & Science University, Portland, Oregon 97239-3098, USA
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