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Faiola S, Mandalari M, Coco C, Casati D, Laoreti A, Mannarino S, Corti C, Consonni D, Cetin I, Lanna M. Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies. J Clin Med 2023; 12:4734. [PMID: 37510848 PMCID: PMC10381265 DOI: 10.3390/jcm12144734] [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: 06/11/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Right ventricular outflow tract anomalies (RVOTAs), such as pulmonary stenosis (PS), pulmonary atresia (PA), and pulmonary insufficiency (PI), are typical cardiac anomalies in monochorionic twins, and they are complicated by twin-to-twin transfusion syndrome (TTTS). The aim of this study was to conduct a long-term postnatal cardiological evaluation of prenatal RVOTAs in monochorionic diamniotic twin pregnancies complicated by TTTS and treated with fetoscopic laser surgery (FLS) and to analyze possible prenatal predictors of congenital heart disease (CHD). Prenatal RVOTAs were retrospectively retrieved from all TTTS cases treated with FLS in our unit between 2009 and 2019. Twenty-eight prenatal cases of RVOTAs (16 PI, 10 PS, 2 PA) were observed out of 335 cases of TTTS. Four cases did not reach the postnatal period. CHD was present in 17 of the remaining 24 cases (70.8%), with 10 being severe (58.8%; 10/17); nine cases of PS required balloon valvuloplasty, and one case required biventricular non-compaction cardiomyopathy. The risk of major CHD increased with prenatal evidence of PS and decreased with the gestational age at the time of TTTS and with the prenatal normalization of blood flow across the pulmonary valve. Despite treatment with FLS, the majority of monochorionic diamniotic twin pregnancies complicated by TTTS with prenatal RVOTAs had CHD at long-term follow-up.
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Affiliation(s)
- Stefano Faiola
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Maria Mandalari
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Chiara Coco
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Daniela Casati
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Arianna Laoreti
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Carla Corti
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Mariano Lanna
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
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Argun M, Sunkak S, Elmalı F, Keskin Ş, Narin N. Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns. Cardiol Young 2023; 33:1092-1096. [PMID: 37458250 DOI: 10.1017/s1047951123002469] [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] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Peripheral perfusion index has been proposed as a possible method for detecting circulatory impairment. We aimed to determine the normal range of peripheral perfusion index in healthy newborns and compare it with that of newborns with CHD. METHODS Right-hand saturation and right-hand peripheral perfusion index levels were recorded, and physical examination and echocardiography were performed in newborns who were 0-28 days old and whom were evaluated in our paediatric cardiology outpatient clinic. The saturation and peripheral perfusion index levels of newborns with normal heart anatomy and function were compared with those of newborns with CHD. RESULTS Out of 358 newborns (238 mature and 75 premature) enrolled in the study, 39 had CHD (20 mild CHD, 13 moderate CHD, and 6 severe CHD), of which 29 had CHD with left-to-right shunting, 5 had obstructive CHD, and 5 had cyanotic CHD. No newborn had clinical signs of hypoperfusion or heart failure, such as prolonged capillary refill, weakened pulses, or coldness of extremities. Peripheral perfusion index level was median (interquartile range) 1.7 (0.6) in healthy newborns, 1.8 (0.7) in newborns with mild CHD, and 1.8 (0.4) in newborns with moderate and severe CHD, and there was no significant difference between the groups regarding peripheral perfusion index level. CONCLUSION Peripheral perfusion index remains unchanged in newborns with CHD without the clinical signs of hypoperfusion or heart failure. Larger studies with repeated peripheral perfusion index measurements can determine how valuable this method will be in the follow-up of newborns with CHD.
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Affiliation(s)
- Mustafa Argun
- Department of Pediatric Cardiology, Health Sciences University, Kayseri Medical Faculty, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Süleyman Sunkak
- Department of Pediatric Cardiology, Health Sciences University, Kayseri Medical Faculty, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Ferhan Elmalı
- Department of Biostatistics, İzmir Katip Çelebi University Medical Faculty, İzmir, Turkey
| | - Şuayip Keskin
- Department of Pediatrics, Health Sciences University, Kayseri Medical Faculty, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Nazmi Narin
- Department of Pediatric Cardiology, İzmir Katip Çelebi University Medical Faculty, İzmir, Turkey
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Small AJ, Bhatla P, Saric M, Halpern DG, Kutty S. Congenital anatomy, acquired pathology - A synergistic approach to echocardiographic evaluation of the adult with congenital heart disease. Echocardiography 2023; 40:158-160. [PMID: 36897538 DOI: 10.1111/echo.15519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/20/2022] [Indexed: 03/11/2023] Open
Affiliation(s)
- Adam J Small
- Adult Congenital Heart Disease, NYU Grossman School of Medicine, New York, New York, USA
| | - Puneet Bhatla
- Director, Pediatric and Congenital Cardiovascular Imaging, NYU Grossman School of Medicine, New York, New York, USA
| | - Muhamed Saric
- Clinical Director, Non-Invasive Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Dan G Halpern
- Medical Director, Adult Congenital Heart Disease, NYU Grossman School of Medicine, New York, New York, USA
| | - Shelby Kutty
- Director, Pediatric and Congenital Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Repeat balloon valvuloplasty for dogs with recurrent or persistent pulmonary stenosis. J Vet Cardiol 2021; 34:29-36. [PMID: 33548736 DOI: 10.1016/j.jvc.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION/OBJECTIVES Pulmonary stenosis (PS) is a common congenital defect in the dog. Severe valvar PS can be treated with balloon valvuloplasty (BV) to reduce obstruction severity and improve clinical signs. Repeat BV is often unnecessary, as restenosis is uncommon. Repeated pulmonary BV in people is generally successful and safe, but outcomes in dogs with recurrent or persistent stenosis have not been reported. The objectives of this study were to retrospectively evaluate outcomes of repeat BV in dogs. ANIMALS, MATERIALS, AND METHODS Medical records and stored echocardiographic images were reviewed from dogs that received repeat BV for pulmonary valvar restenosis or persistent stenosis. Echocardiographic variables included maximum systolic ejection velocity (PVmax), velocity-derived maximal pressure gradient (PGmax) and velocity time integral (VTI) across the pulmonary valve, and ratios of pulmonic to aortic maximum velocity (PVmax/AVmax) and VTI (VTIPV/VTIAV). RESULTS Twenty-three dogs were included; one underwent three BV procedures. The median time between BV procedures was 18.3 months (interquartile range, 6.3-43.6). One dog died during repeat BV, but no others experienced adverse effects. Reductions in PVmax, PGmax, and VTIPV after initial and repeat BV were 1.85 m/s, 76.2 mmHg, and 44.7 cm and 1.33 m/s, 55.6 mmHg, and 30.2 cm, respectively (all p < 0.01). Differences between pre-BV and post-BV PVmax, PGmax, VTIPV, PVmax/AVmax, and VTIPV/VTIAV were not different comparing initial to repeat BV (all p > 0.10). CONCLUSIONS Repeat BV for recurrent or persistent PS is well tolerated and effective in a majority of dogs.
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Wang J, Zhou Y, Wang Q, Du B, Wu Y, Chen Q, Zhang X, Lu Y, Chen S, Sun K. Elabela: A Novel Biomarker for Right Ventricular Pressure Overload in Children With Pulmonary Stenosis or Pulmonary Atresia With Intact Ventricular Septum. Front Cardiovasc Med 2020; 7:581848. [PMID: 33282918 PMCID: PMC7688667 DOI: 10.3389/fcvm.2020.581848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/08/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Assessing right ventricular overload in children is challenging. We conducted this study involving children with pulmonary valvular stenosis (PS) or pulmonary atresia with intact ventricular septum (PA/IVS) to evaluate the potential of a new endogenous ligand of apelin receptor, Elabela (ELA), as a potential biomarker for right heart overload. Methods: In this prospective cohort study, a total of 118 congenital heart diseases patients with right ventricle outflow tract obstruction were recruited from 2018 to 2019. Among them, 44 isolated PS and 7 PA/IVS patients were selected. Their venous blood was collected, and all patients underwent an echocardiographic examination. Among them, post-operative blood was collected from 24 patients with PS after percutaneous balloon pulmonary valvuloplasty. The plasma ELA concentration was measured using enzyme-linked immunosorbent assay. Results: The ELA was significantly associated with the peak transvalvular pulmonary gradient (r = −0.62; p = 0.02), thus reflecting the severity of PS or PA/IVS. The ELA significantly increased at 3 days after intervention, when mechanical obstruction of the right outflow tract was relieved. Based on the receiver-operator characteristic curve results, ELA could be a risk factor for duct dependence in patients with critical PS or PA/IVS who are younger than 6 months (AUC: 0.82). Conclusion: ELA concentration and severity of PS or PA/IVS had a significant negative correlation, indicating that ELA might be a novel biomarker for right ventricular afterload and reflect the immediate pressure changes in the right heart. Furthermore, ELA could predict duct-dependency in PS and PA/IVS patients, as valuable as classical echocardiographic indexes.
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Affiliation(s)
- Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Zhou
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingjie Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bowen Du
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yurong Wu
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Chen
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanan Lu
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Echocardiographic Follow-Up of Congenital Aortic Valvular Stenosis II. Pediatr Cardiol 2018; 39:1547-1553. [PMID: 29980825 DOI: 10.1007/s00246-018-1928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
We evaluated the natural course of congenital aortic valvular stenosis (AVS) and factors affecting AVS progression during long-term follow-up with echocardiography. Medical records of 388 patients with AVS were reviewed; patients with concomitant lesions other than aortic regurgitation (AR) were excluded. Trivial AVS was defined as a transvalvular Doppler peak systolic instantaneous gradient of < 25 mmHg; mild stenosis, 25-49 mmHg; moderate stenosis, 50-75 mmHg; and severe stenosis, > 75 mmHg. Median age of the patients was 3 years (range 0 day to 21 years), and 287 (74%) were male. A total of 355 patients were followed with medical treatment alone for a median of 4.6 years (range 1 month to 20.6 years), and the degree of AVS increased in 75 (21%) patients. The risk of AVS progression was higher when AVS was diagnosed in neonates (OR 4.29, CI 1.81-10.18, p = 0.001) and infants (OR 3.79, CI 2.21-6.49, p = 0.001). After the infancy period, bicuspid valve morphology increased AVS progression risk (OR 2.4, CI 1.2-4.6, p = 0.034). Patients with moderate AVS were more likely to have AVS progression (OR 2.59, CI 1.3-5.1, p = 0.006). Bicuspid valve morphology increased risk of AR development/progression (OR 1.77, CI 1.1-2.7, p = 0.017). The patients with mild and moderate AVS were more likely to have AR development/progression (p = 0.001). The risk of AR development/progression was higher in patients with AVS progression (OR 2.25, CI 1.33-3.81, p = 0.002). Newborn babies and infants should be followed more frequently than older patients according to disease severity. Bicuspid aortic valve morphology and moderate stenosis are risk factors for the progression of AVS and AR.
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Atik SU, Eroğlu AG, Çinar B, Bakar MT, Saltik İL. Comparison of Balloon Dilatation and Surgical Valvuloplasty in Non-critical Congenital Aortic Valvular Stenosis at Long-Term Follow-Up. Pediatr Cardiol 2018; 39:1554-1560. [PMID: 29923134 DOI: 10.1007/s00246-018-1929-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/06/2018] [Indexed: 02/04/2023]
Abstract
The two main modalities used for congenital aortic valvular stenosis (AVS) treatment are balloon aortic valve dilatation (BAD) and surgical aortic valvuloplasty (SAV). This study evaluates residual and recurrent stenosis, aortic regurgitation (AR) development/progression, reintervention rates, and the risk factors associated with this end point in patients with non-critical congenital AVS who underwent BAD or SAV after up to 18 years of follow-up. From 1990 to 2017, 70 consecutive interventions were performed in patients with AVS, and 61 were included in this study (33 BADs and 28 SAVs). There were no significant differences in age, sex distribution, PSIG, and AR frequency between the BAD and SAV groups. Bicuspid valve morphology was more common in the BAD group than the SAV group. There was no statistically significant difference between PSIGs and AR development or progression after intervention at the immediate postoperative echocardiography of patients who underwent BAD or SAV (p = 0.82 vs. p = 0.29). Patients were followed 6.9 ± 5.1 years after intervention. The follow-up period in the SAV group was longer than that of the BAD group (9.5 ± 5.4 vs. 5.5 ± 4.4 years, p = 0.003). There was no statistically significant difference in the last echocardiographic PSIG between patients who underwent SAV or BAD (51.1 ± 33.5 vs. 57.3 ± 35.1, p = 0.659). Freedom from reintervention was 81.3% at 5 years and 57.5% at 10 years in the BAD group and 95.5% at 5 years and 81.8% at 10 years in the SAV group, respectively (p = 0.044). There was no difference in postprocedural immediate PSIG and last PSIG at follow-up and the development/progression of AR between patients who were treated with BAD versus SAV. However, long-term results of SAV were superior to those of BAD, with a somewhat prolonged reintervention interval.
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Affiliation(s)
- Sezen Ugan Atik
- Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Ayşe Güler Eroğlu
- Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Betül Çinar
- Department of Pediatrics, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Murat Tuğberk Bakar
- Department of Public Health, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - İrfan Levent Saltik
- Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
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