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Ciulpan A, Lacatușu A, Pop LL, Paul C, Lungeanu D, Iacob D, Bernad BC, Lascu A, Maghet E, Arnautu DA, Bernad ES. Incidence and Antenatal Detection of Congenital Heart Malformations-Data from a Tertiary Obstetric Romanian Center. Diagnostics (Basel) 2024; 14:1659. [PMID: 39125535 PMCID: PMC11311993 DOI: 10.3390/diagnostics14151659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/04/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVES Congenital heart defects (CHDs) are among the most frequent congenital defects, and they significantly burden the healthcare system due to their high mortality rate and high cost of care for survivors. We aimed to highlight the incidence of CHDs in a tertiary center in Western Romania. METHODS A retrospective study was carried out between 2018 and 2022 at the "Pius Brinzeu" Emergency County Hospital Timisoara. Relevant information about the mothers and the newborns were collected and statistically analyzed. RESULTS The incidence of CHDs from 2018 to 2022 in our center was 5.3%. Eleven types of malformations were diagnosed postnatally in 541 newborns, with 28.8% of cases having more than one type of CHD. The antenatal detection rate was 28%, with the highest rates for tetralogy of Fallot, hypoplastic left heart syndrome, or significant ventricular septal defects and the lowest for pulmonary stenosis. The lower antenatal detection rate was influenced mainly by incomplete or absent prenatal care. CONCLUSIONS The incidence of CHDs is clearly dependent of a multifactorial approach, and the results highlight this. With an incidence almost 50% lower than reported within the literature and a low rate of prenatal detections, CHDs could be a more of a burden to endure regarding medical treatment. Improvements in patients' education, prenatal care, and screening programs could improve diagnosis, decrease mortality, and optimize postnatal care.
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Affiliation(s)
- Adrian Ciulpan
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (A.C.); (B.-C.B.)
- IInd Pediatrics Clinic, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timișoara, Romania; (L.L.P.); (C.P.)
- Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adrian Lacatușu
- IInd Pediatrics Clinic, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timișoara, Romania; (L.L.P.); (C.P.)
- Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Liviu Laurenţiu Pop
- IInd Pediatrics Clinic, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timișoara, Romania; (L.L.P.); (C.P.)
- Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Corina Paul
- IInd Pediatrics Clinic, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timișoara, Romania; (L.L.P.); (C.P.)
- Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Department of Functional Sciences, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Daniela Iacob
- Department of Obstetrics and Gynecology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.I.); (E.S.B.)
- Clinic of Neonatology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Brenda-Cristiana Bernad
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (A.C.); (B.-C.B.)
- Center for Neuropsychology and Behavioral Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Multidisciplinary Heart Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Ana Lascu
- Department of Functional Sciences, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Institute of Cardiovascular Diseases Timișoara, 300310 Timișoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Edida Maghet
- Ist Department, Faculty of Dental Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Diana-Aurora Arnautu
- Multidisciplinary Heart Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Institute of Cardiovascular Diseases Timișoara, 300310 Timișoara, Romania
- Department of Internal Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Elena Silvia Bernad
- Department of Obstetrics and Gynecology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (D.I.); (E.S.B.)
- Center for Neuropsychology and Behavioral Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Ist Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timișoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
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Blixenkrone-Møller E, Dannesbo S, Dehn AM, Pihl CA, Sillesen AS, Vøgg ROB, Raja AA, Colan S, Mertens L, Vejlstrup N, Bundgaard H, Iversen K. Interatrial Communications: Prevalence and Subtypes in 12,385 Newborns-a Copenhagen Baby Heart Study. Pediatr Cardiol 2024:10.1007/s00246-024-03571-0. [PMID: 39003423 DOI: 10.1007/s00246-024-03571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
The prevalence of interatrial communications in newborns, i.e., patent foramen ovale or atrial septal defect, was previously reported to be between 24 and 92%, but the area has been impeded by lack of a universal classification method. A recently published novel echocardiographic diagnostic algorithm for systematic classification of interatrial communications had inter-and intraobserver agreements superior to standard expert assessment. This study aimed to determine the prevalence of subtypes of interatrial communications on transthoracic echocardiography in newborns. Echocardiograms of newborns aged 0-30 days were prospectively collected in the population-based cohort study Copenhagen Baby Heart Study in 2017-2018 and analyzed according to the new diagnostic algorithm, classifying interatrial communications into three subtypes of patent foramen ovale and three subtypes of atrial septal defects. Echocardiograms from 15,801 newborns were analyzed; 3416 (21.6%) were excluded due to suboptimal image quality or severe structural heart disease (n = 3), leaving 12,385 newborns (aged 12 [interquartile range 8; 15] days, 48.2% female) included in the study. An interatrial communication was detected in 9766 (78.9%) newborns. According to the algorithm, 9029 (72.9%) had a patent foramen ovale, while 737 (6.0%) fulfilled criteria for an atrial septal defect, further divided into subtypes. An interatrial communication was seen on echocardiography in almost 80% of newborns aged 0-30 days. Patent foramen ovale was 12 times more frequent than atrial septal defects. The observed prevalence of atrial septal defects was higher than previously reported. Follow up studies could distinguish which interatrial communications require follow-up or intervention. ClinicalTrial.gov, NCT02753348, posted April 27, 2016, [ https://classic.clinicaltrials.gov/ct2/show/NCT02753348 ].
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Affiliation(s)
- Elisabeth Blixenkrone-Møller
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sofie Dannesbo
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anna Maria Dehn
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian A Pihl
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Steven Colan
- Department of Cardiology, Boston Children's Hospital, Boston, USA
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Niels Vejlstrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Yodoya N, Sawada H, Mitani Y, Ohashi H, Tsuboya N, Ohya K, Takeoka M, Hayakawa H, Hirayama M. School electrocardiography screening program prompts the detection of otherwise unrecognized atrial septal defect in children in Japan. Front Pediatr 2024; 12:1396853. [PMID: 38887565 PMCID: PMC11180781 DOI: 10.3389/fped.2024.1396853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
Background Atrial septal defect (ASD) is a congenital heart disease that often presents without symptoms or murmurs. If left untreated, children with ASD can develop comorbidities in adulthood. In Japan, school electrocardiography (ECG) screening has been implemented for all 1st, 7th, and 10th graders. However, the impact of this program in detecting children with ASD is unknown. Methods This is a retrospective study that analyzed consecutive patients with ASD who underwent catheterization for surgical or catheter closure at ≤18 years of age during 2009-2019 at a tertiary referral center in Japan. Results Of the overall 116 patients with ASD (median age: 3.0 years of age at diagnosis and 8.9 years at catheterization), 43 (37%) were prompted by the ECG screening (Screening group), while the remaining 73 (63%) were by other findings (Non-screening group). Of the 49 patients diagnosed at ≥6 years of age, 43 (88%) were prompted by the ECG screening, with the 3 corresponding peaks of the number of patients at diagnosis. Compared with the non-screening group, the screening group exhibited similar levels of hemodynamic parameters but had a lower proportion of audible heart murmur, which were mainly prompted by the health care and health checkups in infancy or preschool period. Patients positive for a composite parameter (rsR' type of iRBBB, inverted T in V4, or ST depression in the aVF lead) accounted for 79% of the screening group at catheterization, each of which was correlated with hemodynamic parameters in the overall patients. Conclusions The present study shows that school ECG screening detects otherwise unrecognized ASD, which prompted the diagnosis of the majority of patients at school age and >one-third of overall patients in Japan. These findings suggest that ECG screening program could be an effective strategy for detecting hemodynamically significant ASD in students, who are asymptomatic and murmurless.
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Affiliation(s)
| | | | - Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
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Mat Bah MN, Kasim AS, Sapian MH, Alias EY. Survival outcomes for congenital heart disease from Southern Malaysia: results from a congenital heart disease registry. Arch Dis Child 2024; 109:363-369. [PMID: 38296612 DOI: 10.1136/archdischild-2023-326622] [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: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Limited population-based studies are available on the survival of congenital heart disease (CHD) from lower- and middle-income countries. Therefore, we evaluated the survival from birth until 15 years and associated factors for mortality. METHODS This population-based cohort study included all children with CHD registered in the Pediatric Cardiology Clinical Information System born between 2006 and 2020 in Johor, Malaysia. The mortality rate was calculated, and Cox proportional hazard regression analysis was used to determine factors associated with mortality. The Kaplan-Meier analysis was used to estimate the survival rates at 1, 5, 10 and 15 years. RESULTS There were 5728 patients with CHD studied, with 1543 (27%) lesions resolved spontaneously, 322 (5.6%) were treated with comfort care, 1189 (21%) required no intervention, and 2674 (47%) needed surgery or intervention. The overall mortality rate was 15%, with a median age of death of 3.7 months (IQR 0.9-9.8 months). Preoperative/intervention death was observed in 300 (11%), and 68 (3.2%) children died within 30 days of surgery or intervention. The overall estimated survival at 1, 5, 10 and 15 years was 88%, 85%, 84% and 83%, respectively. The independent factors associated with mortality were male gender, associated syndrome or extra-cardiac defect, pulmonary hypertension, antenatal diagnosis and severe lesions. CONCLUSIONS Eight out of 10 patients with CHDs survived up to 15 years of age. However, 10% of CHDs who require intervention die before the procedure. Thus, improving congenital cardiac surgery and enhancing the overall healthcare system are crucial to improve survival.
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Affiliation(s)
- Mohd Nizam Mat Bah
- Department of Pediatrics, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Aina Salwa Kasim
- Department of Pediatrics, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Mohd Hanafi Sapian
- Department of Pediatrics, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
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Medina CK, Prabhu NK, Alderete IS, Parker LE, Lim HK, Moya-Mendez ME, Kang L, Campbell MJ, Overbey DM, Turek JW, Andersen ND. Days alive and out of hospital for children born with single-ventricle heart disease. Cardiol Young 2024:1-6. [PMID: 38410043 DOI: 10.1017/s1047951124000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND This study describes the illness burden in the first year of life for children with single-ventricle heart disease, using the metric of days alive and out of hospital to characterize morbidity and mortality. METHODS This is a retrospective single-centre study of single-ventricle patients born between 2005 and 2021 who had their initial operation performed at our institution. Patient demographics, anatomical details, and hospitalizations were extracted from our institutional single-ventricle database. Days alive and out of hospital were calculated by subtracting the number of days hospitalized from number of days alive during the first year of life. A multivariable linear regression with stepwise variable selection was used to determine independent risk factors associated with fewer days alive and out of hospital. RESULTS In total, 437 patients were included. Overall median number of days alive and out of hospital in the first year of life for single-ventricle patients was 278 days (interquartile range 157-319 days). In a multivariable analysis, low birth weight (<2.5kg) (b = -37.55, p = 0.01), presence of a dominant right ventricle (b = -31.05, p = 0.01), moderate-severe dominant atrioventricular valve regurgitation at birth (b = -37.65, p < 0.05), index hybrid Norwood operation (b = -138.73, p < 0.01), or index heart transplant (b = -158.41, p < 0.01) were all independently associated with fewer days alive and out of hospital. CONCLUSIONS Children with single-ventricle heart defects have significant illness burden in the first year of life. Identifying risk factors associated with fewer days alive and out of hospital may aid in counselling families regarding expectations and patient prognosis.
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Affiliation(s)
- Cathlyn K Medina
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
| | - Neel K Prabhu
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
| | - Isaac S Alderete
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
| | - Lauren E Parker
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
| | - Hoe King Lim
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
| | - Mary E Moya-Mendez
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
| | - Lillian Kang
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
| | - M Jay Campbell
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC, USA
| | - Douglas M Overbey
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC, USA
| | - Joseph W Turek
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC, USA
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC, USA
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Saedi T, Siami R, Ghaffari AJ, Farmani D, Saedi S. Aortic dilation in adults with repaired tetralogy of Fallot: a single-centre study. Cardiol Young 2024:1-3. [PMID: 38410047 DOI: 10.1017/s1047951124000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Tetralogy of Fallot is the most prevalent cyanotic CHD. With the advent of advanced surgical methods, the majority of tetralogy of Fallot patients reach adulthood. However, many need re-intervention for the residual anomalies including residual right ventricular outflow obstruction, pulmonary regurgitation, residual ventricular septal defects, and progressive aortic dilatation. Aortic dilation could lead to aortic regurgitation or dissection requiring surgical correction. In the current study, we aimed to determine the prevalence and outcomes of aortic root dilatation in adults with repaired tetralogy of Fallot in our tertiary care centre. METHODS In this retrospective study, 730 consecutive patients with history of repaired tetralogy of Fallot were included. Aortic diameter at the level of annulus, the sinus of Valsalva, sinotubular junction, and the ascending aorta as measured by echocardiography were evaluated. Prevalence of outcomes necessitating re-intervention including aortic regurgitation and dissection were recorded. RESULTS The mean size of annulus, sinus of Valsalva, sinotubular-junction, and ascending aorta in the latest available echocardiography of patients were 2.4+/-0.4 cm, 3.3+/-0.5 cm, 2.9+/-0.5cm, and 3.2+/-0.5cm, respectively. Prevalence of dilatation of sinus of Valsalva, dilation of Ascending aorta, sinotubular-junction, and aortic annulus was 28.7%, 21%, 8.3%, and 1 %, respectively. Five patients had severe aortic regurgitation (0.6%) and underwent surgical repair. One of these patients presented with acute aortic dissection. CONCLUSION Aortic dilation is common in tetralogy of Fallot but prevalence of redo surgery for aortic dilation, regurgitation, and adverse events including acute dissection is low.
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Affiliation(s)
| | - Rashide Siami
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir J Ghaffari
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Danial Farmani
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Saedi
- Congenital Heart Disease Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Danford DA, Yetman AT, Haynatzki G. Derivation and Validation of a General Predictive Model for Long Term Risks for Mortality and Invasive Interventions in Congenital and Acquired Cardiac Conditions Encountered in the Young. Pediatr Cardiol 2023; 44:1763-1777. [PMID: 37069273 DOI: 10.1007/s00246-023-03154-5] [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: 08/15/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
Accurate prognostic assessment is a key driver of clinical decision making in heart disease in the young (HDY). This investigation aims to derive, validate, and calibrate multivariable predictive models for time to surgical or catheter-mediated intervention (INT) and for time to death in HDY. 4108 unique subjects were prospectively and consecutively enrolled, and randomized to derivation and validation cohorts. Total follow-up was 26,578 patient-years, with 102 deaths and 868 INTs. Accelerated failure time multivariable predictive models for the outcomes, based on primary and secondary diagnoses, pathophysiologic severity, age, sex, genetic comorbidities, and prior interventional history, were derived using piecewise exponential methodology. Model predictions were validated, calibrated, and evaluated for sensitivity to changes in the independent variables. Model validity was excellent for predicting mortality and INT at 4 months, 1, 5, 10, and 22 years (areas under receiver operating characteristic curves 0.813-0.915). Model calibration was better for INT than for mortality. Age, sex, and genetic comorbidities were significant independent factors, but predicted outcomes were most sensitive to variations in composite predictors incorporating primary diagnosis, pathophysiologic severity, secondary diagnosis, and prior intervention. Despite 22 years of data acquisition, no significant cohort effects were identified in which predicted mortality and intervention varied by study entry date. A piecewise exponential model predicting survival and freedom from INT is derived which demonstrates excellent validity, and performs well on a clinical sample of HDY outpatients. Objective model-based predictions could educate both patient and provider, and inform clinical decision making in HDY.
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Affiliation(s)
- David A Danford
- University of Nebraska Medical Center, Omaha, NE, USA.
- Criss Heart Center at Children's Hospital and Medical Center, Omaha, NE, USA.
- , 804 S. 129th Ave, Omaha, NE, 68154, USA.
| | - Anji T Yetman
- University of Nebraska Medical Center, Omaha, NE, USA
- Criss Heart Center at Children's Hospital and Medical Center, Omaha, NE, USA
| | - Gleb Haynatzki
- School of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Weichert A, Gembicki M, Weichert J, Weber SC, Koenigbauer J. Semi-Automatic Measurement of Fetal Cardiac Axis in Fetuses with Congenital Heart Disease (CHD) with Fetal Intelligent Navigation Echocardiography (FINE). J Clin Med 2023; 12:6371. [PMID: 37835015 PMCID: PMC10573854 DOI: 10.3390/jcm12196371] [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: 09/18/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Congenital heart disease (CHD) is one of the most common organ-specific birth defects and a major cause of infant morbidity and mortality. Despite ultrasound screening guidelines, the detection rate of CHD is limited. Fetal intelligent navigation echocardiography (FINE) has been introduced to extract reference planes and cardiac axis from cardiac spatiotemporal image correlation (STIC) volume datasets. This study analyses the cardiac axis in fetuses affected by CHD/thoracic masses (n = 545) compared to healthy fetuses (n = 1543) generated by FINE. After marking seven anatomical structures, the FINE software generated semi-automatically nine echocardiography standard planes and calculated the cardiac axis. Our study reveals that depending on the type of CHD, the cardiac axis varies. In approximately 86% (471 of 542 volumes) of our pathological cases, an abnormal cardiac axis (normal median = 40-45°) was detectable. Significant differences between the fetal axis of the normal heart versus CHD were detected in HLHS, pulmonary atresia, TOF (p-value < 0.0001), RAA, situs ambiguus (p-value = 0.0001-0.001) and absent pulmonary valve syndrome, DORV, thoracic masses (p-value = 0.001-0.01). This analysis confirms that in fetuses with CHD, the cardiac axis can significantly deviate from the normal range. FINE appears to be a valuable tool to identify cardiac defects.
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Affiliation(s)
- Alexander Weichert
- Center for Prenatal Diagnosis and Women’s Health, 10961 Berlin, Germany;
| | - Michael Gembicki
- Departments of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany; (M.G.); (J.W.)
| | - Jan Weichert
- Departments of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany; (M.G.); (J.W.)
| | - Sven Christian Weber
- Department of Pediatric Cardiology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Josefine Koenigbauer
- Center for Prenatal Diagnosis and Women’s Health, 10961 Berlin, Germany;
- Department of Obstetrics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
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Turial S, Stimming F, Lux A, Koehn A, Rissmann A. Prevalence and One-Year Survival of Selected Major Congenital Anomalies in Germany: A Population-Based Cohort Study. Eur J Pediatr Surg 2023; 33:403-413. [PMID: 36577437 DOI: 10.1055/s-0042-1758829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Congenital anomalies play an important role in infant mortality worldwide. The present study aims to present the current data on the prevalence rates and the 1-year survival rates for selected major congenital anomalies in Saxony-Anhalt, Germany. MATERIALS AND METHODS The data were collected systematically by the Malformation Monitoring Centre Saxony-Anhalt. Cohort from 2000 to 2017 was retrospectively analyzed to determine the prevalence rates and the survival rates of nine major congenital anomalies. The survival analysis was conducted, including all pregnancy outcomes and various risk factors. RESULTS In total, 1,012 cases of the selected congenital anomalies were registered. The total prevalence rates ranged from 2.5 (congenital diaphragmatic hernia [CDH]) to 5.8 (spina bifida [SB]) per 10,000. The live birth prevalence was lower. In total, 88.3% of live-born cases survived the first year. The 1-year survival rate of all cases, including fetal losses, was merely 61.7%. There was no continual improvement in survival during the study period noted. The 1-year survival rate was 35.7% for "genetic" malformations, 57.6% for "multiple congenital anomalies," and 68.6% for "isolated" cases, with 44.6% for prenatally detected anomalies and 85.2% for postnatally identified anomalies. Gestational age less than 31 weeks and birth weight below 1,000 g affected the survival rate adversely. CONCLUSION The survival rate of infants suffering from congenital anomalies in Saxony-Anhalt is comparable to that reported by national and international studies. Registering all pregnancy outcomes irrespective of whether they result in a live birth, stillbirth, or fetal loss in a malformation register seems to be important as it affects the statistical survival analysis in general.
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Affiliation(s)
- Salmai Turial
- Division of Pediatric Surgery, Pediatric Trauma Surgery and Pediatric Urology, University Medical Centre Magdeburg, Magdeburg, Germany
| | - Friederike Stimming
- Division of Pediatric Surgery, Pediatric Trauma Surgery and Pediatric Urology, University Medical Centre Magdeburg, Magdeburg, Germany
| | - Anke Lux
- Medical Faculty Otto-von-Guericke-University Magdeburg, Institute for Biometrics and Medical Informatics, Magdeburg, Germany
| | - Andrea Koehn
- Medical Faculty Otto-von-Guericke-University Magdeburg, Malformation Monitoring Centre of Saxony-Anhalt, Magdeburg, Germany
| | - Anke Rissmann
- Medical Faculty Otto-von-Guericke-University Magdeburg, Malformation Monitoring Centre of Saxony-Anhalt, Magdeburg, Germany
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Couck T, Buys R, Santens B, De Meester P, Goetschalckx K, Moons P, Troost E, Van De Bruaene A, Budts W. Short-term results of serial cardiopulmonary exercise testing in adults with repaired coarctation of the aorta. Acta Cardiol 2023; 78:798-804. [PMID: 34979884 DOI: 10.1080/00015385.2021.2015143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/22/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Data on the evolution of exercise capacity in adults with repaired coarctation of the aorta (CoA) are scarce. We aimed to investigate the evolution and change of measures of exercise capacity obtained by cardiopulmonary exercise testing (CPET) in adults with repaired CoA. METHODS Patients 16 years of age and older with CoA, who performed at least two maximal CPETs in our institution, were included in the study. The first and last available tests were used for comparative statistical analysis of common exercise variables. RESULTS Sixty patients (43 men) performed serial maximal CPET. Mean age at first assessment was 30 ± 10 years (range 17-68). Mean time between first and last assessment was 3.5 years (range 1-7). Mean peak VO2 was 85.6 ± 20.4% of the predicted value at the initial test, and 87.0 ± 20.5% at the final test (p = 0.294). There were no significant differences in the mean values of oxygen pulse, VO2 at anaerobic threshold, systolic and diastolic blood pressures and peak heart rate between the two assessments. There was a slightly higher VE/VCO2 slope at the final test (p = 0.047). Higher age and Borg scale were found to be related with a decline in percent-predicted peak VO2 from initial to final assessment. CONCLUSION In adults with repaired CoA, we found no significant change in peak VO2 during a mean follow-up of 3.5 years, yet a small increase in VE/VCO2 slope was observed. Higher age was predictive for a decline in percent-predicted peak VO2, starting in the third decade of life.
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Affiliation(s)
- Thomas Couck
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Roselien Buys
- Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Catholic University Leuven, Leuven, Belgium
| | - Béatrice Santens
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pieter De Meester
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Philip Moons
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Catholic University Leuven, Leuven, Belgium
| | - Els Troost
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Werner Budts
- Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
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Mennickent D, Rodríguez A, Opazo MC, Riedel CA, Castro E, Eriz-Salinas A, Appel-Rubio J, Aguayo C, Damiano AE, Guzmán-Gutiérrez E, Araya J. Machine learning applied in maternal and fetal health: a narrative review focused on pregnancy diseases and complications. Front Endocrinol (Lausanne) 2023; 14:1130139. [PMID: 37274341 PMCID: PMC10235786 DOI: 10.3389/fendo.2023.1130139] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Machine learning (ML) corresponds to a wide variety of methods that use mathematics, statistics and computational science to learn from multiple variables simultaneously. By means of pattern recognition, ML methods are able to find hidden correlations and accomplish accurate predictions regarding different conditions. ML has been successfully used to solve varied problems in different areas of science, such as psychology, economics, biology and chemistry. Therefore, we wondered how far it has penetrated into the field of obstetrics and gynecology. Aim To describe the state of art regarding the use of ML in the context of pregnancy diseases and complications. Methodology Publications were searched in PubMed, Web of Science and Google Scholar. Seven subjects of interest were considered: gestational diabetes mellitus, preeclampsia, perinatal death, spontaneous abortion, preterm birth, cesarean section, and fetal malformations. Current state ML has been widely applied in all the included subjects. Its uses are varied, the most common being the prediction of perinatal disorders. Other ML applications include (but are not restricted to) biomarker discovery, risk estimation, correlation assessment, pharmacological treatment prediction, drug screening, data acquisition and data extraction. Most of the reviewed articles were published in the last five years. The most employed ML methods in the field are non-linear. Except for logistic regression, linear methods are rarely used. Future challenges To improve data recording, storage and update in medical and research settings from different realities. To develop more accurate and understandable ML models using data from cutting-edge instruments. To carry out validation and impact analysis studies of currently existing high-accuracy ML models. Conclusion The use of ML in pregnancy diseases and complications is quite recent, and has increased over the last few years. The applications are varied and point not only to the diagnosis, but also to the management, treatment, and pathophysiological understanding of perinatal alterations. Facing the challenges that come with working with different types of data, the handling of increasingly large amounts of information, the development of emerging technologies, and the need of translational studies, it is expected that the use of ML continue growing in the field of obstetrics and gynecology.
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Affiliation(s)
- Daniela Mennickent
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
- Departamento de Análisis Instrumental, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
- Machine Learning Applied in Biomedicine (MLAB), Concepción, Chile
| | - Andrés Rodríguez
- Machine Learning Applied in Biomedicine (MLAB), Concepción, Chile
- Departamento de Ciencias Básicas, Facultad de Ciencias, Universidad del Bío-Bío, Chillán, Chile
| | - Ma. Cecilia Opazo
- Instituto de Ciencias Naturales, Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Claudia A. Riedel
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
- Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Erica Castro
- Departamento de Obstetricia y Puericultura, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - Alma Eriz-Salinas
- Departamento de Obstetricia y Puericultura, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Javiera Appel-Rubio
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Claudio Aguayo
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Alicia E. Damiano
- Cátedra de Biología Celular y Molecular, Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO-Houssay)- CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Enrique Guzmán-Gutiérrez
- Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
- Machine Learning Applied in Biomedicine (MLAB), Concepción, Chile
| | - Juan Araya
- Departamento de Análisis Instrumental, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
- Machine Learning Applied in Biomedicine (MLAB), Concepción, Chile
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Griffin EL, Nees SN, Morton SU, Wynn J, Patel N, Jobanputra V, Robinson S, Kochav SM, Tao A, Andrews C, Cross N, Geva J, Lanzilotta K, Ritter A, Taillie E, Thompson A, Meyer C, Akers R, King EC, Cnota JF, Kim RW, Porter GA, Brueckner M, Seidman CE, Shen Y, Gelb BD, Goldmuntz E, Newburger JW, Roberts AE, Chung WK. Evidence-Based Assessment of Congenital Heart Disease Genes to Enable Returning Results in a Genomic Study. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:e003791. [PMID: 36803080 PMCID: PMC10121846 DOI: 10.1161/circgen.122.003791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/28/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common major congenital anomaly and causes significant morbidity and mortality. Epidemiologic evidence supports a role of genetics in the development of CHD. Genetic diagnoses can inform prognosis and clinical management. However, genetic testing is not standardized among individuals with CHD. We sought to develop a list of validated CHD genes using established methods and to evaluate the process of returning genetic results to research participants in a large genomic study. METHODS Two-hundred ninety-five candidate CHD genes were evaluated using a ClinGen framework. Sequence and copy number variants involving genes in the CHD gene list were analyzed in Pediatric Cardiac Genomics Consortium participants. Pathogenic/likely pathogenic results were confirmed on a new sample in a clinical laboratory improvement amendments-certified laboratory and disclosed to eligible participants. Adult probands and parents of probands who received results were asked to complete a post-disclosure survey. RESULTS A total of 99 genes had a strong or definitive clinical validity classification. Diagnostic yields for copy number variants and exome sequencing were 1.8% and 3.8%, respectively. Thirty-one probands completed clinical laboratory improvement amendments-confirmation and received results. Participants who completed postdisclosure surveys reported high personal utility and no decision regret after receiving genetic results. CONCLUSIONS The application of ClinGen criteria to CHD candidate genes yielded a list that can be used to interpret clinical genetic testing for CHD. Applying this gene list to one of the largest research cohorts of CHD participants provides a lower bound for the yield of genetic testing in CHD.
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Affiliation(s)
- Emily L. Griffin
- Dept of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Shannon N. Nees
- Nemours Cardiac Center, Nemours Children’s Hospital, Delaware. Wilmington, DE
| | - Sarah U. Morton
- Division of Newborn Medicine, Dept of Medicine, Boston Children’s Hospital
- Dept of Pediatrics, Harvard Medical School, Boston, MA
| | - Julia Wynn
- Dept of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Nihir Patel
- Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vaidehi Jobanputra
- Dept of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Scott Robinson
- Dept of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Stephanie M. Kochav
- Division of Cardiology, Dept of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Alice Tao
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Carli Andrews
- Dept of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Nancy Cross
- Division of Pediatric Cardiology, Yale School of Medicine, New Haven, CT
| | - Judith Geva
- Dept of Cardiology, Boston Children’s Hospital
| | - Kristen Lanzilotta
- Division of Cardiology, Children’s Hospital of Philadelphia, Dept of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Alyssa Ritter
- Division of Cardiology, Children’s Hospital of Philadelphia, Dept of Pediatrics, Perelman School of Medicine, University of Pennsylvania
- Division of Human Genetics, Dept of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Eileen Taillie
- Dept of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, NY
| | - Alexandra Thompson
- Division of Cardiothoracic Surgery, Children’s Hospital of Los Angeles, Los Angeles, CA
| | | | - Rachel Akers
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Eileen C. King
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - James F Cnota
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Richard W. Kim
- Pediatric Cardiac Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - George A. Porter
- Dept of Pediatrics, University of Rochester Medical Center, The School of Medicine & Dentistry, Rochester, NY
| | - Martina Brueckner
- Dept of Genetics & Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Christine E. Seidman
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
- Dept of Genetics, Harvard Medical School, Boston, MA
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Yufeng Shen
- Depts of Systems Biology & Biomedical Informatics, Columbia University, New York, NY
| | - Bruce D. Gelb
- Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Depts of Pediatrics and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children’s Hospital of Philadelphia, Dept of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Jane W. Newburger
- Dept of Pediatrics, Harvard Medical School, Boston, MA
- Dept of Cardiology, Boston Children’s Hospital
| | - Amy E. Roberts
- Dept of Cardiology, Boston Children’s Hospital
- Division of Genetics, Dept of Pediatrics, Boston Children’s Hospital
| | - Wendy K. Chung
- Dept of Pediatrics, Columbia University Irving Medical Center, New York, NY
- Dept of Medicine, Columbia University Irving Medical Center, New York, NY
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van Genuchten WJ, Helbing WA, Ten Harkel ADJ, Fejzic Z, Md IMK, Slieker MG, van der Ven JPG, Boersma E, Takken T, Bartelds B. Exercise capacity in a cohort of children with congenital heart disease. Eur J Pediatr 2023; 182:295-306. [PMID: 36334170 PMCID: PMC9829639 DOI: 10.1007/s00431-022-04648-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
Abstract
In patients with congenital heart disease (CHD), reduced exercise capacity can be a predictor for late complications and may be used to guide interventions. Yet, the interpretation of exercise capacity is challenged by changes in body composition during growth. Our aim was to create an overview of disease-specific exercise capacity in children with CHD. We performed a multicentre retrospective study of exercise capacity of CHD patients, aged 6-18 years, tested between January 2001 and October 2018. Sex-specific distribution graphs were made using the LMS method and height to relate to body size. We included all CHD with N > 50, including severe defects (e.g., univentricular heart, tetralogy of Fallot) and "simple" lesions as ventricular septum defect and atrial septum defect. We included 1383 tests of 1208 individual patients for analysis. The peak oxygen uptake (VO2peak, 37.3 ml/min/kg (25th-75th percentile 31.3-43.8)) varied between specific defects; patients with univentricular hearts had lower VO2peak compared with other CHD. All groups had lower VO2peak compared to healthy Dutch children. Males had higher VO2peak, Wpeak and O2pulsepeak than females. Sex- and disease-specific distribution graphs for VO2peak, Wpeak and O2pulsepeak showed increase in variation with increase in height. Conclusion: Disease-specific distribution graphs for exercise capacity in children with CHD from a large multicentre cohort demonstrated varying degrees of reduced VO2peak and Wpeak. The distribution graphs can be used in the structured follow-up of patients with CHD to predict outcome and identify patients at risk. What is Known: • Children with congenital heart disease (COnHD) are at risk to develop heart failure, arrhytmia's and other complications. Exercise capacity may be an important predictor for outcome in children with ConHD. In children, the interpretation of exercise capacity poses an additional challenge related to physical changes during growth. What is New: • In this report of a multi-center cohort >1300 childrewn with ConHD, we related the changes in exercise capacity to length. We demonstrated that exercise capacity was reduced as compared with healthy children and we observed variation between disease groups. Patients with a univentricular circulation (Fontan) had worse exercise capacity. We constructed disease specific charts of development of exercise capacity throughout childhood, accessible via a web-site. These graphs may help practitioner to guide children with ConHD.
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Affiliation(s)
- Wouter J van Genuchten
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC, University Medical Center, Room number Sp2469 attn. Prof. Dr. W.A. Helbing, PO box 2040, 3000 CA, Zuid Holland, Rotterdam, The Netherlands.
| | - Willem A Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC, University Medical Center, Room number Sp2469 attn. Prof. Dr. W.A. Helbing, PO box 2040, 3000 CA, Zuid Holland, Rotterdam, The Netherlands
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Zina Fejzic
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irene M Kuipers Md
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle P G van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC, University Medical Center, Room number Sp2469 attn. Prof. Dr. W.A. Helbing, PO box 2040, 3000 CA, Zuid Holland, Rotterdam, The Netherlands
- Netherlands Heart Institute, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Tim Takken
- Department of Medical Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Beatrijs Bartelds
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC, University Medical Center, Room number Sp2469 attn. Prof. Dr. W.A. Helbing, PO box 2040, 3000 CA, Zuid Holland, Rotterdam, The Netherlands
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Bordbar A, Kashaki M, Vafapour M, Sepehri AA. Determining the incidence of heart malformations in neonates: A novel and clinically approved solution. Front Pediatr 2023; 11:1058947. [PMID: 37009269 PMCID: PMC10050760 DOI: 10.3389/fped.2023.1058947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Background Screening for critical congenital heart defects should be performed as early as possible and is essential for saving the lives of children and reducing the incidence of undetected adult congenital heart diseases. Heart malformations remain unrecognized at birth in more than 50% of neonates at maternity hospitals. Accurate screening for congenital heart malformations is possible using a certified and internationally patented digital intelligent phonocardiography machine. This study aimed to assess the actual incidence of heart defects in neonates. A pre-evaluation of the incidence of unrecognized severe and critical congenital heart defects at birth in our well-baby nursery was also performed. Methods We conducted the Neonates Cardiac Monitoring Research Project (ethics approval number: IR-IUMS-FMD. REC.1398.098) at the Shahid Akbarabadi Maternity Hospital. This study was a retrospective analysis of congenital heart malformations observed after screening 840 neonates. Using a double-blind format, 840 neonates from the well-baby nursery were randomly chosen to undergo routine clinical examinations at birth and digital intelligent phonocardiogram examinations. A pediatric cardiologist performed echocardiography for each neonate classified as having abnormal heart sounds using an intelligent machine or during routine medical examinations. If the pediatric cardiologist requested a follow-up examination, then the neonate was considered to have a congenital heart malformation, and the cumulative incidence was calculated accordingly. Results The incidence of heart malformations in our well-baby nursery was 5%. Furthermore, 45% of heart malformations were unrecognized in neonates at birth, including one critical congenital heart defect. The intelligent machine interpreted innocent murmurs as healthy heart sound. Conclusion We accurately and cost-effectively screened for congenital heart malformations in all neonates in our hospital using a digital intelligent phonocardiogram. Using an intelligent machine, we successfully identified neonates with CCHD and congenital heart defects that could not be detected using standard medical examinations. The Pouya Heart machine can record and analyze sounds with a spectral power level lower than the minimum level of the human hearing threshold. Furthermore, by redesigning the study, the identification of previously unrecognized heart malformations could increase to 58%.
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Affiliation(s)
- Arash Bordbar
- Shahid Akbarabadi Clinical Research & Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mandana Kashaki
- Shahid Akbarabadi Clinical Research & Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Vafapour
- Department of Pediatrics, Ali-Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir A. Sepehri
- Biomedical R&D Department, CAPIS Research and Development Co., Mons, Belgium
- Correspondence: Amir A. Sepehri
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Muñoz H, Enríquez G, Ortega X, Pinto M, Hosiasson S, Germain A, Díaz C, Cortés F. Diagnóstico de cardiopatías congénitas: ecografía de cribado, ecocardiografía fetal y medicina de precisión. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Applying Interventions to Address the Social Determinants of Health and Reduce Health Disparities in Congenital Heart Disease Patients. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Levosimendan in paediatric cardiac anaesthesiology. Eur J Anaesthesiol 2022; 39:646-655. [DOI: 10.1097/eja.0000000000001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Behaviour management problems in Finnish children with operated congenital heart disease: a practice-based study. Eur Arch Paediatr Dent 2022; 23:409-416. [PMID: 35249207 PMCID: PMC9167182 DOI: 10.1007/s40368-022-00696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
Purpose This retrospective, practice-based study investigates behaviour management problems (BMPs) in dental care among Finnish children with operated congenital heart disease (CHD). Methods All the heart-operated children born between the years 1997 and 1999 were identified in the national ProCardio database (n = 570). Primary dental care records were requested from this population and were eventually received from 211 patients. Information on gender, diagnosis, number of heart operations and perioperative care were collected from the ProCardio database, and the CHDs were categorised as shunting/stenotic/complex/other defects. Data on BMP/dental fear, oral conscious sedation, dental general anaesthesia (DGA) and past and present caries indices at 6, 12 and 15 years (d/D, dmft/DMFT) were assessed. Results Notes on behaviour management problems or dental fear were found in 19% of the study population. BMPs in dental care were more frequent among boys. Children with re-operations, longer post-operative intensive care stay and hospitalisation, and complications had not more BMP than others. Those children diagnosed with syndromes had more BMP often than the rest. Past and present caries experience were significantly associated with BMP, need of oral conscious sedation and DGA. Oral conscious sedation, nitrogen oxide sedation and dental general anaesthesia were used in 17/211, 2/221 and 24/211 CHD patients, respectively. Conclusion Dental caries remains a main factor associated with BMP in the CHD population. Need for oral conscious sedation and DGA were rather common. To maintain a good oral health and to avoid development of BMP, CHD children benefit from focus in health promotion and preventive care.
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Edlinger C, Paar V, Kheder SH, Krizanic F, Lalou E, Boxhammer E, Butter C, Dworok V, Bannehr M, Hoppe UC, Kopp K, Lichtenauer M. Endothelialization and Inflammatory Reactions After Intracardiac Device Implantation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1401:1-22. [DOI: 10.1007/5584_2022_712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Akiel M. The genetic architecture behind congenital heart disease: A review of genetic and epigenetic factors. JOURNAL OF NATURE AND SCIENCE OF MEDICINE 2022. [DOI: 10.4103/jnsm.jnsm_126_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Goldmuntz E, Zheng Z, Shea JA. Reported practice patterns in the ambulatory care setting for patients with CHD. Cardiol Young 2021; 32:1-6. [PMID: 34776030 DOI: 10.1017/s1047951121004303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In the absence of evidence-based guidelines, paediatric cardiologists monitor patients in the ambulatory care setting largely according to personal, patient, institutional, and/or financial dictates, all of which likely contribute to practice variability. Minimising practice variability may optimise quality of care while incurring lower costs. We sought to describe self-reported practice patterns and physician attitudes about factors influencing their testing strategies using vignettes describing common scenarios in the care of asymptomatic patients with tetralogy of Fallot and d-transposition of the great arteries. METHODS We conducted a cross-sectional survey of paediatric cardiologists attending a Continuing Medical Educational conference and at our centre. The survey elicited physician characteristics, self-reported testing strategies, and reactions to factors that might influence their decision to order an echocardiogram. RESULTS Of 267 eligible paediatric cardiologists, 110 completed the survey. The majority reported performing an annual physical examination (66-82%), electrocardiogram (74-79%), and echocardiogram (56-76%) regardless of patient age or severity of disease. Other tests (i.e. Holter monitors, exercise stress tests or cardiac MRIs) were ordered less frequently and less consistently. We observed within physician consistency in frequency of test ordering. In vignettes of younger children with mild disease, higher frequency testers were younger than lower frequency testers. CONCLUSIONS These results suggest potential practice pattern variability, which needs to be further explored in real-life settings. If clinical outcomes for patients followed by low frequency testers match that of high frequency testers, then room to modify practice patterns and lower costs without compromising quality of care may exist.
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Affiliation(s)
- Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zihe Zheng
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Jian M, He S, Liu Y, Liu X, Gui J, Zheng M, Feng B, Zhang X, Liu C. The high-risk factors of different severities of bronchopulmonary dysplasia (BPD) based on the national institute of child health and human development (NICHD) diagnosis criteria in 2018. J Bras Pneumol 2021; 47:e20210125. [PMID: 34614093 PMCID: PMC8642818 DOI: 10.36416/1806-3756/e20210125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the clinical characteristics of preterm infants with different severities of bronchopulmonary dysplasia (BPD) and disclose the high-risk factors of exacerbating BPD. Methods Collection of clinical data of 91 preterm infants admitted to the NICU and diagnosed with BPD, categorized in groups according to the disease severity: 41 mild cases,, 24 moderate cases, and 26 severe cases. Comparison and analysis of perinatal risk factors, treatment, complications and prognosis of the infants with different severity degrees. Results The severe group had a higher proportion of infants with congenital heart disease (CHD) higher than the moderate group (P < 0.05), and a higher ratio of pneumonia and mechanical ventilation (MV) ≥ seven days than the mild group (P < 0.05). The severe group also presented higher reintubation incidence than both the mild and moderate groups (P < 0.05). The groups presented different (P < 0.05) incidence rates of hemodynamically significant patent ductus arteriosus (hsPDA) . Ridit analysis suggested that the premature infants (PIs) with hsPDA, multiple microbial pulmonary infections, or Klebsiella pneumoniae pneumonia had more severe illness. Conclusion CHD, hsPDA, MV ≥ seven days, reintubation, pneumonia, especially multiple microbial pulmonary infections, and Klebsiella pneumoniae pneumonia are correlated with the severity of BPD and can be used as BPD progression predictor.
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Affiliation(s)
- Minqiao Jian
- Department of Clinical Medicine, School of Medicine, South China University of Technology, Guangzhou, China.,Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaoru He
- Department of Clinical Medicine, School of Medicine, South China University of Technology, Guangzhou, China.,Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yumei Liu
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoqing Liu
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juan Gui
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Manli Zheng
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bowen Feng
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohui Zhang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Caisheng Liu
- Department of Clinical Medicine, School of Medicine, South China University of Technology, Guangzhou, China
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Freilinger S, Andonian C, Beckmann J, Ewert P, Kaemmerer H, Lang N, Nagdyman N, Oberhoffer-Fritz R, Pieper L, Schelling J, von Scheidt F, Neidenbach R. Differences in the experiences and perceptions of men and women with congenital heart defects: A call for gender-sensitive, specialized, and integrative care. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wang L, Feng B, Zhu S. miR-27b-3p Down-Regulation Prevents Hypoxia-Induced Cardiomyocyte Apoptosis Through Regulating Yes-Associated Protein 1 (YAP1) Expression. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Congenital heart disease (CHD) is one of the most common birth defects. MicroR-NAs (miRNAs) are a group of endogenous, non-coding small RNAs and mediate the target genes expression. An increasing evidence showed that in recent years, miRNAs have given rise to more
and more attention in heart protection and development. In our research, the main purpose was to determine the effect of miR-27b-3p in CHD and analyze related mechanisms. Methods: We performed qRT-PCR analysis to examine miR-27b-3p expression in myocardial tissue from 30 patients with
CHD and hypoxia-induced H9C2 cells. Then, we performed biological software TargetScan to predict the relationship of miR-27b-3p and YAP1, and dual luciferase reporter gene assay was used to verify the results. H9C2 cells were transfected with inhibitor control, miR-27b-3p inhibitor, miR-27b-3p
inhibitor + control-siRNA or miR-27b-3p inhibitor + YAP1-siRNA for 6 hours and then induced by hypoxia for 72 hours. Subsequently, we performed MTT and FCM analysis to detect cell viability and apoptosis. Finally, we used western blot assay to measure the expression of apoptosis-related proteins.
Results: Our study indicated that miR-27b-3p expression in myocardial samples of cyanotic CHD patients was significantly higher than that of the acyanotic CHD patients. miR-27b-3p expression was gradually up-regulated with the increase of hypoxia induction time in H9C2 cells. Besides,
we confirmed that YAP1 was a target gene of miR-27b-3p. Moreover, our results showed that miR-27b-3p inhibitor improved cell viability, decreased apoptosis, and affected apoptosis-related proteins expression in hypoxia induced H9C2 cells. These changes were reversed by YAP1-siRNA. All data
demonstrated that miR-27b-3p/YAP1 might be new potential bio-marker and therapeutic target for CHD treatment.
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Affiliation(s)
- Lilin Wang
- Department of Electrocardiogram (ECG), The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310006, China
| | - Bo Feng
- Department of Imaging Intervention, Hangzhou Dajiangdong Hospital, Hangzhou 311225, China
| | - Shu Zhu
- Department of Internal Medicine, Xihu District Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou 310030, China
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Tack P, Willems R, Annemans L. An early health technology assessment of 3D anatomic models in pediatric congenital heart surgery: potential cost-effectiveness and decision uncertainty. Expert Rev Pharmacoecon Outcomes Res 2021; 21:1107-1115. [PMID: 33475446 DOI: 10.1080/14737167.2021.1879645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Three-dimensional anatomic models have been used for surgical planning and simulation in pediatric congenital heart surgery. This research is the first to evaluate the potential cost-effectiveness of 3D anatomic models with the intent to guide surgeons and decision makers on its use.Method: A decision tree and subsequent Markov model with a 15-year time horizon was constructed and analyzed for nine cardiovascular surgeries. Epidemiological, clinical, and economic data were derived from databases. Literature and experts were consulted to close data gaps. Scenario, one-way, threshold, and probabilistic sensitivity analysis captured methodological and parameter uncertainty.Results: Incremental costs of using anatomical models ranged from -366€ (95% credibility interval: -2595€; 1049€) in the Norwood operation to 1485€ (95% CI: 1206€; 1792€) in atrial septal defect repair. Incremental health-benefits ranged from negligible in atrial septal defect repair to 0.54 Quality Adjusted Life Years (95% CI: 0.06; 1.43) in truncus arteriosus repair. Variability in the results was mainly caused by a temporary postoperative quality-adjusted life years gain.Conclusion: For complex operations, the implementation of anatomic models is likely to be cost-effective on a 15 year time horizon. For the right indication, these models thus provide a clinical advantage at an acceptable cost.
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Affiliation(s)
- Philip Tack
- Department of Innovation, Entrepreneurship and Service Management, Ghent University, Ghent, Belgium
| | - Ruben Willems
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
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26
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Perquy D, Pirenne J, Van De Bruaene A, Rex S, van Malenstein H. Liver-only Transplantation in a Patient With Complex Congenital Heart Disease: Case Report and Review of the Literature. Transplant Direct 2021; 7:e649. [PMID: 33437864 PMCID: PMC7793398 DOI: 10.1097/txd.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with liver failure due to or in addition to congenital heart disease (CHD) represent a growing population in need of organ transplantation. Traditionally, these patients received a combined heart and liver transplantation carrying a high risk of perioperative morbidity and mortality. METHODS We discuss a patient with complex cyanotic CHD and biliary atresia undergoing liver-only transplantation. Furthermore, a literature study was performed on combined congenital heart and liver disease in the setting of transplantation. RESULTS We describe a unique case of a patient with severe CHD undergoing orthotopic liver transplantation for biliary atresia. In the literature, congenital malformations affecting different organs seems not that infrequent. Liver-only transplantation has been described in mild CHD, although data in adult patients are scarce. In severe CHD, the liver usually suffers from congestion. The severity of liver disease and reversibility should be estimated to decide on combined heart-liver transplantation. CONCLUSIONS Our case and a review of the literature demonstrate that a patient-tailored approach with liver-only transplantation may be an appropriate alternative to combined heart and liver transplantation in selected cases.
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Affiliation(s)
- David Perquy
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Department of Cardiovascular Disease, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
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Makkar A, Milsten J, McCoy M, Szyld EG, Lapadula MC, Ganguly A, DeShea LA, Ponniah U. Tele-Echocardiography for Congenital Heart Disease Screening in a Level II Neonatal Intensive Care Unit with Hybrid Telemedicine System. Telemed J E Health 2021; 27:1136-1142. [PMID: 33449839 DOI: 10.1089/tmj.2020.0440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: The nationwide shortage of pediatric cardiologists in medically underserved areas poses a challenge to congenital heart disease (CHD) screening requiring echocardiography, resulting in transfer of neonates to regional Level III/IV Neonatal Intensive Care Units (NICUs). This study aimed to evaluate the accuracy, safety, and cost-effectiveness of tele-echocardiography for advanced CHD screening at a Level II NICU managed by a hybrid telemedicine system. Methods: Retrospective chart review of infants requiring tele-echocardiography at a Level II NICU. Patient demographics, echocardiography indications, and findings were analyzed. Agreement between tele-echocardiography and conventional echocardiography findings was assessed. Transport cost savings were calculated based on preventable transfers to Level IV NICU. Descriptive statistics were computed for demographic and clinical variables. Results: Over 5 years, 52 infants were screened for CHD. Thirty-two infants (62%) had findings consistent with minor CHD or normal neonatal transitional physiology. Twenty infants (38%) had abnormal findings requiring follow-up with either a conventional echocardiography as inpatient at the regional Level IV NICU or as outpatient after discharge. Only 5 infants (10%) required transfer to a Level IV NICU for CHD management, whereas 15 infants (29%) were scheduled for outpatient follow-up. Strong agreement was noted between tele-echocardiography and conventional echocardiography findings. No case of critical congenital heart disease (CCHD) was missed. Tele-echocardiography saved $260,000 in transport costs. Conclusions: Tele-echocardiography can be accurate, safe, and effective in CHD screening, preventing unnecessary transfer of most infants to regional Level III/IV NICUs, saving transfer costs.
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Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer Milsten
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Mike McCoy
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Edgardo G Szyld
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maria C Lapadula
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Abhrajit Ganguly
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lise A DeShea
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Umakumaran Ponniah
- Division of Cardiology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Belem FP, Ba EHB, Leye PA, Diop EHN, Gaye I, Bah MD, Sène EB, Sène MV, Fall ML, Ciss AG, Kane O. [Anaesthesia in on-pump cardiac surgery for congenital heart diseases at the Cuomo Pediatric Cardiology Center (Senegal)]. Pan Afr Med J 2020; 37:362. [PMID: 33708333 PMCID: PMC7912115 DOI: 10.11604/pamj.2020.37.362.17659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Les cardiopathies congénitales surviennent dans 0,5 - 1% des naissances. La prise en charge d´enfants souffrant de malformation cardiaque nécessite un centre adapté, un matériel médical adéquat et des connaissances particulières tant sur le plan anesthésique que chirurgical. L´objectif de ce travail était d´évaluer la prise en charge anesthésique de ces cardiopathies dans notre centre après une première année d´activité et de comparer les résultats obtenus aux données de la littérature. Nous avons mené une étude rétrospective, descriptive sur une année allant de janvier à décembre 2017. Ont été inclus tous les patients opérés au cours de cette période pour une cure de cardiopathie congénitale sous circulation extracorporelle. Nous avons colligé 80 dossiers de patients opérés pour une cardiopathie congénitale. Parmi ces 80 patients, 60 ont été opéré sous circulation extra corporelle (CEC) soit un taux de 75%. L´âge moyen de nos patients était de 7,41 ans avec un sex- ratio de 1,22. La durée de la CEC était en moyenne de 82,82 mn et la durée moyenne du clampage aortique était de 58,31 mn. Soixante-dix pourcent (70%) des patients ont eu des catécholamines en fin d´intervention. La complication la plus fréquente en post opératoire était la défaillance cardiaque droite (69%). La durée moyenne de séjour en réanimation était de 4,33 jours. Nous avons noté le décès d´un patient portant la mortalité à 1,6%. Les cardiopathies congénitales sont complexes et très variables. Avec l´amélioration des techniques de prise en charge, leur morbi-mortalité a fortement diminué.
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Affiliation(s)
| | | | - Papa Alassane Leye
- Service d´Anesthésie - Réanimation, CHU Aristide Ledantec, Dakar, Sénégal
| | | | - Ibrahima Gaye
- Service d´Anesthésie - Réanimation, CHU Aristide Ledantec, Dakar, Sénégal
| | | | | | | | | | - Amadou Gabriel Ciss
- Service de Chirurgie Thoracique et Cardiovasculaire, CHU de Fann, Dakar, Sénégal
| | - Oumar Kane
- Service d´Anesthésie - Réanimation, CHU de Fann, Dakar, Sénégal
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29
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Song WS, Kim CY, Lee BS, Kim EAR, Kim KS, Jung E. Morbidity and Mortality of Very Low Birth Weight Infants with Congenital Heart Disease. Korean Circ J 2020; 50:1113-1123. [PMID: 33258320 PMCID: PMC7707980 DOI: 10.4070/kcj.2020.0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to provide morbidity and mortality information on very low birth weight (VLBW) infants with congenital heart disease (CHD-VLBWs). METHODS The study used a 10-year cohort of VLBW infants from a single institution. CHD was classified according to International Classification of Diseases, Version 9, Clinical Modification. Mortality and neonatal outcomes were assessed by comparing the CHD-VLBWs with gestational age- and birth weight-matched controls. RESULTS The prevalence of CHD-VLBWs was 7.5% (79/1,050), mean gestational age was 31.1±3.2 weeks, and mean birth weight was 1,126.2±268.3 g; 50.6% of the infants were small for the gestational age. The CHD-VLBWs more commonly had bronchopulmonary dysplasia (BPD), and the longer they were exposed to oxygen, the more frequently they developed BPD. Those with cyanotic heart disease developed severe BPD more frequently. Necrotizing enterocolitis (NEC) occurred frequently in the CHD-VLBWs and was not associated with their feeding patterns. CHD-VLBWs had a higher mortality rate; prematurity-related diseases were the leading cause of death before surgery, while heart-related problems were the leading cause of death after surgery. We found no significant difference in mortality from prematurity-related disease between the CHD-VLBWs and controls. In the subgroup analysis of CHD, the cyanotic CHD group had a higher incidence of BPD and higher mortality rate than the acyanotic CHD group. CONCLUSIONS CHD-VLBWs showed higher BPD, NEC, and mortality rates than those without CHD. There was also a higher incidence of BPD and mortality in VLBW infants with cyanotic CHD than in those with acyanotic CHD.
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Affiliation(s)
- Woo Sun Song
- Department of Pediatrics, University of Eulji College of Medicine, Daejeon, Korea
| | - Chae Young Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Byong Sop Lee
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Ellen Ai Rhan Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Ki Soo Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Euiseok Jung
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea.
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Comparison of growth and feeding method in infants with and without genetic abnormalities after neonatal cardiac surgery. Cardiol Young 2020; 30:1826-1832. [PMID: 32972475 DOI: 10.1017/s1047951120002887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Congenital heart disease (CHD) is multifactorial in origin, resulting from an interaction between environmental and genetic factors. Multifactorial growth delay is common in infants with CHD. The impact of a genetic abnormality and CHD on the growth of an infant is lacking in the literature. The aim of this study is to compare the growth and method of feeding following neonatal cardiac surgery in infants with normal versus abnormal genetic testing. METHODS A retrospective chart review of neonates who underwent a Risk Adjustment in Congenital Heart Surgery IV-VI procedure between 1 January, 2006 and 22 September, 2016 was performed at our institution. Weight, length, head circumference measurements, and feeding method were collected at birth, time of neonatal surgery, and monthly up to 6 months of age. RESULTS A total of 53 infants met inclusion criteria, of which 22 had abnormal genetic testing. Approximately 90% of infants were discharged following neonatal cardiac surgery with supplemental tube feeds. At each monthly follow-up visit, more infants were exclusively fed orally: 80% of infants with normal genetics at 5 months post-operative follow-up versus 60% of infants with abnormal genetic testing, although statistically insignificant. Growth was not different among the two groups. CONCLUSIONS Infants with critical CHD with or without genetic abnormalities are at risk for growth delays and many need supplemental tube feeds post-operatively and throughout follow-up. Infants with genetic abnormalities are slower to achieve oral feeds and more likely to require tube feedings. It is important to have a systematic protocol for managing these high-risk infants.
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Creating the BELgian COngenital heart disease database combining administrative and clinical data (BELCODAC): Rationale, design and methodology. Int J Cardiol 2020; 316:72-78. [DOI: 10.1016/j.ijcard.2020.05.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/26/2020] [Accepted: 05/18/2020] [Indexed: 12/23/2022]
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Nees SN, Chung WK. Genetic Basis of Human Congenital Heart Disease. Cold Spring Harb Perspect Biol 2020; 12:cshperspect.a036749. [PMID: 31818857 DOI: 10.1101/cshperspect.a036749] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Congenital heart disease (CHD) is the most common major congenital anomaly with an incidence of ∼1% of live births and is a significant cause of birth defect-related mortality. The genetic mechanisms underlying the development of CHD are complex and remain incompletely understood. Known genetic causes include all classes of genetic variation including chromosomal aneuploidies, copy number variants, and rare and common single-nucleotide variants, which can be either de novo or inherited. Among patients with CHD, ∼8%-12% have a chromosomal abnormality or aneuploidy, between 3% and 25% have a copy number variation, and 3%-5% have a single-gene defect in an established CHD gene with higher likelihood of identifying a genetic cause in patients with nonisolated CHD. These genetic variants disrupt or alter genes that play an important role in normal cardiac development and in some cases have pleiotropic effects on other organs. This work reviews some of the most common genetic causes of CHD as well as what is currently known about the underlying mechanisms.
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Affiliation(s)
| | - Wendy K Chung
- Department of Pediatrics.,Department of Medicine, Columbia University Irving Medical Center, New York, New York 10032, USA
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Qiu X, Weng Z, Liu M, Chen X, Wu Q, Ling W, Ma H, Huang H, Lin Y. Prenatal diagnosis and pregnancy outcomes of 1492 fetuses with congenital heart disease: role of multidisciplinary-joint consultation in prenatal diagnosis. Sci Rep 2020; 10:7564. [PMID: 32371943 PMCID: PMC7200674 DOI: 10.1038/s41598-020-64591-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 04/20/2020] [Indexed: 01/26/2023] Open
Abstract
Early diagnosis of congenital heart disease (CHD) can improve the prognosis of neonates with CHD. We retrospectively evaluated the value of prenatal diagnosis of CHD by comparing the pregnancy outcomes. Prenatal diagnosis of CHD was established by echocardiographic evaluation of fetal heart. Amniotic fluid and/or cord blood genetic examination, pathological anatomy, casting specimen, and/or multidisciplinary-joint consultation (MDJC) were performed. A total of 1492 fetuses with CHD were diagnosed by prenatal echocardiography from 67834 pregnant women. There were 445, 236, 583, and 228 cases in groups A (simple CHD), B (simple CHD plus extra-cardiac abnormality), C (complex CHD), and D (complex CHD plus extra-cardiac abnormality), respectively. The pregnancy continuation rate in the four groups was 98.67%, 85.71%, 67.65%, and 36.84%, respectively (P < 0.001). The pregnancy termination rate for fetal CHD with extra-cardiac abnormalities was significantly higher than that for fetuses with only CHD (81.24% vs. 53.6%, P < 0.05). Prenatal genetic test revealed chromosomal abnormalities in 20.43% of fetuses with CHD. MDJC significantly decreased the pregnancy termination rate. In 88 cases, the original decision to terminate the pregnancy was changed after consultation and the pregnancy was continued. Of these, 87 cases culminated in live births; 65 of these children had better prognosis. Nine-segment sequential segment analysis method for prenatal fetal echocardiography was compared with the results of pathological anatomy, cast specimen, postoperative diagnosis, and postnatal ultrasound. The accuracy of prenatal ultrasound for diagnosis of fetal complex CHD and fetal simple CHD was 90.5–91.66% and 98.6%, respectively. Prenatal ultrasound is still the most effective method for fetal CHD diagnosis.
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Affiliation(s)
- Xiuqing Qiu
- Department of obstetrics and gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Xiujuan Chen
- Department of obstetrics and gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Hong Ma
- Department of pathology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Hailong Huang
- Department of prenatal diagnosis center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China
| | - Yuan Lin
- Department of obstetrics and gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China.
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Referral Pattern for Fetal Echocardiography Over 10 Years in a Single Fetal Imaging Centre from Southern India. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ni J, Wang H, Wei X, Shen K, Sha Y, Dong Y, Shu Y, Wan X, Cheng J, Wang F, Liu Y. Isoniazid causes heart looping disorder in zebrafish embryos by the induction of oxidative stress. BMC Pharmacol Toxicol 2020; 21:22. [PMID: 32178728 PMCID: PMC7076990 DOI: 10.1186/s40360-020-0399-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cardiotoxicity of isoniazid on zebrafish embryos and its underlying mechanism is unclear. METHODS Here, we exposed zebrafish embryos at 4 h post-fertilization to different levels of isoniazid and recorded the morphology and number of malformed and dead embryos under the microscope. RESULTS The high concentration of isoniazid group showed more malformed and dead embryos than the low concentration of isoniazid group and control group. The morphology of the heart and its alteration were visualized using transgenic zebrafish (cmlc2: GFP) and confirmed by in situ hybridization. The negative effects of isoniazid on the developing heart were characterized by lower heart rate and more heart looping disorders. Mechanistically, PCR showed decreased expression of heart-specific transcription factors when exposed to isoniazid. Oxidative stress was induced by isoniazid in cardiomyocytes, mediated by decreased activities of catalase and superoxide dismutase, which were rescued by scavengers of reactive oxygen species. CONCLUSION In conclusion, this study demonstrated that isoniazid led to heart looping disturbance by the downregulation of cardiac-specific transcription factors and induction of cardiomyocyte apoptosis.
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Affiliation(s)
- Jie Ni
- Department of Emergency, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China
| | - Hongye Wang
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Xiyi Wei
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kangjie Shen
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Yeqin Sha
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Yuxiang Dong
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Yimei Shu
- The First Clinical Medical School, Nanjing Medical University, Nanjing, China
| | - Xiaojie Wan
- Clinical School of Imaging, Nanjing Medical University, Nanjing, China
| | - Jingwen Cheng
- The Medical School of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Fang Wang
- Department of Emergency, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
| | - Yihai Liu
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
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Transplantation-free survival after Norwood surgery for hypoplastic left heart syndrome with aortic atresia: A Swedish national cohort study. Cardiol Young 2020; 30:353-360. [PMID: 31920189 DOI: 10.1017/s1047951119003263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Norwood surgery has been available in Sweden since 1993. In this national cohort study, we analysed transplantation-free survival after Norwood surgery for hypoplastic left heart syndrome with aortic atresia. METHODS Patients were identified from the complete national cohort of live-born with hypoplastic left heart syndrome/aortic atresia 1993-2010. Analysis of survival after surgery was performed using Cox proportional hazards models for the total cohort and for birth period and gender separately. Thirty-day mortality and inter-stage mortality were analysed. Patients were followed until September 2016. RESULTS The 1993-2010 cohort consisted of 208 live-born infants. Norwood surgery was performed in 121/208 (58%). The overall transplantation-free survival was 61/121 (50%). The survival was higher in the late period (10-year survival 63%) than in the early period (10-year survival 40%) (p = 0.010) and lower for female (10-year survival 34%) than for male patients (10-year survival 59%) (p = 0.002). Inter-stage mortality between stages I and II decreased from 23 to 8% (p = 0.008). For male patients, low birthweight in relation to gestational age was a factor associated with poor outcome. CONCLUSION The survival after Norwood surgery for hypoplastic left heart syndrome/aortic atresia improved by era of surgery, mainly explained by improved survival between stages I and II. Female gender was a significant risk factor for death or transplantation. For male patients, there was an increased risk of death when birthweight was lower than expected in relation to gestational age.
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37
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Öhman A, El-Segaier M, Bergman G, Hanséus K, Malm T, Nilsson B, Pivodic A, Rydberg A, Sonesson SE, Mellander M. Changing Epidemiology of Hypoplastic Left Heart Syndrome: Results of a National Swedish Cohort Study. J Am Heart Assoc 2020; 8:e010893. [PMID: 30661430 PMCID: PMC6497328 DOI: 10.1161/jaha.118.010893] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Norwood surgery provides a palliative surgical option for hypoplastic left heart syndrome and has been available in Sweden since 1993. The practice of prenatal ultrasound screening was gradually implemented in the same era, resulting in an increased prenatal detection rate. Our primary aims were to study changes in the incidence of live births, prenatal detection rate, and the termination of pregnancies over time. The secondary aims were to study the proportion of live-borns undergoing surgery and to identify factors that influenced whether surgery was or was not performed. Methods and Results Neonates with hypoplastic left heart syndrome with aortic atresia born 1990-2010 were identified through national databases, surgical files, and medical records. The fetal incidence was estimated from the period when prenatal screening was rudimentary. The study period was divided into the presurgical, early surgical, and late surgical periods. The incidence was calculated as the overall yearly incidence for each time period and sex separately. Factors influencing whether surgery was performed were analyzed using Cox-logistic regression. The incidence at live birth decreased from 15.4 to 8.4 per 100 000. The prenatal detection rate increased from 27% to 63%, and terminations increased from 19% to 56%. The odds of having surgery was higher in the late period and higher in the group with prenatal diagnosis. Conclusions We observed a decrease in incidence of live-borns with hypoplastic left heart syndrome aortic atresia. There was in increase in prenatal detection rate and an increase in termination of pregnancy. The proportion of live-borns who underwent surgery increased between time periods.
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Affiliation(s)
- Annika Öhman
- 1 Department of Paediatric Cardiology Queen Silvia Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Milad El-Segaier
- 2 Department of Paediatric Cardiology Skåne University Hospital Lund Sweden
| | - Gunnar Bergman
- 4 Department of Pediatric Cardiology Karolinska University Hospital Stockholm Sweden
| | - Katarina Hanséus
- 2 Department of Paediatric Cardiology Skåne University Hospital Lund Sweden
| | - Torsten Malm
- 3 Department of Paediatric Cardiac Surgery Skåne University Hospital Lund Sweden
| | - Boris Nilsson
- 1 Department of Paediatric Cardiology Queen Silvia Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | | | - Annika Rydberg
- 6 Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - Sven-Erik Sonesson
- 7 Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Mats Mellander
- 1 Department of Paediatric Cardiology Queen Silvia Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden
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Nees SN, Chung WK. The genetics of isolated congenital heart disease. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 184:97-106. [PMID: 31876989 DOI: 10.1002/ajmg.c.31763] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022]
Abstract
The genetic mechanisms underlying congenital heart disease (CHD) are complex and remain incompletely understood. The majority of patients with CHD have an isolated heart defect without other organ system involvement, but the genetic basis of isolated CHD has been even more difficult to elucidate compared to syndromic CHD. Our understanding of the genetics of isolated CHD is advancing in large part due to advances in next generation sequencing, and the list of genes associated with CHD is rapidly expanding. Variants in hundreds of genes have been identified that may cause or contribute to CHD, but a genetic cause can still only be identified in about 20-30% of patients. Identifying a genetic cause for CHD can have an impact on clinical outcomes and prognosis and thus it is important for clinicians to understand when and what to test in patients with isolated CHD. This chapter reviews some of the known genetic mechanisms that contribute to isolated inherited and sporadic CHD as well as recommendations for evaluation and genetic testing in patients with isolated CHD.
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Affiliation(s)
- Shannon N Nees
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,Department of Medicine, Columbia University Irving Medical Center, New York, New York
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A novel dual reporter embryonic stem cell line for toxicological assessment of teratogen-induced perturbation of anterior-posterior patterning of the heart. Arch Toxicol 2019; 94:631-645. [PMID: 31811323 DOI: 10.1007/s00204-019-02632-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
Reliable in vitro models to assess developmental toxicity of drugs and chemicals would lead to improvement in fetal safety and a reduced cost of drug development. The validated embryonic stem cell test (EST) uses cardiac differentiation of mouse embryonic stem cells (mESCs) to predict in vivo developmental toxicity, but does not take into account the stage-specific patterning of progenitor populations into anterior (ventricular) and posterior (atrial) compartments. In this study, we generated a novel dual reporter mESC line with fluorescent reporters under the control of anterior and posterior cardiac promoters. Reporter expression was observed in nascent compartments in transgenic mouse embryos, and mESCs were used to develop differentiation assays in which chemical modulators of Wnt (XAV939: 3, 10 µM), retinoic acid (all-trans retinoic acid: 0.1, 1, 10 µM; 9-cis retinoic acid: 0.1, 1, 10 µM; bexarotene 0.1, 1, 10 µM), and Tgf-β (SB431542: 3, 10 µM) pathways were tested for stage- and dose-dependent effects on in vitro anterior-posterior patterning. Our results suggest that with further development, the inclusion of anterior-posterior reporter expression could be part of a battery of high-throughput tests used to identify and characterize teratogens.
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40
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Pure Aortic Regurgitation in Pediatric Patients. Am J Cardiol 2019; 124:1731-1735. [PMID: 31586532 DOI: 10.1016/j.amjcard.2019.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 01/09/2023]
Abstract
Aortic regurgitation (AR) continues to be an important cause of morbidity and mortality in pediatric patients. Although echocardiographic parameters are well established for the adults, there are no clear cut-off values for AR severity in children. Cardiac magnetic resonance (CMR) imaging is considered a "gold standard" for a quantitative evaluation of the AR, but it is not widely available. This study assesses which echo parameter can accurately define AR severity as assessed by CMR in pediatric patients. A total of 27 pediatric patients (12 ± 3 years, range 6 to 18 years) with different degree of AR underwent echo assessment within an average of 35 days from CMR. CMR included phase-contrast velocity-encoded imaging for the measurement of regurgitant fraction (RF). Severe AR was defined as RF >33%. Echo evaluation included vena contracta, pressure half time, the ratio between the AR jet and the left ventricular outflow tract diameter (jet/left ventricular outflow tract), presence of holodiastolic reversal flow in abdominal aorta, the ratio between the velocity-time integral of the reversal flow over the forward flow in descending aorta (echoRF). Among the studied parameters, the strongest predictor of severe AR, as assessed by CMR, was echoRF. Receiver-operating characteristic curve showed, for a cutoff >0.38, an area under the curve of 0.886 (p <0.0001), a sensitivity of 71%, and a specificity of 100%. Correlation coefficient between echoRF and RF was R = 0.929 (p <0.0001). In conclusion, echoRF is a strong echo-Doppler marker of severe AR in the pediatric population. This parameter should be routinely added in the standard echo evaluation of pediatric patients with AR.
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41
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Zühlke L, Lawrenson J, Comitis G, De Decker R, Brooks A, Fourie B, Swanson L, Hugo-Hamman C. Congenital Heart Disease in Low- and Lower-Middle-Income Countries: Current Status and New Opportunities. Curr Cardiol Rep 2019; 21:163. [PMID: 31784844 DOI: 10.1007/s11886-019-1248-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The paper summarises the most recent data on congenital heart disease (CHD) in low- and lower-middle-income countries (LLMICs). In addition, we present an approach to diagnosis, management and interventions in these regions and present innovations, research priorities and opportunities to improve outcomes and develop new programs. RECENT FINDINGS The reported birth prevalence of CHD in LLMICs is increasing, with clear evidence of the impact of surgical intervention on the burden of disease. New methods of teaching and training are demonstrating improved outcomes. Local capacity building remains the key. There is a significant gap in epidemiological and outcomes data in CHD in LLMICs. Although the global agenda still does not address the needs of children with CHD adequately, regional initiatives are focusing on quality improvement and context-specific interventions. Future research should focus on epidemiology and the use of innovative thinking and partnerships to provide low-cost, high-impact solutions.
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Affiliation(s)
- Liesl Zühlke
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa.
- Division of Cardiology, Department of Medicine, Groote Schur Hospital and University of Cape Town, Cape Town, South Africa.
| | - John Lawrenson
- Western Cape Paediatric Cardiology Services, and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, 7925, South Africa
| | - George Comitis
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
| | - Rik De Decker
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
| | - Andre Brooks
- Chris Barnard Division of Cardiac Surgery, University of Cape Town, Cape Town, South Africa
| | - Barend Fourie
- Western Cape Paediatric Cardiology Services, and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, 7925, South Africa
| | - Lenise Swanson
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
| | - Christopher Hugo-Hamman
- Western Cape Paediatric Cardiology Services, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, 2.17 Institute of Child Health Building, Klipfontein Rd Mowbray, 7700, South Africa
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42
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Ribera I, Ruiz A, Sánchez O, Eixarch E, Antolín E, Gómez-Montes E, Pérez-Cruz M, Cruz-Lemini M, Sanz-Cortés M, Arévalo S, Ferrer Q, Vázquez E, Vega L, Dolader P, Montoliu A, Boix H, Simões RV, Masoller N, Sánchez-de-Toledo J, Comas M, Bartha JM, Galindo A, Martínez JM, Gómez-Roig L, Crispi F, Gómez O, Carreras E, Cabero L, Gratacós E, Llurba E. Multicenter prospective clinical study to evaluate children short-term neurodevelopmental outcome in congenital heart disease (children NEURO-HEART): study protocol. BMC Pediatr 2019; 19:326. [PMID: 31506079 PMCID: PMC6737686 DOI: 10.1186/s12887-019-1689-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background Congenital heart disease (CHD) is the most prevalent congenital malformation affecting 1 in 100 newborns. While advances in early diagnosis and postnatal management have increased survival in CHD children, worrying long-term outcomes, particularly neurodevelopmental disability, have emerged as a key prognostic factor in the counseling of these pregnancies. Methods Eligible participants are women presenting at 20 to < 37 weeks of gestation carrying a fetus with CHD. Maternal/neonatal recordings are performed at regular intervals, from the fetal period to 24 months of age, and include: placental and fetal hemodynamics, fetal brain magnetic resonance imaging (MRI), functional echocardiography, cerebral oxymetry, electroencephalography and serum neurological and cardiac biomarkers. Neurodevelopmental assessment is planned at 12 months of age using the ages and stages questionnaire (ASQ) and at 24 months of age with the Bayley-III test. Target recruitment is at least 150 cases classified in three groups according to three main severe CHD groups: transposition of great arteries (TGA), Tetralogy of Fallot (TOF) and Left Ventricular Outflow Tract Obstruction (LVOTO). Discussion The results of NEURO-HEART study will provide the most comprehensive knowledge until date of children’s neurologic prognosis in CHD and will have the potential for developing future clinical decisive tools and improving preventive strategies in CHD. Trial registration NCT02996630, on 4th December 2016 (retrospectively registered).
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Affiliation(s)
- I Ribera
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - A Ruiz
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - O Sánchez
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain.,Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain
| | - E Eixarch
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - E Antolín
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.,Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Hospital Universitario La Paz, Madrid, Spain
| | - E Gómez-Montes
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.,Hospital Universitario 12 de Octubre, Universidad Computense de Madrid, Madrid, Spain
| | - M Pérez-Cruz
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.,BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - M Cruz-Lemini
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - M Sanz-Cortés
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - S Arévalo
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - Q Ferrer
- Department of Paediatric Cardiology, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - E Vázquez
- Department of Pediatric Radiology,
- Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - L Vega
- Department of Paediatric Cardiology, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - P Dolader
- Department of Paediatric Cardiology, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - A Montoliu
- Department of Neuropsicology, Vall d'Hebron University Hospital Barcelona, Barcelona, Spain
| | - H Boix
- Department of Pediatrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - R V Simões
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - N Masoller
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - J Sánchez-de-Toledo
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.,Department of Cardiology, Hospital Sant Joan de Déu, Barcelona, Barcelona, Spain
| | - M Comas
- Universitary Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J M Bartha
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.,Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Hospital Universitario La Paz, Madrid, Spain
| | - A Galindo
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.,Hospital Universitario 12 de Octubre, Universidad Computense de Madrid, Madrid, Spain
| | - J M Martínez
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - L Gómez-Roig
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain.,BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - F Crispi
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - O Gómez
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - E Carreras
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - L Cabero
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - E Gratacós
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - E Llurba
- Spain Maternal and Child Health Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022, Madrid, Spain. .,Director of Obstetrics and Gynaecology Department, St Creu and St Pau Hospital, Sant Antoni Mª Claret, 167, 08025, Barcelona, Spain.
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Han B, Li Y, Tang Y, Qu X, Wang F, Song H, Xu Y. Clinical analysis of prenatal ultrasound diagnosis of fetal cardiovascular malformations in the first and second trimesters of pregnancy: A CARE-compliant article. Medicine (Baltimore) 2019; 98:e16822. [PMID: 31415400 PMCID: PMC6831343 DOI: 10.1097/md.0000000000016822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Fetal cardiovascular malformations is widely focused and screened, but the accuracy of screening is not satisfactory. In this study, we compared the types of congenital heart malformation, accompanying diseases and fetal outcomes in the first and second trimesters of pregnancy to clarify the advantage of early screening.From January 2013 to June 2018, 230 fetuses were diagnosed with congenital heart malformations using ultrasound method in Qilu Hospital of Shandong University, and divided into 2 groups:the first trimester fetuses (group A) and the second trimester fetuses (group B). In addition, we collected and organized medical data of 347 cases diagnosed with congenital heart disease during 1998 to 2005 (group C). We compared the spectrum of congenital heart disease, associated comorbidities and outcome of fetuses diagnosed with congenital heart disease.There were differences in the types and incidence of cardiac malformations between the first and second trimesters of pregnancy. The number of cases of non-cardiac malformation, congenital heart disease with single ventricular circulation, fetal intrauterine death and premature pregnancy termination was significantly lower in the late stage (group A and group B) than that in the early stage (group C). More patients were screened for trisomy 21, 18, 13 syndromes and Turner syndrome in group A than group B (P <.001). More fetuses with a 22q11 deletion were screened in group B than group C.Early pregnancy screening using ultrasound diagnosis is very important for fetuses with congenital heart disease.
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Affiliation(s)
| | - Ying Li
- Department of Cardiac Ultrasound, Weihai Municipal Hospital
| | - Yi Tang
- Department of Ultrasound, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong, China
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Hautala J, Gissler M, Ritvanen A, Tekay A, Pitkänen-Argillander O, Stefanovic V, Sarkola T, Helle E, Pihkala J, Pätilä T, Mattila IP, Jokinen E, Räsänen J, Ojala T. The implementation of a nationwide anomaly screening programme improves prenatal detection of major cardiac defects: an 11-year national population-based cohort study. BJOG 2019; 126:864-873. [PMID: 30576052 DOI: 10.1111/1471-0528.15589] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate whether a nationwide prenatal anomaly screening programme improves detection rates of univentricular heart (UVH) and transposition of great arteries (TGA), and whether maternal risk factors for severe fetal heart disease affect prenatal detection. DESIGN Population-based cohort study. SETTING Nationwide data from Finnish registries 2004-14. POPULATION A total of 642 456 parturients and 3449 terminated pregnancies due to severe fetal anomaly. METHODS Prenatal detection rates were calculated in three time periods (prescreening, transition and screening phase). The effect of maternal risk factors (obesity, in vitro fertilisation, pregestational diabetes and smoking) was evaluated. MAIN OUTCOME MEASURES Change in detection rates and impact of maternal risk factors on screening programme efficacy. RESULTS In total, 483 cases of UVH and 184 of TGA were detected. The prenatal detection rate of UVH increased from 50.4% to 82.8% and of TGA from 12.3% to 41.0% (P < 0.0001). Maternal risk factors did not affect prenatal detection rate, but detection rate differed substantially by region. CONCLUSIONS A nationwide screening programme improved overall UVH and TGA detection rates, but regional differences were observed. Obesity or other maternal risk factors did not affect the screening programme efficacy. The establishment of structured guidelines and recommendations is essential when implementing the screening programme. In addition, a prospective screening register is highly recommended to ensure high quality of screening. TWEETABLE ABSTRACT Implementation of a nationwide prenatal anomaly screening improved detection rates of UVH and TGA.
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Affiliation(s)
- J Hautala
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - A Ritvanen
- Register of Congenital Malformations, National Institute for Health and Welfare, Helsinki, Finland
| | - A Tekay
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - O Pitkänen-Argillander
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - V Stefanovic
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Sarkola
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Helle
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Pihkala
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Pätilä
- Division of Paediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - I P Mattila
- Division of Paediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Jokinen
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Räsänen
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Ojala
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Zhao QM, Liu F, Wu L, Ma XJ, Niu C, Huang GY. Prevalence of Congenital Heart Disease at Live Birth in China. J Pediatr 2019; 204:53-58. [PMID: 30270157 DOI: 10.1016/j.jpeds.2018.08.040] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/26/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the prevalence of congenital heart disease (CHD) in China based on a large prospective multicenter screening study. STUDY DESIGN A total of 122 765 consecutive infants born at 18 hospitals throughout China between August 1, 2011, and November 30, 2012, were included. Cases of CHD were identified by echocardiography, clinical assessment, and telephone follow-up. RESULTS The overall prevalence of CHD was 8.98 per 1000 live births (critical, 1.46; serious, 1.47; significant, 5.00; nonsignificant, 1.07), including 7.15 in male infants and 11.11 in female infants. The most common CHD was ventricular septal defect (3.3), followed by atrial septal defect (1.7), patent ductus arteriosus (0.78), pulmonary stenosis (0.73), tetralogy of Fallot (0.47), and transposition of the great arteries (0.35). Female predominance was observed for all CHD and mild CHD (significant and nonsignificant), and male predominance was observed for the critical CHDs. The proportion of preterm newborns was substantially higher among the major CHD cases (critical and serious) compared with normal newborns. There were appreciably more low birth weight infants among the critical CHD cases compared with normal newborns. Significantly higher rates of ventricular septal defect and atrioventricular septal defect were found in infants born to mothers aged ≥35 years. Extracardiac anomalies were found in 9.3% of CHD cases. The risk of CHD was increased by approximately 3-fold when a first-degree relative had CHD. CONCLUSIONS Our estimates are concordant with data from Western studies. This screening study may provide more accurate and complete information on the overall prevalence of CHD in China.
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Affiliation(s)
- Qu-Ming Zhao
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Fang Liu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Wu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiao-Jing Ma
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Conway Niu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Guo-Ying Huang
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Birth Defects, Shanghai, China.
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van der Ven JPG, van den Bosch E, Bogers AJCC, Helbing WA. State of the art of the Fontan strategy for treatment of univentricular heart disease. F1000Res 2018; 7. [PMID: 30002816 PMCID: PMC6024235 DOI: 10.12688/f1000research.13792.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Abstract
In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival. However, the resulting Fontan physiology is associated with high morbidity. In this review, we discuss the state of the art of the Fontan strategy by assessing survival and risk factors for mortality. Complications of the Fontan circulation, such as cardiac arrhythmia, thromboembolism, and protein-losing enteropathy, are discussed. Common surgical and catheter-based interventions following Fontan completion are outlined. We describe functional status measurements such as quality of life and developmental outcomes in the contemporary Fontan patient. The current role of drug therapy in the Fontan patient is explored. Furthermore, we assess the current use and outcomes of mechanical circulatory support in the Fontan circulation and novel surgical innovations. Despite large improvements in outcomes for contemporary Fontan patients, a large burden of disease exists in this patient population. Continued efforts to improve outcomes are warranted. Several remaining challenges in the Fontan field are outlined.
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Affiliation(s)
- Jelle P G van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Ad J C C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Pérez-Lescure Picarzo J, Mosquera González M, Latasa Zamalloa P, Crespo Marcos D. Congenital heart disease mortality in Spain during a 10 year period (2003–2012). ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Yoo BW. Epidemiology of Congenital Heart Disease with Emphasis on Sex-Related Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:49-59. [DOI: 10.1007/978-3-319-77932-4_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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49
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Bravo-Valenzuela NJ, Peixoto AB, Araujo Júnior E. Prenatal diagnosis of congenital heart disease: A review of current knowledge. Indian Heart J 2017; 70:150-164. [PMID: 29455772 PMCID: PMC5903017 DOI: 10.1016/j.ihj.2017.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 01/16/2023] Open
Abstract
This article reviews important features to improve the diagnosis of congenital heart disease (CHD) by applying ultrasound in prenatal cardiac screening. As low and high-risk pregnancies for CHD are subject to routine obstetric ultrasound, the diagnosis of structural heart defects represents a challenge that involves a team of specialists and subspecialists on fetal ultrasonography. In this review, the images highlight normal anatomy of the heart as well as pathologic cases consistent with cardiac malposition and isomerism, septal defects, pulmonary stenosis/atresia, aortic malformations, hypoplastic left ventricle, conotruncal anomalies, tricuspid dysplasia, and Ebstein’s anomaly, and univentricular heart, among other congenital cardiovascular defects. Anatomical details of most CHD in fetuses were provided by two-dimensional (2D) ultrasound with higher quality imaging, enhancing diagnostic accuracy in a variety of CHD. Moreover, the accuracy of the cardiac defects in obstetrics ultrasound improves the outcome of most CHD, providing planned delivery, aided genetic counseling, and perinatal management.
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Affiliation(s)
| | - Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, MG, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
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Zaqout M, Vandekerckhove K, Michels N, Bove T, François K, De Wolf D. Physical Fitness and Metabolic Syndrome in Children with Repaired Congenital Heart Disease Compared with Healthy Children. J Pediatr 2017; 191:125-132. [PMID: 28965732 DOI: 10.1016/j.jpeds.2017.08.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine whether children who underwent surgery for congenital heart disease (CHD) are as fit as their peers. STUDY DESIGN We studied 66 children (6-14 years) who underwent surgery for ventricular septal defect (n = 19), coarctation of aorta (n = 10), tetralogy of Fallot (n = 15), and transposition of great arteries (n = 22); and 520 healthy children (6-12 years). All children performed physical fitness tests: cardiorespiratory fitness, muscular strength, balance, flexibility, and speed. Metabolic score was assessed through z-score standardization using 4 components: waist circumference, blood pressure, blood lipids, and insulin resistance. Assessment also included self-reported and accelerometer-measured physical activity. Linear regression analyses with group (CHD vs control) as a predictor were adjusted for age, body mass index, physical activity, and parental education. RESULTS Measured physical activity level, body mass index, cardiorespiratory fitness, flexibility, and total metabolic score did not differ between children with CHD and controls, whereas reported physical activity was greater in the CHD group than control group. Boys with CHD were less strong in upper muscular strength, speed, and balance, whereas girls with CHD were better in lower muscular strength and worse in balance. High-density lipoprotein was greater in boys and girls with CHD, whereas boys with CHD showed unhealthier glucose homeostasis. CONCLUSION Appropriate physical fitness was achieved in children after surgery for CHD, especially in girls. Consequently, children with CHD were not at increased total metabolic risk. Lifestyle counseling should be part of every patient interaction.
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Affiliation(s)
- Mahmoud Zaqout
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
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