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Lang X, Lv L, Zhang S, Zhi A, Wang C, Wang Q. Effectiveness and Safety of Different Patch Materials for Supravalvar Aortic Stenosis (Middle-Term Outcomes). Rev Cardiovasc Med 2024; 25:14. [PMID: 39077638 PMCID: PMC11262331 DOI: 10.31083/j.rcm2501014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 07/31/2024] Open
Abstract
Background To determine the effectiveness and safety of different patch materials in the treatment of pediatric patients with congenital supravalvular aortic stenosis (SVAS). Methods 218 consecutive SVAS patients (age < 14 years) who underwent surgery from Beijing Fuwai and Yunnan Fuwai hospital between 2002 and 2020 were included. Patients were divided into the pericardium patch group (133 (61.0%)), modified patch group (43 (19.7%)) and artificial patch group (42 (19.3%)). The primary safety endpoint was patch-related adverse complications (post-operation patch hemorrhage or aortic sinus aneurysm at 2-year follow-up). The primary effectiveness outcome was the re-operation or restenosis at 2-year follow-up. Multivariable cox regression was used to obtain the hazard ratio (HR). Results The median age at operation was 43.5 months (IQR 24.0-73.0). Only three patients had patch-related adverse complications, and no difference existed among the three groups (p = 0.763). After a median follow-up of 24.0 months (IQR 6.0-48.0), patients with a pericardium patch had a lower re-operation or restenosis rate compared with the other two groups (pericardium patch vs modified patch, HR = 0.30, 95% CI 0.12-0.77; pericardium patch vs artificial patch, HR = 0.33, 95% CI 0.13-0.82), even in the main subgroup and sensitivity analysis. Conclusions In pediatric patients, the safety of autologous pericardium patch is acceptable, along with lower rates of middle-term re-operation or restenosis. Clinical Trial Registration http://www.chictr.org.cn, number: ChiCTR2300067851.
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Affiliation(s)
- Xinyue Lang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, The National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 102300 Beijing, China
| | - Lizhi Lv
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, 650102 Kunming, Yunnan, China
| | - Simeng Zhang
- Department of Cardiac Surgery, Peking University People’s Hospital, 100044 Beijing, China
| | - Aihua Zhi
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
- Department of Radiology, Yunnan Fuwai Cardiovascular Hospital, 650102 Kunming, Yunnan, China
| | - Cheng Wang
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, 650102 Kunming, Yunnan, China
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Qiang Wang
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, 650102 Kunming, Yunnan, China
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Lv L, Lang X, Zhang S, Wang C, Wang Q. Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:987522. [PMID: 36148069 PMCID: PMC9485597 DOI: 10.3389/fcvm.2022.987522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Importance The safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent. Objective To compare the prognosis of single-, two- and three-patch repair for patients with SVAS. Data sources PubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov were searched until April 17, 2022. Study selection Study reported SVAS patients treated with single-, two- or three-patch repair. Data extraction and synthesis Two reviewers independently extracted the data of study characteristics and clinical outcomes. Multiple pairwise and frequentist network meta-analyses were conducted. And a fixed-effect model was used when no heterogeneity existed. Main outcomes and measures Outcomes included the rate of reintervention, aortic insufficiency, early mortality and late mortality, cardiopulmonary bypass (CPB) time, cross-clamping (CCP) time, and postoperative/ follow-up pressure gradient. Binary variables were evaluated by odds ratio (OR) and its 95% confidence interval (CI), while continuous variables were assessed by standardized mean difference (SMD) and its 95% CI. Results Twenty-seven retrospective cohort studies were included, comprising 1,162 patients, undergoing single-patch (46.6% of cases), two-patch (33.9%), and three-patch repair (19.4%). Two-patch method had a lower rate of reintervention compared with single-patch (OR = 0.47, 95 % CI 0.28–0.89), and three-patch (OR = 0.31, 95 % CI 0.15–0.64). This finding also applied to juvenile and non-Asian patients. Three-patch method had a lower rate of aortic insufficiency compared with single-patch (OR = 0.11, 95 % CI 0.01–0.63), and two-patch (OR = 0.11, 95 % CI 0.02–0.83). But this repair had the longest CCP time, which was significantly longer than that of single- (SMD = 0.76, 95 % CI 0.36–1.17) or two-patch repair (SMD = 0.61, 95 % CI 0.06–1.16). No significant difference was found in mortality and pressure gradient among three procedures. Conclusion and relevance Two-patch repair has the lowest reintervention rate and relatively reasonable operation time. Complex and severe SVAS is suggested to be treated with two-patch repair. Further prospective studies of a reasonable sample size will be required with a special focus on the use of different patch materials and surgeons' unique working experience. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022328146.
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Affiliation(s)
- Lizhi Lv
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyue Lang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Simeng Zhang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Wang
- Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Qiang Wang
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3
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Ungvari Z, Tarantini S, Kirkpatrick AC, Csiszar A, Prodan CI. Cerebral microhemorrhages: mechanisms, consequences, and prevention. Am J Physiol Heart Circ Physiol 2017; 312:H1128-H1143. [PMID: 28314762 PMCID: PMC5495931 DOI: 10.1152/ajpheart.00780.2016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
The increasing prevalence of multifocal cerebral microhemorrhages (CMHs, also known as "cerebral microbleeds") is a significant, newly recognized problem in the aging population of the Western world. CMHs are associated with rupture of small intracerebral vessels and are thought to progressively impair neuronal function, potentially contributing to cognitive decline, geriatric psychiatric syndromes, and gait disorders. Clinical studies show that aging and hypertension significantly increase prevalence of CMHs. CMHs are also now recognized by the National Institutes of Health as a major factor in Alzheimer's disease pathology. Moreover, the presence of CMHs is an independent risk factor for subsequent larger intracerebral hemorrhages. In this article, we review the epidemiology, detection, risk factors, clinical significance, and pathogenesis of CMHs. The potential age-related cellular mechanisms underlying the development of CMHs are discussed, with a focus on the structural determinants of microvascular fragility, age-related alterations in cerebrovascular adaptation to hypertension, the role of oxidative stress and matrix metalloproteinase activation, and the deleterious effects of arterial stiffening, increased pulse pressure, and impaired myogenic autoregulatory protection on the brain microvasculature. Finally, we examine potential treatments for the prevention of CMHs based on the proposed model of aging- and hypertension-dependent activation of the reactive oxygen species-matrix metalloproteinases axis, and we discuss critical questions to be addressed by future studies.
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Affiliation(s)
- Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; .,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Angelia C Kirkpatrick
- Veterans Affairs Medical Center, Oklahoma City, Oklahoma.,Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Calin I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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4
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Abstract
Supravalvular aortic stenosis, characterized by narrowing of the ascending aorta above the valve, is the least common form of left ventricular outflow tract obstruction and is usually associated with William's syndrome. We present a case of a 27-year-old male with isolated supravalvar aortic stenosis (SVAS) presenting with heart failure. This case underscores the fact that in rare cases sporadic SVAS can occur in isolation without the classic findings of William's syndrome and highlighting the importance of integration of clinical and echocardiographic recognition for definitive management.
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Affiliation(s)
- Lucky Romero Cuenza
- Department of Adult Cardiology, Philippine Heart Center, Quezon City, Metro Manila, Philippines
| | - Areefah Alonto Adiong
- Section of Non Invasive Cardiology, Philippine Heart Center, Quezon City, Metro Manila, Philippines
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5
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Greutmann M, Tobler D, Sharma NC, Vonder Muhll I, Mebus S, Kaemmerer H, Schuler PK, Deanfield JE, Beauchesne L, Salehian O, Hoffmann A, Golovatyuk V, Oechslin EN, Silversides CK. Cardiac outcomes in adults with supravalvar aortic stenosis. Eur Heart J 2012; 33:2442-50. [DOI: 10.1093/eurheartj/ehs206] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Honda T, Kanazawa H, Fujimoto K. Membranous-type supravalvular aortic stenosis in a 61-year-old woman. Circ J 2011; 75:2714-5. [PMID: 21799267 DOI: 10.1253/circj.cj-11-0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tsuyoshi Honda
- Department of Cardiology, Cardiovascular Center, National Hospital Organization Kumamoto Medical Center, Japan.
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7
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Borghetti V, D'Addario G, Bravi I, Pardinia A. Extended replacement of a calcified ascending aorta in adulthood sporadic, diffuse type, supravalvular aortic stenosis. Interact Cardiovasc Thorac Surg 2011; 13:234-6. [PMID: 21546371 DOI: 10.1510/icvts.2010.261719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The diffuse variant of supravalvular aortic stenosis (SVAS) is one of the most rare congenital vascular pathological conditions of adulthood. Due to its rarity, surgical treatment of this clinical entity is still a matter of debate because of the variable degree of aortic narrowing, presence of multilevel obstruction, and age at presentation, all factors that strongly influence the disease prognosis. We report a case of an adult patient with an extremely calcified diffuse SVAS who underwent successful replacement of the ascending aorta through the interposition of a tubular prosthesis. Six months' follow-up showed complete relief of the aortic gradient and an improvement in clinical performance.
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8
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Vanakker OM, Hemelsoet D, De Paepe A. Hereditary connective tissue diseases in young adult stroke: a comprehensive synthesis. Stroke Res Treat 2011; 2011:712903. [PMID: 21331163 PMCID: PMC3034976 DOI: 10.4061/2011/712903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/15/2010] [Accepted: 12/23/2010] [Indexed: 01/17/2023] Open
Abstract
Though the genetic background of ischaemic and haemorrhagic stroke is often polygenetic or multifactorial, it can in some cases result from a monogenic disease, particularly in young adults. Besides arteriopathies and metabolic disorders, several connective tissue diseases can present with stroke. While some of these diseases have been recognized for decades as causes of stroke, such as the vascular Ehlers-Danlos syndrome, others only recently came to attention as being involved in stroke pathogenesis, such as those related to Type IV collagen. This paper discusses each of these connective tissue disorders and their relation with stroke briefly, emphasizing the main clinical features which can lead to their diagnosis.
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Affiliation(s)
- Olivier M. Vanakker
- Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dimitri Hemelsoet
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Anne De Paepe
- Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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9
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Ferlan G, De Pasquale C, Losito C, Fiorella A, Marraudino N, Tunzi F. Diffuse supravalvular aortic stenosis: surgical repair in adulthood. Cardiol Res Pract 2010; 2009:976190. [PMID: 20049320 PMCID: PMC2796460 DOI: 10.4061/2009/976190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 08/19/2009] [Indexed: 11/20/2022] Open
Abstract
We present the case of a 54-year-old woman in which a diffuse congenital supravalvular aortic stenosis (SVAS) was associated with a severe aortic valve incompetence and heavy calcification of the aortic annulus. Repair consisted in resection of the ascending aorta, patch augmentation of the hypoplastic aortic root and annulus, placement of a 20 mm Dacron tubular graft (Vascutek, Renfrewshire, UK) and aortic valve replacement with a mechanical prosthesis (Sorin, Turin, Italy). Follow-up echocardiography demonstrated normal prosthetic valve function and a postoperative three-dimensional computed tomographic scan showed a normal shape of the reconstructed ascending aorta.
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Affiliation(s)
- Giovanni Ferlan
- Department of Cardiac Surgery, University of Bari Medical School, Piazza Giulio Cesare 11, Bari 70122, Italy
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10
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Brown DW, Giles WH, Croft JB. Association of cardiac ausculatory findings with coronary heart disease mortality. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2009; 1:327-32. [PMID: 22666719 PMCID: PMC3364677 DOI: 10.4297/najms.2009.7327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Relationships between cardiac murmurs detected during physical examination and coronary heart disease mortality among the general population are not well described. AIMS To assess the relationship between cardiac murmurs detected during physical examination and coronary heart disease mortality. METHODS AND RESULTS This relationship was examined with Cox regression analyses of data from 7990 adults, aged 30-75 years, from the Second National Health and Nutrition Examination Survey Mortality Study (1976-1992). Covariates included age, race, sex, history of CVD, diabetes, probable left ventricular hypertrophy, serum cholesterol, body mass index, blood pressure, and smoking status. During 16.8 follow-up years , there were 457 deaths from coronary heart disease (CHD) (ICD-9 410-414) and 661 deaths from diseases of the heart (ICD-9 390-398, 402, 404, 410-414, 415-417, 420-429). A systolic murmur was present in 420 persons and a diastolic murmur was present in 56 persons at baseline. Persons with a heart murmur were at increased risk of death from CHD (relative risk=1.7, 95% confidence interval=1.2, 2.5) and from diseases of the heart (RR=2.2, 95% CI=1.6, 2.9) after multivariate adjustment for cardiovascular disease risk factors. Similar results were observed when murmur intensity (i.e., murmur grade) was accounted for. CONCLUSIONS These results suggest that the presence of a heart murmur may be associated with an increased risk for mortality from both CHD and diseases of the heart.
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Affiliation(s)
- David W. Brown
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Correspondence to: David W Brown, Centers for Disease Control and Prevention (MS K67), 4770 Buford Hwy NE, Atlanta, Georgia, 30341, USA 30341. Tel.: 7704885965,
| | - Wayne H. Giles
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet B. Croft
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Cardiac catheterization and operative outcomes from a multicenter consortium for children with williams syndrome. Pediatr Cardiol 2009; 30:9-14. [PMID: 19052807 DOI: 10.1007/s00246-008-9323-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Revised: 09/11/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
Williams syndrome is a multifaceted disorder that includes a spectrum of cardiovascular anomalies. Due to its rare occurrence, outcome data for operations and cardiac catheterization are limited. We reviewed data from 242 individuals from the Pediatric Cardiac Care Consortium (PCCC) with Williams syndrome and associated cardiovascular lesions, and their frequency, and assessed their effects on mortality. In the PCCC, from 1984 to 1999 there were approximately 100,000 entries for cardiac procedures, involving more than 62,000 patients. The diagnosis of Williams syndrome was based on clinical features and determined by each site. Most patients were diagnosed with the availability of the FISH probe for region 7q11.23. Using a spreadsheet application, Microsoft Excel, the selected patients were analyzed for various types of cardiac anomalies. The most common cardiovascular lesions and the mortality rate in patients with Williams syndrome were examined. A complete tabulation of all cardiovascular lesions was assembled. There were 292 catheterizations and 143 operations reported to the PCCC. One hundred six patients had both an operation and a catheterization. The three main cardiovascular anomalies were supravalvular aortic stenosis (SVAS; 169), pulmonary artery stenosis (PAS; 130), and coarctation or aortic arch hypoplasia (Arch; 32). One hundred five patients had a single lesion, 70 with SVAS, 29 with PAS, and 6 with an arch anomaly. Ninety-two had more than one lesion: 80 with SVAS and PAS, 7 with PAS and Arch, and 5 with SVAS and Arch. Seventy individuals have only SVAS, 29 PAS, and 6 Arch alone. There was a total of 15 deaths. The mortality rate was highest in the group with the combination of SVAS and PAS (7 surgical and 5 catheter; 12 of 80 patients [15%]; p = 0.0001, chi(2)). In conclusion, our data represent the largest collection of individuals with Williams syndrome who underwent cardiac catheterization and/or operation. The data suggest that children with Williams syndrome and bilateral outflow tract obstruction have statistically and clinically significantly higher mortality associated with catheterization or operation.
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12
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De Rubens Figueroa J, Rodríguez LMO, Hach JLP, Del Castillo Ruíz V, Martínez HO. Cardiovascular spectrum in Williams-Beuren syndrome: the Mexican experience in 40 patients. Tex Heart Inst J 2008; 35:279-285. [PMID: 18941598 PMCID: PMC2565537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In this study, we have identified and evaluated the cardiovascular anomalies associated with Williams-Beuren syndrome in children.In a retrospective, lineal, and observational study, we reviewed the files of children who were seen from 1980 through 2005 (25 years) after a clinical diagnosis of Williams-Beuren syndrome.Forty children were diagnosed with this syndrome at the National Institute of Pediatrics in Mexico City. Of these, 32 (80%) were found to have congenital heart defects. The male-to-female ratio was 1.3:1 and ages ranged from 6 months to 15 years (mean, 4.4 years) at the time of diagnosis. All of the patients had morphologic and genetic characteristics typical of the syndrome.We emphasize the cardiovascular aspects from a clinical point of view. Supravalvular aortic stenosis was our most frequent finding, in 18 of 32 patients (56%); gradient differences in these patients ranged from 14 to 81 mmHg. Five patients showed combined lesions, the most frequent being supravalvular aortic stenosis in combination with pulmonary artery brachial stenosis, or with atrial and ventricular defects. Patients with incomplete atrioventricular defect and bicuspid aortic valve, as were seen at our hospital, have not to our knowledge been reported in other studies.One of the patients was scheduled for balloon dilation; another was scheduled for surgery; a 3rd patient was operated on twice for the placement of an aorto-aortic bridge; another underwent ventricular septal defect closure; and yet another underwent aortoplasty, this last dying shortly after surgery.
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MESH Headings
- Adolescent
- Aortic Stenosis, Supravalvular/diagnosis
- Aortic Stenosis, Supravalvular/epidemiology
- Aortic Stenosis, Supravalvular/genetics
- Aortic Stenosis, Supravalvular/surgery
- Aortic Valve/abnormalities
- Aortography
- Child
- Child, Preschool
- Chromosome Deletion
- Chromosomes, Human, Pair 7/genetics
- Constriction, Pathologic/diagnosis
- Constriction, Pathologic/epidemiology
- Constriction, Pathologic/genetics
- Constriction, Pathologic/surgery
- Cross-Cultural Comparison
- Cross-Sectional Studies
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/epidemiology
- Ductus Arteriosus, Patent/genetics
- Ductus Arteriosus, Patent/surgery
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/surgery
- Heart Septal Defects/diagnosis
- Heart Septal Defects/epidemiology
- Heart Septal Defects/genetics
- Heart Septal Defects/surgery
- Humans
- In Situ Hybridization, Fluorescence
- Infant
- Male
- Mexico
- Pulmonary Artery/abnormalities
- Retrospective Studies
- Williams Syndrome/diagnosis
- Williams Syndrome/epidemiology
- Williams Syndrome/genetics
- Williams Syndrome/surgery
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13
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Eroglu AG, Babaoglu K, Oztunc F, Saltik L, Demir T, Ahunbay G, Guzeltas A, Cetin G. Echocardiographic follow-up of children with supravalvular aortic stenosis. Pediatr Cardiol 2006; 27:707-12. [PMID: 17091326 DOI: 10.1007/s00246-006-1320-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 07/18/2006] [Indexed: 11/29/2022]
Abstract
This study evaluates the course of supravalvular aortic stenosis (SVAS)-associated right ventricular outflow tract (RVOT) obstruction and the results of surgery in children. We reviewed the medical records of 24 patients diagnosed with SVAS at initial echocardiographic examination or during the following period of RVOT obstruction. Very mild SVAS was defined as a transvalvular Doppler peak systolic instantanous gradient (PSIG) less than 25 mmHg, mild stenosis as 25-49 mmHg, moderate stenosis as 50-75 mmHg, and severe stenosis as more than 75 mmHg. The mean age of the patients was 3.1 +/- 2.9 years (range, 7 days to 12.7 years), and 18 of the patients (72%) were male. Fifteen patients had Williams' syndrome. Seventeen patients (71%) were followed for a mean of 5.2 +/- 3.8 years (range, 7 months to 13.5 years). Among 17 patients with complete follow-up records, 1 (6%) had very mild, 5 (29%) mild, 3 (18%) moderate, and 3 (18%) severe aortic stenosis at initial echocardiographic examination. In a newborn patient with mild pulmonary valvular stenosis. SVAS became evident after 2 months and progressed rapidly. Supravalvular aortic stenosis was very mild in 4 patients (23%), mild in 3 (18%), moderate in 3 (18%), and severe in 7 (41%) at last echocardiographic examination. Of 17 patients who were followed, 11 (65%) had RVOT obstruction at initial echocardiographic examination. RVOT obstruction disappeared in 5 patients, regressed in 1 patient, and appeared in 1 patient over the follow-up period. Four patients underwent operation. It appears reasonable that patients with very mild and mild stenosis should be followed medically every 1 or 2 years and patients with moderate stenosis once a year. Newborns with SVAS should be followed for rapid progression of SVAS. In some patients, RVOT obstruction may disappear, and SVAS may develop in others with RVOT obstruction. Patients with RVOT obstruction (at the valvular, supravalvular, or peripheral pulmonary arterial level) should be evaluated carefully for development of SVAS at follow-up.
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Affiliation(s)
- Ayse Guler Eroglu
- Division of Pediatric Cardiology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical Faculty, 8083, Aksaray, Istanbul, Turkey.
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14
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Abstract
Left ventricular outflow tract obstruction can occur at the supravalvar, valvar, or subvalvar level. Each level of obstruction is associated with distinct symptomatology, natural history, and operative approach. Reconstructive techniques can usually be used with low operative risk and excellent immediate and longer-term outcomes. Valve replacement for valvar obstruction is advised when reconstruction is not possible. The Ross procedure has greatly improved the results of valve replacement in children.
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15
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von Dadelszen P, Chitayat D, Winsor EJ, Cohen H, MacDonald C, Taylor G, Rose T, Hornberger LK. De novo 46,XX,t(6;7)(q27;q11;23) associated with severe cardiovascular manifestations characteristic of supravalvular aortic stenosis and Williams syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 2000; 90:270-5. [PMID: 10710222 DOI: 10.1002/(sici)1096-8628(20000214)90:4<270::aid-ajmg2>3.0.co;2-r] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Supravalvular aortic stenosis may present as an isolated finding or as part of Williams syndrome. Williams syndrome is a contiguous gene syndrome associated with neurodevelopmental and multisystemic manifestations caused by hemizygous deletion at 7q11.23. We report on the prenatal and histopathological findings in a patient with a chromosome translocation involving the Williams syndrome critical region. The initial abnormality on fetal ultrasound was hydrops fetalis detected at 30 weeks and echocardiography showed narrowing of the aorta and the pulmonary arteries. The baby died shortly after delivery and an autopsy revealed diffuse tubular thickening with luminal narrowing of the aorta, aortic branches, and the pulmonary arteries. Histopathology showed dysplasia of the media with reduced elastic content and "cartwheel" arrangement of collagen, elastic, and muscle fascicles. The karyotype was 46,XX,t(6;7)(q27;q11.23). Three signals were detected using the Oncor fluorescent in situ hybridization probe for elastin-Williams syndrome (WSCR) suggesting that the break in chromosome 7 is within the elastin-Williams gene. This patient is of special interest because of the prenatal presentation and the chromosomal translocation involving the elastin-Williams syndrome locus.
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Affiliation(s)
- P von Dadelszen
- Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, Ontario, Canada
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16
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McElhinney DB, Petrossian E, Tworetzky W, Silverman NH, Hanley FL. Issues and outcomes in the management of supravalvar aortic stenosis. Ann Thorac Surg 2000; 69:562-7. [PMID: 10735699 DOI: 10.1016/s0003-4975(99)01293-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Supravalvar stenosis of the aorta is an uncommon congenital cardiac anomaly that involves not only the supravalvar aorta but the entire aortic root. Despite considerable attention to the importance of maintaining the integrity of the aortic root during supravalvar reconstruction, there has been little focus on the management of other components of the aortic root and left ventricular outflow tract, including the aortic valve, subvalvar region, and coronary arteries. METHODS We reviewed the records of 36 consecutive patients with supravalvar aortic stenosis who underwent repair from 1992-1998 (median age, 4 years). Discrete stenosis was present in 29 patients, whereas the remaining 7 had the diffuse form of the disease. Associated anomalies of the aortic root and adjacent structures were present in 23 patients. The median pressure gradient across the left ventricular outflow tract was 70 mm Hg. Supravalvar stenosis was relieved by extended aortoplasty with a Y-shaped patch in 18 patients, resection of the stenotic segment of ascending aorta at the sinotubular junction with end-to-end anastomosis of the ascending aorta in 7, the Ross procedure in 4, and other techniques in 7. Additional procedures included aortic valvuloplasty in 10 patients, resection of subvalvar stenosis in 11, and procedures on the coronary arteries in 2. RESULTS There was 1 perioperative death, and no reoperations or other significant complications. During follow-up (median 33 months), there were no deaths and 3 reoperations for replacement of the aortic valve with a pulmonary autograft (n = 1) or mechanical prosthesis (n = 2). The median pressure gradient across the left ventricular outflow tract was 10 mm Hg. CONCLUSIONS In patients with supravalvar aortic stenosis, abnormalities of the aortic valve, subaortic region, and coronary arteries are frequently present as well. Management of these issues is as critical to the long-term outcome of these patients as reconstruction of the supravalvar aorta. Aggressive valvuloplasty may help decrease the incidence of late aortic valve replacement, whereas the Ross procedure may be a preferable approach in some patients with complex outflow tract obstruction.
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Affiliation(s)
- D B McElhinney
- Division of Cardiothoracic Surgery, University of California, San Francisco, USA.
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Trittenwein G, Pansi H, Graf B, Golej J, Burda G, Hermon M, Marx M, Wollenek G, Trittenwein H, Pollak A. Proposed entry criteria for postoperative cardiac extracorporeal membrane oxygenation after pediatric open heart surgery. Artif Organs 1999; 23:1010-4. [PMID: 10564307 DOI: 10.1046/j.1525-1594.1999.06457.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria based on parameters readily available, children were examined at postoperative pediatric intensive care unit (PICU) admission. Using hospital mortality as the primary outcome, univariate and multiple logistic regressions were performed to estimate the predictive value of clinical (age, weight, and diagnosis) and laboratory (arterial blood pressure, pH, lactate, creatine kinase, and arterial and central venous oxygen saturation [ScvO2]) variables. Data from 218 children over a 2 year period were analyzed retrospectively. Univariate regression demonstrated that age, weight, diagnosis, blood pressure, venous and arterial saturation, and lactate were significantly associated with postoperative mortality (p < 0.05). In multiple regression, ScvO2 and lactate level were found to be independent predictors and were used in a predictive model (ScvO2 odds ratio: 2.03-828.6, p = 0.016) (lactate odds ratio: 1.58 -4.20, p = 0.0002) (R2 = 0.70). Applying an 80% risk of mortality to establish entry criteria as in neonatal ECMO, PICU admission values of lactate > 70 mg/dl if ScvO2 < 60% or lactate >163 mg/dl if ScvO2 > 60% are proposed to serve as postoperative ECMO entry criteria if bypass weaning has been possible but is followed by low cardiac output.
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Affiliation(s)
- G Trittenwein
- Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Vienna, Austria
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