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Cantinotti M, Di Salvo G, Voges I, Raimondi F, Greil G, Ortiz Garrido A, Bharucha T, Grotenhuis HB, Köstenberger M, Bonnello B, Miller O, McMahon CJ. Standardization in paediatric echocardiographic reporting and critical interpretation of measurements, functional parameters, and prediction scores: a clinical consensus statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology and the Association for European Paediatric and Congenital Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:1029-1050. [PMID: 38833586 DOI: 10.1093/ehjci/jeae147] [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: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Abstract
This document has been developed to provide a guide for basic and advanced reporting in paediatric echocardiography. Furthermore, it aims to help clinicians in the interpretation of echocardiographic measurements and functional data for estimating the severity of disease in different paediatric age groups. The following topics will be reviewed and discussed in the present document: (i) the general principle in constructing a paediatric echocardiographic report, (ii) the basic elements to be included, and (iii) the potential and limitation of currently employed tools used for disease severity quantification during paediatric reporting. A guide for the interpretation of Z-scores will be provided. Use and interpretation of parameters employed for quantification of ventricular systolic function will be discussed. Difficulties in the adoption of adult parameters for the study of diastolic function and valve defects at different ages and pressure and loading conditions will be outlined, with pitfalls for the assessment listed. A guide for careful use of prediction scores for complex congenital heart disease will be provided. Examples of basic and advanced (disease-specific) formats for reporting in paediatric echocardiography will be provided. This document should serve as a comprehensive guide to (i) structure a comprehensive paediatric echocardiographic report; (ii) identify the basic morphological details, measures, and functional parameters to be included during echocardiographic reporting; and (iii) correctly interpret measurements and functional data for estimating disease severity.
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Affiliation(s)
- Massimiliano Cantinotti
- Department of Pediatric Cardiology and Congenital Heart Disease, National Research Council-Tuscany Region G. Monasterio Foundation (FTGM), Massa, Pisa 54100, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease, Woman and Children's Health Department, University of Padua; Experimental Cardiology, Paediatric Research Institute (IRP), Padua, Italy
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Gerald Greil
- Division Pediatric Cardiology, UT Southwestern, Dallas, TX, USA
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, University Hospital Southampton, Southampton, UK
| | - Heynric B Grotenhuis
- Department Pediatric Cardiology, Wilhelmina Children's Hospital/UMCU, Utrecht, The Netherlands
| | - Martin Köstenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of Gratz, Gratz, Austria
| | | | - Owen Miller
- Department Pediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Colin J McMahon
- Department Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Maastricht School of Health Professions Education, Maastricht, The Netherlands
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2
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Albrahimi E, Korun O. Contemporary management of borderline left ventricle. Eur J Cardiothorac Surg 2024; 66:ezae247. [PMID: 38913849 DOI: 10.1093/ejcts/ezae247] [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: 10/26/2023] [Revised: 03/30/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024] Open
Abstract
Borderline left ventricle cases present considerable difficulties in determining the most effective surgical approaches. The evolution of approaches in the field has shifted from classical systemic pulmonary shunts to orthodox univentricular palliation and has subsequently seen the emergence of biventricular repair concepts. The concept of biventricular repair for borderline left heart conditions has developed through studies that aim to establish predictive scoring systems for identifying appropriate candidates. Despite continuous efforts, a definitive scoring system for guiding this decision is still difficult to find. There is a growing trend to provide neonatal patients with borderline ventricles with options other than univentricular palliation. Several centres have developed personalized strategies, including hybrid and staged ventricular recruitment approaches. These strategies provide sufficient time for personalized decision-making, taking into account the individual circumstances of each patient. This article presents an overview of the changing approaches to borderline left ventricular cases. It discusses the use of predictive scoring systems and emphasizes the advancements in staged strategies that improve the likelihood of successful biventricular repairs.
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Affiliation(s)
- Ergida Albrahimi
- Department of Cardiovascular Surgery, İstanbul University Cerrahpasa, Cerrahpasa Medical Hospital, Istanbul, Turkey
| | - Oktay Korun
- Department of Cardiovascular Surgery, İstanbul University Cerrahpasa, Cerrahpasa Medical Hospital, Istanbul, Turkey
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Mazza GA, Oreto L, Tuo G, Sirico D, Moscatelli S, Meliota G, Micari A, Guccione P, Rinelli G, Favilli S. Borderline Ventricles: From Evaluation to Treatment. Diagnostics (Basel) 2024; 14:823. [PMID: 38667469 PMCID: PMC11049651 DOI: 10.3390/diagnostics14080823] [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: 02/27/2024] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
A heart with a borderline ventricle refers to a situation where there is uncertainty about whether the left or right underdeveloped ventricle can effectively support the systemic or pulmonary circulation with appropriate filling pressures and sufficient physiological reserve. Pediatric cardiologists often deal with congenital heart diseases (CHDs) associated with various degrees of hypoplasia of the left or right ventricles. To date, no specific guidelines exist, and surgical management may be extremely variable in different centers and sometimes even in the same center at different times. Thus, the choice between the single-ventricle or biventricular approach is always controversial. The aim of this review is to better define when "small is too small and large is large enough" in order to help clinicians make the decision that could potentially affect the patient's entire life.
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Affiliation(s)
- Giuseppe Antonio Mazza
- Division of Pediatric Cardiology, City of Health and Science University Hospital, 10126 Turin, Italy
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Giulia Tuo
- Pediatric Cardiology and Cardiac Surgery Unit, Surgery Department, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Instutute of Cardiovascular Sciences, University College London, London WC1E 6DD, UK
| | - Giovanni Meliota
- Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, 70126 Bari, Italy
| | - Antonio Micari
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, Interventional Cardiology, University of Messina, 98122 Messina, Italy
| | - Paolo Guccione
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children Hospital, 98039 Taormina, Italy
| | - Gabriele Rinelli
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, 00146 Rome, Italy
| | - Silvia Favilli
- Department of Pediatric Cardiology, Meyer Hospital, 50139 Florence, Italy
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McGeoghegan PB, Lu M, Sleeper LA, Emani SM, Baird CW, Feins EN, Gellis LA, Friedman KG. Cleft closure and other predictors of contemporary outcomes after atrioventricular canal repair in patients with parachute left atrioventricular valve. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae048. [PMID: 38539038 PMCID: PMC11014788 DOI: 10.1093/icvts/ivae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/17/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Parachute left atrioventricular valve (LAVV) complicates atrioventricular septal defect (AVSD) repair. We evaluate outcomes of AVSD patients with parachute LAVV and identify risk factors for adverse outcomes. METHODS We evaluated all patients undergoing repair of AVSD with parachute LAVV from 2012 to 2021. The primary outcome was a composite of time-to-death, LAVV reintervention and development of greater than or equal to moderate LAVV dysfunction (greater than or equal to moderate LAVV stenosis and/or LAVV regurgitation). Event-free survival for the composite outcome was estimated using Kaplan-Meier methodology and competing risks analysis. Cox proportional hazards regression was used to identify predictors of the primary outcome. RESULTS A total of 36 patients were included with a median age at repair of 4 months (interquartile range 2.3-5.5 months). Over a median follow-up of 2.6 years (interquartile range 1.0-5.6 years), 6 (17%) patients underwent LAVV reintervention. All 6 patients who underwent LAVV reintervention had right-dominant AVSD. Sixteen patients (44%) met the composite outcome, and all did so within 2 years of initial repair. Transitional AVSD (versus complete), prior single-ventricle palliation, leaving the cleft completely open and greater than or equal to moderate preoperative LAVV regurgitation were associated with a higher risk of LAVV reintervention in univariate analysis. In multivariate analysis, leaving the cleft completely open was associated with the composite outcome. CONCLUSIONS Repair of AVSD with parachute LAVV remains a challenge with a significant burden of LAVV reintervention and dysfunction in medium-term follow-up. Unbalanced, right-dominant AVSDs are at higher risk for LAVV reintervention. Leaving the cleft completely open might independently predict poor overall outcomes and should be avoided when possible. CLINICAL TRIAL REGISTRATION NUMBER IRB-P00041642.
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Affiliation(s)
| | - Minmin Lu
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
| | - Lynn A Sleeper
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
| | - Sitaram M Emani
- Department of Cardiothoracic Surgery, Children’s Hospital Boston, Boston, MA, USA
| | - Christopher W Baird
- Department of Cardiothoracic Surgery, Children’s Hospital Boston, Boston, MA, USA
| | - Eric N Feins
- Department of Cardiothoracic Surgery, Children’s Hospital Boston, Boston, MA, USA
| | - Laura A Gellis
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
| | - Kevin G Friedman
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
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Jones AL, White BR, Ghosh RM, Mondal A, Ampah S, Ho DY, Whitehead K, Harris MA, Biko DM, Partington S, Fuller S, Cohen MS, Fogel MA. Cardiac magnetic resonance predictors for successful primary biventricular repair of unbalanced complete common atrioventricular canal. Cardiol Young 2024; 34:387-394. [PMID: 37462049 PMCID: PMC10929573 DOI: 10.1017/s1047951123001786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Patients with unbalanced common atrioventricular canal can be difficult to manage. Surgical planning often depends on pre-operative echocardiographic measurements. We aimed to determine the added utility of cardiac MRI in predicting successful biventricular repair in common atrioventricular canal. METHODS We conducted a retrospective cohort study of children with common atrioventricular canal who underwent MRI prior to repair. Associations between MRI and echocardiographic measures and surgical outcome were tested using logistic regression, and models were compared using area under the receiver operator characteristic curve. RESULTS We included 28 patients (median age at MRI: 5.2 months). The optimal MRI model included the novel end-diastolic volume index (using the ratio of left ventricular end-diastolic volume to total end-diastolic volume) and the left ventricle-right ventricle angle in diastole (area under the curve 0.83, p = 0.041). End-diastolic volume index ≤ 0.18 and left ventricle-right ventricle angle in diastole ≤ 72° yield a sensitivity of 83% and specificity of 81% for successful biventricular repair. The optimal multimodality model included the end-diastolic volume index and the echocardiographic atrioventricular valve index with an area under the curve of 0.87 (p = 0.026). CONCLUSIONS Cardiac MRI can successfully predict successful biventricular repair in patients with unbalanced common atrioventricular canal utilising the end-diastolic volume index alone or in combination with the MRI left ventricle-right ventricle angle in diastole or the echocardiographic atrioventricular valve index. A prospective cardiac MRI study is warranted to better define the multimodality characteristic predictive of successful biventricular surgery.
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Affiliation(s)
- Andrea L. Jones
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian R. White
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Reena M. Ghosh
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Antara Mondal
- Department of Biomedical & Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steve Ampah
- Department of Biomedical & Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deborah Y. Ho
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kevin Whitehead
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew A. Harris
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - David M. Biko
- Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sara Partington
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Meryl S. Cohen
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark A. Fogel
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Prasad D, Romanowicz J, Banka P, Beroukhim R, Ghelani SJ, Emani S, Powell AJ. Cardiac magnetic resonance parameters associated with successful conversion from a single ventricular to a one-and-a-half or biventricular circulation in patients with a hypoplastic right ventricle. J Cardiovasc Magn Reson 2023; 25:51. [PMID: 37759303 PMCID: PMC10537142 DOI: 10.1186/s12968-023-00965-6] [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: 03/21/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Some patients with pulmonary atresia with an intact ventricular septum (PA/IVS) or a left ventricle dominant atrioventricular canal defect (LDAVC) with a hypoplastic right ventricle (RV) and univentricular (1 V) circulation may be candidates for conversion to either a complete biventricular (2 V) repair or a one-and-a-half ventricle repair (1.5 V). We sought to identify pre-operative cardiovascular magnetic resonance (CMR) findings associated with successful conversion from 1V to 1.5V or 2V circulation. METHODS In this single center retrospective study, subjects with PA/IVS or LDAVC and no conotruncal abnormalities were included if they had a 1 V circulation at the time of CMR followed by a surgical intervention intended to convert them to a 1.5 V or 2 V circulation. Conversion failure was defined as any of the following: (1) oxygen saturation < 90% at the most recent follow-up, (2) conversion back to a 1.5 V or 1 V circulation, or (3) death. RESULTS In the PA/IVS cohort (n = 15, median age 1.32 years), 10 patients underwent surgical conversion to a 1.5 V circulation and 5 to a 2 V circulation. In the attempted 1.5 V group, there were 2 failures, and these cases had a lower RV mass (p = 0.04). In the attempted 2 V group, there was 1 failure, and no CMR parameters were significantly different compared to the successes. Among the successful 2 V group patients, the minimum RV end-diastolic volume (EDV) was 27 ml/m2. In the LDAVC cohort (n = 15, median age 1.0 years), 1 patient underwent surgical conversion to a 1.5 V circulation and 14 patients to a 2 V circulation. In the attempted 1.5 V group, the 1 conversion was a failure and had an RV EDV of 15 ml/m2. In the attempted 2 V group, there were 2 failures, and these cases had a smaller RV:LV stroke volume ratio (p = 0.05) and a lower RV ejection fraction (p = 0.05) compared to the successes. Among the successful 2 V group patients, the minimum RV EDV was 22 ml/m2. CONCLUSIONS We identified multiple CMR parameters associated with successful conversion from 1 V circulation to 1.5 V or 2 V circulation in patients with PA/IVS and LDAVC. This information may improve patient selection for conversion procedures and encourage larger studies to better define the role of CMR.
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Affiliation(s)
- Deepa Prasad
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Banner Children's at Desert Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Jennifer Romanowicz
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Puja Banka
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Merck & Co., Inc, Rahway, NJ, USA
| | - Rebecca Beroukhim
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Sitaram Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, USA.
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DeCampli WM. Research Enterprise of the Congenital Heart Surgeons' Society 2018 to 2023: History, Accomplishments, Transformation, and Challenges. World J Pediatr Congenit Heart Surg 2023; 14:587-601. [PMID: 37737604 DOI: 10.1177/21501351231176219] [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] [Indexed: 09/23/2023]
Abstract
The history of the research arm of the Congenital Heart Surgeons' Society (CHSS) through 2017 was contained within two prior publications that covered CHSS history in general. The present article is the first to focus explicitly on the research enterprise, with emphasis on the period 2018 to 2023. During this time, the challenges of continuing to build multiple cohorts with lifelong follow-up and to transform the enterprise to a premiere research organization became manifest. Although continuing its commitment to produce impactful research results and to educate the Kirklin/Ashburn Fellow, the research team devoted considerable effort to defining the problems of cohort relevance, workflow, data management, long-term patient follow-up, CHSS member engagement, and the regulatory burden. The team wrote a proposal outlining ways to solve the challenges. A major change from a single-institution "Data Center" to a two-institution Center for Research & Quality (CRQ) was made, assuring increased faculty members and resources. The proposed changes to structure and process began execution in mid-2022. A second Kirklin/Ashburn Fellowship position was created. Between 2018 and 2022, the CRQ produced 17 publications and launched five new research initiatives. This article chronicles the exciting five-year period in which the CHSS research enterprise began a transformation with the intent to become the premiere research organization in the world in the specialty of congenital cardiac surgery.
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Affiliation(s)
- William M DeCampli
- Department of Cardiovascular Surgery, Orlando Health/Arnold Palmer Hospital for Children, Department of Clinical Sciences, The University of Central Florida College of Medicine, Orlando, FL, USA
- Center for Research & Quality, The Congenital Heart Surgeons' Society, The Hospital for Sick Children and the Cleveland Clinic, Cleveland, OH, USA
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Jacobs JP, DeCampli WM, Karamlou T, Najm HK, Marino BS, Blackstone EH, McCrindle BW, Jegatheeswaran A, St Louis JD, Austin EH, Caldarone CA, Mavroudis C, Overman DM, Dearani JA, Jacobs ML, Tchervenkov CI, Svensson LG, Barron D, Kirklin JK, Williams WG. The Academic Impact of Congenital Heart Surgeons' Society (CHSS) Studies. World J Pediatr Congenit Heart Surg 2023; 14:602-619. [PMID: 37737599 DOI: 10.1177/21501351231190916] [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] [Indexed: 09/23/2023]
Abstract
PURPOSE We reviewed all 64 articles ever published by The Congenital Heart Surgeons' Society (CHSS) Data Center to estimate the academic impact of these peer-reviewed articles. MATERIALS AND METHODS The Congenital Heart Surgeons' Society has performed research based on 12 Diagnostic Inception Cohorts. The first cohort (Transposition) began enrolling patients on January 1, 1985. We queried PubMed to determine the number of publications that referenced each of the 64 journal articles generated by the datasets of the 12 Diagnostic Inception Cohorts that comprise the CHSS Database. Descriptive summaries of the data were tabulated using mean with standard deviation and median with range. RESULTS Sixty-four peer-reviewed papers have been published based on the CHSS Database. Fifty-nine peer-reviewed articles have been published based on the 12 Diagnostic Inception Cohorts, and five additional articles have been published based on Data Science. Excluding the recently established Diagnostic Inception Cohort for patients with Ebstein malformation of tricuspid valve, the number of papers published per cohort ranged from 1 for coarctation to 11 for transposition of the great arteries. The 11 articles generated from the CHSS Transposition Cohort were referenced by a total of 111 articles (median number of references per journal article = 9 [range = 0-22, mean = 10.1]). Overall, individual articles were cited by an average of 11 (mean), and a maximum of 41 PubMed-listed publications. Overall, these 64 peer-reviewed articles based on the CHSS Database were cited 692 times in PubMed-listed publications. The first CHSS peer-reviewed article was published in 1987, and during the 35 years from 1987 to 2022, inclusive, the annual number of CHSS publications has ranged from 0 to 7, with a mean of 1.8 publications per year (median = 1, mode = 1). CONCLUSION Congenital Heart Surgeons' Society studies are widely referenced in the pediatric cardiac surgical literature, with over 10 citations per published article. These cohorts provide unique information unavailable in other sources of data. A tool to access this analysis is available at: [https://data-center.chss.org/multimedia/files/2022/CAI.pdf].
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Affiliation(s)
- Jeffrey Phillip Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Tara Karamlou
- Pediatric and Adult Congenital Heart Center, Cleveland Clinic, Cleveland, OH, USA
| | - Hani K Najm
- Pediatric and Adult Congenital Heart Center, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley S Marino
- Pediatric and Adult Congenital Heart Center, Cleveland Clinic, Cleveland, OH, USA
| | - Eugene H Blackstone
- Pediatric and Adult Congenital Heart Center, Cleveland Clinic, Cleveland, OH, USA
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - James D St Louis
- Department of Cardiac Surgery, Inova Fairfax Hospital and Inova L.J Murphy Children's Hospital, Fairfax, VA, USA
- Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Augusta University, Augusta, GA, USA
| | - Erle H Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
- Norton Children's Hospital, Louisville, KY, USA
| | | | - Constantine Mavroudis
- Pediatric Cardiothoracic Surgery, Peyton Manning Children's Hospital, Indianapolis, IN, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Overman
- Division of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA
| | - Marshall L Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada
| | - Lars G Svensson
- Pediatric and Adult Congenital Heart Center, Cleveland Clinic, Cleveland, OH, USA
| | - David Barron
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, Birmingham, AL, USA
| | - William G Williams
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Jegatheeswaran A, Argo MB, Devlin PJ, Callahan CP, Meza JM, Wilder TJ, Hickey EJ, Karamlou T. The Congenital Heart Surgeons' Society Kirklin/Ashburn Fellowship: The Fellows' Perspective. World J Pediatr Congenit Heart Surg 2023; 14:575-586. [PMID: 37737596 DOI: 10.1177/21501351231190087] [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] [Indexed: 09/23/2023]
Abstract
Since its establishment in 2001, the Congenital Heart Surgeons' Society John W. Kirklin/David Ashburn Fellowship has contributed substantially to the field of congenital heart surgery research while simultaneously training the next generation of surgeon- scientists. To date, ten fellows (and counting) have successfully completed this rigorous training, producing over 40 published articles focused on longitudinal outcomes from the various Congenital Heart Surgeons' Society cohorts. As the Kirklin/Ashburn Fellowship expands and additional fellows matriculate, its legacy, the network of support, and the contribution to congenital heart surgery research will undoubtedly hold strong.
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Affiliation(s)
- Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
- Children's Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul J Devlin
- Division of Cardiac Surgery and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Connor P Callahan
- Division of Pediatric Cardiothoracic Surgery, University Hospitals Rainbow Babies and Children's, Cleveland, OH, USA
| | - James M Meza
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Travis J Wilder
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Edward J Hickey
- Department of Cardiothoracic Surgery, Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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10
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Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, Michelfelder E, Morris SA, Peyvandi S, Pinto NM, Pruetz J, Sethi N, Simpson J, Srivastava S, Tian Z. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:679-723. [PMID: 37227365 DOI: 10.1016/j.echo.2023.04.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Joe Kreeger
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wesley Lee
- Baylor College of Medicine, Houston, Texas
| | | | - Shaine A Morris
- Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas
| | - Shabnam Peyvandi
- University of California, San Francisco, San Francisco, California
| | | | - Jay Pruetz
- Children's Hospital of Los Angeles, Los Angeles, California
| | | | - John Simpson
- Evelina London Children's Hospital, London, United Kingdom
| | | | - Zhiyun Tian
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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11
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Oreto L, Mandraffino G, Calaciura RE, Poli D, Gitto P, Saitta MB, Bellanti E, Carerj S, Zito C, Iorio FS, Guccione P, Agati S. Hybrid Palliation for Hypoplastic Borderline Left Ventricle: One More Chance to Biventricular Repair. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050859. [PMID: 37238407 DOI: 10.3390/children10050859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Treatment options for hypoplastic borderline left ventricle (LV) are critically dependent on the development of the LV itself and include different types of univentricular palliation or biventricular repair performed at birth. Since hybrid palliation allows deferring major surgery to 4-6 months, in borderline cases, the decision can be postponed until the LV has expressed its growth potential. We aimed to evaluate anatomic modifications of borderline LV after hybrid palliation. We retrospectively reviewed data from 45 consecutive patients with hypoplastic LV who underwent hybrid palliation at birth between 2011 and 2015. Sixteen patients (mean weight 3.15 Kg) exhibited borderline LV and were considered for potential LV growth. After 5 months, five patients underwent univentricular palliation (Group 1), eight biventricular repairs (Group 2) and three died before surgery. Echocardiograms of Groups 1 and 2 were reviewed, comparing LV structures at birth and after 5 months. Although, at birth, all LV measurements were far below the normal limits, after 5 months, LV mass in Group 2 was almost normal, while in Group 1, no growth was evident. However, aortic root diameter and long axis ratio were significantly higher in Group 2 already at birth. Hybrid palliation can be positively considered as a "bridge-to-decision" for borderline LV. Echocardiography plays a key role in monitoring the growth of borderline LV.
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Affiliation(s)
- Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Rita Emanuela Calaciura
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Daniela Poli
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Placido Gitto
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Michele Benedetto Saitta
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Ermanno Bellanti
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Fiore Salvatore Iorio
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Paolo Guccione
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
| | - Salvatore Agati
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, 98035 Taormina, Italy
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12
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Cantinotti M, Marchese P, Giordano R, Franchi E, Assanta N, Koestenberger M, Jani V, Duignan S, Kutty S, McMahon CJ. Echocardiographic scores for biventricular repair risk prediction of congenital heart disease with borderline left ventricle: a review. Heart Fail Rev 2023; 28:63-76. [PMID: 35332415 DOI: 10.1007/s10741-022-10230-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
The aim of this review is to highlight the strengths and limitations of major echocardiographic biventricular repair (BVR) prediction models for borderline left ventricle (LV) in complex congenital heart disease (CHD). A systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords for critical aortic stenosis (AS), borderline LV, complex left ventricular outflow tract (LVOT) obstruction, hypoplastic left heart syndrome/complex (HLHS/HLHC), and unbalanced atrio-ventricular septal defects (uAVSD). Fifteen studies were selected for the final analysis. We outlined what echocardiographic scores for different types of complex CHD with diminutive LV are available. Scores for CHD with LVOT obstruction including critical AS, HLHS/HLHC, and aortic arch hypoplasia have been validated and implemented by several studies. Scores for uAVSD with right ventricle (RV) dominance have also been established and implemented, the first being the atrioventricular valve index (AVVI). In addition to AVII, both LV/RV inflow angle and LV inflow index have all been validated for the prediction of BVR. We conclude with a discussion of limitations in the development and validation of each of these scores, including retrospective design during score development, heterogeneity in echocardiographic parameters evaluated, variability in the definition of outcomes, differences in adopted surgical and Interventional strategies, and institutional differences. Furthermore, scores developed in the past two decades may have little clinical relevance now. In summary, we provide a review of echocardiographic scores for BVR in complex CHD with a diminutive LV that may serve as a guide for use in modern clinical practice.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Dept. Advanced Biomedical Sciences, University of Naples "Federico II", 80131, Naples, Italy.
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Vivek Jani
- Blalock Taussig, Thomas Heart Center, Johns Hopkins Hospital, Baltimore, USA
| | - Sophie Duignan
- Children's Heart Centre, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shelby Kutty
- Blalock Taussig, Thomas Heart Center, Johns Hopkins Hospital, Baltimore, USA
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13
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Jacobs JP. Hypoplastic Left Ventricle: Definition, Morphology, and Classification of the Cardiac Phenotypes. World J Pediatr Congenit Heart Surg 2022; 13:615-619. [PMID: 36053100 DOI: 10.1177/21501351221114775] [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: 11/17/2022]
Abstract
A prior manuscript provided information about hypoplastic left heart syndrome (HLHS) and related malformations, including definitions, morphology, and classification, based on the 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). This manuscript provides information about the related cardiac phenotypes associated with "hypoplastic left ventricle" that might be suitable for biventricular repair, including definitions, morphology, and classification of the cardiac phenotypes of the following four congenital cardiac malformations that can all include a hypoplastic left ventricle: (1) hypoplastic left heart complex (HLHC), (2) critical aortic stenosis with left ventricular hypoplasia, (3) aortic atresia + ventricular septal defect, and (4) hypoplastic left ventricle with severely unbalanced atrioventricular septal defect.
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Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA
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14
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Cohen MS. Imaging of Left Ventricular Hypoplasia. World J Pediatr Congenit Heart Surg 2022; 13:620-623. [PMID: 36053101 DOI: 10.1177/21501351221114767] [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: 11/17/2022]
Abstract
Left ventricular hypoplasia is a common finding in various forms of congenital heart disease. Echocardiography in the setting of left ventricular hypoplasia must comprehensively assess the size and function of all left-sided structures including the mitral valve, left ventricular outflow tract, aortic valve and aortic arch. Of most importance in any variation of left ventricular hypoplasia is the left ventricular inlet. In neonates, the left ventricular inlet often determines the adequacy of the left ventricle and is the most difficult component to treat surgically.
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Affiliation(s)
- Meryl S Cohen
- Division of Cardiology, Department of Pediatrics, 6567The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PAennsylvania, USA
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15
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Abstract
OBJECTIVE Infants with complete atrioventricular septal defect occasionally accompany pulmonary hypertension; however, the pulmonary circulation can be altered by pulmonary vascular conditions as well as the left heart lesions. This study aimed to explore whether the left heart lesions were related to the pulmonary circulation among them. METHODS We performed echocardiography and cardiac catheterisation in 42 infants with complete atrioventricular septal defect and studied relationships between the pulmonary haemodynamic parameters and the left heart morphology. RESULTS Age and weight at preoperative evaluation were 65 days (47-114) (the median following interquartile range) and 5.5 kg (4.0-7.1), respectively. There were 27 individuals with Down syndrome. Gestational age was 38 weeks (37-39). Catheterisation showed mean pulmonary arterial pressure: 36 (29-46) mmHg, the ratio of pulmonary to systemic blood flow: 3.45 (2.79-4.98), pulmonary vascular resistance: 2.20 Wood units·m2 (1.53-3.65), and pulmonary arterial compliance: 2.78 (1.86-4.10) ml/Hg/m2. Echocardiography showed the Rastelli classification type A in 28 and type C in 14, moderate or severe left atrioventricular valve regurgitation in 19 patients (45%), atrioventricular valve index of 0.67 (0.56-0.79), left ventricular end-diastolic volume z score of 4.46 (1.96-7.78), and aortic valve diameter z score of -0.70 (-1.91 to 0.20). Multivariable regression analysis revealed that preoperative pulmonary vascular resistance was significantly correlated to gestational age (p = 0.002), and that preoperative pulmonary arterial compliance was significantly correlated to gestational age (p = 0.009) and Down syndrome (p = 0.036). CONCLUSIONS The pulmonary circulation does not depend upon the presence of left heart lesions but gestational age and Down syndrome in infants with complete atrioventricular septal defect.
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16
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Salehi D, Fricke K, Bhat M, Arheden H, Liuba P, Hedström E. Utility of Fetal Cardiovascular Magnetic Resonance for Prenatal Diagnosis of Complex Congenital Heart Defects. JAMA Netw Open 2021; 4:e213538. [PMID: 33779747 PMCID: PMC8008290 DOI: 10.1001/jamanetworkopen.2021.3538] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/06/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Prenatal diagnosis of complex congenital heart defects reduces mortality and morbidity in affected infants. However, fetal echocardiography can be limited by poor acoustic windows, and there is a need for improved diagnostic methods. Objective To assess the clinical utility of fetal cardiovascular magnetic resonance imaging in cases in which fetal echocardiography could not visualize all relevant anatomy. Design, Setting, and Participants This cohort study was conducted between January 20, 2017, and June 29, 2020, at Skåne University Hospital (Lund, Sweden), a tertiary center for pediatric cardiology and thoracic surgery. Participants were fetuses referred for fetal cardiovascular magnetic resonance examination by a pediatric cardiologist after an inconclusive echocardiograph. Exposures Fetal cardiovascular magnetic resonance examination requested by the patient's pediatric cardiologist. Main Outcomes and Measures Any change in patient management because of diagnostic information gained from fetal cardiovascular magnetic resonance imaging. Results A total of 31 fetuses underwent cardiovascular magnetic resonance examination at a median gestational age of 36 weeks (range, 31-39 weeks). Overall, fetal cardiovascular magnetic resonance imaging had clinical utility, affecting patient management and/or parental counseling in 26 cases (84%). For aortic arch anatomy including signs of coarctation (20 fetuses), fetal cardiovascular magnetic resonance imaging added diagnostic information in 16 cases (80%). For assessment of univentricular vs biventricular outcome in borderline left ventricle, unbalanced atrioventricular septal defect, and pulmonary atresia with intact ventricular septum (15 fetuses), fetal cardiovascular magnetic resonance imaging visualized intracardiac anatomy and ventricular function, allowing assessment of outcome in 13 cases (87%). In 4 fetuses with hypoplastic left heart syndrome, fetal cardiovascular magnetic resonance imaging helped delivery planning in 3 cases (75%). Finally, fetal cardiovascular magnetic resonance imaging provided valuable information for parental counseling in 21 cases (68%). Conclusions and Relevance In this cohort study, fetal cardiovascular magnetic resonance imaging added clinically useful information to what was available from echocardiography. These findings suggest that fetal CMR has the potential to affect clinical decision-making in challenging cases of congenital heart defects with inconclusive data from echocardiography. Fetal cardiovascular magnetic resonance imaging showed an association with clinical decision-making, including mode of delivery and early postnatal care, as well as with parental counseling.
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Affiliation(s)
- Daniel Salehi
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katrin Fricke
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Misha Bhat
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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17
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Schleiger A, Kramer P, Schafstedde M, Yigitbasi M, Danne F, Murin P, Cho MY, Photiadis J, Berger F, Ovroutski S. Can Left Atrioventricular Valve Reduction Index (LAVRI) Predict the Surgical Strategy for Repair of Atrioventricular Septal Defect? Pediatr Cardiol 2021; 42:898-905. [PMID: 33580286 PMCID: PMC8110484 DOI: 10.1007/s00246-021-02558-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/16/2021] [Indexed: 11/26/2022]
Abstract
Despite improved survival, surgical treatment of atrioventricular septal defect (AVSD) remains challenging. The optimal technique for primary left atrioventricular valve (LAVV) repair and prediction of suitability for biventricular approach in unbalanced AVSD are still controversial. We evaluated the ability of our recently developed echocardiographic left atrioventricular valve reduction index (LAVRI) in predicting LAVV reoperation rate and surgical strategy for unbalanced AVSD. Retrospective echocardiographic analysis was available in 352 of 790 patients with AVSD treated in our institution and included modified atrioventricular valve index (mAVVI), ventricular cavity ratio (VCR), and right ventricle/left ventricle (RV/LV) inflow angle. LAVRI estimates LAVV area after complete cleft closure and was analyzed with regard to surgical strategy in primary LAVV repair and unbalanced AVSD. Of the entire cohort, 284/352 (80.68%) patients underwent biventricular repair and 68/352 (19.31%) patients underwent univentricular palliation. LAVV reoperation was performed in 25/284 (8.80%) patients after surgical correction of AVSD. LAVRI was significantly lower in patients requiring LAVV reoperation (1.92 cm2/m2 [IQR 1.31] vs. 2.89 cm2/m2 [IQR 1.37], p = 0.002) and significantly differed between patients receiving complete and no/partial cleft closure (2.89 cm2/m2 [IQR 1.35] vs. 2.07 cm2/m2 [IQR 1.69]; p = 0.002). Of 82 patients diagnosed with unbalanced AVSD, 14 were suitable for biventricular repair (17.07%). mAVVI, LAVRI, VCR, and RV/LV inflow angle accurately distinguished between balanced and unbalanced AVSD and predicted surgical strategy (all p < 0.001). LAVRI may predict surgical strategy in primary LAVV repair, LAVV reoperation risk, and suitability for biventricular approach in unbalanced AVSD anatomy.
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Affiliation(s)
- Anastasia Schleiger
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marie Schafstedde
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mustafa Yigitbasi
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Friederike Danne
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Peter Murin
- Department of Congenital Heart Surgery/Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Congenital Heart Surgery/Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery/Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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18
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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19
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Ho DY, Katcoff H, Griffis HM, Mercer-Rosa L, Fuller SM, Cohen MS. Left Valvar Morphology Is Associated With Late Regurgitation in Atrioventricular Canal Defect. Ann Thorac Surg 2020; 110:969-978. [PMID: 32088289 DOI: 10.1016/j.athoracsur.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Left atrioventricular valve regurgitation (LAVVR) after atrioventricular canal (AVC) repair remains a significant cause of morbidity. Papillary muscle arrangement may be important. To investigate the implications of left mural leaflet morphology, we examined anatomic characteristics of the LAVV to determine possible associations with postoperative LAVVR. METHODS All patients with biventricular AVC repair at our institution between January 1, 2011, and December 31, 2016, with necessary imaging were retrospectively reviewed. We assessed papillary muscle structure and novel measures of the left mural leaflet from preoperative echocardiograms and the degree of LAVVR from the first and last available follow-up echocardiograms. Associations with degree of early and late postoperative LAVVR were assessed with t tests, analysis of variance, or χ2 or Fisher exact tests, and multivariable logistic regression. RESULTS There were 58 of 156 patients (37%) with significant (moderate or severe) early postoperative LAVVR, and 30 of 93 (32%) had significant LAVVR after 6 or more months. Fewer patients with closely spaced or asymmetric papillary muscles had moderate or severe late LAVVR vs those with widely spaced papillary muscles (17% vs 40%, P = .019). Controlling for weight at operation, genetic syndromes, and bypass time, widely spaced papillary muscles increased the odds ratio for late LAVVR to 3.6 (P = .026). Larger mural leaflet area was also associated with late LAVVR on univariable (P = .019) and multivariable (P = .023) analyses. One-third of patients with significant late LAVVR had no significant early postoperative regurgitation. CONCLUSIONS Mural leaflet and papillary muscle anatomy are associated with late LAVVR after AVC repair. Late regurgitation can develop in the absence of early LAVVR, suggesting different mechanisms.
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Affiliation(s)
- Deborah Y Ho
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, California.
| | - Hannah Katcoff
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather M Griffis
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Laura Mercer-Rosa
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Stephanie M Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Meryl S Cohen
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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20
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Abstract
Objective: In recent years, attempting the biventricular pathway or biventricular conversions in patients with borderline ventricle has become a hot topic. However, inappropriate pursuit of biventricular repair in borderline candidates will lead to adverse clinical outcomes. Therefore, it is important to accurately assess the degree of ventricular development before operation and whether it can tolerate biventricular repair. This review evaluated ventricular development using echocardiography for a better prediction of biventricular repair in borderline ventricle. Data sources: Articles from January 1, 1990 to April 1, 2019 on biventricular repair in borderline ventricle were accessed from PubMed, using keywords including “borderline ventricle,” “congenital heart disease,” “CHD,” “echocardiography,” and “biventricular repair.” Study selection: Original articles and critical reviews relevant to the review's theme were selected. Results: Borderline left ventricle (LV): (1) Critical aortic stenosis: the Rhodes score, Congenital Heart Surgeons Society regression equation and another new scoring system was proposed to predict the feasibility of biventricular repair. (2) Aortic arch hypoplasia: the LV size and the diameter of aortic and mitral valve (MV) annulus should be taken into considerations for biventricular repair. (3) Right-dominant unbalanced atrioventricular septal defect (AVSD): atrioventricular valve index (AVVI), left ventricular inflow index (LVII), and right ventricle (RV)/LV inflow angle were the echocardiographic indices for biventricular repair. Borderline RV: (1) pulmonary atresia/intact ventricular septum (PA/IVS): the diameter z-score of tricuspid valve (TV) annulus, ratio of TV to MV diameter, RV inlet length z-score, RV area z-score, RV development index, and RV-TV index, etc. Less objective but more practical description is to classify the RV as tripartite, bipartite, and unipartite. The presence or absence of RV sinusoids, RV dependent coronary circulation, and the degree of tricuspid regurgitation should also be noted. (2) Left-dominant unbalanced AVSD: AVVI, LV, and RV volumes, whether apex forming ventricles were the echocardiographic indices for biventricular repair. Conclusions: Although the evaluation of echocardiography cannot guarantee the success of biventricular repair surgery, echocardiography can still provide relatively valuable basis for surgical decision making.
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21
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Devlin PJ, Jegatheeswaran A, McCrindle BW, Karamlou T, Blackstone EH, Williams WG, DeCampli WM, Mertens L, Fackoury CT, Eghtesady P, Jacobs JP, Baffa JM, Fleishman CE, Dodge-Khatami A, Pizarro C, Pourmoghadam K, Cohen MS, Meyer DB, Overman DM. Pulmonary artery banding in complete atrioventricular septal defect. J Thorac Cardiovasc Surg 2019; 159:1493-1503.e3. [PMID: 31669019 DOI: 10.1016/j.jtcvs.2019.09.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/19/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze outcomes after pulmonary artery banding (PAB) in complete atrioventricular septal defect (AVSD), with a focus on surgical pathway outcome and timing, survival, and atrioventricular valve function. METHODS PAB was performed in 50 of 474 infants (11%) from 28 institutions between 2012 and 2018 at a median age of 1.1 months. The median duration of follow-up was 2.1 years. Atrioventricular valve function was assessed by review of pre-PAB and predischarge echocardiograms (median, 9 days postoperatively). Competing-risks methodology was used to analyze the risks for biventricular repair, univentricular repair, and death. RESULTS At 2 years, the proportions of patients who underwent biventricular repair, univentricular repair, and death were 68%, 13%, and 12%, respectively, with 8% awaiting definitive repair. After PAB, atrioventricular valve regurgitation decreased in 14 infants and increased in 10, but the distribution of regurgitation severity did not change significantly in the total cohort or subgroups. The intended management plan at PAB was deferred biventricular/univentricular decision (23 infants), 2-stage biventricular repair (24 infants), and univentricular repair (3 infants). Among the 24 infants intended for biventricular repair, 23 achieved biventricular repair and 1 died before repair. Survival at 4 years after biventricular repair among patients with previous PAB (93%) was similar to the 4-year survival of the patients who underwent primary biventricular repair (91%; n = 333). CONCLUSIONS PAB is a successful strategy in complete AVSD to bridge to biventricular repair and has similar post-biventricular repair survival to primary biventricular repair. Changes in atrioventricular valve regurgitation after PAB were variable.
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Affiliation(s)
- Paul J Devlin
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Anusha Jegatheeswaran
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tara Karamlou
- Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - William G Williams
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Luc Mertens
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cheryl T Fackoury
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pirooz Eghtesady
- Department of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St Louis, Mo
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Fla
| | - Jeanne M Baffa
- Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, Del
| | - Craig E Fleishman
- Division of Pediatric Cardiology, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Ali Dodge-Khatami
- Division of Pediatric and Congenital Heart Surgery, University of Texas at Houston/Children's Memorial Hermann Hospital, Houston, Tex
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, Del
| | - Kamal Pourmoghadam
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Meryl S Cohen
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, New Hyde Park, NY
| | - David M Overman
- Division of Cardiovascular Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn
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22
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Lugones I, Biancolini MF, Lugones G, Biancolini JC, de Dios AM. The matter of "unbalance" in right dominant atrioventricular septal defect. Ann Pediatr Cardiol 2019; 12:132-134. [PMID: 31143038 PMCID: PMC6521658 DOI: 10.4103/apc.apc_107_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Unbalance in atrioventricular septal defect can be found in more than one anatomic level and in different degrees at each level. The definition of “unbalance” has historically been focused in comparing the dimensions of main cardiac structures, such as the atrioventricular valve and the ventricles. However, the hemodynamic aspects of unbalance need to be considered as having, at least, similar relevance. New concepts and already described parameters must be combined and understood as a whole to help the surgical decision-making process.
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Affiliation(s)
- Ignacio Lugones
- Cardiac Surgery Department, "Dr. Pedro de Elizalde" General Children's Hospital, Buenos Aires, Argentina
| | - María Fernanda Biancolini
- Pediatric Cardiology Department, "Dr. Pedro de Elizalde" General Children's Hospital, Buenos Aires, Argentina
| | - Germán Lugones
- Physics Department, Center of Natural and Human Science, Federal University of ABC, San Pablo, Brazil
| | - Julio César Biancolini
- Pediatric Cardiology Department, "Dr. Pedro de Elizalde" General Children's Hospital, Buenos Aires, Argentina
| | - Ana Ms de Dios
- Pediatric Cardiology Department, "Dr. Pedro de Elizalde" General Children's Hospital, Buenos Aires, Argentina
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23
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Andersen ND, Turek JW. Echocardiographic Assessment of Complete Atrioventricular Canal Defects: A Balancing Act. Semin Thorac Cardiovasc Surg 2018; 31:87-88. [PMID: 30447289 DOI: 10.1053/j.semtcvs.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Nicholas D Andersen
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, North Carolina
| | - Joseph W Turek
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, North Carolina; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina; Duke Children's Pediatric and Congenital Heart Center, Duke Children's Hospital, Durham, North Carolina.
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24
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Mavroudis C, Kirklin JK, DeCampli WM. Incremental History of the Congenital Heart Surgeons’ Society (2014-2018). World J Pediatr Congenit Heart Surg 2018; 9:668-676. [DOI: 10.1177/2150135118800305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The history of the first 41 years of the Congenital Heart Surgeons Society (CHSS) was recorded in 2015 which chronicled the metamorphosis of a small informal meeting into a mature organization with bylaws, officers, committees, funded research, the Kirklin-Ashburn Fellowship, and a vision to become the premier organization of congenital heart surgery in North America. Chief among these transformations was the implementation and development of the CHSS Data Center. Member participation, fellowship education, and significant outcomes research have been the hallmark of the CHSS. This incremental historical review highlights continued CHSS sentinel advances. Fifty-three CHSS Data Center manuscripts have been published. Citation scores (number of literature citations that each manuscript has accrued) have been collated and analyzed by cohort study. The average citation score for all manuscripts was 75.4 ± 76.3 (range: 1-333). The Kirklin/Ashburn Fellowship continues to thrive with academic achievements and generous contributions to the endowment. The World Journal of Pediatric and Congenital Heart Surgery has been adopted as the official organ of the CHSS. A Past President’s Dinner has been inaugurated serving as a senior advisory committee to the Executive Council. Toronto Work Weekends continue. Congenital Heart Surgeons Society growth has accrued to 159 active members and 82 institutional members. Future considerations include the size, content, and duration of the annual meeting; the potential for increased membership; and political penetrance into national cardiothoracic governing organizations regarding committee appointments, executive council representation, and education initiatives. Congenital Heart Surgeons Society has achieved numerous advances during this incremental period.
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Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins University School of Medicine, Florida Hospital for Children, Orlando, FL, USA
| | - James K. Kirklin
- Department of Surgery, University of Alabama, Birmingham, AL, USA
| | - William M. DeCampli
- Congenital Heart Surgery, Arnold Palmer Children’s Hospital, Orlando, FL, USA
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25
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Three-Dimensional Echocardiography for Evaluation of the Right Ventricle—Updates on Image Acquisition and Analysis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9460-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Assessing the borderline ventricle in a term infant: combining imaging and physiology to establish the right course. Curr Opin Cardiol 2018; 33:95-100. [PMID: 29084001 DOI: 10.1097/hco.0000000000000466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the challenges associated with the diagnosis and treatment of children with borderline ventricles. A borderline ventricle is one in which there is concern that it will not be able to support its circulation. If a biventricular repair is attempted and fails, outcome is often poor. Thus, this early decision is important. RECENT FINDINGS For the borderline right ventricle, options to add an additional source of pulmonary blood flow make the surgical strategy a bit more flexible than for patients with a borderline left ventricle. In general, outcome for a so-called one and one-half ventricle repair are generally good, though the long-term outcome and the effects of this physiology on lifelong exercise performance and quality of life remain to be seen. For the small left ventricle, often multiple surgeries are required to 'force' blood into the left ventricle and potentially help it grow. Though this strategy is successful in some, in others it results in significant residual cardiac issues including pulmonary hypertension. SUMMARY Determining whether a patient will be better off in the long term with a marginal biventricular repair versus a Fontan circulation remains one of the most difficult problems in the field of pediatric cardiology and cardiac surgery.
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27
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Rao PS, Harris AD. Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects. F1000Res 2018; 7. [PMID: 29770201 PMCID: PMC5931264 DOI: 10.12688/f1000research.14102.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
This review discusses the management of ventricular septal defects (VSDs) and atrioventricular septal defects (AVSDs). There are several types of VSDs: perimembranous, supracristal, atrioventricular septal, and muscular. The indications for closure are moderate to large VSDs with enlarged left atrium and left ventricle or elevated pulmonary artery pressure (or both) and a pulmonary-to-systemic flow ratio greater than 2:1. Surgical closure is recommended for large perimembranous VSDs, supracristal VSDs, and VSDs with aortic valve prolapse. Large muscular VSDs may be closed by percutaneous techniques. A large number of devices have been used in the past for VSD occlusion, but currently Amplatzer Muscular VSD Occluder is the only device approved by the US Food and Drug Administration for clinical use. A hybrid approach may be used for large muscular VSDs in small babies. Timely intervention to prevent pulmonary vascular obstructive disease (PVOD) is germane in the management of these babies. There are several types of AVSDs: partial, transitional, intermediate, and complete. Complete AVSDs are also classified as balanced and unbalanced. All intermediate and complete balanced AVSDs require surgical correction, and early repair is needed to prevent the onset of PVOD. Surgical correction with closure of atrial septal defect and VSD, along with repair and reconstruction of atrioventricular valves, is recommended. Palliative pulmonary artery banding may be considered in babies weighing less than 5 kg and those with significant co-morbidities. The management of unbalanced AVSDs is more complex, and staged single-ventricle palliation is the common management strategy. However, recent data suggest that achieving two-ventricle repair may be a better option in patients with suitable anatomy, particularly in patients in whom outcomes of single-ventricle palliation are less than optimal. The majority of treatment modes in the management of VSDs and AVSDs are safe and effective and prevent the development of PVOD and cardiac dysfunction.
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Affiliation(s)
- P Syamasundar Rao
- University of Texas-Houston McGovern Medical School, Children Memorial Hermann Hospital, Houston, USA
| | - Andrea D Harris
- Pediatrix Cardiology Associates of New Mexico, Albuquerque, USA
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28
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Identifying Patients with Atrioventricular Septal Defect in Down Syndrome Populations by Using Self-Normalizing Neural Networks and Feature Selection. Genes (Basel) 2018; 9:genes9040208. [PMID: 29649131 PMCID: PMC5924550 DOI: 10.3390/genes9040208] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 02/06/2023] Open
Abstract
Atrioventricular septal defect (AVSD) is a clinically significant subtype of congenital heart disease (CHD) that severely influences the health of babies during birth and is associated with Down syndrome (DS). Thus, exploring the differences in functional genes in DS samples with and without AVSD is a critical way to investigate the complex association between AVSD and DS. In this study, we present a computational method to distinguish DS patients with AVSD from those without AVSD using the newly proposed self-normalizing neural network (SNN). First, each patient was encoded by using the copy number of probes on chromosome 21. The encoded features were ranked by the reliable Monte Carlo feature selection (MCFS) method to obtain a ranked feature list. Based on this feature list, we used a two-stage incremental feature selection to construct two series of feature subsets and applied SNNs to build classifiers to identify optimal features. Results show that 2737 optimal features were obtained, and the corresponding optimal SNN classifier constructed on optimal features yielded a Matthew’s correlation coefficient (MCC) value of 0.748. For comparison, random forest was also used to build classifiers and uncover optimal features. This method received an optimal MCC value of 0.582 when top 132 features were utilized. Finally, we analyzed some key features derived from the optimal features in SNNs found in literature support to further reveal their essential roles.
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29
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Cabrera R, Miranda-Fernández MC, Huertas-Quiñones VM, Carreño M, Pineda I, Restrepo CM, Silva CT, Quero R, Cano JD, Manrique DC, Camacho C, Tabares S, García A, Sandoval N, Moreno Medina KJ, Dennis Verano RJ. Identification of clinically relevant phenotypes in patients with Ebstein anomaly. Clin Cardiol 2018; 41:343-348. [PMID: 29569399 DOI: 10.1002/clc.22870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ebstein anomaly (EA) is a heterogeneous congenital heart defect (CHD), frequently accompanied by diverse cardiac and extracardiac comorbidities, resulting in a wide range of clinical outcomes. HYPOTHESIS Phenotypic characterization of EA patients has the potential to identify variables that influence prognosis and subgroups with distinct contributing factors. METHODS A comprehensive cross-sectional phenotypic characterization of 147 EA patients from one of the main referral institutions for CHD in Colombia was carried out. The most prevalent comorbidities and distinct subgroups within the patient cohort were identified through cluster analysis. RESULTS The most prevalent cardiac comorbidities identified were atrial septal defect (61%), Wolff-Parkinson-White syndrome (WPW; 27%), and right ventricular outflow tract obstruction (25%). Cluster analysis showed that patients can be classified into 2 distinct subgroups with defined phenotypes that determine disease severity and survival. Patients in cluster 1 represented a particularly homogeneous subgroup with a milder spectrum of disease, including only patients with WPW and/or supraventricular tachycardia (SVT). Cluster 2 included patients with more diverse cardiovascular comorbidities. CONCLUSIONS This study represents one of the largest phenotypic characterizations of EA patients reported. The data show that EA is a heterogeneous disease, very frequently associated with cardiovascular and noncardiovascular comorbidities. Patients with WPW and SVT represent a homogeneous subgroup that presents with a less severe spectrum of disease and better survival when adequately managed. This should be considered when searching for genetic causes of EA and in the clinical setting.
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Affiliation(s)
- Rodrigo Cabrera
- Laboratorio de Biología Molecular y Pruebas Diagnósticas de Alta Complejidad, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Marta Catalina Miranda-Fernández
- Laboratorio de Biología Molecular y Pruebas Diagnósticas de Alta Complejidad, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Victor Manuel Huertas-Quiñones
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia
| | - Marisol Carreño
- Departamento de Cirugía Cardiovascular, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Ivonne Pineda
- Departamento de Cirugía Cardiovascular, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Carlos M Restrepo
- Centro de Investigación en Genética y Genómica-CIGGUR, Grupo GENIUROS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Claudia Tamar Silva
- Centro de Investigación en Genética y Genómica-CIGGUR, Grupo GENIUROS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rossi Quero
- Centro de Investigación en Genética y Genómica-CIGGUR, Grupo GENIUROS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Cano
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | - Camila Camacho
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Sebastián Tabares
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Alberto García
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia.,Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia.,Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia
| | - Néstor Sandoval
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia
| | | | - Rodolfo José Dennis Verano
- Departamento de Investigaciones, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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30
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Meza JM, Devlin PJ, Overman DM, Gremmels D, Baffa G, Cohen MS, Quartermain MD, Caldarone CA, Pourmoghadam K, DeCampli WM, Fackoury CT, Mertens L. The Congenital Heart Surgeon's Society Complete Atrioventricular Septal Defect Cohort: Baseline, Preintervention Echocardiographic Characteristics. Semin Thorac Cardiovasc Surg 2018; 31:80-86. [PMID: 29428621 DOI: 10.1053/j.semtcvs.2018.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 12/20/2022]
Abstract
Quantifying unbalance, the threshold for single ventricle palliation vs biventricular repair in patients with unbalanced complete atrioventricular septal defect (AVSD), is challenging. Using a core laboratory review of baseline echocardiograms, we sought to assess the correlations among commonly used measures of unbalance and common atrioventricular valve (AVV) and ventricular sizes. A single reviewer evaluated baseline echocardiograms from an inception cohort of babies age < 1 year with complete AVSD admitted to 1 of 25 Congenital Heart Surgeon's Society institutions. A standardized echo review protocol of 111 quantitative and qualitative measures was used. Descriptive statistics were computed and Pearson correlation coefficients were calculated to assess correlation among unbalance indices with valvar and ventricular dimensions. Two-hundred fifty-seven baseline echocardiograms of infants with complete AVSD were included. Median age at baseline echocardiogram was 11 days (interquartile range 1-79) and mean atrioventricular valve index was 0.45 ± 0.1. Mean right ventricle/left ventricle inflow angle was 90.2 ± 15.6° and median left ventricular inflow index was 0.46 (interquartile range 0.4-0.5). There are weak or moderate correlations between the measures of unbalance. Correlations between the measures of unbalance with common AVV leaflet or ventricular sizes are also weak to moderate, when statistically significant. Measures of unbalance in common clinical use correlate poorly, or not at all, with one another, common AVV, and ventricular dimensions. The concept of "unbalance" is difficult to define using baseline echocardiographic indices. These findings suggest that the indices may describe different morphologic and functional characteristics. Further analysis is necessary to quantify the contributions of unbalance indices to patient outcome.
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Affiliation(s)
- James M Meza
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Paul J Devlin
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - David M Overman
- Division of Cardiovascular Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - David Gremmels
- Division of Pediatric Cardiology, The Children's Heart Clinic, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Gina Baffa
- Division of Pediatric Cardiology, Nemours Cardiac Center, Wilmington, Delaware
| | - Meryl S Cohen
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael D Quartermain
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Kamal Pourmoghadam
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida
| | - Cheryl T Fackoury
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Luc Mertens
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada.
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31
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Deri A, English K. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Echocardiographic assessment of left to right shunts: atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent arterial duct. Echo Res Pract 2018; 5:R1-R16. [PMID: 29432197 PMCID: PMC5840804 DOI: 10.1530/erp-17-0062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 02/05/2018] [Indexed: 12/22/2022] Open
Abstract
This review article will guide the reader through the basics of echocardiographic assessment of congenital left to right shunts in both paediatric and adult age groups. After reading this article, the reader will understand the pathology and clinical presentation of atrial septal defects (ASDs), ventricular septal defects (VSDs), atrioventricular septal defects (AVSDs) and patent arterial duct. Echocardiography is the mainstay in diagnosis and follow-up assessment of patients with congenital heart disease. This article will therefore describe the echocardiographic appearances of each lesion, and point the reader towards specific features to look for echocardiographically.
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Affiliation(s)
- Antigoni Deri
- Yorkshire Heart Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate English
- Yorkshire Heart Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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32
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Medvedofsky D, Mor-Avi V, Kruse E, Guile B, Ciszek B, Weinert L, Yamat M, Volpato V, Addetia K, Patel AR, Lang RM. Quantification of Right Ventricular Size and Function from Contrast-Enhanced Three-Dimensional Echocardiographic Images. J Am Soc Echocardiogr 2017; 30:1193-1202. [DOI: 10.1016/j.echo.2017.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Indexed: 11/16/2022]
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33
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Overman DM. Decision-Making in Unbalanced Atrioventricular Septal Defect: Examining Another Piece of the Puzzle. World J Pediatr Congenit Heart Surg 2017; 8:468-469. [PMID: 28696883 DOI: 10.1177/2150135117718460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David M Overman
- 1 Division of Cardiac Surgery, The Children's Heart Clinic, Minneapolis, MN, USA.,2 Division of Cardiovascular Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
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34
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Lugones I, Biancolini MF, Biancolini JC, Dios AMSD, Lugones G. Feasibility of Biventricular Repair in Right Dominant Unbalanced Atrioventricular Septal Defect: A New Echocardiographic Metric to Refine Surgical Decision-Making. World J Pediatr Congenit Heart Surg 2017; 8:460-467. [PMID: 28696869 DOI: 10.1177/2150135117716420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unbalanced forms of atrioventricular septal defect continue to be challenging and present poor surgical outcomes. Echocardiographic indicators such as atrioventricular valve index, right ventricle/left ventricle inflow angle, and size of the ventricular septal defect have been identified as relevant discriminators that may guide surgical strategy. Our purpose is to describe another metric to refine surgical decision-making. METHODS We outline a geometrical description of the anatomic features of atrioventricular septal defect and describe equations that help explain the interplay between the main echocardiographic variables. RESULTS A new metric called "indexed ventricular septal defect" is defined as the size of the defect in relation to the valve diameter. We derive a final equation relating this index with the atrioventricular valve index and the right ventricle/left ventricle inflow angle. In the light of that equation, we discuss the interdependence of variables and employ data from a Congenital Heart Surgeons' Society study to set the limits of the new index. CONCLUSION Combined use of indexed ventricular septal defect and atrioventricular valve index might help clarify surgical decision-making in patients with mild and moderate unbalance (modified atrioventricular valve index between 0.2 and 0.39). For indexed ventricular septal defect smaller than 0.2, biventricular repair may be recommended. Between 0.2 and 0.35, this strategy could probably be achieved depending on other factors. However, other strategies should be considered for those patients showing an indexed ventricular septal defect between 0.35 and 0.5. For values above 0.5 to 0.55, univentricular palliation might be a reasonable strategy.
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Affiliation(s)
- Ignacio Lugones
- 1 Cardiac Surgery Unit, Children's Hospital Buenos Aires "Pedro de Elizalde," Buenos Aires, Argentina
| | | | - Julio César Biancolini
- 2 Cardiology Unit, Children's Hospital Buenos Aires "Pedro de Elizalde," Buenos Aires, Argentina
| | - Ana M S de Dios
- 2 Cardiology Unit, Children's Hospital Buenos Aires "Pedro de Elizalde," Buenos Aires, Argentina
| | - Germán Lugones
- 3 Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Santo André, São Paulo, Brazil
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Nathan M, Emani S, IJsselhof R, Liu H, Gauvreau K, del Nido P. Mid-term outcomes in unbalanced complete atrioventricular septal defect: role of biventricular conversion from single-ventricle palliation†. Eur J Cardiothorac Surg 2017; 52:565-572. [DOI: 10.1093/ejcts/ezx129] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/04/2017] [Indexed: 12/28/2022] Open
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Arunamata A, Balasubramanian S, Mainwaring R, Maeda K, Selamet Tierney ES. Right-Dominant Unbalanced Atrioventricular Septal Defect: Echocardiography in Surgical Decision Making. J Am Soc Echocardiogr 2016; 30:216-226. [PMID: 27939051 DOI: 10.1016/j.echo.2016.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Management of right-dominant atrioventricular septal defect (AVSD) remains a challenge given the spectrum of ventricular hypoplasia. The purpose of this study was to assess whether reported echocardiographic indices and additional measurements were associated with operative strategy in right-dominant AVSD. METHODS A blinded observer retrospectively reviewed preoperative echocardiograms of patients who underwent surgery for right-dominant AVSD (January 2000 to July 2013). Ventricular dimensions, atrioventricular valve index (AVVI; left valve area/right valve area), and right ventricular (RV)/left ventricular (RV/LV) inflow angle were measured. A second observer measured a subset of studies to assess agreement. Pearson correlation analysis was performed to examine the relationship between ventricular septal defect size (indexed to body surface area) and RV/LV inflow angle in systole. A separate validation cohort was identified using the same methodology (August 2013 to July 2016). RESULTS Of 46 patients with right-dominant AVSD (median age, 1 day; range, 0-11 months), overall survival was 76% at 7 years. Twenty-eight patients (61%) underwent single-ventricle palliation and had smaller LV dimensions and volumes, AVVIs (P = .005), and RV/LV inflow angles in systole (P = .007) compared with those who underwent biventricular operations. Three patients undergoing biventricular operations underwent transplantation or died and had lower indexed LV end-diastolic volumes compared with the remaining patients (P = .005). Interobserver agreement for the measured echocardiographic indices was good (intraclass correlation coefficient = 0.70-0.95). Ventricular septal defect size and RV/LV inflow angle in systole had a strong negative correlation (r = -0.7, P < .001). In the validation cohort (n = 12), RV/LV inflow angle in systole ≤ 114° yielded sensitivity of 100% and AVVI ≤ 0.70 yielded sensitivity of 88% for single-ventricle palliation. CONCLUSIONS Mortality remains high among patients with right-dominant AVSD. RV/LV inflow angle in systole and AVVI are reproducible measurements that may be used in conjunction with several echocardiographic parameters to support suitability for a biventricular operation in right-dominant AVSD.
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Affiliation(s)
- Alisa Arunamata
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California.
| | - Sowmya Balasubramanian
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Richard Mainwaring
- Department of Cardiovascular Surgery, Stanford University Medical Center, Palo Alto, California
| | - Katsuhide Maeda
- Department of Cardiovascular Surgery, Stanford University Medical Center, Palo Alto, California
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
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The functional single ventricle: how imaging guides treatment. Clin Imaging 2016; 40:1146-1155. [DOI: 10.1016/j.clinimag.2016.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/06/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
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Boyd R, Patel J, Harden B. Complete Unbalanced Atrioventricular Septal Defect With a Common Arterial Trunk in an Uncontrolled Type 1 Diabetic Mother. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316663208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
When performed by a trained sonographer, fetal echocardiography can be instrumental in identifying cardiac pathology and abnormal cardiac physiology before a baby is born. Even though the diagnostic accuracy of a fetal echocardiogram can be limited by maternal body habitus, gestational age, and fetal position, sequential exams allow for detailed analysis of the cardiac structures. Early identification and diagnosis of intrauterine cardiac anomalies and subsequent pregnancy management and delivery planning are essential to providing the best possible outcome for fetuses born with heart defects. In this case study, we describe a rare combination of congenital heart defects diagnosed in an uncontrolled type 1 diabetic mother while in her second trimester of pregnancy.
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Affiliation(s)
- Roberta Boyd
- Sibley Heart Center Cardiology, Atlanta, GA, USA
| | - Jayur Patel
- Sibley Heart Center Cardiology, Atlanta, GA, USA
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Abarbanell GL, Morrow G, Kelleman MS, Kanter KR, Border WL, Sachdeva R. Echocardiographic Predictors of Left Ventricular Outflow Tract Obstruction following Repair of Atrioventricular Septal Defect. CONGENIT HEART DIS 2016; 11:554-561. [DOI: 10.1111/chd.12370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Ginnie L. Abarbanell
- Division of Pediatric Cardiology, Department of Pediatrics; Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology; Atlanta Ga USA
| | - Gemma Morrow
- Division of Pediatric Cardiology, Department of Pediatrics; Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology; Atlanta Ga USA
| | - Michael S. Kelleman
- Division of Pediatric Cardiology, Department of Pediatrics; Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology; Atlanta Ga USA
| | - Kirk R. Kanter
- Division of Pediatric Cardiology, Department of Pediatrics; Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology; Atlanta Ga USA
| | - William L. Border
- Division of Pediatric Cardiology, Department of Pediatrics; Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology; Atlanta Ga USA
| | - Ritu Sachdeva
- Division of Pediatric Cardiology, Department of Pediatrics; Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology; Atlanta Ga USA
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The angulation of the septal structures impacts ventricular imbalance in atrioventricular septal defects with a common atrioventricular junction. Cardiol Young 2016; 26:321-6. [PMID: 25733014 DOI: 10.1017/s1047951115000219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Multiplanar re-formatting of full-volume three-dimensional echocardiography data sets offers new insights into the morphology of atrioventricular septal defects. We hypothesised that distortion of the alignment between the atrial and ventricular septums results in imbalanced venous return to the ventricles, with consequent proportional ventricular hypoplasia. METHODS A single observer evaluated 31 patients, with a mean age of 52.09 months, standard deviation of 55, and with a range from 2 to 264 months, with atrioventricular septal defects, of whom 17 were boys. Ventricular imbalance, observed in nine patients, was determined by two-dimensional assessment, and confirmed at surgical inspection in selected cases when a univentricular strategy was undertaken. Offline analysis using multiplanar re-formatting was performed. A line was drawn though the length of the ventricular septum and a second line along the plane of the atrial septum, taking the angle between these two lines as the atrioventricular septal angle. We compared the angle between 22 patients with adequately sized ventricles, and those with ventricular imbalance undergoing univentricular repair. RESULTS In the 22 patients undergoing biventricular repair, the septal angle was 0 in 14 patients; the other eight patients having angles ranging from 1 to 36, with a mean angle of 7.4°, and standard deviation of 11.1°.The mean angle in the nine patients with ventricle imbalance was 28.6°, with a standard deviation of 3.04°, and with a range from 26 to 35°. Of those undergoing univentricular repair, two patients died, with angles of 26 and 30°, respectively. CONCLUSIONS The atrioventricular septal angle derived via multiplanar formatting gives important information regarding the degree of ventricular hypoplasia and imbalance. When this angle is above 25°, patients are likely to have ventricular imbalance requiring univentricular repair.
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Novel Approach to Three-Dimensional Echocardiographic Quantification of Right Ventricular Volumes and Function from Focused Views. J Am Soc Echocardiogr 2015; 28:1222-31. [DOI: 10.1016/j.echo.2015.06.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Indexed: 11/19/2022]
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Davies RR, Pizarro C. Decision-Making for Surgery in the Management of Patients with Univentricular Heart. Front Pediatr 2015; 3:61. [PMID: 26284226 PMCID: PMC4515559 DOI: 10.3389/fped.2015.00061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/21/2015] [Indexed: 12/24/2022] Open
Abstract
A series of technical refinements over the past 30 years, in combination with advances in perioperative management, have resulted in dramatic improvements in the survival of patients with univentricular heart. While the goal of single-ventricle palliation remains unchanged - normalization of the pressure and volume loads on the systemic ventricle, the strategies to achieve that goal have become more diverse. Optimal palliation relies on a thorough understanding of the changing physiology over the first years of life and the risks and consequences of each palliative strategy. This review describes how to optimize surgical decision-making in univentricular patients based on a current understanding of anatomy, physiology, and surgical palliation.
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Affiliation(s)
- Ryan Robert Davies
- Nemours Cardiac Center, A. I. duPont Hospital for Children , Wilmington, DE , USA ; Thomas Jefferson University , Philadelphia, PA , USA
| | - Christian Pizarro
- Nemours Cardiac Center, A. I. duPont Hospital for Children , Wilmington, DE , USA ; Thomas Jefferson University , Philadelphia, PA , USA
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Banka P, Schaetzle B, Komarlu R, Emani S, Geva T, Powell AJ. Cardiovascular magnetic resonance parameters associated with early transplant-free survival in children with small left hearts following conversion from a univentricular to biventricular circulation. J Cardiovasc Magn Reson 2014; 16:73. [PMID: 25314952 PMCID: PMC4189673 DOI: 10.1186/s12968-014-0073-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/27/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We sought to identify cardiovascular magnetic resonance (CMR) parameters associated with successful univentricular to biventricular conversion in patients with small left hearts. METHODS Patients with small left heart structures and a univentricular circulation who underwent CMR prior to biventricular conversion were retrospectively identified and divided into 2 anatomic groups: 1) borderline hypoplastic left heart structures (BHLHS), and 2) right-dominant atrioventricular canal (RDAVC). The primary outcome variable was transplant-free survival with a biventricular circulation. RESULTS In the BHLHS group (n = 22), 16 patients (73%) survived with a biventricular circulation over a median follow-up of 40 months (4-84). Survival was associated with a larger CMR left ventricular (LV) end-diastolic volume (EDV) (p = 0.001), higher LV-to-right ventricle (RV) stroke volume ratio (p < 0.001), and higher mitral-to-tricuspid inflow ratio (p = 0.04). For predicting biventricular survival, the addition of CMR threshold values to echocardiographic LV EDV improved sensitivity from 75% to 93% while maintaining specificity at 100%. In the RDAVC group (n = 10), 9 patients (90%) survived with a biventricular circulation over a median follow-up of 29 months (3-51). The minimum CMR values were a LV EDV of 22 ml/m² and a LV-to-RV stroke volume ratio of 0.19. CONCLUSIONS In BHLHS patients, a larger LV EDV, LV-to-RV stroke volume ratio, and mitral-to-tricuspid inflow ratio were associated with successful biventricular conversion. The addition of CMR parameters to echocardiographic measurements improved the sensitivity for predicting successful conversion. In RDAVC patients, the high success rate precluded discriminant analysis, but a range of CMR parameters permitting biventricular conversion were identified.
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Affiliation(s)
- Puja Banka
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Barbara Schaetzle
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Current address: Kantonsspital Winterthur, Winterthur, Switzerland.
| | - Rukmini Komarlu
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Current address: Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Sitaram Emani
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Surgery, Harvard Medical School, Boston, MA, USA.
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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