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Weigand J, Stephens-Novy S, Sachdeva S, Doan TT, Yasso A, Morris SA. Evidence of cardiomyopathy associated with Marfan syndrome in children. Heart 2024; 110:887-891. [PMID: 38816063 DOI: 10.1136/heartjnl-2024-323922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Marfan syndrome (MFS)-associated cardiomyopathy, defined as ventricular dilation and dysfunction unexplained by volume loading, is not well defined in children. This study evaluated ventricular size and function in paediatric MFS using cardiac MRI (cMRI). METHODS This retrospective cohort study examined patients with MFS <19 years old at first cMRI. Left ventricular (LV) ejection fraction (EF) <55% was considered abnormal, as were z-scores >2. Combined mitral and aortic regurgitation indexed to LV stroke volume <20% defined absent/mild volume load. Biventricular volumes and EF on serial cMRI studies were compared with normative paediatric cMRI values, with measures converted to z-scores as appropriate. Longitudinal changes in volumes and EF were evaluated by mixed linear regression. Associations between ventricular, aortic and mitral characteristics were evaluated. RESULTS 58 patients (60% male) were evaluated. Median age at initial cMRI was 13.6 years (IQR 10.0-15.8 years). Among patients with absent/mild LV volume load at initial cMRI (n=44, 76%), indexed LV end-diastolic volume (EDV) was significantly increased above normative values (median z-score 1.8, IQR 0.6-3.5, p<0.0001) and LVEF was abnormal in 48% (21/44). In the absence of volume loading, mitral valve prolapse (MVP) was associated with larger ventricular volumes and lower LVEF. Among those with serial cMRIs, LVEF and EDV z-scores did not significantly change over a mean follow-up time between cMRI studies of 1.5 years. CONCLUSION Ventricular dilation and reduced EF are common in children with MFS and occur with no/mild LV volume load, suggesting intrinsic cardiomyopathy. MVP may be associated with cardiomyopathy.
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Affiliation(s)
- Justin Weigand
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Sara Stephens-Novy
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Shagun Sachdeva
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Tam T Doan
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Abigail Yasso
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Shaine A Morris
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Pediatrics, Texas Children's Hospital, Houston, Texas, USA
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Alexander ME, Gongwer R, Trachtenberg FL, Minich LL, Triedman JK, Kaltman JR, Czosek RJ, Tristani-Firouzi M, LaPage MJ, Tsao SS, Radbill AE, DiLorenzo MP, Kovach JR, Stephenson EA, Janson C, Mao C, Salerno JC, Clark BC, Mahgerefteh J, Pilcher T, Johnson TR, Kim JJ, Valdes SO, Cain N, Jackson L, Saarel EV. Limited Relationship Between Echocardiographic Measures and Electrocardiographic Markers of Left Ventricular Size in Healthy Children. Pediatr Cardiol 2024; 45:1055-1063. [PMID: 38520508 DOI: 10.1007/s00246-024-03448-2] [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] [Received: 09/19/2023] [Accepted: 02/07/2024] [Indexed: 03/25/2024]
Abstract
Pediatric ECG standards have been defined without echocardiographic confirmation of normal anatomy. The Pediatric Heart Network Normal Echocardiogram Z-score Project provides a racially diverse group of healthy children with normal echocardiograms. We hypothesized that ECG and echocardiographic measures of left ventricular (LV) dimensions are sufficiently correlated in healthy children to imply a clinically meaningful relationship. This was a secondary analysis of a previously described cohort including 2170 digital ECGs. The relationship between 6 ECG measures associated with LV size were analyzed with LV Mass (LVMass-z) and left ventricular end-diastolic volume (LVEDV-z) along with 11 additional parameters. Pearson or Spearman correlations were calculated for the 78 ECG-echocardiographic pairs with regression analyses assessing the variance in ECG measures explained by variation in LV dimensions and demographic variables. ECG/echocardiographic measurement correlations were significant and concordant in 41/78 (53%), though many were significant and discordant (13/78). Of the 6 ECG parameters, 5 correlated in the clinically predicted direction for LV Mass-z and LVEDV-z. Even when statistically significant, correlations were weak (0.05-0.24). R2 was higher for demographic variables than for echocardiographic measures or body surface area in all pairs, but remained weak (R2 ≤ 0.17). In a large cohort of healthy children, there was a positive association between echocardiographic measures of LV size and ECG measures of LVH. These correlations were weak and dependent on factors other than echocardiographic or patient derived variables. Thus, our data support deemphasizing the use of solitary, traditional measurement-based ECG markers traditionally thought to be characteristic of LVH as standalone indications for further cardiac evaluation of LVH in children and adolescents.
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Affiliation(s)
- Mark E Alexander
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | | | | | | | - John K Triedman
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | | | - Richard J Czosek
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Sabrina S Tsao
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong
| | | | | | | | | | | | - Chad Mao
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Joseph Mahgerefteh
- Children's Hospital at Montefiore, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, New York, USA
| | | | | | - Jeff J Kim
- Texas Children's Hospital, Houston, TX, USA
| | | | - Nicole Cain
- Medical University of South Carolina, Charleston, SC, USA
| | - Lanier Jackson
- Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth V Saarel
- St. Luke's Health System, Boise, ID, USA
- Cleveland Clinic Lerner College of Medicine at CWRU, Cleveland, OH, USA
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Verpalen VA, Ververs FA, Slieker M, Nuboer R, Swart JF, van der Ent CK, Fejzic Z, Westenberg JJ, Leiner T, Grotenhuis HB, Schipper HS. Enhanced aortic stiffness in adolescents with chronic disease is associated with decreased left ventricular global longitudinal strain. IJC HEART & VASCULATURE 2024; 52:101385. [PMID: 38694268 PMCID: PMC11061239 DOI: 10.1016/j.ijcha.2024.101385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 05/04/2024]
Abstract
Background The recent Cardiovascular Disease in Adolescents with Chronic Disease (CDACD) study showed enhanced aortic stiffness and wall thickness in adolescents with various chronic disorders. Enhanced aortic stiffness can increase left ventricular (LV) afterload and trigger a cascade of adverse arterioventricular interaction. Here, we investigate the relation between aortic changes and LV function in the CDACD study participants. Methods This cross-sectional study included 114 adolescents 12-18 years old with cystic fibrosis (CF, n = 24), corrected coarctation of the aorta (CoA, n = 25), juvenile idiopathic arthritis (JIA, n = 20), obesity (n = 20), and healthy controls (n = 25). Aortic pulse wave velocity (PWV), which reflects aortic stiffness, and aortic wall thickness (AWT) were assessed with cardiovascular magnetic resonance imaging (CMR). Echocardiography was employed to study conventional markers of LV function, as well as LV global longitudinal strain (LVGLS), which is an established (pre)clinical marker of LV dysfunction. Results First, aortic PWV and AWT were increased in all chronic disease groups, compared to controls. Second, in adolescents with CoA, JIA, and obesity, echocardiography showed a decreased LVGLS, while LV dimensions and conventional LV function markers were similar to controls. Third, multivariable linear regression identified aortic PWV as the most important determinant of their decreased LVGLS (standardized β -0.522, p < 0.001). Conclusions The decreased LVGLS in several adolescent chronic disease groups was associated with enhanced aortic PWV, which might reflect adverse arterioventricular interaction. Whether the decreased LVGLS in the chronic disease groups could negatively impact their long-term cardiovascular outcomes requires further study.
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Affiliation(s)
- Victor A. Verpalen
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, the Netherlands
| | - Francesca A. Ververs
- Center for Translational Immunology, University Medical Center Utrecht, the Netherlands
| | - Martijn Slieker
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Roos Nuboer
- Department of Pediatrics, Meander Medical Center Amersfoort, the Netherlands
| | - Joost F. Swart
- Department of Pediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Zina Fejzic
- Department of Pediatric Cardiology, Amalia Children’s Hospital Radboud University Medical Center Nijmegen, the Netherlands
| | | | - Tim Leiner
- Department of Radiology, Mayo Clinics, United States of America
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
| | - Henk S. Schipper
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, the Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, the Netherlands
- Department of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
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Maskatia SA, Glatz AC, Goldstein BH, Qureshi AM, Zampi JD, McCracken CE, Nicholson GT, Meadows JJ, Shahanavaz S, Law MA, Batlivala SP, Mascio CE, Chai PJ, Romano JC, O'Byrne ML, Ligon A, Beshish AG, Petit CJ. Outcomes of Neonates Born with Symptomatic Tetralogy of Fallot and Absent Ductus Arteriosus. J Pediatr 2024; 272:114122. [PMID: 38815742 DOI: 10.1016/j.jpeds.2024.114122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To test the hypothesis that neonates with symptomatic tetralogy of Fallot (TOF) and absent ductus arteriosus (ADA) have worse clinical outcomes compared with those with a ductus arteriosus (DA), and that this difference is driven by those born with ADA and with critically deficient pulmonary blood flow (CDPBF). STUDY DESIGN We performed a retrospective, multicenter cohort study of neonates who underwent intervention for symptomatic TOF comparing death and reintervention between subjects with and without a DA identified on fetal echocardiogram or on echocardiogram performed in the first postnatal day. Exclusion criteria were as follows: inability to define DA status, collaterals supplying pulmonary blood flow, atrioventricular septal defect, and absent pulmonary valve. We defined CDPBF as undergoing a procedure to augment pulmonary blood flow on the date of birth or extracorporeal membrane oxygenation prior to such a procedure. RESULTS The study cohort included 519 patients, among whom 11% had ADA. Patients with ADA were more likely to have a genetic syndrome and had smaller branch pulmonary artery size. In analyses adjusting for center, interventional treatment strategy, genetic syndrome, and minimum branch pulmonary artery size, ADA was associated with higher mortality risk (adjusted hazard ratio of 2.37 (95% CI: 1.07,5.27; P = .034). Seven patients had CDPBF (1.3% of the entire cohort and 12% of patients with ADA). CONCLUSIONS A minority of symptomatic TOF neonates have ADA, which is associated with higher adjusted mortality risk compared with those with a DA. CDPBF appears to be a rare but important entity in this population.
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Affiliation(s)
- Shiraz A Maskatia
- Department of Pediatrics, Berry Irene Moore Heart Center, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA.
| | - Andrew C Glatz
- The Heart Center, Washington University and St. Louis Children's Hospital, St. Louis, MO
| | - Bryan H Goldstein
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Jeffrey D Zampi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI
| | | | - George T Nicholson
- Pediatric Heart Institute, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Jeffery J Meadows
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Shabana Shahanavaz
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mark A Law
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Sarosh P Batlivala
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher E Mascio
- Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University Medicine Children's, Morgantown, WV
| | - Paul J Chai
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Jennifer C Romano
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Michael L O'Byrne
- Cardiac Center at the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Allen Ligon
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Asaad G Beshish
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Christopher J Petit
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
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Sengupta A, Colan SD, Nathan M. Reply: Understanding of Aging Effects on the Clinical Course in Patients With Congenital Heart Disease. J Am Coll Cardiol 2024; 83:e205-e206. [PMID: 38777517 DOI: 10.1016/j.jacc.2024.03.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 05/25/2024]
Affiliation(s)
| | - Steven D Colan
- Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Meena Nathan
- Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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Donthula R, Li W, Duvvada A, Dyer D, Uppu SC. Normative Computed Tomography Angiography Values of the Aortic Root, Aorta and Aortic arch in Children. RESEARCH SQUARE 2024:rs.3.rs-4406785. [PMID: 38798643 PMCID: PMC11118707 DOI: 10.21203/rs.3.rs-4406785/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Purpose Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data are not currently available for ECG-gated Computed Tomography Angiography (CTA). We sought to establish ECG-gated CTA derived normative values for the aortic root, aorta and aortic arch in children. Methods and Results Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface areaAE (BSAAE) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements. Conclusion Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta and aortic arch in children.
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Affiliation(s)
| | - Wen Li
- the University of Texas McGovern Medical School at Houston
| | | | | | - Santosh C Uppu
- The University of Texas Health Science Center at Houston
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7
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Cantinotti M, Scalese M, Contini FV, Franchi E, Viacava C, Corana G, Pizzuto A, Pietro M, Santoro G, Assanta N. Comprehensive Two-Dimensional Pediatric Echocardiographic Nomograms for Coronary Artery Sizes in Caucasian Children and Comparison among Major Nomograms. Diagnostics (Basel) 2024; 14:1029. [PMID: 38786327 PMCID: PMC11119586 DOI: 10.3390/diagnostics14101029] [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: 04/09/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Although coronary artery nomograms in children have been published, data on Caucasian children are lacking. The aim of this study is to provide: (i) a full dataset of coronary artery diameters in healthy children and (ii) a comparison among major previous nomograms. MATERIALS AND METHODS We prospectively evaluated 606 healthy subjects (age range, 1 days-<18 years; median age 8.7 years; 62.5% male). Coronary artery measurements in a short-axis view were performed. Age, heart rate, and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. To assess the accuracy of the predictive models of different studies, a Z-score calculator was created using Lopez's nomograms for comparison. RESULTS The association with BSA was found to be stronger, and was used for normalization of our data. The best-fit models, satisfying the assumption of homoscedasticity and normality of residuals and showing the highest R2 scores, were logarithmic (ln[y] = a + b*ln[x]). Predicted values and Z-score boundaries by BSA are provided. Our ranges of normality are slightly lower than those, diverging from -0.22 to -0.59 Z-scores for the left main coronary artery and from -0.23 to -0.3 Z-scores for the right coronary artery. CONCLUSIONS We report a complete dataset of normal echocardiography coronary artery diameter (including new measures of the proximal origin) values in a large population of healthy children. Our data were statistically like those of north American nomograms.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Marco Scalese
- Department of Statistics, National Research Institute, National Research Council, 56121 Pisa, Italy;
| | | | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Cecilia Viacava
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Giulia Corana
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Alessandra Pizzuto
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Marchese Pietro
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy; (E.F.); (C.V.); (G.C.); (A.P.); (M.P.); (G.S.); (N.A.)
- Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
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Savis A, Haseler E, Beardsley H, Chowienczyk PJ, Simpson JM, Sinha MD. Aortic Dilatation in Children and Young People With ADPKD. Kidney Int Rep 2024; 9:1210-1219. [PMID: 38707792 PMCID: PMC11068958 DOI: 10.1016/j.ekir.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Aortic root dilatation is a reported cardiovascular sequela seen in children and young people (CYP) with chronic kidney disease (CKD) but has yet to be described in those with autosomal dominant polycystic kidney disease (ADPKD). Methods Single center, cross-sectional study in a dedicated ADPKD clinic. Echocardiograms were evaluated for the presence of dilatation (defined by a z-score ≥2 [≥99th percentile] SDs from the mean) at 4 standardized locations, namely the aortic valve annulus, sinuses of Valsalva (SoV), sinotubular junction (STJ), and the ascending aorta. Measurements were compared with a control group to assess prevalence, severity, and determinants of aortic dilatation. Results Ninety-seven children, median age (interquartile range) of 9.3 (6.1, 13.6) years were compared with 19 controls without ADPKD or other CKD. The prevalence of dilatation ranged from 5.2% to 17% in ADPKD, depending on anatomical location with no aortic dilatation identified in the control group. In multivariable regression, aortic root dilatation was significantly associated with cyst burden at the aortic valve annulus and SoV (β = 0.42 and β = 0.39, both P < 0.001), with age at SoV (β = -0.26, P = 0.02), systolic blood pressure (SBP) z-score at SoV (β = -0.20, P = 0.04) and left ventricular mass index (LVMI) at SoV and STJ (β = 0.24, P = 0.02 and β = 0.25, P = 0.03, respectively) following adjustment for age, sex (male or female), body mass index (BMI) z-score, estimated glomerular filtration rate (eGFR), SBP z-score, and LVMI. Conclusion Our data suggests increased prevalence of aortic root and ascending aortic dilatation in CYP with ADPKD compared with controls. Further studies are needed to understand the pathogenesis and its contribution to the high cardiovascular morbidity in ADPKD.
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Affiliation(s)
- Alexandra Savis
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Hayley Beardsley
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | | | - John M. Simpson
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
- Department of Clinical Pharmacology, Kings College London, UK
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Barros A, Udine M, Spurney C, Olivieri L, Loke YH. Discordance interpretation of left ventricular size between echocardiography and cardiac magnetic resonance in pediatric patients with aortic/mitral regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1049-1057. [PMID: 38519822 PMCID: PMC11147931 DOI: 10.1007/s10554-024-03073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This study investigated discordance between echocardiography (echo) and cardiac magnetic resonance (CMR) measurements of the left ventricle (LV) in pediatric patients with aortic and/or mitral regurgitation (AR/MR). METHODS Retrospective cohort study of pediatric patients. The cohorts were comprised of patients with AR/MR vs. non-AR/MR. Left ventricular end diastolic volume (LVEDV) by CMR and left ventricular internal diameter diastolic (LVIDd) by echo were obtained from clinical reports then echo images were reviewed to remeasure LVEDV by bullet method. Left ventricular internal diameter systolic (LVIDs) and left ventricular ejection fraction (LVEF) measurements by echo and LVEF by CMR were obtained from clinical reports. Fractional shortening (FS%) was recalculated. Z-scores were calculated using normative data. Correlation between echo and CMR LV measurements was assessed using correlation coefficients. Bland-Altman plots assessed bias between imaging modalities. Receiver operator characteristic (ROC) analysis was performed for detection of LV enlargement and LV dysfunction. RESULTS AR/MR patients had greater discrepancy in LV size interpretation by Z-score compared to non-AR/MR patients. This discrepancy persisted when the bullet method short axis measurements were incorporated. There was negative bias in echo-based measurements compared to CMR. The diagnostic performance of echo in identifying moderate LV enlargement was worse for AR/MR pediatrics patients. CONCLUSION The discordant interpretation of LV size by echo compared to CMR is worse in pediatric patients with AR/MR when compared to patients without AR/MR even when short axis measurements are incorporated. This finding suggests non-uniform geometrical changes in the LV as it enlarges due to AR/MR.
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Affiliation(s)
| | | | | | - Laura Olivieri
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Yue-Hin Loke
- Children's National Hospital, Washington, DC, USA
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10
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Griffeth EM, Dearani JA, Hassler KR, Todd A, Johnson JN, Miranda WR, Stephens EH. Late Outcomes of Konno-Rastan and Modified Konno for Left Ventricular Outflow Tract Obstruction. Ann Thorac Surg 2024; 117:973-981. [PMID: 37479125 PMCID: PMC10799181 DOI: 10.1016/j.athoracsur.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/20/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND While early outcomes of the Konno-Rastan and modified Konno procedures are known, long-term outcomes remain undetermined. Our objective was to examine long-term clinical and echocardiographic outcomes. METHODS Retrospective review was performed of patients undergoing Konno-Rastan and modified Konno for complex left ventricular outflow tract (LVOT) obstruction from January 1980 to January 2021. The Ross-Konno procedure was excluded due to its often limited ventriculotomy. RESULTS A total of 92 patients were identified: 73 Konno-Rastan and 19 modified Konno. The modified Konno group was significantly younger (median [interquartile range, IQR]: 6, [2-12] years vs 16 [9-32] years, P = .001). LVOT obstruction was multilevel (39 of 92 [42.4%]), tunnel subaortic (35 of 92 [38.0%]), or aortic valve stenosis/annular hypoplasia (18 of 92 [19.6%]). Shone syndrome was present in 20 of 92 (21.7%) patients. Operative mortality was 7 of 92 (7.6%); 4 of 86 (4.7%) in elective vs 3 of 6 (50.0%) in urgent cases (P = .005). Median follow-up was 12 (IQR, 5-22) years. Aortic valve/LVOT mean gradient was 13 (IQR, 10-18) mm Hg at 1 year but gradually increased to 25 (IQR, 13-46) mm Hg at 10 years. Ejection fraction remained normal. Freedom from reoperation at 5 and 10 years was 77.2% and 58.4% among Konno-Rastan and 57.7% and 41.7% among modified Konno patients (P = .28), respectively. Overall survival at 5, 10, and 15 years was 82.9%, 76.3%, and 65.5%. Risk factors for mortality included older age, New York Heart Association class III/IV, longer cardiopulmonary bypass time, and multilevel LVOT obstruction. CONCLUSIONS While LVOT obstruction is alleviated early, recurrent LVOT obstruction occurs over time after Konno-Rastan and modified Konno procedures. Additionally, despite preserved left ventricular systolic function, late overall survival is poor in this young population.
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Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kenneth R Hassler
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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11
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Perkins DR, Talbot JS, Lord RN, Dawkins TG, Baggish AL, Zaidi A, Uzun O, Mackintosh KA, McNarry MA, Cooper SM, Lloyd RS, Oliver JL, Shave RE, Stembridge M. Adaptation of Left Ventricular Twist Mechanics in Exercise-Trained Children Is Only Evident after the Adolescent Growth Spurt. J Am Soc Echocardiogr 2024; 37:538-549. [PMID: 38056578 DOI: 10.1016/j.echo.2023.11.024] [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: 10/27/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The extent of structural cardiac remodeling in response to endurance training is maturity dependent. In adults, this structural adaptation is often associated with the adaptation of left ventricular (LV) twist mechanics. For example, an increase in LV twist often follows an expansion in end-diastolic volume, whereas a reduction in twist may follow a thickening of the LV walls. While structural cardiac remodeling has been shown to be more prominent post-peak height velocity (PHV), it remains to be determined how this maturation-dependent structural remodeling influences LV twist. Therefore, we aimed to (1) compare LV twist mechanics between trained and untrained children pre- and post-PHV and (2) investigate how LV structural variables relate to LV twist mechanics pre- and post-PHV. METHODS Left ventricular function and morphology were assessed (echocardiography) in endurance-trained and untrained boys (n = 38 and n = 28, respectively) and girls (n = 39 and n = 34, respectively). Participants were categorized as either pre- or post-PHV using maturity offset to estimate somatic maturation. RESULTS Pre-PHV, there were no differences in LV twist or torsion between trained and untrained boys (twist: P = .630; torsion: P = .382) or girls (twist: P = .502; torsion: P = .316), and LV twist mechanics were not related with any LV structural variables (P > .05). Post-PHV, LV twist was lower in trained versus untrained boys (P = .004), with torsion lower in trained groups, irrespective of sex (boys: P < .001; girls: P = .017). Moreover, LV torsion was inversely related to LV mass (boys: r = -0.55, P = .001; girls: r = -0.46, P = .003) and end-diastolic volume (boys: r = -0.64, P < .001; girls: r = -0.36, P = .025) in both sexes. CONCLUSIONS A difference in LV twist mechanics between endurance-trained and untrained cohorts is only apparent post-PHV, where structural and functional remodeling were related.
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Affiliation(s)
- Dean R Perkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Jack S Talbot
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Aaron L Baggish
- Institute of Sports Science, University of Lausanne, Lausanne, Switzerland
| | - Abbas Zaidi
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Orhan Uzun
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Stephen-Mark Cooper
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rhodri S Lloyd
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom; Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand; Centre for Sport Science and Human Performance, Waikato Institute of Technology, Waikato, New Zealand
| | - Jon L Oliver
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom; Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - Rob E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom.
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12
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Yu JJ, Choi HJ, Cho HJ, Kim SH, Cheon EJ, Kim GB, Eun LY, Jung SY, Jun HO, Woo HO, Park SA, Yoon S, Ko H, Ban JE, Choi JW, Song MS, Han JW. Newly Developed Sex-Specific Z Score Model for Coronary Artery Diameter in a Pediatric Population. J Korean Med Sci 2024; 39:e144. [PMID: 38685889 PMCID: PMC11058341 DOI: 10.3346/jkms.2024.39.e144] [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: 12/15/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This study aimed to generate a Z score calculation model for coronary artery diameter of normal children and adolescents to be adopted as the standard calculation method with consensus in clinical practice. METHODS This study was a retrospective, multicenter study that collected data from multiple institutions across South Korea. Data were analyzed to determine the model that best fit the relationship between the diameter of coronary arteries and independent demographic parameters. Linear, power, logarithmic, exponential, and square root polynomial models were tested for best fit. RESULTS Data of 2,030 subjects were collected from 16 institutions. Separate calculation models for each sex were developed because the impact of demographic variables on the diameter of coronary arteries differs according to sex. The final model was the polynomial formula with an exponential relationship between the diameter of coronary arteries and body surface area using the DuBois formula. CONCLUSION A new coronary artery diameter Z score model was developed and is anticipated to be applicable in clinical practice. The new model will help establish a consensus-based Z score model.
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Affiliation(s)
- Jeong Jin Yu
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hee Joung Choi
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Hye Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Gi Beom Kim
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| | - Lucy Youngmin Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Se Yong Jung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ok Jun
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Institute of Medical Science, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sin-Ae Park
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Soyoung Yoon
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Hoon Ko
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji-Eun Ban
- Department of Pediatrics, Ewha Womans University Medical Center, Seoul, Korea
| | - Jong-Woon Choi
- Department of Pediatrics, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University Paik Hospital, Busan, Korea
| | - Ji Whan Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Kadeetham K, Samankatiwat P. Impact of right ventriculotomy on cardiac function after pulmonary valve sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis. Cardiol Young 2024:1-8. [PMID: 38602093 DOI: 10.1017/s1047951124000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES Pulmonary valve-sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis has the advantage of reduced incidence of late pulmonary valve regurgitation and better-preserved cardiac function. However, a right ventriculotomy is sometimes necessary in order to adequately relieve subvalvular pulmonary stenosis. We aimed to compare postoperative cardiac function and patients' symptoms between pulmonary valve-sparing repair with and without right ventriculotomy. MATERIALS AND METHODS We retrospectively collected data from electronic medical records of Ramathibodi Hospital from 1st January 2013 to 31st October 2023. Patients diagnosed with tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis who underwent pulmonary valve-sparing repair were included. Patients who underwent other types of repairs and whose medical record data were significantly missing were excluded. Demographic data, operative, and postoperative details were collected and reviewed. RESULTS There were 49 patients included in our study with 10 patients undergoing pulmonary valve-sparing repair with and the other 39 without right ventriculotomy. Before-discharge echocardiographic parameters were generally similar between both groups (tricuspid annular plane systolic excursion = 0.9 versus 0.89 cm, P = 0.737; pressure gradient across pulmonary valve across pulmonary valve = 24 versus 19 mmHg, P = 0.275; left ventricular end-systolic volume index = 17.84 versus 19.19 ml/m2, P = 0.437; left ventricular end-diastolic volume index = 63.79 versus 61.13 ml/m2, P = 0.436). Patients' symptoms were also not statistically different. There was no early and late death up to the end date of our study. CONCLUSIONS Right ventriculotomy in pulmonary valve-sparing repair did not result in worse postoperative cardiac function and symptoms. This suggested that the previously thought-to-be hazardous incision could be strongly considered if mandated.
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Affiliation(s)
- Khunthorn Kadeetham
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piya Samankatiwat
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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14
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Baban A, Parlapiano G, Cicenia M, Armando M, Franceschini A, Pacifico C, Panfili A, Zinzanella G, Romanzo A, Fusco A, Caiazza M, Perri G, Galletti L, Digilio MC, Buonuomo PS, Bartuli A, Novelli A, Raponi M, Limongelli G. Unique Features of Cardiovascular Involvement and Progression in Children with Marfan Syndrome Justify Dedicated Multidisciplinary Care. J Cardiovasc Dev Dis 2024; 11:114. [PMID: 38667733 PMCID: PMC11050181 DOI: 10.3390/jcdd11040114] [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: 03/01/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Marfan syndrome (MIM: # 154700; MFS) is an autosomal dominant disease representing the most common form of heritable connective tissue disorder. The condition presents variable multiorgan expression, typically involving a triad of cardiovascular, eye, and skeletal manifestations. Other multisystemic features are often underdiagnosed. Moreover, the disease is characterized by age related penetrance. Diagnosis and management of MFS in the adult population are well-described in literature. Few studies are focused on MFS in the pediatric population, making the clinical approach (cardiac and multiorgan) to these cases challenging both in terms of diagnosis and serial follow-up. In this review, we provide an overview of MFS manifestations in children, with extensive revision of major organ involvement (cardiovascular ocular and skeletal). We attempt to shed light on minor aspects of MFS that can have a significant progressive impact on the health of affected children. MFS is an example of a syndrome where an early personalized approach to address a dynamic, genetically determined condition can make a difference in outcome. Applying an early multidisciplinary clinical approach to MFS cases can prevent acute and chronic complications, offer tailored management, and improve the quality of life of patients.
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Affiliation(s)
- Anwar Baban
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Cardiogenetic Center, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (G.P.); (A.P.)
| | - Giovanni Parlapiano
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Cardiogenetic Center, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (G.P.); (A.P.)
| | - Marianna Cicenia
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.); (A.F.)
| | - Michela Armando
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy;
| | - Alessio Franceschini
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.); (A.F.)
| | - Concettina Pacifico
- Audiology and Otosurgery Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Arianna Panfili
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Cardiogenetic Center, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (G.P.); (A.P.)
| | - Gaetano Zinzanella
- Ophthalmology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.Z.); (A.R.)
| | - Antonino Romanzo
- Ophthalmology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.Z.); (A.R.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (A.F.); (M.C.); (G.L.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (A.F.); (M.C.); (G.L.)
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.P.); (L.G.)
| | - Lorenzo Galletti
- Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.P.); (L.G.)
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.D.); (P.S.B.); (A.B.)
| | - Paola Sabrina Buonuomo
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.D.); (P.S.B.); (A.B.)
| | - Andrea Bartuli
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.C.D.); (P.S.B.); (A.B.)
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (A.F.); (M.C.); (G.L.)
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
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15
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Chinawa JM, Chukwu B, Chinawa A. Estimation of z-scores of cardiac structures in healthy children in Southeast Nigeria. Ir J Med Sci 2024; 193:689-698. [PMID: 37861940 DOI: 10.1007/s11845-023-03542-z] [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: 07/14/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The z-scoring system shows the mean deviation of cardiac dimensions from age-specific population. The use of the European-based z-score studies has resulted in misdiagnosis and late treatment of Nigerian children with heart diseases leading to increased mortality and morbidity. OBJECTIVES This study aimed to determine the z‑scores for various cardiac structures and functions among healthy children in Southeast Nigeria. MATERIALS AND METHODS This is a cross-sectional observational study where z-scores of the cardiac structure and function of three hundred healthy children were estimated using echocardiography and compared with the standard Detroit values. RESULT There was a significant positive correlation between age and cardiac valve diameter. The aortic valve strongly correlated positively with age with the Pearson correlation coefficient (ρ) of 0.8 and probability value (P-value) of 0.00. None of the ventricular function variables deviated beyond the +2 or -2 z-score. There was a positive correlation between the z-scores of ventricular function parameters and participants' age, although the strength of the correlation varied. Comparing these values with that of Detroit values, there was a significant difference in the deviation of the mean of the mitral valve and left pulmonary artery diameters from the Detroit values between the males and the females. While the mean z-score mitral valve was 0.8 in males, it was 0.6 in females (P = 0.02). CONCLUSION Z-scores of cardiac structures and function are derived from children in this locale. These values were similar to that of Detroit values except for the mitral valve and left pulmonary artery.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Bartholomew Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Awoere Chinawa
- Department of Community Medicine, ESUCOM, Parklane, Enugu, Nigeria
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16
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Rwebembera J, Marangou J, Mwita JC, Mocumbi AO, Mota C, Okello E, Nascimento B, Thorup L, Beaton A, Kado J, Kaethner A, Kumar RK, Lawrenson J, Marijon E, Mirabel M, Nunes MCP, Piñeiro D, Pinto F, Ralston K, Sable C, Sanyahumbi A, Saxena A, Sliwa K, Steer A, Viali S, Wheaton G, Wilson N, Zühlke L, Reményi B. 2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease. Nat Rev Cardiol 2024; 21:250-263. [PMID: 37914787 DOI: 10.1038/s41569-023-00940-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/03/2023]
Abstract
Rheumatic heart disease (RHD) is an important and preventable cause of morbidity and mortality among children and young adults in low-income and middle-income countries, as well as among certain at-risk populations living in high-income countries. The 2012 World Heart Federation echocardiographic criteria provided a standardized approach for the identification of RHD and facilitated an improvement in early case detection. The 2012 criteria were used to define disease burden in numerous epidemiological studies, but researchers and clinicians have since highlighted limitations that have prompted a revision. In this updated version of the guidelines, we incorporate evidence from a scoping review, an expert panel and end-user feedback and present an approach for active case finding for RHD, including the use of screening and confirmatory criteria. These guidelines also introduce a new stage-based classification for RHD to identify the risk of disease progression. They describe the latest evidence and recommendations on population-based echocardiographic active case finding and risk stratification. Secondary antibiotic prophylaxis, echocardiography equipment and task sharing for RHD active case finding are also discussed. These World Heart Federation 2023 guidelines provide a concise and updated resource for clinical and research applications in RHD-endemic regions.
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Affiliation(s)
| | - James Marangou
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | | | - Cleonice Mota
- Departamento de Paediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo, Horizonte, Brazil
- Divisão de Cardiologia Pediátrica e Fetal/Serviço de Cardiologia e Cirurgia Cardiovascular e Serviço de Paediatria, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo, Horizonte, Brazil
| | - Emmy Okello
- Division of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Bruno Nascimento
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo, Horizonte, Brazil
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo, Horizonte, Brazil
| | - Lene Thorup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andrea Beaton
- Department of Paediatrics, School of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Cardiology, The Heart Institute, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Joseph Kado
- Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Alexander Kaethner
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NT Cardiac, Darwin, Northern Territory, Australia
| | | | - John Lawrenson
- Paediatric Cardiology Service of the Western Cape, Red Cross War Memorial Children's Hospital and Tygerberg Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Maria Carmo Pereira Nunes
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo, Horizonte, Brazil
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo, Horizonte, Brazil
| | - Daniel Piñeiro
- Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Fausto Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, The Cardiovascular Centre of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Craig Sable
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Amy Sanyahumbi
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Anita Saxena
- Pt BD Sharma University of Health Sciences, Rohtak, India
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Steer
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Gavin Wheaton
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Liesl Zühlke
- South African Medical Research Council, Extramural Research & Internal Portfolio, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Bo Reményi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NT Cardiac, Darwin, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
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17
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Boleti O, Norrish G, Field E, Dady K, Summers K, Nepali G, Bhole V, Uzun O, Wong A, Daubeney PEF, Stuart G, Fernandes P, McLeod K, Ilina M, Ali MNL, Bharucha T, Donne GD, Brown E, Linter K, Jones CB, Searle J, Regan W, Mathur S, Boyd N, Reinhardt Z, Duignan S, Prendiville T, Adwani S, Kaski JP. Natural history and outcomes in paediatric RASopathy-associated hypertrophic cardiomyopathy. ESC Heart Fail 2024; 11:923-936. [PMID: 38217456 DOI: 10.1002/ehf2.14637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 01/15/2024] Open
Abstract
AIMS This study aimed to describe the natural history and predictors of all-cause mortality and sudden cardiac death (SCD)/equivalent events in children with a RASopathy syndrome and hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS This is a retrospective cohort study from 14 paediatric cardiology centres in the United Kingdom and Ireland. We included children <18 years with HCM and a clinical and/or genetic diagnosis of a RASopathy syndrome [Noonan syndrome (NS), NS with multiple lentigines (NSML), Costello syndrome (CS), cardiofaciocutaneous syndrome (CFCS), and NS with loose anagen hair (NS-LAH)]. One hundred forty-nine patients were recruited [111 (74.5%) NS, 12 (8.05%) NSML, 6 (4.03%) CS, 6 (4.03%) CFCS, 11 (7.4%) Noonan-like syndrome, and 3 (2%) NS-LAH]. NSML patients had higher left ventricular outflow tract (LVOT) gradient values [60 (36-80) mmHg, P = 0.004]. Over a median follow-up of 197.5 [inter-quartile range (IQR) 93.58-370] months, 23 patients (15.43%) died at a median age of 24.1 (IQR 5.6-175.9) months. Survival was 96.45% [95% confidence interval (CI) 91.69-98.51], 90.42% (95% CI 84.04-94.33), and 84.12% (95% CI 75.42-89.94) at 1, 5, and 10 years, respectively, but this varied by RASopathy syndrome. RASopathy syndrome, symptoms at baseline, congestive cardiac failure (CCF), non-sustained ventricular tachycardia (NSVT), and maximal left ventricular wall thickness were identified as predictors of all-cause mortality on univariate analysis, and CCF, NSVT, and LVOT gradient were predictors for SCD or equivalent event. CONCLUSIONS These findings highlight a distinct category of patients with Noonan-like syndrome with a milder HCM phenotype but significantly worse survival and identify potential predictors of adverse outcome in patients with RASopathy-related HCM.
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Affiliation(s)
- Olga Boleti
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Kathleen Dady
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
| | - Kim Summers
- Institute of Cardiovascular Science, University College London, London, UK
| | - Gauri Nepali
- The Heart Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Vinay Bhole
- The Heart Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Orhan Uzun
- Children's Heart Unit, University Hospital of Wales, Cardiff, UK
| | - Amos Wong
- Children's Heart Unit, University Hospital of Wales, Cardiff, UK
| | - Piers E F Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Precylia Fernandes
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, UK
| | | | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, UK
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, UK
| | - Caroline B Jones
- Department of Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Jonathan Searle
- Children's Heart Service, Evelina Children's Hospital, London, UK
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - William Regan
- Children's Heart Service, Evelina Children's Hospital, London, UK
| | - Sujeev Mathur
- Children's Heart Service, Evelina Children's Hospital, London, UK
| | - Nicola Boyd
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, UK
| | - Zdenka Reinhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, UK
| | - Sophie Duignan
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Terence Prendiville
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
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18
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Aslan S, Liu X, Wu Q, Mass P, Loke YH, Johnson J, Huddle J, Olivieri L, Hibino N, Krieger A. Virtual Planning and Patient-Specific Graft Design for Aortic Repairs. Cardiovasc Eng Technol 2024; 15:123-136. [PMID: 37985613 DOI: 10.1007/s13239-023-00701-2] [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] [Received: 10/19/2022] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Patients presenting with coarctation of the aorta (CoA) may also suffer from co-existing transverse arch hypoplasia (TAH). Depending on the risks associated with the surgery and the severity of TAH, clinicians may decide to repair only CoA, and monitor the TAH to see if it improves as the patient grows. While acutely successful, eventually hemodynamics may become suboptimal if TAH is left untreated. The objective of this work aims to develop a patient-specific surgical planning framework for predicting and assessing postoperative outcomes of simple CoA repair and comprehensive repair of CoA and TAH. METHODS The surgical planning framework consisted of virtual clamp placement, stenosis resection, and design and optimization of patient-specific aortic grafts that involved geometrical modeling of the graft and computational fluid dynamics (CFD) simulation for evaluating various surgical plans. Time-dependent CFD simulations were performed using Windkessel boundary conditions at the outlets that were obtained from patient-specific non-invasive pressure and flow data to predict hemodynamics before and after the virtual repairs. We applied the proposed framework to investigate optimal repairs for six patients (n = 6) diagnosed with both CoA and TAH. Design optimization was performed by creating a combination of a tubular graft and a waterslide patch to reconstruct the aortic arch. The surfaces of the designed graft were parameterized to optimize the shape. RESULTS Peak systolic pressure drop (PSPD) and time-averaged wall shear stress (TAWSS) were used as performance metrics to evaluate surgical outcomes of various graft designs and implantation. The average PSPD improvements were 28% and 44% after the isolated CoA repair and comprehensive repair, respectively. Maximum values of TAWSS were decreased by 60% after CoA repair and further improved by 22% after the comprehensive repair. The oscillatory shear index was calculated and the values were confirmed to be in the normal range after the repairs. CONCLUSION The results showed that the comprehensive repair outperforms the simple CoA repair and may be more advantageous in the long term in some patients. We demonstrated that the surgical planning and patient-specific flow simulations could potentially affect the selection and outcomes of aorta repairs.
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Affiliation(s)
- Seda Aslan
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA.
| | - Xiaolong Liu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | - Qiyuan Wu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
| | - Paige Mass
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | | | - Laura Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
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19
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Khodabakhshian N, Howell AJ, Lopez PP, Hui W, Mertens LL, Guerra VC. Impact of Genotype-Phenotype Interactions on Cardiovascular Function in Paediatric Loeys-Dietz Syndrome. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2024; 3:47-54. [PMID: 38774681 PMCID: PMC11103043 DOI: 10.1016/j.cjcpc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/22/2023] [Indexed: 05/24/2024]
Abstract
Background The relationship between genotype and phenotypical vascular and cardiac properties in paediatric Loeys-Dietz syndrome (LDS) patients are not well characterized. This study explores the phenotypical differences in aortic properties and cardiac structural and functional parameters between paediatric LDS patients with TGFBR1 and TGFBR2 mutations. Methods We included 32 LDS patients with either TGFBR1 (n = 17) or TGFBR2 (n = 15) mutations. Echocardiographic data included aortic dimensions, distensibility, strain, and stiffness at the level of the annulus, sinuses of Valsalva, sinotubular junction, ascending aorta, and descending aorta. Parameters for left ventricular size and function were also recorded. Results Demographics were similar between the groups. Patients with TGFBR2 were more likely to have undergone aortic surgery (47% vs 12%, P = 0.057) and use angiotensin receptor blockers (93% vs 47%, P = 0.015). Aortic z scores were significantly larger in the TGFBR2 group at the level of the aortic valve annulus (P = 0.007), sinuses of Valsalva (P = 0.001), sinotubular junction (P = 0.001), and ascending aorta (P = 0.054). Patients with TGFBR2 also had significantly lower aortic distensibility and strain coupled with higher stiffness index at the level of the annulus, sinotubular junction, and ascending aorta. Parameters for the descending aorta, cardiac morphology, and cardiac function were similar between the groups. Conclusions Paediatric LDS patients with TGFBR2 present with more severe cardiovascular phenotypes than patients with TGFBR1 with larger aortic dimensions and increased aortic stiffness. Our findings suggest that genotypes should be taken into consideration in the clinical management of paediatric LDS patients.
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Affiliation(s)
- Nairy Khodabakhshian
- Department of Pediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alison J. Howell
- Department of Pediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Perez Lopez
- Department of Pediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
- Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Wei Hui
- Department of Pediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luc L. Mertens
- Department of Pediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vitor C. Guerra
- Department of Pediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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20
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Bhat M, Malm T, Sjöberg G, Nordenstam F, Hanséus K, Rosenkvist CJ, Liuba P. Longitudinal ECG changes in tetralogy of Fallot and association with surgical repair. Front Cardiovasc Med 2024; 11:1349166. [PMID: 38606378 PMCID: PMC11007042 DOI: 10.3389/fcvm.2024.1349166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Background ECG abnormalities have been linked to adverse changes in right ventricular (RV) morphology and poor clinical outcomes in repaired Tetralogy of Fallot (rTOF). Our aim was to describe how ECG changes progress in early and intermediate follow-up and whether types of surgical strategy at the time of primary repair affected these changes. Methods We studied patients with rTOF born 2000-2018 operated at our institution. Seven time points in relation to primary repair, follow-up, and pulmonary valve replacement (PVR) were identified. Patients correct with valve sparing repair (VSR), trans-annular patch (TAP) including with a monocusp valve (TAP + M) and with at least 3 ECGs were included. PQ interval, QRS duration, dispersion, and fragmentation, QTc duration and dispersion, JTc as well as presence of a right bundle branch block (RBBB) were analyzed. Medical records were reviewed for demographic and surgical data. Results Two hundred nineteen patients with 882 ECGs were analyzed with a median follow-up time of 12.3 years (8.4, 17) with 41 (19%) needing PVR during the study period. QRS duration increased at time of primary repair to discharge from 66 msec (IQR 12) to 129 msec (IQR 27) (p < 0.0001) and at 1- and 6- year follow-up but showed only a modest and temporary decrease after PVR. QTc increased at the time of primary repair as well as prior to PVR. PQ interval showed a small increase at the time of primary repair, was at its highest prior to PVR and decreased with PVR. Type of surgical repair affected mainly QTc and JTc and was consistently longer in the TAP + M group until PVR. In VSR, QTc and JTc were prolonged initially compared to TAP but were similar after 1 year. After PVR, there were no differences in adverse ECG changes between surgical groups. Conclusions PQ interval and QRS duration best correspond to the assumed volume load whereas the relationship with QTc and JTc is more complex, suggesting that these represent more complex remodeling of the myocardium. Before PVR, QTc and JTc are longer in the TAP + M group which may be due to a longer surgical incision.
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Affiliation(s)
- Misha Bhat
- Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torsten Malm
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Cardiac Surgery, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
| | - Gunnar Sjöberg
- Department of Pediatric Cardiology, Department of Women’s and Children’s Health Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Felicia Nordenstam
- Department of Pediatric Cardiology, Department of Women’s and Children’s Health Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Hanséus
- Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Petru Liuba
- Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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21
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Forså MI, Smedsrud MK, Haugaa KH, Bjerring AW, Früh A, Sarvari SI, Landgraff HW, Hallén J, Edvardsen T. Distinguishing left ventricular hypertrophy from hypertrophic cardiomyopathy in adolescents: a longitudinal observation study. Eur J Prev Cardiol 2024; 31:591-598. [PMID: 37992187 DOI: 10.1093/eurjpc/zwad361] [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] [Received: 06/29/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
AIMS Echocardiographic characteristics to distinguish physiological left ventricular (LV) hypertrophy from pathology are warranted in early adolescent athletes. This study aimed to explore the phenotype, progression, and potential grey zone of LV hypertrophy during adolescence in athletes and hypertrophic cardiomyopathy (HCM) genotype-positive patients. METHODS AND RESULTS In this longitudinal observation study, we compared seventy-six 12-year-old athletes with 55 age-matched and sex-matched HCM genotype-positive patients. Echocardiographic parameters were evaluated by using paediatric reference values (Z-scores). Hypertrophic cardiomyopathy genotype-positive patients were included if they had no or mild LV hypertrophy [maximum wall thickness <13 mm, Z-score <6 for interventricular septum diameter (ZIVSd), or posterior wall thickness]. We collected clinical data, including data on cardiac events. The mean follow-up-time was 3.2 ± 0.8 years. At baseline, LV hypertrophy was found in 28% of athletes and 21% of HCM genotype-positive patients (P = 0.42). Septum thickness values were similar (ZIVSd 1.4 ± 0.9 vs. 1.0 ± 1.3, P = 0.08) and increased only in HCM genotype-positive patients {ZIVSd progression rate -0.17 [standard error (SE) 0.05], P = 0.002 vs. 0.30 [SE 0.10], P = 0.001}. Left ventricular volume Z-scores (ZLVEDV) were greater in athletes [ZLVEDV 1.0 ± 0.6 vs. -0.1 ± 0.8, P < 0.001; ZLVEDV progression rate -0.05 (SE 0.04), P = 0.21 vs. -0.06 (SE 0.04), P = 0.12]. Cardiac arrest occurred in two HCM genotype-positive patients (ages 13 and 14), with ZIVSd 8.2-11.5. CONCLUSION Left ventricular hypertrophy was found in a similar proportion in early adolescence but progressed only in HCM genotype-positive patients. A potential grey zone of LV hypertrophy ranged from a septum thickness Z-score of 2.0 to 3.3. Left ventricular volumes remained larger in athletes. Evaluating the progression of wall thickness and volume may help clinicians distinguish physiological LV hypertrophy from early HCM.
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Affiliation(s)
- Marianne I Forså
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Marit K Smedsrud
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Department of Paediatric Cardiology, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo NO-0424, Norway
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Anders W Bjerring
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Andreas Früh
- Department of Paediatric Cardiology, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, Oslo NO-0424, Norway
| | - Sebastian I Sarvari
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Hege W Landgraff
- Department of Physical Performance, Norwegian School of Sport Sciences, PO Box 4012 Ullevål stadion, Oslo NO-0806, Norway
| | - Jostein Hallén
- Department of Physical Performance, Norwegian School of Sport Sciences, PO Box 4012 Ullevål stadion, Oslo NO-0806, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
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22
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Mayourian J, La Cava WG, Vaid A, Nadkarni GN, Ghelani SJ, Mannix R, Geva T, Dionne A, Alexander ME, Duong SQ, Triedman JK. Pediatric ECG-Based Deep Learning to Predict Left Ventricular Dysfunction and Remodeling. Circulation 2024; 149:917-931. [PMID: 38314583 PMCID: PMC10948312 DOI: 10.1161/circulationaha.123.067750] [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] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Artificial intelligence-enhanced ECG analysis shows promise to detect ventricular dysfunction and remodeling in adult populations. However, its application to pediatric populations remains underexplored. METHODS A convolutional neural network was trained on paired ECG-echocardiograms (≤2 days apart) from patients ≤18 years of age without major congenital heart disease to detect human expert-classified greater than mild left ventricular (LV) dysfunction, hypertrophy, and dilation (individually and as a composite outcome). Model performance was evaluated on single ECG-echocardiogram pairs per patient at Boston Children's Hospital and externally at Mount Sinai Hospital using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC). RESULTS The training cohort comprised 92 377 ECG-echocardiogram pairs (46 261 patients; median age, 8.2 years). Test groups included internal testing (12 631 patients; median age, 8.8 years; 4.6% composite outcomes), emergency department (2830 patients; median age, 7.7 years; 10.0% composite outcomes), and external validation (5088 patients; median age, 4.3 years; 6.1% composite outcomes) cohorts. Model performance was similar on internal test and emergency department cohorts, with model predictions of LV hypertrophy outperforming the pediatric cardiologist expert benchmark. Adding age and sex to the model added no benefit to model performance. When using quantitative outcome cutoffs, model performance was similar between internal testing (composite outcome: AUROC, 0.88, AUPRC, 0.43; LV dysfunction: AUROC, 0.92, AUPRC, 0.23; LV hypertrophy: AUROC, 0.88, AUPRC, 0.28; LV dilation: AUROC, 0.91, AUPRC, 0.47) and external validation (composite outcome: AUROC, 0.86, AUPRC, 0.39; LV dysfunction: AUROC, 0.94, AUPRC, 0.32; LV hypertrophy: AUROC, 0.84, AUPRC, 0.25; LV dilation: AUROC, 0.87, AUPRC, 0.33), with composite outcome negative predictive values of 99.0% and 99.2%, respectively. Saliency mapping highlighted ECG components that influenced model predictions (precordial QRS complexes for all outcomes; T waves for LV dysfunction). High-risk ECG features include lateral T-wave inversion (LV dysfunction), deep S waves in V1 and V2 and tall R waves in V6 (LV hypertrophy), and tall R waves in V4 through V6 (LV dilation). CONCLUSIONS This externally validated algorithm shows promise to inexpensively screen for LV dysfunction and remodeling in children, which may facilitate improved access to care by democratizing the expertise of pediatric cardiologists.
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Affiliation(s)
- Joshua Mayourian
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - William G. La Cava
- Computational Health Informatics Program, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Akhil Vaid
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Girish N. Nadkarni
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sunil J. Ghelani
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Rebekah Mannix
- Department of Medicine, Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark E. Alexander
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Son Q. Duong
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John K. Triedman
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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23
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McCrary AW, Hung F, Foster MC, Koech M, Nekesa J, Thielman N, Chakraborty H, Bloomfield GS, Nyandiko W. Letter to the Editor: Cardiac Dysfunction Among Youth With Perinatal HIV Acquisition and Exposure. J Acquir Immune Defic Syndr 2024; 95:e2-e4. [PMID: 38408218 PMCID: PMC10901440 DOI: 10.1097/qai.0000000000003353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Andrew W McCrary
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Global Health Institute, Durham, NC
| | - Frances Hung
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Michael C Foster
- Cardiac Unit, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Myra Koech
- Department of Child Health and Pediatrics, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model for Providing Access to Healthcare, Eldoret, Kenya
| | - Joan Nekesa
- Academic Model for Providing Access to Healthcare, Eldoret, Kenya
| | - Nathan Thielman
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Hrishikesh Chakraborty
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Gerald S Bloomfield
- Duke Global Health Institute, Durham, NC
- Duke Clinical Research Institute and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Winstone Nyandiko
- Department of Child Health and Pediatrics, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model for Providing Access to Healthcare, Eldoret, Kenya
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24
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Landsem L, Brown N, Cox R, Ross F. Perioperative and Anesthetic Considerations in Shone's Complex. Semin Cardiothorac Vasc Anesth 2024; 28:28-37. [PMID: 38134942 DOI: 10.1177/10892532231223840] [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: 12/24/2023]
Abstract
Shone's complex is a congenital cardiac disease consisting of the following four lesions: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and aortic coarctation. Though not all components are required for a diagnosis, the end result is both left ventricular inflow and outflow obstruction, which typically present in patients as congestive heart failure. The complex pathology requires careful management and surgical decision-making to ensure an optimal outcome. This review will focus on the anatomy, physiology, and perioperative anesthetic management of patients with Shone's complex.
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Affiliation(s)
- Leah Landsem
- Division of Paediatric Cardiac Anesthesiology, Department of Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Nicholas Brown
- Department of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Ryan Cox
- Department of Anesthesiology, University of Washington, Seattle, WA, USA
| | - Faith Ross
- Division of Paediatric Cardiac Anesthesiology, Department of Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
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Hunter-Adamson L, Tierney S. Echogenomics: Echocardiography in Heritable Aortopathies. Curr Cardiol Rep 2024; 26:179-189. [PMID: 38372858 DOI: 10.1007/s11886-024-02024-7] [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] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the current echocardiographic considerations in the diagnosis and monitoring of patients with inherited aortopathies. RECENT FINDINGS Aortic dilation is a key feature in heritable aortopathies, and dissection is a leading cause of morbidity and mortality. New genetic and histopathologic findings are helpful in better understanding these conditions. Non-invasive imaging modalities, including echocardiogram, computerized tomography, and magnetic resonance imaging, are essential in monitoring these patients, as well as providing new prognostic factors of arterial stiffness that may help with risk stratification in the future. Diagnosis of heritable aortopathies should be considered with identification of aortic root dilation, particularly in children and young adults, or when there is a family history of aortic disease. Recent adult consensus guidelines highlight the importance of underlying genotype and phenotypic features when considering prophylactic surgical intervention. There are currently no consensus pediatric guidelines.
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Affiliation(s)
- Lyndsey Hunter-Adamson
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94304, USA
| | - Seda Tierney
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94304, USA.
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26
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Donthula R, Li W, Kaur H, Adebo DA, Uppu SC. Normative computed tomography angiography values of the main and branch pulmonary arteries in children. Eur J Pediatr 2024; 183:1183-1193. [PMID: 38078969 DOI: 10.1007/s00431-023-05363-9] [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: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
Non-invasive cardiac imaging like echocardiogram, cardiac magnetic resonance imaging (CMR), and computed tomography angiography (CTA) play a key role in the diagnosis, aid in management and follow-up of congenital heart disease patients. Normative data for intracardiac and extracardiac vascular structures in children are currently available for echocardiogram, CMR, and non-gated CTA. We sought to establish systolic and diastolic normative data for main and branch pulmonary arteries in children using electrocardiogram (ECG)-gated CTA. Diameters and cross-sectional areas of the main and branch pulmonary arteries were measured in systole and diastole based on the aortic valve position (open versus closed) in 100 subjects who had ECG-gated cardiac CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface area (BSAAE) was established using the previously described methods. A total of 100 children aged 0-18 years were analyzed; mean age was 5.3 years (SD, 6.1 years). Z-score curves were plotted in relation to the BSA for the mean, maximum, and minimum diameters and cross-sectional area of the main and branch pulmonary arteries for systole and diastole. Conclusion: We report systolic and diastolic mean, maximum, and minimum diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children derived using ECG-gated cardiac CTA. We believe our results can help identify abnormally sized main and branch pulmonary arteries. What is Known: • Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity. What is New: • Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children.
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Affiliation(s)
- Rakesh Donthula
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, the University of Texas McGovern Medical School at Houston, Houston, TX, 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Harmanpreet Kaur
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Dilachew A Adebo
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Santosh C Uppu
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA.
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Duman D, Tunca Sahin G, Stuart G, Walsh M, Caputo M, Parry A, Beattie B, Conner C, Uzun O. Influence of improved antenatal detection on the outcomes of complete atrioventricular block diagnosed in fetal-neonatal life and childhood periods - a single-centre experience in South Wales for 55 years. Cardiol Young 2024; 34:412-420. [PMID: 38149337 DOI: 10.1017/s1047951123003967] [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: 12/28/2023]
Abstract
OBJECTIVE This study aimed to analyse the influence of improved antenatal detection on the course, contemporary outcomes, and mortality risk factors of the complete atrioventricular block during fetal-neonatal and childhood periods in South Wales. METHODS The clinical characteristics and outcomes of complete atrioventricular block in patients without structural heart disease at the University Hospital of Wales from January 1966 to April 2021 were studied. Patients were divided into two groups according to their age at diagnosis: I-fetal-neonatal and II-childhood. Contemporary outcomes during the post-2001 era were compared with historical data preceding fetal service development and hence earlier detection. RESULTS There were 64 patients: 26 were identified in the fetal-neonatal period and the remaining 38 in the childhood period. Maternal antibodies/systemic lupus erythematosus disease (anti-Ro/Sjögren's-syndrome-related Antigen A and/or anti-La/Sjögren's-syndrome-related Antigen B) were present in 15 (57.7%) of the fetal-neonatal. Fetal/neonatal and early diagnosis increased after 2001 with an incidence of 1:25000 pregnancies. Pacemaker implantation was required in 34 patients, of whom 13 were diagnosed in the fetal-neonatal group. Survival rates in cases identified before 2001 were at 96.3% (26/27), whereas it was 83.8% (31/37) in patients diagnosed after 2001 (P > 0.05). Other mortality risk factors comprised a lower gestational week at birth, maternal antibodies, and an average ventricular heart rate of < 55 bpm. CONCLUSIONS Fetal diagnosis of complete atrioventricular block is still portends high fetal and neonatal mortality and morbidity despite significantly improved antenatal detection after 2001. Pacemaker intervention is needed earlier in the fetal-neonatal group. Whether routine antenatal medical treatment might alter this outcome calls for further prospective multicentre studies.
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Affiliation(s)
| | | | | | - Mark Walsh
- Bristol Royal Children's Hospital, Bristol, UK
| | | | | | | | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, UK
- Cardiff University, School of Medicine, Cardiff, UK
- Swansea University, School of Engineering and Sport Sciences, Swansea, UK
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Bhagra S. Donor-Recipient Size Matching in Pediatric Heart Transplantation: Is it Time to Look Beyond Weight? JACC. HEART FAILURE 2024; 12:392-394. [PMID: 37804310 DOI: 10.1016/j.jchf.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Sai Bhagra
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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29
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Lopez L, Saurers DL, Barker PCA, Cohen MS, Colan SD, Dwyer J, Forsha D, Friedberg MK, Lai WW, Printz BF, Sachdeva R, Soni-Patel NR, Truong DT, Young LT, Altman CA. Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:119-170. [PMID: 38309834 DOI: 10.1016/j.echo.2023.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Echocardiography is a fundamental component of pediatric cardiology, and appropriate indications have been established for its use in the setting of suspected, congenital, or acquired heart disease in children. Since the publication of guidelines for pediatric transthoracic echocardiography in 2006 and 2010, advances in knowledge and technology have expanded the scope of practice beyond the use of traditional modalities such as two-dimensional, M-mode, and Doppler echocardiography to evaluate the cardiac segmental structures and their function. Adjunct modalities such as contrast, three-dimensional, and speckle-tracking echocardiography are now used routinely at many pediatric centers. Guidelines and recommendations for the use of traditional and newer adjunct modalities in children are described in detail in this document. In addition, suggested protocols related to standard operations, infection control, sedation, and quality assurance and improvement are included to provide an organizational structure for centers performing pediatric transthoracic echocardiograms.
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Affiliation(s)
- Leo Lopez
- Department of Pediatrics Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, California.
| | - Daniel L Saurers
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Piers C A Barker
- Duke Children's Hospital & Health Center, Duke University, Durham, North Carolina
| | - Meryl S Cohen
- Cardiac Center and Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeanine Dwyer
- Pediatric Heart Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Daniel Forsha
- Ward Family Heart Center, Children's Mercy Kansas City Hospital, Kansas City, Missouri
| | - Mark K Friedberg
- Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wyman W Lai
- Division of Pediatric Cardiology, University of California School of Medicine, Irvine, California; Department of Pediatrics, Children's Hospital of Orange County, Orange, California
| | - Beth F Printz
- Rady Children's Hospital San Diego and University of California, San Diego, San Diego, California
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Neha R Soni-Patel
- Pediatric & Adult Congenital Heart Center, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Dongngan T Truong
- University of Utah and Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah
| | - Luciana T Young
- Seattle Children's Hospital and Pediatric Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A Altman
- Baylor College of Medicine and Texas Children's Heart Center, Texas Children's Hospital, Houston, Texas
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30
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Braunlin E, Bay L, Guffon N, Yang M, Pangaud N, Clarke LA. Natural history of cardiac findings in mucopolysaccharidosis type I: report from an international registry. Cardiol Young 2024; 34:401-411. [PMID: 37850463 DOI: 10.1017/s1047951123003347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Mucopolysaccharidosis type I is an inborn error of glycosaminoglycan catabolism with phenotypes ranging from severe (Hurler syndrome) to attenuated (Hurler-Scheie and Scheie syndromes). Cardiovascular involvement is common and contributes significantly to morbidity and mortality. We conducted a retrospective analysis of the prevalence and natural history of cardiac abnormalities in treatment-naïve individuals enrolled in the international Mucopolysaccharidosis Type I Registry. Interrogation of echocardiography data (presence of cardiac valve regurgitation and/or stenosis; measurements of left ventricular chamber dimensions in diastole and systole, diastolic left ventricular posterior wall and interventricular septal thicknesses and ventricular systolic function (shortening fraction)) showed that mitral regurgitation was the most common and earliest finding for individuals with both severe (58.3%, median age 1.2 years) and attenuated (74.2%, median age 8.0 years) disease. Left-sided valve stenosis was also common in individuals with attenuated disease (mitral 30.3%; aortic 25%). Abnormal ventricular wall and septal thickness (Z-scores ≥2) were observed early in both phenotypes. Z-scores for diastolic left ventricular posterior wall and interventricular septal thicknesses increased with age in the severe phenotype (annualised slopes of 0.2777 [p = 0.037] and 0.3831 [p = 0.001], respectively); a similar correlation was not observed in the attenuated phenotype (annualised slopes of -0.0401 [p = 0.069] and -0.0029 [p = 0.875], respectively). Decreased cardiac ventricular systolic function (defined as shortening fraction <28%) was uncommon but, when noted, was more frequent in infants with the severe phenotype. While cardiac abnormalities occur early in both severe and attenuated mucopolysaccharidosis type I, the pattern of valve dysfunction and progression of ventricular abnormalities vary by phenotype.
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Affiliation(s)
| | - Luisa Bay
- Hospital Nacional de Pediatría J. P. Garrahan, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Nathalie Guffon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Femme Mère Enfant, Lyon, France
| | - Meng Yang
- Formerly Epidemiology and Biostatistics, Sanofi, Cambridge, MA, USA
| | - Nicolas Pangaud
- Cardiology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lorne A Clarke
- Department of Medical Genetics and the British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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31
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Cantinotti M, Jani V, Kutty S, Marchese P, Franchi E, Pizzuto A, Viacava C, Assanta N, Santoro G, Giordano R. Neonates and Infants with Left Heart Obstruction and Borderline Left Ventricle Undergoing Biventricular Repair: What Do We Know about Long-Term Outcomes? A Critical Review. Healthcare (Basel) 2024; 12:348. [PMID: 38338232 PMCID: PMC10855671 DOI: 10.3390/healthcare12030348] [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: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The decision to perform biventricular repair (BVR) in neonates and infants presenting with either single or multiple left ventricle outflow obstructions (LVOTOs) and a borderline left ventricle (BLV) is subject to extensive discussion, and limited information is known regarding the long-term outcomes. As a result, the objective of this study is to critically assess and summarize the available data regarding the prognosis of neonates and infants with LVOTO and BLV who underwent BVR. METHODS In February 2023, we conducted a review study with three different medical search engines (the National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings and free text terms including "congenital heart disease", "outcome", and "borderline left ventricle". The search was refined by adding keywords for "Shone's complex", "complex LVOT obstruction", "hypoplastic left heart syndrome/complex", and "critical aortic stenosis". RESULTS Out of a total of 51 studies, 15 studies were included in the final analysis. The authors utilized heterogeneous definitions to characterize BLV, resulting in considerable variation in inclusion criteria among studies. Three distinct categories of studies were identified, encompassing those specifically designed to evaluate BLV, those focused on Shone's complex, and finally those on aortic stenosis. Despite the challenges associated with comparing data originating from slightly different cardiac defects and from different eras, our results indicate a favorable survival rate and clinical outcome following BVR. However, the incidence of reintervention remains high, and concerns persist regarding residual pulmonary hypertension, which has been inadequately investigated. CONCLUSIONS The available data concerning neonates and infants with LVOTO and BLV who undergo BVR are inadequate and fragmented. Consequently, large-scale studies are necessary to fully ascertain the long-term outcome of these complex defects.
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Affiliation(s)
- Massimiliano Cantinotti
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Vivek Jani
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Pietro Marchese
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Eliana Franchi
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Alessandra Pizzuto
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Cecilia Viacava
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Nadia Assanta
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Giuseppe Santoro
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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32
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Li H, Zhou M, Sun Y, Yang J, Zeng X, Qiu Y, Xia Y, Zheng Z, Yu J, Feng Y, Shi Z, Huang T, Tan L, Lin R, Li J, Fan X, Ye J, Duan H, Shi S, Shu Q. A Patient Similarity Network (CHDmap) to Predict Outcomes After Congenital Heart Surgery: Development and Validation Study. JMIR Med Inform 2024; 12:e49138. [PMID: 38297829 PMCID: PMC10850852 DOI: 10.2196/49138] [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: 05/24/2023] [Revised: 08/21/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024] Open
Abstract
Background Although evidence-based medicine proposes personalized care that considers the best evidence, it still fails to address personal treatment in many real clinical scenarios where the complexity of the situation makes none of the available evidence applicable. "Medicine-based evidence" (MBE), in which big data and machine learning techniques are embraced to derive treatment responses from appropriately matched patients in real-world clinical practice, was proposed. However, many challenges remain in translating this conceptual framework into practice. Objective This study aimed to technically translate the MBE conceptual framework into practice and evaluate its performance in providing general decision support services for outcomes after congenital heart disease (CHD) surgery. Methods Data from 4774 CHD surgeries were collected. A total of 66 indicators and all diagnoses were extracted from each echocardiographic report using natural language processing technology. Combined with some basic clinical and surgical information, the distances between each patient were measured by a series of calculation formulas. Inspired by structure-mapping theory, the fusion of distances between different dimensions can be modulated by clinical experts. In addition to supporting direct analogical reasoning, a machine learning model can be constructed based on similar patients to provide personalized prediction. A user-operable patient similarity network (PSN) of CHD called CHDmap was proposed and developed to provide general decision support services based on the MBE approach. Results Using 256 CHD cases, CHDmap was evaluated on 2 different types of postoperative prognostic prediction tasks: a binary classification task to predict postoperative complications and a multiple classification task to predict mechanical ventilation duration. A simple poll of the k-most similar patients provided by the PSN can achieve better prediction results than the average performance of 3 clinicians. Constructing logistic regression models for prediction using similar patients obtained from the PSN can further improve the performance of the 2 tasks (best area under the receiver operating characteristic curve=0.810 and 0.926, respectively). With the support of CHDmap, clinicians substantially improved their predictive capabilities. Conclusions Without individual optimization, CHDmap demonstrates competitive performance compared to clinical experts. In addition, CHDmap has the advantage of enabling clinicians to use their superior cognitive abilities in conjunction with it to make decisions that are sometimes even superior to those made using artificial intelligence models. The MBE approach can be embraced in clinical practice, and its full potential can be realized.
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Affiliation(s)
- Haomin Li
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Mengying Zhou
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuhan Sun
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xian Zeng
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yunxiang Qiu
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuanyuan Xia
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhijie Zheng
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jin Yu
- Ultrasonography Department, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuqing Feng
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhuo Shi
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ting Huang
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Linhua Tan
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ru Lin
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianhua Li
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiangming Fan
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Ye
- Ultrasonography Department, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Shanshan Shi
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Kotidis C, Nirmal N, Kantzis M. Percutaneous pulmonary valve implantation in children and adults with an age and gender-specific analysis. Cardiol Young 2024:1-7. [PMID: 38185984 DOI: 10.1017/s1047951123004328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND There are limited studies with medium-term follow-up following percutaneous pulmonary valve implantation and no studies with a gender-specific analysis. AIMS To report clinical outcomes up to five years following percutaneous pulmonary valve implantation using the two most common balloon expandable valves in a mixed population of paediatric and adult patients with an age and gender-specific analysis. METHODS This was a single-centre retrospective observation study. Relevant data were obtained retrospectively from the case files. Age and gender- specific analysis was performed using SPSS. RESULTS Totally, 58 patients (13 children, 45 adults) underwent percutaneous pulmonary valve implantation. Statistically significant reduction in median right ventricular outflow tract flow velocity following valve implantation was maintained for the whole five years in adults but not in children. There were no gender-specific differences despite the study being adequately powered. Independent of valve type used, there was significant reduction of the right ventricular outflow tract flow velocity in the immediate post valve implantation period (Edwards P = 0.001, Melody P = 0.013). There was a significant negative correlation between implanted valve Z-score and subsequent right ventricular outflow tract gradient during the first two years following valve implantation. CONCLUSION Gender does not significantly affect valve function following percutaneous pulmonary valve implantation. It is important to consider patients' age and body surface area in relation to existing right ventricular outflow tract size during decisions for percutaneous pulmonary valve implantation.
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Affiliation(s)
| | - Neeraj Nirmal
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Marinos Kantzis
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
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34
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Chinawa JM, Chinawa AT, Ujunwa FA, Odimegwu CL, Onyia JT, Chukwu K, Chukwu BF, Aronu AE, Ikefuna A. Normalization of Cardiac Structural dimension and Function to Body Surface Area in South East Nigeria Children. Niger J Clin Pract 2024; 27:109-116. [PMID: 38317043 DOI: 10.4103/njcp.njcp_547_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Standardizing cardiac valve structures and function to body surface area will help the clinician and surgeons in decision-making. AIM To evaluate the z-scores of the sizes of cardiac structures and function and to present them in Gaussian curves and reference values. MATERIALS AND METHODS This was a cross-sectional study that involved 300 apparently healthy children. This study was performed among healthy children from birth to 18 years. Children with a normal echocardiogram, those with no chronic illness, no congenital heart defect, and no acquired heart defect were included in the study. RESULT The majority fell within the normal limits, as shown in the Gaussian curves. For instance, 40 (13.3%) of atrioventricular (AV) valve diameters were +1 Z-score above the normal, and only 5 (1.7%) were +2 Z-score above the normal. About 9.3% (28/300) had below -2 Z-score below normal, while only 5% had -1 Z-score below normal. Similarly, the left ventricular function z-scores were also derived at -3 Z-scores to +3 Z-scores. The standard reference values were compared with the results obtained from our Z score values. There was no significant difference noted in the Z-scores. P values ranged from 0.07 to 0.84 for all the cardiac structures except for gender, where Z-scores of the mitral valve and left pulmonary artery varied significantly (P = 0.02). CONCLUSION Reference values of cardiac structure and function were presented using Z scores, and we noted no significant difference when compared with the Western standard values except for the mitral valve and left pulmonary artery.
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Affiliation(s)
- J M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla Enugu State, Nigeria
| | - A T Chinawa
- Department of Community Medicine, ESUCOM, Parklane Enugu, Nigeria
| | - F A Ujunwa
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla Enugu State, Nigeria
| | - C L Odimegwu
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla Enugu State, Nigeria
| | - J T Onyia
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla Enugu State, Nigeria
| | - K Chukwu
- Department of Paediatrics, College of Medicine, ESUCOM Parklane Enugu, Nigeria
| | - B F Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla Enugu State, Nigeria
| | - A E Aronu
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla Enugu State, Nigeria
| | - A Ikefuna
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla Enugu State, Nigeria
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Boleti OD, Roussos S, Norrish G, Field E, Oates S, Tollit J, Nepali G, Bhole V, Uzun O, Daubeney PEF, Stuart GA, Fernandes P, McLeod K, Ilina M, Liaqath MNA, Bharucha T, Delle Donne G, Brown E, Linter K, Khodaghalian B, Jones C, Searle J, Mathur S, Boyd N, Reindhardt Z, Duignan S, Prendiville T, Adwani S, Zenker M, Wolf CM, Kaski JP. Sudden cardiac death in childhood RASopathy-associated hypertrophic cardiomyopathy: Validation of the HCM risk-kids model and predictors of events. Int J Cardiol 2023; 393:131405. [PMID: 37777071 DOI: 10.1016/j.ijcard.2023.131405] [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] [Received: 07/12/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND RASopathies account for nearly 20% of cases of childhood hypertrophic cardiomyopathy (HCM). Sudden cardiac death (SCD) occurs in patients with RASopathy-associated HCM, but the risk factors for SCD have not been systematically evaluated. AIM To validate the HCM Risk-Kids SCD risk prediction model in children with RASopathy-associated HCM and investigate potential specific SCD predictors in this population. METHODS Validation of HCM Risk-Kids was performed in a retrospective cohort of 169 patients with a RASopathy-associated HCM from 15 international paediatric cardiology centres. Multiple imputation by chained equations was used for missing values related to the HCM Risk-Kids parameters. RESULTS Eleven patients (6.5%) experienced a SCD or equivalent event at a median age of 12.5 months (IQR 7.7-28.64). The calculated SCD/equivalent event incidence was 0.78 (95% CI 0.43-1.41) per 100 patient years. Six patients (54.54%) with an event were in the low-risk category according to the HCM Risk-Kids model. Harrell's C index was 0.60, with a sensitivity of 9.09%, specificity of 63.92%, positive predictive value of 1.72%, and negative predictive value of 91%; with a poor distinction between the different risk groups. Unexplained syncope (HR 42.17, 95% CI 10.49-169.56, p < 0.001) and non-sustained ventricular tachycardia (HR 5.48, 95% CI 1.58-19.03, p < 0.007) were predictors of SCD on univariate analysis. CONCLUSION Unexplained syncope and the presence of NSVT emerge as predictors for SCD in children with RASopathy-associated HCM. The HCM Risk-Kids model may not be appropriate to use in this population, but larger multicentre collaborative studies are required to investigate this further.
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Affiliation(s)
- Olga D Boleti
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabrielle Norrish
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Ella Field
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Stephanie Oates
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Jennifer Tollit
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Gauri Nepali
- The Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Vinay Bhole
- The Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Orhan Uzun
- Children's Heart Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Piers E F Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Graham A Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Precylia Fernandes
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Grazia Delle Donne
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Bernadette Khodaghalian
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Caroline Jones
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Jonathan Searle
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom; Children's Heart Service, Evelina Children's Hospital, London, United Kingdom
| | - Sujeev Mathur
- Children's Heart Service, Evelina Children's Hospital, London, United Kingdom
| | - Nicola Boyd
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Zdenka Reindhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Sophie Duignan
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Terence Prendiville
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Martin Zenker
- Institute of Human Genetics, University Hospital, Magdeburg, Germany
| | - Cordula Maria Wolf
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Juan Pablo Kaski
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.
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Li D, Zhao T, Hu S, Zhang W, Wu Z, Liu J. Comparison between the modified Blalock-Taussig shunt and right ventricular outflow tract stent in the palliative treatment for tetralogy of Fallot. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1325-1332. [PMID: 38044643 PMCID: PMC10929863 DOI: 10.11817/j.issn.1672-7347.2023.230105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES For patients with tetralogy of Fallot (TOF) who are not suitable candidates for primary corrective surgery or have a high surgical risk, transcatheter right ventricular outflow tract (RVOT) stent implantation is considered a safe and effective palliative intervention. This study aims to investigate the therapeutic outcomes of RVOT stent implantation in neonates and infants with TOF in comparison with the modified Blalock-Taussig shunt (mBTS) and to compare the impact of the 2 palliative interventions on arterial oxygen saturation and pulmonary artery development in pediatric patients. METHODS Clinical data of 32 patients with TOF admitted to the Second Xiangya Hospital of Central South University from March 2011 to March 2021 were retrospectively collected. The patients were divided into an mBTS group (undergoing mBTS, n=15) and a stent implantation group (undergoing RVOT stenting, n=17) according to the surgical procedures. The 2 groups were assessed and compared in the surgical-related arterial oxygen saturation, postoperative complication rate, mortality rate, and re-intervention rate. The development of the patients' main pulmonary artery, right pulmonary artery, and left pulmonary artery was assessed by z-scores according to echocardiographic results. RESULTS The children in the stent implantation group were younger and less weighed compared with the mBTS group (both P<0.05). Compared with the preoperative period, children in the stent implantation group had significantly higher arterial oxygen saturation [(75±17)% vs (96±3)%, P=0.026]; z-scores of pulmonary trunk [(-2.82±1.27) points vs (0.86±0.77) points, P=0.014], right pulmonary artery [(-1.88±0.59) points vs (-0.28±0.71) points, P=0.011], and left pulmonary artery [(-2.34±0.36) points vs (-1.67±0.36) points, P=0.036] were significantly increased. However, there were no significant differences in arterial oxygen saturation and pulmonary artery z-scores between pre- and post-mBTS procedures (all P>0.05). CONCLUSIONS RVOT stent would have good surgical outcomes used in TOF patients with low weight and severe comorbidities. It also leads to an higher postoperative oxygen saturation and better promotion of pulmonary artery growth with RVOT stent compared to mBTS.
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Affiliation(s)
- Diwen Li
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Tianli Zhao
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Shijun Hu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Weizhi Zhang
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jijia Liu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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Recco DP, Kizilski SB, Ghosh RM, Piekarski B, Prakash A, Hoganson DM. Aortic growth after arch reconstruction with patch augmentation: a 2-decade experience. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad210. [PMID: 38134426 PMCID: PMC10752579 DOI: 10.1093/icvts/ivad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Optimal aortic sizing during aortic arch reconstruction remains unknown. Negative effects of arch under- or oversizing are well-published. We aimed to characterize longitudinal aortic growth after patch-augmented arch reconstruction to identify the initial reconstructed arch size that results in normal mid-term arch dimensions. METHODS Single-centre, retrospective review of infants undergoing Damus-Kaye-Stansel (DKS) or non-DKS patch-augmented aortic arch reconstruction between 2000 and 2021. Ascending aorta, proximal and distal transverse arch, aortic isthmus (AIsth) and descending aorta dimensions were measured in postoperative echocardiograms (<3 months from index operation) and cross-sectional imaging (>12 months). Longitudinal changes to aortic dimensions and z-scores were analysed. Secondary outcomes included reintervention, valve and ventricular function, mortality and transplantation. RESULTS Fifty-four patients (16 DKS, 38 non-DKS) were included. At 6.3 [2.2, 12.0]-year follow-up, all aortic segments grew significantly in both groups, while z-scores remained unchanged except for non-DKS proximal and distal transverse arch z-scores, which significantly increased (P < 0.05 each). When stratified by initial postoperative z-score (z < -1, -1 ≤ z ≤ 1, z > 1), non-DKS patients with initial AIsth z-score <-1 had a final z-score significantly smaller than both the targeted z-score zero (P = 0.014) and final z-score in a group with initial postoperative z-score ±1 (P = 0.009). Valve and ventricular function remained stable. Eighteen patients required reintervention, 1 died and 1 underwent transplant. CONCLUSIONS Over mid-term follow-up, aortic growth after arch reconstruction with patch augmentation was proportional when repaired to normal z-score dimensions, aside from proximal transverse arch, which disproportionately dilated. AIsth undersizing prevailed mid-term and trended towards a higher reintervention rate. Initial reconstruction between z-score 0 and +1 resulted in maintenance of that z-score size at mid-term follow-up. Overall, it is crucial to achieve targeted aortic sizing at index operation to maintain appropriate aortic dimensions over time and reduce reintervention risk with specific focus on the AIsth.
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Affiliation(s)
- Dominic P Recco
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shannen B Kizilski
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Reena M Ghosh
- Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Breanna Piekarski
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ashwin Prakash
- Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - David M Hoganson
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Mertens L, Singh G, Armenian S, Chen MH, Dorfman AL, Garg R, Husain N, Joshi V, Leger KJ, Lipshultz SE, Lopez-Mattei J, Narayan HK, Parthiban A, Pignatelli RH, Toro-Salazar O, Wasserman M, Wheatley J. Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:1227-1253. [PMID: 38043984 DOI: 10.1016/j.echo.2023.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Luc Mertens
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gautam Singh
- Children's Hospital of Michigan, Detroit, Michigan; Central Michigan University School of Medicine, Saginaw, Michigan
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ming-Hui Chen
- Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Adam L Dorfman
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ruchira Garg
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Vijaya Joshi
- St. Jude Children's Research Hospital/University of Tennessee College of Medicine, Memphis, Tennessee
| | - Kasey J Leger
- University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Steven E Lipshultz
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Oishei Children's Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Hari K Narayan
- University of California San Diego, Rady Children's Hospital San Diego, San Diego, California
| | - Anitha Parthiban
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | - Olga Toro-Salazar
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
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Ghorbannia A, Spearman AD, Sawalhi S, Woods RK, Maadooliat M, LaDisa JF. Consistency of the continuous flow pressure gradient despite aortic arch anomalies co-existing with coarctation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.30.23297763. [PMID: 37961134 PMCID: PMC10635219 DOI: 10.1101/2023.10.30.23297763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Aims Severity assessment for coarctation of the aorta (CoA) is challenging due to concomitant morphological anomalies (complex CoA) and inaccurate Doppler-based indices. Promising diagnostic performance has been reported for the continuous flow pressure gradient (CFPG), but it has not been studied in complex CoA. Our objective was to characterize the effect of complex CoA and associated hemodynamics on CFPG in a clinical cohort. Methods and Results Retrospective analysis identified discrete juxtaductal (n=25) and complex CoA (n=43; transverse arch and/or isthmus hypoplasia) patients with arm-leg systolic blood pressure gradients (BPG) within 24 hours of echocardiography for comparison to BPG by conventional Doppler indices (simplified Bernoulli equation and modified forms correcting for proximal kinetic energy and/or recovered pressure). Results were interpreted using the current CoA guideline (BPG ≥20 mmHg) to compare diagnostic performance indicators including receiver operating characteristic curves, sensitivity, specificity, and diagnostic accuracy, among others. Echocardiography Z-scored aortic diameters were applied with computational stimulations from a preclinical CoA model to understand aspects of the CFPG driving performance differences.Diagnostic performance was substantially reduced from discrete to complex CoA for conventional Doppler indices calculated from patient data, and by hypoplasia and/or long segment stenosis in simulations. In contrast, diagnostic indicators for the CFPG only modestly dropped for complex vs discrete CoA. Simulations revealed differences in performance due to inclusion of the Doppler velocity index and diastolic pressure half-time in the CFPG calculation. Conclusion CFPG is less affected by aortic arch anomalies co-existing with CoA when compared to conventional Doppler indices.
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Affiliation(s)
- Arash Ghorbannia
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew D. Spearman
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shahd Sawalhi
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ronald K. Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Mehdi Maadooliat
- Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, Wisconsin, USA
| | - John F. LaDisa
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Departments of Physiology, and Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Lorenzo M, Lynch A, Ashkanase J, Fazari L, George K, Arathoon K, Minn S, Nicolson D, Jeewa A, Jean-St-Michel E. Symptomatic presentation influences outcomes in pediatric restrictive cardiomyopathy. Front Pediatr 2023; 11:1264751. [PMID: 37928350 PMCID: PMC10620919 DOI: 10.3389/fped.2023.1264751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Children with restrictive cardiomyopathy (RCM) traditionally have a poor prognosis, with most patients either dying or requiring heart transplantation within 2 years of diagnosis. The development of symptoms in RCM suggests advanced disease. However, as screening practices evolve and lead to diagnosis of early disease, identifying appropriate timing of transplant listing becomes increasingly important. In this context we compared outcomes of children with RCM presenting with clinical symptoms to those asymptomatic at initial presentation. Methods This retrospective cohort study included 25 patients with RCM presenting to a quaternary care center between 2001 and 2018. Times to transplantation, death, and a composite outcome of adverse cardiac events (CPR, cardioversion, inotropic support, mechanical ventilation, mechanical support, or heart transplant) were compared between those symptomatic and asymptomatic at presentation. Results At 2 years following diagnosis, patients asymptomatic at presentation had a significantly better transplant-free survival at 57% compared to 17% for symptomatic patients (p = 0.03). Those asymptomatic at diagnosis also had significantly improved cardiac event-free survival at 71% compared to symptomatic patients at 25% (p = 0.01). In multivariable analysis, cardiac symptoms at presentation remained an independent risk factor for heart-transplant or death [hazard ratio 5.17 (1.28-20.85), p = 0.02]. Conclusion Patients with RCM who are symptomatic at time of diagnosis have significantly worse transplant-free survival and cardiac event-free survival. Given current practice variability in timing of transplant listing, the presence of any cardiac symptoms is an important negative prognostic marker and should prompt urgent transplant listing.
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Affiliation(s)
- Melissa Lorenzo
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aine Lynch
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jenna Ashkanase
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Linda Fazari
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Kristen George
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Katelyn Arathoon
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Sunghoon Minn
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Dawn Nicolson
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aamir Jeewa
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Emilie Jean-St-Michel
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Argo MB, Barron DJ, Eghtesady P, Yerebakan C, DeCampli WM, Alsoufi B, Honjo O, Jacobs JP, Paramananthan T, Rahman M, Lambert LM, Jegatheeswaran A, Carrillo SA, Husain SA, Ramakrishnan K, Caldarone CA, Karamlou T, Nelson J, Mannie C, Romano JC, Turek JW, Blackstone EH, Galantowicz ME, Kirklin JK, Mitchell ME, McCrindle BW. Outcomes After Hybrid Palliation for Infants With Critical Left Heart Obstruction. J Am Coll Cardiol 2023; 82:1427-1441. [PMID: 37758438 DOI: 10.1016/j.jacc.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/02/2023] [Accepted: 07/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) is an initial management strategy for infants with critical left heart obstruction and serves as palliation until subsequent operations are pursued. OBJECTIVES This study sought to determine patient characteristics and factors associated with subsequent outcomes for infants who underwent hybrid palliation. METHODS From 2005 to 2019, 214 of 1,236 prospectively enrolled infants within the Congenital Heart Surgeons' Society's critical left heart obstruction cohort underwent hybrid palliation across 24 institutions. Multivariable hazard modeling with competing risk methodology was performed to determine risk and factors associated with outcomes of biventricular repair, Fontan procedure, transplantation, or death. RESULTS Preoperative comorbidities (eg, prematurity, low birth weight, genetic syndrome) were identified in 70% of infants (150 of 214). Median follow-up was 7 years, ranging up to 17 years. Overall 12-year survival was 55%. At 5 years after hybrid palliation, 9% had biventricular repair, 36% had Fontan procedure, 12% had transplantation, 35% died without surgical endpoints, and 8% were alive without an endpoint. Factors associated with transplantation were absence of ductal stent, older age, absent interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, and larger left ventricular volume. Factors associated with death were low birth weight, concomitant genetic syndrome, cardiopulmonary bypass use during hybrid palliation, moderate to severe tricuspid valve regurgitation, and smaller ascending aortic size. CONCLUSIONS Mortality remains high after hybrid palliation for infants with critical left heart obstruction. Nonetheless, hybrid palliation may facilitate biventricular repair for some infants and for others may serve as stabilization for intended functional univentricular palliation or primary transplantation.
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Affiliation(s)
- Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA; Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital, St Louis, Missouri, USA
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
| | - Williams M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, Louisville, Kentucky, USA
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Tharini Paramananthan
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maha Rahman
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - S Adil Husain
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, Tennessee, USA
| | | | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer Nelson
- Division of Pediatric Cardiovascular Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Chelsea Mannie
- Division of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital, St Louis, Missouri, USA
| | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph W Turek
- Department of Surgery, Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark E Galantowicz
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - James K Kirklin
- Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian W McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Lishman J, Abraham DR, Fourie B, Yunis NA, Redfern A, van der Zalm MM, Rabie H. Short-term outcomes of South African children with multisystem inflammatory syndrome in children: a prospective cohort study. Arch Dis Child 2023; 108:792-798. [PMID: 37236771 DOI: 10.1136/archdischild-2022-325287] [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: 01/15/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Despite the life-threatening presentation of multisystem inflammatory syndrome in children (MIS-C), the overall prognosis is favourable in centres with access to appropriate supportive care. In this study, we investigate the short-term outcomes in children with MIS-C in Cape Town, South Africa. METHODS This prospective observational cohort study included children <13 years who fulfilled the WHO case definition of MIS-C and were admitted to Tygerberg Hospital in Cape Town, South Africa between 1 June 2020 and 31 October 2021. Clinical features were recorded at baseline and at follow-up at the 6-week cardiology and 3-month rheumatology-immunology clinics, respectively. FINDINGS Fifty-three children with a median age of 7.4 years (IQR 4.2-9.9) were included. There was a slight male predominance (30/53; 56.6%) and the majority was of mixed ancestry (28/53; 52.83%) or black African ancestry (24/53; 45.3%). Fourteen children (14/53; 26.4%) had comorbid disease. The median length of hospital stay was 8 days (IQR 6-10). All children had an echocardiogram performed at baseline of which 39 were abnormal (39/53; 73.6%). All children were discharged alive. The median days from discharge to cardiology follow-up was 39 days (IQR 33.5-41.5) and for rheumatology-immunology clinic was 70.5 days (IQR 59.5-85.0). Eleven children (11/41; 26.8%) had a persistently abnormal echocardiogram at cardiology follow-up. Systemic inflammation and organ dysfunction resolved in most. INTERPRETATION Although the short-term outcomes of MIS-C in our cohort were generally good, the cardiac morbidity needs further characterisation and follow-up.
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Affiliation(s)
- Juanita Lishman
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Deepthi Raju Abraham
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Barend Fourie
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Nurea Abdulbari Yunis
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Andrew Redfern
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Marieke M van der Zalm
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Paediatrics and Child Health, Tygerberg Hospital, Cape Town, Western Cape, South Africa
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Connell PS, Morris SA, Doan TT, Weigand J. Abnormal Left Ventricular Strain Correlates with Left Ventricular Dysfunction but not Aortic Pathology in Marfan Syndrome in Children. Pediatr Cardiol 2023; 44:1536-1545. [PMID: 37505267 DOI: 10.1007/s00246-023-03232-8] [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] [Received: 05/09/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
Cardiomyopathy is a complication in adults with Marfan syndrome (MFS). Early recognition of MFS patients at high risk of cardiomyopathy could impact monitoring and treatment. Abnormal ventricular strain has been associated with impaired ventricular function among adults with MFS but remains understudied in children. We retrospectively analyzed a cohort of patients with MFS undergoing cardiac magnetic resonance imaging (CMR) performed in 2003-2018 at age < 19 years. Correlations were evaluated between initial global circumferential strain (GCS) and global longitudinal strain (GLS) and the outcomes of left ventricular ejection fraction (LVEF), aortic root z-score, and vertebral artery tortuosity index corrected for height (VTI-h), all measured from CMR, using Spearman correlation. In those with serial CMR, the ability of ventricular strain to predict development of abnormal LVEF within a 5-year period was assessed. A total of 31 subjects were included (median age at initial CMR 13.5 years, Q1Q3 10.7-16.2 years), with 48% (n = 15) having LVEF < 55%. Worse GCS and worse GLS were associated with lower LVEF (ρ = - 0.629, p < 0.001 and ρ = - 0.411, p = 0.030, respectively). A clinical cutoff of GCS = - 34% predicted LVEF < 55% with sensitivity = 80% and specificity = 50%. Neither GCS nor GLS was associated with aortic root z-score (GCS: p = 0.524; GLS: p = 0.624) nor VTI-h (GCS: p = 0.949; GLS: p = 0.593). Of those with LVEF ≥ 55%, initial GCS and GLS did not differ between those with later normal versus abnormal LVEF (GCS: p = 0.505; GLS: p = 0.232). In this cohort, abnormal LV strain was associated with abnormal LVEF, but not with aortic dilation or low LVEF within the 5 years post-CMR.
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Affiliation(s)
- Patrick S Connell
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA
| | - Shaine A Morris
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA
| | - Tam T Doan
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA
| | - Justin Weigand
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, 6651 Main St., MC E2060.14, Houston, TX, 77030, USA.
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Farook TH, Ahmed S, Talukder MSI, Dudley J. A 3D printed electronic wearable device to generate vertical, horizontal and phono-articulatory jaw movement parameters: A concept implementation. PLoS One 2023; 18:e0290497. [PMID: 37703272 PMCID: PMC10499219 DOI: 10.1371/journal.pone.0290497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE The current research aimed to develop a concept open-source 3D printable, electronic wearable head gear to record jaw movement parameters. MATERIALS & METHODS A 3D printed wearable device was designed and manufactured then fitted with open-source sensors to record vertical, horizontal and phono-articulatory jaw motions. Mean deviation and relative error were measured invitro. The device was implemented on two volunteers for the parameters of maximum anterior protrusion (MAP), maximum lateral excursion (MLE), normal (NMO), and maximum (MMO) mouth opening and fricative phono-articulation. Raw data was normalized using z-score and root mean squared error (RMSE) values were used to evaluate relative differences in readings across the two participants. RESULTS RMSE differences across the left and right piezoresistive sensors demonstrated near similar bilateral movements during normal (0.12) and maximal mouth (0.09) opening for participant 1, while varying greatly for participant 2 (0.25 and 0.14, respectively). There were larger differences in RMSE during accelerometric motion in different axes for MAP, MLE and Fricatives. CONCLUSION The current implementation demonstrated that a 3D printed electronic wearable device with open-source sensor technology can record horizontal, vertical, and phono-articulatory maxillomandibular movements in two participants. However, future efforts must be made to overcome the limitations documented within the current experiment.
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Affiliation(s)
| | - Saif Ahmed
- Department of Electrical and Computer Engineering, North South University, Dhaka, Bangladesh
| | | | - James Dudley
- Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
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Xiang X, Zhu X, Zheng M, Tang Y. Comparison of two echocardiography-based methods for evaluating pediatric left ventricular diastolic dysfunction. Front Pediatr 2023; 11:1206314. [PMID: 37732011 PMCID: PMC10507386 DOI: 10.3389/fped.2023.1206314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives To investigate the consistency between the 2016 America Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline-based recommendations and the body surface area (BSA)-transformed Z value-based cut-off for the assessment of left ventricular diastolic function (LVDF) in children. Methods Clinical data of children with heart failure (HF) and those with a high risk of HF and a low risk of HF were collected from the Children's Hospital of Chongqing Medical University between March 2021 and October 2022. The mitral annular e' velocity, lateral E/e' ratio, left atrial volume index, and peak tricuspid regurgitation velocity were detected by Echocardiography. The cut-off values recommended by the 2016 ASE/EACVI guidelines and the cut-off value based on the BSA-transformed Z value were used to evaluate LVDF. The consistencies and differences of the two criteria were compared. Results A total of 132 children with HF, 189 with a high risk of HF, and 231 with a low risk of HF, were enrolled. The consistency of the two criteria in evaluating LVDF in children with HF and with high risk of HF was moderate, with weighted kappa coefficients of 0.566 and 0.468, respectively (P < 0.001). The positivity rate of left ventricular diastolic dysfunction (LVDD) with Z value-based criteria (HF group, 23.5%; high-risk group, 8.5%) was higher than that with guideline-based criteria (HF group, 15.6%; high-risk group, 3.2%). In children with a low risk of HF, no case with LVDD was found. The consistency between the two criteria for grading the degree of LVDD was moderate, with a kappa coefficient of 0.522 (P = 0.001). The degree of LVDD according to the Z value-based criteria was higher than that of the guideline-based criteria (P = 0.004). Conclusions The Z value-based criteria used to evaluate LVDD in children with HF and high risk of HF may be more conducive to the early identification of LVDD, thereby permitting the possibility of early treatment intervention.
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Affiliation(s)
| | | | - Min Zheng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yi Tang
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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46
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Argo MB, Barron DJ, Eghtesady P, Alsoufi B, Honjo O, Yerebakan C, DeCampli WM, Jacobs JP, Carrillo SA, Jegatheeswaran A, Karamlou T, Paramananthan T, Rahman M, Lambert LM, Nelson J, Caldarone CA, Husain SA, Galantowicz ME, Ramakrishnan K, Kirklin JK, Turek JW, Mannie C, Blackstone EH, Mitchell ME, McCrindle BW. Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction. J Thorac Cardiovasc Surg 2023; 166:943-954.e1. [PMID: 36804212 DOI: 10.1016/j.jtcvs.2023.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/15/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine patient characteristics and outcomes after Norwood versus comprehensive stage II (COMPSII) for infants with critical left heart obstruction who had prior hybrid palliation (bilateral pulmonary artery banding ± ductal stent). METHODS From 23 Congenital Heart Surgeons' Society institutions (2005-2020), 138 infants underwent hybrid palliation followed by either Norwood (n = 73, 53%) or COMPSII (n = 65). Baseline characteristics were compared between Norwood and COMPSII groups. Parametric hazard model with competing risk methodology was used to determine risk and factors associated with outcomes of Fontan, transplantation, or death. RESULTS Infants who underwent Norwood versus COMPSII had a higher prevalence of prematurity (26% vs 14%, P = .08), lower birth weight (median 2.8 vs 3.2 kg, P < .01) and less frequent ductal stenting (37% vs 99%; P < .01). Norwood was performed at a median age of 44 days and median weight of 3.5 kg, versus COMPSII at 162 days and 6.0 kg (both P < .01). Median follow-up was 6.5 years. At 5 years after Norwood and COMPSII, respectively; 50% versus 68% had Fontan (P = .16), 3% versus 5% had transplantation (P = .70), 40% versus 15% died (P = .10), and 7% versus 11% are alive without transition, respectively. For factors associated with either mortality or Fontan, only preoperative mechanical ventilation occurred more frequently in the Norwood group. CONCLUSIONS Higher prevalence of prematurity, lower birth weight, and other patient-related characteristics in the Norwood versus COMPSII groups may influence differences in outcomes that were not statistically significant for this limited risk-adjusted cohort. The clinical decision regarding Norwood versus COMPSII after initial hybrid palliation remains challenging.
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Affiliation(s)
- Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wis; Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, Louisville, Ky
| | - Osami Honjo
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tharini Paramananthan
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maha Rahman
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jennifer Nelson
- Division of Pediatric Cardiovascular Surgery, Children's Mercy Kansas City, Kansas City, Mo
| | | | - S Adil Husain
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Mark E Galantowicz
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, Tenn
| | - James K Kirklin
- Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Ala
| | - Joseph W Turek
- Department of Surgery, Duke Children's Hospital and Health Center, Durham, NC
| | - Chelsea Mannie
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Children's Wisconsin, Milwaukee, Wis
| | - Brian W McCrindle
- Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Jičínský M, Kubuš P, Pavlíková M, Ložek M, Janoušek J. Natural History of Nonsurgical Complete Atrioventricular Block in Children and Predictors of Pacemaker Implantation. JACC Clin Electrophysiol 2023; 9:1379-1389. [PMID: 37086232 DOI: 10.1016/j.jacep.2023.02.016] [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: 07/21/2022] [Revised: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Data on the natural history of complete atrioventricular block (CAVB) in children are scarce, and criteria for pacemaker (PM) implantation are based on low levels of evidence. OBJECTIVES This study aimed to evaluate the natural course and predictors of PM implantation in a nationwide cohort of pediatric patients with nonsurgical CAVB. METHODS All children with CAVB in the absence of structural heart disease presenting from 1977 to 2016 were retrospectively identified, yielding 95 subjects with a mean age of 4.05 years at the first presentation with a follow-up median of 0.80 years (IQR: 0.02-6.82 years). PM implantation was performed according to the available guidelines. Serial 24-hour Holter recordings and echocardiograms were reviewed. Predictors of PM implantation performed >1 month after the first presentation were evaluated. RESULTS The minimum and mean 24-hour heart rates and maximum RR intervals had a nonlinear correlation with age (P < 0.0001 for all). The left ventricular (LV) size was moderately increased, and the shortening fraction was normal in the majority throughout follow-up. PM implantation was performed in 62 patients (65.3%) reaching guideline criteria. The mean 24-hour heart rate at presentation was a predictor of subsequent PM implantation (HR: 0.938; 95% CI: 0.894-0.983; P = 0.003 per unit increase) regardless of age at presentation. Patients presenting with a mean 24-hour heart rate >58 beats/min (>75th percentile) had a high probability of freedom from PM within the subsequent 5 years (91.7% vs 44.4%; P < 0.001). CONCLUSIONS Pediatric patients with CAVB showed an age-dependent decrease in heart rate, moderate LV dilation, and preserved LV function. The probability of subsequent PM implantation could be predicted by the heart rate profile at presentation, defining a low-risk group and allowing for individualized follow-up.
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Affiliation(s)
- Michal Jičínský
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
| | - Peter Kubuš
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Markéta Pavlíková
- Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Miroslav Ložek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic; 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jan Janoušek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
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Bonaventura J, Maron BJ, Berul CI, Rowin EJ, Maron MS. Analysis of risk stratification and prevention of sudden death in pediatric patients with hypertrophic cardiomyopathy: Dilemmas and clarity. Heart Rhythm O2 2023; 4:506-516. [PMID: 37645261 PMCID: PMC10461211 DOI: 10.1016/j.hroo.2023.06.007] [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: 08/31/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) has been considered the most common cause of sudden death (SD) in the young. However, introduction of implantable cardioverter-defibrillators (ICDs) in HCM has proved highly effective and the mainstay of preventing SD in children, adolescents, and adults by terminating malignant ventricular tachyarrhythmias. Nevertheless, ICD decision making is generally regarded as more difficult in pediatrics, and the strategy for selecting ICD patients from this population remains without consensus. Prospective studies in HCM children and adolescents have shown the American Heart Association/American College of Cardiology traditional major risk marker strategy to be reliable with >90% sensitivity in selecting patients for SD prevention. International data in >2000 young HCM patients assembled over 20 years who were stratified by major risk markers showed ICDs effectively prevented SD in 20%. Alternatively, novel quantitative risk scoring initiatives provide 5-year risk estimates that are potentially useful as adjunctive tools to facilitate discussion of prophylactic ICD risks vs benefit but are as yet unsupported by prospective outcome studies. Risk scoring strategies are characterized by reasonable discriminatory statistical power (C-statistic 0.69-0.76) for identifying patients with SD events but with relatively low sensitivity, albeit with specificity comparable with the risk marker strategy. While some reticence for obligating healthy-appearing young patients to lifelong device implants is understandable, underutilization of the ICD in high-risk children and adolescents can represent a lost opportunity for fulfilling the long-standing aspiration of SD prevention. This review provides a critical assessment of the current strengths and weaknesses of SD risk stratification strategies in young HCM patients in an effort to clarify clinical decision making in this challenging subpopulation.
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Affiliation(s)
- Jiri Bonaventura
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Barry J. Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Charles I. Berul
- Division of Cardiology, Children’s National Hospital, Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Ethan J. Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Martin S. Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Rodríguez-Palomares JF, Dux-Santoy L, Guala A, Galian-Gay L, Evangelista A. Mechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:448-464. [PMID: 37495282 DOI: 10.1016/j.jacc.2022.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 07/28/2023]
Abstract
Bicuspid aortic valve is the most common congenital heart disease and exposes patients to an increased risk of aortic dilation and dissection. Aortic dilation is a slow, silent process, leading to a greater risk of aortic dissection. The prevention of adverse events together with optimization of the frequency of the required lifelong imaging surveillance are important for both clinicians and patients and motivated extensive research to shed light on the physiopathologic processes involved in bicuspid aortic valve aortopathy. Two main research hypotheses have been consolidated in the last decade: one supports a genetic basis for the increased prevalence of dilation, in particular for the aortic root, and the second supports the damaging impact on the aortic wall of altered flow dynamics associated with these structurally abnormal valves, particularly significant in the ascending aorta. Current opinion tends to rule out mutually excluding causative mechanisms, recognizing both as important and potentially clinically relevant.
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Affiliation(s)
- Jose F Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | | | - Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain.
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
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50
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Monda E, Prosnitz A, Aiello R, Lioncino M, Norrish G, Caiazza M, Drago F, Beattie M, Tartaglia M, Russo MG, Colan SD, Calcagni G, Gelb BD, Kaski JP, Roberts AE, Limongelli G. Natural History of Hypertrophic Cardiomyopathy in Noonan Syndrome With Multiple Lentigines. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:350-358. [PMID: 37199218 DOI: 10.1161/circgen.122.003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/10/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND We aimed to examine clinical features and outcomes of consecutive molecularly characterized patients with Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy. METHODS A retrospective, longitudinal multicenter cohort of consecutive children and adults with a genetic diagnosis of Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy between 2002 and 2019 was assembled. We defined a priori 3 different patterns of left ventricular remodeling during follow-up: (1) an increase in ≥15% of the maximal left ventricular wall thickness (MLVWT), both in mm and z-score (progression); (2) a reduction ≥15% of the MLVWT, both in mm and z-score (absolute regression); (3) a reduction ≥15% of the MLVWT z-score with a stable MLVWT in mm (relative regression). The primary study end point was a composite of cardiovascular death, heart transplantation, and appropriate implantable cardioverter defibrillator-shock. RESULTS The cohort comprised 42 patients with Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy, with a median age at diagnosis of 3.5 (interquartile range, 0.2-12.3) years. Freedom from primary end point was 92.7% (95% CI, 84.7%-100%) 1 year after presentation and 80.9% (95% CI, 70.1%-90.7%) at 5 years. Patients with MLVWT z-score >13.7 showed reduced survival compared with those with <13.7. During a median follow-up of 3.7 years (interquartile range, 2.6-7.9), absolute regression was the most common type of left ventricular remodeling (n=9, 31%), followed by progression (n=6, 21%), and relative regression (n=6, 21%). CONCLUSIONS These findings provide insights into the natural history of left ventricular hypertrophy, and can help inform clinicians regarding risk stratification and clinical outcomes in patients with Noonan syndrome with multiple lentigines and hypertrophic cardiomyopathy.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Aaron Prosnitz
- Congenital Heart Center, Levine Children's Hospital, Atrium Health, Charlotte, NC (A.P.)
| | - Rossella Aiello
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Gabrielle Norrish
- Centre for Pediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, United Kingdom (G.N., J.P.K.)
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., J.P.K.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy (F.D., G.C.)
| | - Meaghan Beattie
- Department of Cardiology and Division of Genetics, Department of Pediatrics, Boston Children's Hospital, MA (M.B., S.D.C., A.E.R.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy (M.T.)
| | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
| | - Steven D Colan
- Department of Cardiology and Division of Genetics, Department of Pediatrics, Boston Children's Hospital, MA (M.B., S.D.C., A.E.R.)
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy (F.D., G.C.)
| | - Bruce D Gelb
- Mindich Child Health and Development Institute and Departments of Pediatrics and Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.G.)
| | - Juan Pablo Kaski
- Centre for Pediatric Inherited and Rare Cardiovascular Disease, Institute of Cardiovascular Science, University College London, United Kingdom (G.N., J.P.K.)
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., J.P.K.)
| | - Amy E Roberts
- Department of Cardiology and Division of Genetics, Department of Pediatrics, Boston Children's Hospital, MA (M.B., S.D.C., A.E.R.)
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (E.M., R.A., M.L., M.C., M.G.R., G.L.)
- Institute of Cardiovascular Sciences, University College of London and St Bartholomew's Hospital, United Kingdom (G.L.)
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