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Li L, Sun JP, Zuo R, Shen Y, Zhao M, Zhao W, Luo Z. Cardiac function evaluated by two-dimensional speckle tracking imaging in fetuses with congenital heart disease of ventricular afterload increase. J Matern Fetal Neonatal Med 2023; 36:2214663. [PMID: 37217449 DOI: 10.1080/14767058.2023.2214663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
AIMS To study myocardial deformation in fetuses with ventricular afterload increase compared with gestational age-matched controls using speckle tracking echocardiography. METHODS AND RESULTS Eighty-nine fetuses were retrospectively selected from the pregnancy screen by echocardiography. There are 41 fetuses with gestational age-matched normal heart served as the control group, 25 fetuses with congenital heart disease (CHD) leading to left ventricular (LV) afterload increase as group LVA and 23 fetuses with CHD leading to right ventricular(RV) afterload increases as group RVA. LV and RV fractional shortening (FS) were measured by conventional methods. The longitudinal strain (LS) and strain rate (LSr) were analyzed by EchoPac software. Group LVA and RVA compared with control group, the LV FS was no significant difference, but LS and LSr values of LV were lower in fetuses with LVA compared to the control group (LS:-15.97(-12.50,-22.52)vs -27.53(-24.33,-29.16) %, p < .01; systolic strain rate (SRs):-1.34(-1.12,-2.16) vs -2.55(-2.28,-2.92) 1/sec, p < .01; early diastolic strain rate (SRe):1.70 ± 0.57 vs 2.46 ± 0.61 1/sec, p < 0.01; late diastolic strain rate (SRa):1.62 ± 0.82 vs 2.39 ± 0.81 1/sec, p < .01). LS and LSr values of LV or RV were lower in fetuses with RVA compared to the control group (LV: LS:-21.52 ± 6.68 vs -26.79 ± 3.22%, p < .01; SRs:-2.11 ± 0.78 vs -2.56 ± 0.43 1/sec; p = .02; RV: LS:-17.64 ± 7.58 vs -26.38 ± 3.97%, p < .01; SRs:-1.62 ± 0.67 vs -2.37 ± 0.44 1/sec; p < .01). CONCLUSION The results of this study showed that the ventricular LS, LSr, SRs, SRe, SRa values were lower in fetuses with LV or RV afterload increasing CHD estimated by speckle tracking imaging but LV and RV FS were normal,which indicated the strain imaging is feasible in evaluating cardiac function of fetus, and may be more sensitive.
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Affiliation(s)
- Li Li
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | | | - Rongyu Zuo
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Yan Shen
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Miao Zhao
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Wanyu Zhao
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Zhiling Luo
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
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2
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Mampaey G, Bové T, De Somer F, Devriendt N, Bouchez S, Bosmans T, Stammeleer L, Panzer J, Hellemans A, Smets P. Surgical correction of an infundibular pulmonic stenosis and ventricular septal defect in a Shetland Sheepdog. J Vet Cardiol 2023; 49:29-37. [PMID: 37573623 DOI: 10.1016/j.jvc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/08/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
A four-month-old male Shetland Sheepdog presented with exercise intolerance. Physical examination revealed an IV/VI left cranial systolic heart murmur. Echocardiography showed a severe infundibular pulmonic stenosis and a concomitant restrictive ventricular septal defect. As clinical signs of congestive right-sided heart failure worsened and were refractory to medical treatment, surgical correction was advised. Via sternotomy, with cardiopulmonary bypass and cardioplegic cardiac arrest, ventricular septal defect closure and resection of the stenotic infundibular band were performed through right ventriculotomy, followed by patch enlargement. Postoperative recovery was uneventful and echocardiography showed complete resolution of the stenosis and successful closure of the ventricular septal defect. Follow-up echocardiography revealed restenosis after seven weeks and recurrence of right-sided heart failure three months postoperatively. Stenting of the restenosis was attempted via a hybrid procedure with sternotomy and direct transventricular approach. The dog developed fatal ventricular fibrillation during stent deployment. This is the first dog in which surgical right ventricular patch enlargement under cardiopulmonary bypass is reported for the treatment of a primary infundibular pulmonic stenosis.
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Affiliation(s)
- G Mampaey
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - T Bové
- Department of Cardiac Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - F De Somer
- Department of Cardiac Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - N Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - S Bouchez
- Department of Cardiac Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - T Bosmans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - L Stammeleer
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - J Panzer
- Department of Pediatrics, Pediatric Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - A Hellemans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - P Smets
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
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Hanse LC, Tjørnild MJ, Karunanithi Z, Høgfeldt Jedrzejczyk J, Islamagič L, Hummelshøj NE, Enevoldsen M, Lugones G, Høj Lauridsen M, Hjortdal VE, Lugones I. Trileaflet Semilunar Valve Reconstruction: Acute Porcine in Vivo Evaluation. World J Pediatr Congenit Heart Surg 2023; 14:509-515. [PMID: 37039366 DOI: 10.1177/21501351231166662] [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: 04/12/2023]
Abstract
Objective: The surgical treatment of malformed semilunar valves in congenital heart defects is challenging in terms of providing both longevity and the potential to grow with the recipient. We investigated a new surgical technique "Trileaflet Semilunar Valve Reconstruction" in an acute porcine model, a technique with geometrical properties that could remain sufficient and allow for some growth with the child. Methods: An acute 60-kg porcine model was used. With echocardiography, baseline pulmonary valvular geometry and hemodynamics were investigated. On cardiopulmonary bypass, the pulmonary leaflets were explanted, and the Trileaflet Semilunar Valve Reconstruction was performed with customized homograft-treated pericardial neo-leaflets. Off bypass, hemodynamics was reassessed. Results: Twelve animals were investigated. The neo-valves were found sufficient in ten animals and with minimal regurgitation in two animals. The neo-valve had a peak gradient of 3 ± 2 mm Hg with a peak velocity of 0.8 ± 0.2 m/s. The coaptation in the neo-valve had a mean increase of 4 ± 3 mm, P < .001. The neo-valve had a windmill shape in the echocardiographic short-axis view, and the neo-leaflets billowed at the annular plane in the long-axis view. Conclusions: In this acute porcine model, the neo-valve had no clinically significant regurgitation or stenosis. The neo-valve had an increased coaptation, a windmill shape, and leaflets that billowed at the annular plane. These geometric findings may allow for sustained sufficiency as the annular and pulmonary artery dimension increase with the child's growth. Further long-term studies should be performed to evaluate the efficacy and the growth potential.
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Affiliation(s)
- Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marcell Juan Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Johannes Høgfeldt Jedrzejczyk
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lejla Islamagič
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Malene Enevoldsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Germán Lugones
- Centro de Ciencias Naturais e Humanas, Universidade Federal do ABC, Santo André, Sao Paulo, Brazil
| | - Mette Høj Lauridsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ignacio Lugones
- Department of Congenital Heart Surgery, Hospital General de Niños "Dr Pedro de Elizalde", Buenos Aires, Argentina
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4
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Liang Y, Pan Z, Zhu M, Gao R, Wang Y, Cheng Y, Zhang N. Exposure to essential and non-essential trace elements and risks of congenital heart defects: A narrative review. Front Nutr 2023; 10:1121826. [PMID: 36998909 PMCID: PMC10043220 DOI: 10.3389/fnut.2023.1121826] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
Congenital heart defects (CHDs) are congenital abnormalities involving the gross structures of the heart and large blood vessels. Environmental factors, genetic factors and their interactions may contribute to the pathogenesis of CHDs. Generally, trace elements can be classified into essential trace elements and non-essential trace elements. Essential trace elements such as copper (Cu), zinc (Zn), iron (Fe), selenium (Se), and manganese (Mn) play important roles in human biological functions such as metabolic function, oxidative stress regulation, and embryonic development. Non-essential trace elements such as cadmium (Cd), arsenic (As), lead (Pb), nickle (Ni), barium (Ba), chromium (Cr) and mercury (Hg) are harmful to health even at low concentrations. Recent studies have revealed the potential involvement of these trace elements in the pathogenesis of CHDs. In this review, we summarized current studies exploring exposure to essential and non-essential trace elements and risks of CHDs, in order to provide further insights for the pathogenesis and prevention of CHDs.
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Affiliation(s)
- Yipu Liang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zijian Pan
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mingzheng Zhu
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ruonan Gao
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yijue Wang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yijuan Cheng
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Nannan Zhang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Nannan Zhang,
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5
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Wallet J, Kimura Y, Zeppenfeld K. Ventricular Tachycardia Ablation in Adult Congenital Heart Disease. Card Electrophysiol Clin 2022; 14:709-727. [PMID: 36396188 DOI: 10.1016/j.ccep.2022.06.008] [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: 06/16/2023]
Abstract
Patients with congenital heart disease (CHD) are at risk for late ventricular tachycardia (VT) and sudden cardiac death. Slow conducting anatomical isthmuses, bordered by unexcitable tissue created by valve annuli, ventricular incisions, and prosthetic material are the dominant substrate for macroreentrant monomorphic VTs in repaired CHD. These well-defined substrates allow for catheter or surgical transection with clear endpoints. This review elaborates on VT substrates in various CHD, and evolving mapping and ablation approaches. Because most research is conducted in patients with repaired tetralogy of Fallot, this malformation will serve as a paradigm.
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Affiliation(s)
- Justin Wallet
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Postbus 9600, Leiden 2300 RC, the Netherlands; Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), the Netherlands; Willem Einthoven Center of Arrhythmia Research and Management
| | - Yoshitaka Kimura
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Postbus 9600, Leiden 2300 RC, the Netherlands; Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), the Netherlands; Willem Einthoven Center of Arrhythmia Research and Management
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Postbus 9600, Leiden 2300 RC, the Netherlands; Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), the Netherlands; Willem Einthoven Center of Arrhythmia Research and Management.
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6
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Dynamic cardiac computed tomography characteristics of double-chambered right ventricle. Sci Rep 2022; 12:20607. [PMID: 36446892 PMCID: PMC9708647 DOI: 10.1038/s41598-022-25230-1] [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: 08/21/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
To introduce image characteristics of double-chambered right ventricle on cardiac computed tomography and set a diagnostic criterion for the diagnosis. We retrospectively collected and measured the right ventricular constrictive ratio on computed tomography images in children who had simple ventricular septal defects in the past 10 years, because double-chambered right ventricle is often associated with ventricular septal defects. The right ventricular constrictive ratio was defined as the subinfundibular cross-sectional intraluminal area during end-systole divided by the area during end-diastole in the same patient. We compared the right ventricular constrictive ratio between subjects with concomitant double-chambered right ventricle and those without. 52 children were included, and 23 (44.2%) of them have concomitant double-chambered right ventricle. In most cases (n = 21; 91.3%), the hypertrophied muscular bundles occur just inferior to the level of the supraventricular crest in the right ventricle. Mean right ventricular constrictive ratio in patients with double-chambered right ventricle (15%) was significantly smaller than that without (29%). A cut-off value of a right ventricular constrictive ratio less than 20.1% was established to diagnose double-chambered right ventricle with an 89.7% sensitivity and 78. 3% specificity. Right ventricular constrictive ratio can be a valuable asset for the preoperative diagnosis of double-chambered right ventricle with cardiac computed tomography.
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7
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Carlson Hanse L, Tjørnild MJ, Sørensen SG, Johansen P, Lugones I, Hjortdal VE. Trileaflet semilunar valve reconstruction: pulsatile in vitro evaluation. Interact Cardiovasc Thorac Surg 2022; 35:6692721. [PMID: 36066430 PMCID: PMC9462423 DOI: 10.1093/icvts/ivac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Residual regurgitation is common after congenital surgery for right ventricular outflow tract malformation. It is accepted as there is no competent valve solution in a growing child. We investigated a new surgical technique of trileaflet semilunar valve reconstruction possessing the potential of remaining sufficient and allowing for some growth with the child. In this proof-of-concept study, our aim was to evaluate if it is achievable as a functional pulmonary valve reconstruction in vitro.
METHODS
Explanted pulmonary trunks from porcine hearts were evaluated in a pulsatile flow-loop model. First, the native pulmonary trunk was investigated, after which the native leaflets were explanted. Then, trileaflet semilunar valve reconstruction was performed and investigated. All valves were initially investigated at a flow output of 4 l/min and subsequently at 7 l/min. The characterization was based on hydrodynamic pressure and echocardiographic measurements.
RESULTS
Eight pulmonary trunks were evaluated. All valves are competent on colour Doppler. There is no difference in mean pulmonary systolic artery pressure gradient at 4 l/min (P = 0.32) and at 7 l/min (P = 0.20). Coaptation length is increased in the neo-valve at 4 l/min (P < 0.001, P < 0.001, P = 0.008) and at 7 l/min (P < 0.001, P = 0.006, P = 0.006). A windmill shape is observed in all neo-valves.
CONCLUSIONS
Trileaflet semilunar valve reconstruction is sufficient and non-stenotic. It resulted in an increased coaptation length and a windmill shape, which is speculated to decrease with the growth of the patient, yet remains sufficient as a transitional procedure until a long-term solution is feasible. Further in vivo investigations are warranted.
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Affiliation(s)
- Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Simon G Sørensen
- Department of Clinical Medicine, Aarhus University Hospital , Aarhus, Denmark
- Department of Molecular Medicine (MOMA), Aarhus University Hospital , Aarhus, Denmark
| | - Peter Johansen
- Department of Engineering, Aarhus University , Aarhus, Denmark
| | - Ignacio Lugones
- Department of Congenital Heart Surgery in Hospital General de Niños “Pedro de Elizalde” , Buenos Aires, Argentina
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery , Rigshospitalet, Copenhagen, Denmark
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8
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Ge J, Hu T, Liu Y, Wang Q, Fan G, Liu C, Zhang J, Chen S, Maduray K, Zhang Y, Chen T, Zhong J. Case report: Double-chambered right ventricle diagnosed in a middle-aged female with hypertrophic cardiomyopathy and atrial flutter: A rare case. Front Cardiovasc Med 2022; 9:937758. [PMID: 35935646 PMCID: PMC9353184 DOI: 10.3389/fcvm.2022.937758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Double-chambered right ventricle (DCRV) is a rare congenital heart defect in adults, manifesting with progressive right ventricular outflow tract obstruction. We describe the first case of DCRV coexisting with hypertrophic cardiomyopathy, which is complicated by atrial flutter. A middle-aged woman with recurrent symptomatic atrial flutter who had previously been diagnosed with biventricular hypertrophic cardiomyopathy was admitted to our department. Echocardiography and cardiac magnetic resonance revealed asymmetrical interventricular septal hypertrophy, and abnormal muscle bundles within the right ventricle, generating an obstructive gradient. Genetic testing detected a hypertrophic cardiomyopathy-associated mutation: MYH7, c.4135G > A, p. Ala1379Thr. A diagnosis of DCRV complicated by hypertrophic cardiomyopathy and atrial flutter was made. Surgical intervention was performed, which included radiofrequency ablation, removal of abnormal muscle bundles, and ventricular septal defect repair. Intraoperative transesophageal echocardiography demonstrated the well-corrected right ventricular outflow tract. Free of early postoperative complications, the patient was discharged in sinus rhythm on the 11th day after the surgery. Unfortunately, the patient died from a sudden death 38 days following the surgery. In conclusion, the coexistence of DCRV with hypertrophic cardiomyopathy in patients is an uncommon condition. The present case highlights the importance of diagnostic imaging in the management of this disorder.
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Affiliation(s)
- Junye Ge
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tong Hu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qian Wang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Guanqi Fan
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chuanzhen Liu
- Department of Cardiovascular Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Jun Zhang
- Department of Cardiovascular Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Shiming Chen
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, China
| | - Kellina Maduray
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yun Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Tongshuai Chen,
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
- Jingquan Zhong,
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9
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Kumar P, Bhatia M. Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies. Radiol Cardiothorac Imaging 2022; 4:e210089. [PMID: 35923747 PMCID: PMC9308465 DOI: 10.1148/ryct.210089] [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: 03/27/2021] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
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10
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Bonet F, Inácio JM, Bover O, Añez SB, Belo JA. CCBE1 in Cardiac Development and Disease. Front Genet 2022; 13:836694. [PMID: 35222551 PMCID: PMC8864227 DOI: 10.3389/fgene.2022.836694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
The collagen- and calcium-binding EGF-like domains 1 (CCBE1) is a secreted protein extensively described as indispensable for lymphangiogenesis during development enhancing VEGF-C signaling. In human patients, mutations in CCBE1 have been found to cause Hennekam syndrome, an inherited disease characterized by malformation of the lymphatic system that presents a wide variety of symptoms such as primary lymphedema, lymphangiectasia, and heart defects. Importantly, over the last decade, an essential role for CCBE1 during heart development is being uncovered. In mice, Ccbe1 expression was initially detected in distinct cardiac progenitors such as first and second heart field, and the proepicardium. More recently, Ccbe1 expression was identified in the epicardium and sinus venosus (SV) myocardium at E11.5–E13.5, the stage when SV endocardium–derived (VEGF-C dependent) coronary vessels start to form. Concordantly, CCBE1 is required for the correct formation of the coronary vessels and the coronary artery stem in the mouse. Additionally, Ccbe1 was found to be enriched in mouse embryonic stem cells (ESC) and revealed as a new essential gene for the differentiation of ESC-derived early cardiac precursor cell lineages. Here, we bring an up-to-date review on the role of CCBE1 in cardiac development, function, and human disease implications. Finally, we envisage the potential of this molecule’s functions from a regenerative medicine perspective, particularly novel therapeutic strategies for heart disease.
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Affiliation(s)
- Fernando Bonet
- Stem Cells and Development Laboratory, CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Medicine Department, School of Medicine, University of Cádiz (UCA), Cádiz, Spain
- Research Unit, Biomedical Research and Innovation Institute of Cadiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - José M. Inácio
- Stem Cells and Development Laboratory, CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Oriol Bover
- Stem Cells and Development Laboratory, CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Sabrina B. Añez
- Stem Cells and Development Laboratory, CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - José A. Belo
- Stem Cells and Development Laboratory, CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- *Correspondence: José A. Belo,
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11
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de Lange C, Quattrone A, Try K, Bakke AH, Borger Kvaslerud A, Haugaa K, Estensen ME. Is experienced pregnancy in women with repaired tetralogy of Fallot related to diffuse myocardial fibrosis? Int J Cardiol 2021; 344:95-102. [PMID: 34555445 DOI: 10.1016/j.ijcard.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/13/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the impact of pregnancy on cardiac function and fibrosis by cardiovascular magnetic resonance (CMR) in patients with repaired Tetralogy of Fallot (rToF). BACKGROUND CMR T1 mapping can assess diffuse myocardial fibrosis which is associated to adverse clinical outcomes. Right ventricular (RV) accelerated remodeling is reported in rToF women with experienced pregnancy. METHODS We included rToF women from the national registry of congenital heart disease to perform CMR, assessing functional data, T1 mapping/ extracellular volume fraction (ECV). The results including clinical data were compared between women with experienced pregnancy vs non-experienced pregnancy and healthy individuals. RESULTS Fifty rToF women performed CMR, median age 36 (range 21-67) years. Fifteen were nulliparous. T1 mapping was compared to 30 controls, (14 women) median age 42 (24-64) years. In the left ventricle (LV), T1 times and ECV in all rToF women vs female controls were 1248 ± 61 ms/ 25.8 ± 2.9% vs 1255 ± 40 ms/ 26.8 ± 3.1%, p = 0.7 and p = 0.3, respectively. In rToF, RV T1 times was 1385 ± 124 ms and ECV 37.7 ± 5.4%. There was no association to parity or age in rToF LV T1/ ECV, p = 0.9 for both, or RV T1/ECV, p = 0.4 and p = 0.6, respectively. Indexed LV mass was higher in the rToF pregnancy group, 43 ± 10 vs 38 ± 6 g/m2, p = 0.03 while RV ejection fraction was lower, 49 ± 7% vs 53 ± 6%, p = 0.04. CONCLUSION Women with rTOF showed evidence of increased RV CMR markers suggestive of diffuse fibrosis while LV CMR markers were within normal values. Having experienced pregnancy might affect RV function, however without association to CMR biomarkers.
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Affiliation(s)
- Charlotte de Lange
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, PO Box 4950, Nydalen 0424, Oslo, Norway; Department of Radiology, Queen Silvia Childrens' Hospital, Sahlgrenska University Hospital, Diagnosv. 11, 41650 Göteborg, Sweden.
| | - Alessia Quattrone
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen 0424, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern 0318, Oslo, Norway; Dept. of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen 0424, Oslo, Norway
| | - Kirsti Try
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, PO Box 4950, Nydalen 0424, Oslo, Norway
| | - Anita Helset Bakke
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, PO Box 4950, Nydalen 0424, Oslo, Norway
| | - Anette Borger Kvaslerud
- Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern 0318, Oslo, Norway; Dept. of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen 0424, Oslo, Norway
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen 0424, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern 0318, Oslo, Norway; Dept. of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen 0424, Oslo, Norway
| | - Mette-Elise Estensen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen 0424, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern 0318, Oslo, Norway; Dept. of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen 0424, Oslo, Norway
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12
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Zeng YH, Calderone A, Rousseau-Saine N, Elmi-Sarabi M, Jarry S, Couture ÉJ, Aldred MP, Dorval JF, Lamarche Y, Miles LF, Beaubien-Souligny W, Denault AY. Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review and Meta-analysis. CJC Open 2021; 3:1153-1168. [PMID: 34746729 PMCID: PMC8551422 DOI: 10.1016/j.cjco.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Right ventricular outflow tract obstruction (RVOTO) is a cause of hemodynamic instability that can occur in several situations, including cardiac surgery, lung transplantation, and thoracic surgery, and in critically ill patients. The timely diagnosis of RVOTO is important because it requires specific considerations, including the adverse effects of positive inotropes, and depending on the etiology, the requirement for urgent surgical intervention. Methods The objective of this systematic review and meta-analysis was to determine the prevalence of RVOTO in adult patients, and the distribution of all reported cases by etiology. Results Of 233 available reports, there were 229 case reports or series, and 4 retrospective cohort studies, with one study also reporting a prospective cohort. Of 291 reported cases of RVOTO, 61 (21%) were congenital, 56 (19%) were iatrogenic, and 174 (60%) were neither congenital nor iatrogenic (including intracardiac tumour). The mechanism of RVOTO was an intrinsic obstruction in 169 cases (58%), and an extrinsic obstruction in 122 cases (42%). A mechanical obstruction causing RVOTO was present in 262 cases (90%), and 29 cases of dynamic RVOTO (10%) were reported. In the 5 included cohorts, with a total of 1122 patients, the overall prevalence was estimated to be 4.0% (1%-9%). Conclusions RVOTO, though rare, remains clinically important, and therefore, multicentre studies are warranted to better understand the prevalence, causes, and consequences of RVOTO.
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Affiliation(s)
- Yu Hao Zeng
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander Calderone
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Rousseau-Saine
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mahsa Elmi-Sarabi
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Stéphanie Jarry
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Étienne J Couture
- Department of Anesthesiology and Department of Medicine, Division of Intensive Care Medicine, Quebec Heart & Lung Institute, Quebec, Quebec, Canada
| | - Matthew P Aldred
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Dorval
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Lachlan F Miles
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia and Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - William Beaubien-Souligny
- Department of Medicine, Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - André Y Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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13
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Ventricular outflow tract obstruction: An in-silico model to relate the obstruction to hemodynamic quantities in cardiac paediatric patients. PLoS One 2021; 16:e0258225. [PMID: 34653194 PMCID: PMC8519477 DOI: 10.1371/journal.pone.0258225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Right (R) or left (L) ventricular outflow tract (VOT) obstruction can be either a dynamic phenomenon or a congenital anatomic lesion, which requires a prompt and optimal timing of treatment to avoid a pathological ventricular remodelling. OBJECTIVE To develop a simple and reliable numerical tool able to relate the R/L obstruction size with the pressure gradient and the cardiac output. To provide indication of the obstruction severity and be of help in the clinical management of patients and designing the surgical treatment for obstruction mitigation. METHODS Blood flow across the obstruction is described according to the classical theory of one-dimensional flow, with the obstruction uniquely characterized by its size. Hemodynamics of complete circulation is simulated according to the lumped parameter approach. The case of a 2 years-old baby is reproduced, with the occlusion placed in either the R/ or the L/VOT. Conditions from wide open to almost complete obstruction are reproduced. RESULTS Both R/LVOT obstruction in the in-silico model resulted in an increased pressure gradient and a decreased cardiac output, proportional to the severity of the VOT obstruction and dependent on the R/L location of the obstruction itself, as it is clinically observed. CONCLUSION The in-silico model of ventricular obstruction which simulates pressure gradient and/or cardiac output agrees with clinical data, and is a first step towards the creation of a tool that can support the clinical management of patients from diagnosis to surgical treatments.
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14
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Kumar P, Bhatia M. Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle. J Cardiovasc Imaging 2021; 29:205-227. [PMID: 34080329 PMCID: PMC8318812 DOI: 10.4250/jcvi.2020.0196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 01/22/2023] Open
Abstract
Double-outlet right ventricle (DORV) is a type of ventriculoarterial connection in which both great arteries arise entirely or predominantly from the right ventricle. The morphology of DORV is characterized by a ventricular septal defect (location and relationship with the semilunar valve); bilateral coni and aortomitral continuity; the presence or absence of outflow tract obstruction; tricuspid-pulmonary annular distance; and associated cardiac anomalies. The surgical approach varies with the type of DORV and is based on multiple variables. Computed tomography (CT) is a robust diagnostic tool for the preoperative and postoperative assessment of DORV. Unlike echocardiography and magnetic resonance imaging (MRI), CT imaging is not limited by small acoustic window, need for anaesthesia and can be used in patients with metallic implants. Current generations CT scanners with high spatial and temporal resolution, wide detectors, high-pitch scanning mode, dose-reduction algorithms, and advanced three-dimensional post-processing tools provide a low-risk, high-quality alternative to diagnostic cardiac catheterization or MRI, and have been increasingly utilized in nearly every type of congenital heart defect, including DORV.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, New Delhi, India.
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, New Delhi, India.,Cardiological Society of India, Kolkata, India.,International Regional Committee, India Chapter of the Society of Cardiovascular Computed Tomography, New Delhi, India
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15
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Saef JM, Ghobrial J. Valvular heart disease in congenital heart disease: a narrative review. Cardiovasc Diagn Ther 2021; 11:818-839. [PMID: 34295708 DOI: 10.21037/cdt-19-693-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/29/2021] [Indexed: 12/29/2022]
Abstract
Patients with congenital heart disease (CHD) are one of the fastest growing populations in cardiology, and valvular pathology is at the center of many congenital lesions. Derangements in valvular embryology lead to several anomalies prone to dysfunction, each with hemodynamic effects that require appropriate surveillance and management. Surgical innovation has provided new treatments that have improved survival in this population, though has also contributed to esotericism in patients who already have unique anatomic and physiologic considerations. Conduit and prosthesis durability are often monitored collaboratively with general and specialized congenital-focused cardiologists. As such, general cardiologists must become familiar with valvular disease with CHD for appropriate care and referral practices. In this review, we summarize the embryology of the semilunar and atrioventricular (AV) valves as a foundation for understanding the origins of valvular CHD and describe the mechanisms that account for heterogeneity in disease. We then highlight the categories of pathology from the simple (e.g., bicuspid aortic valve, isolated pulmonic stenosis) to the more complex (e.g., Ebstein's anomaly, AV valvular disease in single ventricle circulations) with details on natural history, diagnosis, and contemporary therapeutic approaches. Care for CHD patients requires collaborative effort between providers, both CHD-specialized and not, to achieve optimal patient outcomes.
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Affiliation(s)
- Joshua M Saef
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joanna Ghobrial
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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16
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Papakonstantinou NA, Kanakis MA, Bobos D, Giannopoulos NM. Congenital, acquired, or both? The only two congenitally based, acquired heart diseases. J Card Surg 2021; 36:2850-2856. [PMID: 33908651 DOI: 10.1111/jocs.15588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Discrete subaortic stenosis (DSS) is a type of left ventricular outflow tract obstruction whereas double-chambered right ventricle is a form of right ventricular outflow tract obstruction. Both of these cardiac malformations share lots of similar characteristics which classify them as acquired developmental heart diseases despite their congenital anatomical substrate. Both of them are frequently associated to ventricular septal defects. The initial stimulus in their pathogenetic process is anatomical abnormalities or variations. Subsequently, a hemodynamic process is triggered finally leading to an abnormal subaortic fibroproliferative process with regard to DSS or to hypertrophy of ectopic muscles as far as double-chambered right ventricle is concerned. In many cases, these pathologies are developed secondarily to surgical management of other congenital or acquired heart defects. Moreover, high recurrence rates after initial successful surgical therapy, particularly regarding DSS, have been described. Finally, an interesting coexistence of DSS and double-chambered aortic ventricle has also been reported in some cases.
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Affiliation(s)
| | - Meletios A Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitrios Bobos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nicholas M Giannopoulos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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17
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Evaluation and Management of Pulmonic Valve Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Pregnancy in tetralogy of fallot: When and where. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Chang TI, Hsu KH, Li SJ, Chuang MK, Luo CW, Chen YJ, Chang CI. Evolution of pulmonary valve reconstruction with focused review of expanded polytetrafluoroethylene handmade valves. Interact Cardiovasc Thorac Surg 2020; 32:585-592. [PMID: 33377488 DOI: 10.1093/icvts/ivaa302] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for congenital heart diseases. Expanded polytetrafluoroethylene (ePTFE) stands out as a reliable synthetic material, and clinical results with handmade ePTFE valves have been promising. This review focuses on the historical evolution of the use of ePTFE in pulmonary valve replacement and in the techniques for pioneering the translation of the handmade ePTFE trileaflet design for the transcatheter approach. METHODS We searched for and reviewed publications from 1990 to 2020 in the Pubmed database. Nineteen clinical studies from 2005 to 2019 that focused on ePTFE-based valves were summarized. The evolution of the ePTFE-based valve over 3 decades and recent relevant in vitro studies were investigated. RESULTS The average freedom from reintervention or surgery in the recorded ePTFE-based valve population was 90.2% at 5 years, and the survival rate was 96.7% at 3 years. CONCLUSIONS Non-inferior clinical results of this ePTFE handmade valve were revealed compared to allograft or xenograft options for pulmonary valve replacement. Future investigations on transferring ePTFE trileaflet design to transcatheter devices should be considered.
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Affiliation(s)
- Te-I Chang
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Kang-Hong Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shao-Jung Li
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Min-Kai Chuang
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chi-Wen Luo
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Jen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chung-I Chang
- Division of Cardiovascular Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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20
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Guarque-Rus A, Martín-González L, Puerto-Tamayo LG, Landeyro J. Prenatal diagnosis of truncus arteriosus with interrupted aortic arch and abnormal limbs due to an umbilical cord amniotic band: rare entities with an unusual association. BMJ Case Rep 2020; 13:13/11/e236049. [PMID: 33148593 DOI: 10.1136/bcr-2020-236049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Truncus arteriosus, interrupted aortic arch and amniotic band syndrome are rare conditions. We report a case of a 38-year-old pregnant woman who was diagnosed on a routine morphological ultrasound scan with a Van Praagh type A4 persistent truncus arteriosus with an aortic arch interruption type B and abnormal limbs (oedematous left hand, hypoplastic fingers on the right hand and right big toe amputation). Elective termination of the pregnancy was carried out and the pathological examination confirmed all the sonographic findings. Furthermore, an amniotic band parallel to the umbilical cord undetected during the ultrasound scans was revealed, and was entangled around the right hand, left wrist and the umbilical cord, causing strangulation. We present the unusual association of these independent pathologies and emphasise the usefulness of fetal autopsy in all cases of pregnancy termination and abnormal ultrasound findings to make the complete diagnosis.
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Affiliation(s)
- Albert Guarque-Rus
- Department of Obstetrics and Gynecology, Joan XXIII University Hospital, Tarragona, Spain .,Pere Virgili Health Research Institute, Reus, Spain
| | | | | | - Julieta Landeyro
- Department of Pathology, Joan XXIII University Hospital, Tarragona, Spain.,Department of Pathology, Pius Hospital de Valls, Valls, Spain
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21
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Joshi A, Ghadimi Mahani M, Dorfman A, Balasubramanian S. Cardiac MR Evaluation of Repaired Tetralogy of Fallot. Semin Roentgenol 2020; 55:290-300. [PMID: 32859345 DOI: 10.1053/j.ro.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aparna Joshi
- Department of Radiology, Section of Pediatric Radiology, Michigan Medicine, Ann Arbor, MI.
| | - Maryam Ghadimi Mahani
- Department of Radiology, Section of Pediatric Radiology and Division of Cardiothoracic Radiology, Michigan Medicine, Ann Arbor, MI
| | - Adam Dorfman
- Department of Pediatrics, Division of Pediatric Cardiology, Michigan Medicine, Ann Arbor, MI
| | - Sowmya Balasubramanian
- Department of Pediatrics, Division of Pediatric Cardiology, Michigan Medicine, Ann Arbor, MI
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22
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Stenotic lesions of pulmonary arteries: imaging evaluation using multidetector computed tomography angiography. Clin Imaging 2020; 69:17-26. [PMID: 32652453 DOI: 10.1016/j.clinimag.2020.06.036] [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: 04/23/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022]
Abstract
Stenotic lesions of the pulmonary arteries can be congenital or acquired. Different etiologies may affect the pulmonary arteries, unilaterally or bilaterally, at different levels. The clinical scenario, age of presentation and the precipitating event may provide clues to the underlying etiology. Diagnosis is important as these lesions may have hemodynamic and clinical consequences. Multidetector computed tomography angiography allows for accurate depiction of these lesions along with a comprehensive assessment of the pulmonary arterial wall, intra- or extraluminal involvement, associated cardiac or extracardiac anomalies, effects secondary to pulmonary stenosis on the cardiac chambers as well as associated causative or resultant lung parenchymal changes.
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23
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Suto M, Matsumoto K, Onishi A, Shibata N, Yokota S, Mukai J, Hisamatsu E, Takada H, Dokuni K, Hatazawa K, Tanaka H, Hirata KI. Noninvasive Leg-Positive Pressure Stress Echocardiography Reveals Preload Reserve in Adult Patients after Complete Repair of Tetralogy of Fallot. J Am Soc Echocardiogr 2020; 33:858-867. [PMID: 32336610 DOI: 10.1016/j.echo.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term sequelae such as right ventricular dysfunction and reduced hemodynamic reserve are the main determinants of cardiovascular outcomes after repair of tetralogy of Fallot (TOF). Echocardiographic parameters at rest offer only partial information on impaired hemodynamics in these patients, and data during stress testing are lacking. The leg-positive pressure (LPP) maneuver has recently been reported to be able to apply acute preload stress. The aim of this study was to test the hypothesis that preload reserve is impaired and ventricular interaction is exacerbated in patients with TOF. METHODS In this prospective cross-sectional study, we recruited 44 consecutive patients with TOF and 30 normal control subjects. Echocardiography was performed both at rest and during LPP stress, and preload reserve was defined as the change between baseline stroke volume (SV) and that obtained during LPP stress. The eccentricity index was calculated as the ratio of the left ventricular anteroposterior to septal-lateral dimensions to quantify ventricular interaction. RESULTS LPP stress significantly increased SV from 73 ± 14 to 83 ± 16 mL (P < .01) in control subjects, while the increase in SV was significantly blunted (from 75 ± 19 to 79 ± 18 mL; P < .01 for interaction) in patients with TOF. The eccentricity index significantly changed during LPP stress in patients with TOF only from 1.07 ± 0.13 to 1.13 ± 0.14 (P < .01 for interaction). Patients with TOF were subdivided into two subgroups on the basis of the median value of increased response in SV (22 with sufficient and 22 with insufficient preload reserve). Multivariate analysis identified significant pulmonary regurgitation as the only independent determinant factor for insufficient preload reserve (odds ratio, 4.57; 95% CI, 1.048-19.90; P = .04). CONCLUSIONS In patients after repair of TOF, ventricular interaction was exacerbated and preload reserve was impaired, especially in patients with significant pulmonary regurgitation. LPP stress testing may direct tailored treatment approaches, risk stratification, and clinical decision-making, such as more aggressive pharmacologic therapy, meticulous outpatient follow-up, or earlier reintervention.
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Affiliation(s)
- Makiko Suto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Akira Onishi
- Division of Rheumatology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nao Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun Yokota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Mukai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eriko Hisamatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Takada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kumiko Dokuni
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiko Hatazawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Abstract
Congenital cardiac anomalies are a common finding during prenatal anatomical survey ultrasound examination. Cardiac anomalies are a major cause of prenatal and neonatal mortality and morbidity. If the anomaly is not lethal, most would require surgical correction. Therefore, early recognition of these abnormalities is essential for parental counseling and delivery planning, as well as analysis of neonatal treatment options. Although prenatal ultrasound plays an important role in identification of such anomalies, diagnosis and interpretation of imaging findings require familiarity and knowledge of the common imaging features. In this article, we provide a comprehensive review of ultrasound appearance of common fetal cardiac anomalies.
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25
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Computed Tomography Appearance of Uncorrected Congenital Heart Disease in Adults. J Thorac Imaging 2019; 34:W13-W22. [DOI: 10.1097/rti.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Torres-Alba F, Kaleschke G, Baumgartner H. Impacto del implante percutáneo de válvula pulmonar en cuanto al momento de reintervenir por disfunción del tracto de salida del ventrículo derecho. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Enezate T, Omran J, Bhatt DL. Percutaneous Versus Surgical Pulmonic Valve Implantation for Right Ventricular Outflow Tract Dysfunction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:553-558. [PMID: 30201480 DOI: 10.1016/j.carrev.2018.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND/PURPOSE Percutaneous pulmonic valve implantation (PPVI) is an alternative treatment strategy to surgical pulmonic valve implantation (SPVI) for right ventricular outflow tract (RVOT) dysfunction. This study sought to compare outcomes of both treatment strategies. METHODS The study population was extracted from the 2014 Nationwide Readmissions Database (NRD) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for PPVI and SPVI. Study outcomes included all-cause in-hospital mortality, length of index hospital stay (LOS), post-procedural bleeding, mechanical complications of heart valve prosthesis, vascular complications (VC), infective endocarditis (IE), total hospitalization charges, and 30-day readmission rates. RESULTS A total of 975 patient discharges (176 in PPVI and 799 in SPVI group) were identified (average age 25.7 years; 57.5% male). PPVI was associated with significantly shorter median LOS (1 versus 5 days, p < 0.01), lower risk of bleeding (4.6% versus 26.4%, p < 0.01), and lower total hospitalization charges ($169,551.7 versus $210,681.8, p = 0.02). There was no significant difference between both groups in terms of all-cause in-hospital mortality (0% versus 1.4%, p = 0.12), mechanical complications of heart valve prosthesis (1.7% versus 2.0%, p = 0.78), VC (2.3% versus 2.0%, p = 0.82), IE (1.7% versus 3.1%, p = 0.31), or 30-day readmission rates (4.4% versus 7.6%, p = 0.16). CONCLUSION Compared with SPVI, PPVI was associated with shorter LOS, lower bleeding, and lower total charges. There was no significant difference between the two strategies in terms of all-cause in-hospital mortality, mechanical complications of heart valve prosthesis, VC, IE, or 30-day readmission rates.
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Affiliation(s)
- Tariq Enezate
- University of Missouri, Cardiovascular Division, Columbia, MO, United States of America.
| | - Jad Omran
- University of California San Diego, Sulpizio Cardiovascular Center, San Diego, CA, United States of America
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States of America.
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de Torres-Alba F, Kaleschke G, Baumgartner H. Impact of Percutaneous Pulmonary Valve Implantation on the Timing of Reintervention for Right Ventricular Outflow Tract Dysfunction. ACTA ACUST UNITED AC 2018; 71:838-846. [PMID: 29859895 DOI: 10.1016/j.rec.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect. Early surgical repair has dramatically improved the outcome of this condition. However, despite the success of contemporary approaches with early complete repair, these are far from being curative and late complications are frequent. The most common complication is right ventricle outflow tract (RVOT) dysfunction, affecting most patients in the form of pulmonary regurgitation, pulmonary stenosis, or both, and can lead to development of symptoms of exercise intolerance, arrhythmias, and sudden cardiac death. Optimal timing of restoration of RVOT functionality in asymptomatic patients with RVOT dysfunction after TOF repair is still a matter of debate. Percutaneous pulmonary valve implantation, introduced almost 2 decades ago, has become a major game-changer in the treatment of RVOT dysfunction. In this article we review the pathophysiology, the current indications, and treatment options for RVOT dysfunction in patients after TOF repair with a focus on the role of percutaneous pulmonary valve implantation in the therapeutic approach to these patients.
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Affiliation(s)
- Fernando de Torres-Alba
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
| | - Gerrit Kaleschke
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
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Abstract
PURPOSE OF REVIEW Our review is intended to provide readers with an overview of disease processes involving the pulmonic valve, highlighting recent outcome studies and guideline-based recommendations; with focus on the two most common interventions for treating pulmonic valve disease, balloon pulmonary valvuloplasty and pulmonic valve replacement. RECENT FINDINGS The main long-term sequelae of balloon pulmonary valvuloplasty, the gold standard treatment for pulmonic stenosis, remain pulmonic regurgitation and valvular restenosis. The balloon:annulus ratio is a major contributor to both, with high ratios resulting in greater degrees of regurgitation, and small ratios increasing risk for restenosis. Recent studies suggest that a ratio of approximately 1.2 may provide the most optimal results. Pulmonic valve replacement is currently the procedure of choice for patients with severe pulmonic regurgitation and hemodynamic sequelae or symptoms, yet it remains uncertain how it impacts long-term survival. Transcatheter pulmonic valve replacement is a rapidly evolving field and recent outcome studies suggest short and mid-term results at least equivalent to surgery. The Melody valve® was FDA approved for failing pulmonary surgical conduits in 2010 and for failing bioprosthetic surgical pulmonic valves in 2017 and has been extensively studied, whereas the Sapien XT valve®, offering larger diameters, was approved for failing pulmonary conduits in 2016 and has been less extensively studied. Patients with pulmonic valve disease deserve lifelong surveillance for complications. Transcatheter pulmonic valve replacement is a novel and attractive therapeutic option, but is currently only FDA approved for patients with failing pulmonary conduits or dysfunctional surgical bioprosthetic valves. New advances will undoubtedly increase the utilization of this rapidly expanding technology.
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Koestenberger M, Ravekes W, Avian A, Grangl G, Burmas A, Raith W, Cvirn G, Grillitsch M, Gamillscheg A. Right Ventricular Outflow Tract (RVOT) Changes in Children with an Atrial Septal Defect: Focus on RVOT Velocity Time Integral, RVOT Diameter, and RVOT Systolic Excursion. Echocardiography 2017; 33:1389-96. [PMID: 27677644 DOI: 10.1111/echo.13246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Aim of the study was to determine the influence of right heart volume overload in children with atrial septal defect (ASD) on right ventricular outflow tract (RVOT) variables. METHODS A prospective study was conducted in 115 children (age range: 2 days-18.1 years) with a moderate to large ASD. We determined effects of age, body length (BL), body weight (BW), and body surface area (BSA) on the variables RVOT diameter, RVOT velocity time integral (VTI), and RVOT systolic excursion (SE), and tested the predictive value of published normal values for age, BW, BL, and BSA in our ASD patients. RESULTS In our pediatric ASD patients, the age-specific RVOT diameter (z-score: +2.2, 95% CI: 2.0-2.4, P < 0.001) was significantly increased compared to normal values with 54% of our ASD patients having a z-score >2.0. The age-specific RVOT VTI z-score (z-score: +3.6, 95% CI: 3.2-3.9, P < 0.001) was significantly increased compared to normal values with 81% of our ASD patients having a z-score >2.0. The age-specific RVOT SE z-score was not increased but slightly lower compared to normal values (z-score: -0.5, 95% CI: -0.7 to -0.3, P < 0.001) with 3% of our ASD patients having a z-score >2.0 while 12% of the patients had a z-score <-2. CONCLUSION In our study population, we show the RVOT VTI and diameter to be relevant predictors in identifying an enlarged RVOT size and flow in children with moderate to large ASD.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria. ,
| | - William Ravekes
- Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Gernot Grangl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Wolfgang Raith
- Division of Neonatology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Gerhard Cvirn
- Institute of Physiological Chemistry, Centre of Physiological Medicine, Medical University Graz, Graz, Austria
| | - Marlene Grillitsch
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Andreas Gamillscheg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
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Kampman MAM, Siegmund AS, Bilardo CM, van Veldhuisen DJ, Balci A, Oudijk MA, Groen H, Mulder BJM, Roos-Hesselink JW, Sieswerda G, de Laat MWM, Sollie-Szarynska KM, Pieper PG. Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:231-239. [PMID: 27071979 DOI: 10.1002/uog.15938] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pregnancy in women with surgically corrected tetralogy of Fallot (ToF) is associated with cardiac, obstetric and neonatal complications. We compared uteroplacental Doppler flow (UDF) measurements and pregnancy outcome in women with ToF and in healthy women and aimed to assess whether a relationship exists between cardiac function and UDF in women with ToF. METHODS We evaluated prospectively pregnant women with ToF and healthy pregnant women from the ZAHARA studies. Clinical evaluation, standardized echocardiography and UDF measurements were performed at 20 and 32 weeks' gestation. RESULTS We included 62 women with ToF and 69 healthy controls. Cardiac complications, mostly arrhythmia, occurred in 8.1% of women with ToF. There was a higher incidence of small-for-gestational age (21.0% vs 4.4%, P = 0.004) and low birth weight (16.1% vs 2.9%, P = 0.009) in the group of women with ToF than in healthy controls. In women with ToF, early diastolic notching of uterine artery waveform at 20 and 32 weeks occurred more frequently (9.8% vs 1.5%, P = 0.034 and 7.0% vs 0%, P = 0.025, respectively) and the umbilical artery pulsatility index at 32 weeks was higher (1.02 ± 0.20 vs 0.94 ± 0.17, P = 0.015) than in healthy controls. Right ventricular function parameters prepregnancy and at 20 weeks' gestation were significantly associated with abnormal UDF. UDF parameters were associated with adverse neonatal outcome. CONCLUSION The majority of women with surgically corrected ToF tolerate pregnancy well. However, UDF indices are more frequently abnormal in these women, suggesting impaired placentation. The association of impaired right ventricular function parameters with abnormal UDF suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M A M Kampman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - A S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Balci
- Department of Cardiology, Isala, Zwolle, The Netherlands
| | - M A Oudijk
- Department of Obstetrics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - H Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - G Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M de Laat
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Sollie-Szarynska
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Timóteo AT, Branco LM, Rosa SA, Ramos R, Agapito AF, Sousa L, Galrinho A, Oliveira JA, Oliveira MM, Ferreira RC. Usefulness of right ventricular and right atrial two-dimensional speckle tracking strain to predict late arrhythmic events in adult patients with repaired Tetralogy of Fallot. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Timóteo AT, Branco LM, Rosa SA, Ramos R, Agapito AF, Sousa L, Galrinho A, Oliveira JA, Oliveira MM, Ferreira RC. Usefulness of right ventricular and right atrial two-dimensional speckle tracking strain to predict late arrhythmic events in adult patients with repaired Tetralogy of Fallot. Rev Port Cardiol 2016; 36:21-29. [PMID: 27939278 DOI: 10.1016/j.repc.2016.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/27/2016] [Accepted: 07/26/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine whether right ventricular and/or atrial speckle tracking strain is associated with previous arrhythmic events in patients with repaired tetralogy of Fallot. METHODS AND RESULTS We studied right ventricular and atrial strain in 100 consecutive patients with repaired tetralogy of Fallot referred for routine echocardiographic evaluation. Patients were divided into two groups, one with previous documentation of arrhythmias (n=26) and one without arrhythmias, in a median follow-up of 22 years. Patients with arrhythmias were older (p<0.001) and had surgical repair at an older age (p=0.001). They also had significantly reduced right ventricular strain (-14.7±5.5 vs. -16.9±4.0%, p=0.029) and right atrial strain (19.1±7.7% vs. 25.8±11.4%, p=0.001). Neither right ventricular nor right atrial strain were independent predictors of the presence of a history of documented arrhythmias, which was associated with age at correction and with the presence of residual defects. In a subanalysis after excluding 23 patients who had had more than one corrective surgery, right ventricular strain was an independent predictor of the presence of previous arrhythmic events (OR 1.19, 95% CI 1.02-1.38, p=0.025). Right atrial strain was also an independent predictor after adjustment (OR 0.93, 95% CI 0.87-0.99, p=0.029). The ideal cut-off for right ventricular strain was -15.3% and for right atrial strain 23.0%. CONCLUSIONS Compared with conventional echocardiographic parameters, strain measures of the right heart are associated with the presence of arrhythmic events, and may be useful for risk stratification of patients with repaired tetralogy of Fallot, although a prospective study is required.
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Affiliation(s)
- Ana T Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
| | - Luísa M Branco
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Sílvia A Rosa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ruben Ramos
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana F Agapito
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Lídia Sousa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana Galrinho
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - José A Oliveira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Mário M Oliveira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui C Ferreira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Théveniau-Ruissy M, Pérez-Pomares JM, Parisot P, Baldini A, Miquerol L, Kelly RG. Coronary stem development in wild-type and Tbx1 null mouse hearts. Dev Dyn 2016; 245:445-59. [PMID: 26708418 DOI: 10.1002/dvdy.24380] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary artery (CA) stems connect the ventricular coronary tree with the aorta. Defects in proximal CA patterning are a cause of sudden cardiac death. In mice lacking Tbx1, common arterial trunk is associated with an abnormal trajectory of the proximal left CA. Here we investigate CA stem development in wild-type and Tbx1 null embryos. RESULTS Genetic lineage tracing reveals that limited outgrowth of aortic endothelium contributes to proximal CA stems. Immunohistochemistry and fluorescent tracer injections identify a periarterial vascular plexus present at the onset of CA stem development. Transplantation experiments in avian embryos indicate that the periarterial plexus originates in mesenchyme distal to the outflow tract. Tbx1 is required for the patterning but not timing of CA stem development and a Tbx1 reporter allele is expressed in myocardium adjacent to the left but not right CA stem. This expression domain is maintained in Sema3c(-/-) hearts with a common arterial trunk and leftward positioned CA. Ectopic myocardial differentiation is observed on the left side of the Tbx1(-/-) common arterial trunk. CONCLUSIONS A periarterial plexus bridges limited outgrowth of the aortic endothelium with the ventricular plexus during CA stem development. Molecular differences associated with left and right CA stems provide new insights into the etiology of CA patterning defects.
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Affiliation(s)
| | - José-Maria Pérez-Pomares
- Department of Animal Biology, Instituto de Investigación Biomedica de Málaga (IBIMA), Faculty of Science, University of Málaga, Málaga, Spain.,Andalusian Centre for Nanomedicine and Biotechnology (BIONAND), Málaga, Spain
| | - Pauline Parisot
- Aix-Marseille University, CNRS, IBDM UMR 7288, Marseille, France
| | | | - Lucile Miquerol
- Aix-Marseille University, CNRS, IBDM UMR 7288, Marseille, France
| | - Robert G Kelly
- Aix-Marseille University, CNRS, IBDM UMR 7288, Marseille, France
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Risk Factors for Prosthetic Pulmonary Valve Failure in Patients With Congenital Heart Disease. Am J Cardiol 2015; 116:1252-6. [PMID: 26303636 DOI: 10.1016/j.amjcard.2015.07.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 11/21/2022]
Abstract
The incidence and risk factors for prosthetic pulmonary valve failure (PPVF) should be considered when determining optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with congenital heart disease (CHD). The cumulative freedom for reintervention due to PPVF after 146 PVR in 114 patients with CHD was analyzed. Six potential risk factors (underlying cardiac defect, history of palliative procedures, number of previous cardiac interventions, hemodynamic indication for PVR, type of intervention, and age at intervention) were analyzed using Cox proportional hazard modeling. Receiver operating characteristic (ROC) curves were used for discrimination. Internal validation in patients with tetralogy of Fallot was also performed. Median age at intervention was 23 years. There were 60 reinterventions due to PPVF (41%). Median event-free survival was 14 years (95% confidence interval [CI] 12 to 16 years). The only independent risk factor was the age at intervention (hazard ratio [HR] 0.93, 95% CI 0.90 to 0.97; p = 0.001; area under the ROC curve 0.95, 95% CI 0.92 to 0.98; p <0.001). The best cut-off point was 20.5 years. Freedom from reintervention for PPVF 15 years after surgery was 70% when it was performed at age >20.5 years compared with 33% when age at intervention was <20.5 years (p = 0.004). Internal validation in 102 PVR in patient cohort with tetralogy of Fallot (ROC area 0.98, 95% CI 0.96 to 1.0; p <0.001) was excellent. In conclusion, age at intervention is the main risk factor of reintervention for PPVF. The risk of reintervention is 2-fold when PVR is performed before the age of 20.5 years.
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Assessment of inter-atrial, inter-ventricular, and atrio-ventricular interactions in tetralogy of Fallot patients after surgical correction. Insights from two-dimensional speckle tracking and three-dimensional echocardiography. Cardiol Young 2015; 25:1254-62. [PMID: 25339059 DOI: 10.1017/s1047951114002108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to assess biatrial size and function, interactions on atrial and ventricular levels, and atrio-ventricular coupling in patients after tetralogy of Fallot repair. METHODS A total of 34 patients with a mean age of 20.9±9 years, and 35 healthy controls, underwent two-dimensional speckle tracking echocardiography for ventricular and atrial strain measurements and real-time three-dimensional echocardiography to assess ventricular and atrial volumes. RESULTS When compared with controls, tetralogy of Fallot patients had significantly reduced right atrial peak atrial longitudinal strain (p<0.01), right atrial peak atrial contraction strain (p<0.01), right atrial ejection fraction (p<0.01), left atrial peak atrial longitudinal strain (p<0.01), left atrial peak atrial contraction strain (p<0.05), and left atrial ejection fraction (p<0.01). In the tetralogy of Fallot group, left ventricular ejection fraction was negatively related to the right ventricular end-systolic volume normalised to body surface area (r=-0.62, p<0.01). An association was found in patients between the right atrial peak longitudinal strain and mean right ventricular strain (r=0.64, p<0.01). In patients, the left atrial peak longitudinal strain correlated negatively with right atrial end-diastolic volume normalised to body surface area (r=-0.67, p<0.01), whereas the left atrial ejection fraction correlated weakly with left ventricular ejection fraction (r=0.41, p<0.05). CONCLUSIONS In asymptomatic tetralogy of Fallot patients, biatrial dysfunction exists and can be quantified via two-dimensional speckle tracking echocardiography as well as real-time three-dimensional echocardiography. Different forms of interactions on atrial and ventricular levels are evident among such cohorts.
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Kokotsakis J, Rouska EG, Harling L, Ashrafian H, Anagnostakou V, Charitos C, Athanasiou T. Right ventricular outflow tract obstruction caused by double-chambered right ventricle presenting in adulthood. Tex Heart Inst J 2014; 41:425-8. [PMID: 25120399 DOI: 10.14503/thij-13-3398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often difficult to diagnose. We report the case of a 49-year-old man who presented with long-standing shortness of breath on exertion. Imaging revealed right ventricular outflow tract obstruction caused by a double-chambered right ventricle, and he was referred for surgical correction. This case emphasizes both the detailed perioperative evaluation that is needed when diagnosing adults who present with manifestations of congenital heart disease and a method of successful surgical correction that resulted in symptom resolution.
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Affiliation(s)
- John Kokotsakis
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Efthymia G Rouska
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Leanne Harling
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Hutan Ashrafian
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Vania Anagnostakou
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Christos Charitos
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
| | - Thanos Athanasiou
- Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom
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Abd El Rahman MY, Hui W, Schuck R, Rentzsch A, Berger F, Gutberlet M, Abdul-Khaliq H. Regional analysis of longitudinal systolic function of the right ventricle after corrective surgery of tetralogy of Fallot using myocardial isovolumetric acceleration index. Pediatr Cardiol 2014; 34:1848-53. [PMID: 23780551 DOI: 10.1007/s00246-013-0726-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
To assess regional longitudinal systolic function of the right ventricle in patients with repaired tetralogy of Fallot (TOF) by tissue Doppler imaging-derived isovolumetric acceleration (IVA) index and determine the effect of right-ventricular (RV) enlargement on regional systolic function. In 30 consecutive TOF patients and 30 age-matched controls, myocardial velocity of the RV ventricular free wall in the basal and middle regions were examined in the apical four-chamber view. Peak myocardial velocity during IVA was recorded on the free RV wall. IVA index was calculated as the difference between baseline and peak velocity divided by their time interval. In 23 of the studied TOF patients, magnetic resonance imaging was performed on the same day to determine global RV volume and ejection fraction. IVA index of the RV lateral free wall was significantly lower in the basal (8.31 ± 6.00 vs. 19.00 ± 10.85 m/s(2), p = 0.0001) and middle segments (6.56 ± 5.22 vs. 16.17 ± 7.44 m/s(2), p = 0.0001) in patients than in controls. Among TOF patients, a negative correlation was found between IVA index in the middle segment and RV end-diastolic volume/body surface area (r = -0.549, p < 0.01). Similar to other longitudinal RV wall parameters, the IVA index showed a decreased value in the RV free wall, which is related to the impaired regional and global longitudinal RV systolic dysfunction. RV enlargement adversely affects regional longitudinal systolic function.
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Zdradzinski MJ, Qureshi AM, Stewart R, Pettersson G, Krasuski RA. Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis. Am J Cardiol 2014; 114:300-4. [PMID: 24878128 DOI: 10.1016/j.amjcard.2014.04.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 01/18/2023]
Abstract
Patients with tetralogy of Fallot (TOF) after complete repair and pulmonic stenosis (PS) after surgical valvotomy often develop significant pulmonic regurgitation (PR) that eventually requires valve replacement. Although criteria exist for the timing of pulmonary valve replacement in TOF, it remains less clear when to intervene in valvotomy patients and whether TOF recommendations can be applied. Our aim was to compare the structural and functional sequelae of valvotomy for PS with complete repair for TOF. We compared the clinical characteristics, electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI), and invasive hemodynamics of 109 adults (34 PS and 75 TOF) newly referred to a congenital heart disease center for evaluation of PR between 2005 and 2012. Both cohorts were similar in terms of baseline demographics and presenting New York Heart Association function class. Valvotomy patients had a slightly greater degree of PR by echocardiogram, although it was similar by cardiac MRI. Electrocardiography QRS width was greater in patients with TOF (114±27 vs 150±28 ms, p<0.001). MRI right ventricular ejection fraction (49±8 vs 41±11%, p=0.001) and left ventricular ejection fraction (59±7 vs 52±10%, p=0.002) were lower in patients with TOF. Pacemaker or defibrillator implantation was significantly greater in patients with TOF (3% vs 23%, p=0.011). In conclusion, patients postvalvotomy and complete repair present with similar degrees of PR and severity of symptoms. Biventricular systolic function and electrocardiography QRS width appear less affected, suggesting morphologic changes in TOF and its repair that extend beyond the effects of PR. These findings suggest the need for developing disease-specific guidelines for patients with PR postvalvotomy.
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Pulmonic regurgitation and management challenges in the adult with tetralogy of fallot. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:314. [PMID: 24777673 DOI: 10.1007/s11936-014-0314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OPINION STATEMENT Patients with tetralogy of Fallot (TOF) are living longer than ever because of advances in surgery in childhood since the 1950s. However, surgery in childhood is not a cure and remains only a palliative procedure because almost all patients will require further intervention throughout life. The most common intervention required in adulthood is pulmonary valve replacement (PVR) because of residual pulmonary regurgitation leading to right ventricular dilation and eventual dysfunction. The most appropriate timing for PVR remains difficult to determine and is based on many factors. Our practice is to weigh not only objective factors such as right ventricular size and function but also careful objective assessment of the patient's current quality of life and functional status.
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Koestenberger M, Ravekes W, Nagel B, Avian A, Heinzl B, Cvirn G, Fritsch P, Fandl A, Rehak T, Gamillscheg A. Reference values of the right ventricular outflow tract systolic excursion in 711 healthy children and calculation of z-score values. Eur Heart J Cardiovasc Imaging 2014; 15:980-6. [DOI: 10.1093/ehjci/jeu041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Harris RC, Fries MH, Boyle A, Adeniji-Adele H, Cherian Z, Klein N, John AS. Multidisciplinary management of pregnancy in complex congenital heart disease: a model for coordination of care. CONGENIT HEART DIS 2014; 9:E204-11. [PMID: 24447432 DOI: 10.1111/chd.12163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
Abstract
With advancements in medical care, many women with complex congenital heart disease (CHD) are now living into adulthood and childbearing years. The strains of pregnancy and parturition can be dangerous in such patients, and careful interdisciplinary plans must be made to optimize maternal and fetal health through this process. Several large studies have been published regarding risk prediction and medical management of pregnancy in complex CHD, though few case studies detailing clinical care plans have been published. The objective of this report is to describe the process of developing a detailed pregnancy and delivery care plan for three women with complex CHD, including perspectives from the multidisciplinary specialists involved in the process. This article demonstrates that collaboration between specialists in the fields of cardiology, anesthesiology, high-risk obstetrics, maternal fetal medicine, and neonatology results in clinically successful individualized treatment plans for the management of pregnancy in complex CHD. Multidisciplinary collaboration is a crucial element in the management of pregnancy in complex CHD. We provide a template used in three cases which can serve as a model for the design of future care plans.
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Affiliation(s)
- Rachel C Harris
- Harvard Medical School, Massachusetts General Hospital, Boston, Mass, USA
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Piazza L, Chessa M, Giamberti A, Bussadori CM, Butera G, Negura DG, Micheletti A, Callus E, Carminati M. Timing of pulmonary valve replacement after tetralogy of Fallot repair. Expert Rev Cardiovasc Ther 2014; 10:917-23. [DOI: 10.1586/erc.12.67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Saremi F, Gera A, Yen Ho S, Hijazi ZM, Sánchez-Quintana D. CT and MR Imaging of the Pulmonary Valve. Radiographics 2014; 34:51-71. [DOI: 10.1148/rg.341135026] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tang YK, Flora Tsang HF, Ranjan Das S, Vance ML, Kussman BD. CASE 6—2013 Perioperative Management of an Adult Patient With Tetralogy of Fallot and Pheochromocytoma. J Cardiothorac Vasc Anesth 2013; 27:1399-406. [DOI: 10.1053/j.jvca.2013.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Indexed: 01/09/2023]
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Egidy Assenza G, Cassater D, Landzberg M, Geva T, Schreier J, Graham D, Volpe M, Barker N, Economy K, Valente AM. The effects of pregnancy on right ventricular remodeling in women with repaired tetralogy of Fallot. Int J Cardiol 2013; 168:1847-52. [DOI: 10.1016/j.ijcard.2012.12.071] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/03/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
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Yousif M, Elhassan NB, Ali SKM, Ahmed Y. Isolated subpulmonic fibrous ring, mirror-image dextrocardia and situs solitus in a young lady unreported and a near miss. Interact Cardiovasc Thorac Surg 2013; 17:1043-4. [PMID: 23962853 DOI: 10.1093/icvts/ivt278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Congenital diseases causing obstruction of the right ventricular outflow tract (RVOT) are common, but the isolated subpulmonary membrane/ring is extremely rare and can be difficult to diagnose precisely, especially in adults. We report a case of surgically resected isolated subpulmonic fibrous ring in a lady with mirror-image dextrocardia and abdominal situs solitus that was misdiagnosed by echocardiography as a subaortic membrane.
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Affiliation(s)
- Musaab Yousif
- Department of Cardiothoracic Surgery and Cardiology, Sudan Heart Institute, Khartoum, Sudan
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Biffi A, Delise P, Zeppilli P, Giada F, Pelliccia A, Penco M, Casasco M, Colonna P, D’Andrea A, D’Andrea L, Gazale G, Inama G, Spataro A, Villella A, Marino P, Pirelli S, Romano V, Cristiano A, Bettini R, Thiene G, Furlanello F, Corrado D. Italian Cardiological Guidelines for Sports Eligibility in Athletes with Heart Disease. J Cardiovasc Med (Hagerstown) 2013; 14:477-99. [DOI: 10.2459/jcm.0b013e32835f6a21] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Ordovas KG, Muzzarelli S, Hope MD, Naeger DM, Karl T, Reddy GP, Marchiori E, Higgins CB. Cardiovascular MR Imaging after Surgical Correction of Tetralogy of Fallot: Approach Based on Understanding of Surgical Procedures. Radiographics 2013; 33:1037-52. [DOI: 10.1148/rg.334115084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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