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Mavroudis C, Ong CS, Vricella LA, Cameron DE. Historical Accounts of Congenital Heart Surgery. World J Pediatr Congenit Heart Surg 2023; 14:626-641. [PMID: 37737603 DOI: 10.1177/21501351231186415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
We present historical accounts of congenital heart surgery since the early 1900s, as our specialty evolved from individual heroic efforts into an established and sophisticated surgical specialty with consistent and excellent results. We highlight colleagues and intrepid pioneers who have strived to solve seemingly insurmountable problems during this remarkable journey and celebrate continued success into the 21st century with surgical advances that have resulted in innovative operations, database inquiries, quality measures, new techniques of medical illustration, and the establishment of the Congenital Heart Surgeons' Society, which has become the leading organization dedicated to congenital heart surgery in North America.
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Affiliation(s)
- Constantine Mavroudis
- Department of Surgery, Johns Hopkins University School of Medicine, Peyton Manning Children's Hospital, Indianapolis, IN, USA
| | - Chin Siang Ong
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Luca A Vricella
- Department of Surgery, University of Chicago School of Medicine, Chicago, IL, USA
| | - Duke E Cameron
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Mavroudis C, Backer CL, Brown JW, Williams WG. The Congenital Heart Surgeons' Society Presidents and Their Contributions. World J Pediatr Congenit Heart Surg 2023; 14:559-571. [PMID: 37737595 DOI: 10.1177/21501351231181331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The Congenital Heart Surgeons' Society (CHSS) was founded by 16 congenital heart surgeons in 1973, who endeavored to share their clinical advances in an informal setting that would stimulate honest and forthright discussions. As the Society grew, prospective studies were organized from a centralized data center that was established and based first in Birmingham, Alabama, thence to Toronto, and recently in a collaboration between Toronto and the Cleveland Clinic. These studies formed the basis for a myriad of outcomes reports that favorably impacted surgical results. The Kirklin-Ashburn Fellowship was created and endowed by the membership which has been successful in training many congenital heart surgeons. The CHSS was then incorporated into a 501(c) (3) not-for-profit organization with bylaws, officers, and committees in 2002. Increased membership followed. The CHSS has become the face of congenital heart surgery in North America by affiliating with the World Journal for Pediatric and Congenital Heart Surgery, having one designated member on the American Board of Thoracic Surgery, and hosting joint meetings with the European Congenital Heart Surgeons Association. Since 2002, 11 presidents have been elected for two-year terms and have guided the advances that have been achieved by the CHSS. Their contributions and achievements are highlighted in chronological order.
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Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Peyton Manning Children's Hospital, Indianapolis, Indiana, USA
| | - Carl L Backer
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Kentucky, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John W Brown
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Hazekamp MG, Barron DJ, Dangel J, Homfray T, Jongbloed MRM, Voges I. Consensus document on optimal management of patients with common arterial trunk. Eur J Cardiothorac Surg 2021; 60:7-33. [PMID: 34017991 DOI: 10.1093/ejcts/ezaa423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mark G Hazekamp
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, Netherlands
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tessa Homfray
- Department of Medical Genetics, Royal Brompton and Harefield hospitals NHS Trust, London, UK
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric Cardiology, University Medical Center of Schleswig-Holstein, Kiel, Germany
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Dangrungroj E, Vijarnsorn C, Chanthong P, Chungsomprasong P, Kanjanauthai S, Durongpisitkul K, Soongswang J, Tantiwongkosri K, Subtaweesin T, Sriyoschati S. Long-term outcomes of repaired and unrepaired truncus arteriosus: 20-year, single-center experience in Thailand. PeerJ 2020; 8:e9148. [PMID: 32435545 PMCID: PMC7227657 DOI: 10.7717/peerj.9148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Truncus arteriosus (TA) is a complex congenital heart disease that carries morbidities in the first year of life. Previous authors have reported an operative mortality of 50%. In this report, we aim to report on the survival of patients with TA in our medical center in the recent era. Methods A retrospective review of all patients diagnosed with TA in Siriraj Hospital, Thailand from August 1995 to March 2018 was performed. Patients with single ventricle, hemiTA were excluded. The characteristics and outcomes of repaired and unrepaired TA patients with a known recent functional status in 2018 were reviewed. Operative mortality risks were analyzed using a multivariate model. Results A total of 74 patients (median age at referral: 70 days) were included in the cohort. One-third of the patients had associated anomalies including DiGeorge syndrome (13.5%). Anatomical repair was not performed in 22 patients (29.7%). The median age at time of repair for the 52 patients was 133 days (range: 22 days to 16.7 years). Complex TA was 10%. Early mortality occurred in 16 patients (30.8%). Five patients (9.6%) had late deaths at 0.3–1.2 years. Significant mortality risk was weight at time of operation <4 kg (HR 3.05, 95% CI [1.05–8.74], p-value 0.041). Of the 31 operation survivors, 17 required re-intervention within 0.4–11.4 years. Eight patients had reoperation at 8.7 years (range: 2.7–14.6 years) post-repair. Freedom from reoperation was 93%, 70.4%, and 31%, at 5, 10, and 15 years, respectively. All late survivors were in functional class I–II. Of the 22 unrepaired TA patients, 11 patients (50%) died (median age: 13.6 years; range: 14 days–32.8 years). Survival of unrepaired TA patients was 68.2%, 68.2%, and 56.8, at 5, 10, and 15 years of age, respectively. At the end of study, 11 survivors of TA with palliative treatment had a recent mean oxygen saturation value of 84.1 ± 4.8% and a mean weight for height of 81.4 ± 12.7%, which were significantly lower than those of 31 late-survivors who had undergone anatomical repair. Conclusion Contemporary survival rates of patients with TA following operation in the center has been gradually improved over time. Most of the operative mortality occurs in the early postoperative period. Compared to patients with TA who had palliative treatment, operative survivors have a better functional status even though they carry a risk for re-intervention.
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Affiliation(s)
- Ekkachai Dangrungroj
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakul Chanthong
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paweena Chungsomprasong
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaluck Kanjanauthai
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kritvikrom Durongpisitkul
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarupim Soongswang
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thaworn Subtaweesin
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Sriyoschati
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Misra A, Sriram C, Gupta P, Humes R. The Adult with Post-operative Congenital Heart Disease: a Systematic Echocardiographic Approach. Curr Cardiol Rep 2019; 21:29. [PMID: 30887232 DOI: 10.1007/s11886-019-1116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW This article attempts to review some of the commonly seen repaired congenital heart defects in the adult population (ACHD), with a focus on important echocardiographic findings that may assist a practitioner in recognizing and managing this group of patients. RECENT FINDINGS The prevalence of ACHD population is increasing, and currently, there are over 1 million adults with congenital heart disease. At the current time, the total number of ACHD patients exceeds the total number of pediatric patients with CHD. The recently released 2018 American College of Cardiology/American Heart Association guidelines for the management of adults with congenital heart disease (ACHD) recommends transthoracic echocardiography for all ACHD patients for initial assessment and serial assessment as needed (class of recommendation: I) and echocardiography remains the mainstay for diagnosing and managing these patients in adjunct with other available imaging modalities. It is imperative for all cardiologists to be familiar with the echocardiographic features of the commonly seen repaired CHD in adult population.
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Affiliation(s)
- Amrit Misra
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
| | - Chenni Sriram
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA.
| | - Pooja Gupta
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
| | - Richard Humes
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
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Abstract
OBJECTIVES Early surgical management of common arterial trunk is well established and has good prognosis. Late diagnosis is less common. We reviewed late-diagnosed common arterial trunk management and prognosis for children in developing countries. We also discuss the need for prior catheterisation. Material and methods We reviewed all common arterial trunk patients managed by our humanitarian organization since 1996. RESULTS A total of 41 children with common arterial trunk were managed at a mean age of 3 years old. The lack of adequate facilities in developing countries explains the late management. The decision to proceed with surgery was based on clinical and radiological symptoms of persistent shunt, particularly a high cutaneous saturation level, regardless of catheterization - not carried out systematically. Eight children had to be withdrawn and 33 (80.5%) received operation - mean saturation 91%. The postoperative course was marked by pulmonary arterial hypertension requiring specific treatment in 30% of cases. The operative mortality was 1/33. The 32 children returned home without treatment after a mean post operative stay of 49 days and were followed up (mean FU 3.4 years, none lost to follow-up). At last contact, 1 child died six months after surgery, 1 child had a massive truncal valve insufficiency, 5 had a significant stenosis of the RV-PA tube, and 2 have had further surgery for tube replacement. CONCLUSIONS Late management and surgery of common arterial trunk is possible with good long-term results without prior hemodynamic examination up to an advanced childhood when signs of left-to-right shunt persist. A high saturation level (above 88%) seems to be a good operability criterion.
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Louis C, Swartz MF, Simon BV, Cholette JM, Atallah-Yunes N, Wang H, Gensini F, Alfieris GM. Modified Repair of Type I and II Truncus Arteriosus Limits Early Right Ventricular Outflow Tract Reoperation. Semin Thorac Cardiovasc Surg 2018; 30:199-204. [DOI: 10.1053/j.semtcvs.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/11/2022]
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Wilder TJ. Don't toss the excess: Using the redundant truncal valve cusp may improve repair for truncus arteriosus. J Thorac Cardiovasc Surg 2017; 155:1190-1191. [PMID: 29249488 DOI: 10.1016/j.jtcvs.2017.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Travis J Wilder
- Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah.
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Buffinton CM, Benjamin AK, Firment AN, Moon AM. Myocardial wall stiffening in a mouse model of persistent truncus arteriosus. PLoS One 2017; 12:e0184678. [PMID: 28961240 PMCID: PMC5621674 DOI: 10.1371/journal.pone.0184678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background Genetic and epigenetic programs regulate dramatic structural changes during cardiac morphogenesis. Concurrent biomechanical forces within the heart created by blood flow and pressure in turn drive downstream cellular, molecular and genetic responses. Thus, a genetic-morphogenetic-biomechanical feedback loop is continually operating to regulate heart development. During the evolution of a congenital heart defect, concomitant abnormalities in blood flow, hemodynamics, and patterns of mechanical loading would be predicted to change the output of this feedback loop, impacting not only the ultimate morphology of the defect, but potentially altering tissue-level biomechanical properties of structures that appear structurally normal. Aim The goal of this study was to determine if abnormal hemodynamics present during outflow tract formation and remodeling in a genetically engineered mouse model of persistent truncus arteriosus (PTA) causes tissue-level biomechanical abnormalities. Methods The passive stiffness of surface locations on the left ventricle (LV), right ventricle (RV), and outflow tract (OFT) was measured with a pipette aspiration technique in Fgf8;Isl1Cre conditional mutant embryonic mouse hearts and controls. Control and mutant experimental results were compared by a strain energy metric based on the measured relationship between pressure and aspirated height, and also used as target behavior for finite element models of the ventricles. Model geometry was determined from 3D reconstructions of whole-mount, confocal-imaged hearts. The stress-strain relationship of the model was adjusted to achieve an optimal match between model and experimental behavior. Results and conclusion Although the OFT is the most severely affected structure in Fgf8;Isl1Cre hearts, its passive stiffness was the same as in control hearts. In contrast, both the LV and RV showed markedly increased passive stiffness, doubling in LVs and quadrupling in RVs of mutant hearts. These differences are not attributable to differences in ventricular volume, wall thickness, or trabecular density. Excellent agreement was obtained between the model and experimental results. Overall our findings show that hearts developing PTA have early changes in ventricular tissue biomechanics relevant to cardiac function and ongoing development.
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Affiliation(s)
- Christine Miller Buffinton
- Department of Mechanical Engineering, Bucknell University, Lewisburg, Pennsylvania, United States of America
- * E-mail:
| | - Alyssa K. Benjamin
- Department of Biology, Bucknell University, Lewisburg, Pennsylvania, United States of America
| | - Ashley N. Firment
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Medical Center, Danville, Pennsylvania, United States of America
| | - Anne M. Moon
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Medical Center, Danville, Pennsylvania, United States of America
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