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Rocha LO, Miyague NI, Solarewicz LA, Fernandes-Silva MM. Impact of Age and of the Patent Ductus Arteriosus on Pulmonary Hemodynamics in Children with Complete Atrioventricular Septal Defect. Pediatr Cardiol 2024:10.1007/s00246-024-03636-0. [PMID: 39223337 DOI: 10.1007/s00246-024-03636-0] [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: 06/05/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Complete atrioventricular septal defect (CAVSD) can lead to the development of pulmonary obstructive vascular disease due to high pulmonary blood flow and pressures. This study aimed to evaluate the changes in pulmonary hemodynamics with aging and with patent ductus arteriosus (PDA) in children with CAVSD. We retrospectively evaluated 137 children (94% with trisomy 21, median age of 195 (25-2963) days, 58.4% female) with CASVD referred to cardiac catheterization from January 2000 to December 2020. Those with associated congenital heart disease, except PDA, had been excluded. They were divided into three age terciles (T1, T2, and T3). Aging was directly associated with higher mean (T1: 34.2 ± 9.1; T2: 37.1 ± 5.8; T3: 42 ± 10.6 mmHg, p < 0.001) and diastolic (T1: 19.4 ± 5.3; T2 21.6 ± 5.0; T3: 26.0 ± 9.5 mmHg, P < 0.001) pulmonary arterial pressures, and with higher pulmonary vascular resistance (T1: 3.24 ± 1.69, T2: 3.47 ± 1.19; T3: 4.49 ± 3.91 Wu.m2, p = 0.023). This resulted in a loss of eligibility for anatomical correction, which became evident only after 300 days of age. PDA was associated with a higher mean (37.2 [35.9; 38.5] vs. 41.3 [37.5; 45.0] mmHg, p = 0.049) and diastolic (21.7 [20.7; 22.6] vs. 26.4 [24.1; 29.0] mmHg, p = 0.001) pulmonary pressure, and resistor-compliance time (0.28 [0.26; 0.29] vs. 0.36 [0.31; 0.40], p = 0.001) after adjusting for age and sex. In children with CAVSD, aging was associated with worsening of pulmonary vascular hemodynamics, particularly when PDA was associated, resulting in loss of eligibility for anatomical correction after 10 months of age as the first surgical option.
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Condos GJ, McCabe JM, Joffe DC, Sheu RD. Novel Transcatheter Approach to Treat Primum Atrial Septal Defects. CASE (PHILADELPHIA, PA.) 2024; 8:180-185. [PMID: 38524970 PMCID: PMC10954577 DOI: 10.1016/j.case.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Degenerative common AVC defect can mimic rheumatic MV stenosis.•Closure of primum ASD can be achieved percutaneously.•Live 3D multiplanar TEE is crucial for procedural guidance.
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Affiliation(s)
- Gregory J. Condos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - James M. McCabe
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Denise C. Joffe
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, Seattle, Washington
| | - Richard D. Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Zhang QL, Chen YK, Lin SH, Du XW, Chen Q, Wang SM, Cao H. Tricuspid mechanical valve replacement for severe tricuspid stenosis in a child who underwent surgical correction of complete atrioventricular septal defect, a rare long-term complications. J Cardiothorac Surg 2024; 19:77. [PMID: 38336747 PMCID: PMC10858579 DOI: 10.1186/s13019-024-02580-7] [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: 12/13/2022] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Complete atrioventricular septal defect is a complicated congenital heart malformations, and surgical correction is the best treatment, the severe tricuspid stenosis is a rare long-term complication after the surgery. CASE PRESENTATION We report a case with the complication of severe tricuspid stenosis 7 years after the surgical correction of complete atrioventricular septal defect in a child. Then the patient underwent tricuspid mechanical valve replacement, Glenn, atrial septostomy, and circumconstriction of the right pulmonary artery. CONCLUSIONS The patient recovered successfully with good short-term.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yu-Kun Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shi-Hao Lin
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xin-Wei Du
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shun-Min Wang
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
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Habermann AC, Meza JM, Dischinger AN, Kang L, Prabhu NK, Benkert AR, Turek JW, Andersen ND. Predictors of increased postoperative length of stay after complete atrioventricular canal repair. Cardiol Young 2023; 33:1657-1662. [PMID: 36168722 PMCID: PMC11075806 DOI: 10.1017/s1047951122003067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The optimal timing of surgical repair for infants with complete atrioventricular canal defect remains controversial, as there are risks to both early and late repair. We address this debate by investigating the association of various risk factors, including age and weight at surgery, markers of failure to thrive, and pulmonary vascular disease, with postoperative length of stay following complete atrioventricular canal repair. METHODS Infants who underwent repair of complete atrioventricular canal were identified from our institutional Society of Thoracic Surgeons Congenital Heart Surgery Database. Additional clinical data were collected from the electronic medical record. Descriptive statistics were computed. Associations between postoperative length of stay and covariates of interest were evaluated using linear regression with bootstrap aggregation. RESULTS From 2001 to 2020, 150 infants underwent isolated complete atrioventricular canal repair at our institution. Pre-operative failure to thrive and evidence of pulmonary disease were common. Surgical mortality was 2%. In univariable analysis, neither weight nor age at surgery were associated with mortality, postoperative length of stay, duration of mechanical ventilation, or post-operative severe valvular regurgitation. In multivariable analysis of demographic and preoperative clinical factors using bootstrap aggregation, increased postoperative length of stay was only significantly associated with previous pulmonary artery banding (33.9 day increase, p = 0.03) and preoperative use of supplemental oxygen (19.9 day increase, p = 0.03). CONCLUSIONS Our analysis shows that previous pulmonary artery banding and preoperative use of supplemental oxygen were associated with increased postoperative length of stay after complete atrioventricular canal repair, whereas age and weight were not. These findings suggest operation prior to the onset of pulmonary involvement may be more important than reaching age or weight thresholds.
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Affiliation(s)
- Alyssa C. Habermann
- Department of Surgery, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - James M. Meza
- Department of Surgery, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Ashley N. Dischinger
- Department of Pediatrics, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Lillian Kang
- Department of Surgery, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Neel K. Prabhu
- Department of Surgery, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Abigail R. Benkert
- Department of Surgery, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Joseph W. Turek
- Department of Surgery, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Nicholas D. Andersen
- Department of Surgery, Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
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Kumar R, Halder V, Ghosh S, Thingnam S, Singh H, Mishra AK, Mahajan S, Aggarwal P, Dutta ARS, Mishra A. Early and Mid-Term Outcomes of Primary Repair After Atrioventricular Canal Defect: A Single-Center Eight-Year Experience. Cureus 2023; 15:e45304. [PMID: 37846269 PMCID: PMC10576971 DOI: 10.7759/cureus.45304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND/AIM Surgical repair techniques and management of patients with atrioventricular septal defect (AVSD) have progressed over the last few decades. Early and definitive interventions have become the choice of treatment for these patients. Based on this background, we aimed to review the early and mid-term outcomes of primary AVSD repair. METHODS A total of 53 patients with a mean age of 3.45 ± 5.67 years underwent definitive repair for AVSD between January 2014 and June 2021. The clinical data including age, type of defect, associated co-anomalies, symptoms, pulmonary hypertension, etc. were collected and assessed retrospectively. Mitral regurgitation (MR) as a clinical outcome was assessed at 0, 1, 2, and 5 years. RESULTS Among the recruited patients, 35 (66.1%) were male and 18 (33.9%) were female. Of 53 patients, repair for the complete defect was done in 38 (71.69%) patients, repair for intermediate/partial defect was done in 15 (23.1%) patients, and one patient underwent repair for incomplete type. Other associated co-anomalies were anterior mitral leaflet (12 (22.6%)), atrial and ventricular septal defect (VSD) (30 (56.6%)), and patent ductus arteriosus (PDA) (11 (20.8%)). Different procedures for surgical repair included patch closure, cleft repair, and polytetrafluoroethylene (PTFE) VSD closure. After repair, the mean follow-up period was 46.73 ± 27.37 months. Overall mortality was 3.78% (2/53), and two patients underwent reintervention due to symptomatic severe MR. CONCLUSIONS A definitive and timely correction of AVSD shows satisfactory early and mid-term results.
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Affiliation(s)
- Rupesh Kumar
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vikram Halder
- Department of Cardiothoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, IND
| | - Soumitra Ghosh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Shyam Thingnam
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Harkant Singh
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Anand K Mishra
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sachin Mahajan
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Pankaj Aggarwal
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Aduri Raja S Dutta
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Amit Mishra
- Department of Cardiothoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, IND
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Nemes A, Kormányos Á, Ruzsa Z, Achim A, Ambrus N, Lengyel C. Three-Dimensional Speckle-Tracking Echocardiography-Derived Tricuspid Annular Dimensions and Right Atrial Strains in Healthy Adults-Is There a Relationship? (Insights from the MAGYAR-Healthy Study). J Clin Med 2023; 12:4240. [PMID: 37445275 DOI: 10.3390/jcm12134240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION The tricuspid valve and its annulus (TA) are thought to be integrally related to right atrial (RA) size and function. The present study aimed to assess associations between TA dimensions and RA strains, and quantitative features of its contractility were determined by 3DSTE in healthy adults. METHODS The study comprised 145 healthy volunteers with a mean age of 34.4 ± 12.5 years (73 males). Electrocardiographic, two-dimensional Doppler echocardiographic and 3DSTE parameters were in normal reference ranges in all subjects. RESULTS Enlarged TA areas, regardless of which phase of the cardiac cycle were measured, were not associated with the deterioration of peak RA strains in longitudinal (LS) and circumferential (CS) directions. Increased end-diastolic TA area was associated with reduced RA strain in the radial direction (RS). Dilation of end-diastolic and end-systolic TA areas was related to increased RA volumes. End-diastolic TA area was the smallest in case of increased peak global RA-RS, and other associations between increasing TA areas and peak global strains could not be detected. Peak global RA-CS and RA-LS were not related to TA areas. Increasing peak global RA-RS was not associated with peak global RA-LS and RA-CS, while increasing peak global RA-LS and RA-CS were not associated with peak global RA-RS. Increasing peak global RS did not show associations with RA volumes, Vmin was the smallest in the case of highest peak global RA-CS and RA-LS. Vmax increased with increasing peak global RA-LS. CONCLUSIONS 3DSTE is suitable for simultaneous non-invasive determination of TA dimensions and RA volumes and strains using the same acquired 3D dataset, allowing physiologic studies. RA volumes are associated with end-diastolic and end-systolic TA areas. RA strains in radial direction (RS) show associations with end-diastolic TA area.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Árpád Kormányos
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Zoltán Ruzsa
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Alexandru Achim
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Nóra Ambrus
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, H-6725 Szeged, Hungary
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Daene M, De Pauw L, De Meester P, Troost E, Moons P, Gewillig M, Rega F, Van De Bruaene A, Budts W. Outcome of Down patients with repaired versus unrepaired atrioventricular septal defect. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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8
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Rosca I, Turenschi A, Nicolescu A, Constantin AT, Canciu AM, Dica AD, Bratila E, Coroleuca CA, Nastase L. Endocrine Disorders in a Newborn with Heterozygous Galactosemia, Down Syndrome and Complex Cardiac Malformation: Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050856. [PMID: 37241085 DOI: 10.3390/medicina59050856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Down syndrome is the most common chromosomal abnormality diagnosed in newborn babies. Infants with Down syndrome have characteristic dysmorphic features and can have neuropsychiatric disorders, cardiovascular diseases, gastrointestinal abnormalities, eye problems, hearing loss, endocrine and hematologic disorders, and many other health issues. We present the case of a newborn with Down syndrome. The infant was a female, born at term through c-section. She was diagnosed before birth with a complex congenital malformation. In the first few days of life, the newborn was stable. In her 10th day of life, she started to show respiratory distress, persistent respiratory acidosis, and persistent severe hyponatremia, and required intubation and mechanical ventilation. Due to her rapid deterioration our team decided to do a screening for metabolic disorders. The screening was positive for heterozygous Duarte variant galactosemia. Further testing on possible metabolic and endocrinologic issues that can be associated with Down syndrome was performed, leading to hypoaldosteronism and hypothyroidism diagnoses. The case was challenging for our team because the infant also had multiple metabolic and hormonal deficiencies. Newborns with Down syndrome often require a multidisciplinary team, as besides congenital cardiac malformations they can have metabolic and hormonal deficiencies that can negatively impact their short- and long-term prognosis.
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Affiliation(s)
- Ioana Rosca
- Neonatology Department, Clinical Hospital of Obstetrics and Gynecology "Prof. Dr. P.Sirbu", 060251 Bucharest, Romania
- Faculty of Midwifery and Nursery, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
| | - Alina Turenschi
- Emergency Clinical Hospital for Children "Grigore Alexandrescu", 011743 Bucharest, Romania
| | - Alin Nicolescu
- Cardiology Department, Emergency Clinical Hospital for Children "M.S. Curie", 41451 Bucharest, Romania
| | - Andreea Teodora Constantin
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
- Pediatrics Department, National Institute for Mother and Child Health "Alessandrescu-Rusescu", 020395 Bucharest, Romania
| | - Adina Maria Canciu
- Emergency Clinical Hospital for Children "Grigore Alexandrescu", 011743 Bucharest, Romania
| | - Alice Denisa Dica
- Pediatric Neurology Department, Clinical Psychiatric Hospital "Al. Obregia", 041914 Bucharest, Romania
| | - Elvira Bratila
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
- Obstetrics and Gynecology Department, Clinical Hospital of Obstetrics and Gynecology "Prof. Dr. P.Sirbu", 060251 Bucharest, Romania
| | - Ciprian Andrei Coroleuca
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
- Obstetrics and Gynecology Department, Clinical Hospital of Obstetrics and Gynecology "Prof. Dr. P.Sirbu", 060251 Bucharest, Romania
| | - Leonard Nastase
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
- Neonatology Department, National Institute for Mother and Child Health "Alessandrescu-Rusescu", 011061 Bucharest, Romania
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Transcatheter Edge-to-Edge Repair for Left Atrioventricular Valve Cleft After Previously Repaired Complete Atrioventricular Canal Defect in Down Syndrome. CASE (PHILADELPHIA, PA.) 2022; 7:35-38. [PMID: 36704485 PMCID: PMC9871344 DOI: 10.1016/j.case.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
TEER of mitral leaflet clefts has been reported sparingly. Patients with DS may have left AVV disease including clefts. TEER may be feasible in high surgical risk patients with AVV cleft.
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Balpande N, Bodhey NK, Singh S. Cardiac Computed Tomography Pictorial Equivalent of Angiographic Gooseneck Sign in a Case of Atrioventricular Septal Defect with Cor Triatriatum Sinister. Heart Views 2022; 23:235-239. [PMID: 36605927 PMCID: PMC9809459 DOI: 10.4103/heartviews.heartviews_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/02/2022] [Indexed: 01/07/2023] Open
Abstract
In the literature, multiple radiological signs of clinically important congenital cardiovascular abnormalities have been described which are named as per the object they resemble. These signs are very useful in learning. The Gooseneck sign is a sign seen in left ventricle catheter angiography in case of an atrioventricular septal defect. This sign has not been demonstrated on a cardiac computed tomography (CT) so far, to the best of our knowledge. We present a case showing cardiac CT pictorial equivalent of angiographic Gooseneck sign.
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Affiliation(s)
- Nikhil Balpande
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Narendra Kuber Bodhey
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Satyajit Singh
- Department of Cardiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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The effect of surgical technique, age, and Trisomy 21 on early outcome of surgical management of complete atrioventricular canal defect. Cardiol Young 2022; 32:869-873. [PMID: 34350818 DOI: 10.1017/s1047951121003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The optimal timing, surgical technique, and the influence of Trisomy 21 on the outcome of surgical repair of Complete Atrioventricular Canal Defect remains uncertain. We reviewed our experience in the repair of CAVC to identify the influence of these factors on operative outcomes. METHODS A prospective study included 70 patients, who underwent repair of CAVC at our institute between July, 2016 and October, 2019. Primary endpoint was mortality and the secondary endpoint was a degree of left atrioventricular valve regurgitation. RESULTS No significant difference was noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single-patch technique showed a significant reduction in bypass time (71.13 ± 13.507 min versus 99.19 ± 27.092 min, p-value = 0.001). Compared to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2 + 43 versus 7 %, p-value = 0.03) and at 6 months of follow-up (LAVV 2 + 35.4 versus 0 %, p-value = 0.01), respectively. CONCLUSIONS Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with a significant decrease in post-operative LAVV regurgitation and early mortality in comparison to the closure of cleft only.
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12
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Vera F, Sarria E, Ortiz A, García N, Conejo L, Ruiz E. Cirugía de reparación valvular mitral en el canal auriculoventricular completo. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Predisposition to atrioventricular septal defects may be caused by SOX7 variants that impair interaction with GATA4. Mol Genet Genomics 2022; 297:671-687. [PMID: 35260939 DOI: 10.1007/s00438-022-01859-5] [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: 06/01/2021] [Accepted: 01/12/2022] [Indexed: 10/18/2022]
Abstract
Atrioventricular septal defects (AVSD) are a complicated subtype of congenital heart defects for which the genetic basis is poorly understood. Many studies have demonstrated that the transcription factor SOX7 plays a pivotal role in cardiovascular development. However, whether SOX7 single nucleotide variants are involved in AVSD pathogenesis is unclear. To explore the potential pathogenic role of SOX7 variants, we recruited a total of 100 sporadic non-syndromic AVSD Chinese Han patients and screened SOX7 variants in the patient cohort by targeted sequencing. Functional assays were performed to evaluate pathogenicity of nonsynonymous variants of SOX7. We identified three rare SOX7 variants, c.40C > G, c.542G > A, and c.743C > T, in the patient cohort, all of which were found to be highly conserved in mammals. Compared to the wild type, these SOX7 variants had increased mRNA expression and decreased protein expression. In developing hearts, SOX7 and GATA4 were highly expressed in the region of atrioventricular cushions. Moreover, SOX7 overexpression promoted the expression of GATA4 in human umbilical vein endothelial cells. A chromatin immunoprecipitation assay revealed that SOX7 could directly bind to the GATA4 promoter and luciferase assays demonstrated that SOX7 activated the GATA4 promoter. The SOX7 variants had impaired transcriptional activity relative to wild-type SOX7. Furthermore, the SOX7 variants altered the ability of GATA4 to regulate its target genes. In conclusion, our findings showed that deleterious SOX7 variants potentially contribute to human AVSD by impairing its interaction with GATA4. This study provides novel insights into the etiology of AVSD and contributes new strategies to the prenatal diagnosis of AVSD.
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14
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Morton SU, Quiat D, Seidman JG, Seidman CE. Genomic frontiers in congenital heart disease. Nat Rev Cardiol 2022; 19:26-42. [PMID: 34272501 PMCID: PMC9236191 DOI: 10.1038/s41569-021-00587-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
The application of next-generation sequencing to study congenital heart disease (CHD) is increasingly providing new insights into the causes and mechanisms of this prevalent birth anomaly. Whole-exome sequencing analysis identifies damaging gene variants altering single or contiguous nucleotides that are assigned pathogenicity based on statistical analyses of families and cohorts with CHD, high expression in the developing heart and depletion of damaging protein-coding variants in the general population. Gene classes fulfilling these criteria are enriched in patients with CHD and extracardiac abnormalities, evidencing shared pathways in organogenesis. Developmental single-cell transcriptomic data demonstrate the expression of CHD-associated genes in particular cell lineages, and emerging insights indicate that genetic variants perturb multicellular interactions that are crucial for cardiogenesis. Whole-genome sequencing analyses extend these observations, identifying non-coding variants that influence the expression of genes associated with CHD and contribute to the estimated ~55% of unexplained cases of CHD. These approaches combined with the assessment of common and mosaic genetic variants have provided a more complete knowledge of the causes and mechanisms of CHD. Such advances provide knowledge to inform the clinical care of patients with CHD or other birth defects and deepen our understanding of the complexity of human development. In this Review, we highlight known and candidate CHD-associated human genes and discuss how the integration of advances in developmental biology research can provide new insights into the genetic contributions to CHD.
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Affiliation(s)
- Sarah U. Morton
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Genetics, Harvard Medical School, Boston, MA, USA.,These authors contributed equally: Sarah U. Morton, Daniel Quiat
| | - Daniel Quiat
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Genetics, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA.,These authors contributed equally: Sarah U. Morton, Daniel Quiat
| | | | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA.,Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA.,Howard Hughes Medical Institute, Harvard University, Boston, MA, USA.,
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15
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Qabha H, Alanazi T, Khouqeer M, Dawary M, Khouqeer F. A surgical approach of an unusual variant of complete atrioventricular defect; A case report. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Complete atrioventricular canal is a congenital heart defect that is characterized by an atrial septal defect, ventricular septal defect, and a common atrioventricular valve. Standard surgical techniques for repairing complete atrioventricular canal defect mainly includes repairing the defect with a single patch, a double patch, or with the modified single patch technique.
Case presentation
This paper presents a novel surgical repair technique of an unusual anatomical presentation for a complete atrioventricular canal defect in a patient with Down syndrome.
Conclusions
Unusual anatomical variant for congenital heart defects occurs frequently, which gives surgeons real opportunities to innovate surgical approaches. This patient was an example of an unusual anatomical presentation for complete atrioventricular canal, and the surgical technique used for this patient was novel. Follow up for these patients is mandatory for long term results.
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16
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Complete atrio-ventricular canal in natural history. A case in adulthood and a mini-review. COR ET VASA 2021. [DOI: 10.33678/cor.2021.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Zhang X, Wang B, You G, Xiang Y, Fu Q, Yu Y, Zhang X. Copy number variation analysis in Chinese children with complete atrioventricular canal and single ventricle. BMC Med Genomics 2021; 14:243. [PMID: 34627233 PMCID: PMC8502261 DOI: 10.1186/s12920-021-01090-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is one of the most common birth defects. Copy number variations (CNVs) have been proved to be important genetic factors that contribute to CHD. Here we screened genome-wide CNVs in Chinese children with complete atrioventricular canal (CAVC) and single ventricle (SV), since there were scarce researches dedicated to these two types of CHD. METHODS We screened CNVs in 262 sporadic CAVC cases and 259 sporadic SV cases respectively, using a customized SNP array. The detected CNVs were annotated and filtered using available databases. RESULTS Among 262 CAVC patients, we identified 6 potentially-causative CNVs in 43 individuals (16.41%, 43/262), including 2 syndrome-related CNVs (7q11.23 and 8q24.3 deletion). Surprisingly, 90.70% CAVC patients with detected CNVs (39/43) were found to carry duplications of 21q11.2-21q22.3, which were recognized as trisomy 21 (Down syndrome, DS). In CAVC with DS patients, the female to male ratio was 1.6:1.0 (24:15), and the rate of pulmonary hypertension (PH) was 41.03% (16/39). Additionally, 6 potentially-causative CNVs were identified in the SV patients (2.32%, 6/259), and none of them was trisomy 21. Most CNVs identified in our cohort were classified as rare (< 1%), occurring just once among CAVC or SV individuals except the 21q11.2-21q22.3 duplication (14.89%) in CAVC cohort. CONCLUSIONS Our study identified 12 potentially-causative CNVs in 262 CAVC and 259 SV patients, representing the largest cohort of these two CHD types in Chinese population. The results provided strong correlation between CAVC and DS, which also showed sex difference and high incidence of PH. The presence of potentially-causative CNVs suggests the etiology of complex CHD is incredibly diverse, and CHD candidate genes remain to be discovered.
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Affiliation(s)
- Xingyu Zhang
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Wang
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoling You
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Xiang
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qihua Fu
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yongguo Yu
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiaoqing Zhang
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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18
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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Olariu IC, Popoiu A, Ardelean AM, Isac R, Steflea RM, Olariu T, Chirita-Emandi A, Stroescu R, Gafencu M, Doros G. Challenges in the Surgical Treatment of Atrioventricular Septal Defect in Children With and Without Down Syndrome in Romania-A Developing Country. Front Pediatr 2021; 9:612644. [PMID: 34307243 PMCID: PMC8292620 DOI: 10.3389/fped.2021.612644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Atrioventricular septal defect (AVSD) is a cardiac malformation that accounts for up to 5% of total congenital heart disease, occurring with high frequency in people with Down Syndrome (DS). We aimed to establish the surgical challenges and outcome of medical care in different types of AVSD in children with DS compared to those without DS (WDS). Methods: The study included 62 children (31 with DS) with AVSD, evaluated over a 5 year period. Results: Complete AVSD was observed in 49 (79%) children (27 with DS). Six children had partial AVSD (all WDS) and seven had intermediate types of AVSD (4 with DS). Eight children had unbalanced complete AVSD (1 DS). Median age at diagnosis and age at surgical intervention in complete AVSD was not significantly different in children with DS compared to those WDS (7.5 months vs. 8.6). Median age at surgical intervention for partial and transitional AVSDs was 10.5 months for DS and 17.8 months in those without DS. A large number of patients were not operated: 13/31 with DS and 8/31 WDS. Conclusion: The complete form of AVSD was more frequent in DS group, having worse prognosis, while unbalanced AVSD was observed predominantly in the group without DS. Children with DS required special attention due to increased risk of pulmonary hypertension. Late diagnosis was an important risk factor for poor prognosis, in the setting of suboptimal access to cardiac surgery for patients in Romania. Although post-surgery mortality was low, infant mortality before surgery remains high. Increased awareness is needed in order to provide early diagnosis of AVSD and enable optimal surgical treatment.
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Affiliation(s)
- Ioana-Cristina Olariu
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pediatrics, "Louis Turcanu" Emergency Hospital for Children, Timisoara, Romania
| | - Anca Popoiu
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pediatrics, "Louis Turcanu" Emergency Hospital for Children, Timisoara, Romania
| | - Andrada-Mara Ardelean
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pediatrics, "Louis Turcanu" Emergency Hospital for Children, Timisoara, Romania
| | - Raluca Isac
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pediatrics, "Louis Turcanu" Emergency Hospital for Children, Timisoara, Romania
| | - Ruxandra Maria Steflea
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Tudor Olariu
- Department of Organic Chemistry, Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Adela Chirita-Emandi
- Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine Timisoara, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Regional Centre of Medical Genetics Timis, "Louis Turcanu" Emergency Hospital for Children Timisoara, Part of ERN ITHACA, Timisoara, Romania
| | - Ramona Stroescu
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pediatrics, "Louis Turcanu" Emergency Hospital for Children, Timisoara, Romania
| | - Mihai Gafencu
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pediatrics, "Louis Turcanu" Emergency Hospital for Children, Timisoara, Romania
| | - Gabriela Doros
- Department of Pediatrics, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pediatrics, "Louis Turcanu" Emergency Hospital for Children, Timisoara, Romania
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20
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Abstract
The focus of this article is noncardiac surgery in the adult with congenital heart disease (CHD). The purpose is to provide the general and pediatric anesthesiologist with a basic overview of the most common congenital cardiac lesions, their long-term sequelae, and expected perioperative concerns during noncardiac surgery. Because of the very heterogeneous nature of CHD, it is difficult to make a single article a comprehensive guide for every lesion and its associated perioperative concerns. The authors hope to provide those who are not specifically trained in congenital cardiac anesthesia the basic principles and a greater understanding of each defect.
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Affiliation(s)
- Meagan King
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Anesthesiology, University of Minnesota, B515 Mayo, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
| | - Kumar Belani
- Department of Anesthesiology, University of Minnesota, B515 Mayo, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA
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21
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Hu Y, Gu M, Hua W, Li H, Niu H, Liu X, Zhang S. Left bundle branch pacing, the only feasible physiological pacing modality for a patient with complete atrioventricular septal defect after surgical correction. J Cardiovasc Electrophysiol 2019; 30:3002-3005. [PMID: 31670426 DOI: 10.1111/jce.14256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/17/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Yiran Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Li
- Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Hongxia Niu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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22
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Dawary MA, Alshamdin FD, Alkhalaf LH, Alkhamis AO, Khouqeer FA. Outcomes of surgical repair of complete atrioventricular canal defect in patients younger than 2 years of age. Ann Saudi Med 2019; 39:422-425. [PMID: 31804135 PMCID: PMC6894453 DOI: 10.5144/0256-4947.2019.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early surgical management of complete atrioventricular (AV) canal defect is the optimal treatment option. Since the published evidence on outcomes is inconclusive, we retrospectively studied the outcomes of patients in our institution. OBJECTIVE Study outcomes of complete AV canal repair. DESIGN Retrospective, descriptive. SETTINGS Single institute. PATIENTS AND METHODS Medical records of patients under 2 years of age who underwent complete AV canal repair from January 2004 to December 2014 were retrospectively reviewed. MAIN OUTCOME MEASURES Pre- and postoperative morbidity and mortality. SAMPLE SIZE 140 patients. RESULT The median (IQR) age at the time of surgery was 5.4 (3.9-8.2) months. Down syndrome was diagnosed in 98 (70%) of patients. AV valve regurgitation was found preoperatively in 129 (92%) and postoperatively in 135 (96%) patients. There was a significant association between preoperative pulmonary hypertension and the development of pulmonary hypertension in the postoperative period ( P=.04). Thirty-three patients needed reoperation. Arrhythmia was found in 19 patients, 16 of whom required pacemaker insertion. Seven patients died (5%). CONCLUSION The presence of preoperative and postoperative AV valve regurgitation was common in this cohort but did not significantly affect patient survival. Our findings suggest an acceptable outcome for repair of complete AV septal defect with few complications postoperatively. LIMITATION Retrospective in single institute. CONFLICT OF INTEREST None.
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Affiliation(s)
- Mohannad Ali Dawary
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Louai Hassan Alkhalaf
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Othman Alkhamis
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fareed Ahmed Khouqeer
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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23
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Wang W, Feng P, Wang L, Dong Q, Huang W. Endocarditis and bacterial brain abscess in a young woman with a single atrium, patent ductus arteriosus, and Eisenmenger syndrome: A case report. Medicine (Baltimore) 2019; 98:e17044. [PMID: 31490396 PMCID: PMC6739013 DOI: 10.1097/md.0000000000017044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
RATIONALE A single atrium is a rare congenital heart disease (CHD) involving zero atrial septal traces and preserved intact ventricular septum and atrioventricular valves, requiring careful surgical intervention. However, developing to Eisenmenger syndrome (ES) makes the surgery complicated. Based on bidirectional cardiac shunting, vegetation easily develops in case of bacterial infection. PATIENT CONCERN AND DIAGNOSES We reported a 35-year-old woman with a single atrium, patent ductus arteriosus, pulmonary hypertension, and ES who developed infective endocarditis on her left ventricular outflow tract and complicated cerebral abscess and who underwent challenged medical treatment. INTERVENTION Infection was successfully controlled after 4-time change in antibiotics over 4 months. However, surgery is complicated for her. OUTCOMES The patient presented a relatively good outcome during follow-up for >6 months. LESSONS This case report suggests that patients with complex CHD should accept surgery therapy earlier before developing ES. It is imperative to avoid invasive interventions to prevent infectious endocarditis.
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24
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Nampijja D. Burden of Heart Diseases in Children Attending Cardiology Clinic in a Regional Referral Hospital in Uganda. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/icpjl.2017.04.00102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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25
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THE CLINICAL FEATURES OF ATRIOVENTRICULAR CANAL DEFECT. EUREKA: HEALTH SCIENCES 2017. [DOI: 10.21303/2504-5679.2017.00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atrioventricular canal defect (AVCD) is a congenital heart defect, which occurs in 2.9 % of all congenital heart defects (CHD) and is characterized by a wide variety of anatomical forms and often don’t have clear cardiac manifestation. Untreated AVCD may lead to the development of pulmonary hypertension.
Aim. To determine clinical features of AVCD in children, considering variable anatomical forms of the pathology and its association with genetic pathology.
Materials and methods. Patients history and outpatient statistic records of children with AVCD, who were admitted to Lviv Regional Children’s Hospital from September 1999 till January 2016 have been analyzed (n=84).
The aspects of clinical manifestation of AVCD without associated pathology have been identified (n=48). Clinical manifestation of complete (n=36) and incomplete (n=12) AVCD and clinical manifestation with and without Down syndrome have been discussed.
Children with AVCD were divided into two groups: A – children with complete (n=36) and B – with incomplete (n=12) form of AVCD. Group A was divided into A1 – with trisomy 21 (n=14), A2 – without genetic pathology (n=22).
Results. In group А2 – 36,36±10,26 % and in group В – 50±14,4 % children were asymptomatic. Dyspnea, increased sweating during feeds, growth retardation and frequent respiratory viral infections during early childhood period were leading symptoms. Most frequent auscultation findings were accent of II heart sound over the pulmonary artery and 2-3/6 systolic murmur over left sternal border. According to echocardiographic examination mitral valve insufficiency was predominantly of mild grade, tricuspid insufficiency and pulmonary hypertension was diagnosed in group А2 with the frequency of 9,09±6,13 %).
Conclusions: The absence of clinical features in group A2 and B 36,36±10,26 and 50,00±14,40 respectively, saturation levels 92,36±0,49 % in patients without genetic pathology and 95,25±0,40 % with incomplete AVCD provide a need to adopt protocol of children examination with saturation level under 95 % and compulsory echocardiographic diagnosis within the first month of life
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26
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Mahadevaiah G, Gupta M, Ashwath R. Down Syndrome with Complete Atrioventricular Septal Defect, Hypertrophic Cardiomyopathy, and Pulmonary Vein Stenosis. Tex Heart Inst J 2015; 42:458-61. [PMID: 26504441 DOI: 10.14503/thij-14-4256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The prevalence of congenital heart disease in infants with Down syndrome is 40%, compared with 0.3% in children who have normal chromosomes. Atrioventricular and ventricular septal defects are often associated with chromosomal aberrations, such as in trisomy 21, whereas hypertrophic cardiomyopathy is chiefly thought to be secondary to specific gene mutations. We found only one reported case of congenital hypertrophic cardiomyopathy and atrioventricular septal defect in an infant with Down syndrome. Here, we report atrioventricular septal defect, hypertrophic cardiomyopathy, and pulmonary vein stenosis in a neonate with Down syndrome-an apparently unique combination. In addition, we discuss the relevant medical literature.
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27
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Rice K, Simpson J. Three-dimensional echocardiography of congenital abnormalities of the left atrioventricular valve. Echo Res Pract 2015; 2:R13-24. [PMID: 26693328 PMCID: PMC4676473 DOI: 10.1530/erp-15-0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 01/01/2023] Open
Abstract
Congenital abnormalities of the left atrioventricular (AV) valve are a significant diagnostic challenge. Traditionally, reliance has been placed on two-dimensional echocardiographic (2DE) imaging to guide recognition of the specific morphological features. Real-time 3DE can provide unique views of the left AV valve with the potential to improve understanding of valve morphology and function to facilitate surgical planning. This review illustrates the features of congenital abnormalities of the left AV valve assessed by 3DE. The similarities and differences in morphology between different lesions are described, both with respect to the valve itself and supporting chordal apparatus. The potential advantages as well as limitations of this technique in clinical practice are outlined.
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Affiliation(s)
- Kathryn Rice
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust , Westminster Bridge Road, London, SE1 7EH , UK
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust , Westminster Bridge Road, London, SE1 7EH , UK
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28
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Chen X, Xiao B, Yang W, Chen Y, Zhang W, Zhu H. Complete endocardial cushion defects in pregnancy: a case report. J Med Case Rep 2014; 8:91. [PMID: 24607268 PMCID: PMC3976158 DOI: 10.1186/1752-1947-8-91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/10/2014] [Indexed: 11/10/2022] Open
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29
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Schrope DP. Atrioventricular septal defects: Natural history, echocardiographic, electrocardiographic, and radiographic findings in 26 cats. J Vet Cardiol 2013; 15:233-42. [DOI: 10.1016/j.jvc.2013.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/19/2013] [Accepted: 06/18/2013] [Indexed: 11/24/2022]
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30
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Atrioventricular septal defects among infants in Europe: a population-based study of prevalence, associated anomalies, and survival. Cardiol Young 2013. [PMID: 23182167 DOI: 10.1017/s1047951112001400] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the epidemiology of chromosomal and non-chromosomal cases of atrioventricular septal defects in Europe. METHODS Data were obtained from EUROCAT, a European network of population-based registries collecting data on congenital anomalies. Data from 13 registries for the period 2000-2008 were included. RESULTS There was a total of 993 cases of atrioventricular septal defects, with a total prevalence of 5.3 per 10,000 births (95% confidence interval 4.1 to 6.5). Of the total cases, 250 were isolated cardiac lesions, 583 were chromosomal cases, 79 had multiple anomalies, 58 had heterotaxia sequence, and 23 had a monogenic syndrome. The total prevalence of chromosomal cases was 3.1 per 10,000 (95% confidence interval 1.9 to 4.3), with a large variation between registers. Of the 993 cases, 639 cases were live births, 45 were stillbirths, and 309 were terminations of pregnancy owing to foetal anomaly. Among the groups, additional associated cardiac anomalies were most frequent in heterotaxia cases (38%) and least frequent in chromosomal cases (8%). Coarctation of the aorta was the most common associated cardiac defect. The 1-week survival rate for live births was 94%. CONCLUSION Of all cases, three-quarters were associated with other anomalies, both chromosomal and non-chromosomal. For infants with atrioventricular septal defects and no chromosomal anomalies, cardiac defects were often more complex compared with infants with atrioventricular septal defects and a chromosomal anomaly. Clinical outcomes for atrioventricular septal defects varied between regions. The proportion of termination of pregnancy for foetal anomaly was higher for cases with multiple anomalies, chromosomal anomalies, and heterotaxia sequence.
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31
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Agopian AJ, Moulik M, Gupta-Malhotra M, Marengo LK, Mitchell LE. Descriptive epidemiology of non-syndromic complete atrioventricular canal defects. Paediatr Perinat Epidemiol 2012; 26:515-24. [PMID: 23061687 PMCID: PMC3482101 DOI: 10.1111/ppe.12006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete atrioventricular canal defects (CAVC) are a common heart defect, but few epidemiologic studies have evaluated non-syndromic CAVC. Risk factors for non-syndromic CAVC have not been well established. METHODS To assess the relationship between risk for non-syndromic CAVC in offspring and several sociodemographic and reproductive parental factors, including maternal diabetes and obesity, we conducted Poisson regression analyses, using data ascertained through the Texas Birth Defects Registry, a large, population-based birth defects registry. Data were evaluated for 563 non-syndromic cases with CAVC. RESULTS Significant associations were observed between non-syndromic CAVC in offspring and maternal pregestational diabetes (adjusted prevalence ratio (aPR) 6.74; 95% confidence interval (CI) 3.67, 12.37), gestational diabetes (aPR 1.69; 95% CI 1.03, 2.79) and obesity (aPR 1.69; 95% CI 1.24, 2.30). CONCLUSIONS Our findings add non-syndromic CAVC to the growing list of birth defects that appear to be associated with maternal diabetes and obesity.
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Affiliation(s)
- A. J. Agopian
- Center for Human Genetics, Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas
| | - Mousumi Moulik
- Division of Cardiology, Department of Pediatrics, University of Texas Medical School, Houston, Texas
| | - Monesha Gupta-Malhotra
- Division of Cardiology, Department of Pediatrics, University of Texas Medical School, Houston, Texas
| | - Lisa K. Marengo
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Laura E. Mitchell
- Center for Human Genetics, Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas,Correspondence: Laura E. Mitchell, Ph.D., University of Texas School of Public Health, 1200 Herman Pressler Dr., Houston, TX 77030, , Phone: 713-500-9954, Fax: 713-500-9958
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Kaza E, Marx GR, Kaza AK, Colan SD, Loyola H, Perrin DP, Del Nido PJ. Changes in left atrioventricular valve geometry after surgical repair of complete atrioventricular canal. J Thorac Cardiovasc Surg 2011; 143:1117-24. [PMID: 22078711 DOI: 10.1016/j.jtcvs.2011.06.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/07/2011] [Accepted: 06/07/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The most common reason for late surgical reintervention after repair of complete atrioventricular canal defects is the development of left atrioventricular valve regurgitation. We sought to determine the changes in left atrioventricular valve geometry after surgical repair that may predispose to regurgitation. METHODS Atrioventricular valve measurements were obtained by 2-dimensional echocardiography at 3 different time points (preoperative, early postoperative, and midterm postoperative [6-12 months]). Left atrioventricular valve annulus area and left ventricular volume were calculated; vena contracta of the regurgitant jet orifice was measured. All measurements were normalized relative to an appropriate power of body surface area. RESULTS From January 2000 to January 2008, 101 patients with complete atrioventricular canal repair were included. Left atrioventricular valve annulus was noted to remodel from an elliptical shape to a circular shape after surgery. Left atrioventricular valve annulus area increased early postoperatively (systole: 4.1 ± 0.2 cm(2)/m(2) vs 6.1 ± 0.3 cm(2)/m(2), P < .001; diastole: 7.2 ± 0.4 cm(2)/m(2) vs 10.0 ± 0.5 cm(2)/m(2), P < .001, pre- vs postoperative, respectively). This increase was sustained in the midterm postoperative period (systole: 6.1 ± 0.3 cm(2)/m(2), P = .85, vs diastole: 10.0 ± 0.4 cm(2)/m(2), P = .78, early vs midterm postoperative). Left ventricular volume increased in the early and midterm postoperative periods compared with preoperative (systole: 16.9 ± 1.2 mL/m(2) vs 26.2 ± 1.7 mL/m(2), P < .001; diastole: 35.0 ± 2.4 mL/m(2) vs 52.5 ± 3.2 mL/m(2), P < .001). CONCLUSIONS Complete atrioventricular canal repair leads to left atrioventricular valve annular shape change with increased area and circular shape. The change in left atrioventricular valve annulus shape appeared to be mainly due to increased circumference in the posterior free wall of the annulus. These findings may provide a mechanism for the progression of central regurgitation seen after complete atrioventricular canal repair and a potential solution.
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Affiliation(s)
- Elisabeth Kaza
- Division of Cardiac Surgery and Cardiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
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Yamano S, Uechi M, Tanaka K, Hori Y, Ebisawa T, Harada K, Mizukoshi T. Surgical Repair of a Complete Endocardial Cushion Defect in a Dog. Vet Surg 2011; 40:408-12. [DOI: 10.1111/j.1532-950x.2011.00797.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Emergency department diagnosis of atrial and ventricular septal defects, bicuspid aortic valve and pulmonary hypertension. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0061-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction
A 41-year-old Cuban man with Down syndrome and mental retardation was brought to the Emergency Department for episodes of worsening shortness of breath over one day. Bedside color Doppler ultrasound subcostal and apical four-chamber examination of the heart revealed atrial and ventricular septal defects with left-to-right shunting of blood. A right ventricular outflow tract view revealed a bicuspid aortic valve, and continuous wave Doppler ultrasound in the right ventricular inflow tract view revealed tricuspid regurgitation and pulmonary hypertension.
Conclusion
Bedside echocardiography with color Doppler and continuous wave Doppler imaging can assist the emergency physician and the critical care physician in the diagnosis of ASD, VSD, bicuspid aortic valve, and pulmonary hypertension in the Down syndrome patient who is short of breath.
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Rodríguez Dehli C, Ariza Hevia F, Riaño Galán I, Moro Bayón C, Suárez Menéndez E, Mosquera Tenreiro C, García López E. Epidemiología de las cardiopatías congénitas en Asturias durante el período 1990–2004. An Pediatr (Barc) 2009; 71:502-9. [DOI: 10.1016/j.anpedi.2009.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 07/07/2009] [Accepted: 08/02/2009] [Indexed: 01/13/2023] Open
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Nomoto K, Hollinger I, DiLuozzo G, Fischer GW. Recognition of a cleft mitral valve utilizing real-time three-dimensional transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging 2008; 10:367-9. [PMID: 19074783 DOI: 10.1093/ejechocard/jen318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a case in which real-time three-dimensional transoesophageal echocardiography was utilized to obtain better understanding of a cleft mitral valve. Additionally, the embryological development of a cleft mitral valve will be reiterated.
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Affiliation(s)
- Koichi Nomoto
- Department of Anesthesiology, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1010, New York, NY 10029, USA
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Abstract
The development of the embryonic heart is dependent upon the generation and incorporation of different mesenchymal subpopulations that derive from intra- and extra-cardiac sources, including the endocardium, epicardium, neural crest, and second heart field. Each of these populations plays a crucial role in cardiovascular development, in particular in the formation of the valvuloseptal apparatus. Notwithstanding shared mechanisms by which these cells are generated, their fate and function differ profoundly by their originating source. While most of our early insights into the origin and fate of the cardiac mesenchyme has come from experimental studies in avian model systems, recent advances in transgenic mouse technology has enhanced our ability to study these cell populations in the mammalian heart. In this article, we will review the current understanding of the role of cardiac mesenchyme in cardiac morphogenesis and discuss several new paradigms based on recent studies in the mouse.
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Affiliation(s)
- Brian S Snarr
- Department of Cell Biology and Anatomy, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Halit V, Oktar GL, Imren VY, Iriz E, Erer D, Kula S, Tunaoglu FS, Gokgoz L, Olgunturk R. Traditional single patch versus the “Australian” technique for repair of complete atrioventricular canal defects. Surg Today 2008; 38:999-1003. [DOI: 10.1007/s00595-008-3786-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 01/21/2008] [Indexed: 11/30/2022]
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