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Carvalho ES, Penha JG, Maeda NY, Abud KCO, Souza MFS, Castro CRP, Dos Santos JX, Pereira J, Lopes AA. Down syndrome and postoperative hemodynamics in patients undergoing surgery for congenital cardiac communications. Sci Rep 2024; 14:16612. [PMID: 39025999 PMCID: PMC11258288 DOI: 10.1038/s41598-024-67097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
Although Down syndrome (DS) is considered a risk factor for hemodynamic instabilities (mainly pulmonary hypertension-PH) following surgery for congenital cardiac communications, many DS patients do surprising well postoperatively. We prospectively analyzed perioperative factors for a possible correlation with post-cardiopulmonary bypass (CPB) inflammatory reaction and postoperative PH in pediatric subjects. Sixty patients were enrolled (age 3 to 35 months), 39 of them with DS. Clinical and echocardiographic parameters (anatomical and hemodynamic) were computed preoperatively. Pulmonary and systemic mean arterial pressures (PAP and SAP) were assessed invasively intra and postoperatively. Immediate postoperative PAP/SAP ratio (PAP/SAPIPO) and the behavior of pressure curves were selected as primary outcome. Serum levels of 36 inflammatory proteins were measured by chemiluminescence preoperatively and 4 h post CPB. Of all factors analyzed, peripheral oxygen saturation (O2Sat, bedside assessment) was the only preoperative predictor of PAP/SAPIPO at multivariate analysis (p = 0.007). Respective values in non-DS, DS/O2Sat ≥ 95% and DS/O2Sat < 95% subgroups were 0.34 (0.017), 0.40 (0.027) and 0.45 (0.026), mean (SE), p = 0.004. The difference between non-DS and DS groups regarding postoperative PAP curves (upward shift in DS patients, p = 0.015) became nonsignificant (p = 0.114) after adjustment for preoperative O2Sat. Post-CPB levels of at least 5 cytokines were higher in patients with O2Sat < 95% versus those at or above this level, even within the DS group (p < 0.05). Thus, a baseline O2Sat < 95% representing pathophysiological phenomena in the airways and the distal lung, rather than DS in a broad sense, seems to be associated with post-CPB inflammation and postoperative PH in these patients.
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Affiliation(s)
- Eloisa Sassá Carvalho
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Juliano Gomes Penha
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Kelly Cristina O Abud
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Claudia R P Castro
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Johnny X Dos Santos
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Juliana Pereira
- Laboratory of Medical Investigation On Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo, São Paulo, Brazil
| | - Antonio Augusto Lopes
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil.
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Heart Institute (InCor) - HCFMUSP, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil.
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Nawaytou H, Lakkaraju R, Stevens L, Reddy VM, Swami N, Keller RL, Teitel DF, Fineman JR. Management of pulmonary vascular disease associated with congenital left-to-right shunts: A single-center experience. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00438-0. [PMID: 38763305 DOI: 10.1016/j.jtcvs.2024.05.007] [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: 12/09/2023] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE The study objective was to describe the course and outcomes of children under 18 years of age, with left-to-right shunts and pulmonary arterial hypertension undergoing 1 of 2 management approaches: pulmonary arterial hypertension treatment before left-to-right shunt repair (Treat First) and left-to-right shunt repair first with or without subsequent pulmonary arterial hypertension treatment (Repair First). METHODS We performed a retrospective single-center study, conducted from September 2015 to September 2021, of children with left-to-right shunts and pulmonary arterial hypertension (defined as indexed pulmonary vascular resistance ≥ 4 Wood units [WU]∗m2) but without Eisenmenger physiology. Patient characteristics, longitudinal hemodynamics data, pulmonary arterial hypertension management, left-to-right shunt repair, and outcomes were reviewed. RESULTS Of 768 patients evaluated for left-to-right shunt closure, 51 (6.8%) had left-to-right shunts associated with pulmonary arterial hypertension (median age 1.1 [0.37-5] years, median indexed pulmonary vascular resistance 6 [5.2-8.7] WU∗m2). In the "Treat First" group (n = 33, 65%), 27 patients (82%) underwent left-to-right shunt closure and 6 patients (18%) did not respond to pulmonary arterial hypertension therapy and did not undergo left-to-right shunt closure. In the "Repair First" group (n = 18, 35%), 12 patients (67%) received pulmonary arterial hypertension therapy and 6 patients (33%) did not. Mortality rates were 6% in the "Treat First" group and 11% in "Repair First" group with follow-ups of 3.4 and 2.5 years, respectively. After left-to-right shunt closure, there was no significant change in indexed pulmonary vascular resistance over a median follow-up of 2 years after surgery (P = .77). CONCLUSIONS In children with left-to-right shunts and associated pulmonary arterial hypertension, treatment with pulmonary arterial hypertension-targeted therapy before defect repair does not appear to endanger the subjects and may have some benefit. The response to pulmonary arterial hypertension-targeted therapy before shunt closure persists 2 to 3 years postclosure, providing valuable insights into the long-term management of these patients.
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Affiliation(s)
- Hythem Nawaytou
- Department of Pediatrics, Cardiology, University of California, San Francisco, Calif.
| | - Ramya Lakkaraju
- Department of Pediatrics, Cardiology, University of California, San Francisco, Calif; University of Massachusetts Chan Medical School, Worcester, Mass
| | - Leah Stevens
- Department of Pediatrics, Intensive Care, University of California, San Francisco, Calif
| | - Vadiyala Mohan Reddy
- Department of Surgery, Cardiothoracic Surgery, University of California, San Francisco, Calif
| | - Naveen Swami
- Department of Surgery, Cardiothoracic Surgery, University of California, San Francisco, Calif
| | - Roberta L Keller
- Department of Pediatrics, Neonatology, University of California, San Francisco, Calif
| | - David F Teitel
- Department of Pediatrics, Cardiology, University of California, San Francisco, Calif
| | - Jeffrey R Fineman
- Department of Pediatrics, Intensive Care, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif
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Ivy DD, Frank BS. Treat and Repair for Congenital Heart Disease and Pulmonary Hypertension: Not a Panacea. JACC. ADVANCES 2024; 3:100891. [PMID: 38939683 PMCID: PMC11198098 DOI: 10.1016/j.jacadv.2024.100891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- D. Dunbar Ivy
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Benjamin S. Frank
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
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Sato M, Saiki H, Saito K, Sato A, Kuwata S, Nakano S, Koizumi J, Oyama K, Akasaka M. Successful Atrial Septal Defect Closure Subsequent to Medical Pulmonary Preconditioning in an Infant With Severe Pulmonary Hypertension Associated With Bronchopulmonary Dysplasia. Cureus 2024; 16:e57290. [PMID: 38690499 PMCID: PMC11058753 DOI: 10.7759/cureus.57290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
While atrial septal defect (ASD) may contribute to right ventricular decompression in patients with severe pulmonary hypertension (PH), the pulmonary vasculature might be compromised by increased pulmonary blood flow, even though pulmonary vasodilators successfully reduce resistance. ASD closure is a treatment option that may ameliorate PH symptoms associated with bronchopulmonary dysplasia (BPD) in infants. However, the feasibility of ASD closure is obscure in patients with BPD-PH causing right-to-left shunting. Here, we present an eight-month-old girl with ASD complicated by BPD-PH, in which the pulmonary pressure exceeded the systemic pressure; the ASD was successfully closed after pulmonary preconditioning with dexamethasone and high-dose diuretics. Our patient was delivered as the third baby in triplets at a gestational age of 25 weeks, with a birth weight of 344 g. She was diagnosed with BPD at three months of age (37 weeks of postmenstrual age) with a body weight of 1.4 kg. Mild pulmonary hypertension was identified at the age of five months, and oral sildenafil was initiated. While her atrial septal defect was small at the time of PH diagnosis, it became hemodynamically significant when she grew up to 3.4 kg of body weight, at seven months after birth. Her estimated right ventricular pressure was apparently more than the systemic pressure, and oxygen saturation fluctuated between 82% and 97% under oxygen supplementation due to bidirectional interatrial shunt with predominant right-to-left shunting. Pulmonary preconditioning lowered the estimated right ventricular pressure to almost equal the systemic pressure and elevated arterial oxygen saturation while also suppressing right-to-left shunting. Cardiac catheterization after preconditioning revealed a ratio of pulmonary blood pressure to systemic blood pressure ratio (Pp/Ps) of 0.9, pulmonary resistance of 7.3 WU-m2, and a pulmonary to systemic blood flow ratio (Qp/Qs) of 1.3 (approximately 1.0 in the normal circulation without significant shunt), with the cardiac index of 2.8 L/min/m2. The acute pulmonary vasoreactivity test against the combination of 20 ppm nitric oxide and 100% oxygen was negative, although the patient had consistently high pulmonary flow with makeshift improvements after preconditioning. Despite the high pulmonary resistance even after preconditioning, aggressive ASD closure was performed so that pulmonary flow could be consistently suppressed regardless of the pulmonary condition. Her Pp/Ps under 100% oxygen with 20 ppm nitric oxide was 0.7 immediately after closure. After two years of follow-up, her estimated right ventricular pressure was less than half of the systemic pressure with the use of three pulmonary vasodilators, including sildenafil, macitentan, and beraprost. A strategy to temporarily improve PH and respiratory status aimed at ASD closure could be a treatment option for the effective use of multiple pulmonary vasodilators, by which intensive treatment of BPD can be achieved.
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Affiliation(s)
- Maki Sato
- Neonatology and Pediatrics, Iwate Medical University, Shiwa, JPN
| | - Hirofumi Saiki
- Pediatric Cardiology, Iwate Medical University, Shiwa, JPN
| | - Kanchi Saito
- Pediatric Cardiology, Iwate Medical University, Shiwa, JPN
| | - Akira Sato
- Pediatric Cardiology, Iwate Medical University, Shiwa, JPN
| | - Seiko Kuwata
- Pediatric Cardiology, Iwate Medical University, Shiwa, JPN
| | - Satoshi Nakano
- Pediatric Cardiology, Iwate Medical University, Shiwa, JPN
| | - Junichi Koizumi
- Cardiovascular Surgery, Iwate Medical University, Shiwa, JPN
| | - Kotaro Oyama
- Pediatrics, Michinoku Medical Center on Disability and Health, Shiwa, JPN
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Calderón-Colmenero J, Massó F, González-Pacheco H, Sandoval J, Guerrero C, Cervantes-Salazar J, García-Montes JA, Paéz A, Pereira-López GI, Zabal-Cerdeira C, Sandoval JP. Pulmonary arterial hypertension in children with congenital heart disease: a deeper look into the role of endothelial progenitor cells and circulating endothelial cells to assess disease severity. Front Pediatr 2023; 11:1200395. [PMID: 37484769 PMCID: PMC10357291 DOI: 10.3389/fped.2023.1200395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Endothelial progenitor cells and circulating endothelial cells have been proposed as useful markers of severity and disease progression in certain vascular diseases, including pulmonary arterial hypertension. Our study focused on evaluating the levels of circulating endothelial progenitor cells and circulating endothelial cells in patients with congenital left-to-right shunts and pulmonary hypertension undergoing definitive repair. Endothelial progenitor cells (identified by simultaneous co-expression of CD45dim, CD34 + and KDR2 + surface antibodies) and circulating endothelial cells (identified by simultaneous co-expression of inherent antibodies CD45-, CD31+, CD146 + and CD105+) were prospectively measured in seventy-four children (including children with Down syndrome), median age six years (2.75-10), with clinically significant left-to-right shunts undergoing transcatheter or surgical repair and compared to thirty healthy controls. Endothelial progenitor cells and, particularly, circulating endothelial cells were significantly higher in children with heart disease and pulmonary arterial hypertension when compared to controls. Endothelial progenitor cells showed significant correlation with pulmonary vascular resistance index when measured both systemically (r = 0.259; p = 0.026) and in the superior vena cava (r = 0.302; p = 0.009). Children with Down syndrome showed a stronger correlation between systemic cellularity and pulmonary vascular resistance index (r = 0.829; p = 0.002). Endothelial progenitor cells were reduced along their transit through the lung, whereas circulating endothelial cells did not suffer any modification across the pulmonary circulation. In children with yet to be repaired left-to-right shunts, endothelial progenitor cells and circulating endothelial cell counts are increased compared to healthy subjects.
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Affiliation(s)
- Juan Calderón-Colmenero
- Department of Pediatric Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Felipe Massó
- Department of Molecular Biology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | | | - Julio Sandoval
- Department of Cardiopulmonary Medicine, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Carlos Guerrero
- Department of Pediatric Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Jorge Cervantes-Salazar
- Department of Cardiovascular Surgery in Congenital Heart Disease, Instituto Nacional de Cardiologia Ignacio Chavez, MexicoCity, Mexico
| | - José A. García-Montes
- Department of Pediatric Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Araceli Paéz
- Department of Molecular Biology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Gabriela I. Pereira-López
- Department of Pediatric Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Carlos Zabal-Cerdeira
- Department of Pediatric Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Juan Pablo Sandoval
- Department of Pediatric Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
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Sun L, Li JJ, Xu YK, Xie YM, Wang SS, Zhang ZW. Initial status and 3-month results relating to the use of biodegradable nitride iron stents in children and the evaluation of right ventricular function. Front Cardiovasc Med 2022; 9:914370. [PMID: 35979021 PMCID: PMC9376250 DOI: 10.3389/fcvm.2022.914370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pulmonary artery stenosis is often associated with congenital heart disease. The aim of the study was to evaluate the efficacy and safety of stenting for branch pulmonary artery stenosis using a biodegradable nitride iron stent (IBS® Angel™) and right ventricular systolic and diastolic function. Methods From July 2021 to February 2022, a total of 11 cases (ages ranged from 36 to 86 months old) were included in this pre and post-intervention, prospective, cohort and preclinical study. All cases underwent transthoracic echocardiographic (TTE), chest radiography, along with computed tomography (256-slice scanner, multiple-detector) and right heart catheterization. Different types of biodegradable nitride iron stents were implanted. TTE was performed serially 1 day, 1 month and 3 months after the procedure to evaluate the rate of restenosis and right ventricular function. Results Stenting was successful in 11 patients. There were no major adverse cardiovascular events related to the device or to the procedure. Blood perfusion in the branch pulmonary artery was improved immediately. At follow-up, there was no significant restenosis that required re-intervention. None of the patients suffered from in-stent thrombosis, vascular embolism, stent displacement or heart failure. Compared with normal values, there were statistical with regards to FAC, E/A and E′/A′. Furthermore, we found that TAPSE correlated significantly with pulsed Doppler S wave (p = 0.008) and left ventricular ejection fraction (p < 0.01). The early trans-tricuspid inflow velocities E/E′ (tissue doppler at the lateral tricuspid annulus) correlated significantly with E′/A′ (p = 0.009). FAC and E′/A′ were statistically different from those prior to stenting (p = 0.041 and p = 0.035) when tested one month postoperatively. At three months postoperatively, only E/A showed a statistical difference (p = 0.015). Conclusion Our analysis suggests that biodegradable nitride iron stents are feasible, safe, and effective in children. Some small improvements were observed in right ventricular systolic and diastolic function after successful transcatheter intervention, although change was not statistically significant due to the small sample number. (A clinical Trial to Evaluate the Safety and Efficacy of IBS Angel in Patients With Pulmonary Artery Stenosis (IRIS); NCT04973540).
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Hypoxia signaling in human health and diseases: implications and prospects for therapeutics. Signal Transduct Target Ther 2022; 7:218. [PMID: 35798726 PMCID: PMC9261907 DOI: 10.1038/s41392-022-01080-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
Molecular oxygen (O2) is essential for most biological reactions in mammalian cells. When the intracellular oxygen content decreases, it is called hypoxia. The process of hypoxia is linked to several biological processes, including pathogenic microbe infection, metabolic adaptation, cancer, acute and chronic diseases, and other stress responses. The mechanism underlying cells respond to oxygen changes to mediate subsequent signal response is the central question during hypoxia. Hypoxia-inducible factors (HIFs) sense hypoxia to regulate the expressions of a series of downstream genes expression, which participate in multiple processes including cell metabolism, cell growth/death, cell proliferation, glycolysis, immune response, microbe infection, tumorigenesis, and metastasis. Importantly, hypoxia signaling also interacts with other cellular pathways, such as phosphoinositide 3-kinase (PI3K)-mammalian target of rapamycin (mTOR) signaling, nuclear factor kappa-B (NF-κB) pathway, extracellular signal-regulated kinases (ERK) signaling, and endoplasmic reticulum (ER) stress. This paper systematically reviews the mechanisms of hypoxia signaling activation, the control of HIF signaling, and the function of HIF signaling in human health and diseases. In addition, the therapeutic targets involved in HIF signaling to balance health and diseases are summarized and highlighted, which would provide novel strategies for the design and development of therapeutic drugs.
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Sevim D, Felder S. Decision Thresholds for Medical Tests Under Ambiguity Aversion. FRONTIERS IN HEALTH SERVICES 2022; 2:825315. [PMID: 36925866 PMCID: PMC10012708 DOI: 10.3389/frhs.2022.825315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 06/18/2023]
Abstract
We consider medical decision-making under diagnostic and therapeutic uncertainty and analyze how ambiguity aversion affects the decisions to test and treat, thereby contributing to the understanding of the observed heterogeneity of such decisions. We show that under diagnostic ambiguity (i.e., the probability of disease is ambiguous), prior testing becomes more attractive if the default option is no treatment and less so if the default option is treatment. Conversely, with therapeutic ambiguity (i.e., the probability of a successful treatment is ambiguous), ambiguity aversion reduces the tolerance toward treatment failure so that the test option is chosen at a lower probability of failure. We differentiate between conditional and unconditional ambiguity aversion and show that this differentiation has implications for the propensity to test. We conclude by discussing the normative scope of ambiguity aversion for the recommendations and decisions of regulatory bodies.
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Affiliation(s)
- Dilek Sevim
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
| | - Stefan Felder
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
- CINCH, University of Duisburg-Essen, Essen, Germany
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9
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George B, Sood MR. Coronary-pulmonary artery fistula with lung hypoplasia and a bicuspid aortic valve: A case report. JRSM Cardiovasc Dis 2022; 11:20480040221082905. [PMID: 35295191 PMCID: PMC8918961 DOI: 10.1177/20480040221082905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background With an incidence of less than 1%, a Coronary Artery to Pulmonary Artery fistula (CAPF) is a rare coronary anomaly that causes heart failure. It causes a left to right cardiac shunt. While guidelines favor surgical correction in symptomatic patients, we present a challenging case with multiple cardio-thoracic pathologies. Case Presentation We present a 38-year-old obese male with persistent atrial fibrillation (AF). He presented to our hospital in decompensated heart failure and AF with rapid ventricular response. He was found to have a CAPF, a bicuspid aortic valve and left lung hypoplasia in the presence of severely reduced left ventricular systolic dysfunction. The patient subsequently underwent various cardiac testing demonstrating advanced anatomical and physiologic involvement of his CAPF, including suggested coronary steal. Despite some indications for percutaneous or surgical referral, we optimized his AF and congestive heart failure in lieu of formulating a treatment strategy for his CAPF and other abnormalities. Conclusion This report illustrates a case of a young adult who presented in decompensated heart failure with newly diagnosed left ventricular systolic function and rapid AF, who had a triad of congenital defects including a CAPF, a bicuspid aortic valve and left lung hypoplasia. To the best of our knowledge, this triad of defects is unreported. This case highlights the clinical approach in the evaluation of a cardiac shunt and it's management strategies in the presence of multiple cardio-thoracic comorbidities.
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Affiliation(s)
- Blessen George
- Department of Medicine, Mount Sinai South Nassau, One Healthy way, Oceanside, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael R Sood
- Department of Medicine, Mount Sinai South Nassau, One Healthy way, Oceanside, New York, USA
- Division of Cardiology, Mount Sinai South Nassau
- Icahn School of Medicine at Mount Sinai, New York, USA
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Das D, Dutta N, Das P, Sharma MK, Koley R, Das S, Chattopadhyay A, Ghosh S, Narayan P. Late presentation of aortopulmonary window: a contemporary series. Indian J Thorac Cardiovasc Surg 2022; 38:403-407. [DOI: 10.1007/s12055-021-01306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
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Pulmonary Hypertension in Children across Africa: The Silent Threat. Int J Pediatr 2021; 2021:9998070. [PMID: 34858504 PMCID: PMC8632426 DOI: 10.1155/2021/9998070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/23/2021] [Indexed: 11/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a complex puzzle in Africa, especially among children who present with a cocktail of issues including recurrent pulmonary infections, unoperated congenital heart disease, and advanced rheumatic heart disease. Sickle cell anemia and neonatal complications of transiting from fetal circulation also contribute to the burden of pulmonary hypertension. Mortality from pulmonary arterial hypertension (PAH) remains high in Africa (18-21%), claiming sufferers in the first 6 months after diagnosis. Unfortunately, PH remains underreported in sub-Saharan Africa since many centers lack the capacity to diagnose and confirm it by the recommended gold standard, right heart catheterization. The unresolved burden of unoperated congenital heart lesions and rheumatic heart disease, among other preventable causes, stand out as major causes of PH in African children. This paper highlights pediatric PAH as a result of major gaps in care and illustrates the need for its prevention as well as for the promotion of research into the most important drivers, to prevent premature mortality in the continent.
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Wang JK, Chiu SN, Lin MT, Chen CA, Lu CW, Wu MH. Transcatheter Closure of Atrial Septal Defect Associated With Pulmonary Artery Hypertension using Fenestrated Devices. Am J Cardiol 2021; 147:122-128. [PMID: 33667439 DOI: 10.1016/j.amjcard.2021.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
In patients with pulmonary artery hypertension (PAH) associated with atrial septal defect (ASD), closure of ASD may carry significant risks. We aimed to evaluate the safety and efficacy of transcatheter closure of ASD in selected patients with PAH using a fenestrated device followed by pulmonary vasodilator therapy. During the 14.8-year period, 51 ASD patients (10 males, age 46 ± 18 years) with a mean pulmonary artery pressure (PAP) ≥ 35 mm Hg and/or systolic PAP ≥ 60 mm Hg, underwent closure with a fenestrated device. Of them, mean Qp/Qs ratio, systolic PAP and mean PAP were 2.6 ± 1.2, 73 ± 14 mm Hg, and 44 ± 8 mm Hg, respectively. A total of 35 patients received pulmonary vasodilator therapy. The New York Heart Association (NYHA) functional class improved at 3 to 6 months follow-up. (p < 0.001) Nineteen patients underwent repeated catheterization. A comparison of the hemodynamic parameters between baseline and repeated catheterization revealed significant decreases in both systolic and mean PAP (77 ± 11 vs 55 ± 14 mm Hg, p < 0.0001 & 48 ± 7 vs 37 ± 8 mm Hg, p = 0.001, respectively), pulmonary vascular resistance (PVR) (5.1 ± 2.3 vs 4.0 ± 1.7 WU, p = 0.011) and PVRi (7.7 ± 3.3 vs 6.2 ± 2.4 WU*m2, p = 0.024). After a follow-up period of 84 ± 45 months, 6 mortalities were noted in which 2 were due to cardiac causes. In conclusion, catheter closure of ASD in patients with PAH using a fenestrated device followed by vasodilator therapy is safe and effective.
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Arafuri N, Murni IK, Idris NS, Uiterwaal CSPM, Savitri AI, Nugroho S, Noormanto N. Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country. Glob Heart 2021; 16:25. [PMID: 34040938 PMCID: PMC8064284 DOI: 10.5334/gh.831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background In low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair. Methods All cases of PAH related to left-to-right shunt CHD repairs from 2015-2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019-2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth's correction and restricted mean survival time were used for survival analysis. Results Of the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m2). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had -476.1 days (95% confidence interval [CI]: -714.4, -237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups. Conclusion In low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.
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Affiliation(s)
- Nadya Arafuri
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Indah K. Murni
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Nikmah S. Idris
- Pulmonary Hypertension Department, Great Ormond Street Hospital for Children, London, GB
| | - Cuno S. P. M. Uiterwaal
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, NL
| | - Ary I. Savitri
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, NL
| | - Sasmito Nugroho
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
| | - Noormanto Noormanto
- Department of Pediatrics, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, ID
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14
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Xu J, Wang L, Shen Y, Geng L, Chen F. Transcatheter closure for patent ductus arteriosus in patients with Eisenmenger syndrome: to do or not? BMC Cardiovasc Disord 2020; 20:505. [PMID: 33261574 PMCID: PMC7709273 DOI: 10.1186/s12872-020-01795-5] [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: 06/12/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) complicated by Eisenmenger syndrome (ES) remains to be a major cause of morbidity and mortality worldwide. Giving increasing evidences of benefit from targeted therapies, ES patients once thought to be inoperable may have increasing options for management. This study aims to explore whether PDA in patients with ES can be treated with transcatheter closure (TCC). METHODS Between August 2014 and July 2016, four of fifteen PDA-ES patients whose Qp/Qs improved significantly and Qp/Qs > 1.5 after acute vasodilator testing with 100% oxygen were selected to receive TCC and pulmonary vasodilator therapy. PAH-targeted drugs were prescribed before and after occlusion for all. Trial occlusion was performed before permanent closure. RESULTS The first TCC failed after initiation of PAH-targeted drugs for 6 months in four patients. After the medication was adjusted and extended to 12 months, TCC was performed for all without hemodynamic intolerances during perioperative period. Pulmonary artery systolic pressure (PASP) was significantly decreased (≥ 40%) immediately after TCC. During a mean follow-up of 48 ± 14.70 months, there were a further decrease of PASPs in two patients, the other two showed improved pulmonary vascular resistance, WHO functional class and six-minute walking distance despite deteriorated PASP. CONCLUSION Some selected PDA-ES patients might benefit from TCC and combined PAH-targeted drugs play a crucial role.
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Affiliation(s)
- Jing Xu
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Liang Wang
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Yunli Shen
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Liang Geng
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China
| | - Fadong Chen
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, No. 150, Jimo Road, Pudong District, Shanghai, 200120, China.
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15
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Rajanbabu BB, Chigullapally R. The effect of distal pulmonary obstruction or elevated atrial pressures on pulmonary flow and pulmonary vascular disease: a mathematical flow circuit analogy model-based analysis. Indian J Thorac Cardiovasc Surg 2020; 35:548-556. [PMID: 33061050 DOI: 10.1007/s12055-019-00816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022] Open
Abstract
Background Late presentation of large left to right shunts is a major problem in developing countries and evaluating the operability is a challenge during preoperative evaluation. The factors that determine the development and progression of the pulmonary vascular disease are still largely unknown, though there is evidence to show that increased pulmonary flow is the main contributing factor. We have found cases of operability despite late presentation of ventricular septal defect (VSD). In some of these cases, the reason for operability may lie in associations. We herein attempt to provide a mathematical explanation for their operability. Aims and objectives To assess the effect of different levels of obstruction and elevated ventricular end-diastolic pressure on pulmonary flow. Materials and methods Mathematical flow analogy models were constructed and analysed based on Ohm's law and the laws governing flow in series and parallel flow circuits. Results Any narrowing in the pulmonary circulation produces a reduction in pulmonary blood flow and the pulmonary to systemic blood flow ratio, irrespective of its position. This increases the systemic flow and blood pressure if the ventricular performance remains constant. A rise in ventricular end-diastolic pressure reduces the total cardiac output, pulmonary flow and systemic blood flow with a preserved pulmonary to systemic flow ratio. The absolute reduction in pulmonary flow will exceed the absolute reduction in systemic flow, with its ratio being in proportion to the ratio of systemic to pulmonary vascular resistance. However, a higher pressure will be transmitted distally in these settings. These mechanisms of flow reduction may prevent irreversible pulmonary vascular disease. Conclusion Distal pulmonary obstruction or elevated ventricular end-diastolic pressure can reduce pulmonary blood flow and may prevent irreversible pulmonary vascular disease. Clinical studies in this direction are recommended for validation.
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16
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Fujii T, Tomita H, Kobayashi T, Kato H, Sugiyama H, Mizukami A, Ueda H. Clinical trial of the CP stent for pulmonary artery stenosis: the first investigator-initiated clinical trial for pediatric interventional cardiology in Japan. Heart Vessels 2020; 36:291-296. [PMID: 32889644 DOI: 10.1007/s00380-020-01691-0] [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: 04/24/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022]
Abstract
Stenting is an important treatment option for pulmonary artery stenosis (PS) associated with congenital heart disease (CHD). However, no stent has been approved for this indication in Japan, despite negotiation between academia and the regulatory bodies for longer than 20 years. To evaluate efficacy and safety of the CP stent, we performed the first investigator-initiated clinical trial for pediatric interventional cardiology in Japan. This trial was designed as a single-arm, prospective, clinical trial. Patients who had postoperative PS associated with CHD were included. Stenting was attempted in 24 cases and succeeded in 22 cases. The median age of the patients was 11 years (3-36 years) and weight was 38 kg (12-69 kg), while follow-up for 12 months was completed. In all 22 cases, stenting was successful, with a 50% increase in the minimum lumen diameter (MLD) in 86.4% of patients (90% confidence interval, 68.4-96.2%). The mean percent change in MLD was 119.3 ± 52.5%. In two-ventricle repair, the mean percent change in systolic right ventricular/aortic pressure was - 8.5 ± 16.1%, while that of pressure gradient was - 55.9 ± 41.7%. In single-ventricle repair, the percent change in the mean pressure gradient was - 100.0 ± 0%, while that of SaO2 was 1.4 ± 1.7%. No serious adverse events or significant restenosis was reported. The CP stent is highly effective and safe for PS associated with CHD. This study has significant importance in not only scientific but also social considerations.
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Affiliation(s)
- Takanari Fujii
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan.
| | - Hideshi Tomita
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hitoshi Kato
- Department of Pediatric Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ayumi Mizukami
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Japan
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17
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Pradegan N, Pesce R, Castaldi B, Zanotto L, Stellin G, Vida VL. Reversing Inoperability in Eisenmenger Syndrome: The "Drug-and-Banding" Approach. World J Pediatr Congenit Heart Surg 2020; 11:646-648. [PMID: 32853073 DOI: 10.1177/2150135120926977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Eisenmenger syndrome (ES) has been considered a cause of inoperability in patients with congenital heart disease (CHD). Even if long-standing vasodilators are efficient to reduce pulmonary vascular resistance (PVR), the best approach to grant stable repair of these patients is still unknown. We describe the case of a 28-year-old man with a diagnosis of untreated large ventricular septal defect and established ES. After few years of vasodilator therapy, the patient underwent pulmonary banding with significant reduction of his PVR. His CHD was then repaired, with clinical and functional improvement at 2-year follow-up.
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Affiliation(s)
- Nicola Pradegan
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, 9308University of Padua, Padua, Italy
| | - Rita Pesce
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, 9308University of Padua, Padua, Italy
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Child and Woman's Health, 9308University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, 9308University of Padua, Padua, Italy
| | - Giovanni Stellin
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, 9308University of Padua, Padua, Italy
| | - Vladimiro L Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, 9308University of Padua, Padua, Italy
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18
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Jančauskaitė D, Rudienė V, Jakutis G, Geenen LW, Roos-Hesselink JW, Gumbienė L. Residual Pulmonary Hypertension more than 20 Years after Repair of Shunt Lesions. ACTA ACUST UNITED AC 2020; 56:medicina56060297. [PMID: 32560260 PMCID: PMC7353861 DOI: 10.3390/medicina56060297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/04/2022]
Abstract
Background and Objectives: After successful surgical repair of a congenital shunt lesion, pulmonary hypertension (PH) often disappears. However, PH can persist long-term after the closure. This study aimed to assess the prevalence of PH long-term after surgical repair of congenital heart disease (CHD), and to evaluate the outcomes and preoperative factors related to residual PH. Materials and Methods: In this retrospective cohort study, we reviewed patients who underwent right heart catheterisation in Vilnius University Hospital Santaros Klinikos during the period of 1985–2007. Among 4118 right heart catheterisations performed, 160 patients underwent congenital systemic-to-pulmonary shunt repair at a young age (<18 years) and had pre-operative PH. Half of the patients were foreigners whose follow-up data were unavailable. Eventually, 88 patients with available follow-up data were included in this study. Results: The median age at diagnosis of CHD with PH was 0.8 (0.6–3.0) and 1.1 (0.6–3.9) years at surgery (50% females). Residual PH was assessed 9.5 years after surgery and observed in 30.7% (n = 27) of the patients. It was associated with having more than one shunt (44.4% (n = 12), p = 0.016) and higher median pulmonary vascular resistance (3.4 (2.5–6.5) vs. 2.2 (1.0–3.7), p = 0.035) at baseline. After a median follow-up of 21 (15–24) years, 9.1% of the patients were deceased. Kaplan–Meier survival analysis revealed significantly higher mortality in the residual PH group (p = 0.035). Conclusions: Residual PH affects a significant proportion of patients after surgical repair of a shunt lesion and is associated with worse long-term outcome.
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Affiliation(s)
- Dovilė Jančauskaitė
- Centre of Cardiology and Angiology, Vilnius University, LT 08661 Vilnius, Lithuania;
- Correspondence: ; Tel.: +370-5-250-1442
| | - Virginija Rudienė
- Faculty of Medicine, Vilnius University, LT 03101 Vilnius, Lithuania; (V.R.); (G.J.)
| | - Gabrielius Jakutis
- Faculty of Medicine, Vilnius University, LT 03101 Vilnius, Lithuania; (V.R.); (G.J.)
| | - Laurie W Geenen
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.WG.); (J.WR.-H.)
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.WG.); (J.WR.-H.)
| | - Lina Gumbienė
- Centre of Cardiology and Angiology, Vilnius University, LT 08661 Vilnius, Lithuania;
- Centre of Heart and Chest Surgery, Vilnius University, LT 08661 Vilnius, Lithuania
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19
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Fernández Carbonell A, Merino Cejas C, Rodríguez Guerrero E, Inga Tavara LI, Conejero Jurado MT, Muñoz Carvajal I. Comunicación interauricular y drenaje venoso anómalo parcial con sospecha de síndrome de Eisenmenger corregido con la técnica de Warden y parche de Dacron valvulado. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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20
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Reverse Remodeling of Pulmonary Arterioles After Pulmonary Artery Banding in Patients ≥ 2 Years Old with Severe Pulmonary Arterial Hypertension and Congenital Heart Disease. Pediatr Cardiol 2019; 40:958-964. [PMID: 30982075 DOI: 10.1007/s00246-019-02097-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to evaluate the pathological changes of the pulmonary arterioles in patients ≥ 2 years of age who first underwent a pulmonary artery banding (PAB) procedure, followed by bidirectional Glenn or Fontan according to their specific conditions. This was a prospective study of 15 children diagnosed and treated with PAB at the Department of Cardiothoracic Surgery of Anzhen Hospital between January 2009 and December 2012. The percentage of media area (%MS) of pulmonary arteriole, the percentage of media thickness (%MT), and pulmonary arterial density (APSC) were calculated from lung tissue sections. Pulmonary artery pressure decreased significantly after PAB surgery (P < 0.01). Postoperative mean pulmonary artery pressure declined significantly (P < 0.01), the cardiothoracic ratio was reduced (P < 0.05), and percutaneous oxygen saturation (inhaled air) decreased to 80-85% (P < 0.01). %MT (from 35.1 ± 5.6% to 26.9 ± 4.3%, P < 0.01), %MS (from 51.4 ± 6.7% to 32.2 ± 7.4%, P < 0.01), and APSC (from 108.3 ± 38.5 to 83.6 ± 19.6, P < 0.01) were decreased significantly after PAB. Five patients underwent the bidirectional Glenn procedure and four underwent Fontan. In conclusion, the results suggest that PAB can reduce pulmonary artery pressure and that pulmonary arterial lesions can be reversed after PAB.
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21
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Bradley EA, Ammash N, Martinez SC, Chin K, Hebson C, Singh HS, Aboulhosn J, Grewal J, Billadello J, Chakinala MM, Daniels CJ, Zaidi AN. "Treat-to-close": Non-repairable ASD-PAH in the adult: Results from the North American ASD-PAH (NAAP) Multicenter Registry. Int J Cardiol 2019; 291:127-133. [PMID: 31031077 DOI: 10.1016/j.ijcard.2019.03.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adults presenting with an unrepaired atrial septal defect and pulmonary arterial hypertension (ASD-PAH) are typically classified as "correctable" or "non-correctable". The use of directed PAH medical therapy in non-correctable ASD-PAH leading to favorable closure candidacy, repair status and long-term follow-up is not well studied. We therefore sought to characterize response to PAH targeted therapy in 'non-correctable' ASD-PAH. METHODS AND RESULTS Nine North American tertiary care centers submitted retrospective data from adults with unrepaired ASD-PAH that did not meet recommendations for repair at initial presentation (1996-2017). Sixty-nine patients (women 51(74%), 40 ± 15 years, mean pulmonary artery pressure (mPA) 51 ± 13 mm Hg, pulmonary vascular resistance (PVR) 8.7 ± 4.9 Wood units, Qp:Qs 1.6 ± 0.4) were enrolled. All patients were prescribed PAH targeted therapy and late shunt repair occurred in 19(28%) (Women 15(29%) vs. Men 4(22%), p = 0.6). At late follow-up (4.4 ± 2.9 years) 6-minute walk test distance (6MWTD) was significantly better in the group that underwent repair (486 ± 89 m vs. 375 ± 139 m, p < 0.05). Transthoracic echo showed significant improvement in right ventricular (RV) function (severe dysfunction in repaired 8(40%) vs. unrepaired groups 35(69%), p < 0.05). Divergent survival curves suggest that with larger studies and more follow-up, differences in survival between repaired and unrepaired groups may be important. (repaired: 17(94%) vs. unrepaired: 32(81%), p = 0.18). CONCLUSIONS This is the first and largest multicenter study evaluating the "treat-to-close" approach in non-correctable ASD-PAH. Our new data supports further study of this strategy in patients who have reversibility of PAH in response to targeted therapy. We demonstrate that in the carefully selected patient with non-correctable ASD-PAH, successful shunt repair is possible if post-therapy PVR is ≤6.5 Wood units. Patients who underwent repair had improved RV function following PAH targeted therapy. Divergent survival curves suggest that with further study, defect repair may affect medium-term to late survival.
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Affiliation(s)
- Elisa A Bradley
- The Ohio State University & Nationwide Children's Hospital, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America.
| | - Naser Ammash
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Sara C Martinez
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, United States of America
| | - Kelly Chin
- University of Texas Southwestern, Division of Pulmonary Medicine, Dallas, TX, United States of America
| | - Camden Hebson
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Harsimran S Singh
- Weill Cornell Medicine New York Presbyterian Hospital, Division of Cardiovascular Medicine, New York, NY, United States of America
| | - Jamil Aboulhosn
- Ahmanson/University of California, Los Angeles, David Geffen School of Medicine at UCLA, Divisions of Adult and Pediatric Cardiology, Los Angeles, CA, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Jasmine Grewal
- University of British Columbia, St. Paul's Hospital and Vancouver General Hospital, Division of Cardiovascular Medicine, Vancouver, BC, Canada; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Joseph Billadello
- Washington University, Division of Cardiovascular Medicine, St. Louis, MO, United States of America
| | - Murali M Chakinala
- Washington University, Division of Pulmonary and Critical Care Medicine, St. Louis, MO, United States of America
| | - Curt J Daniels
- The Ohio State University & Nationwide Children's Hospital, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Ali N Zaidi
- Montefiore Einstein Center for Heart & Vascular Care & The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
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22
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Datt V, Khurana P, Aggarwal S, Mishra S, Sujith CN, Virmani S. Perioperative management of a patient with double orifice mitral valve with supramitral ring with subaortic membrane with ventricular septal defect and severe pulmonary hypertension: Report of a rare case. Ann Card Anaesth 2019; 22:215-220. [PMID: 30971608 PMCID: PMC6489406 DOI: 10.4103/aca.aca_123_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Double-orifice mitral valve (DOMV) is an unusual congenital anomaly characterized by a mitral valve with a single fibrous annulus with two orifices or rarely two orifices with two separate mitral annuli opening into the left ventricle. We present a first report of a patient with a DOMV with supramitral ring (SMR), subaortic membrane (SAM), a large ventricular septal defect (VSD) with more than 50% aortic override, and severe pulmonary arterial hypertrophy (PAH). This patient underwent excision of the SAM, and SMR, with closure of the VSD together under cardiopulmonary bypass (CPB). However postoperatively, the patient developed an irreversible fatal pulmonary hypertensive crisis (PHC), immediately after transferring the patient to the cardiac intensive care unit from the operating room (OR). The PHC was refractory to intravenous and inhaled milrinone and nitroglycerine and intravenous adrenaline, dobutamine, norepinephrine, vasopressin, patent foramen oval (PFO), and CPB support. The management of DOMV and perioperative pulmonary hypertension is discussed.
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Affiliation(s)
- Vishnu Datt
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
| | - Priyanka Khurana
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
| | - Saket Aggarwal
- Department CTVS, GB pant Hospital (GIPMER), New Delhi, India
| | - Smita Mishra
- Department of Cardiology, Jaypee Hospital, New Delhi, India
| | - C N Sujith
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
| | - Sanjula Virmani
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
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23
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Huang WC, Hsu CH, Sung SH, Ho WJ, Chu CY, Chang CP, Chiu YW, Wu CH, Chang WT, Lin L, Lin SL, Cheng CC, Wu YJ, Wu SH, Hsieh TY, Hsu HH, Fu M, Dai ZK, Kuo PH, Hwang JJ, Cheng SM. 2018 TSOC guideline focused update on diagnosis and treatment of pulmonary arterial hypertension. J Formos Med Assoc 2019; 118:1584-1609. [PMID: 30926248 DOI: 10.1016/j.jfma.2018.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/18/2018] [Accepted: 12/14/2018] [Indexed: 01/04/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized as a progressive and sustained increase in pulmonary vascular resistance, which may induce right ventricular failure. In 2014, the Working Group on Pulmonary Hypertension of the Taiwan Society of Cardiology (TSOC) conducted a review of data and developed a guideline for the management of PAH.4 In recent years, several advancements in diagnosis and treatment of PAH has occurred. Therefore, the Working Group on Pulmonary Hypertension of TSOC decided to come up with a focused update that addresses clinically important advances in PAH diagnosis and treatment. This 2018 focused update deals with: (1) the role of echocardiography in PAH; (2) new diagnostic algorithm for the evaluation of PAH; (3) comprehensive prognostic evaluation and risk assessment; (4) treatment goals and follow-up strategy; (5) updated PAH targeted therapy; (6) combination therapy and goal-orientated therapy; (7) updated treatment for PAH associated with congenital heart disease; (8) updated treatment for PAH associated with connective tissue disease; and (9) updated treatment for chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Chih-Hsin Hsu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shih-Hsien Sung
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Jing Ho
- Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Ping Chang
- Division of Cardiology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Wei Chiu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Hsien Wu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ting Chang
- Division of Cardiovascular Medicine, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Lin Lin
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Shoa-Lin Lin
- Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan; Pulmonary Hypertension Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yih-Jer Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Pulmonary Hypertension Interventional Medicine, Cardiovascular Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Shu-Hao Wu
- Pulmonary Hypertension Interventional Medicine, Cardiovascular Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Tsu-Yi Hsieh
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Morgan Fu
- Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan.
| | - Shu-Meng Cheng
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Thomaz AM, Kajita LJ, Aiello VD, Zorzanelli L, Galas FRB, Machado CG, Barbero-Marcial M, Jatene MB, Rabinovitch M, Lopes AA. EXPRESS: Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments. Pulm Circ 2019; 9:2045894019837885. [PMID: 30806154 PMCID: PMC6688149 DOI: 10.1177/2045894019837885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/20/2019] [Indexed: 01/22/2023] Open
Abstract
Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT-CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT-CHD received sildenafil orally pre- and postoperatively for six months and then were subjected to a catheter study. Thirty-three patients were enrolled (age range = 4.6–37.0 months). Pulmonary vascular resistance (PVR) was 4.9 (range = 3.9–7.2) Wood units × m2 (median with IQR). Twenty-two patients had a ≥ 20% decrease in PVR and pulmonary-to-systemic vascular resistance ratio (PVR/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles (P < 0.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non-responders had a ≥ 30% increase in pulmonary blood flow in response to sildenafil (3.0 [2.0–4.0] mg/kg/day). Six months after surgery, PAP and PVR were significantly lower (P < 0.001 vs. baseline), even in seven patients with Heath-Edwards grade III/IV pulmonary vascular lesions (P = 0.018), but still abnormal in 12 individuals (>25 mmHg and >3.0 U × m2, respectively). A preoperative PVR/SVR of ≥24% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of ≥4.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio [95% CI] = 1.09 [1.01–1.18], P = 0.036; and 0.69 [0.49–0.98], P = 0.040, respectively). Thus, in PHT-CHD patients receiving oral sildenafil pre- and post-surgical repair of cardiac lesions, mid-term postoperative outcome is predictable to some extent.
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Affiliation(s)
- Ana Maria Thomaz
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Luiz J. Kajita
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Vera D. Aiello
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Leína Zorzanelli
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | | | - Cleide G. Machado
- Hospital das Clínicas, University of São
Paulo School of Medicine, São Paulo, Brazil
| | | | - Marcelo B. Jatene
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
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25
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Lee JS, Cha SG, Kim GB, Lee SY, Song MK, Kwon HW, Bae EJ, Kwak JG, Kim WH, Lee JR. Reversibility of Pulmonary Hypertension Following Surgical Atrial Septal Defect Closure in Children with Down Syndrome. J Cardiovasc Imaging 2019; 27:247-253. [PMID: 31614394 PMCID: PMC6795567 DOI: 10.4250/jcvi.2019.27.e33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Many Down syndrome (DS) patients have an atrial septal defect (ASD) and associated pulmonary hypertension (PH) from early childhood. ASD closure in DS patients with PH is often controversial due to concerns regarding exacerbation of PH. The aim of this study was to investigate the clinical outcome following surgical ASD closure in children with DS. METHODS We retrospectively reviewed the medical records of DS patients who underwent surgical ASD patch closure from January 2000 to December 2016. RESULTS A total of 15 patients underwent surgery for ASD. Prior to ASD patch closure, nine patients were diagnosed with PH, three of whom took medications for PH. The mean age of patients at ASD patch closure was 17.3 months, and the mean diameter of the ASD was 10.2 mm. Three patients who took medications for severe PH underwent ASD patch closure at ages 7, 12, and 25 months. Two patients continued medication for an additional 13 and 21 months, and one patient remained on medication 52 months after ASD closure. PH did not recur following discontinuation of selective pulmonary vasodilators in two patients. Although a moderate degree of PH remained in one patient due to a chronic lung problem, it was improved compared to before ASD closure. No PH was observed in the remaining 12 patients following ASD closure. CONCLUSIONS A large ASD can be closed even in DS patients with severe PH during early childhood with the support of multiple selective pulmonary vasodilators.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Seul Gi Cha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Woong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
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26
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Veeram Reddy SR, Nugent AW, Zellers TM, Dimas VV. Invasive Hemodynamics of Adult Congenital Heart Disease: From Shunts to Coarctation. Interv Cardiol Clin 2018; 6:345-358. [PMID: 28600089 DOI: 10.1016/j.iccl.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adults with congenital heart disease are a growing population with increasingly more complex disease, in large part due to improvements in delivery of care to the pediatric population. Cardiac catheterization is an integral component of diagnosis and management in these patients. Careful attention to detail and a thorough understanding of intracardiac hemodynamics are critical to performing complete diagnostic evaluations. This article outlines the most commonly encountered lesions with guidelines for invasive assessment to help guide further therapy.
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Affiliation(s)
- Surendranath R Veeram Reddy
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Alan W Nugent
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Thomas M Zellers
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - V Vivian Dimas
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA.
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27
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Wagdy R. The role of diagnostic cardiac catheterization for children with congenital heart diseases: local experience. Arch Med Sci Atheroscler Dis 2018; 3:e72-e79. [PMID: 30775593 PMCID: PMC6374569 DOI: 10.5114/amsad.2018.76824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the development of non-invasive tools of investigations for congenital heart diseases (CHDs), still the role of diagnostic cardiac catheterization (DCC) cannot be undermined. The study aimed to analyze the clinical profile of indicated CHDs cases at our center for DCC to evaluate the contribution of DCC in patients' management plans. MATERIAL AND METHODS The study checked files of cases performed DCC between 2011 and 2012 at the pediatric catheterization unit of Alexandria University Children's Hospital by the same operator. Demographic, laboratory and hemodynamic data were collected and analyzed. RESULTS Files of 61 children were included in the study. They were grouped into: group I (GI) (n = 25) with pulmonary hypertension (PH), and group II (GII) (n = 36) cases with obstructive pulmonary artery diseases. For the PH group, ventricular septal defect (VSD) was the most common (55%), and patients' outcome plans were based on angiography - operable subgroup GI-A: (84%) (n = 21) and non-operable (16%) GI-B: (4% inoperable, 12% recommended for sildenafil). GI-B cases were significantly older, with higher PVRI and PVRI/SVRI (3.62, 0.68, p = 0.002) compared to GI-A (0.89, 0.23, p = 0.002, respectively). For group II, tetralogy of Fallot (TOF) was predominant (60%) among the disease spectrum, and the McGoon ratio ranged from 0.7 to 3.2 (median: 1.8). Outcome for GII: 63% operable, 25% shunt, 12% stent. Only pulmonary atresia cases showed a significant difference in the unmatched plans between echocardiography and catheterization reports (χ2 = 7.438, p = 0.023). CONCLUSIONS Diagnostic cardiac catheterization had a positive contribution for determination of the management plans for more than 84% of cases. The utility of pediatric cardiac catheterization in diagnosis should be adjusted according to the local needs of every cardiac center.
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Affiliation(s)
- Reham Wagdy
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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28
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Akagi S, Kasahara S, Sarashina T, Nakamura K, Ito H. Treat-and-repair strategy is a feasible therapeutic choice in adult patients with severe pulmonary arterial hypertension associated with a ventricular septal defect: case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty033. [PMID: 31020114 PMCID: PMC6176981 DOI: 10.1093/ehjcr/yty033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/23/2018] [Indexed: 12/17/2022]
Abstract
Introduction Recent advances in pulmonary arterial hypertension (PAH)-specific drugs have dramatically changed the therapeutic strategy for PAH. A strategy that includes 'treatment' with PAH-specific drugs initially and then 'repair' by closure of the cardiac defect (i.e. 'treat and repair') was devised, and has been attempted, in patients with PAH associated with a cardiac defect. Case presentation We present three cases of severe PAH associated with a ventricular septal defect (VSD) in adult patients who were initially treated with PAH-specific drugs followed by VSD closure. Two of the patients were treated with a combination of an endothelin receptor antagonist (ERA), phosphodiesterase type 5 inhibitor, and intravenous prostacyclin before VSD closure. The third patient was treated with an ERA and pulmonary artery banding before VSD closure. After 12 months of anti-PAH treatment, the pulmonary vascular resistance index and the ratio of the pulmonary vascular index to the systemic vascular resistance index decreased to levels that allowed VSD closure. At the mid- and long-term follow-up measurements after surgical closure of the VSD, the mean pulmonary artery pressure had markedly decreased. Discussion Our case series suggests that the treat-and-repair strategy is a promising approach for adult patients with severe PAH associated with VSD.
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Affiliation(s)
- Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, Japan
| | - Toshihiro Sarashina
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
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29
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Masaki N, Saiki Y, Endo M, Maeda K, Adachi O, Akiyama M, Kawamoto S, Saiki Y. Evidence of Pulmonary Vascular Reverse Remodeling After Pulmonary Artery Banding Performed in Early Infancy in Patients With Congenital Heart Defects. Circ J 2018; 82:684-690. [DOI: 10.1253/circj.cj-17-0379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yuriko Saiki
- Department of Molecular Pathology, Tohoku University Graduate School of Medicine
| | - Masato Endo
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Kay Maeda
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Osamu Adachi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Masatoshi Akiyama
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
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30
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Abstract
In many parts of the world, mostly low- and middle-income countries, timely diagnosis and repair of congenital heart diseases (CHDs) is not feasible for a variety of reasons. In these regions, economic growth has enabled the development of cardiac units that manage patients with CHD presenting later than would be ideal, often after the window for early stabilisation - transposition of the great arteries, coarctation of the aorta - or for lower-risk surgery in infancy - left-to-right shunts or cyanotic conditions. As a result, patients may have suffered organ dysfunction, manifest signs of pulmonary vascular disease, or the sequelae of profound cyanosis and polycythaemia. Late presentation poses unique clinical and ethical challenges in decision making regarding operability or surgical candidacy, surgical strategy, and perioperative intensive care management.
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31
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Avriel A, Klement AH, Johnson SR, de Perrot M, Granton J. Impact of Left Ventricular Diastolic Dysfunction on Lung Transplantation Outcome in Patients With Pulmonary Arterial Hypertension. Am J Transplant 2017; 17:2705-2711. [PMID: 28508451 DOI: 10.1111/ajt.14352] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/31/2017] [Accepted: 05/02/2017] [Indexed: 01/25/2023]
Abstract
Diastolic dysfunction may influence perioperative outcome, early graft function, and long-term survival. We compared the outcomes of double lung transplantation (DLTx) for patients with pulmonary arterial hypertension (PAH) with preoperative left ventricular (LV) diastolic dysfunction with the outcomes of patients without diastolic dysfunction. Of 116 consecutive patients with PAH (who underwent transplantation between January 1995 and December 2013), 44 met our inclusion and exclusion criteria. Fourteen (31.8%) patients with diastolic dysfunction pretransplantation had a higher body mass index (29 [IQR 21.5-32.6] vs 22.4 [IQR 19.9-25.3] kg/m2 ) and mean pulmonary arterial pressure (54.6 ± 10 mmHg vs 47 ± 11.3 mmHg) and right atrial pressure (16.5 ± 5.2 mmHg vs 10.6 ± 5.2 mmHg). The patients received extracorporeal life support more frequently (33% vs 7% [p = 0.02]), had worse APACHE II scores (21.7 ± 7.4 vs 15.3 ± 5.3 [p = 0.02]), and a trend toward worse ventilator-free days (2.5 [IQR 6.5-32.5] vs 17 [IQR 3-23] [p = 0.08]). There was no effect on development of primary graft dysfunction or intensive care unit/hospital survival. One-year survival was worse (hazard ratio [HR] 4.45, 95% confidence interval [CI] 1.3-22, p = 0.02). Diastolic dysfunction was the only variable that correlated with overall survival (HR 5.4, 95% CI 1.3-22, p = 0.02). Diastolic dysfunction leads to early postoperative morbidity and worse survival in patients with PAH after DLTx.
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Affiliation(s)
- A Avriel
- Pulmonology Institute, Department of Medicine, Soroka Medical Center, Faculty of Health Sciences Ben-Gurion University, Beer-Sheva, Israel
| | - A H Klement
- Meir Medical Center, Faculty of Health Sciences, Tel- Aviv University, Tel-Aviv, Israel
| | - S R Johnson
- Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - M de Perrot
- Multiorgan Transplant Program, University Health Network, and the Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - J Granton
- Multiorgan Transplant Program, University Health Network, and the Division of Respirology, University Health Network, Toronto, Ontario, Canada
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32
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Caicedo-Cuenca LM. Enfoque de la hipertensión pulmonar en el paciente pediátrico. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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33
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Seghaye MC. Management of children with congenital heart defect: state of the art and future prospects. Future Cardiol 2016; 13:65-79. [PMID: 27936920 DOI: 10.2217/fca-2016-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The treatment of children with congenital heart defects has evolved in the last 60 years from conservative care to a highly specialized management where advances in imaging, surgical, interventional and support techniques meet together to ensure satisfactory development and good quality of life to the child and to the upcoming grown up. Management of congenital heart defects best begins before birth with the aim, whenever possible, to maintain or establish biventricular physiology or, if this is excluded, to optimize the conditions for univentricular physiology. Current research in the field of genetics, device bioengineering and miniaturization, stem cell therapy, and fusion imaging technology is expected to help to improve further patient outcome. In this review, current management strategies and future prospects are discussed.
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Affiliation(s)
- Marie-Christine Seghaye
- Department of Pediatrics-Pediatric Cardiology, University Hospital Liège, Rue de Gaillarmont 600, B. 4032 Liège, Belgium
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34
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Myers PO, Beghetti M. Response by Myers and Beghetti to Letter Regarding Article, "Unrestrictive Aortopulmonary Window: Extreme Presentation as Non-Eisenmenger in a 30-Year-Old Patient". Circulation 2016; 134:e330-e331. [PMID: 27753617 DOI: 10.1161/circulationaha.116.024456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick O Myers
- From Cardiovascular Surgery (P.O.M.), Pulmonary Hypertension Program (P.O.M., M.B.), and Unit of Pediatric Cardiology (M.B.), Children's University Hospital Geneva, Geneva, Switzerland
| | - Maurice Beghetti
- From Cardiovascular Surgery (P.O.M.), Pulmonary Hypertension Program (P.O.M., M.B.), and Unit of Pediatric Cardiology (M.B.), Children's University Hospital Geneva, Geneva, Switzerland
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35
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Myers PO, Lador F, Beghetti M. eComment: How to define operability in pulmonary hypertension secondary to congenital heart disease? Interact Cardiovasc Thorac Surg 2016; 22:859. [PMID: 27231252 DOI: 10.1093/icvts/ivw131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick O Myers
- Pulmonary Hypertension Program, Cardiovascular Surgery, Pulmonology and Pediatric Cardiology, Geneva
| | - Frederic Lador
- Pulmonary Hypertension Program, Cardiovascular Surgery, Pulmonology and Pediatric Cardiology, Geneva
| | - Maurice Beghetti
- Pulmonary Hypertension Program, Cardiovascular Surgery, Pulmonology and Pediatric Cardiology, Geneva
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36
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Myers PO, Lador F, Hachulla AL, Bouchardy J, Noble S, Licker M, Pache JC, Kalimanovaska-Ostric D, Djukic M, Kalangos A, Beghetti M. Unrestrictive Aortopulmonary Window: Extreme Presentation as Non-Eisenmenger in a 30-Year-Old Patient. Circulation 2016; 133:1907-10. [PMID: 27166350 DOI: 10.1161/circulationaha.115.020819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick O Myers
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.).
| | - Frédéric Lador
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Anne-Lise Hachulla
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Judith Bouchardy
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Stéphane Noble
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Marc Licker
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Jean-Claude Pache
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Dimitra Kalimanovaska-Ostric
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Milan Djukic
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Afksendiyos Kalangos
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
| | - Maurice Beghetti
- From Divisions of Cardiovascular Surgery (P.O.M., A.K.), Pulmonary Hypertension Program (P.O.M., F.L., A.-L.H., S.N., M.L., M.B.), Pneumology (F.L.), Radiology (A.-L.H.), Cardiology (J.B., S.N.), Anesthesiology (M.L.), and Pathology (J.-C.P.), Geneva University Hospitals & Faculty of Medicine, Switzerland; Cardiology Clinic, Clinical Center of Serbia, Belgrade (D.-K.O.); University Children's Hospital, Belgrade, Serbia (M.D.); and Unit of Pediatric Cardiology, Children's University Hospital Geneva, Switzerland (M.B.)
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Couperus LE, Henkens IR, Jongbloed MRM, Hazekamp MG, Schalij MJ, Vliegen HW. Tailored circulatory intervention in adults with pulmonary hypertension due to congenital heart disease. Neth Heart J 2016; 24:400-409. [PMID: 27098530 DOI: 10.1007/s12471-016-0833-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 03/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Adults with pulmonary hypertension associated with congenital heart disease (PH-CHD) often have residual shunts. Invasive interventions aim to optimise pulmonary flow and prevent right ventricular failure. However, eligibility for procedures strongly depends on the adaptation potential of the pulmonary vasculature and right ventricle to resultant circulatory changes. Current guidelines are not sufficiently applicable to individual patients, who exhibit great diversity and complexity in cardiac anomalies. METHODS AND RESULTS We present four complex adult PH-CHD patients with impaired pulmonary flow, including detailed graphics of the cardiopulmonary circulation. All these patients had an ambiguous indication for shunt intervention. Our local multidisciplinary Grown-Ups with Congenital Heart Disease team reached consensus regarding a patient-tailored invasive treatment strategy, adjacent to relevant guidelines. Interventions improved pulmonary haemodynamics and short-term clinical functioning in all cases. CONCLUSIONS Individual evaluation of disease characteristics is mandatory for tailored interventional treatment in PH-CHD patients, adjacent to relevant guidelines. Both strict registration of cases and multidisciplinary and multicentre collaboration are essential in the quest for optimal therapy in this patient population.
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Affiliation(s)
- L E Couperus
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
| | - I R Henkens
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Anatomy, Leiden University Medical Center, Leiden, Netherlands
| | - M G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - H W Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Ma C, Shen DR, Zhang Q, Ding YQ, Wang YX, Peng L, Meng BY, Ti YX. [A preliminary investigation of relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:340-344. [PMID: 27097580 PMCID: PMC7390076 DOI: 10.7499/j.issn.1008-8830.2016.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To preliminarily investigate the relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease. METHODS One hundred and twenty-six children with congenital heart disease undergoing surgical treatment were enrolled as subjects. The serum level of apelin was determined before surgery and at 7 days after surgery. The ratio of pulmonary artery systolic pressure to aortic systolic pressure (Pp/Ps) was calculated before extracorporeal circulation. According to the Pp/Ps value, patients were classified into non-pulmonary arterial hypertension (PAH) group, mild PAH group, moderate PAH group, and severe PAH group. Pulmonary artery mean pressure was estimated by echocardiography at 7 days after surgery. RESULTS The non-PAH group had the highest serum level of apelin before and after surgery, followed by the mild PAH group, moderate PAH group, and severe PAH group (P<0.05). All groups had significantly increased serum levels of apelin at 7 days after surgery (P<0.05). The serum level of apelin was negatively correlated with pulmonary artery pressure before surgery (r=-0.51, P<0.05) and at 7 days after surgery (r=-0.54, P<0.05). CONCLUSIONS The decrease in serum apelin level is associated with the development of pulmonary hypertension in children with congenital heart disease. The significance of serum apelin in predicting the development and degree of pulmonary hypertension in children with congenital heart disease deserves further studies.
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Affiliation(s)
- Chao Ma
- Cardiovascular Center, Shenzhen Children's Hospital of Chinese Medical University, Shenzhen, Guangdong 518026, China.
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39
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Rosic M, Susak S, Redzek A, Velicki L. Closure of an atrial septal defect with a one-way flap patch in a patient with severe pulmonary hypertension. Interact Cardiovasc Thorac Surg 2016; 22:856-8. [PMID: 26920727 DOI: 10.1093/icvts/ivw032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/18/2016] [Indexed: 11/14/2022] Open
Abstract
An isolated atrial septal defect (ASD) can occasionally go unrecognized for decades and accounts for 25-30% of congenital heart disease cases diagnosed in adulthood. Pulmonary hypertension often develops as a result of a long-lasting, left-to-right shunt and may ultimately be associated with a fixed increase of pulmonary vascular resistance, sometimes rendering these patients inoperable. To reduce the risk of developing postoperative morbidity and possible mortality, we employed our technique of a unidirectional valved patch for the closure of ASD.
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Affiliation(s)
- Milenko Rosic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Stamenko Susak
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandar Redzek
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
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40
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Kijima Y, Akagi T, Takaya Y, Akagi S, Nakagawa K, Kusano K, Sano S, Ito H. Treat and Repair Strategy in Patients With Atrial Septal Defect and Significant Pulmonary Arterial Hypertension. Circ J 2016; 80:227-34. [DOI: 10.1253/circj.cj-15-0599] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yasufumi Kijima
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Teiji Akagi
- Cardiac Intensive Care Unit, Okayama University Hospital
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Shunji Sano
- Cardiac Intensive Care Unit, Okayama University Hospital
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Hospital
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Fujii T, Tomita H, Fujimoto K, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T. Morphological and Hemodynamic Effectiveness of Stenting for Pulmonary Artery Stenosis – Subanalysis of JPIC Stent Survey –. Circ J 2016; 80:1852-6. [DOI: 10.1253/circj.cj-15-1196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takanari Fujii
- Cardiovascular Center, Showa University Northern Yokohama Hospital
| | - Hideshi Tomita
- Cardiovascular Center, Showa University Northern Yokohama Hospital
| | - Kazuto Fujimoto
- Cardiovascular Center, Showa University Northern Yokohama Hospital
| | - Shinichi Otsuki
- Division of Pediatric Cardiology, Department of Pediatrics, Okayama University
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yasuo Ono
- Department of Cardiology, Shizuoka Children’s Hospital
| | - Satoshi Yazaki
- Department of Pediatric Cardiology, Sakakibara Heart Institute
| | - Sung-Hae Kim
- Department of Cardiology, Shizuoka Children’s Hospital
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women’s Medical University
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42
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Yao A. “Treat-and-Repair” Strategy for Atrial Septal Defect and Associated Pulmonary Arterial Hypertension. Circ J 2016; 80:69-71. [DOI: 10.1253/circj.cj-15-1235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Atsushi Yao
- Division for Health Service Promotion, The University of Tokyo
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Abstract
Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic state that can be found in multiple conditions with associated symptoms of dyspnea, decreased exercise tolerance, and progression to right heart failure. The World Health Organization has classified PH into five groups. The first group is pulmonary arterial hypertension (PAH), which can be idiopathic, heritable, due to drugs and toxins, or associated with conditions such as connective tissue diseases, congenital heart disease, portal hypertension, and others. The development of PAH is believed to result from smooth muscle cells and endothelial dysfunction that impairs production of vasodilators, including nitric oxide and prostacyclin. The importance of distinguishing this group from the other groups of PH is that there are PAH-specific drugs that target the molecular pathways that are pathogenic in the vascular derangements, leading to arterial hypertension, which should not be used in the other forms of PH. Other groups of PH include PH due to left heart disease, lung disease, chronic thromboembolic disease, as well as a miscellaneous category. Echocardiography is used to screen for PH and has varying sensitivity and specificity in detecting PH. Additionally, the right heart pressures estimated during echocardiogram often differ from those obtained during confirmatory testing with right heart catheterization. The most challenging PH diagnosis is in a case that does not fit one group of PH, but meets criteria that overlap between several groups. This also makes the treatment challenging because each group of PH is managed differently. This review provides an overview of the five groups of PH and discusses the diagnostic and therapeutic challenges of each.
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Affiliation(s)
- Isabel S Bazan
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA
| | - Wassim H Fares
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA
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[Pulmonary hypertension associated with congenital heart disease and Eisenmenger syndrome]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:32-49. [PMID: 25650280 DOI: 10.1016/j.acmx.2014.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/12/2014] [Accepted: 11/14/2014] [Indexed: 11/24/2022] Open
Abstract
Pulmonary arterial hypertension is a common complication of congenital heart disease (CHD). Congenital cardiopathies are the most frequent congenital malformations. The prevalence in our country remains unknown, based on birthrate, it is calculated that 12,000 to 16,000 infants in our country have some cardiac malformation. In patients with an uncorrected left-to-right shunt, increased pulmonary pressure leads to vascular remodeling and endothelial dysfunction secondary to an imbalance in vasoactive mediators which promotes vasoconstriction, inflammation, thrombosis, cell proliferation, impaired apotosis and fibrosis. The progressive rise in pulmonary vascular resistance and increased pressures in the right heart provocated reversal of the shunt may arise with the development of Eisenmenger' syndrome the most advanced form de Pulmonary arterial hypertension associated with congenital heart disease. The prevalence of Pulmonary arterial hypertension associated with CHD has fallen in developed countries in recent years that is not yet achieved in developing countries therefore diagnosed late as lack of hospital infrastructure and human resources for the care of patients with CHD. With the development of targeted medical treatments for pulmonary arterial hypertension, the concept of a combined medical and interventional/surgical approach for patients with Pulmonary arterial hypertension associated with CHD is a reality. We need to know the pathophysiological factors involved as well as a careful evaluation to determine the best therapeutic strategy.
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Myers PO, Tissot C, Beghetti M. Treat-and-repair approach to Eisenmenger syndrome. J Card Surg 2014; 29:836. [PMID: 24869498 DOI: 10.1111/jocs.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Patrick O Myers
- Division of Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland
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Iwashima S, Ishikawa T. Quantitative, Noninvasive Assessment of Patent Ductus Arteriosus Shunt Flow by Measuring Proximal Isovelocity Surface Area on Color Doppler Imaging. Circ J 2014; 78:2302-2308. [DOI: 10.1253/circj.cj-14-0229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Satoru Iwashima
- Department of Pediatrics, Hamamatsu University School of Medicine
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