1
|
Weiss EK, Baraboo J, Rigsby CK, Robinson JD, Ma L, Falcão MBL, Roy CW, Stuber M, Markl M. Respiratory-resolved five-dimensional flow cardiovascular magnetic resonance : In-vivo validation and respiratory-dependent flow changes in healthy volunteers and patients with congenital heart disease. J Cardiovasc Magn Reson 2024; 26:101077. [PMID: 39098573 PMCID: PMC11417305 DOI: 10.1016/j.jocmr.2024.101077] [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: 11/13/2023] [Revised: 06/13/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND This study aimed to validate respiratory-resolved five-dimensional (5D) flow cardiovascular magnetic resonance (CMR) against real-time two-dimensional (2D) phase-contrast MRI, assess the impact of number of respiratory states, and measure the impact of respiration on hemodynamics in congenital heart disease (CHD) patients. METHODS Respiratory-resolved 5D flow MRI-derived net and peak flow measurements were compared to real-time 2D phase-contrast MRI-derived measurements in 10 healthy volunteers. Pulmonary-to-systemic flow ratios (Qp:Qs) were measured in 19 CHD patients and aortopulmonary collateral burden was measured in 5 Fontan patients. Additionally, the impact of number of respiratory states on measured respiratory-driven net flow changes was investigated in 10 healthy volunteers and 19 CHD patients (shunt physiology, n = 11, single ventricle disease [SVD], n = 8). RESULTS There was good agreement between 5D flow MRI and real-time 2D phase-contrast-derived net and peak flow. Respiratory-driven changes had a good correlation (rho = 0.64, p < 0.001). In healthy volunteers, fewer than four respiratory states reduced measured respiratory-driven flow changes in veins (5.2 mL/cycle, p < 0.001) and arteries (1.7 mL/cycle, p = 0.05). Respiration drove substantial venous net flow changes in SVD (64% change) and shunt patients (57% change). Respiration had significantly greater impact in SVD patients compared to shunt patients in the right and left pulmonary arteries (46% vs 15%, p = 0.003 and 59% vs 20%, p = 0.002). Qp:Qs varied by 37 ± 24% over respiration in SVD patients and 12 ± 20% in shunt patients. Aortopulmonary collateral burden varied by 118 ± 84% over respiration in Fontan patients. The smallest collateral burden was measured during active inspiration in all patients and the greatest burden was during active expiration in four of five patients. Reduced respiratory resolution blunted measured flow changes in the caval veins of shunt and SVD patients (p < 0.005). CONCLUSIONS Respiratory-resolved 5D flow MRI measurements agree with real-time 2D phase contrast. Venous measurements are sensitive to number of respiratory states, whereas arterial measurements are more robust. Respiration has a substantial impact on caval vein flow, Qp:Qs, and collateral burden in CHD patients.
Collapse
Affiliation(s)
- Elizabeth K Weiss
- Department of Radiology, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA.
| | - Justin Baraboo
- Department of Radiology, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Cynthia K Rigsby
- Department of Radiology, Northwestern University, Chicago, Illinois, USA; Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Illinois, USA
| | - Joshua D Robinson
- Department of Cardiology, Ann & Robert Lurie Children's Hospital, Chicago, Illinois, USA
| | - Liliana Ma
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Mariana B L Falcão
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Christopher W Roy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|
2
|
Ahmad Azahari AFA, Wan Ab Naim WN, Md Sari NA, Lim E, Mohamed Mokhtarudin MJ. Advancement in computational simulation and validation of congenital heart disease: a review. Comput Methods Biomech Biomed Engin 2024:1-14. [PMID: 39001803 DOI: 10.1080/10255842.2024.2377338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
The improvement in congenital heart disease (CHD) treatment and management has increased the life expectancy in infants. However, the long-term efficacy is difficult to assess and thus, computational modelling has been applied for evaluating this. Here, we provide an overview of the applications of computational modelling in CHD based on three categories; CHD involving large blood vessels only, heart chambers only, and CHD that occurs at multiple heart structures. We highlight the advancement of computational simulation of CHD that uses multiscale and multiphysics modelling to ensure a complete representation of the heart and circulation. We provide a brief future direction of computational modelling of CHD such as to include growth and remodelling, detailed conduction system, and occurrence of myocardial infarction. We also proposed validation technique using advanced three-dimensional (3D) printing and particle image velocimetry (PIV) technologies to improve the model accuracy.
Collapse
Affiliation(s)
| | - Wan Naimah Wan Ab Naim
- Faculty of Manufacturing and Mechatronic Engineering Technology, Universiti Malaysia Pahang, Pekan, Pahang, Malaysia
| | - Nor Ashikin Md Sari
- Division of Cardiology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Jamil Mohamed Mokhtarudin
- Faculty of Manufacturing and Mechatronic Engineering Technology, Universiti Malaysia Pahang, Pekan, Pahang, Malaysia
- Centre for Research in Advanced Fluid and Processes (Fluid Centre), Universiti Malaysia Pahang, Lebuhraya Tun Razak, Kuantan, Pahang, Malaysia
| |
Collapse
|
3
|
Park J, Kim S, Sohn JH, Kim JI, Hyun C. Successful interventional occlusion of muscular ventricular septal defect in a dog. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2024; 65:221-226. [PMID: 38434169 PMCID: PMC10880404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Ventricular septal defect (VSD) is a rare congenital heart disease in dogs. Hemodynamically important interventricular defects must be closed to improve the prognosis. This case report describes successful interventional transcatheter closure of a muscular VSD in a young Maltese and poodle mixed-breed dog with a large muscular interventricular defect (~5 mm in diameter) with a high rate of left-to-right shunt flow. The VSD was closed with a customized Amplatzer-type VSD occluder via a percutaneous transvenous (jugular) approach. We concluded that interventional occlusion of a muscular VSD with an Amplatzer-type occluder is a viable treatment option for dogs. A regular follow-up study for this dog is ongoing and has not detected complications. Key clinical message: Interventional occlusion of a muscular VSD with an Amplatzer-type occluder is a viable treatment option for dogs.
Collapse
Affiliation(s)
- Jiyoung Park
- VIP Animal Medical Center (Chungdam), Seoul, Korea 06068
| | - Sunyoung Kim
- VIP Animal Medical Center (Chungdam), Seoul, Korea 06068
| | - Ji-Heui Sohn
- VIP Animal Medical Center (Chungdam), Seoul, Korea 06068
| | - Jong-In Kim
- VIP Animal Medical Center (Chungdam), Seoul, Korea 06068
| | - Changbaig Hyun
- VIP Animal Medical Center (Chungdam), Seoul, Korea 06068
| |
Collapse
|
4
|
Bhende VV, Sharma TS, Krishnakumar M, Ramaswamy AS, Bilgi K, Pathan SR. Beyond Synthetics: Promising Outcomes With the Invengenx® Bovine Pericardial Patch for Ventricular Septal Defect Repair in a Young Pediatric Population. Cureus 2024; 16:e55530. [PMID: 38444930 PMCID: PMC10913133 DOI: 10.7759/cureus.55530] [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: 02/29/2024] [Indexed: 03/07/2024] Open
Abstract
Ventricular septal defects (VSDs) are a prevalent congenital heart anomaly demanding safe and lasting interventions. This paper explores the application of Invengenx® bovine pericardial patch (Tisgenx, Irvine, California), a promising biomaterial, in VSD repair. We present two case studies: a seven-month-old infant and a three-year-old child undergoing VSD closure using autologous and bovine pericardial patches, respectively. Both patients tolerated the procedures well, experiencing no intra-operative complications and demonstrating excellent postoperative recovery. Echocardiography postoperatively showed no complications and improved clinical outcomes. Notably, the pericardial patches exhibited excellent integration and suture retention, highlighting their durability and compatibility with the growing heart. These cases establish the feasibility and effectiveness of the Invengenx® pericardial patch for VSD repair. The favorable outcomes in terms of safety and efficacy support the potential of this biomaterial as a valuable alternative in pediatric cardiac surgery, particularly for complex VSDs or patients with contraindications to synthetic patches. Further research is crucial to unlock the full potential of bovine pericardium as a durable and advantageous option for VSD repair in a broader range of pediatric patients.
Collapse
Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | | | - Anikode S Ramaswamy
- Pathology, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Kanchan Bilgi
- Neuroanesthesiology, People Tree Hospitals, Bengaluru, IND
| | - Sohilkhan R Pathan
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| |
Collapse
|
5
|
Kumar A, Kumar P. Echocardiographic Study of Ventricular Septal Defect in 1- to 12-Year-Old Children Visiting a Tertiary Care Center in Patna, India. Cureus 2023; 15:e46363. [PMID: 37920619 PMCID: PMC10619588 DOI: 10.7759/cureus.46363] [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: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Background Symptoms of serious heart problems present at birth often appear during the first few days, weeks, or months of a child's life. Shunt formation between the left and right ventricle is a crucial component of the pathophysiology of ventral septal defects. Objectives We aim to determine the most frequent types of ventricular septal defect (VSD) by echocardiography and whether there is any gender variation in the type of ventricular septal defect. Material and methods A total of 100 children who were clinically suspected of or diagnosed with VSD at the age of 1-12 years were enrolled in this study. The septum of the atrioventricular (AV) canal, the muscular septum, and the parietal band of the distal conal septum were evaluated by color Doppler. Ventricular septal defect (VSD) size and kind are similarly impacted by the 2D echo mode. The size and site of the VSD, associated congenital anomaly, and significant morphological changes in ventricular cavities, gender discrimination, and relation-specific types of ventricular septal defect were observed. Results A total of 100 VSD children presented with clinical symptoms of fast breathing, retraction of the chest, cough, cyanosis, fever, difficulty during feeding, cyanotic spell, chest pain, and edema at 65%, 62%, 54%, 52%, 54%, 29%, 9%, 11%, and 4%, respectively. Conclusion Early diagnosis is essential for effective medical care of diseases such as infective endocarditis (IE), which is present in some cases of VSD, and the avoidance of persistent pulmonary veno-occlusive disease (PVOD).
Collapse
Affiliation(s)
- Amish Kumar
- Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Pankaj Kumar
- Department of Anatomy, Narayan Medical College and Hospital, Patna, IND
| |
Collapse
|
6
|
Nathani PS, Krishna R, Solunke V, Mundada S. Pearl Syndrome With an Unusual Association of Spina Bifida and Congenital Cholesteatoma. Cureus 2022; 14:e22832. [PMID: 35399447 PMCID: PMC8980244 DOI: 10.7759/cureus.22832] [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] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
We report a case of a one-day-old female with congenital facial nerve palsy, bilateral microtia, congenital heart disease, spina bifida, and congenital cholesteatoma. The newborn was brought by the mother with complaints of abnormally looking ear and a facial droop toward the left side, following which a two-dimensional echocardiography was done showing the atrial septal defect and ventricular septal defect. Computed tomography of the temporal bone showed the presence of congenital cholesteatoma in the left ear. MRI of the lumbosacral spine was suggestive of spina bifida occulta. Brainstem evoked response audiometry was suggestive of sensorineural hearing loss. Such a combination of symptoms is very rare, and therefore this case is being reported.
Collapse
|
7
|
Chen TY, Ju YT, Wei YJ, Hsieh ML, Wu JM, Wang JN. Clinical Experience of Transcatheter Closure for Ventricular Septal Defects in Children Weighing under 15 kg. ACTA CARDIOLOGICA SINICA 2021; 37:618-624. [PMID: 34812235 PMCID: PMC8593479 DOI: 10.6515/acs.202111_37(6).20210726a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Failure to thrive and poor weight gain are the main problems associated with ventricular septal defects complicated by heart failure in pediatric patients. Recent advances in transcatheter closure have enabled safe and effective interventions in these patients. OBJECTIVES The purpose of this study was to describe our experience with transcatheter closure of ventricular septal defects in young children with low weight. METHODS Pediatric patients weighing < 15 kg who underwent transcatheter closure of ventricular septal defects between January 2018 and December 2019 at our hospital were retrospectively enrolled. RESULTS Twelve patients were enrolled: one with a muscular defect, two with outlet defects, and nine with perimembranous defects. Their median age was 24 (7-60) months, and their median weight before the procedure was 11.8 kg (4.7-14.9 kg; mean Z-score: -1.3). The median precordial echocardiographic defect diameter was 5.6 (2.0-9.3) mm. Successful transcatheter closure was achieved in 11 cases. The mean weight at 1-month follow-up after defect closure was 13.5 kg (6.2-19.8 kg; mean Z-score: -0.2). The mean length of hospitalization was 2.7 days. CONCLUSIONS This study highlights the potential safety and therapeutic efficacy of transcatheter ventricular septal defect closure in infants with low weight. Considerable weight gain and heart failure symptom attenuation at 1 month after transcatheter closure were observed.
Collapse
Affiliation(s)
- Tsung-Yen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Department of Pediatrics, E-Da Hospital and School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ying-Tzu Ju
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yu-Jen Wei
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Min-Ling Hsieh
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Jing-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| |
Collapse
|
8
|
Rao PS. Single Ventricle-A Comprehensive Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:441. [PMID: 34073809 PMCID: PMC8225092 DOI: 10.3390/children8060441] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
In this paper, the author enumerates cardiac defects with a functionally single ventricle, summarizes single ventricle physiology, presents a summary of management strategies to address the single ventricle defects, goes over the steps of staged total cavo-pulmonary connection, cites the prevalence of inter-stage mortality, names the causes of inter-stage mortality, discusses strategies to address the inter-stage mortality, reviews post-Fontan issues, and introduces alternative approaches to Fontan circulation.
Collapse
Affiliation(s)
- P Syamasundar Rao
- McGovern Medical School, University of Texas-Houston, Children's Memorial Hermann Hospital, 6410 Fannin Street, UTPB Suite # 425, Houston, TX 77030, USA
| |
Collapse
|
9
|
Nayak S, Patel A, Haddad L, Kanakriyeh M, Varadarajan P. Echocardiographic evaluation of ventricular septal defects. Echocardiography 2020; 37:2185-2193. [PMID: 33368542 DOI: 10.1111/echo.14511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/18/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022] Open
Abstract
Ventricular septal defects (VSDs) are the most common forms of acyanotic congenital heart disease accounting for 37% of congenital heart disease in children. A VSD is defined by parts of the ventricular septum involved. There are four major types of VSDs: perimembranous, muscular, outlet, and inlet VSDs. Echocardiography is the most important clinical tool to help diagnose and characterize a VSD. Although most VSDs are clinically nonsignificant or close on their own, echocardiography with Doppler and color flow mapping can be used to provide accurate anatomic and hemodynamic evaluation of VSDs in order to determine if surgical or transcatheter-based intervention is needed. Hence, understanding how to use echocardiography to characterize VSDs is of crucial importance when caring for patients with adult congenital heart disease.
Collapse
Affiliation(s)
- Srishti Nayak
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Akash Patel
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Lana Haddad
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Mohammad Kanakriyeh
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Padmini Varadarajan
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| |
Collapse
|
10
|
Isolated Unroofed Coronary Sinus without Persistent Left Superior Vena Cava. COR ET VASA 2020. [DOI: 10.33678/cor.2020.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
Haddad RN, Daou LS, Saliba ZS. Percutaneous closure of restrictive-type perimembranous ventricular septal defect using the new KONAR multifunctional occluder: Midterm outcomes of the first middle-eastern experience. Catheter Cardiovasc Interv 2020; 96:E295-E302. [PMID: 31886940 DOI: 10.1002/ccd.28678] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the safety, efficiency, and midterm outcomes of transcatheter perimembranous ventricular septal defect (pmVSD) closure using the new KONAR-MF™ VSD occluder. BACKGROUND Off-label percutaneous pmVSD closure is a well-established procedure with promising results. Yet, interventionists are still searching for the ideal device. METHODS Between June 2018 and March 2019, 20 patients with hemodynamically significant but restrictive-type pmVSD underwent an attempted transcatheter closure using the new KONAR-MF™. All implantations were performed retrogradely under general anesthesia, transoesophageal echocardiography, and fluoroscopic guidance. Prospective follow-up using transthoracic echocardiography and electrocardiogram was done until August 2019. RESULTS The median age was 6.4 years (8 months to 43.4 years), and the median body weight was 17.3 (9-74) kg. The mean defect size on the left ventricular aspect was 11.7 ± 2.8 mm. All devices were successfully and rapidly implanted. One device embolized in the pulmonary artery, 24 hr after implantation and was percutaneously retrieved with no complication. Over a mean follow-up period of 8.2 ± 3.0 months, complete closure was achieved in 84.2% of patients. One new onset of mild aortic regurgitation was detected before discharge and remained stable. Tricuspid valve regurgitation, complete heart block, major complication, and death were not observed. CONCLUSIONS Transcatheter pmVSD closure using the KONAR-MF™ can be successfully performed in adult and pediatric patients. It is a safe and promising device, designed to provide high conformability to septal defects with a lower risk of heart block. Retrograde implantation allows procedural flexibility, efficient deliverability, and control of valvular interferences.
Collapse
Affiliation(s)
- Raymond N Haddad
- Hotel Dieu de France University Medical Center, Department of Pediatrics, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Linda S Daou
- Hotel Dieu de France University Medical Center, Department of Pediatric Cardiology, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| | - Zakhia S Saliba
- Hotel Dieu de France University Medical Center, Department of Pediatric Cardiology, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
| |
Collapse
|
12
|
Shmukler A, Haramati A, Haramati LB. Overview of Common Surgical Procedures in CHD. Semin Roentgenol 2020; 55:264-278. [PMID: 32859343 DOI: 10.1053/j.ro.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Shmukler
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY..
| | - Adina Haramati
- Department of Radiology, Northwell Health, Manhasset, NY
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| |
Collapse
|
13
|
Abstract
Approximately 50 million adults worldwide have known congenital heart disease (CHD). Among the most common types of CHD defects in adults are atrial septal defects and ventricular septal defects followed by complex congenital heart lesions such as tetralogy of Fallot. Adults with CHDs are more likely to have hypertension, cerebral vascular disease, diabetes and chronic kidney disease than age-matched controls without CHD. Moreover, by the age of 50, adults with CHD are at a greater than 10% risk of experiencing cardiac dysrhythmias and approximately 4% experience sudden death. Consequently, adults with CHD require healthcare that is two- to four-times greater than adults without CHD. This paper discusses the diagnosis and treatment of adults with atrial septal defects, ventricular septal defects and tetralogy of Fallot.
Collapse
Affiliation(s)
- Robert J Henning
- School of Public Health, University of South Florida, Tampa, FL 33612, USA
| |
Collapse
|
14
|
Tanghöj G, Liuba P, Sjöberg G, Naumburg E. Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age. Front Cardiovasc Med 2020; 6:185. [PMID: 31998753 PMCID: PMC6965016 DOI: 10.3389/fcvm.2019.00185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3–5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. “Cases” were children with ASD closure at ≤1 or ≤2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were ≤2 years, and 50 (12%) were ≤1 year. Risk factors associated with a ≤2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5–3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8–6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6–12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7–4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.
Collapse
Affiliation(s)
- Gustaf Tanghöj
- Department of Clinical Sciences, Unit of Pediatrics, Umeå University, Umeå, Sweden
| | - Petru Liuba
- Department of Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Estelle Naumburg
- Department of Clinical Sciences, Unit of Pediatrics, Umeå University, Umeå, Sweden
| |
Collapse
|
15
|
Noori NM, Teimouri A. Clinical course in children and adolescents with ventricular septal defect. Asian Cardiovasc Thorac Ann 2019; 27:529-534. [PMID: 31362513 DOI: 10.1177/0218492319867001] [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: 11/16/2022]
Abstract
Background Ventricular septal defect, the most common congenital heart defect, is characterized by an opening between the ventricles. This study aimed to evaluate the clinical course and associations between the characteristics of ventricular septal defect. Methods This cross-sectional study was conducted on 1498 children with ventricular septal defects, aged <19 years, who were referred to our center between 2003 and 2018. The diagnosis was suspected from a combination of clinical and laboratory findings, and confirmed by transthoracic echocardiography. Results Of the 1498 children, 54.9% were boys, 78.4% of defects were perimembranous, 30.4% of patients had pulmonary hypertension, 67.5% had regular follow-up, and 76 (5.1%) had complications including 28 (1.9%) with Eisenmenger syndrome; 10 died due to Eisenmenger syndrome during follow-up. The defects closed spontaneously in 38.9% and after surgery in 20.9%. Boys tended to have more perimembranous, inlet, and outlet forms (56.40%, 50.60%, 51.90%, respectively), whereas girls had more muscular types (51.80%). Most patients with pulmonary hypertension had perimembranous defects (83.10%). The majority of patients with pulmonary hypertension had large (63.40%) or moderate (36.60%) defects. Pulmonary hypertension had a significant association with defect size ( p < 0.001). After surgery, residual defects were found mostly in cases of large defects (84.60%). Most patients with spontaneous closure were younger than 4 years. Conclusion Almost four-fifths of children with ventricular septal defects had perimembranous types, and almost one-third had pulmonary hypertension which was associated with defect size. Two-fifths of the defects closed spontaneously. There was a low incidence of complications after surgery.
Collapse
Affiliation(s)
- Noor Mohammad Noori
- Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| |
Collapse
|
16
|
Schubert S, Kelm M, Koneti NR, Berger F. First European experience of percutaneous closure of ventricular septal defects using a new CE-marked VSD occluder. EUROINTERVENTION 2019; 15:e242-e243. [PMID: 30585782 DOI: 10.4244/eij-d-18-00867] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Stephan Schubert
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | | | | | | |
Collapse
|
17
|
Rajderkar S, Mann JM, Panaretos C, Yumoto K, Li HD, Mishina Y, Ralston B, Kaartinen V. Trim33 is required for appropriate development of pre-cardiogenic mesoderm. Dev Biol 2019; 450:101-114. [PMID: 30940539 DOI: 10.1016/j.ydbio.2019.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 11/25/2022]
Abstract
Congenital cardiac malformations are among the most common birth defects in humans. Here we show that Trim33, a member of the Tif1 subfamily of tripartite domain containing transcriptional cofactors, is required for appropriate differentiation of the pre-cardiogenic mesoderm during a narrow time window in late gastrulation. While mesoderm-specific Trim33 mutants did not display noticeable phenotypes, epiblast-specific Trim33 mutant embryos developed ventricular septal defects, showed sparse trabeculation and abnormally thin compact myocardium, and died as a result of cardiac failure during late gestation. Differentiating embryoid bodies deficient in Trim33 showed an enrichment of gene sets associated with cardiac differentiation and contractility, while the total number of cardiac precursor cells was reduced. Concordantly, cardiac progenitor cell proliferation was reduced in Trim33-deficient embryos. ChIP-Seq performed using antibodies against Trim33 in differentiating embryoid bodies revealed more than 4000 peaks, which were significantly enriched close to genes implicated in stem cell maintenance and mesoderm development. Nearly half of the Trim33 peaks overlapped with binding sites of the Ctcf insulator protein. Our results suggest that Trim33 is required for appropriate differentiation of precardiogenic mesoderm during late gastrulation and that it will likely mediate some of its functions via multi-protein complexes, many of which include the chromatin architectural and insulator protein Ctcf.
Collapse
Affiliation(s)
- Sudha Rajderkar
- Department of Biologic and Materials Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jeffrey M Mann
- Department of Biologic and Materials Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Christopher Panaretos
- Department of Biologic and Materials Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Kenji Yumoto
- Department of Biologic and Materials Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Hong-Dong Li
- Center for Bioinformatics, School of Information Science and Engineering, Central South University, Changsha, Hunan, 410083, PR China
| | - Yuji Mishina
- Department of Biologic and Materials Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Benjamin Ralston
- Department of Biologic and Materials Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Vesa Kaartinen
- Department of Biologic and Materials Sciences, University of Michigan, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
18
|
Rao PS. Management of Congenital Heart Disease: State of the Art; Part I-ACYANOTIC Heart Defects. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E42. [PMID: 30857252 PMCID: PMC6463202 DOI: 10.3390/children6030042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 12/31/2022]
Abstract
Since the description of surgery for patent ductus arteriosus in late 1930s, an innumerable number of advances have taken place in the management of congenital heart defects (CHDs). In this review the current status of treatment of seven of the most common acyanotic CHDs was reviewed. The discussion included indications for, and timing of, intervention and methods of intervention. The indications are, by and large, determined by the severity of the lesion. Pressure gradients in obstructive lesions and the magnitude of the shunt in left-to-right shunt lesions are used to assess the severity of the lesion. The timing of intervention is different for each lesion and largely dependent upon when the criteria for indications for intervention were met. Appropriate medical management is necessary in most patients. Trans-catheter methods are preferable in some defects while surgery is a better option in some other defects. The currently available medical, trans-catheter, and surgical methods to treat acyanotic CHD are feasible, safe, and effective.
Collapse
Affiliation(s)
- P Syamasundar Rao
- McGovern Medical School, University of Texas-Houston, Children's Memorial Hermann Hospital, Houston, TX 77030, USA.
| |
Collapse
|
19
|
Dyck GJB, Raj P, Zieroth S, Dyck JRB, Ezekowitz JA. The Effects of Resveratrol in Patients with Cardiovascular Disease and Heart Failure: A Narrative Review. Int J Mol Sci 2019; 20:ijms20040904. [PMID: 30791450 PMCID: PMC6413130 DOI: 10.3390/ijms20040904] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular disease (CVD) is the main cause of death globally and responsible for the second highest number of deaths in Canada. Medical advancements in the treatment of CVD have led to patients living longer with CVD but often progressing to another condition called heart failure (HF). As a result, HF has emerged in the last decade as a major medical concern. Fortunately, various “traditional” pharmacotherapies for HF exist and have shown success in reducing HF-associated mortality. However, to augment the treatment of patients with CVD and/or HF, alternative pharmacotherapies using nutraceuticals have also shown promise in the prevention and treatment of these two conditions. One of these natural compounds considered to potentially help treat HF and CVD and prevent their development is resveratrol. Herein, we review the clinical findings of resveratrol’s ability to be used as an effective treatment to potentially help treat HF and CVD. This will allow us to gain a more fulsome appreciation for the effects of resveratrol in the health outcomes of specific patient populations who have various disorders that constitute CVD.
Collapse
Affiliation(s)
- Garrison J B Dyck
- Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada.
| | - Pema Raj
- St Boniface Hospital, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
| | - Shelley Zieroth
- St Boniface Hospital, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada.
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada.
| |
Collapse
|
20
|
Optimizing Cardiac CTA Acquisition in Congenital Heart Disease. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|