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Lîm HK, Wang JK, Tsai KS, Chien YH, Chang YC, Cheng CH, Tsai CY, Peng YW, Hwang JJ, Huei-Ming Ma M. Cardiac screening in school children: Combining auscultation and electrocardiography with a crowdsourcing model. J Formos Med Assoc 2023; 122:1313-1320. [PMID: 37468409 DOI: 10.1016/j.jfma.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 03/05/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND/PURPOSE School-based cardiac screening is useful for identifying children and adolescents with a high risk of sudden cardiac death. However, because of challenges associated with cost, distance, and human resources, cardiac screening is not widely implemented, especially in rural areas with limited medical resources. This study aims to establish a cloud-based system suitable for mass cardiac screening of schoolchildren in rural areas with limited medical resources. METHODS Students from three schools were included. They or their guardians completed a simple questionnaire, administered in paper or electronic form. Heart sounds were recorded using an electronic stethoscope. Twelve-lead electrocardiograms (ECGs) were recorded and digitalized. The signals were transmitted through Bluetooth to a tablet computer and then uploaded to a cloud server over Wi-Fi. Crowdsourced pediatric cardiologists reviewed those data from a web-based platform and provided remote consultation. In cases in which abnormal heart sounds or ECGs were noted, the students were referred to the hospital for further evaluation. RESULTS A total of 1004 students were enrolled in this study. Of the 138 students referred, 62 were diagnosed as having an abnormal heart condition and most had previously been undiagnosed. The interrater agreeability was high. CONCLUSION An innovative strategy combining a cloud-based cardiac screening system with remote consultation by crowdsourced experts was established. This system allows pediatric cardiologists to provide consultation and make reliable diagnoses. Combined with crowdsourcing, the system constitutes a viable approach for mass cardiac screening in children and adolescents living in rural areas with insufficient medical resources.
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Affiliation(s)
- Hīng-Ka Lîm
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | | | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
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Is There a Role for the Microbiome and Sudden Death? A Systematic Review. Life (Basel) 2021; 11:life11121345. [PMID: 34947876 PMCID: PMC8706612 DOI: 10.3390/life11121345] [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: 10/18/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background. Sudden unexpected death (SUD) is one of the most important and worthy investigation case profiles in emergency medicine and forensic pathology. Sudden unexpected deaths in adults (SUDA) are frequently caused by cardiac events, while infections usually cause those in infants younger than one year (SUDI), and to a lesser extent, in children older than one year (SUDC). However, in some instances of children under the age of one dying (SIDS), a cause is not discovered despite a thorough investigation that includes a review of clinical history, examination of the death scene, and a complete autopsy. Several studies demonstrate that the microbiome influences host immunity, alters susceptibility to viral respiratory infections, and has a vital role in various health, disease, and death outcomes. The main objective of this systematic review was to compile and offer a complete vision of the main lines of research on microbiome and sudden death that have emerged in recent years and their relationship with forensic sciences, as well as the possible contributions or limitations in the field of forensic sciences. Methods. Following PRISMA principles, a systematic evaluation of the microbiome and sudden death in forensic science was conducted. In this review, our study classified the sudden deaths as SUDA, SUDI, and SIDS. Results. The role of microbiome research in sudden death is discussed in this review. Various studies have linked the detection of different bacteria or viruses as a probable cause of sudden death. Bacteria analysed differ between studies that used autopsy specimens from deaths classified as SUDA, SUDI, and SIDS, or, except in the case of Staphylococcus aureus and Escherichia coli, which have been analysed in both SUDI and SIDS autopsies. In the case of viruses, only Cytomegalovirus has been analysed in both SIDS and SUDI cases. However, all the viruses studied are respiratory viruses found in samples of nasopharyngeal or lung fluid. Conclusions. Although the application of the microbiome in sudden death and other fields of forensic science is still in its early stages, a role of the microbiome in sudden deaths cannot be ruled out, but we cannot conclude that it is a significant factor either.
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Liu HW, Huang LW, Chiu SN, Lue HC, Wu MH, Chen MR, Wang JK. Cardiac Screening for High Risk Sudden Cardiac Death in School-Aged Children. ACTA CARDIOLOGICA SINICA 2020; 36:641-648. [PMID: 33235421 DOI: 10.6515/acs.202011_36(6).20200515a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Sudden cardiac death (SCD) is an uncommon but significant cause of death in the young. Citywide cardiac screening of school-aged children has been performed in Taipei since 1989. In this study, we investigate the efficacy of this screening method for identifying those at high risk of SCD. Methods This study analyzed the data from the results of cardiac screening for school-aged children in Taipei from 2003 to 2014. The cardiac screening included: Stage I, questionnaire surveys, simplified phonocardiography test and simplified electrocardiography (ECG) test; Stage II, physical examination and auscultation by a pediatric cardiologist for all children who had abnormal findings in stage I screening; Stage III, referral to a pediatric cardiologist for further examinations. Logistic regression and decision tree analyses were performed. Results A total of 566,447 students were screened, of whom 685 were identified as being at high risk of SCD. The most common causes of being at high risk of SCD included Wolff-Parkinson-White syndrome, long QT syndrome, cardiomyopathy and Marfan's syndrome. Using logistic regression analysis, the simplified ECG test was identified as being the most effective tool (odds ratio = 16.4, p < 0.001) and past history as the second most crucial factor (odds ratio = 3.95, p < 0.001) for detecting a high risk of SCD. Decision tree analysis showed that serial studies with a past history and the simplified ECG test could accurately identify those at high risk of SCD. Conclusions Questionnaire survey and simplified electrocardiography test-based cardiovascular screening in school-aged children can identify those at high risk of SCD.
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Affiliation(s)
- Hsiu-Wen Liu
- Department of Business Administration, Soochow University
| | | | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Hung-Chi Lue
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Ming-Ren Chen
- Department of Pediatrics, MacKay Memorial Hospital and Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
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Sudden infant death syndrome: Do the parents follow the recommendations? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ruiz Botia I, Cassanello Peñarroya P, Díez Izquierdo A, Martínez Sánchez JM, Balaguer Santamaria A. [Sudden infant death syndrome: Do the parents follow the recommendations?]. An Pediatr (Barc) 2020; 92:222-228. [PMID: 31353309 DOI: 10.1016/j.anpedi.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Prone sleeping position is the main known modifiable risk factor for sudden infant death syndrome (SIDS). There are other SIDS recommendations although with less impact. The objective of this study is to describe the prevalence of prone position during sleep as well as other risk factors associated with SIDS in a sample of Spanish babies and infants. METHODS Cross-sectional study carried out on 640 families with children from 0 months to 11 months. In addition to the sleep position, the adherence to four other recommendations regarding SIDS was analysed: place where infant sleeps, breastfeeding, use of non-nutritive suction, and maternal smoking. RESULTS A total of 41.3% of infants under 6 months and 59.7% of infants aged 6 to 11 months slept in a non-recommended position. Only 6.4% of families analysed followed all five recommendations. DISCUSSION There is a high prevalence of modifiable risk factors for SIDS among the studied population. Personalized education should be promoted, along with other campaigns to raise awareness and prevent SIDS.
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Affiliation(s)
- Irene Ruiz Botia
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España.
| | - Pía Cassanello Peñarroya
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
| | - Ana Díez Izquierdo
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
| | | | - Albert Balaguer Santamaria
- Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
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Tseng WC, Wu MH, Chiu SN, Chen HC, Kao FY, Huang SK. Cumulative postnatal risk of pediatric sudden death and all-cause mortality in nationwide birth cohorts of Taiwan and the United States. J Formos Med Assoc 2020; 119:1842-1853. [PMID: 32173231 DOI: 10.1016/j.jfma.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate the cumulative postnatal risk of pediatric sudden death (SD) for each neonate and the temporal/regional differences which are still unclear. METHODS We established a birth cohort (2000-2014) from our national database and obtained reference data about the United States (US) from the national website. RESULTS Among 3,097,277 live births, we identified 1661 children with SD (56.8% male). The postnatal cumulative risk of SD was 0.35, 0.49, 0.56 and 0.59/1000 by age 0, 5, 11 and 14 years. Coexisting cardiac diagnosis was noted in 347 (20.9%) and non-cardiac diagnosis in 300 (18.1%) patients. Cumulative all-cause mortality was 5.3, 6.78, 7.63 and 8.06/1000 by age 0, 5, 11 and 14 years. Risks of SD and all-cause death decreased over birthyear. SD risk decreased particularly after the 2008 birthyear. Risks of SD and all-cause death were the highest in Eastern Taiwan, but SD/all-cause death ratio was high in Taipei metropolitan and Northern Taiwan. Cumulative risk of SD (0.54/1000 by age 14) and all-cause mortality (9.06/1000 by age 14) in the US decreased over time. African-Americans were at the highest risks of SD and all-cause mortality. However, American-Indians/Alaska-natives exhibited the highest SD/all-cause death ratio. CONCLUSION This study provides the cumulative risk of SD (1 in 1694 newborns) by age 14 years. The time trend underlines the effect of medical advance and education on SD prevention. Distinct regional/ethnic differences in risks of SD and all-cause death in Taiwan and the US indicate the necessity of different strategies to diminish the disparity.
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Mei-Hwan Wu
- Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan.
| | - Sheunn-Nan Chiu
- Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Hui-Chi Chen
- Obstetrics and Gynecology, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Feng-Yu Kao
- Administration of National Health Insurance, Taipei, Taiwan
| | - San-Kuei Huang
- Administration of National Health Insurance, Taipei, Taiwan
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Pregnancy and newborn outcomes in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Int J Cardiol 2018; 258:172-178. [DOI: 10.1016/j.ijcard.2017.11.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022]
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Takiguchi M, Knight T, Nguyen TT, Limm B, Hayes D, Reddy V, Bratincsak A. Underdiagnosis of Conditions Associated with Sudden Cardiac Death in Children--Is it the Absence of a Comprehensive Screening Program or a True Low Prevalence? HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2016; 75:42-5. [PMID: 26918207 PMCID: PMC4755066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aimed to assess the prevalence of conditions associated with sudden cardiac death (SCD) among all children and children with sudden infant death syndrome (SIDS) in the State of Hawai'i, where no comprehensive screening program is conducted for such conditions. A retrospective chart review was conducted from the single tertiary pediatric hospital in Hawai'i, from offices of all pediatric cardiologists in Hawai'i, and the Hawai'i State Department of Health from 1/1/2000 to 12/31/2013. Children aged 0-18 years were included in the study. A subset of the study analyzed records of infants aged 0-12 months. SIDS rate was calculated and compared to national data. Prevalence was calculated for known conditions associated with SCD. The identified prevalence was compared to the established prevalence of conditions associated with SCD. In Hawai'i, the infant SIDS rate (66.4/100,000) was similar to the national rate (54.4/100,000). Over 14 years, only 51 children were diagnosed with a condition associated with SCD; 28 with a cardiomyopathy and 21 with a channelopathy. A 14-year retrospective analysis in the State of Hawai'i revealed that less than 1 in 30 children, who are expected to harbor a SCD-associated condition, had been appropriately diagnosed. The underdiagnosis of conditions associated with SCD reflects that in the absence of a comprehensive screening program, conditions without obvious signs and symptoms are difficult to diagnose. Many children with these conditions will remain at risk of SCD.
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Affiliation(s)
- Marisa Takiguchi
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Tristan Knight
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Tin Toan Nguyen
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Blair Limm
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Donald Hayes
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Venu Reddy
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Andras Bratincsak
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
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Kohorst JJ, Bos JM, Hagler DJ, Ackerman MJ. Sudden cardiac arrest in a young patient with hypertrophic cardiomyopathy and zero canonical risk factors: the inherent limitations of risk stratification in hypertrophic cardiomyopathy. CONGENIT HEART DIS 2013; 9:E51-7. [PMID: 23648018 DOI: 10.1111/chd.12073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/29/2022]
Abstract
Hypertrophic cardiomyopathy is the most common heritable cardiovascular disease and a common cause of sudden cardiac death (SCD) in young adolescents and athletes. Clinical risk stratification for SCD is predicated on the presence of established risk factors; however, this assessment is far from perfect. Herein, we present a 16-year-old male who was resuscitated successfully from his sentinel event of out-of-hospital cardiac arrest. Prior to this event, he was asymptomatic and lacked all traditional SCD-predisposing risk factors for hypertrophic cardiomyopathy.
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Kim JO, Kim YH, Hyun MC. Electrocardiography recordings in higher intercostal space for children with right ventricular outlet obstruction reconstruction operation. Korean Circ J 2012; 42:414-8. [PMID: 22787472 PMCID: PMC3390427 DOI: 10.4070/kcj.2012.42.6.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/01/2011] [Accepted: 01/09/2012] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives We checked traditional and high-level precordial electrocardiogram (ECG) leads in patients who had undergone right ventricular outlet obstruction (RVOT) reconstruction surgery and evaluated the effect of ECG lead position on their QRS duration. Subjects and Methods We enrolled 34 patients who had undergone surgery for congenital heart disease with RVOT obstruction and who had received followed up care that included recorded ECG at a pediatric cardiac out-patient clinic. The control group included 29 patients who did not have hemodynamically significant intracardiac abnormality. We recorded traditional standard 12-leads ECG from the 4th intercostals space, and moved the precordial leads to the 3rd and 2nd intercostals spaces, and recorded ECGs repeatedly. Results In all groups, there was no significant difference of mean QRS duration and QTc interval between traditional standard 12-leads ECGs and ECGs at higher intercostals spaces. There was no significant difference of ECG parameters between groups. In the control group, the degree of the change between the 4th intercostals space (ICS) QRS and 3rd ICS QRS was significant (p=0.031), and although, it was insignificant, ECGs at the 3rd ICS showed decreased QRS duration in group 1 (V1: 3rd ICS 119.21±21.53 msec vs. 4th ICS 122.80±31.78 msec. V2: 3rd ICS 113.68±19.43 msec vs. 4th ICS 118.24±19.16 msec). Conclusion Although the positional change of ECG leads did not result in a significant effect on measuring QRS duration after surgery, ECG leads at the 3rd ICS rather than at the 4th ICS may cause alteration of ECG readings. Therefore, we suggest that ECGs should be recorded in as accurate a position as possible.
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Affiliation(s)
- Jung Ok Kim
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea
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Lee SY, Baek JS, Kim GB, Kwon BS, Bae EJ, Noh CI, Choi JY, Lim HK, Kim WH, Lee JR, Kim YJ. Clinical significance of thrombosis in an intracardiac blind pouch after a Fontan operation. Pediatr Cardiol 2012; 33:42-8. [PMID: 21818649 PMCID: PMC3248640 DOI: 10.1007/s00246-011-0074-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 07/13/2011] [Indexed: 11/30/2022]
Abstract
The univentricular heart after the Fontan operation may have a blind pouch formed by the pulmonary stump or rudimentary ventricle according to the anatomy before surgery. Thrombosis in an intracardiac blind pouch of patients with a univentricular heart is a hazardous complication. Because only a few reports have described this complication, the authors evaluated the clinical significance of thrombosis in an intracardiac blind pouch of a univentricular heart. They performed a retrospective review of medical records from August 1986 to December 2007. Four patients were confirmed as having thrombosis in a pulmonary artery stump and one patient as having thrombosis in a rudimentary ventricle shown by cardiac computed tomography (CT). This represents 1.85% (5/271) of patients with ongoing regular follow-up evaluation after the Fontan operation. The median age at diagnosis was 14.2 years. Two of the five patients were taking aspirin and one patient was taking warfarin when they were identified for the development of thrombosis. None of the patients demonstrated thrombosis in the Fontan tract or venous side of the circulation. Brain magnetic resonance imaging (MRI) showed that three patients had cerebral infarction and one patient had suggestive old ischemia. Three patients with thrombus in the pulmonary stump underwent pulmonary artery stump thrombectomy and pulmonary valve obliteration. One patient with thrombus in the rudimentary ventricle underwent ventricular septal defect (VSD) closure with thrombectomy. Thrombus in a blind pouch could cause systemic thromboembolism despite little blood communication. Therefore, surgical modification of the pulmonary stump and VSD closure of the rudimentary ventricle are required to reduce the risk of later thrombus formation. Clinicians should not overlook the possibility of thrombus in a ligated pulmonary artery stump or a rudimentary ventricle after the Fontan operation, which may increase the risk of embolic stroke for patients with single-ventricle physiology.
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Affiliation(s)
- Sang Yun Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Jae Suk Baek
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Bo Sang Kwon
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Chung Il Noh
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Jung Yun Choi
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Hong Kuk Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Woong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
| | - Yong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, 101 Daehang-Ro, Jongno-gu, Seoul, 110-744 South Korea
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