1
|
Conal Septal Hypoplasia in Tetralogy of Fallot-Impact on Clinical Course, Treatment Strategies, and Outcomes After Surgical Intervention. Pediatr Cardiol 2023; 44:587-598. [PMID: 35852568 DOI: 10.1007/s00246-022-02962-5] [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: 05/11/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
We sought to characterize the clinical course and outcomes of intervention for Tetralogy of Fallot (TOF) with associated conal septal hypoplasia (CSH) compared to those with identifiable conal septum on initial newborn echocardiogram. We performed a retrospective, 1:2 case-control study of children with TOF anatomy, 33 with CSH and 66 with typical TOF, who underwent surgical repair from 1991-2019 at Children's Wisconsin. Data on echocardiographic anatomic features, systemic oxygen saturations, medical therapies, admissions, palliative interventions, operative strategies, and long-term follow-up were compared. The CSH group had fewer hypercyanotic spells (6% vs 42%, p < 0.001), beta-blockers prescribed (12% vs 41%, p = 0.005), and hospital admissions for cyanosis (12% vs 44%; p = 0.001) prior to any intervention. Of 14 who required palliative intervention, 8 had balloon pulmonary valvuloplasty (BPV) (7 from the CSH group and 1 from the control group), and 6 had systemic-to-pulmonary artery shunts (all from the control group). Definitive repair was performed at a significantly older age in the CSH group (10.2 ± 10 vs 5.6 ± 5.9 months, p = 0.011), with less subpulmonary muscle resection (57.6% in vs 92.4%, p < 0.001) and higher use of a transannular patch (84.8% vs 65.2%, p = 0.040). The average time to surgical reintervention was similar in both groups (9.7 ± 5.9 vs 8.6 ± 6.4 years in controls). We conclude that infants with TOF and CSH have a milder preoperative clinical course with fewer hypercyanotic spells or need for medical therapy. They also respond well to palliative BPV and can safely undergo later definitive repair compared to typical TOF with a well-developed conal septum.
Collapse
|
2
|
Blum KM, Mirhaidari G, Breuer CK. Tissue engineering: Relevance to neonatal congenital heart disease. Semin Fetal Neonatal Med 2022; 27:101225. [PMID: 33674254 PMCID: PMC8390581 DOI: 10.1016/j.siny.2021.101225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Congenital heart disease (CHD) represents a large clinical burden, representing the most common cause of birth defect-related death in the newborn. The mainstay of treatment for CHD remains palliative surgery using prosthetic vascular grafts and valves. These devices have limited effectiveness in pediatric patients due to thrombosis, infection, limited endothelialization, and a lack of growth potential. Tissue engineering has shown promise in providing new solutions for pediatric CHD patients through the development of tissue engineered vascular grafts, heart patches, and heart valves. In this review, we examine the current surgical treatments for congenital heart disease and the research being conducted to create tissue engineered products for these patients. While much research remains to be done before tissue engineering becomes a mainstay of clinical treatment for CHD patients, developments have been progressing rapidly towards translation of tissue engineering devices to the clinic.
Collapse
Affiliation(s)
- Kevin M Blum
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Childrens Hospital, Columbus, OH, USA; Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
| | - Gabriel Mirhaidari
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Childrens Hospital, Columbus OH, USA,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus OH, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Childrens Hospital, Columbus, OH, USA.
| |
Collapse
|
3
|
Agarwal A, Al Amer SR, Al Tarif H, Ismael AA, Alshaiji AF, Arulselvam V, Kalis NN. Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain. Heart Views 2022; 23:78-85. [PMID: 36213434 PMCID: PMC9542972 DOI: 10.4103/heartviews.heartviews_77_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 06/14/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required. Objectives The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence these results. Materials and Methods This is a retrospective study conducted in a tertiary care center. Records of patients diagnosed with TOF from 1992 to 2019 (37 years) were retrieved from a detailed database. Patients who underwent complete correction were grouped according to diagnosis, the technique utilized in surgical repair, need for staged repair, and syndromic association. Univariate actuarial and event-free survival analysis was performed. The endpoint for an event was death or re-intervention. Results A total of 230 patients were diagnosed with TOF and 174 patients underwent complete surgical repair. At 40 years postoperatively, survival was 96%. Actuarial survival was independent of syndromic associations, anatomical diagnosis, type of surgery, or previous shunt. Event-free survival (EFS) survival was 8.12%. EFS was significantly worse for patients with pulmonary atresia (PA) (Hazard ratio, 4.1125; 95% confidence interval [CI], 1.2654-13.3657; P < 0.0001) and for those that required homograft/conduit. The median duration for EFS was 22.73 years, 19.58 years, and 9.12 years for transannular patch (TAP), pulmonary valve-sparing (PVS), and homograft group, respectively. The survival curve for the PVS group merged with that of TAP 20 years postoperatively. Similarly, it merged at 22 years for staged versus primary repair and at 22.73 years for syndromic versus nonsyndromic patients. A weak correlation was found between age at surgery and event-free duration (cc, 0.309; P < 0.0001). The need for TAP was not influenced by the previous palliation, χ2(1, n = 154) = 3.36, P = 0.0667, or with interval to complete correction after the shunt procedure (P = 0.9672). Conclusions Total correction of TOF has low perioperative mortality and good long-term survival, but the need for re-interventions is high. This study demonstrated that patients requiring homograft/conduit and those with a diagnosis of PA had worse outcomes. Comparison between different surgical groups showed merging of survival curves in follow-up that signifies gradual loss of survival advantage over time.
Collapse
Affiliation(s)
- Abhinav Agarwal
- Mohammed Bin Khalifa Bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Awali, Kingdom of Bahrain
| | - Suad R. Al Amer
- Mohammed Bin Khalifa Bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Awali, Kingdom of Bahrain,Department Pediatric Cardiology, Royal College of Surgeons of Ireland – Medical University of Bahrain, Muharraq, Kingdom of Bahrain
| | - Habib Al Tarif
- Mohammed Bin Khalifa Bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Awali, Kingdom of Bahrain
| | - Aieshah Ahmed Ismael
- Mohammed Bin Khalifa Bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Awali, Kingdom of Bahrain
| | - Abdulla Faisal Alshaiji
- Mohammed Bin Khalifa Bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Awali, Kingdom of Bahrain
| | - Vimalarani Arulselvam
- Mohammed Bin Khalifa Bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Awali, Kingdom of Bahrain
| | - Neale Nicola Kalis
- Mohammed Bin Khalifa Bin Salman Al-Khalifa Cardiac Center, Bahrain Defense Forces Hospital, Awali, Kingdom of Bahrain,Department Pediatric Cardiology, Royal College of Surgeons of Ireland – Medical University of Bahrain, Muharraq, Kingdom of Bahrain
| |
Collapse
|
4
|
Javed N, Malik J. Pierre Robin sequence with tetralogy of Fallot: An unusual finding. Int J Health Sci (Qassim) 2021; 15:58-60. [PMID: 33708045 PMCID: PMC7934134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Pierre Robin sequence has been known to present with multiple somatic abnormalities. It is known that the syndrome impairs cardiogenesis. However, the reason for this is unknown. Impaired cardiogenesis manifests in the form of various defects such as ventricular septal defect and atrial septal defect but the presence of tetralogy of Fallot is very rare.
Collapse
Affiliation(s)
- Nismat Javed
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan,Address for correspondence: Nismat Javed, Shifa College of Medicine, NCBMS Tower, Near FBISE, Pitras Bukhari Road, Islamabad, Pakistan. E-mail:
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| |
Collapse
|
5
|
Li MQ, Ding WH, Jin M, Wang ZY, Gu Y, Ye WQ, Lu ZY, Li W. Pulmonary valve annular and right ventricular outflow tract size as predictions values for moderate to severe pulmonary regurgitation after repaired Tetralogy of Fallot. Echocardiography 2020; 37:1627-1633. [PMID: 32969521 DOI: 10.1111/echo.14839] [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: 05/14/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study sought to investigate the variation of right heart structure pre- and post-operation as risk factors for moderate to severe pulmonary regurgitation (PR) after repaired Tetralogy of Fallot and the best "cutoff" values for the transannular patch (TAP). METHODS We collected surgical, echocardiographic, and computed tomographic data of Teralogy of Fallot (TOF) patients over two years and calculated z-score values based on the echocardiographic data. Based on the PR level after follow-up, the patients were divided into two groups, trivial to mild PR and moderate to severe PR. A multivariate logistic regression analysis was performed, and the receiver operating characteristic curve analysis was used to find the best "cutoff" value for risk factors. RESULTS A total of 104 TOF patients were included in our cohort study. From the multivariate analysis, correction strategy (P = .002), difference in zRVOT (OR 1.974, 95% CI 1.354 to 2.878, P < .0001), and zPVA (OR 3.605, 95% CI 1.980 to 6.562, P < .0001) were the significant risk factors for moderate to severe PR. The "cutoff" value for the difference in zPVA that could predict moderate to severe PR in the TAP group was 3, and the optimal "cutoff" value for TAP was -1.4. CONCLUSIONS The TAP is a risk factor for significant PR after surgery. We recommend the optimal "cutoff" value for TAP is -1.4 calculated using Shan-Shan Wang's data set. During the procedure, to limit the RVOT resection and restrict the enlargement of pulmonary annulus within a variation of z-score as 3 would reduce significant PR.
Collapse
Affiliation(s)
- Mo-Qi Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Wen-Hong Ding
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Mei Jin
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Zhi-Yuan Wang
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Yan Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Wen-Qian Ye
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Zhen-Yu Lu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Romeo JL, Etnel JR, Takkenberg JJ, Roos-Hesselink JW, Helbing WA, van de Woestijne P, Bogers AJ, Mokhles MM. Outcome after surgical repair of tetralogy of Fallot: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2020. [DOI: 10.1016/j.jtcvs.2019.08.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
7
|
Dash N, Verma S, Jayashree M, Kumar R, Vaidya PC, Singh M. Clinico-epidemiological profile and predictors of outcome in children with diphtheria: a study from northern India. Trop Doct 2019; 49:96-101. [PMID: 30636517 DOI: 10.1177/0049475518823657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diphtheria, a vaccine preventable disease in children, is still being reported from India. Details of 99 children with a clinical diagnosis of diphtheria admitted to a paediatric tertiary care teaching and referral hospital between January 2008 and December 2015 were collected retrospectively and analysed. The median (interquartile range [IQR]) age of the study group was 7.0 years (IQR = 5.0-8.0 years). Nearly two-thirds were unimmunised. Clinical features included fever (97%), dysphagia (82%), sore throat (67%), bull neck (54%), stridor (40%), neuropathy (27%) and nasal discharge (14%). Throat swab for Albert stain was positive in only 21% of cases and C. diphtheriae was isolated in only 28%. Complications included airway compromise (61.7%) followed by myocarditis (35.4%), acute kidney injury (22.3%), thrombocytopenia (25.3%) and neuropathy (27.3%). In all, 66% survived, 23% died and 11% opted for discontinuity of care owing to unfavourable prognoses. On multivariable logistic regression analysis, shorter duration of symptoms before presentation to our hospital was an independent predictor of unfavourable outcome (adjusted odds ratio = 0.88, 95% confidence interval = 0.79-0.99, P = 0.03).
Collapse
Affiliation(s)
- Nabaneeta Dash
- 1 Senior Resident, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Sanjay Verma
- 2 Professor, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Muralidharan Jayashree
- 3 Professor, Department of Pediatrics (Emergency and Critical Care), PGIMER, Chandigarh, India
| | - Rakesh Kumar
- 2 Professor, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Pankaj C Vaidya
- 2 Professor, Department of Pediatrics, PGIMER, Chandigarh, India
| | - Meenu Singh
- 3 Professor, Department of Pediatrics (Emergency and Critical Care), PGIMER, Chandigarh, India
| |
Collapse
|
8
|
Awori MN, Mehta NP, Mitema FO, Kebba N. Optimal Use of Z-Scores to Preserve the Pulmonary Valve Annulus During Repair of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2018; 9:285-288. [DOI: 10.1177/2150135118757991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The size of the pulmonary annulus measured as a z-score is often used to determine when to insert a transannular patch (TAP). Multiple “cutoffs” are quoted in the literature; this could lead to inappropriate insertion. We aimed to determine whether the use of z-scores derived from different populations may have contributed to the varied “cutoffs” quoted. Methods: PubMed was searched using the terms: “tetralogy,” “Fallot,” “transannular,” “patch,” “mortality,” and “death.” Studies published between January 1, 2005, and October 5, 2017, were included; studies without participants under the age of 18 years and studies that did not describe the operative procedure were excluded. Results: Of 52 papers retrieved, 19 were included representing 2,500 repaired patients; 1,371 (54.8%) had a TAP. Five (26.3%) papers representing 638 patients (25.5%) quoted a z-score “cutoff” and what data set was used; “cutoffs” ranged from −2 to −4 and were derived from 2 different data sets. Three studies quoted a data set that has been shown in previous work to be problematic; the only quoted “cutoffs” of −4 were from two of these studies. Conclusions: Surprisingly few (26.3%) studies mention what pulmonary annulus size “cutoff” was used to decide when to insert a TAP. Z-scores derived from different populations were used by different studies and it is possible that this may have contributed to the varied “cutoffs’ quoted. Recommendations to perform valve-sparing surgery in pulmonary annuli as small as −4 may not be warranted. Future papers should record “cutoffs” employing recommended z-score data set.
Collapse
Affiliation(s)
- Mark Nelson Awori
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Nikita P. Mehta
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Frederick O. Mitema
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Naomi Kebba
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| |
Collapse
|