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Soliman O, Acharya Y, Gilard M, Duffy G, Wijns W, Kannan V, Sultan S. Systematic review of cardiovascular neurocristopathy-contemporary insights and future perspectives. Front Cardiovasc Med 2024; 11:1333265. [PMID: 38660479 PMCID: PMC11040563 DOI: 10.3389/fcvm.2024.1333265] [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] [Received: 12/02/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Neural crest cells (NCCs) are multipotent and are attributed to the combination of complex multimodal gene regulatory mechanisms. Cardiac neural crest (CNC) cells, originating from the dorsal neural tube, are pivotal architects of the cardio-neuro-vascular domain, which orchestrates the embryogenesis of critical cardiac and vascular structures. Remarkably, while the scientific community compiled a comprehensive inventory of neural crest derivatives by the early 1980s, our understanding of the CNC's role in various cardiovascular disease processes still needs to be explored. This review delves into the differentiation of NCC, specifically the CNC cells, and explores the diverse facets of non-syndromic cardiovascular neurocristopathies. Methods A systematic review was conducted as per the PRISMA Statement. Three prominent databases, PubMed, Scopus, and Embase, were searched, which yielded 1,840 studies. We excluded 1,796 studies, and the final selection of 44 studies formed the basis of this comprehensive review. Results Neurocristopathies are a group of genetic disorders that affect the development of cells derived from the NC. Cardiovascular neurocristopathy, i.e., cardiopathy and vasculopathy, associated with the NCC could occur in the form of (1) cardiac septation disorders, mainly the aortico-pulmonary septum; (2) great vessels and vascular disorders; (3) myocardial dysfunction; and (4) a combination of all three phenotypes. This could result from abnormalities in NCC migration, differentiation, or proliferation leading to structural abnormalities and are attributed to genetic, familial, sporadic or acquired causes. Discussion Phenotypic characteristics of cardiovascular neurocristopathies, such as bicuspid aortic valve and thoracic aortic aneurysm, share a common embryonic origin and are surprisingly prevalent in the general population, necessitating further research to identify the underlying pathogenic and genetic factors responsible for these cardiac anomalies. Such discoveries are essential for enhancing diagnostic screening and refining therapeutic interventions, ultimately improving the lives of individuals affected by these conditions.
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Affiliation(s)
- Osama Soliman
- Department of Cardiology, Galway University Hospital, Galway, Ireland
- CORRIB-CURAM-Vascular Group Collaborators, University of Galway, Galway, Ireland
| | - Yogesh Acharya
- CORRIB-CURAM-Vascular Group Collaborators, University of Galway, Galway, Ireland
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
| | - Martine Gilard
- CORRIB-CURAM-Vascular Group Collaborators, University of Galway, Galway, Ireland
- Department of Cardiology, La Cavale Blanche Hospital, Brest, France
| | - Garry Duffy
- CORRIB-CURAM-Vascular Group Collaborators, University of Galway, Galway, Ireland
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - William Wijns
- Department of Cardiology, Galway University Hospital, Galway, Ireland
- CORRIB-CURAM-Vascular Group Collaborators, University of Galway, Galway, Ireland
| | - Venkatesh Kannan
- CORRIB-CURAM-Vascular Group Collaborators, University of Galway, Galway, Ireland
- Irish Centre for High-End Computing (ICHEC), University of Galway, Galway, Ireland
| | - Sherif Sultan
- CORRIB-CURAM-Vascular Group Collaborators, University of Galway, Galway, Ireland
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and University of Galway Affiliated Hospital, Galway, Ireland
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Ko Y, Nomura K, Murayama F, Isobe S. Posterior aortic plication for tracheal compression by aortic dilatation in infants with congenital heart disease. Interact Cardiovasc Thorac Surg 2021; 33:496-497. [PMID: 34059906 DOI: 10.1093/icvts/ivab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Two infants with congenital heart disease developed life-threatening airway obstruction due to progressive dilatation of the aorta. Both underwent posterior aortic plication with extracorporeal bypass (9 and 4 months of age). After surgery, the arterial diameter was adequately reduced with a smooth aortic route leading to a wide airway space. Both patients were weaned from the ventilator shortly after surgery and are currently asymptomatic.
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Affiliation(s)
- Yoshihiro Ko
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Koji Nomura
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Fumiaki Murayama
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Sho Isobe
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
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Rácz G, Kormányos Á, Domsik P, Kalapos A, Gyenes N, Havasi K, Ambrus N, Hartyánszky I, Bogáts G, Nemes A. Left ventricular strains correlate with aortic elastic properties in adult patients with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study). Cardiovasc Diagn Ther 2021; 11:611-622. [PMID: 33968638 DOI: 10.21037/cdt-20-366] [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: 11/06/2022]
Abstract
Background Aortopathy is a common phenomenon in tetralogy of Fallot (TOF). The current study was designed to detect left ventricular (LV) deformation abnormalities and its relation to aortic stiffness in corrected TOF (cTOF) using the novel three-dimensional (3D) speckle-tracking echocardiography (3DSTE). Detailed comparative analysis between patients with early palliation-late correction (pcTOF) and early total reconstruction (etrTOF) was also performed. Methods The present study consisted of 28 cTOF patients (35.0±15.7 years, 11 males) from which 15 and 13 proved to be pcTOF and etrTOF, respectively. Their clinical parameters were compared to those of 39 matched healthy adults (35.5±6.0 years, 16 males). Results cTOF patients showed significantly lower global LV longitudinal, circumferential and area strains as compared to controls. In etrTOF patients, global LV 3D strain was higher than in controls. In pcTOF patients, all LV strains proved to be significantly lower as compared to those of etrTOF patients and controls. In all cTOF patients, several moderate correlations could be detected between LV strain parameters and aortic elastic properties. Conclusions Significant LV deformational abnormalities could be demonstrated in cTOF patients. etrTOF patients have beneficial LV strain parameters as compared to those of pcTOF patients. LV strains show correlations with aortic elastic properties.
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Affiliation(s)
- Gergely Rácz
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Árpád Kormányos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nándor Gyenes
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Kálmán Havasi
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nóra Ambrus
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - István Hartyánszky
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gábor Bogáts
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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4
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Kaemmerer AS, Freilinger S, Andonian C, Ewert P, Havasi K, Nagdyman N, Pieper L, Nebel K, Seidel L, Neidenbach R, Nemes A. Provision of medical health care for adults with congenital heart disease associated with aortic involvement. Cardiovasc Diagn Ther 2021; 11:518-528. [PMID: 33968630 DOI: 10.21037/cdt-20-359] [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] [Indexed: 12/28/2022]
Abstract
Background All patients with congenital heart disease (CHD) are chronically ill from their cardiac disease. Despite the increasing evidence that aortic alterations are becoming relevant, the importance of aortopathy in CHD has long been underestimated. This study was conducted to determine the health status of patients and/or the provision of health services of adults with CHD (ACHD) with manifest aortopathy or at risk thereof. Methods In a questionnaire-based cross-sectional survey, the "real life"-care of ACHD was analysed, comparing patients with risk of developing aortopathy and/or manifest aortopathy. Results Of the 563 enrolled ACHD (49.6% female, mean age 35.8±12.1, 18-86 years) 56.8% (n=320) had a risk of developing aortopathy and/or manifest aortopathy. Of the 320 patients at risk, 187 (33.2% of the total number) had a proven aortopathy. Within this subgroup, the basic medical care for CHD-independent medical problems was given by primary medical care providers [family doctors/general practitioners (GP) in 89.4% (n=286), internists in 13.4% (n=43), physicians of another specialty in 2.5% (n=8)]. Almost all primary medical care providers knew about the CHD of their patients. Even for CHD-specific health problems, the basic medical care of risk patients was provided by a family doctor or GP in 56.6% (n=181) and by an internist in 18.4% (n=59). 30.0% (n=96) primarily consulted another specialist, including cardiologists. Only 32.8% of ACHD at risk had ever been referred to a CHD specialist by a GP for cardiac problems related to their CHD. In contrast, the need for advice was high for ACHD with aortopathy and related mainly to physical activity, employment and education, pregnancy, rehabilitation or health and life insurance. Only 35.5% of patients at risk indicated that their information on specific care structures for ACHD was sufficient, and a further 38.1% of patients were aware of patient organizations. Conclusions Even today, aortic involvement in ACHD is an often-overlooked condition, although considerable negative effects on morbidity and mortality exist. As aortopathy gains in importance with increasing age and complexity of CHD, almost all affected ACHD need lifelong medical advice and access to modern, scientifically based care concepts. According to the study-results, primary care providers and also patients are mostly insufficiently informed about the specialized ACHD facilities. The future goal is therefore to create a better awareness of CHD problems among both primary care physicians and the patients concerned.
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Caroline Andonian
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Kalman Havasi
- Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Lars Pieper
- Department of Behavioural Epidemiology, Technical University of Dresden, Dresden, Germany
| | - Kathrin Nebel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Lavinia Seidel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Rhoia Neidenbach
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Attila Nemes
- Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Combined Rastelli procedure with supra-coronary ascending aorta replacement. Cardiol Young 2021; 31:496-498. [PMID: 33261699 DOI: 10.1017/s1047951120004163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a 5-year-old child with pulmonary atresia palliated at infancy with midline shunt now for complete repair with aneurysmally dilated aorta. Patient underwent a combined Rastelli procedure with supra-coronary ascending aorta replacement with hemi-arch repair. Patient was discharged on post-operative day 10 and was asymptomatic on follow-up.
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Schusterova I, Banovcinova A, Vachalcova M, Jakubova M, Artemiou P. Primary and secondary aortopathy associated with adult congenital heart disease - retrospective study. J Cardiothorac Surg 2020; 15:242. [PMID: 32912339 PMCID: PMC7488153 DOI: 10.1186/s13019-020-01283-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Primary and secondary aortopathy are frequently encountered in patients with congenital heart disease. The aim of this study is to present our experience and the incidence of primary and secondary adult CHD-associated aortopathy. Methods The cohort is comprised of adult patients with congenital heart disease from the registry of the Eastern Slovakia Institute of Cardiovascular Diseases. Data from the last follow-up examinations are included in this study. In the primary and secondary aortopathy groups were 35 and 12 patients respectively. As a control group were selected 64 patients with non aortopathy associated congenital heart disease (atrial and ventricular septal defect). Results Patients with primary and secondary aortopathy had larger ascending aorta/aortic root diameters than the control group (36.28 (26–49) mm vs 30.25 (21–41) mm p = 0.000113, 33.82 27–49) mm vs 29.03 (19–38)mm p = 0.000366 and 42.1 (30–50) mm vs 30.25 (21–41) mm, p = 0.000106, 35.67 (27–48) mm vs 29.03 (19–38) mm, p = 0.000119 respectively). Moreover, patients with secondary aortopathy had statistically significant larger ascending aorta diameter compared to the patients with primary aortopathy (42.1 (30–50) mm vs 36.28 (26–49) mm p = 0.030). During the follow-up period, were performed only in 2 patients (one from each group) operations on the aortic root and the ascending aorta due to aortic root or ascending aorta dilatation. Conclusion More patients with secondary aortopathy had dilated ascending aorta/ aortic root, as well as larger aortic diameters compare to the patients with primary aortopathy. Routine follow-up of these patients with attention to aortic diameter is necessary.
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Affiliation(s)
- Ingrid Schusterova
- 1th Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Alžbeta Banovcinova
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Marianna Vachalcova
- 1th Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Marta Jakubova
- 1th Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Pod krasnou horkou 1, 83101, Bratislava, Slovakia.
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Horiuchi C, Kamiya CA, Ohuchi H, Nakanishi A, Tsuritani M, Iwanaga N, Kurosaki K, Niwa K, Ikeda T, Yoshimatsu J. Impact of Pregnancy on Aortic Root in Women with Repaired Conotruncal Anomalies. Pediatr Cardiol 2019; 40:1134-1143. [PMID: 31087143 DOI: 10.1007/s00246-019-02112-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
The effect of pregnancy on aortic root in women with repaired conotruncal anomalies (CTA) has not been clarified. This study examined aortic diameters during and after pregnancy in women with repaired CTA. A retrospective review of consecutive pregnant women with repaired CTA was performed for results of echocardiography from 1 year before pregnancy to 3 years after delivery and compared with findings from healthy pregnant volunteers. Participants comprised 42 subjects and 49 deliveries with repaired CTA (CTA group), and 47 healthy pregnant women (control group). Although no maternal aortic events were encountered, aortic diameters during pregnancy increased by 1.0 ± 2.2 mm (maximum, 7.0 mm) in the CTA group and 0.6 ± 1.3 mm (maximum, 3.4 mm) in the control group (p = 0.13). The CTA subgroup with increase in aortic diameter ≥ 3.5 mm during pregnancy showed no reversion to baseline diameter at follow-up > 6 months after delivery. Significant risk factors for increased aortic diameter and no reversal included pulmonary atresia, history of aortopulmonary shunt, older age at repair, and smaller left ventricular end-diastolic diameter pre-pregnancy. Women with repaired CTA tolerated pregnancy and delivery well. However, the aortic root progressively dilated during pregnancy and 1/4 of them, especially those with longstanding high aortic blood flow before repair, showed an increase of aortic root size of ≥ 3.5 mm during the peripartum period; this dilatation tended not to revert to the pre-pregnancy diameter. Therefore, serial measurement of the aortic root during pregnancy and after delivery is recommended in these women.
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Affiliation(s)
- Chinami Horiuchi
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan.
- Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
| | - Chizuko A Kamiya
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Hideo Ohuchi
- Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Atsushi Nakanishi
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Mitsuhiro Tsuritani
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Naoko Iwanaga
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Kenichi Kurosaki
- Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koichiro Niwa
- Cardiovascular Center, St. Luke'S International Hospital, 9-1 Akashi, Chuo-ku, Tokyo, 104-8560, Japan
| | - Tomoaki Ikeda
- Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Jun Yoshimatsu
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
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Is there a role for autophagy in ascending aortopathy associated with tricuspid or bicuspid aortic valve? Clin Sci (Lond) 2019; 133:805-819. [PMID: 30991346 DOI: 10.1042/cs20181092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 01/04/2023]
Abstract
Autophagy is a conserved process by which cytoplasmatic elements are sequestered in vesicles and degraded after their fusion with lysosomes, thus recycling the precursor molecules. The autophagy-mediated removal of redundant/harmful/damaged organelles and biomolecules plays not only a replenishing function, but protects against stressful conditions through an adaptive mechanism. Autophagy, known to play a role in several pathological conditions, is now gaining increasing attention also in the perspective of the identification of the pathogenetic mechanisms at the basis of ascending thoracic aortic aneurysm (TAA), a localized or diffused dilatation of the aorta with an abnormal widening greater than 50 percent of the vessel's normal diameter. TAA is less frequent than abdominal aortic aneurysm (AAA), but is encountered with a higher percentage in patients with congenital heart disease or known genetic syndromes. Several biological aspects of TAA pathophysiology remain to be elucitated and therapeutic needs are still widely unmet. One of the most controversial and epidemiologically important forms of TAA is that associated with the congenital bicuspid malformation of the aortic valve (BAV). Dysregulated autophagy in response, for example, to wall shear stress alterations, has been demonstrated to affect the phenotype of vascular cells relevant to aortopathy, with potential consequences on signaling, remodeling, and angiogenesis. The most recent findings and hypotheses concerning the multiple aspects of autophagy and of its dysregulation are summarized, both in general and in the context of the different vascular cell types and of TAA progression, with particular reference to BAV-related aortopathy.
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Association of aortic root dilatation with left ventricular function in patients with postoperative ventricular septal defect. Heart Vessels 2019; 34:1491-1498. [PMID: 30859378 DOI: 10.1007/s00380-019-01372-7] [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: 12/05/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Proximal aortic enlargement is associated with an increased risk of heart failure and all-cause mortality. Recently, aortic root dilatation (ARD) was reported in postoperative patients with ventricular septal defects (VSDs). However, the impact of ARD on left ventricular (LV) function in postoperative VSD patients remains unclear. Thus, the aim of this study was to investigate the effect of ARD on LV function in patients with postoperative VSD. One hundred and thirty-five patients (> 15 years of age) with surgically repaired isolated ventricular defects and who underwent transthoracic echocardiography in our institution between 2009 and 2013 were identified. ARD was defined as an observed aortic root diameter/body surface area > 2.1 cm/m2. The propensity score estimating the probability of having ARD adjusted for anatomical and clinical characteristics was calculated. Forty-four patients (32.6%) had ARD. In unadjusted analyses, right ventricular systolic pressure, Tei index, and E/e' were significantly (p < 0.05) higher in patients with ARD than in those without ARD (31.3 ± 7.5 vs. 35.4 ± 13.7 mmHg, 0.32 ± 0.10 vs. 0.44 ± 0.15, and 7.1 ± 1.7 vs. 9.5 ± 2.9, respectively). In the propensity score-adjusted analysis, significant differences in the Tei index and E/e' were confirmed between the two groups (Tei index difference: 0.11, 95% confidence interval 0.05-0.17; E/e' difference: 2.4, 95% confidence interval 1.3-3.5). However, there were no differences in the other echocardiographic measurements. The presence of ARD in patients with postoperative VSD was significantly associated with LV diastolic dysfunction. Thus, surgically repaired VSD patients require careful screening for aortic enlargement and LV function.
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Forte A, Balistreri CR, De Feo M, Della Corte A, Hellstrand P, Persson L, Nilsson BO. Polyamines and microbiota in bicuspid and tricuspid aortic valve aortopathy. J Mol Cell Cardiol 2019; 129:179-187. [PMID: 30825483 DOI: 10.1016/j.yjmcc.2019.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
Polyamines are small aliphatic cationic molecules synthesized via a highly regulated pathway and involved in general molecular and cellular phenomena. Both mammalian cells and microorganisms synthesize polyamines, and both sources may contribute to the presence of polyamines in the circulation. The dominant location for microorganisms within the body is the gut. Accordingly, the gut microbiota probably synthesizes most of the polyamines in the circulation in addition to those produced by the mammalian host cells. Polyamines are mandatory for cellular growth and proliferation. Established evidence suggests that the polyamine spermidine prolongs lifespan and improves cardiovascular health in animal models and humans through both local mechanisms, involving improved cardiomyocyte function, and systemic mechanisms, including increased NO bioavailability and reduced systemic inflammation. Higher levels of polyamines have been detected in non-dilated aorta of patients affected by bicuspid aortic valve congenital malformation, an aortopathy associated with an increased risk for thoracic ascending aorta aneurysm. In this review, we discuss metabolism of polyamines and their potential effects on vascular smooth muscle and endothelial cell function in vascular pathology of the thoracic ascending aorta associated with bicuspid or tricuspid aortic valve.
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Affiliation(s)
- Amalia Forte
- Department of Translational Medical Sciences, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Per Hellstrand
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Lo Persson
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Bengt-Olof Nilsson
- Department of Experimental Medical Science, Lund University, Lund, Sweden.
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11
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Shum KK, Gupta T, Canobbio MM, Durst J, Shah SB. Family Planning and Pregnancy Management in Adults with Congenital Heart Disease. Prog Cardiovasc Dis 2018; 61:336-346. [PMID: 30102921 DOI: 10.1016/j.pcad.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
With advances in congenital heart disease management, there are an increasing number of women reaching reproductive age. Pregnancy results in a surge of hormones and increased demands on both the cardiovascular (CV) and respiratory systems. Depending on the heart defect and the treatments the mother has undergone, these hemodynamic changes can result in an increased risk of maternal CV events and an increased risk of fetal morbidity and mortality. Thus, it is important to have a comprehensive approach to adult congenital heart disease patients involving pre-pregnancy planning in addition to diligent peri- and post-partum care.
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Affiliation(s)
- Kelly K Shum
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Tripti Gupta
- Department of Internal Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Mary M Canobbio
- Ahmanson UCLA Center for Adult Congenital Heart Disease, UCLA School of Nursing, United States of America
| | - Jennifer Durst
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ochsner Baptist, New Orleans, LA, United States of America
| | - Sangeeta B Shah
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America.
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Murakami T, Mori Y, Inoue N, Kaneko S, Nakashima Y. Aortopathy in an Adult With Tricuspid Atresia and Left Ventricular Non-Compaction After Fontan Procedure. Circ J 2017; 81:1745-1746. [PMID: 28381694 DOI: 10.1253/circj.cj-17-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yoshiki Mori
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Nao Inoue
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Sachie Kaneko
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Yasumi Nakashima
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital
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Abstract
PURPOSE OF REVIEW Hypoplastic left heart syndrome (HLHS) is characterized by underdevelopment of the mitral valve, left ventricle, and aorta and is ultimately palliated with a single-ventricle repair. Universally fatal in infancy prior to the advent of modern surgical techniques, the majority of HLHS patients will now reach adulthood. However, despite improvements in early survival, the HLHS population continues to face significant morbidity and early mortality. This review delineates common sources of patient morbidity and highlights areas in need of additional research for this growing segment of the adult congenital heart disease population. RECENT FINDINGS It has become increasingly clear that palliated adult single ventricle patients, like those with HLHS, face significant life-long morbidity from elevated systemic venous pressures as a consequence of the Fontan procedure. Downstream organ dysfunction secondary to elevated Fontan pressures has the potential to significantly impact long-term management decisions, including strategies of organ allocation. Because of the presence of a morphologic systemic right ventricle, HLHS patients may be at even higher risk than other adult patients with a Fontan. Because the adult HLHS population continues to grow, recognition of common sources of patient morbidity and mortality is becoming increasingly important. A coordinated effort between patients and providers is necessary to address the many remaining areas of clinical uncertainty to help ensure continued improvement in patient prognosis and quality of life.
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Saito C, Fukushima N, Fukushima K, Matsumura G, Ashihara K, Hagiwara N. Factors associated with aortic root dilatation after surgically repaired ventricular septal defect. Echocardiography 2017; 34:1203-1209. [PMID: 28681451 DOI: 10.1111/echo.13622] [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: 11/28/2022] Open
Abstract
BACKGROUND Aortic root dilatation (ARD) in congenital heart disease is related to aortic aneurysm, rupture, and dissection. This study aimed to investigate the factors associated with ARD in patients with surgically repaired ventricular septal defect (VSD). METHODS This cross-sectional study included 152 patients with surgically repaired VSD. Two definitions of ARD were used: (1) observed Valsalva diameter to body surface area (BSA) ratio >2.1 cm/m2 and (2) absolute value of Valsalva diameter ≥4.0 cm. Odds ratios (ORs) and 95% confidence intervals (CIs) of ARD presence were calculated using multivariate logistic regressions. RESULTS The prevalence of ARD ranged between 8.6% and 32.9%. Using the definition of observed aortic root diameter/BSA >2.1 cm/m2 , patients with nonsubarterial VSD type were more likely to have ARD (OR 5.65, 95% CI; 1.83-17.44, P=.003) than those with subarterial type, and patients with preoperative right- or noncoronary cusp prolapse (R/NCCP) were more likely to have ARD (OR 3.68, 95% CI; 1.20-11.23, P=.022) than patients without preoperative R/NCCP after adjustment for sex, age at repair (ie, shunt duration), VSD size, and postoperative follow-up period. Using the definition of absolute Valsalva diameter ≥4 cm, nonsubarterial VSD type and presence of R/NCCP were also significantly associated with ARD after adjustment for the same covariates. CONCLUSIONS Anatomical and morphological features (nonsubarterial type and presence of preoperative R/NCCP) are independently correlated with ARD in patients with VSD regardless of the different definitions of ARD. Patients with surgically repaired VSD may need careful monitoring for potential ARD development.
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Affiliation(s)
- Chihiro Saito
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Noritoshi Fukushima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Keiko Fukushima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Goki Matsumura
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Shiina Y, Murakami T, Kawamatsu N, Niwa K. Aortopathy in adults with tetralogy of Fallot has a negative impact on the left ventricle. Int J Cardiol 2017; 228:380-384. [DOI: 10.1016/j.ijcard.2016.11.252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 10/24/2022]
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Abstract
Echocardiography is the primary modality for imaging the aorta for the diagnosis and serial evaluation of pathological conditions. In this article, we review the methodology for optimal echocardiographic imaging of the various segments of the aorta and discuss abnormalities of the aorta including stenosis, dilation including aortopathy and sinus of Valsalva aneurysms, and fistulous communications involving the ascending aorta including aortoventricular tunnel and ruptured sinus of Valsalva aneurysm. We review novel echocardiographic measurements of aortic functional properties of the aorta such as elasticity and stiffness, and review the literature on the potential additive value of such measurements for structural assessment alone. Finally, we discuss the limitations of echocardiography in the precise and optimal imaging of the aorta.
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Navarrete Santos A, Yan J, Lochmann P, Pfeil H, Petersen M, Simm A, Treede H, Sievers HH, Mohamed SA. Collagen analysis of the ascending aortic dilatation associated with bicuspid aortic valve disease compared with tricuspid aortic valve. Arch Physiol Biochem 2016; 122:289-294. [PMID: 27595307 DOI: 10.1080/13813455.2016.1211710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dilatation of the ascending aorta is a common occurrence in patients with bicuspid aortic valve (BAV). The aim of the current study was to characterize collagen content in advanced glycation end products (AGEs) of dilated aortic tissue from two distinct areas, concave and convex aortic sites in patients with BAV and TAV. Collagen contents extracted from 100 mg tissue was isolated by enzymatic digestion using pepsin and the nondigested material was further digested using cyanogen bromide, insoluble collagen fraction (ICF) was extracted by hydrochloric acid hydrolysis. BAV tissue showed diminished fluorescence of the pepsin extracted fraction (PEF) compared with TAV tissue (12.4 ± 1.0% vs 32.9 ± 7.6%, p = 0.05). Patients with BAV had PEF of collagens significantly diminished in the dilated ascending aorta, especially in its convex portion, in course of aging and increment of dilated diameters. It is suggestible that BAV patients present more highly AGE-modified collagens in their ascending aorta.
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Affiliation(s)
| | - Junfeng Yan
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Peter Lochmann
- a Department of heart surgery , Martin Luther University , Halle-Wittenberg , Germany and
| | - Heike Pfeil
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Michael Petersen
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Andreas Simm
- a Department of heart surgery , Martin Luther University , Halle-Wittenberg , Germany and
| | - Hendrik Treede
- a Department of heart surgery , Martin Luther University , Halle-Wittenberg , Germany and
| | - Hans H Sievers
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Salah A Mohamed
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
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Austin C, Mathur SK, Pepper J. Personalised External Aortic Root Support (PEARS): Utilisation in dilatational aortopathies after the arterial switch operation V4. Int J Cardiol 2016; 220:772-4. [PMID: 27393865 DOI: 10.1016/j.ijcard.2016.06.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- C Austin
- Department of Paediatric Cardiology and Cardiothoracic Surgery, St. Thomas' Hospital, London, United Kingdom.
| | - S K Mathur
- Department of Paediatric Cardiology and Cardiothoracic Surgery, St. Thomas' Hospital, London, United Kingdom.
| | - J Pepper
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
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