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Schumacher K, Marin-Cuartas M, Aydin MI, de la Cuesta M, Meier S, Borger MA, Dähnert I, Kostelka M, Vollroth M. Long-term outcomes following mitral valve replacement in children at heart center Leipzig: a 20-year analysis. J Cardiothorac Surg 2024; 19:419. [PMID: 38961486 PMCID: PMC11221183 DOI: 10.1186/s13019-024-02904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Although mitral valve repair is the preferred surgical strategy in children with mitral valve disease, there are cases of irreparable severe dysplastic valves that require mitral valve replacement. The aim of this study is to analyze long-term outcomes following mitral valve replacement in children in a tertiary referral center. METHODS A total of 41 consecutive patients underwent mitral valve replacement between February 2001 and February 2021. The study data was prospectively collected and retrospectively analyzed. Primary outcomes were in-hospital mortality, long-term survival, and long-term freedom from reoperation. RESULTS Median age at operation was 23 months (IQR 5-93), median weight was 11.3 kg (IQR 4.8-19.4 kg). One (2.4%) patient died within the first 30 postoperative days. In-hospital mortality was 4.9%. Four (9.8%) patients required re-exploration for bleeding, and 2 (4.9%) patients needed extracorporeal life support. Median follow-up was 11 years (IQR 11 months - 16 years). Long-term freedom from re-operation after 1, 5, 10 and 15 years was 97.1%, 93.7%, 61.8% and 42.5%, respectively. Long-term survival after 1, 5, 10 and 15 years was 89.9%, 87%, 87% and 80.8%, respectively. CONCLUSION If MV repair is not feasible, MV replacement offers a good surgical alternative for pediatric patients with MV disease. It provides good early- and long-term outcomes.
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Affiliation(s)
- Katja Schumacher
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany
| | - Mateo Marin-Cuartas
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany
| | - Muhammed Ikbal Aydin
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany
| | - Manuela de la Cuesta
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany
| | - Sabine Meier
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany
| | - Michael Andrew Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany
| | - Ingo Dähnert
- Department of Pediatric Cardiology, Leipzig Heart Center, Leipzig, Germany
| | - Martin Kostelka
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany
| | - Marcel Vollroth
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig University, Leipzig, Germany.
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Gilg S, Delaney J, Curzon C, Danford D, Ibrahimiye A, House AV, Hammel J. Predictors of Valve Failure Following Surgical Atrioventricular Valve Replacement with a Melody Valve in Infants and Children. Pediatr Cardiol 2024:10.1007/s00246-024-03538-1. [PMID: 38907874 DOI: 10.1007/s00246-024-03538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/01/2024] [Indexed: 06/24/2024]
Abstract
Options for atrioventricular (AV) valve replacement in small pediatric patients are very limited. The Melody valve has shown reasonable short-term outcomes. This study was aimed at identifying predictors of valve failure following AV valve replacement with a Melody valve at a single-center. 26 patients underwent 37 AV valve replacements with 31/37 (84%) of valves placed in the systemic AV valve position. Median age at procedure was 17 months (IQR 4-33) and weight was 8.5 kg (IQR 6.25-12.85). Median balloon size for valve implant was 20 mm (IQR 18-22). Repeat intervention occurred in 21 cases (57%) with repeat surgery in all but one. Median freedom from re-intervention was 31 months; 19% were free from re-intervention at 60 months. Age < 12 months weight < 10 kg and BSA < 0.4 m2 were all significant risk factors for early valve failure (p = 0.003, p 0.017, p 0.025, respectively). Valve longevity was greatest with balloon inflation to diameter 1.20-1.35 times the patient's expected annular diameter (Z0), relative to both smaller or larger balloons (p = 0.038). In patients less than 12 months of age, patients with single ventricle physiology had an increased risk of early valve failure (p = 0.004).
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Affiliation(s)
- Samantha Gilg
- Department of Pediatric Cardiology, Children's Nebraska, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Jeffrey Delaney
- Department of Pediatric Cardiology, Children's Nebraska, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher Curzon
- Department of Pediatric Cardiology, Children's Nebraska, University of Nebraska Medical Center, Omaha, NE, USA
| | - David Danford
- Department of Pediatric Cardiology, Children's Nebraska, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ali Ibrahimiye
- Department of Cardiothoracic Surgery, Children's Nebraska, University of Nebraska Medical Center, Omaha, NE, USA
| | - Aswathy Vaikom House
- Department of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - James Hammel
- Department of Cardiothoracic Surgery, Helen De Vos Children's Hospital, Grand Rapids, MI, USA
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3
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Honjo O, Chetan D, Fan CPS, Kadowaki S, Marshall AC, Chaturvedi RR, Benson L, Dipchand AI, Seed M, Haller C, Barron DJ. Surgical Melody Mitral Valve: A Paradigm Shift for Infants With Unrepairable Mitral Valve Disease. Ann Thorac Surg 2024:S0003-4975(24)00384-9. [PMID: 38810907 DOI: 10.1016/j.athoracsur.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The Melody valve (Medtronic, Minneapolis, MN) for mitral valve replacement (MVR) (MelodyMVR) has been an effective strategy to treat unrepairable mitral valve disease in small children. This study analyzed survival, durability, and complications of the MelodyMVR strategy. METHODS Patients who underwent MelodyMVR between 2014 and 2023 were included. Transplant-free survival was analyzed with Kaplan-Meier analysis. The Fine and Gray subdistribution method was applied to quantify the cumulative incidence. RESULTS Twenty-five patients underwent MelodyMVR. Median age and weight were 6.3 months (interquartile range, 4.4-15.2 months) and 6.36 kg (interquartile range, 4.41-7.57 kg). Fifteen patients (60%) had congenital mitral valve disease and 13 (52%) had dominant mitral regurgitation. The median diameter of the implanted Melody was 16 mm (interquartile range, 14-18 mm). Mortality at 6 months, 1 year, and 5 years was 8.3% (95% CI, 2.2%-29.4%), 12.5% (95% CI, 4.2%-33.9%), and 17.6% (95% CI, 7.0%-40.7%), respectively. Two hospital survivors (8%) required early Melody replacement. Competing risk analysis showed that ∼50% of patients underwent mechanical MVR by 3.5 years after MelodyMVR. Freedom from bleeding and thrombosis at 4 years was 87.5% (95% CI, 74.2%-100%). Eleven patients underwent subsequent mechanical MVR with no deaths. One (9%) required pacemaker implantation after mechanical MVR. CONCLUSIONS MelodyMVR provides reasonable early and medium-term survival in small children and a high rate of successful bridge to mechanical MVR. MelodyMVR is associated with minimal pacemaker requirement, bleeding, and thrombosis. Early Melody functional deterioration necessitates early repeat MVR, which can be achieved with minimal morbidity and mortality.
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Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Devin Chetan
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po S Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sachiko Kadowaki
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Audrey C Marshall
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv R Chaturvedi
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lee Benson
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Anne I Dipchand
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David J Barron
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Liu L, Fang A, Chen H, Shao Y, Ni B, Yao J. A rare case of mitral valve dysplasia and left ventricular noncompaction: surgical management and genetic investigation. Quant Imaging Med Surg 2024; 14:2120-2123. [PMID: 38415133 PMCID: PMC10895090 DOI: 10.21037/qims-23-1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Lei Liu
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Aijuan Fang
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Hui Chen
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yongfeng Shao
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Buqing Ni
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Yao
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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6
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Hussein N, Turek JW, Rajab TK. Partial heart transplantation of atrioventricular valves in complete atrioventricular septal defect-simulation of techniques using silicone-molded heart models. JTCVS Tech 2023; 22:251-254. [PMID: 38152226 PMCID: PMC10750954 DOI: 10.1016/j.xjtc.2023.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Nabil Hussein
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, United Kingdom
| | - Joseph W. Turek
- Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC
| | - Taufiek Konrad Rajab
- Division of Pediatric Cardiovascular Surgery, Arkansas Children's Hospital, Little Rock, Ark
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7
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El-Said H, Hussein A, Ganta S, Ryan J, Nigro J. Surgical Mitral Valve Replacement Using a Catheter-Based Melody TM Valve in a Landing Zone Constructed With a PTFE-Covered Expandable Cheatham-Platinum TM Stent. World J Pediatr Congenit Heart Surg 2023; 14:368-370. [PMID: 36872629 DOI: 10.1177/21501351231154213] [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: 03/07/2023]
Abstract
Mitral valve replacement using a Melody valve is a promising solution to the challenge of surgical mitral valve replacement in infants with a hypoplastic annulus. We report the creation of a landing zone in the mitral valve annulus using a Cheatham-Platinum (CP)-covered stent that facilitates Melody valve placement, helps prevent paravalvular leak, minimizes left ventricular outflow tract obstruction, and allows for potential future dilation of the valve.
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Affiliation(s)
- Howaida El-Said
- Division of Pediatric Cardiology, University of California San Diego and 14444Rady Children's Hospital, San Diego, CA, USA
| | - Amira Hussein
- Division of Pediatric Cardiology, University of California San Diego and 14444Rady Children's Hospital, San Diego, CA, USA
| | - Srujan Ganta
- Division of Cardiothoracic Surgery, 14444Rady Children's Hospital, San Diego, CA, USA
| | - Justin Ryan
- Webster Foundation 3D Innovations Lab, 14444Rady Children's Hospital, San Diego, CA, USA.,Department of Neurological Surgery, 14444Rady Children's Hospital, UC San Diego, San Diego, CA, USA
| | - John Nigro
- Division of Cardiothoracic Surgery, 14444Rady Children's Hospital, San Diego, CA, USA.,Division Cardiovascular and Thoracic Surgery, 14444University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
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8
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Overman DM, Moga FX, Stephens EH, Dearani JA, MacIver RH. Infant Mitral Valve Replacement: Current State of the Art. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:75-80. [PMID: 36842801 DOI: 10.1053/j.pcsu.2023.01.001] [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: 11/07/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
Mitral valve replacement (MVR) in the very young is an imposing clinical challenge. Early and late mortality risk is substantial, severe adverse events are common, and redo mitral valve replacement is inevitable. Therapeutic options are limited. In the older infant with an annulus of 17mm or larger, mechanical MVR is associated with low risk of mortality and predictable durability. For the very young with annular hypoplasia, bovine jugular vein conduit MVR appears to offer equivalent or better early outcomes with the possibility of subsequent valve expansion, potentially prolonging the interval to redo MVR. Experience with cylinder MVR and other forms of surgeon-manufactured MVR is quite limited, and there is currently no information on late outcomes or durability.
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Affiliation(s)
- David M Overman
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA.
| | - Francis X Moga
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA
| | - Elizabeth H Stephens
- Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA; Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA; Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robroy H MacIver
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA
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9
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Valvulopatías en edad pediátrica: alternativas quirúrgicas cuando no hay posibilidades de reparación. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2021.12.004] [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] Open
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10
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Sampathkumar A. Mitral valve replacement in infants. Ann Pediatr Cardiol 2021; 14:249. [PMID: 34103874 PMCID: PMC8174630 DOI: 10.4103/apc.apc_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arkalgud Sampathkumar
- Department of Cardiothoracic Surgery, AIIMS, New Delhi, India.,Senior Consultant, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India. E-mail:
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11
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Dave H. Response from the authors to the letter to editor (MVR in infants). Ann Pediatr Cardiol 2021; 14:249-250. [PMID: 34103875 PMCID: PMC8174639 DOI: 10.4103/apc.apc_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hitendu Dave
- Division of Congenital Cardiovascular Surgery, Children's Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland. E-mail:
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