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Thorat JV, Tambolkar S, Mane S. Central Tetrapolydactyly With Atrial Septal Defect and Facial Nerve Palsy in a 15-Month-Old Female Child. Cureus 2024; 16:e64915. [PMID: 39156437 PMCID: PMC11330633 DOI: 10.7759/cureus.64915] [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: 06/20/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Polydactyly, which is the presence of an extra appendage on the hand or the foot, is a common congenital anomaly encountered in children. It may be an isolated finding or found in conjunction with other congenital anomalies and syndromes. Polydactyly can occur in the hands or the feet. In the hand, it may occur as radial polydactyly (pre-axial polydactyly) or ulnar polydactyly (post-axial polydactyly (PAP)). Depending upon the side of occurrence, it may be medial, that is, toward the little finger (called ulnar polydactyly) or lateral, that is, toward the thumb (called radial polydactyly). On the feet, the extra digit can either be present on the side of the great toe (called tibial polydactyly) or on the side of the little toe (called fibular polydactyly). In both the upper and the lower limbs, affection of the central three digits is called central polydactyly. Central tetrapolydactyly, which is the presence of an extra appendage on all four limbs, is much more rarely encountered. This case report describes a 15-month-old female child who presented with findings of six digits on all four limbs and deviation of the left angle of mouth since birth. Her echocardiography showed a large atrial septal defect measuring 7 mm, with a left-to-right shunt. This is the first such case reported from all over the world from a tertiary care hospital with the aforementioned findings. Polydactyly, a very common congenital anomaly, should not be ignored in pediatric settings. It is important to diagnose associated features such as congenital heart diseases (CHDs), genitourinary abnormalities, and orofacial abnormalities to facilitate timely surgical correction and help improve the quality of life of those affected.
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Affiliation(s)
- Janhavi V Thorat
- Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Sampada Tambolkar
- Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shailaja Mane
- Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Sandeep G, Singha SK, Kalbande JV, Gupta A. Navigating the Complexities: Addressing the Challenges of Aneurysmal Atrial Septal Defects. Cureus 2024; 16:e59030. [PMID: 38800289 PMCID: PMC11128137 DOI: 10.7759/cureus.59030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Aneurysmal atrial septal defects (ASDs) represent a rare subset of congenital cardiac anomalies, characterized by bulging of the interatrial septum. This condition poses unique challenges in diagnosis, management, and outcomes due to its variable clinical presentation and associated complications. While echocardiography remains the cornerstone of diagnosis, advanced imaging modalities such as cardiac magnetic resonance imaging (MRI) and computed tomography (CT) may provide additional insights. Optimal management strategies for aneurysmal ASDs require careful consideration of patient-specific factors, including the size and location of the defect, associated cardiovascular abnormalities, and the presence of pulmonary hypertension. Surgical repair, whether through conventional open-heart techniques or transcatheter interventions, remains the primary treatment modality; however, the approach may vary based on individual patient characteristics. Anesthetic considerations, including hemodynamic monitoring and perioperative care, are crucial in optimizing outcomes and reducing the risk of complications during surgical interventions. Long-term follow-up is essential to monitor potential complications such as residual shunting, arrhythmias, and the development of pulmonary vascular disease. Collaborative efforts among cardiologists, cardiothoracic surgeons, anesthesiologists, and other multidisciplinary specialists are paramount in providing comprehensive care for patients with aneurysmal ASDs.
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Affiliation(s)
- Gade Sandeep
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Subrata K Singha
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Jitendra V Kalbande
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Anil Gupta
- Cardiac Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Elsayed YMH, Almarghany AA. Resolution of Trifascicular Heart Block with Effective Closure of Congenital Atrial Septal Defect Followed by Later Coronavirus Disease 2019-associated Cardiac Strain. J Innov Card Rhythm Manag 2023; 14:5533-5536. [PMID: 37650121 PMCID: PMC10464646 DOI: 10.19102/icrm.2023.14081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/13/2023] [Indexed: 09/01/2023] Open
Abstract
Heart block (HB) is one of the most serious arrhythmias. Higher degrees of HB-for example, trifascicular HB-result in a more intense patient condition. Atrial septal defects (ASDs) represent the most common congenital heart disease in adults. All ASDs generally result in a left-to-right shunt, commonly causing right-side enlargement and dilation and, to a lesser extent, left atrial enlargement. A 26-year-old woman presented to the physician outpatient clinic with a complicated ASD with trifascicular HB and severe mitral and tricuspid regurgitations. The trifascicular HB with valvular regurgitations resolved with congenital ASD closure; however, she was diagnosed with coronavirus disease 2019 (COVID-19)-associated cardiac strain 3 years later. Interventions included electrocardiography, oxygenation, echocardiography, and cardiovascular surgical repair. A dramatic electrocardiographic response and better clinical outcomes despite dilations of both atria were observed. Trifascicular HB is a newly recorded association after congenital ASDs in adults. The disappearance of trifascicular HB after surgical closure of the congenital ASD is an indicator of effective surgical repair. The occurrence of COVID-19 pneumonia later, with atrial dilations continuing after the infection, may be a constellation of risk factors for the observed cardiac strain.
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Nathani PS, Krishna R, Solunke V, Mundada S. Pearl Syndrome With an Unusual Association of Spina Bifida and Congenital Cholesteatoma. Cureus 2022; 14:e22832. [PMID: 35399447 PMCID: PMC8980244 DOI: 10.7759/cureus.22832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
We report a case of a one-day-old female with congenital facial nerve palsy, bilateral microtia, congenital heart disease, spina bifida, and congenital cholesteatoma. The newborn was brought by the mother with complaints of abnormally looking ear and a facial droop toward the left side, following which a two-dimensional echocardiography was done showing the atrial septal defect and ventricular septal defect. Computed tomography of the temporal bone showed the presence of congenital cholesteatoma in the left ear. MRI of the lumbosacral spine was suggestive of spina bifida occulta. Brainstem evoked response audiometry was suggestive of sensorineural hearing loss. Such a combination of symptoms is very rare, and therefore this case is being reported.
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Wang X, Mu C, Zhang W, Xue C, Yong X, Chen K, Li D. Cardiopulmonary haemodynamics after sieve-shaped atrial septal defect repair: a multicenter study. Am J Transl Res 2021; 13:13394-13405. [PMID: 35035683 PMCID: PMC8748155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The study aimed to collect case data on cardiopulmonary bypass (CPB) sieve-shaped (S-S) and non-sieve-shaped (N-S-S) atrial septal defects (ASDs). METHODS We analysed and summarized the postoperative blood flow in the cardiopulmonary system. We retrospectively collected 86 patients who underwent CPB S-S and N-S-S ASD repair. The data collected included sex, age, CPB time, ASD area, percentage change in ventricular value (PVV) (preoperative/postoperative), left ventricular wall thickness, ejection fraction (EF) (preoperative/postoperative), fluid inflow value, pulmonary arterial pressure/pulmonary venous pressure, percentage change in total lung resistance (PTLR) (preoperative/postoperative) for statistical analysis and comparison. RESULTS There were 86 eligible patients in this study, 37 and 49 of whom had S-S and N-S-S ASDs, respectively. The PVV, PTLR, and pulmonary arterial pressure/pulmonary venous pressure (postoperative) were significantly different between the S-S and N-S-S groups. The mean PTLR in the S-S and N-S-S groups was 0.78±0.24 and 0.62±0.28, respectively. The mean PVV in the S-S group was 11.53±7.63, and that in the N-S-S group was 16.47±9.71. Multivariate analysis revealed PVV (OR, 0.143; 95% CI, 0.026-0.790; P=0.026), PTLR (OR, 0.156; 95% CI, 0.049-0.500; P=0.002), and pulmonary arterial pressure/pulmonary venous pressure (postoperative) (OR, 9.014; 95% CI, 2.480-32.755; P=0.001) as significant factors. The rate of pulmonary infection absence postoperatively in the S-S group was 76.52%, and that in the N-S-S group was 42.75%. CONCLUSION Due to the differences in heart structure between the S-S and N-S-S groups, the haemodynamic index (PVV and PTLR, postoperative pulmonary arterial pressure/pulmonary venous pressure) changes after S-S ASD repair were less than those after N-S-S ASD repair, so the postoperative pulmonary infection rate was higher after N-S-S ASD repair. The pulmonary infection rate was low after S-S ASD repair, and drugs should be reasonably administered to prevent infection.
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Affiliation(s)
- Xianzhi Wang
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Cunfu Mu
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Wenlin Zhang
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Chunzhu Xue
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Xi Yong
- Department of Vascular Surgery, North Sichuan Medical CollegeNanchong 637100, Sichuan Province, China
| | - Kai Chen
- Department of Vascular Surgery, North Sichuan Medical CollegeNanchong 637100, Sichuan Province, China
| | - Dianyuan Li
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical UniversitySuzhou 215000, Jiangsu, China
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Alkashkari W, Albugami S, Hijazi ZM. Current practice in atrial septal defect occlusion in children and adults. Expert Rev Cardiovasc Ther 2020; 18:315-329. [PMID: 32441165 DOI: 10.1080/14779072.2020.1767595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Atrial septal defect (ASD) is one of the most common congenital heart diseases (CHD) in children and adults. This group of malformations includes several types of atrial communications allowing shunting of blood between the systemic and the pulmonary circulations. Early diagnosis and treatment carries favorable outcomes. Patients diagnosed during adulthood often present with complications related to longstanding volume overload such as pulmonary artery hypertension (PAH), atrial dysrhythmias, and right (RV) and left (LV) ventricular dysfunction. AREA COVERED This article intended to review all aspects of ASD; anatomy, pathophysiology, clinical presentation, natural history, and indication for treatment. Also, we covered the transcatheter therapy in detail, including the procedural aspect, available devices, and outcomes. EXPERT OPINION There has been a remarkable improvement in the treatment strategy of ASD over the last few decades. Transcatheter closure of ASD is currently accepted as the treatment of choice in most patients with appropriately selected secundum ASDs. This review will focus on the most recent advances in diagnosis and treatment strategy of secundum ASD.
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Affiliation(s)
- Wail Alkashkari
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs , Jeddah, Saudi Arabia.,Department of Postgraduate, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia.,Department of Medical Research, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia
| | - Saad Albugami
- Department of Postgraduate, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Ziyad M Hijazi
- Sidra Heart Center, Sidra Medicine , Doha, Qatar.,Weill Cornell Medicine , New York, NY, USA
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Ghaderian M, Shahsanaei F, Behdad S, Shirvani E. Long-Term Outcome After Transcatheter Atrial Septal Defect Closure in Adults: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2020; 46:100595. [PMID: 32684350 DOI: 10.1016/j.cpcardiol.2020.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
AIMS We performed a systematic review and meta-analysis of published studies to characterize the current literature and help determine the long-term outcomes after transcatheter ASD closure in adults. METHODS AND RESULTS Two investigators searched the manuscript databases for all eligible studies in accordance with the considered keywords. The pooled prevalence of each event according to the meta-analysis and considering the weight calculated for each study included 10.1% (for arrhythmia), 1.8% (for emboli), 2.3% (for stroke), 12.5% (for residual shunt), 1.8% (for erosion), and 2.5% (for death). CONCLUSION The present meta-analysis show high long-term successfulness of transcatheter ASD closure in adults.
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Le Gloan L, Legendre A, Iserin L, Ladouceur M. Pathophysiology and natural history of atrial septal defect. J Thorac Dis 2018; 10:S2854-S2863. [PMID: 30305945 DOI: 10.21037/jtd.2018.02.80] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Atrial septal defects are among the third most common types of congenital heart disease. This group of malformations includes several types of atrial communications allowing shunting of blood between the systemic and the pulmonary circulations. The nature of shunting across the defect in patients with atrial septal defect is of particular interest. Understanding the underlying mechanisms of interatrial shunts and their natural history will help selecting the best timing for closure, before irreversible cardiac and pulmonary injury occur. This review describes the different pathophysiologic mechanisms involved in the direction and magnitude of blood flow through atrial septal defects. The natural history of an individual born with an isolated atrial septal defect is then discussed, including the impact of a longstanding shunt on survival.
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Affiliation(s)
- Laurianne Le Gloan
- Department of Cardiology, Adult Congenital Heart Disease. Institut du thorax, CHU de Nantes, Université de Nantes, boulevard Jacques Monod, Saint-Herblain, France
| | - Antoine Legendre
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Laurence Iserin
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Magalie Ladouceur
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France.,INSERM U970, PARCC, Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Bhatt P, Patel A, Kumar V, Lekshminarayanan A, Patel V, Alapati S, Billimoria ZC. Impact of hospital volume on outcomes of percutaneous ASD/PFO closure in pediatric patients. World J Pediatr 2018; 14:364-372. [PMID: 29508364 DOI: 10.1007/s12519-018-0120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/24/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. METHODS We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002-2011. Patients with age ≤ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project. RESULTS 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79-0.87, P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62-0.89, P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27-0.42, P < 0.001) were lower as compared to the 1st tertile of hospital volume. CONCLUSION Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.
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Affiliation(s)
- Parth Bhatt
- Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Achint Patel
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Varun Kumar
- Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, NY, USA
| | | | - Viranchi Patel
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Zeenia Cyrus Billimoria
- University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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Shen L, Liu J, Li JK, Xu M, Yuan L, Zhang GQ, Wang JY, Huang YJ. The Significance of Crochetage on the R wave of an Electrocardiogram for the Early Diagnosis of Pediatric Secundum Atrial Septal Defect. Pediatr Cardiol 2018; 39:1031-1035. [PMID: 29564520 DOI: 10.1007/s00246-018-1857-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/03/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to test the hypothesis that the incidence of crochetage on the R wave in inferior limb leads can be used for the diagnosis of pediatric secundum atrial septal defect (ASD). Two hundred fifty-six children with secundum ASD (case cohort) and 256 age- and gender-matched children without heart disease (control cohort) were included in the study. Statistical analyses were performed to test the relationship between the ASD and the crochetage on the R wave with a single lead and three leads, respectively. The impact of incomplete right bundle branch block (IRBBB) and ASD diameter (≥ 5 and < 5 mm) on ASD diagnosis were also explored. Crochetage on the R wave was observed in all three inferior limb leads on 28.13% (72/256, 28 with IRBBB) of subjects with secundum ASD, while it was seen in only 2.73% (7/256, one with IRBBB) of control subjects (P < 0.001). Subgroup analysis showed that the incidence of R wave crochetage correlated with ASD size in both the single inferior limb lead (26.14%, 23/88 on ASD ≥ 5 mm vs. 10.71%, 18/168 on ASD < 5 mm; P = 0.001) and all three inferior limb leads (44.32%, 39/88 on ASD ≥ 5 mm vs. 19.64%, 33/168 on ASD < 5 mm; P < 0.001). Our findings suggest that crochetage on the R wave in inferior limb leads can serve as an independent marker for ASD diagnosis.
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Affiliation(s)
- Lei Shen
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Jian Liu
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Jin-Kang Li
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Meng Xu
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Lang Yuan
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Guo-Qin Zhang
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Jian-Yi Wang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Yu-Juan Huang
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China.
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