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Norrish G, Cleary A, Field E, Cervi E, Boleti O, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernandez A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PE, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Gonzales-Lopez E, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, Elliott PM, Kaski JP. Clinical Features and Natural History of Preadolescent Nonsyndromic Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2022; 79:1986-1997. [PMID: 35589160 PMCID: PMC9125690 DOI: 10.1016/j.jacc.2022.03.347] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. OBJECTIVES The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. METHODS Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. RESULTS At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. CONCLUSIONS Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom,Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Aoife Cleary
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Olga Boleti
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | | | | | | | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania “Luigi Vanvitelli,” Naples, Italy
| | | | | | - Elena Biagini
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | - Luca Ragni
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | | | | | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Chiara Marrone
- Papa Giovanni XXIII Hospital, Bergamo, Italy,Fondazione Toscana G. Monasterio, Massa-Pisa, Italy
| | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite–Universitatsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine, Charite–Universitatsmedizin Berlin, Berlin, Germany,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H. Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vinay Bhole
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, United Kingdom
| | | | - Ferran Gran
- Vall d’Hebron University Hospital, Barcelona, Spain
| | | | | | - Graham Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom
| | | | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca Granda – Ospedale Maggiore Policlinico Milano, Department di Medicina Interna – UOC Cardiologica, Milan, Italy
| | | | | | - Toru Kubo
- Kochi Medical School Hospital, Kochi, Japan
| | | | - Anca Popoiu
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Department of Pediatrics, Children’s Hospital “Louis Turcanu,” Timisoara, Romania
| | | | | | | | | | | | - Perry M. Elliott
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom,St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
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Norrish G, Ding T, Field E, Cervi E, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Vignati G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, O'Mahony C, Omar RZ, Elliott PM, Kaski JP. Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2022; 15:e010075. [PMID: 35491873 PMCID: PMC7612749 DOI: 10.1161/circep.121.010075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. METHODS The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). RESULTS MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. CONCLUSIONS In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
| | - Tao Ding
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | | | | | | | | | | | | | - Elena Biagini
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | - Luca Ragni
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | | | - Sophie Duignan
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Adrián Fernández
- Fundación Favaloro University Hospital, Buenos Aires, Argentina (A.F.)
| | | | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic (P.K.)
| | - Piers E F Daubeney
- Royal Brompton and Harefield NHS Trust, London, United Kingdom (P.E.F.D.)
| | | | - Sergi Cesar
- Sant Joan de Deu, Barcelona, Spain (G.S.-B., S.C.)
| | - Sabine Klaassen
- Department of Pediatric Cardiology (S.K.), Charite-Universitatsmedizin Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine (S.K.), Charite-Universitatsmedizin Berlin, Germany.,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (S.K.)
| | - Tiina H Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Finland (T.H.O.)
| | - Vinay Bhole
- Birmingham Children's Hospital, United Kingdom (V.B.)
| | - Constancio Medrano
- Fondazione Toscana G. Monasterio, Massa-Pisa, Italy (C.M.).,Hospital General Universitario Gregorio Marañón, Madrid, Spain (C.M.)
| | - Orhan Uzun
- University Hospital of Wales, Cardiff (O.U.)
| | | | - Ferran Gran
- Val d'Hebron University Hospital, Barcelona, Spain (F.G.)
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Italy (G.S.)
| | | | - Graham Stuart
- Bristol Royal Hospital for Children, United Kingdom (G.S.)
| | | | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan (H.Y.)
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom (T.B.)
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Dept di Medicina Interna, UOC Cardiologica, Milano, Italy (M.C.)
| | - Caroline B Jones
- Alder Hey Children's Hospital, Liverpool, United Kingdom (C.B.J.)
| | | | - Toru Kubo
- Kochi Medical School Hospital, Japan (T.K.)
| | | | - Anca Popoiu
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes" Timisoara, Children's Hospital 'Louis Turcanu,' Romania (A.P.)
| | | | - Sujeev Mathur
- Evelina Children's Hospital, London, United Kingdom (S.M.)
| | | | | | | | - Costas O'Mahony
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Rumana Z Omar
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Perry M Elliott
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
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3
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Martens T, François K, De Wilde H, Campens L, Demulier L, De Backer J, Dewolf D, Bove T. QRS Duration During Follow-Up of Tetralogy of Fallot: How Valuable is it? Analysis of ECG Changes in Relation to Pulmonary Valve Implantation. Pediatr Cardiol 2021; 42:1488-1495. [PMID: 33961085 DOI: 10.1007/s00246-021-02632-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
Long-term results after tetralogy of Fallot (TOF) repair are determined by the extent of right ventricular remodeling to chronic pulmonary regurgitation entailing progressive RV dysfunction and a risk of developing ventricular arrhythmia. Pulmonary valve replacement (PVR) can alleviate this burden. As a predictor of ventricular arrhythmia, QRS duration remains a strong parameter in this decision. We performed a retrospective analysis of all PVR patients between 2005 and 2018, studying the time evolution of electrocardiographic parameters before and after PVR through linear mixed model analysis. 42 TOF patients underwent PVR. The median timespan between primary repair and PVR was 18 years (IQR 13-30). The indication for PVR was primarily based on the association of exercise intolerance (67%) and significant RV dilation on cMRI (median RVEDVi 161 ml/m2 IQR 133-181). Median QRS length was 155 ms (IQR 138-164), 4 (10%) patients had a QRS > 180 ms. QRS duration increased significantly before PVR, but barely showed regression after PVR. Changes of QRS duration after PVR were independent of RV dilation. In conclusion, when the decision for PVR in TOF patients is primarily based on RV volume and/or function threshold, QRS duration > 180 ms is rarely observed. In contrast with the significant increase of QRS duration before PVR, QRS length regression appears to be independent of the extent of RV dilation or QRS > 160 ms. Considering that the decision for PVR is based on mechanical RV characteristics, the utility of serial follow-up of QRS duration in contemporary operated TOF patients becomes questionable in absence of clinical arguments for ventricular arrhythmia.
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Affiliation(s)
- Thomas Martens
- Department of Cardiac Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium.
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Hans De Wilde
- Department of Pediatric Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Laurence Campens
- Department of Adult Congenital Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Laurent Demulier
- Department of Adult Congenital Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Julie De Backer
- Department of Adult Congenital Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Daniel Dewolf
- Department of Pediatric Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
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Meerschaut I, Vergult S, Dheedene A, Menten B, De Groote K, De Wilde H, Muiño Mosquera L, Panzer J, Vandekerckhove K, Coucke PJ, De Wolf D, Callewaert B. A Reassessment of Copy Number Variations in Congenital Heart Defects: Picturing the Whole Genome. Genes (Basel) 2021; 12:genes12071048. [PMID: 34356064 PMCID: PMC8304049 DOI: 10.3390/genes12071048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Copy number variations (CNVs) can modulate phenotypes by affecting protein-coding sequences directly or through interference of gene expression. Recent studies in cancer and limb defects pinpointed the relevance of non-coding gene regulatory elements such as long non-coding RNAs (lncRNAs) and topologically associated domain (TAD)-related gene-enhancer interactions. The contribution of such non-coding elements is largely unexplored in congenital heart defects (CHD). We performed a retrospective analysis of CNVs reported in a cohort of 270 CHD patients. We reviewed the diagnostic yield of pathogenic CNVs, and performed a comprehensive reassessment of 138 CNVs of unknown significance (CNV-US), evaluating protein-coding genes, lncRNA genes, and potential interferences with TAD-related gene-enhancer interactions. Fifty-two of the 138 CNV-US may relate to CHD, revealing three candidate CHD regions, 19 candidate CHD genes, 80 lncRNA genes of interest, and six potentially CHD-related TAD interferences. Our study thus indicates a potential relevance of non-coding gene regulatory elements in CNV-related CHD pathogenesis. Shortcomings in our current knowledge on genomic variation call for continuous reporting of CNV-US in international databases, careful patient counseling, and additional functional studies to confirm these preliminary findings.
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Affiliation(s)
- Ilse Meerschaut
- Center for Medical Genetics, Ghent University Hospital, Belgium and Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (I.M.); (S.V.); (A.D.); (B.M.); (L.M.M.); (P.J.C.)
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (K.D.G.); (H.D.W.); (J.P.); (K.V.); (D.D.W.)
| | - Sarah Vergult
- Center for Medical Genetics, Ghent University Hospital, Belgium and Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (I.M.); (S.V.); (A.D.); (B.M.); (L.M.M.); (P.J.C.)
| | - Annelies Dheedene
- Center for Medical Genetics, Ghent University Hospital, Belgium and Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (I.M.); (S.V.); (A.D.); (B.M.); (L.M.M.); (P.J.C.)
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital, Belgium and Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (I.M.); (S.V.); (A.D.); (B.M.); (L.M.M.); (P.J.C.)
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (K.D.G.); (H.D.W.); (J.P.); (K.V.); (D.D.W.)
| | - Hans De Wilde
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (K.D.G.); (H.D.W.); (J.P.); (K.V.); (D.D.W.)
| | - Laura Muiño Mosquera
- Center for Medical Genetics, Ghent University Hospital, Belgium and Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (I.M.); (S.V.); (A.D.); (B.M.); (L.M.M.); (P.J.C.)
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (K.D.G.); (H.D.W.); (J.P.); (K.V.); (D.D.W.)
| | - Joseph Panzer
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (K.D.G.); (H.D.W.); (J.P.); (K.V.); (D.D.W.)
| | - Kristof Vandekerckhove
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (K.D.G.); (H.D.W.); (J.P.); (K.V.); (D.D.W.)
| | - Paul J. Coucke
- Center for Medical Genetics, Ghent University Hospital, Belgium and Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (I.M.); (S.V.); (A.D.); (B.M.); (L.M.M.); (P.J.C.)
| | - Daniël De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium; (K.D.G.); (H.D.W.); (J.P.); (K.V.); (D.D.W.)
- Department of Pediatric Cardiology, Brussels University Hospital, 1090 Brussels, Belgium
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, Belgium and Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (I.M.); (S.V.); (A.D.); (B.M.); (L.M.M.); (P.J.C.)
- Correspondence: ; Tel.: +32-9-332-3603
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5
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De Wolf R, François K, Bové T, Coomans I, De Groote K, De Wilde H, Panzer J, Vandekerckhove K, De Wolf D. Paediatric subaortic stenosis: long-term outcome and risk factors for reoperation. Interact Cardiovasc Thorac Surg 2021; 33:588-596. [PMID: 34002231 DOI: 10.1093/icvts/ivab121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Surgical repair of subaortic stenosis (SAS) is associated with a substantial reoperation risk. We aimed to identify risk factors for reintervention in relation to discrete and tunnel-type SAS morphology. METHODS Single-centre retrospective study of paediatric SAS diagnosed between 1992 and 2017. Multivariable Cox regression analysis was performed to identify reintervention risk factors. RESULTS Eighty-five children [median age 2.5 (0.7-6.5) years at diagnosis] with a median follow-up of 10.1 (5.5-16.4) years were included. Surgery was executed in 83% (n = 71). Freedom from reoperation was 88 ± 5% at 5 years and 82 ± 6% at 10 years for discrete SAS, compared to, respectively, 33 ± 16% and 17 ± 14% for tunnel-type SAS (log-rank P < 0.001). Independent risk factors for reintervention were a postoperative gradient >20 mmHg [hazard ratio (HR) 6.56, 95% confidence interval (CI) 1.41-24.1; P = 0.005], tunnel-type SAS (HR 7.46, 95% CI 2.48-22.49; P < 0.001), aortic annulus z-score <-2 (HR 11.07, 95% CI 3.03-40.47; P < 0.001) and age at intervention <2 years (HR 3.24, 95% CI 1.09-9.86; P = 0.035). Addition of septal myectomy at initial intervention was not associated with lesser reintervention. Fourteen children with a lower left ventricular outflow tract (LVOT) gradient (P < 0.001) and older age at diagnosis (P = 0.024) were followed expectatively. CONCLUSIONS Children with SAS remain at risk for reintervention, despite initially effective LVOT relief. Regardless of SAS morphology, age <2 years at first intervention, a postoperative gradient >20 mmHg and presence of a hypoplastic aortic annulus are independent risk factors for reintervention. More extensive LVOT surgery might be considered at an earlier stage in these children. SAS presenting in older children with a low LVOT gradient at diagnosis shows little progression, justifying an expectative approach.
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Affiliation(s)
- Rik De Wolf
- Faculty of Medicine and Pharmacy, Free University of Brussels, Brussels, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ilse Coomans
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Katya De Groote
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Hans De Wilde
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Joseph Panzer
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Daniël De Wolf
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium.,Department of Paediatric Cardiology, University Hospital of Brussels, Brussels, Belgium
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Bove T, Alipour Symakani R, Verbeke J, Vral A, El Haddad M, De Wilde H, Stroobandt R, De Pooter J. Study of the time-relationship of the mechano-electrical interaction in an animal model of tetralogy of Fallot: implications for the risk assessment of ventricular arrhythmias. Interact Cardiovasc Thorac Surg 2021; 31:129-137. [PMID: 32243531 DOI: 10.1093/icvts/ivaa047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The long-term outcome of tetralogy of Fallot (TOF) is determined by progressive right ventricular (RV) dysfunction through pulmonary regurgitation (PR) and the risk of malignant arrhythmia. Although mechano-electrical coupling in TOF is well-known, its time effect on the inducibility of arrhythmia remains ill-defined. The goal of this study was to investigate the mechano-electrical properties at different times in animals with chronic PR. METHODS PR was induced by a transannular patch with limited RV scarring in infant pigs. Haemodynamic assessment included biventricular pressure-volume loops after 3 (n = 8) and 6 months (n = 7) compared to controls (n = 5). The electrophysiological study included endocardial monophasic action potential registration, intraventricular conduction velocity and induction of ventricular arrhythmia by burst pacing. RESULTS Progressive RV dilation was achieved at 6 months (RV end-diastolic volume 143 ± 13 ml/m2-RV end-systolic volume 96 ± 7 ml/m2; P < 0.001), in association with depressed RV contractility (preload recruitable stroke work-slope: 19 ± 1 and 11 ± 3 Mw.ml-1.s-1 for control and 6 m; P < 0.001) and left ventricular contractility (preload recruitable stroke work-slope: 60 ± 13 and 40 ± 11 Mw.ml-1.s-1 for control and 6 m; P = 0.005). Concomitant to QRS prolongation, monophasic action potential90-duration and dispersion at the RV and left ventricle were increased at 6 months. Intraventricular conduction was delayed only in the RV at 6 months (1.8 ± 0.2 and 2.4 ± 0.6 m/s for group 6M and the control group; P = 0.035). Sustained ventricular arrhythmias were not inducible. CONCLUSIONS In animals yielding the sequelae of a contemporary operation for TOF, mechano-electrical alterations are progressive and affect predominantly the RV after midterm exposure of PR. Because ventricular arrhythmias were not inducible despite significant RV dilation, the data suggest that the haemodynamic RV deterioration effectively precedes the risk of inducing sustained arrhythmia after TOF repair and opens a window for renewed stratification of contemporary risk factors of ventricular arrhythmias in patients operated on with currently used pulmonary valve- and RV-related techniques.
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Affiliation(s)
- Thierry Bove
- Department of Cardiac Surgery, University Hospital Gent, Gent, Belgium.,Laboratory of Experimental Cardiac Surgery - Cardio-Circulatory Physiology, Faculty of Medical Sciences, University Gent, Gent, Belgium
| | - Rahi Alipour Symakani
- Laboratory of Experimental Cardiac Surgery - Cardio-Circulatory Physiology, Faculty of Medical Sciences, University Gent, Gent, Belgium
| | - Jonas Verbeke
- Laboratory of Experimental Cardiac Surgery - Cardio-Circulatory Physiology, Faculty of Medical Sciences, University Gent, Gent, Belgium
| | - Anne Vral
- Radiobiology Research Unit, Faculty of Biomedical Science, University Gent, Gent, Belgium
| | - Milad El Haddad
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium
| | - Hans De Wilde
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium.,Department of Pediatric Cardiology, University Hospital Gent, Gent, Belgium
| | - Roland Stroobandt
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium
| | - Jan De Pooter
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium
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7
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Coomans I, De Kinder S, Van Belleghem H, De Groote K, Panzer J, De Wilde H, Muiño Mosquera L, François K, Bové T, Martens T, De Wolf D, Boone J, Vandekerckhove K. Analysis of the recovery phase after maximal exercise in children with repaired tetralogy of Fallot and the relationship with ventricular function. PLoS One 2020; 15:e0244312. [PMID: 33338081 PMCID: PMC7748266 DOI: 10.1371/journal.pone.0244312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Few studies demonstrate delayed recovery after exercise in children and adults with heart disease. We assess the recovery patterns of gas exchange parameters and heart rate (HR) in children with repaired Tetralogy of Fallot (rToF) compared to healthy peers and investigate the correlation with ventricular function and QRS duration. Methods 45 children after rToF and 45 controls performed a maximal incremental cardiopulmonary exercise test. In the subsequent recovery period, patterns of VO2, VCO2 and HR were analysed. Half-life time (T1/2) of the exponential decay and drop per minute (Recmin) were compared between groups. In the rToF group, correlations were examined between the recovery parameters and QRS-duration and ventricular function, described by fractional shortening (FS) and tricuspid annular plane systolic excursion (TAPSE) measured at baseline prior to exercise. Results Recovery of VO2 and VCO2 was delayed in rToF patients, half-life time values were higher compared to controls (T1/2VO2 52.51 ±11.29 s vs. 44.31 ± 10.47 s; p = 0.001 and T1/2VCO2 68.28 ± 13.84 s vs. 59.41 ± 12.06 s; p = 0.002) and percentage drop from maximal value was slower at each minute of recovery (p<0.05). Correlations were found with FS (T1/2VO2: r = -0.517; p<0.001; Rec1minVO2: r = -0.636, p<0.001; Rec1minVCO2: r = -0.373, p = 0.012) and TAPSE (T1/2VO2: r = -0.505; p<0.001; Rec1minVO2: r = -0.566, p<0.001; T1/2VCO2: r = -0.466; p = 0.001; Rec1minVCO2: r = -0.507, p<0.001), not with QRS-duration. No difference was found in HR recovery between patients and controls. Conclusions Children after rToF show a delayed gas exchange recovery after exercise. This delay correlates to ventricular function, demonstrating its importance in recovery after physical activity.
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Affiliation(s)
- Ilse Coomans
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- * E-mail:
| | | | | | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Joseph Panzer
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Hans De Wilde
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thomas Martens
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Daniël De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan Boone
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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8
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Nijak A, Labro AJ, De Wilde H, Dewals W, Peigneur S, Tytgat J, Snyders D, Sieliwonczyk E, Simons E, Van Craenenbroeck E, Schepers D, Van Laer L, Saenen J, Loeys B, Alaerts M. Compound Heterozygous SCN5A Mutations in Severe Sodium Channelopathy With Brugada Syndrome: A Case Report. Front Cardiovasc Med 2020; 7:117. [PMID: 32850980 PMCID: PMC7396896 DOI: 10.3389/fcvm.2020.00117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022] Open
Abstract
Aims: Brugada syndrome (BrS) is an inherited cardiac arrhythmia with an increased risk for sudden cardiac death (SCD). About 20% of BrS cases are explained by mutations in the SCN5A gene, encoding the main cardiac sodium Nav1.5 channel. Here we present a severe case of cardiac sodium channelopathy with BrS caused by SCN5A compound heterozygous mutations. We performed a genetic analysis of SCN5A in a male proband who collapsed during cycling at the age of 2 years. Because of atrial standstill, he received a pacemaker, and at the age of 3 years, he experienced a collapse anew with left-sided brain stroke. A later ECG taken during a fever unmasked a characteristic BrS type-1 pattern. The functional effect of the detected genetic variants was investigated. Methods and Results: Next-generation sequencing allowed the detection of two SCN5A variants in trans: c.4813+3_4813+6dupGGGT-a Belgian founder mutation-and c.4711 T>C, p.Phe1571Leu. A familial segregation analysis showed the presence of the founder mutation in the proband's affected father and paternal aunt and the de novo occurrence of the p.Phe1571Leu. The functional effect of the founder mutation was previously described as a loss-of-function. We performed a functional analysis of the p.Phe571Leu variant in HEK293 cells alone or co-expressed with the β1-subunit. Compared to the SCN5A wild type, p.Phe1571Leu displayed a hyperpolarizing shift in the voltage dependence of inactivation (loss-of-function), while the activation parameters were unaffected. Using the peptide toxin nemertide α-1, the variant's loss-of-function effect could be restored due to a toxin-dependent reduction of channel inactivation. Conclusion: This is the first report providing support for the pathogenicity of the p.Phe1571Leu SCN5A variant which, together with the c.4813+3_4813+6dupGGGT founder mutation, explains the severity of the phenotype of cardiac sodium channelopathy with BrS in the presented case.
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Affiliation(s)
- Aleksandra Nijak
- Center of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Alain J Labro
- Laboratory of Molecular, Cellular and Network Excitability, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans De Wilde
- Department of Paediatric Cardiology, Antwerp University Hospital, Antwerp, Belgium.,Department of Invasive Cardiology and Electrophysiology, Ghent University Hospital, Ghent, Belgium
| | - Wendy Dewals
- Department of Paediatric Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Steve Peigneur
- Toxicology and Pharmacology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Jan Tytgat
- Toxicology and Pharmacology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Dirk Snyders
- Laboratory of Molecular, Cellular and Network Excitability, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Ewa Sieliwonczyk
- Center of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Eline Simons
- Center of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Dorien Schepers
- Center of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lut Van Laer
- Center of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Johan Saenen
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Bart Loeys
- Center of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.,Department of Human Genetics, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Maaike Alaerts
- Center of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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9
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Vandekerckhove K, Panzer J, Coomans I, Moerman A, De Groote K, De Wilde H, Bové T, François K, De Wolf D, Boone J. Different Patterns of Cerebral and Muscular Tissue Oxygenation 10 Years After Coarctation Repair. Front Physiol 2019; 10:1500. [PMID: 31920705 PMCID: PMC6917622 DOI: 10.3389/fphys.2019.01500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/25/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristof Vandekerckhove
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- *Correspondence: Kristof Vandekerckhove, ;
| | - Joseph Panzer
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Ilse Coomans
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Annelies Moerman
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Hans De Wilde
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan Boone
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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10
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François K, De Groote K, Vandekerckhove K, De Wilde H, De Wolf D, Bové T. Small-sized conduits in the right ventricular outflow tract in young children: bicuspidalized homografts are a good alternative to standard conduits. Eur J Cardiothorac Surg 2019; 53:409-415. [PMID: 29029050 DOI: 10.1093/ejcts/ezx354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Downsizing a homograft (HG) through bicuspidalization has been used for more than 2 decades to overcome the shortage of small-sized conduits for reconstruction of the right ventricular outflow tract (RVOT) in young children. Our goal was to investigate the durability of bicuspidalized HGs compared with other small HGs. METHODS A retrospective analysis of 93 conduits ≤20 mm, implanted over 23 years, was performed. The end-points were survival, structural valve degeneration and conduit replacement. The conduits comprised 40 pulmonary HGs, 12 aortic HGs, 17 bicuspidalized HGs and 24 xenografts. RESULTS The median age, mean conduit diameter and z-value at implantation were 1.4 (interquartile range 0.3-3) years, 16.5 ± 2.7 mm and 2.8 ± 1.3, respectively. Valve position was heterotopic in 59 patients and orthotopic in 34 patients. At a mean follow-up period of 7.6 ± 5.9 years, the hospital survival rate was 89%. Freedom from explant at 5 and 10 years was 83 ± 5% and 52 ± 6%, respectively. Freedom from structural valve degeneration was 79 ± 5% at 5 years and 47 ± 6% at 10 years [68 ± 8% for pulmonary HG, 42 ± 16% for bicuspidalized HG, 31 ± 15% for aortic HG and 20 ± 9% for xenografts (log rank P < 0.001)]. Multivariable analysis indicated an increased risk for structural valve degeneration with smaller conduit size (hazard ratio 0.79, 95% confidence interval 0.67-0.94; P < 0.008), extra-anatomic position (hazard ratio 2.71, 95% confidence interval 1.33-5.50; P = 0.006) and the use of xenografts compared with non-downsized pulmonary HGs (hazard ratio 4.90, 95% confidence interval 2.23-10.76; P < 0.001). CONCLUSIONS Appropriately sized pulmonary HGs remain the most durable option for a right ventricular outflow tract conduit in young children. However, when a small pulmonary HG is unavailable, bicuspidalization offers a valid alternative, preferable to xenograft conduits, at mid-term follow-up.
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Affiliation(s)
- Katrien François
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | | | - Hans De Wilde
- Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
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11
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Vandekerckhove K, Coomans I, Moerman A, Panzer J, De Groote K, De Wilde H, Bove T, François K, De Wolf D, Boone J. Differences in cerebral and muscle oxygenation patterns during exercise in children with univentricular heart after Fontan operation compared to healthy peers. Int J Cardiol 2019; 290:86-92. [PMID: 31133431 DOI: 10.1016/j.ijcard.2019.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/02/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assess whether the lower exercise tolerance in children with univentricular heart (UVH) after Fontan operation is associated with altered peripheral muscular and cerebral tissue oxygenation. METHODS 18 children with UVH and 20 healthy subjects performed an incremental ramp exercise test. Changes in the cerebral and muscular pattern of oxygenated (O2Hb) and deoxygenated hemoglobin (HHb) and local tissue oxygenation (TOI) were analyzed by means of Near Infrared Spectroscopy (NIRS). Correlations between arterial saturation during exercise and tissue oxygenation were evaluated. RESULTS In UVH, maximal oxygen consumption (VO2peak/kg, 28.9 ± 7.9 vs. 46.3 ± 11.9 ml/min/kg, P < 0.001), heart rate (HRpeak, 168 ± 13 vs. 193 ± 12 bpm, P < 0.001) and load (Ppeak, 73 ± 19 vs. 133 ± 68 W, P < 0.001) were lower, VE/VCO2 slope was higher (34.5 ± 5.9 vs. 27.1 ± 3.9, P < 0.001). A faster and steeper course up to the same level of HHb and absent increase in O2Hb was seen at cerebral level in UVH; tissue oxygenation index (TOI) demonstrated a steady decrease from the start of exercise. At the muscular level, HHb curve has a similar pattern compared to controls, with an early cessation. O2Hb has a similar pattern, but with early discontinuation at a higher O2Hb-level. Muscular TOI has the same course throughout exercise, starting from a lower level. Lower arterial saturation and higher age correlated with lower VO2peak; higher amplitude of muscular TOI and lower amplitude cerebral TOI correlated with higher VO2peak. CONCLUSION Children after Fontan procedure have different oxygenation mechanisms at muscular and cerebral level. This reflects a different balance between O2 supply to O2 demand which might contribute to the reduced exercise tolerance in this patient population.
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Affiliation(s)
| | - Ilse Coomans
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Annelies Moerman
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Joseph Panzer
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Hans De Wilde
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan Boone
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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12
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Norrish G, Ding T, Field E, Ziółkowska L, Olivotto I, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Bökenkamp R, Baban A, Kubuš P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Marrone C, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Castro FJ, Stuart G, Vignati G, Barriales-Villa R, Guereta LG, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Rasmussen TB, Calcagnino MM, Jones CB, De Wilde H, Toru-Kubo J, Felice T, Mogensen J, Mathur S, Reinhardt Z, O’Mahony C, Elliott PM, Omar RZ, Kaski JP. Development of a Novel Risk Prediction Model for Sudden Cardiac Death in Childhood Hypertrophic Cardiomyopathy (HCM Risk-Kids). JAMA Cardiol 2019; 4:918-927. [PMID: 31411652 PMCID: PMC6694401 DOI: 10.1001/jamacardio.2019.2861] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/19/2019] [Indexed: 12/16/2022]
Abstract
Importance Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM), but there is no validated algorithm to identify those at highest risk. Objective To develop and validate an SCD risk prediction model that provides individualized risk estimates. Design, Setting, and Participants A prognostic model was developed from a retrospective, multicenter, longitudinal cohort study of 1024 consecutively evaluated patients aged 16 years or younger with HCM. The study was conducted from January 1, 1970, to December 31, 2017. Exposures The model was developed using preselected predictor variables (unexplained syncope, maximal left-ventricular wall thickness, left atrial diameter, left-ventricular outflow tract gradient, and nonsustained ventricular tachycardia) identified from the literature and internally validated using bootstrapping. Main Outcomes and Measures A composite outcome of SCD or an equivalent event (aborted cardiac arrest, appropriate implantable cardioverter defibrillator therapy, or sustained ventricular tachycardia associated with hemodynamic compromise). Results Of the 1024 patients included in the study, 699 were boys (68.3%); mean (interquartile range [IQR]) age was 11 (7-14) years. Over a median follow-up of 5.3 years (IQR, 2.6-8.3; total patient years, 5984), 89 patients (8.7%) died suddenly or had an equivalent event (annual event rate, 1.49; 95% CI, 1.15-1.92). The pediatric model was developed using preselected variables to predict the risk of SCD. The model's ability to predict risk at 5 years was validated; the C statistic was 0.69 (95% CI, 0.66-0.72), and the calibration slope was 0.98 (95% CI, 0.59-1.38). For every 10 implantable cardioverter defibrillators implanted in patients with 6% or more of a 5-year SCD risk, 1 patient may potentially be saved from SCD at 5 years. Conclusions and Relevance This new, validated risk stratification model for SCD in childhood HCM may provide individualized estimates of risk at 5 years using readily obtained clinical risk factors. External validation studies are required to demonstrate the accuracy of this model's predictions in diverse patient populations.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Tao Ding
- Department of Statistical Science, University College London, London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Lidia Ziółkowska
- Department of Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Iacopo Olivotto
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Limongelli
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Cardiothoracic Sciences, Monaldi Hospital, Naples, Italy
| | | | - Robert Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Australia
- Department of Clinical Sciences, The Murdoch Children’s Research Institute, Parkville, Australia
- Department of Medical and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Elena Biagini
- Department of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Ragni
- Department of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Terence Prendiville
- The Children’s Heart Centre, Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Sophie Duignan
- The Children’s Heart Centre, Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Adrián Fernández
- Department of Ambulatory Cardiology, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Regina Bökenkamp
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anwar Baban
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesu Hospital, Rome, Italy
| | - Peter Kubuš
- Children’s Heart Centre, University Hospital Motol, Prague, Czech Republic
| | - Piers E. F. Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Georgia Sarquella-Brugada
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Sergi Cesar
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Chiara Marrone
- Department of Paediatric Cardiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Vinay Bhole
- The Heart Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Constancio Medrano
- Department of Paediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Orhan Uzun
- Children’s Heart Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Ferran Gran
- Paediatric Cardiology Department, Val d’Hebron University Hospital, Barcelona, Spain
| | - Francisco J. Castro
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - Roberto Barriales-Villa
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, A Coruña, Spain
| | - Luis G. Guereta
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Pablo Garcia-Pavia
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- Department of Cardiology, University Francisco de Vitoria, Pozuelo de Alarcon, Spain
| | | | - Margherita M. Calcagnino
- Department of Cardiology, University Hospitals Parma, Parma, Italy
- Cardiology Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Caroline B. Jones
- Department of Cardiology, Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Hans De Wilde
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - J. Toru-Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tiziana Felice
- Department of Paediatric Cardiology, Mater Dei Hospital, Msida, Malta
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sujeev Mathur
- Children’s Heart Service, Evelina Children’s Hospital, London, United Kingdom
| | - Zdenka Reinhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Constantinos O’Mahony
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Perry M. Elliott
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Rumana Z. Omar
- Department of Statistical Science, University College London, London, United Kingdom
| | - Juan P. Kaski
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
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13
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Muiño-Mosquera L, Bauters F, Dhondt K, De Wilde H, Jordaens L, De Groote K, De Wolf D, Hertegonne K, De Backer J. Sleep apnea and the impact on cardiovascular risk in patients with Marfan syndrome. Mol Genet Genomic Med 2019; 7:e805. [PMID: 31245936 PMCID: PMC6687621 DOI: 10.1002/mgg3.805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/23/2019] [Indexed: 12/25/2022] Open
Abstract
Background Marfan syndrome (MFS) is an inherited connective tissue disorder characterized by ectopia lentis, aortic root dilation and dissection and specific skeletal features. Obstructive sleep apnea (OSA) in MFS has been described earlier but the prevalence and its relation with the cardiovascular risk is still controversial. This study aimed to further investigate these aspects. Methods In this prospective longitudinal study, we performed an attended polysomnography in 40 MFS patients (60% women, 37 ± 12.8 years) and evaluated several cardiovascular parameters through echocardiography, resting electrocardiogram, 24 hr‐Holter monitoring and serum NT‐ProBNP measurements. Results We found that OSA was present in 42.5% of the patients and that higher body mass index was the most important factor associated with the presence of OSA. We observed that overweight was present in 27.5% of the patients in the whole cohort and in 55.6% if >40 years. Furthermore, when evaluating the impact of OSA on the cardiovascular system, we observed that patients with OSA tended to have higher systolic blood pressure, larger distal aortic diameters and a higher prevalence of ventricular arrhythmia. These differences were, however, not significant after adjusting for confounders. Conclusions Our study shows a high prevalence of OSA and a high prevalence of overweight in MFS patients. We found some trends between OSA and cardiovascular features but we could not establish a solid association. Our study, however might be underpowered, and a multicenter collaborative study could be very useful to answer some important open questions.
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Affiliation(s)
- Laura Muiño-Mosquera
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Fré Bauters
- Department of Pneumology, Ghent University Hospital, Ghent, Belgium
| | - Karlien Dhondt
- Department of Pneumology, Ghent University Hospital, Ghent, Belgium.,Department of Psychiatry, Division of Child and Adolescent Psychiatry, Pediatric Sleep Centre, Ghent University Hospital, Ghent, Belgium
| | - Hans De Wilde
- Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Luc Jordaens
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Julie De Backer
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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14
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De Groote K, Vanhie E, Roets E, Ramaekers P, De Wilde H, Panzer J, Vandekerckhove K, Bove T, François K, Van Herck K, De Wolf D. Outcome after prenatal and postnatal diagnosis of complex congenital heart defects and the influence of genetic anomalies. Prenat Diagn 2017; 37:983-991. [DOI: 10.1002/pd.5117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 07/14/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Katya De Groote
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Ellen Vanhie
- Department of Pediatrics; Ghent University Hospital; Ghent Belgium
| | - Ellen Roets
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Centre; Ghent University Hospital; Ghent Belgium
| | - Paul Ramaekers
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Centre; Ghent University Hospital; Ghent Belgium
| | - Hans De Wilde
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Joseph Panzer
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Kristof Vandekerckhove
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Thierry Bove
- Department of Cardiac Surgery; Ghent University Hospital; Ghent Belgium
| | - Katrien François
- Department of Cardiac Surgery; Ghent University Hospital; Ghent Belgium
| | - Koen Van Herck
- Department of Public Health; Ghent University; Ghent Belgium
| | - Daniël De Wolf
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
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15
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Bogaert DJ, Dullaers M, Kuehn HS, Leroy BP, Niemela JE, De Wilde H, De Schryver S, De Bruyne M, Coppieters F, Lambrecht BN, De Baets F, Rosenzweig SD, De Baere E, Haerynck F. Early-onset primary antibody deficiency resembling common variable immunodeficiency challenges the diagnosis of Wiedeman-Steiner and Roifman syndromes. Sci Rep 2017. [PMID: 28623346 PMCID: PMC5473876 DOI: 10.1038/s41598-017-02434-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Syndromic primary immunodeficiencies are rare genetic disorders that affect both the immune system and other organ systems. More often, the immune defect is not the major clinical problem and is sometimes only recognized after a diagnosis has been made based on extra-immunological abnormalities. Here, we report two sibling pairs with syndromic primary immunodeficiencies that exceptionally presented with a phenotype resembling early-onset common variable immunodeficiency, while extra-immunological characteristics were not apparent at that time. Additional features not typically associated with common variable immunodeficiency were diagnosed only later, including skeletal and organ anomalies and mild facial dysmorphism. Whole exome sequencing revealed KMT2A-associated Wiedemann-Steiner syndrome in one sibling pair and their mother. In the other sibling pair, targeted testing of the known disease gene for Roifman syndrome (RNU4ATAC) provided a definite diagnosis. With this study, we underline the importance of an early-stage and thorough genetic assessment in paediatric patients with a common variable immunodeficiency phenotype, to establish a conclusive diagnosis and guide patient management. In addition, this study extends the mutational and immunophenotypical spectrum of Wiedemann-Steiner and Roifman syndromes and highlights potential directions for future pathophysiological research.
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Affiliation(s)
- Delfien J Bogaert
- Clinical Immunology Research Lab, Department of Pulmonary Medicine, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Department of Paediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium.,Laboratory of Immunoregulation, VIB Inflammation Research Centre, Ghent, Belgium
| | - Melissa Dullaers
- Clinical Immunology Research Lab, Department of Pulmonary Medicine, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.,Laboratory of Immunoregulation, VIB Inflammation Research Centre, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Hye Sun Kuehn
- Immunology Service, Department of Laboratory Medicine, NIH Clinical Centre, National Institutes of Health, Bethesda, MD, USA
| | - Bart P Leroy
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium.,Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Julie E Niemela
- Immunology Service, Department of Laboratory Medicine, NIH Clinical Centre, National Institutes of Health, Bethesda, MD, USA
| | - Hans De Wilde
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Sarah De Schryver
- Department of Paediatric Allergy and Immunology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marieke De Bruyne
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Frauke Coppieters
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Bart N Lambrecht
- Laboratory of Immunoregulation, VIB Inflammation Research Centre, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Pulmonology, Ghent University Hospital, Ghent, Belgium
| | - Frans De Baets
- Department of Paediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium
| | - Sergio D Rosenzweig
- Immunology Service, Department of Laboratory Medicine, NIH Clinical Centre, National Institutes of Health, Bethesda, MD, USA
| | - Elfride De Baere
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Filomeen Haerynck
- Clinical Immunology Research Lab, Department of Pulmonary Medicine, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium. .,Department of Paediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent, Belgium.
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16
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François K, Panzer J, De Groote K, Vandekerckhove K, De Wolf D, De Wilde H, Marchau F, De Caluwe W, Benatar A, Bové T. Early and late outcomes after surgical management of congenital vascular rings. Eur J Pediatr 2017; 176:371-377. [PMID: 28091779 DOI: 10.1007/s00431-017-2850-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/01/2017] [Accepted: 01/04/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED Persistent respiratory or feeding problems in children may be associated with a congenital vascular ring. Surgical management is fairly standardized, but long-term outcomes are not well described. This study aims to investigate clinical presentation, surgical treatment, and risk factors for early mortality and late outcome. Our database revealed 62 surgically treated vascular ring patients between 1993 and 2014. Double aortic arch was the most common diagnosis (53%). Median age at operation was 1 year. Symptoms were mainly respiratory (89%) and feeding problems (32%). Median extubation time and hospital stay were 4 h and 5 days. Mean follow-up was 7.8 ± 5.8 years. Early mortality was 8% and was related to anatomical diagnosis, concomitant anomalies, and a need for preoperative intubation. Freedom from residual symptoms at 1 and 6 months was 63 and 82%, respectively. Freedom from inhalation therapy at the last follow-up was 82% and was influenced by a type of vascular ring and preoperative ventilation. Dysphagia symptoms always disappeared. CONCLUSION Surgical relief of tracheoesophageal compression is commonly effective in vascular ring anomalies. Respiratory symptoms necessitating chronic inhalation therapy only persist in a minority of children. Patients with double aortic arch are at increased risk to remain symptomatic, particularly with infectious exacerbations.
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Affiliation(s)
- Katrien François
- Department of Congenital Cardiac Surgery, Cardiac Center, University Hospital Ghent, Ghent, Belgium.
| | - Joseph Panzer
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Katya De Groote
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Kristof Vandekerckhove
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Daniel De Wolf
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Hans De Wilde
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Fabienne Marchau
- Department of Pediatric Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Wim De Caluwe
- Department of Neonatology, Sint-Jan Hospital, Bruges, Belgium
| | - Abraham Benatar
- Department of Pediatric Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Thierry Bové
- Department of Congenital Cardiac Surgery, Cardiac Center, University Hospital Ghent, Ghent, Belgium
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17
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Timmers L, Van Heuverswyn F, De Wilde H, Jordaens L. Evaluating current implantable cardioverter defibrillator implantation procedures: can common complications be minimised? Expert Rev Cardiovasc Ther 2016; 14:579-89. [DOI: 10.1586/14779072.2016.1144471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Bove T, Vandekerckhove K, Devos D, Panzer J, De Groote K, De Wilde H, De Wolf D, De Backer J, Demulier L, François K. Functional analysis of the anatomical right ventricular components: should assessment of right ventricular function after repair of tetralogy of Fallot be refined? Eur J Cardiothorac Surg 2013; 45:e6-12. [PMID: 24186927 DOI: 10.1093/ejcts/ezt505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Follow-up after tetralogy of Fallot (ToF) repair is directed to detect timely right ventricular (RV) dysfunction by following pulmonary regurgitation and global RV size, with little attention for the effective contribution of regional RV dysfunction. This study investigates the contribution of regional RV dysfunction on exercise capacity after ToF repair. METHODS Forty-two patients were investigated with cardiac magnetic resonance imaging for regional RV dysfunction in relation to global RV function by functional quantification of the sinus and outflow part of the RV. The impact of regional and global RV dysfunction on clinical status was studied by exercise testing. RESULTS Global RV function was lower than sinus function (ejection fraction (EF) 52±12% vs 58±10%, P<0.001), attributable to the adverse influence of right ventricular outflow tract (RVOT) dysfunction (EF 34±17%). Percent predicted peak VO2 correlated better with the RV sinus ejection fraction compared with the global RV ejection fraction (r=0.51, P=0.001 vs r=0.44, P=0.004). Multivariate analysis revealed the EF of RV sinus (β=0.34, 95% CI 0.07-0.61, P=0.013) and the extent of RVOT akinesia (β=-0.28, 95% CI -0.50; -0.06, P=0.015) as significant determinants of exercise capacity. Impaired exercise performance occurred in 43% of the patients, and was independently determined by the type of repair (transventricular vs transatrial: OR 6.0, 95% CI 1.31-17.3, P=0.02) by associating greater sinus and RVOT dysfunction. CONCLUSION Functional analysis of the RV components shows that exercise capacity after repair of ToF is better predicted by systolic function of the RV sinus as the extent of RVOT dysfunction commonly leads to underestimation of global RV function. This method of differential quantification of regional RV function might be more appropriate than assessment of global RV function during the long-term follow-up of repaired ToF patients.
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Affiliation(s)
- Thierry Bove
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
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19
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François K, Zaqout M, Bové T, Vandekerckhove K, De Groote K, Panzer J, De Wilde H, De Wolf D. The fate of the aortic root after early repair of tetralogy of Fallot. Eur J Cardiothorac Surg 2010; 37:1254-8. [PMID: 20137972 DOI: 10.1016/j.ejcts.2009.12.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/06/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Late aortic root dilatation is a growing concern in patients operated on for tetralogy of Fallot (ToF). This longitudinal follow-up study sought to evaluate the changes in the aortic root dimensions in relation to body growth, assuming that early repair of tetralogy of Fallot might prevent late aortic dilatation. METHODS A retrospective analysis of the aortic root dimensions was performed in 88 patients repaired early for tetralogy of Fallot by echocardiographic measurement of aortic annulus, sinus of Valsalva and sinotubular junction, adjusted for body surface area and expressed as z-scores. Mean age at repair was 9.7 + or - 7.4 months. Median age was 7.3 months (range 45 days-29 months). RESULTS At the time of repair, all root dimensions were enlarged: z-score of the annulus 3.32 + or - 1.66; sinus 3.54 + or - 1.49; sinotubular junction 2.74 + or - 1.19. Within a mean follow-up of 6.9 + or - 4.4 years, the mean z-scores of both annulus and sinotubular junction significantly decreased to normal size at 7 years postoperatively: z-score of annulus 0.95 + or - 0.7 (p=0.006), z-score of sinotubular junction 0.99 + or - 1.47 (p=0.006). The z-score of the aortic sinuses appeared to regress slower to 2.78 + or - 1.26 (p=0.262). The indexed sinus diameter however regressed significantly from a mean of 51.4 + or - 13.4 mmm(-2) at correction to 28.9 + or - 7.2 mmm(-2) (p=0.0001) at latest follow-up. Evolution of aortic root size after repair was independent of aortic arch side, sex, age at repair or previous shunt palliation. CONCLUSIONS The initially dilated aortic root in tetralogy of Fallot normalises in size at the level of the annulus and sinotubular junction within 7 years after early repair. This process seems delayed at the level of the aortic sinuses, although the indexed root diameter shows significant regression over time. These results suggest that early repair of ToF abrogates the enlargement of the aortic root, validating one aspect of the need for tetralogy correction at a young age.
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Affiliation(s)
- Katrien François
- Department of Cardiac Surgery, The Cardiac Centre, University Hospital Gent, Gent, Belgium.
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20
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Zaqout M, Suys B, De Wilde H, De Wolf D. Transthoracic echocardiography guidance of transcatheter atrial septal defect closure in children. Pediatr Cardiol 2009; 30:992-4. [PMID: 19458994 DOI: 10.1007/s00246-009-9456-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 03/26/2009] [Accepted: 04/18/2009] [Indexed: 11/26/2022]
Abstract
Transesophageal echocardiography (TEE) guidance is part of interventional closure of secundum atrial septal defect (ASD) in children and adults. However, sometimes TEE is impossible for technical or anatomical reasons. If available, intracardiac echocardiography can be used, but especially in children, transthoracic echocardiography (TTE) can be an easy, safe, and cheap alternative. We report two cases in which TEE was replaced by TTE during percutaneous ASD closure. In the first case VACTERL association with a surgically repaired tracheoesophageal fistula was a relative contraindication to TEE. In the second case, technical failure of the transesophageal probe occurred during the procedure. In both cases the ASD was successfully closed with an atrial septal occluder device under TTE guidance. Using TTE can be sufficient and safe in children with good imaging windows, especially from subcostal views.
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Affiliation(s)
- Mahmoud Zaqout
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium
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21
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De Wilde H, Benatar A. Cardiac rhabdomyoma with long-term conduction abnormality: progression from pre-excitation to bundle branch block and finally complete heart block. Med Sci Monit 2007; 13:CS21-3. [PMID: 17261989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 10/12/2006] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Cardiac rhabdomyoma, a benign smooth muscle hamartoma, is the commonest heart tumor encountered in children. Arrhythmias and conduction disorders have been described with these tumors, although most electrocardiographic abnormalities will resolve over time, concomitant with the resolution of the tumor. CASE REPORT The case of a child, diagnosed with cardiac rhabdomyomas in fetal life, is reported in whom the tumors regressed in size over a four-year period whilst displaying a spectrum of conduction disturbances. He finally developed potentially lethal complete heart block. CONCLUSIONS Cardiac rhabdomyomas may be asymptomatic, cause hemodynamic compromise, or be associated with rhythm disorders. In the presence of conduction disorders, close monitoring is required with regular electrocardiograms to detect potential lethal conduction disorders.
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Affiliation(s)
- Hans De Wilde
- Department of Pediatric cardiology, Academic Hospital AZ-VUB, Free University of Brussels, Brussels, Belgium
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22
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Hazel CB, Klein TM, Anis M, Wilde HD, Parrott WA. Growth characteristics and transformability of soybean embryogenic cultures. Plant Cell Rep 1998; 17:765-772. [PMID: 30736589 DOI: 10.1007/s002990050480] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Embryogenic cultures of soybean [Glycine max (L.) Merr. cv. Jack and Asgrow A2872] were established in liquid Finer and Nagasawa medium, maintained by transfer to fresh medium at biweekly intervals, and subjected to microprojectile bombardment over time. Cultures were not amenable to transformation until they were at least 6 months old. Over time, different cell lines of the same genotype acquired very different culture phenotypes. Histological analysis of cell lines differing in transformation ability showed that the most transformable cultures had cytoplasmic-rich cells in the outermost layers of the tissue. In contrast, the outer layers of less transformable cultures contained cells with prominent vacuoles. Although fresh weight accumulation of the cultures was curvilinear during the 2-week subculture period, a burst of mitotic activity was evident shortly after transfer to fresh medium. This activity usually lasted from the 2nd to the 6th day following subculture, and peaked on the 4th day. Tissues at or near this stage always produced more transient expression of a reporter gene than did bombardments at other times. In addition, the cell lines most amenable to transformation also exhibited the highest mitotic index. Thus any treatment to increase the mitotic index, especially when the cell lines are less than 6 months old, may facilitate the transformation of cell lines from which efficient recovery of transgenic plants is still possible.
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Affiliation(s)
- C B Hazel
- DuPont Agricultural Products, Agbiotechnology, Experimental Station, Wilmington, DE 19880-4296, USA, , , , , , US
| | - T M Klein
- DuPont Agricultural Products, Agbiotechnology, Experimental Station, Wilmington, DE 19880-4296, USA, , , , , , US
| | - M Anis
- Department of Crop and Soil Sciences, The University of Georgia, Athens, GA 30602-7272, USA; Fax no.: +1-706-542-0914, , , , , , GE
| | - H D Wilde
- Department of Crop and Soil Sciences, The University of Georgia, Athens, GA 30602-7272, USA; Fax no.: +1-706-542-0914, , , , , , GE
| | - W A Parrott
- Department of Crop and Soil Sciences, The University of Georgia, Athens, GA 30602-7272, USA; Fax no.: +1-706-542-0914, , , , , , GE
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23
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Rugh CL, Wilde HD, Stack NM, Thompson DM, Summers AO, Meagher RB. Mercuric ion reduction and resistance in transgenic Arabidopsis thaliana plants expressing a modified bacterial merA gene. Proc Natl Acad Sci U S A 1996; 93:3182-7. [PMID: 8622910 PMCID: PMC39579 DOI: 10.1073/pnas.93.8.3182] [Citation(s) in RCA: 134] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
With global heavy metal contamination increasing, plants that can process heavy metals might provide efficient and ecologically sound approaches to sequestration and removal. Mercuric ion reductase, MerA, converts toxic Hg2+ to the less toxic, relatively inert metallic mercury (Hg0) The bacterial merA sequence is rich in CpG dinucleotides and has a highly skewed codon usage, both of which are particularly unfavorable to efficient expression in plants. We constructed a mutagenized merA sequence, merApe9, modifying the flanking region and 9% of the coding region and placing this sequence under control of plant regulatory elements. Transgenic Arabidopsis thaliana seeds expressing merApe9 germinated, and these seedlings grew, flowered, and set seed on medium containing HgCl2 concentrations of 25-100 microM (5-20 ppm), levels toxic to several controls. Transgenic merApe9 seedlings evolved considerable amounts of Hg0 relative to control plants. The rate of mercury evolution and the level of resistance were proportional to the steady-state mRNA level, confirming that resistance was due to expression of the MerApe9 enzyme. Plants and bacteria expressing merApe9 were also resistant to toxic levels of Au3+. These and other data suggest that there are potentially viable molecular genetic approaches to the phytoremediation of metal ion pollution.
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Affiliation(s)
- C L Rugh
- Daniel B. Warnell School of Forest Resources, University of Georgia, Athens, 30602, USA
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24
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Abstract
Cells of yellow-poplar (Liriodendron tulipifera L.) were transformed by direct gene transfer and regenerated into plants by somatic embryogenesis. Plasmid DNA bearing marker genes encoding beta-glucuronidase (GUS) and neomycin phosphotransferase (NPT II) were introduced by microprojectile bombardment into single cells and small cell clusters isolated from embryogenic suspension cultures. The number of full-length copies of the GUS gene in independently transformed callus lines ranged from approximately 3 to 30. An enzyme-linked immunosorbent assay for NPT II and a fluorometric assay for GUS showed that the expression of both enzymes varied by less than fourfold among callus lines. A histochemical assay for GUS activity revealed a heterogeneous pattern of staining with the substrate 5-bromo-4-chloro-3-indoyl-beta-d-glucuronic acid in some transformed cell cultures. However, cell clusters reacting positively (blue) or negatively (white) with 5-bromo-4-chloro-3-indoyl-beta-d-glucuronic acid demonstrated both GUS activity and NPT II expression in quantitative assays. Somatic embryos induced from transformed cell cultures were found to be uniformly GUS positive by histochemical analysis. All transgenic plants sampled expressed the two marker genes in both root and shoot tissues. GUS activity was found to be higher in leaves than roots by fluorometric and histochemical assays. Conversely, roots expressed higher levels of NPT II than leaves.
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Affiliation(s)
- H D Wilde
- School of Forest Resources, University of Georgia, Athens, Georgia 30602
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Seffens WS, Almoguera C, Wilde HD, Vonder Haar RA, Thomas TL. Molecular analysis of a phylogenetically conserved carrot gene: developmental and environmental regulation. Dev Genet 1990; 11:65-76. [PMID: 2361335 DOI: 10.1002/dvg.1020110108] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Extensive studies of gene expression programs in carrot somatic embryos identified a gene, designated Dc3, that serves as a reliable molecular marker for the acquisition of embryogenic potential by carrot cells in culture. The complete sequence of a carrot genomic region, DcG3, encoding a Dc3-like mRNA, was determined. The DcG3 transcription unit contains a single intron and encodes mRNA that is expressed at high levels in embryonic tissue but is undetectable in somatic tissue of carrot. The predicted protein sequence of DcG3 is 163 amino acids and includes two approximately 50 amino acid direct repeats which in turn include additional repetitive elements with an unusual distribution of charged amino acids. Dc3 and Dc3-like mRNAs are encoded by a small divergent gene family. Furthermore, similarities of the Dc3 gene family with genes from other plant species that are expressed in response to environmental and developmental cues suggest a possible role in seed desiccation and possibly in more general water-stress responses in plants. Analysis of transgenic tobacco containing a beta-glucuronidase (GUS) reporter gene fused to a 1.7 kb 5' upstream element of DcG3 defined a promoter/enhancer complex that confers developmentally and environmentally regulated expression of GUS activity. Thus, DcG3 is phylogenetically conserved together with the trans-acting factors required for its regulated expression in transgenic tobacco.
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Affiliation(s)
- W S Seffens
- Department of Biology, Texas A&M University, College Station
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de Vries SC, Booij H, Meyerink P, Huisman G, Wilde HD, Thomas TL, van Kammen A. Acquisition of embryogenic potential in carrot cell-suspension cultures. Planta 1988; 176:196-204. [PMID: 24220773 DOI: 10.1007/bf00392445] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/1987] [Accepted: 03/31/1988] [Indexed: 06/02/2023]
Abstract
Embryogenic suspension cultures of domesticated carrot (Daucus carota L.) are characterized by the presence of proembryogenic masses (PEMs) from which somatic embryos develop under conditions of low cell density in the absence of phytohormones. A culture system, referred to as starting cultures, was developed that allowed analysis of the emergence of PEMs in newly initiated hypocotyl-derived suspension cultures. Embryogenic potential, reflected by the number of FEMs present, slowly increased in starting cultures over a period of six weeks. Addition of excreted, high-molecular-weight, heat-labile cell factors from an established embryogenic culture considerably accelerated the acquisition of embryogenic potential in starting cultures. Analysis of [(35)S]methionine-labeled proteins excreted into the medium revealed distinct changes concomitant with the acquisition of embryogenic potential in these cultures. Analysis of the pattern of gene expression by in-vitro translation of total cellular mRNA from starting cultures with different embryogenic potential and subsequent separation of the [(35)S]methionine-labeled products by two-dimensional polyacrylamide gel electrophoresis demonstrated a small number of abundant in-vitro-translation products to be present in somatic embryos and in embryogenic cells but absent in nonembryogenic cells. Several other in-vitro-translation products were present in explants, non-embryogenic and embryogenic cells but were absent in somatic embryos. Hybridization of an embryoregulated complementary-DNA sequence, Dc3, to RNA extracted from starting cultures showed that the corresponding gene is expressed in somatic embryos and PEMs but not in non-embryogenic cells.
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Affiliation(s)
- S C de Vries
- Department of Molecular Biology, Agricultural University Wageningen, De Dreijen 11, NL-6703 BC, Wageningen, The Netherlands
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Wilde HD, Nelson WS, Booij H, de Vries SC, Thomas TL. Gene-expression programs in embryogenic and non-embryogenic carrot cultures. Planta 1988; 176:205-211. [PMID: 24220774 DOI: 10.1007/bf00392446] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/1987] [Accepted: 05/06/1988] [Indexed: 06/02/2023]
Abstract
Somatic embryogenesis can be synchronized by enriching carrot (Daucus carota L.) suspension cultures for small, dense clusters of cells termed proembryogenic masses (PEMs). Gene-expression programs of PEMs were compared with those of embryonic and mature tissues by in-vitro translation of representative mRNA populations and by nucleic-acid hybridization. Analysis of invitro-translated polypeptides by two-dimensional polyacrylamide gel electrophoresis revealed striking similarities between the mRNA populations of PEM and torpedo-stage embryos; substantial differences, however, were observed when in-vitro translation products of PEMs and torpedo embryos were compared with those of hypocotyls and leaves. Northern blots of RNA isolated from PEMs, staged embryos, and mature carrot tissues were hybridized with cDNA probes for Dc3, Dc5 and Dc13; these cDNA recombinants represent mRNAs that are regulated during carrot somatic embryogenesis. The pattern of expression of these embryo-regulated transcripts was similar in PEMs and somatic embryos but differed in other carrot tissues. These results indicate that many of the molecular processes of embryogenesis are already established in PEMs in the presence of auxin. Additional experiments indicate the utility of Dc3 as a molecular marker for the acquisition of embryogenic potential.
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Affiliation(s)
- H D Wilde
- Department of Biology, Texas A & M University, 77843, College station, Texas, USA
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Fechner RE, Wilde HD. Chondroblastoma in the metaphysis of the femoral neck. A case report and review of the literature. J Bone Joint Surg Am 1974; 56:413-5. [PMID: 4452700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Bessemans A, Wilde HD. Remarks on "A Method for the Quantitative Estimation of Inocula in Experimental Syphilis" and on the Virulence Variation of Treponema in General Paralysis. Sex Transm Infect 1939; 15:222-7. [PMID: 21773287 DOI: 10.1136/sti.15.3.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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