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Ching AS, Zhang X, Furuya KN, Benoy ME, Bartlett HL. Turner syndrome may be associated with hepatic adenoma. Am J Med Genet A 2023; 191:2578-2584. [PMID: 37431210 DOI: 10.1002/ajmg.a.63341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/12/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023]
Abstract
Turner syndrome, caused by complete or partial loss of an X chromosome, is marked by a range of clinical manifestations including short stature, cardiovascular and renal disease. Hepatic involvement is an increasingly recognized concern. Steatosis and elevated transaminases are commonly observed in this population, but case reports have also described hepatic adenoma. Hepatic adenomas are rare, occurring in one per million people in the general population. They are typically benign but malignant transformation or rupture can occur. We sought to investigate whether Turner syndrome is associated with hepatic adenoma. Patients with Turner syndrome encountered at a single, academic institution between 2006 and 2020 were identified using ICD-10 codes and demographic, medication, laboratory, and imaging data were analyzed. Of the 228 patients identified, 46.9% had liver function testing, which were abnormal in 48.6%. Five of 77 patients with hepatic imaging had abnormalities. Three patients (1.3%) had hepatic adenoma, one after presenting in hemorrhagic shock due to rupture. These findings suggest that patients with Turner syndrome may have an increased risk for developing hepatic adenoma. Annual monitoring of liver function tests is already recommended in Turner syndrome. The addition of periodic hepatic imaging may also be beneficial.
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Affiliation(s)
- Alisha S Ching
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Xiao Zhang
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Katryn N Furuya
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Megan E Benoy
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Heather L Bartlett
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
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2
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Allen CC, Swanson BL, Zhang X, Schnapp B, Ruhland SM, Bartlett HL. Optimizing efficiency of a custom clinical decision support tool improves adult congenital heart disease care. Am Heart J Plus 2023; 31:100303. [PMID: 38510558 PMCID: PMC10945959 DOI: 10.1016/j.ahjo.2023.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 05/19/2023] [Indexed: 03/22/2024]
Abstract
Study objective Improve the efficiency of an inpatient clinical decision support tool (CDS) for patients with adult congenital heart disease (ACHD). Design The efficiency of a CDS was evaluated across two time periods and compared. Setting An academic, tertiary care center. Participants ACHD patients roomed in an inpatient setting. Intervention Plan-Do-Study-Act (PDSA) methods were applied starting in 2021 and included refinement of diagnostic codes and the addition of department encounter codes. Main outcome measures True positive and false positive CDS alerts. Results Baseline data from 2017 had a median (IQR) of 38 (17) and 2019 baseline data had 65 (19) total alerts per month. Combining both baseline data years, the median true positive CDS alerts was 47.3 %. There were 71 (6) total alerts per month for the 2021-2022 time period and with ongoing PDSA cycles and optimization in the CDS the true positive alerts improved substantially resulting in a shifting of the median to 78.9 % within 9 months. Conclusion CDS can efficiently notify providers when an ACHD patient is encountered. The use of ICD 10 codes alone to identify ACHD patients has limited accuracy with a high proportion of false positives. Ongoing revision of the CDS system methods is important to improving efficiency and minimizing provider alert fatigue.
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Affiliation(s)
- Catherine C. Allen
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, United States of America
| | - Briana L. Swanson
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, United States of America
| | - Xiao Zhang
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, United States of America
| | - Benjamin Schnapp
- Center for Clinical Knowledge Management, UW Hospitals and Clinics, Madison, WI, United States of America
| | - Sherri M. Ruhland
- Department of Cardiology, UW Hospitals and Clinics, Madison, WI, United States of America
| | - Heather L. Bartlett
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, United States of America
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin – Madison, Madison, WI, United States of America
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3
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Schefelker J, Zhang X, Dodge A, Marten K, Dimailig G, Bartlett HL, Peterson AL. Impact of the COVID-19 pandemic on cardiometabolic health parameters in children with preexisting dyslipidemia. J Clin Lipidol 2022; 16:643-648. [PMID: 35798651 PMCID: PMC9232258 DOI: 10.1016/j.jacl.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Juliette Schefelker
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, USA
| | - Xiao Zhang
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, USA
| | - Ann Dodge
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, USA
| | - Kristen Marten
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, USA
| | - Greigory Dimailig
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, USA
| | - Heather L Bartlett
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, USA
| | - Amy L Peterson
- Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, USA.
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4
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Dimailig G, Zhang X, Bartlett HL. HEART FAILURE THERAPY IN ADULTS WITH CONGENITAL HEART DISEASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02420-2] [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: 11/30/2022]
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Rizner JD, Bartlett HL, Shaw RE. New-Onset Accelerated Idioventricular Rhythm During Dental Rehabilitation. Anesth Prog 2022; 69:32-36. [PMID: 36534779 PMCID: PMC9773410 DOI: 10.2344/anpr-69-02-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/26/2021] [Accepted: 03/29/2022] [Indexed: 12/23/2022] Open
Abstract
Accelerated idioventricular rhythm has been documented in several cases involving the induction of general anesthesia; however, it has not previously been known to occur during reversal of neuromuscular blockade with neostigmine and glycopyrrolate. The current understanding of the pathophysiology of accelerated idioventricular rhythm involves enhanced automaticity of ventricular myocardium in the setting of increased vagal tone suppressing sinoatrial node pace making. We present the case of an 8-year-old boy who developed accelerated idioventricular rhythm during dental rehabilitation. In this case, accelerated idioventricular rhythm developed immediately upon reversal of neuromuscular blockade with neostigmine and glycopyrrolate and recurred intermittently during his recovery in the postanesthesia care unit. This was a benign occurrence in our patient who remained asymptomatic and hemodynamically stable, and his arrhythmia eventually subsided without intervention after several hours of telemetry. This case suggests that reversal of neuromuscular blockade with neostigmine and glycopyrrolate may induce accelerated idioventricular rhythm in certain patients without known cardiovascular disease.
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Affiliation(s)
| | - Heather L. Bartlett
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Division of Cardiology, Madison, Wisconsin
| | - Robert E. Shaw
- University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Division of Pediatric Anesthesiology, Madison Wisconsin
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6
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Broberg CS, Kovacs AH, Sadeghi S, Rosenbaum MS, Lewis MJ, Carazo MR, Rodriguez FH, Halpern DG, Feinberg J, Galilea FA, Baraona F, Cedars AM, Ko JM, Porayette P, Maldonado J, Sarubbi B, Fusco F, Frogoudaki AA, Nir A, Chaudhry A, John AS, Karbassi A, Hoskoppal AK, Frischhertz BP, Hendrickson B, Bouma BJ, Rodriguez-Monserrate CP, Broda CR, Tobler D, Gregg D, Martinez-Quintana E, Yeung E, Krieger EV, Ruperti-Repilado FJ, Giannakoulas G, Lui GK, Ephrem G, Singh HS, Almeneisi HM, Bartlett HL, Lindsay I, Grewal J, Nicolarsen J, Araujo JJ, Cramer JW, Bouchardy J, Al Najashi K, Ryan K, Alshawabkeh L, Andrade L, Ladouceur M, Schwerzmann M, Greutmann M, Meras P, Ferrero P, Dehghani P, Tung PP, Garcia-Orta R, Tompkins RO, Gendi SM, Cohen S, Klewer S, Hascoet S, Mohammadzadeh S, Upadhyay S, Fisher SD, Cook S, Cotts TB, Aboulhosn JA. COVID-19 in Adults With Congenital Heart Disease. J Am Coll Cardiol 2021; 77:1644-1655. [PMID: 33795039 PMCID: PMC8006800 DOI: 10.1016/j.jacc.2021.02.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
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Affiliation(s)
- Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Soraya Sadeghi
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA
| | - Marlon S Rosenbaum
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew J Lewis
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew R Carazo
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dan G Halpern
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | - Jodi Feinberg
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | | | - Fernando Baraona
- Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ari M Cedars
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jong M Ko
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prashob Porayette
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jennifer Maldonado
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Berardo Sarubbi
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - Flavia Fusco
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | | | - Amiram Nir
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anisa Chaudhry
- Penn State Hershey Heart and Vascular Institute, State College, Pennsylvania, USA
| | - Anitha S John
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | - Arvind K Hoskoppal
- UPMC Adult Congenital Heart Disease Program, Pittsburgh, Pennsylvania, USA
| | - Benjamin P Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Hendrickson
- University of Tennessee Health Science Center, Le Bonheur Heart Institute, Memphis, Tennessee, USA
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | - Daniel Tobler
- Division of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - David Gregg
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Efren Martinez-Quintana
- Cardiology Service, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Elizabeth Yeung
- Anschutz Medical Campus, Colorado's Adult and Teen Congenital Heart Program, Aurora, Colorado, USA
| | - Eric V Krieger
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - George K Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Georges Ephrem
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Harsimran S Singh
- Weill Cornell Medicine, New York Presbyterian Hospital, Department of Medicine and Pediatrics, New York, New York, USA
| | - Hassan Mk Almeneisi
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Heather L Bartlett
- Department of Pediatrics and Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Ian Lindsay
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - Jasmine Grewal
- University of British Columbia, St. Paul's Hospital, Vancouver, British Colombia, Canada
| | - Jeremy Nicolarsen
- Providence Adult and Teen Congenital Heart Program, Pediatric and Adult Cardiology, Spokane, Washington, USA
| | - John J Araujo
- Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Rionegro, Colombia
| | - Jonathan W Cramer
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Khalid Al Najashi
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Kristi Ryan
- OSF Healthcare Children's Hospital of Illinois, Adult Congenital Heart Program, Peoria, Illinois, USA
| | - Laith Alshawabkeh
- Department of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Lauren Andrade
- Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Magalie Ladouceur
- Hôpital Européen Georges Pompidou, Adult Congenital Heart Disease Unit, Paris, France
| | - Markus Schwerzmann
- University Hospital Inselspital, Center for Congenital Heart Disease, Bern, Switzerland
| | | | | | - Paolo Ferrero
- ASST Papa Giovanni XXIII, Cardiovascular Department, University of Milano, Bergamo, Italy
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Poyee P Tung
- University of Texas at Houston, Adult Congenital Heart Disease, Houston, Texas, USA
| | - Rocio Garcia-Orta
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rose O Tompkins
- Cedars-Sinai Medical Center, The Geurin Family Congenital Heart Program, Los Angeles, California, USA
| | - Salwa M Gendi
- West Virginia University, Adult Congenital Heart Disease Program, Morgantown, West Virginia, USA
| | - Scott Cohen
- Medical College of Wisconsin, Adult Congenital Heart Disease Program, Milwaukee, Wisconsin, USA
| | - Scott Klewer
- Division of Cardiology, University of Arizona, Tucson, Arizona, USA
| | | | | | - Shailendra Upadhyay
- Connecticut Children's Medical Center, Pediatric Cardiology Hartford, Connecticut, USA
| | - Stacy D Fisher
- Department of Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephen Cook
- Helen DeVos Children's Hospital, Adult Congenital Heart Center, Grand Rapids, Michigan, USA
| | - Timothy B Cotts
- Department of Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA.
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Abstract
This paper describes the design of a new type of knee prosthesis called a stance-control, swing-assist (SCSA) knee prosthesis. The device is motivated by the recognition that energetically-passive stance-controlled microprocessor-controlled knees (SCMPKs) offer many desirable characteristics, such as quiet operation, low weight, high-impedance stance support, and an inertially-driven swing-phase motion. Due to the latter, however, SCMPKs are also highly susceptible to swing-phase perturbations, which can increase the likelihood of falling. The SCSA prosthesis supplements the behavior of an SCMPK with a small motor that maintains the low output impedance of the SCMPK swing state, while adding a supplemental closed-loop controller around it. This paper elaborates upon the motivation for the SCSA prosthesis, describes the design of a prosthesis prototype, and provides human-subject testing data that demonstrates potential device benefits relative to an SCMPK during both non-perturbed and perturbed walking.
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Affiliation(s)
- J T Lee
- Department of Mechanical Engineering Vanderbilt University, Nashville, TN, USA
| | - H L Bartlett
- Department of Mechanical Engineering Vanderbilt University, Nashville, TN, USA
| | - M Goldfarb
- Department of Mechanical Engineering Vanderbilt University, Nashville, TN, USA
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8
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Lushaj EB, Bartlett HL, Lamers LJ, Arndt S, Hermsen J, Ralphe JC, Anagnostopoulos PV. Technical Performance Score Predicts Perioperative Outcomes in Complex Congenital Heart Surgery Performed in a Small-to-Medium-Volume Program. Pediatr Cardiol 2020; 41:88-93. [PMID: 31676956 DOI: 10.1007/s00246-019-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/29/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
As the quality of surgical outcomes depend on many factors, the development of validated tools to assess the different aspects of complex multidisciplinary teams' performance is crucial. The Technical Performance Score (TPS) has only been validated to correlate with outcomes in large-volume surgical programs. Here we assess the utility of TPS in correlation to perioperative outcomes for complex congenital heart surgeries (CHS) performed in a small-to-medium-volume program. 673 patients underwent CHS from 4/2012 to 12/2017 at our institution. Of those, 122 were STAT 4 and STAT 5. TPS was determined for each STAT 4 and STAT 5 operation using discharge echocardiogram: 1 = optimal, 2 = adequate, 3 = inadequate. Patient outcomes were compared including mortality, length of stay, ventilation times, and adverse events. 69 patients (57%) were neonates, 32 (26%) were infants, 17 (14%) were children, 4 (3%) were adults. TPS class 1 was assigned to 85 (70%) operations, TPS class 2 was assigned to 25 (20%) operations, and TPS class 3 was assigned to 12 (10%) operations. TPS was associated with re-intubation, ICU length of stay, postoperative length of stay, and mortality. TPS did not correlate with unplanned 30-day readmissions, need for reoperation, and inotropic score. Technical performance score was associated with perioperative outcomes and is a useful tool to assess the adequacy of repair for high complexity CHS in a small-to-medium-volume surgical program. TPS should be a part of program review in congenital heart programs of all sizes to identify strategies that may reduce postoperative morbidity and potentially improve long-term outcomes.
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Affiliation(s)
- Entela B Lushaj
- Department of Surgery-Cardiothoracic, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Heather L Bartlett
- Department of Pediatrics-Cardiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Luke J Lamers
- Department of Pediatrics-Cardiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Shannon Arndt
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Joshua Hermsen
- Department of Surgery-Cardiothoracic, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - J Carter Ralphe
- Department of Pediatrics-Cardiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Petros V Anagnostopoulos
- Department of Pediatrics-Cardiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. .,Division of Cardiothoracic Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA.
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9
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Pettit KA, Francois CJ, Aggarwal NR, Hess TM, Bartlett HL. Sex-Specific Differences in Ventricular Dimensions in Repaired Tetralogy of Fallot: A Retrospective Study. Pediatr Cardiol 2019; 40:1530-1535. [PMID: 31401720 DOI: 10.1007/s00246-019-02181-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
The timing of pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) is typically based on cardiac magnetic resonance imaging-derived ventricular volume measurements. Current criteria do not account for sex-based differences in chamber size. The purpose of this study was to compare male and female ventricular volumes and function in TOF patients with a hypothesis that females are less likely to meet common-indexed right ventricular end-diastolic volume (RVEDVi) and right ventricular end-systolic volume (RVESVi) criteria for PVR. Cardiac magnetic resonance data from 17 females (age 31.7 ± 15.4 years) and 23 males (30.7 ± 15.4 years) with TOF were retrospectively analyzed. Demographic and imaging data were recorded. Differences in sex-based means and standard deviations were evaluated using the Wilcoxon rank-sum test with continuity correction. Age and pulmonary regurgitant fraction were similar in females and males. RVEDVi was lower in females than in males, but the difference was not statistically significant. Differences in RVESVi, LVEDVi, LVESVi, and left ventricular ejection fraction were statistically significant, while the difference in right ventricular ejection fraction was not. RVEDVi was greater than 150 mL/m2 in 3/17 (17.6%) females and 10/23 (43.5%) males (OR 3.6). RVESVi was greater than 82 mL/m2 in 2/17 females and 8/23 males (OR 4.0). Sex-specific differences in right ventricular and left ventricular volumes and function are present in patients with TOF despite similar pulmonary regurgitation. These differences may need to be considered when evaluating patients for PVR.
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Affiliation(s)
- Kevin A Pettit
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, USA
| | - Christopher J Francois
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, USA
| | - Niti R Aggarwal
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, USA
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, MC 4108, Madison, WI, 53792, USA
| | - Timothy M Hess
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, MC 4108, Madison, WI, 53792, USA
| | - Heather L Bartlett
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, USA.
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, MC 4108, Madison, WI, 53792, USA.
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10
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Rutkowski DR, Barton G, François CJ, Bartlett HL, Anagnostopoulos PV, Roldán-Alzate A. Analysis of cavopulmonary and cardiac flow characteristics in fontan Patients: Comparison with healthy volunteers. J Magn Reson Imaging 2019; 49:1786-1799. [PMID: 30635978 DOI: 10.1002/jmri.26583] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Characterizing the flow of the Fontan circuit, and correlating flow characteristics with the development of complications, is an important clinical challenge. Past work has analyzed the flow characteristics of Fontan circulation on a component-by-component basis. 4D flow MRI with radial projections allows for large volumetric coverage, and therefore can be used to analyze the flow through many codependent cardiovascular components in a single imaging session. PURPOSE To describe flow characteristics across the entire Fontan circuit and to compare these with the flow characteristics in healthy volunteers. STUDY TYPE Prospective. SUBJECTS Eleven single ventricle patients with a Fontan connection and 15 healthy controls. SEQUENCE Phase contrast with vastly undersampled isotropic projection reconstruction (PC-VIPR) at a field strength of 3 T. ASSESSMENT Cavopulmonary and ventricular flow distributions, blood flow kinetic energy, vorticities, efficiency indices, and other flow parameters were analyzed using Ensight and MatLab. STATISTICAL TESTS The results were compared across Fontan subjects, between respiratory phases, and between Fontan subjects and healthy volunteers using a Student's t-test for unequal sample sizes and linear regression. RESULTS Cava-specific pulmonary flow distributions of Fontan patients varied significantly between respiratory phases (P < 0.05). Ventricular kinetic energy (KE) was significantly higher in Fontan patients than it was in healthy controls, leading to a lower cardiac efficiency metric in the Fontan group. A significant diastolic KE time-shift was also observed in the Fontan patient group. Peak diastolic KE was significantly higher in the single ventricle of patients with right ventricle morphology than it was in left ventricle morphology patients. DATA CONCLUSION Radial 4D flow MRI can be used for comprehensive analysis of single ventricle Fontan flow characteristics. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
- David R Rutkowski
- Mechanical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Gregory Barton
- Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Heather L Bartlett
- Pediatrics and Medicine, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Alejandro Roldán-Alzate
- Mechanical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Biomedical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Legare JM, Modaff P, Strom SP, Pauli RM, Bartlett HL. Geleophysic dysplasia: 48 year clinical update with emphasis on cardiac care. Am J Med Genet A 2018; 176:2237-2242. [PMID: 30195254 DOI: 10.1002/ajmg.a.40377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 03/20/2018] [Revised: 05/16/2018] [Accepted: 06/03/2018] [Indexed: 01/02/2023]
Abstract
Geleophysic dysplasia is a rare skeletal dysplasia often complicated by progressive cardiac disease. Information about long-term outcomes is limited. A clinical update of the oldest surviving patient described with geleophysic dysplasia type 1 is provided. Special note is made in relation to the cardiac disease and interventions. Genetic testing of ADAMTSL2 revealed a previously reported missense mutation as well as a novel nonsense mutation, which can be added to the list of causative mutations in geleophysic dysplasia.
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Affiliation(s)
- Janet M Legare
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peggy Modaff
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Richard M Pauli
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Heather L Bartlett
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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12
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Wightman A, Bartlett HL, Zhao Q, Smith JM. Prevalence and outcomes of heart transplantation in children with intellectual disability. Pediatr Transplant 2017; 21. [PMID: 27801533 DOI: 10.1111/petr.12839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Accepted: 09/26/2016] [Indexed: 11/28/2022]
Abstract
Heart transplantation in children with intellectual disability is a controversial issue. We sought to describe the prevalence and outcomes of heart transplantation in children with intellectual disability and hypothesized that recipients with intellectual disability have comparable short-term outcomes compared to recipients without intellectual disability. We performed a retrospective cohort analysis of children receiving a first heart-alone transplant in the UNOS STAR database from 2008 to 2013. Recipients with intellectual disability were compared to those without using chi-square tests. Kaplan-Meier curves were constructed for patient and graft survival. Cox proportional hazard models were used to estimate the association between intellectual disability and graft failure and patient survival. Over the study period, 107 children with intellectual disability underwent initial heart transplantation, accounting for 8.9% of first pediatric heart transplants (total=1204). There was no difference in the incidence of acute rejection between groups in the first year after transplant. Mean functional status scores at follow-up improved in both groups after transplantation, but tended to be lower among children with intellectual disability than children without. Log-rank tests did not suggest significant differences in graft survival between those with and without intellectual disability during the first 4 years following transplantation. Children with intellectual disability constitute a significant portion of total heart transplants with short-term outcomes comparable to children without intellectual disability.
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Affiliation(s)
- Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Heather L Bartlett
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Qianqian Zhao
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jodi M Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Alshawabkeh LI, Hu N, Carter KD, Opotowsky AR, Light-McGroary K, Cavanaugh JE, Bartlett HL. Wait-List Outcomes for Adults With Congenital Heart Disease Listed for Heart Transplantation in the U.S. J Am Coll Cardiol 2016; 68:908-17. [DOI: 10.1016/j.jacc.2016.05.082] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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Morriss FH, Lindower JB, Bartlett HL, Atkins DL, Kim JO, Klein JM, Ford BA. Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications. AJP Rep 2016; 6:e344-e351. [PMID: 27695644 PMCID: PMC5042705 DOI: 10.1055/s-0036-1593406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective We describe five neonates with enteroviral (EV) infection to demonstrate central nervous system (CNS) and cardiac complications and report successful treatment of myocarditis with immunoglobulin intravenous (IVIG) in two. Study Design Case series identified during three enteroviral seasons in one neonatal intensive care unit (NICU) by cerebral spinal fluid (CSF) reverse transcriptase polymerase chain reaction (PCR) testing for EV in neonates suspected to have sepsis, but with sterile bacterial cultures. Results Cases were identified in each of three sequential years in a NICU with 800 to 900 admissions/year. Two cases were likely acquired perinatally; all were symptomatic with lethargy and poor feeding by age 5 to 10 days. All had signs of sepsis and/or meningitis; one progressed to periventricular leukomalacia and encephalomalacia. Two recovered from myocarditis after treatment that included IVIG 3 to 5 g/kg. Conclusion Neonates who appear septic without bacterial etiology may have EV CNS infections that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment.
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Affiliation(s)
- Frank H Morriss
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Julie B Lindower
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Dianne L Atkins
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Jean O Kim
- Department of Pediatrics, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Jonathan M Klein
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Bradley A Ford
- Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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15
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Ledoux ED, Lawson BE, Shultz AH, Bartlett HL, Goldfarb M. Metabolics of stair ascent with a powered transfemoral prosthesis. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5307-10. [PMID: 26737489 DOI: 10.1109/embc.2015.7319589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper evaluates the effectiveness of a powered knee and ankle prosthesis for stair ascent through a metabolic assessment comparing energy expenditure of a single transfemoral amputee subject while ascending stairs with the powered prosthesis relative to his passive daily use device, as well as comparing the kinematics and kinetics obtained with the passive prosthesis to healthy biomechanics. The subject wore a portable system that measured pulmonary gaseous exchange rates of oxygen and carbon dioxide while he ascended stairs with each of the prostheses in alternating tests. The results indicated that the amputee's energy expenditure decreased by 32 percent while climbing with the powered prosthesis as compared to his passive one, and the kinematics and kinetics achieved were representative of healthy biomechanics.
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Abstract
Mutations in actin cause a range of human diseases due to specific molecular changes that often alter cytoskeletal function. In this study, imaging of fluorescently tagged proteins using total internal fluorescence (TIRF) microscopy is used to visualize and quantify changes in cytoskeletal dynamics. TIRF microscopy and the use of fluorescent tags also allows for quantification of the changes in cytoskeletal dynamics caused by mutations in actin. Using this technique, quantification of cytoskeletal function in live cells valuably complements in vitro studies of protein function. As an example, missense mutations affecting the actin residue R256 have been identified in three human actin isoforms suggesting this amino acid plays an important role in regulatory interactions. The effects of the actin mutation R256H on cytoskeletal movements were studied using the yeast model. The protein, Aip1, which is known to assist cofilin in actin depolymerization, was tagged with green fluorescent protein (GFP) at the N-terminus and tracked in vivo using TIRF microscopy. The rate of Aip1p movement in both wild type and mutant strains was quantified. In cells expressing R256H mutant actin, Aip1p motion is restricted and the rate of movement is nearly half the speed measured in wild type cells (0.88 ± 0.30 μm/sec in R256H cells compared to 1.60 ± 0.42 μm/sec in wild type cells, p < 0.005).
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Affiliation(s)
- Alyson R Pierick
- Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa
| | - Melissa McKane
- Department of Biochemistry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa
| | - Kuo-Kuang Wen
- Department of Biochemistry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa
| | - Heather L Bartlett
- Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa; Department of Biochemistry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa;
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Ng B, Mathews KD, Bartlett HL. A 16-week-old infant with failure to thrive and hypotonia. Clin Pediatr (Phila) 2013; 52:1075-8. [PMID: 24027232 DOI: 10.1177/0009922813502125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Benton Ng
- 1University of Iowa, Iowa City, IA, USA
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Malloy LE, Wen KK, Pierick AR, Wedemeyer EW, Bergeron SE, Vanderpool ND, McKane M, Rubenstein PA, Bartlett HL. Thoracic aortic aneurysm (TAAD)-causing mutation in actin affects formin regulation of polymerization. J Biol Chem 2012; 287:28398-408. [PMID: 22753406 PMCID: PMC3436569 DOI: 10.1074/jbc.m112.371914] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/07/2012] [Indexed: 01/01/2023] Open
Abstract
More than 30 mutations in ACTA2, which encodes α-smooth muscle actin, have been identified to cause autosomal dominant thoracic aortic aneurysm and dissection. The mutation R256H is of particular interest because it also causes patent ductus arteriosus and moyamoya disease. R256H is one of the more prevalent mutations and, based on its molecular location near the strand-strand interface in the actin filament, may affect F-actin stability. To understand the molecular ramifications of the R256H mutation, we generated Saccharomyces cerevisiae yeast cells expressing only R256H yeast actin as a model system. These cells displayed abnormal cytoskeletal morphology and increased sensitivity to latrunculin A. After cable disassembly induced by transient exposure to latrunculin A, mutant cells were delayed in reestablishing the actin cytoskeleton. In vitro, mutant actin exhibited a higher than normal critical concentration and a delayed nucleation. Consequently, we investigated regulation of mutant actin by formin, a potent facilitator of nucleation and a protein needed for normal vascular smooth muscle cell development. Mutant actin polymerization was inhibited by the FH1-FH2 fragment of the yeast formin, Bni1. This fragment strongly capped the filament rather than facilitating polymerization. Interestingly, phalloidin or the presence of wild type actin reversed the strong capping behavior of Bni1. Together, the data suggest that the R256H actin mutation alters filament conformation resulting in filament instability and misregulation by formin. These biochemical effects may contribute to abnormal histology identified in diseased arterial samples from affected patients.
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Affiliation(s)
| | - Kuo-Kuang Wen
- Biochemistry, Roy A. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | | | | | - Sarah E. Bergeron
- From the Departments of Pediatrics and
- Biochemistry, Roy A. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Nicole D. Vanderpool
- Biochemistry, Roy A. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Melissa McKane
- Biochemistry, Roy A. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Peter A. Rubenstein
- Biochemistry, Roy A. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Heather L. Bartlett
- From the Departments of Pediatrics and
- Biochemistry, Roy A. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
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Pietra BA, Kantor PF, Bartlett HL, Chin C, Canter CE, Larsen RL, Edens RE, Colan SD, Towbin JA, Lipshultz SE, Kirklin JK, Naftel DC, Hsu DT. Early predictors of survival to and after heart transplantation in children with dilated cardiomyopathy. Circulation 2012; 126:1079-86. [PMID: 22800850 DOI: 10.1161/circulationaha.110.011999] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND The importance of clinical presentation and pretransplantation course on outcome in children with dilated cardiomyopathy listed for heart transplantation is not well defined. METHODS AND RESULTS The impact of age, duration of illness, sex, race, ventricular geometry, and diagnosis of myocarditis on outcome in 261 children with dilated cardiomyopathy enrolled in the Pediatric Cardiomyopathy Registry and Pediatric Heart Transplant Study was studied. End points included listing as United Network for Organ Sharing status 1, death while waiting, and death after transplantation. The median age at the time of diagnosis was 3.4 years, and the mean time from diagnosis to listing was 0.62±1.3 years. Risk factors associated with death while waiting were ventilator use and older age at listing in patients not mechanically ventilated (P=0.0006 and P=0.03, respectively). Shorter duration of illness (P=0.04) was associated with listing as United Network for Organ Sharing status 1. Death after transplantation was associated with myocarditis at presentation (P=0.009), nonwhite race (P<0.0001), and a lower left ventricular end-diastolic dimension z score at presentation (P=0.04). In the myocarditis group, 17% (4 of 23) died of acute rejection after transplantation. CONCLUSIONS Mechanical ventilator use and older age at listing predicted death while waiting, whereas nonwhite race, smaller left ventricular dimension, and myocarditis were associated with death after transplantation. Although 97% of children with clinically or biopsy-diagnosed myocarditis at presentation survived to transplantation, they had significantly higher posttransplantation mortality compared with children without myocarditis, raising the possibility that preexisting viral infection or inflammation adversely affects graft survival.
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Affiliation(s)
- Biagio A Pietra
- Division of Cardiology, The Children's Hospital Denver, 13123 E 16th Ave, Aurora, CO 80045, USA.
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20
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Bergeron SE, Wedemeyer EW, Lee R, Wen KK, McKane M, Pierick AR, Berger AP, Rubenstein PA, Bartlett HL. Allele-specific effects of thoracic aortic aneurysm and dissection alpha-smooth muscle actin mutations on actin function. J Biol Chem 2011; 286:11356-69. [PMID: 21288906 DOI: 10.1074/jbc.m110.203174] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Twenty-two missense mutations in ACTA2, which encodes α-smooth muscle actin, have been identified to cause thoracic aortic aneurysm and dissection. Limited access to diseased tissue, the presence of multiple unresolvable actin isoforms in the cell, and lack of an animal model have prevented analysis of the biochemical mechanisms underlying this pathology. We have utilized actin from the yeast Saccharomyces cerevisiae, 86% identical to human α-smooth muscle actin, as a model. Two of the known human mutations, N115T and R116Q, were engineered into yeast actin, and their effect on actin function in vivo and in vitro was investigated. Both mutants exhibited reduced ability to grow under a variety of stress conditions, which hampered N115T cells more than R116Q cells. Both strains exhibited abnormal mitochondrial morphology indicative of a faulty actin cytoskeleton. In vitro, the mutant actins exhibited altered thermostability and nucleotide exchange rates, indicating effects of the mutations on monomer conformation, with R116Q the most severely affected. N115T demonstrated a biphasic elongation phase during polymerization, whereas R116Q demonstrated a markedly extended nucleation phase. Allele-specific effects were also seen on critical concentration, rate of depolymerization, and filament treadmilling. R116Q filaments were hypersensitive to severing by the actin-binding protein cofilin. In contrast, N115T filaments were hyposensitive to cofilin despite nearly normal binding affinities of actin for cofilin. The mutant-specific effects on actin behavior suggest that individual mechanisms may contribute to thoracic aortic aneurysm and dissection.
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Affiliation(s)
- Sarah E Bergeron
- Department of Biochemistry, Roy A. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA
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21
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Bartlett HL, Escalera RB, Patel SS, Wedemeyer EW, Volk KA, Lohr JL, Reinking BE. Echocardiographic assessment of cardiac morphology and function in Xenopus. Comp Med 2010; 60:107-113. [PMID: 20412684 PMCID: PMC2855036] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 10/07/2009] [Accepted: 11/20/2009] [Indexed: 05/29/2023]
Abstract
Advances using Xenopus as a model permit valuable inquiries into cardiac development from embryo to adult. Noninvasive methods are needed to study cardiac function longitudinally. The objective of this study was to evaluate the feasibility of echocardiographic studies in Xenopus and establish normative data of adult cardiac structure and function. Doppler and 2D echocardiograms and electrocardiograms were acquired from adult Xenopus laevis and X. tropicalis. Frogs were exposed to either isoflurane or tricaine to discern the effect of sedating agents on cardiac function. Cardiac dimensions, morphology, flow velocities, and electrophysiologic intervals were measured and evaluated by using bivariate and regression analyses. Normal cardiac dimensions relative to body weight and species were established by echocardiography. Normal conduction intervals were determined by electrocardiography and did not vary by body weight or species. Anesthetic agent did not affect ejection fraction or flow velocity but did alter the QRS duration and QT interval. Echocardiographic and electrocardiographic studies in Xenopus provide information about cardiac anatomy and physiology and can readily be used for longitudinal analyses of developmental inquiries. Body weight, species, and anesthetic agent are factors that should be considered in experimental design and analyses.
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Abstract
The developing embryos of the South African (Xenopus laevis) and Western (Xenopus tropicalis) clawed frogs provide an experimentally tractable and easily visualized model for vertebrate cardiovascular development. Most of the genes used to execute the cardiac developmental program are the same in frogs and humans. Experiments using Xenopus provide an underutilized but valuable complement to studies on the molecular, cellular, physiological and morphological consequences of genetic and environmental influences on cardiac disease.
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Affiliation(s)
- Heather L Bartlett
- Department of Pediatrics, Roy J. and Lucille Carver College of Medicine, University of Iowa
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Bartlett HL, Sutherland L, Kolker SJ, Welp C, Tajchman U, Desmarais V, Weeks DL. Transient early embryonic expression of Nkx2-5 mutations linked to congenital heart defects in human causes heart defects in Xenopus laevis. Dev Dyn 2007; 236:2475-84. [PMID: 17685485 PMCID: PMC2078326 DOI: 10.1002/dvdy.21244] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nkx2-5 is a homeobox containing transcription factor that is conserved and expressed in organisms that form hearts. Fruit flies lacking the gene (tinman) fail to form a dorsal vessel, mice that are homozygous null for Nkx2-5 form small, deformed hearts, and several human cardiac defects have been linked to dominant mutations in the Nkx2-5 gene. The Xenopus homologs (XNkx2-5) of two truncated forms of Nkx2-5 that have been identified in humans with congenital heart defects were used in the studies reported here. mRNAs encoding these mutations were injected into single cell Xenopus embryos, and heart development was monitored. Our results indicate that the introduction of truncated XNkx2-5 variants leads to three principle developmental defects. The atrial septum and the valve of the atrioventricular canal were both abnormal. In addition, video microscopic timing of heart contraction indicated that embryos injected with either mutant form of XNkx2-5 have conduction defects.
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Affiliation(s)
| | - Lillian Sutherland
- Department of Biochemistry, Bowen Science Building, University of Iowa, Iowa City, Iowa
| | - Sandra J. Kolker
- Department of Biochemistry, Bowen Science Building, University of Iowa, Iowa City, Iowa
| | - Chelsea Welp
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | | | - Vera Desmarais
- Department of Biochemistry, Bowen Science Building, University of Iowa, Iowa City, Iowa
| | - Daniel L. Weeks
- Department of Biochemistry, Bowen Science Building, University of Iowa, Iowa City, Iowa
- *Correspondence to: Daniel L. Weeks, Department of Biochemistry, Bowen Science Building, University of Iowa, Iowa City, IA 52242-1109. E-mail:
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Von Bergen NH, Burkhart HM, Latson LA, Emery SP, Younoszai AK, Bartlett HL. Complete cavopulmonary shunt completion after in utero balloon atrial septoplasty for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2007; 134:1355-6. [PMID: 17976479 DOI: 10.1016/j.jtcvs.2007.07.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Nicholas H Von Bergen
- Department of Pediatric Cardiology, the University of Iowa Children's Hospital, Iowa City, Iowa 52242, USA.
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Patel PM, Bartlett HL, Scholz T, Burzynski J, Behrendt DM, Burkhart HM. Norwood modification in a patient with hypoplastic left heart and a right aortic arch. J Thorac Cardiovasc Surg 2007; 134:1065-6. [PMID: 17903541 DOI: 10.1016/j.jtcvs.2007.04.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 04/23/2007] [Indexed: 11/20/2022]
Affiliation(s)
- Priti M Patel
- Department of Pediatric Cardiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Abstract
BACKGROUND Early outcomes after tricuspid valve replacement in young children are ill defined. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1984 to 2002) was reviewed to evaluate the results of tricuspid valve replacement in children <6 years of age. METHODS AND RESULTS Ninety-seven patients who underwent initial tricuspid valve replacement are included in the present analysis. The most frequent cardiac diagnoses were Ebstein's anomaly (40%), pulmonary atresia (11%), and tetralogy of Fallot (8%). Age at tricuspid valve replacement was 2.9+/-1.7 years (mean+/-SD). Mean patient weight was 12.7+/-6.1 kg. The major outcome was survival to discharge. Associations among age, diagnosis, valve type/size, and outcome were evaluated through the use of chi2 analysis and logistic regression model fitting approaches. Hospital mortality was 26% and was very high (64%) in patients <1 year of age. A large size-to-weight ratio was the strongest predictor of mortality based on multivariable analysis (P<0.001). Mortality was 54% for patients with a size-to-weight ratio >2.5. Other complications included heart block requiring a pacemaker (13%) and thrombosis (5%). Pacemaker implantation was associated with the use of a mechanical valve (23% versus 6% bioprosthetic valve; P=0.01) CONCLUSIONS Tricuspid valve replacement in young children is associated with high mortality, especially in infants <1 year of age. Surgical options other than tricuspid valve replacement such as transplantation may need to be considered in infants.
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Affiliation(s)
- Heather L Bartlett
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Bartlett HL, Scholz TD, Lamb FS, Weeks DL. Characterization of embryonic cardiac pacemaker and atrioventricular conduction physiology in Xenopus laevis using noninvasive imaging. Am J Physiol Heart Circ Physiol 2004; 286:H2035-41. [PMID: 15148055 PMCID: PMC3530895 DOI: 10.1152/ajpheart.00807.2003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Indexed: 11/22/2022]
Abstract
Congenital heart defects often include altered conduction as well as morphological changes. Model organisms, like the frog Xenopus laevis, offer practical advantages for the study of congenital heart disease. X. laevis embryos are easily obtained free living, and the developing heart is readily visualized. Functional and morphological evidence for a conduction system is available for adult frog hearts, but information on the normal properties of embryonic heart contraction is lacking, especially in intact animals. With the use of fine glass microelectrodes, we were able to obtain cardiac recordings and make standard electrophysiological measurements in 1-wk-old embryos (stage 46). In addition, a system using digital analysis of video images was adapted for measurement of the standard cardiac intervals and compared with invasive measurements. Video images were obtained of the heart in live, pharmacologically paralyzed, stage 46 X. laevis embryos. Normal values for the timing of the cardiac cycle were established. Intervals determined by video analysis (n = 53), including the atrial and ventricular cycle lengths (473 +/- 10 ms and 464 +/- 19 ms, respectively) and the atrioventricular interval (169 +/- 5 ms) were not statistically different from those determined by intrathoracic cardiac recordings. We also present the data obtained from embryos treated with standard medications that affect the human conduction system. We conclude that the physiology of embryonic X. laevis cardiac conduction can be noninvasively studied by using digital video imaging. Additionally, we show the response of X. laevis embryonic hearts to chronotropic agents is similar but not identical to the response of the human heart.
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Affiliation(s)
- Heather L Bartlett
- Department of Pediatrics, 2801 JPP, University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, USA.
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