1
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Buyon JP, Masson M, Izmirly CG, Phoon C, Acherman R, Sinkovskaya E, Abuhamad A, Makhoul M, Satou G, Hogan W, Pinto N, Moon-Grady A, Howley L, Donofrio M, Krishnan A, Ahmadzia H, Levasseur S, Paul E, Owens S, Cumbermack K, Matta J, Joffe G, Lindblade C, Haxel C, Kohari K, Copel J, Strainic J, Doan T, Bermudez-Wagner K, Holloman C, Sheth SS, Killen S, Tacy T, Kaplinski M, Hornberger L, Carlucci PM, Izmirly P, Fraser N, Clancy RM, Cuneo BF. Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies. Arthritis Rheumatol 2024; 76:411-420. [PMID: 37947364 PMCID: PMC11095662 DOI: 10.1002/art.42733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 09/18/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti-SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second-degree atrioventricular block (AVB). METHODS Women with anti-SSA/Ro autoantibodies by commercial testing were stratified into high and low anti-52-kD and/or 60-kD SSA/Ro titers applying at-risk thresholds defined by previous evaluation of AVB pregnancies. The high-titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17-26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. RESULTS Anti-52-kD and/or 60-kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti-60-kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non-AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second-degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third-degree and two participants with third-degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. CONCLUSION High-titer antibodies are associated with an increased incidence of AVB. Anti-SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction abnormalities, which may reduce the need for serial echocardiograms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gary Satou
- University of California, Los Angeles, California
| | | | | | | | - Lisa Howley
- Midwest Fetal Care Center, Children's Minnesota/Allina Health, Minneapolis, Minnesota
| | | | | | | | | | - Erin Paul
- Mount Sinai Hospital, New York City, New York
| | | | | | | | - Gary Joffe
- Perinatal Associates of New Mexico, Rio Rancho, New Mexico
| | | | - Caitlin Haxel
- University of Vermont Children's Hospital, Burlington, Vermont
| | | | | | - James Strainic
- UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Tam Doan
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Conisha Holloman
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Shreya S Sheth
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
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2
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Villalaín C, Moon-Grady AJ, Herberg U, Strainic J, Cohen JL, Shah A, Levi DS, Gómez-Montes E, Herraiz I, Galindo A. Prediction of postnatal circulation in pulmonary atresia/critical stenosis with intact ventricular septum: systematic review and external validation of models. Ultrasound Obstet Gynecol 2023; 62:14-22. [PMID: 36776132 DOI: 10.1002/uog.26176] [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] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE A favorable postnatal prognosis in cases of pulmonary atresia/critical stenosis with intact ventricular septum (PA/CS-IVS) is generally equated with the possibility of achieving biventricular (BV) repair. Identification of fetuses that will have postnatal univentricular (UV) circulation is key for prenatal counseling, optimization of perinatal care and decision-making regarding fetal therapy. We aimed to evaluate the accuracy of published models for predicting postnatal circulation in PA/CS-IVS using a large internationally derived validation cohort. METHODS This was a systematic review of published uni- and multiparametric models for the prediction of postnatal circulation based on echocardiographic findings at between 20 and 28 weeks of gestation. Models were externally validated using data from the International Fetal Cardiac Intervention Registry. Sensitivity, specificity, predictive values, area under the receiver-operating-characteristics curves (AUCs) and proportion of cases with true vs predicted outcome were calculated. RESULTS Eleven published studies that reported prognostic parameters of postnatal circulation were identified. Models varied widely in terms of the main outcome (UV (n = 3), non-BV (n = 3), BV (n = 3), right-ventricle-dependent coronary circulation (n = 1) or tricuspid valve size at birth (n = 1)) and in terms of the included predictors (single parameters only (n = 6), multiparametric score (n = 4) or both (n = 1)), and were developed on small sample sizes (range, 15-38). Nine models were validated externally given the availability of the required parameters in the validation cohort. Tricuspid valve diameter Z-score, tricuspid regurgitation, ratios between right and left cardiac structures and the presence of ventriculocoronary connections (VCC) were the most commonly evaluated parameters. Multiparametric models including up to four variables (ratios between right and left structures, right ventricular inflow duration, presence of VCC and tricuspid regurgitation) had the best performance (AUC, 0.80-0.89). Overall, the risk of UV outcome was underestimated and that of BV outcome was overestimated by most models. CONCLUSIONS Current prenatal models for the prediction of postnatal outcome in PA/CS-IVS are heterogeneous. Multiparametric models for predicting UV and non-BV circulation perform well in identifying BV patients but have low sensitivity, underestimating the rate of fetuses that will ultimately have UV circulation. Until better discrimination can be achieved, fetal interventions may need to be limited to only those cases in which non-BV postnatal circulation is certain. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Villalaín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - A J Moon-Grady
- Department of Pediatrics, Division of Cardiology, University of California San Francisco, UCSF Benioff Children's Hospital, CA, USA
| | - U Herberg
- Klinik für Kinderkardiologie Universitätsklinikum, Aachen, Germany
| | - J Strainic
- Department of Pediatrics, Division of Pediatric Cardiology, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland Medical Center, Case Western University, Cleveland, OH, USA
| | - J L Cohen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Shah
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, NY, USA
| | - D S Levi
- Division of Cardiology, UCLA Mattel Children's Hospital, University of California Los Angeles Medical School, Los Angeles, CA, USA
| | - E Gómez-Montes
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - I Herraiz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - A Galindo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
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3
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Hogan WJ, Punn R, Dean P, Strainic J, Rychik J, Williams RV, Moon-Grady AJ, Silverman NH. Prenatally diagnosed pseudoaneurysm of mitral-aortic intervalvular fibrous area. Ultrasound Obstet Gynecol 2022; 59:682-686. [PMID: 34494326 DOI: 10.1002/uog.24762] [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] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
The mitral-aortic intervalvular fibrosa (MAIVF) is an avascular, fibrous structure that provides continuity between the anterior leaflet of the mitral valve and the aortic valve. Pseudoaneurysm of the MAIVF is rare and has been most commonly described in adults and, more rarely, in children following cardiac surgery or endocarditis. Few reports have been published on cases with congenital pseudoaneurysm of the MAIVF. Here, we describe five cases of congenital pseudoaneurysm of the MAIVF identified prenatally and an additional six cases diagnosed postnatally. This is an unusual finding of varying clinical significance, which can be isolated or associated with complex congenital heart disease but, importantly, can be identified and monitored in the fetus. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W J Hogan
- Department of Pediatrics, Division of Pediatric Cardiology, The University of California, San Francisco, CA, USA
| | - R Punn
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - P Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - J Strainic
- Rainbow Babies and Children's Hospital Division of Pediatric Cardiology, University Hospitals, Cleveland, OH, USA
| | - J Rychik
- Division of Cardiology, Departments of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - R V Williams
- University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - A J Moon-Grady
- Department of Pediatrics, Division of Pediatric Cardiology, The University of California, San Francisco, CA, USA
| | - N H Silverman
- Department of Pediatrics, Division of Pediatric Cardiology, The University of California, San Francisco, CA, USA
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4
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Furtun BY, Pundi K, Moon-Grady A, Cresalia N, Nieuwsma A, Gelehrter S, Arya B, Donofrio MT, Statile C, Kavanaugh-McHugh A, Freud L, Bolin E, Warner M, Balasubramanian S, Strainic J, Wittlieb-Weber C, Pinto N, Morris SA. MODERATE TO SEVERE MITRAL REGURGITATION IN THE FETUS AND PREDICTORS OF PRE AND POST-NATAL OUTCOMES, A FETAL HEART SOCIETY COLLABORATIVE STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01834-9] [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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Abstract
OBJECTIVES Abnormal early angiogenesis appears to impact both placental disorders and fetal congenital heart defects (CHD). We sought to assess the association of placental perfusion defects (PPD) and fetal (CHD). METHODS Singleton pregnancies with isolated severe fetal CHD were compared to controls without congenital anomalies or maternal malperfusion (MVM) risk factors. CHD was categorized into group 1: single left ventricle morphology and transposition of the great vessels (TGA) and group 2: single right ventricle and two ventricle morphology. Malperfusion was defined as fetal vascular malperfusion (FVM), MVM, and both FVM and MVM. RESULTS PPD was increased for all CHD (n = 47), CHD with or without risk factors, and CHD groups compared to controls (n = 92). Overall CHD cases and CHD with risk factors had an increased risk of FVM (30% and 80% vs 14%), and MVM (43% and 50% vs 21%), respectively. MVM rates were similar in CHD with and without maternal risk factors. FVM (38% vs 14%) and MVM (44% vs 21%) were increased in Group 1. MVM (42% vs 21%) and both FVM and MVM (16% vs 3%) were increased in Group 2. CONCLUSIONS PPD risk is increased in severe isolated fetal CHD. The highest risk is seen in fetal CHD with maternal risk factors.
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Affiliation(s)
- Tulin Ozcan
- Division of Maternal Fetal Medicine, Department of OB/GYN, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Sandra Kikano
- Department of Pediatrics, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Sarah Plummer
- Divison of Pediatric Cardiology, Department of Pediatrics, University Hospitals Case Medical Center, Cleveland, Ohio
| | - James Strainic
- Divison of Pediatric Cardiology, Department of Pediatrics, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Sanjita Ravishankar
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio
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6
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Pradhan S, Strainic J. Congenitally corrected transposition and mitral atresia complicated by restrictive atrial septum. J Clin Ultrasound 2020; 48:510-512. [PMID: 32748445 DOI: 10.1002/jcu.22897] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/26/2020] [Accepted: 07/04/2020] [Indexed: 06/11/2023]
Abstract
Congenitally corrected transposition (ccTGA), also known as L-transposition of the great arteries (L-TGA), is a rare cardiac malformation accounting for approximately 0.05% of congenital heart disease, characterized by ventricular inversion, discordant ventriculo-arterial connections with a normal visceroatrial relationship. It was first described by Baron Rokitansky in 1875, and prenatal sonographic diagnosis can be difficult. Symptomatology and clinical presentation of this malformation are related to the associated intracardiac defects. We report a rare case of severe, complex cardiac disease: prenatally diagnosed ccTGA with atrial restriction, mitral atresia, Ebsteinoid tricuspid valve, and severe pulmonary valve stenosis, who subsequently developed left pulmonary vein stenosis.
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Affiliation(s)
- Sarah Pradhan
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - James Strainic
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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7
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Zakko J, Blum KM, Drews JD, Wu YL, Hatoum H, Russell M, Gooden S, Heitkemper M, Conroy O, Kelly J, Carey S, Sacks M, Texter K, Ragsdale E, Strainic J, Bocks M, Wang Y, Dasi LP, Armstrong AK, Breuer C. Development of Tissue Engineered Heart Valves for Percutaneous Transcatheter Delivery in a Fetal Ovine Model. JACC Basic Transl Sci 2020; 5:815-828. [PMID: 32875171 PMCID: PMC7452327 DOI: 10.1016/j.jacbts.2020.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/30/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023]
Abstract
A fully biodegradable fetal valve was developed using a zinc-aluminum alloy stent and electrospun PCL leaflets. In vitro evaluation of the valve was performed with accelerated degradation, mechanical, and flow loop testing, and the valve showed trivial stenosis and trivial regurgitation. A large animal model was used for percutaneous delivery of the valve to the fetal pulmonary annulus. Following implantation, the valve had no stenosis or regurgitation by echocardiography, and the fetal sheep matured and was delivered at term with the tissue-engineered valve.
This multidisciplinary work shows the feasibility of replacing the fetal pulmonary valve with a percutaneous, transcatheter, fully biodegradable tissue-engineered heart valve (TEHV), which was studied in vitro through accelerated degradation, mechanical, and hemodynamic testing and in vivo by implantation into a fetal lamb. The TEHV exhibited only trivial stenosis and regurgitation in vitro and no stenosis in vivo by echocardiogram. Following implantation, the fetus matured and was delivered at term. Replacing a stenotic fetal valve with a functional TEHV has the potential to interrupt the development of single-ventricle heart disease by restoring proper flow through the heart.
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Key Words
- EOA, effective orifice area
- MPA, main pulmonary artery
- Mn, molecular size
- Mw, molecular weight
- NOI, normalized orientation index
- PCL, polycaprolactone
- PDI, polydispersity index
- PG, pressure gradient
- RF, regurgitant fraction
- RV, right ventricular/ventricle
- SEM, scanning electron microscopy
- TEHV, tissue-engineered heart valve
- congenital heart disease
- tissue-engineered heart valve
- transcatheter heart valve
- translational medicine
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Affiliation(s)
- Jason Zakko
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Joseph D Drews
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yen-Lin Wu
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Hoda Hatoum
- Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia
| | - Madeleine Russell
- Oden Institute for Computational and Engineering Sciences, University of Texas at Austin, Austin, Texas
| | - Shelley Gooden
- Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia
| | - Megan Heitkemper
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Olivia Conroy
- Oden Institute for Computational and Engineering Sciences, University of Texas at Austin, Austin, Texas
| | - John Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Stacey Carey
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Michael Sacks
- Oden Institute for Computational and Engineering Sciences, University of Texas at Austin, Austin, Texas
| | - Karen Texter
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Ellie Ragsdale
- Department of OB/GYN-Maternal Fetal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James Strainic
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Martin Bocks
- University Hospitals Rainbow Babies and Children's Hospital, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Yadong Wang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Lakshmi Prasad Dasi
- Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia
| | | | - Christopher Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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8
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Hogan WJ, Grinenco S, Armstrong A, Devlieger R, Dangel J, Ferrer Q, Frommelt M, Galindo A, Gardiner H, Gelehrter S, Herberg U, Howley L, Jaeggi E, Miranda J, Morris SA, Oepkes D, Pedra S, Peterson R, Sholler G, Simpson J, Strainic J, Vigneswarran TV, Wacker-Gussmann A, Moon-Grady AJ. Fetal Cardiac Intervention for Pulmonary Atresia with Intact Ventricular Septum: International Fetal Cardiac Intervention Registry. Fetal Diagn Ther 2020; 47:1-9. [PMID: 32634804 DOI: 10.1159/000508045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/19/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Invasive fetal cardiac intervention (FCI) for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (PS) has been performed with small single-institution series reporting technical and physiological success. We present the first multicenter experience. OBJECTIVES Describe fetal and maternal characteristics of those being evaluated for FCI, including pregnancy/neonatal outcome data using the International Fetal Cardiac Intervention Registry (IFCIR). METHODS We queried the IFCIR for PAIVS/PS cases evaluated from January 2001 to April 2018 and reviewed maternal/fetal characteristics, procedural details, pregnancy and neonatal outcomes. Data were analyzed using standard descriptive statistics. RESULTS Of the 84 maternal/fetal dyads in the registry, 58 underwent pulmonary valvuloplasty at a median gestational age of 26.1 (21.9-31.0) weeks. Characteristics of fetuses undergoing FCI varied in terms of tricuspid valve (TV) size, TV regurgitation, and pulmonary valve patency. There were fetal complications in 55% of cases, including 7 deaths and 2 delayed fetal losses. Among those who underwent successful FCI, the absolute measurement of the TV increased by 0.32 (±0.17) mm/week from intervention to birth. Among 60 liveborn with known outcome, there was a higher percentage having a biventricular circulation following successful FCI (87 vs. 43%). CONCLUSIONS Our data suggest a possible benefit to fetal therapy for PAIVS/PS, though rates of technically unsuccessful procedures and procedure-related complications, including fetal loss were substantial. FCI criteria are extremely variable, making direct comparison to nonintervention patients challenging and potentially biased. More uniform FCI criteria for fetuses with PAIVS/PS are needed to avoid unnecessary procedures, expose only fetuses most likely to sustain a benefit, and to enable comparisons to be made with nonintervention patients.
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Affiliation(s)
- Whitnee J Hogan
- University of California-San Francisco, San Francisco, California, USA,
| | - Sofia Grinenco
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | | | - Alberto Galindo
- Hospital Universitario, Universidad Complutense de Madrid, Madrid, Spain
| | - Helena Gardiner
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Sarah Gelehrter
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lisa Howley
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Edgar Jaeggi
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Dick Oepkes
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gary Sholler
- Heart Center for Children, Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | - John Simpson
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust Hospitals, London, United Kingdom
| | - James Strainic
- Rainbow Babies and Children's Hospital Division of Pediatric Cardiology, University Hospitals, Cleveland, Ohio, USA
| | - Trisha V Vigneswarran
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust Hospitals, London, United Kingdom
| | - Annette Wacker-Gussmann
- German Heart Center, Department of Pediatric Cardiology and Adult Congenital Heart Disease, Munich, Germany
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9
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Strainic J, Armstrong A. Fetal Cardiac Intervention: a Review of the Current Literature. Curr Pediatr Rep 2020. [DOI: 10.1007/s40124-020-00209-6] [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: 11/27/2022]
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10
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Ozcan T, Ravishankar S, Kikano S, Plummer S, Strainic J. 162: Congenital cardiac defects and placental vascular malperfusion. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.178] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Strainic J. Fetal cardiac intervention for right sided heart disease: Pulmonary atresia with intact ventricular septum. Birth Defects Res 2019; 111:395-399. [PMID: 30920148 DOI: 10.1002/bdr2.1499] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/08/2019] [Indexed: 12/28/2022]
Abstract
Congenital heart disease (CHD), the most common of birth defects, can be serious enough to require a lifetime of medical care including multiple surgeries or other interventions. Advances in ultrasound technology and a better understanding of the progression of CHDs have made it possible to intervene in utero. This early stage intervention allows the still plastic cardiovascular system to return to a more normal trajectory thus sparing the newborn from negative consequences to morbidity and mortality. Fetal cardiac intervention (FCI) has been successful for the alleviation of left ventricular dysfunction resulting in remarkably positive outcomes for many families. Promising results support that FCI may also be useful in alleviating right ventricular dysfunction. This bodes well for expanding the use of FCI to lead to better postnatal adaptation and improved long-term function for more children with CHD.
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Affiliation(s)
- James Strainic
- Department of Pediatrics, Division of Pediatric Cardiology, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
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12
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Ford SM, McPheeters MT, Wang YT, Ma P, Gu S, Strainic J, Snyder C, Rollins AM, Watanabe M, Jenkins MW. Increased regurgitant flow causes endocardial cushion defects in an avian embryonic model of congenital heart disease. CONGENIT HEART DIS 2017; 12:322-331. [PMID: 28211263 DOI: 10.1111/chd.12443] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 08/08/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The relationship between changes in endocardial cushion and resultant congenital heart diseases (CHD) has yet to be established. It has been shown that increased regurgitant flow early in embryonic heart development leads to endocardial cushion defects, but it remains unclear how abnormal endocardial cushions during the looping stages might affect the fully septated heart. The goal of this study was to reproducibly alter blood flow in vivo and then quantify the resultant effects on morphology of endocardial cushions in the looping heart and on CHDs in the septated heart. METHODS Optical pacing was applied to create regurgitant flow in embryonic hearts, and optical coherence tomography (OCT) was utilized to quantify regurgitation and morphology. Embryonic quail hearts were optically paced at 3 Hz (180 bpm, well above intrinsic rate 60-110 bpm) at stage 13 of development (3-4 weeks human) for 5 min. Pacing fatigued the heart and led to at least 1 h of increased regurgitant flow. Resultant morphological changes were quantified with OCT imaging at stage 19 (cardiac looping-4-5 weeks human) or stage 35 (4 chambered heart-8 weeks human). RESULTS All paced embryos imaged at stage 19 displayed structural changes in cardiac cushions. The amount of regurgitant flow immediately after pacing was inversely correlated with cardiac cushion size 24-h post pacing (P value < .01). The embryos with the most regurgitant flow and smallest cushions after pacing had a decreased survival rate at 8 days (P < .05), indicating that those most severe endocardial cushion defects were lethal. Of the embryos that survived to stage 35, 17/18 exhibited CHDs including valve defects, ventricular septal defects, hypoplastic ventricles, and common AV canal. CONCLUSION The data illustrate a strong inverse relationship in which regurgitant flow precedes abnormal and smaller cardiac cushions, resulting in the development of CHDs.
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Affiliation(s)
- Stephanie M Ford
- Rainbow Babies and Children's Hospital Division of Neonatology, University Hospitals, Cleveland, Ohio, USA
| | - Matthew T McPheeters
- Department of Pediatric Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yves T Wang
- Case Western Reserve University Department of Biomedical Engineering, Cleveland, Ohio, USA
| | - Pei Ma
- Case Western Reserve University Department of Biomedical Engineering, Cleveland, Ohio, USA
| | - Shi Gu
- Case Western Reserve University Department of Biomedical Engineering, Cleveland, Ohio, USA
| | - James Strainic
- Rainbow Babies and Children's Hospital Division of Pediatric Cardiology, University Hospitals, Cleveland, Ohio, USA
| | - Christopher Snyder
- Rainbow Babies and Children's Hospital Division of Pediatric Cardiology, University Hospitals, Cleveland, Ohio, USA
| | - Andrew M Rollins
- Case Western Reserve University Department of Biomedical Engineering, Cleveland, Ohio, USA
| | - Michiko Watanabe
- Department of Pediatric Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael W Jenkins
- Department of Pediatric Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Lai N, Martis A, Belfiori A, Tolentino-Silva F, Nasca MM, Strainic J, Cabrera ME. Gender differences in V˙O2 and HR kinetics at the onset of moderate and heavy exercise intensity in adolescents. Physiol Rep 2016; 4:4/18/e12970. [PMID: 27655810 PMCID: PMC5037918 DOI: 10.14814/phy2.12970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 11/24/2022] Open
Abstract
The majority of the studies on V˙O2 kinetics in pediatric populations investigated gender differences in prepubertal children during submaximal intensity exercise, but studies are lacking in adolescents. The purpose of this study was to test the hypothesis that gender differences exist in the V˙O2 and heart rate (HR) kinetic responses to moderate (M) and heavy (H) intensity exercise in adolescents. Twenty-one healthy African-American adolescents (9 males, 15.8 ± 1.1 year; 12 females, 15.7 ± 1 year) performed constant work load exercise on a cycle ergometer at M and H. The V˙O2 kinetics of the male group was previously analyzed (Lai et al., Appl. Physiol. Nutr. Metab. 33:107-117, 2008b). For both genders, V˙O2 and HR kinetics were described with a single exponential at M and a double exponential at H. The fundamental time constant (τ1) of V˙O2 was significantly higher in female than male at M (45 ± 7 vs. 36 ± 11 sec, P < 0.01) and H (41 ± 8 vs. 29 ± 9 sec, P < 0.01), respectively. The functional gain (G1) was not statistically different between gender at M and statistically higher in females than males at H: 9.7 ± 1.2 versus 10.9 ± 1.3 mL min-1 W-1, respectively. The amplitude of the slow component was not significantly different between genders. The HR kinetics were significantly (τ1, P < 0.01) slower in females than males at M (61 ± 16 sec vs. 45 ± 20 sec, P < 0.01) and H (42 ± 10 sec vs. 30 ± 8 sec, P = 0.03). The G1 of HR was higher in females than males at M: 0.53 ± 0.11 versus 0.98 ± 0.2 bpm W-1 and H: 0.40 ± 0.11 versus 0.73 ± 0.23 bpm W-1, respectively. Gender differences in the V˙O2 and HR kinetics suggest that oxygen delivery and utilization kinetics of female adolescents differ from those in male adolescents.
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Affiliation(s)
- Nicola Lai
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio Department of Pediatrics Cardiology, Case Western Reserve University, Cleveland, Ohio Center for Modeling Integrated Metabolic Systems, Cleveland, Ohio Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, Virginia Biomedical Engineering Institute, Old Dominion University, Norfolk, Virginia
| | - Alessandro Martis
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Alfredo Belfiori
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | | | - Melita M Nasca
- Department of Pediatrics Cardiology, Case Western Reserve University, Cleveland, Ohio Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - James Strainic
- Department of Pediatrics Cardiology, Case Western Reserve University, Cleveland, Ohio Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Marco E Cabrera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio Department of Pediatrics Cardiology, Case Western Reserve University, Cleveland, Ohio Center for Modeling Integrated Metabolic Systems, Cleveland, Ohio Rainbow Babies and Children's Hospital, Cleveland, Ohio
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14
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Lai N, Pfaff N, Fiutem JJ, Shivapour J, Strainic J, Grassi B. Gender Differences In The Cardiorespiratory Response To Exercise Using A Modified Bruce Protocol In Children. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000488078.57709.52] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Ford S, McPheeters MT, Wang YT, Gu S, Doughman YQ, Strainic J, Rollins AM, Watanabe M, Jenkins M. INCREASED REGURGITANT FLOW CAUSES ENDOCARDIAL CUSHION DEFECTS IN AN AVIAN EMBRYONIC MODEL OF CONGENITAL HEART DISEASE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30994-9] [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: 10/22/2022]
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16
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Ravi P, Ashwath R, Strainic J, Li H, Steinberg J, Snyder C. Clinical and Financial Impact of Ordering an Echocardiogram in Children with Left Axis Deviation on Their Electrocardiogram. CONGENIT HEART DIS 2015; 11:110-4. [DOI: 10.1111/chd.12294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Prasad Ravi
- Division of Pediatric Cardiology; Rainbow Babies & Children's Hospital; Case Western Reserve University School of Medicine; Cleveland Ohio USA
| | - Ravi Ashwath
- Division of Pediatric Cardiology; Rainbow Babies & Children's Hospital; Case Western Reserve University School of Medicine; Cleveland Ohio USA
| | - James Strainic
- Division of Pediatric Cardiology; Rainbow Babies & Children's Hospital; Case Western Reserve University School of Medicine; Cleveland Ohio USA
| | - Hong Li
- Division of Pediatric Cardiology; Rainbow Babies & Children's Hospital; Case Western Reserve University School of Medicine; Cleveland Ohio USA
| | - Jon Steinberg
- Tulane University; School of Public Health and Tropical Medicine; New Orleans La USA
| | - Christopher Snyder
- Division of Pediatric Cardiology; Rainbow Babies & Children's Hospital; Case Western Reserve University School of Medicine; Cleveland Ohio USA
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18
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Abstract
The absence of a right superior vena cava (SVC) in situs solitus is very rare, and even then it is usually associated with left SVC. There have been few case reports in the literature of isolated bilateral absence of SVC. Bilateral absent SVC can have clinical implication, including pacemaker placements, central venous line placement, monitoring, and occasionally associated anomalies. We describe a case detected on fetal echocardiogram with bilateral absent SVC and structurally normal heart.
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Affiliation(s)
- Manish Bansal
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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