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Chin CY, Chen CA, Fu CM, Hsu JY, Lin HC, Chiu SN, Chang YM, Lu CW, Chou HW, Huang SC, Chen YS, Wu MH, Wang JK, Lin MT. Risk Factors of Long-Term Sequelae After Transcatheter Closure of Perimembranous Ventricular Septal Defect in Young Children. Circ J 2024; 88:663-671. [PMID: 38325819 DOI: 10.1253/circj.cj-23-0891] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Complications arising from transcatheter closure of perimembranous ventricular septal defects (pmVSD) in children, such as residual shunts and aortic regurgitation (AR), have been observed. However, the associated risk factors remain unclear. This study identified risk factors linked with residual shunts and AR following transcatheter closure of pmVSD in children aged 2-12 years.Methods and Results: The medical records of 63 children with pmVSD and a pulmonary-to-systemic blood flow ratio <2.0 who underwent transcatheter closure between 2011 and 2018 were analyzed with a minimum 3-year follow-up. The success rate of transcatheter closure was 98.4%, with no emergency surgery, permanent high-degree atrioventricular block, or mortality. Defects ≥4.5 mm had significantly higher odds of persistent residual shunt (odds ratio [OR] 6.85; P=0.03). The use of an oversize device (≥1.5 mm) showed a trend towards reducing residual shunts (OR 0.23; P=0.06). Age <4 years (OR 27.38; 95% confidence interval [CI] 2.33-321.68) and perimembranous outlet-type VSD (OR 11.94, 95% CI 1.10-129.81) were independent risk factors for AR progression after closure. CONCLUSIONS Careful attention is crucial for pmVSDs ≥4.5 mm to prevent persistent residual shunts in transcatheter closure. Assessing AR risk, particularly in children aged <4 years, is essential while considering the benefits of pmVSD closure.
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Affiliation(s)
- Chia-Yi Chin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jui-Yu Hsu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Hsin-Chia Lin
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ya-Mei Chang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Heng-Wen Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Shu-Chien Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
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Hsiao YH, Chung HT, Wang JK, Mu PF, Chen SW, Shu YM, Chen CW. Subjective experience of parent-child relationship in adolescents with congenital heart disease: A qualitative study. J Pediatr Nurs 2024; 77:204-211. [PMID: 38593571 DOI: 10.1016/j.pedn.2024.03.028] [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: 05/17/2023] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE To explore the parent-child relationship through the subjective experience of adolescents with congenital heart disease (CHD). DESIGN AND METHODS A descriptive phenomenology approach was adopted. Twelve adolescents aged from 12 to 18 years with CHD were recruited from the pediatric cardiology clinics at two medical centers in Taiwan. Data were collected through in-depth interviews. Data were analyzed using Colaizzi's phenomenological analysis method, and results were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS The experiences of the adolescents with CHD revealed five themes: 1. the enhancement of self-worth through parents' love; 2. the importance of parental support in desperate situations; 3. the development of a sense of security through mutual understanding; 4. growth under parental expectations; and 5. parental overcontrol disguised as love. CONCLUSIONS The parent-child relationship encompasses both positive and negative experiences. Adolescents prioritize their relationship with parents over that with peers. PRACTICE IMPLICATIONS Nurses caring for adolescents with CHD can improve care by recognizing the influence of parental love, support in challenges, mutual understanding, parental expectations, and potential negative consequences of overcontrol. This insight guides effective guidance for adolescents, enhancing parent-child interactions and overall well-being.
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Affiliation(s)
- Yu-Hsuan Hsiao
- Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Hung-Tao Chung
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatric Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Pei-Fan Mu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shu-Wen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Ying-Mei Shu
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan.
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Park WY, Kim GB, Lee SY, Kim AY, Choi JY, Jang SI, Kim SH, Cha SG, Wang JK, Lin MT, Chen CA. The adaptability of the Pulsta valve to the diverse main pulmonary artery shape of native right ventricular outflow tract disease. Catheter Cardiovasc Interv 2024; 103:587-596. [PMID: 38341624 DOI: 10.1002/ccd.30968] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Pulsta valve is increasingly used for percutaneous pulmonary valve implantation (PPVI) in patients with a large native right ventricular outflow tract (RVOT). This study aims to elucidate the outcomes of Pulsta valve implantation within the native RVOT and assess its adaptability to various native main pulmonary artery (PA) anatomies. METHODS A multicenter retrospective study included 182 patients with moderate to severe pulmonary regurgitation in the native RVOT who underwent PPVI with Pulsta valves® between February 2016 and August 2023 at five Korean and Taiwanese tertiary referral centers. RESULTS Pulsta valve implantation was successful in 179 out of 182 patients (98.4%) with an average age of 26.7 ± 11.0 years. The median follow-up duration was 29 months. Baseline assessments revealed enlarged right ventricle (RV) volume (mean indexed RV end-diastolic volume: 163.1 (interquartile range, IQR: 152.0-180.3 mL/m²), which significantly decreased to 123.6(IQR: 106.6-137.5 mL/m2 after 1 year. The main PA types were classified as pyramidal (3.8%), straight (38.5%), reverse pyramidal (13.2%), convex (26.4%), and concave (18.1%) shapes. Pulsta valve placement was adapted, with distal main PA for pyramidal shapes and proximal or mid-PA for reverse pyramidal shapes. Two patients experienced Pulsta valve embolization to RV, requiring surgical removal, and one patient encountered valve migration to the distal main PA, necessitating surgical fixation. CONCLUSIONS Customized valve insertion sites are pivotal in self-expandable PPVI considering diverse native RVOT shape. The rather soft and compact structure of the Pulsta valve has characteristics to are adaptable to diverse native RVOT geometries.
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Affiliation(s)
- Woo Young Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ah Young Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Ick Jang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Seong Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Seul Gi Cha
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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Lîm HK, Wang JK, Tsai KS, Chien YH, Chang YC, Cheng CH, Tsai CY, Peng YW, Hwang JJ, Huei-Ming Ma M. Cardiac screening in school children: Combining auscultation and electrocardiography with a crowdsourcing model. J Formos Med Assoc 2023; 122:1313-1320. [PMID: 37468409 DOI: 10.1016/j.jfma.2023.07.002] [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: 05/31/2022] [Revised: 03/05/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND/PURPOSE School-based cardiac screening is useful for identifying children and adolescents with a high risk of sudden cardiac death. However, because of challenges associated with cost, distance, and human resources, cardiac screening is not widely implemented, especially in rural areas with limited medical resources. This study aims to establish a cloud-based system suitable for mass cardiac screening of schoolchildren in rural areas with limited medical resources. METHODS Students from three schools were included. They or their guardians completed a simple questionnaire, administered in paper or electronic form. Heart sounds were recorded using an electronic stethoscope. Twelve-lead electrocardiograms (ECGs) were recorded and digitalized. The signals were transmitted through Bluetooth to a tablet computer and then uploaded to a cloud server over Wi-Fi. Crowdsourced pediatric cardiologists reviewed those data from a web-based platform and provided remote consultation. In cases in which abnormal heart sounds or ECGs were noted, the students were referred to the hospital for further evaluation. RESULTS A total of 1004 students were enrolled in this study. Of the 138 students referred, 62 were diagnosed as having an abnormal heart condition and most had previously been undiagnosed. The interrater agreeability was high. CONCLUSION An innovative strategy combining a cloud-based cardiac screening system with remote consultation by crowdsourced experts was established. This system allows pediatric cardiologists to provide consultation and make reliable diagnoses. Combined with crowdsourcing, the system constitutes a viable approach for mass cardiac screening in children and adolescents living in rural areas with insufficient medical resources.
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Affiliation(s)
- Hīng-Ka Lîm
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | | | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
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Liu YS, Lu CW, Chung HT, Wang JK, Su WJ, Chen CW. Health-promoting lifestyle and life satisfaction in full-time employed adults with congenital heart disease: grit as a mediator. Eur J Cardiovasc Nurs 2023:zvad104. [PMID: 37847800 DOI: 10.1093/eurjcn/zvad104] [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: 05/01/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023]
Abstract
AIMS Enhancing life satisfaction is vital for adults with congenital heart disease (ACHD). Life satisfaction potentially correlates with a health-promoting lifestyle and grit. However, the mediating role of grit-a trait marked by perseverance and long-term goal-oriented passion-between a health-promoting lifestyle and life satisfaction in ACHD remains unverified. This study aimed to examine the relationships between health-promoting lifestyle, grit, and life satisfaction in full-time employed ACHD and to confirm the mediating role of grit. METHODS AND RESULTS A total of 181 full-time employed ACHD aged 20-59 years with patient-reported New York Heart Association class I-IV were recruited from two medical centers in northern Taiwan. Participants completed questionnaires, including the short version of the Chinese Health-Promoting Lifestyle Profile scale, Grit-10 scale, and Satisfaction with Life Scale between February and December 2022. Data analysis employed the Hayes PROCESS macro. Health-promoting lifestyle, grit, and life satisfaction were discovered to be positively correlated. Overall grit score was a partial mediator between a health-promoting lifestyle and life satisfaction, accounting for 20% of the total variation. Of the grit domains, perseverance served as a partial mediator between a health-promoting lifestyle and life satisfaction, accounting for 32% of the total variation, whereas passion had a nonsignificant mediation effect. CONCLUSION A health-promoting lifestyle boosts ACHD individuals' life satisfaction through grit, particularly perseverance. Integrating grit into such a lifestyle could benefit from comprehending support systems and influential factors aiding grit development for enhanced life satisfaction.
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Affiliation(s)
- Yu-Shiu Liu
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei City 112304, Taiwan
| | - Chun-Wei Lu
- Department of Pediatric Cardiology, National Taiwan University Children's Hospital, No. 8, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 10041, Taiwan
| | - Hung-Tao Chung
- Department of Pediatrics, Chang Gung Children's Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan
| | - Jou-Kou Wang
- Department of Pediatric Cardiology, National Taiwan University, Children's Hospital, No. 8, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 10041, Taiwan
| | - Wen-Jen Su
- Department of Pediatrics, Chang Gung Children's Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei City 112304, Taiwan
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Chien LW, Huang SC, Wang JK, Mu PF, Shu YM, Chen CW. [The Unknown Journey: Uncertain Experiences in Mothers of Infants With Congenital Heart Disease Before Undergoing Open Heart Surgery]. Hu Li Za Zhi 2023; 70:56-66. [PMID: 37469320 DOI: 10.6224/jn.202308_70(4).08] [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] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Most children with complex congenital heart disease (CHD) require open-heart surgery within one year of birth to survive. Thus, new mothers of infants with CHD are faced with making unexpected and difficult decisions. PURPOSE This study was designed to explore the essence of the maternal uncertain experience prior to infants with CHD undergoing open-heart surgery. METHODS In this study, a phenomenological approach was used and data were collected using open-ended interview guidelines structured around the Uncertainty in Illness Theory. Nine mothers of infants with CHD who had received open-heart surgery were interviewed in a hospital interview room within two weeks the operation. Colaizzi's (1978) data processing procedure was applied in the post-interview analysis. RESULTS Five themes emerged: (1) Hit bottom and felt helpless; (2) Hit the road - An overwhelming sense of emergency; (3) The crunch - Do your best to accept destiny (4) Disease brought the unknown; (5) Hope in uncertainty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE The high-risk nature of and their unfamiliarity with the surgery made the participants experience illness uncertainty. The medical system should develop more-structured CHD information and provide emotional support in a timely manner to alleviate illness uncertainty in mothers of infants with CHD.
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Affiliation(s)
- Li-Wen Chien
- MSN, RN, Department of Nursing, National Taiwan University Children's Hospital, Taiwan, ROC
| | - Shu-Chien Huang
- PhD, MD, Department of Surgery, National Taiwan University Hospital, Taiwan, ROC
| | - Jou-Kou Wang
- PhD, MD, Department of Pediatric Cardiology, National Taiwan University Children's Hospital, Taiwan, ROC
| | - Pei-Fan Mu
- PhD, RN, Distinguished Professor, College of Nursing, National Yang Ming Chiao Tung University, Taiwan, ROC
| | - Ying-Mei Shu
- MS, RN, Instructor, Department of Nursing, Chang Gung University of Science and Technology, and Doctoral Candidate, Department of Education, University of Taipei, Taiwan, ROC
| | - Chi-Wen Chen
- PhD, RN, Professor, College of Nursing, National Yang Ming Chiao Tung University, Taiwan, ROC.
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Huang YL, Chen CA, Wu MH, Wang JK, Hung HC, Lîm HK. Hepatorenal Syndrome in Fontan Circulation with Atypical Hemodynamic Presentation. Acta Cardiol Sin 2023; 39:646-650. [PMID: 37456937 PMCID: PMC10346047 DOI: 10.6515/acs.202307_39(4).20230307a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/07/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Yu-Ling Huang
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei
| | - Hsi-Chuan Hung
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Hīng-ka Lîm
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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Lin MT, Chen CA, Chen SJ, Huang JH, Chang YH, Chiu SN, Lu CW, Wu MH, Wang JK. Self-Expanding Pulmonary Valves in 53 Patients With Native Repaired Right Ventricular Outflow Tracts. Can J Cardiol 2023; 39:997-1006. [PMID: 36933796 DOI: 10.1016/j.cjca.2023.03.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/18/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Self-expanding pulmonary valve grafts have been designed for percutaneous pulmonary valve implantation (PPVI) in patients with native repaired right ventricular (RV) outflow tracts (RVOTs). However, their efficacy, in terms of RV function and graft remodelling remain unclear. METHODS Patients with native RVOTs who received Venus P-valve (N = 15) or Pulsta valve (N = 38) implants between 2017 and 2022 were enrolled. We collected data on patient characteristics and cardiac catheterization parameters as well as imaging and laboratory data before, immediately after, and 6 to 12 months after PPVI and identified risk factors for RV dysfunction. RESULTS Valve implantation was successful in 98.1% of patients. The median duration of follow-up was 27.5 months. In the first 6 months after PPVI, all patients exhibited resolution of paradoxical septal motion and a significant reduction (P < 0.05) in RV volume, N-terminal pro-B-type natriuretic peptide levels, and valve eccentricity indices (-3.9%). Normalization of the RV ejection fraction (≥ 50%) was detected in only 9 patients (17.3%) and was independently associated with the RV end-diastolic volume index before PPVI (P = 0.03). Nine patients had residual or recurrent pulmonary regurgitation or paravalvular leak (graded as ≥ mild), which was associated with a larger eccentricity index (> 8%) and subsided by 12 months postimplantation. CONCLUSIONS We identified the risk factors likely to be associated with RV dysfunction and pulmonary regurgitation following PPVI in patients with native repaired RVOTs. RV volume-based patient selection is recommended for PPVI of a self-expanding pulmonary valve, along with monitoring of graft geometry.
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Affiliation(s)
- Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Hsuan Huang
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Chang
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
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Chang TI, Hsu KH, Hung WL, Yeh SJ, Chen MR, Chien YS, Hsu RB, Wang JK, Chang RF, Chang CI. Clinical outcomes of handmade polytetrafluoroethylene trileaflet-valved conduit used for pulmonary valve replacement. Eur J Cardiothorac Surg 2023; 63:ezad120. [PMID: 36971610 DOI: 10.1093/ejcts/ezad120] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/07/2023] [Accepted: 03/27/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To mitigate the shortage of homograft sources, the use of handmade trileaflet expanded polytetrafluoroethylene valves in pulmonary valve replacement has shown excellent results from multicentre studies conducted in Japan. However, world-wide data outside Japan are relatively insufficient. This study presents the long-term results of a single surgeon's use of flipped-back trileaflet method in a 10-year case series. METHODS We have developed an efficient way to make a trileaflet-valved conduit utilizing flipped-back method for pulmonary valve replacement and have employed the technique since 2011. Retrospective data were studied between October 2010 and January 2020. Echocardiography, electrocardiogram, Pro-Brain Natriuretic Peptide and Magnetic Resonance Imaging data were analysed. RESULTS Fifty-five patients were reviewed and median follow-up duration was 2.9 years. The majority of diagnoses was Tetralogy of Fallot (n = 41), and these patients subsequently underwent secondary pulmonary valve replacement at a median age of 15.6 years. Survival was 92.7% with the longest follow-up period being 10 years. There was no need for reoperation, and freedom from reintervention was 98.0% at 10 years. There were 4 deaths (3 in-hospital and 1 outpatient). One patient eventually received transcatheter pulmonary valve implantation. Postoperative echocardiography showed mild or less pulmonary stenosis and pulmonary regurgitation degree in 92.2% and 92.0% of patients, respectively. Comparable magnetic resonance imaging data (n = 25) showed significant reduction in right ventricular volumes but not in ejection fractions. CONCLUSIONS Our series showed satisfactory long-term function of handmade flipped-back trileaflet-valved conduit used in our patients. The simple design is efficiently reproducible without complex fabrication process.
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Affiliation(s)
- Te-I Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Kang-Hong Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Mackay Children's Hospital & Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei-Li Hung
- Division of Pediatric Cardiology, Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Shu-Jen Yeh
- Division of Pediatric Cardiology, Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Ming-Ren Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Yu-San Chien
- Department of Critical Care, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ron-Bin Hsu
- Department of Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ruey-Feng Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chung-I Chang
- Division of Cardiovascular Surgery, Department of Surgery, Mackay Children's Hospital & Mackay Memorial Hospital, Taipei, Taiwan
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Huang YC, Chen YC, Gau BS, Wang JK, Chang SH, Yang HL. Psychometric evaluation of the traditional chinese version of PedsQL ™ 3.0 cardiac module scale in adolescents with congenital heart disease: reliability, validity, measurement invariance, and adolescent-parent agreement. Health Qual Life Outcomes 2023; 21:39. [PMID: 37147623 PMCID: PMC10163758 DOI: 10.1186/s12955-023-02121-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/25/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In recent decades, 95% of children with congenital heart disease (CHD) can survive to adolescence and adulthood. However, adolescents with CHD are prone to poorer health-related quality of life (HRQoL). It is imperative to develop a reliable and valid instrument for health professionals to monitor the HRQoL. This study aims to: (1) evaluate the psychometric properties of the traditional Chinese version of Pediatric Quality of Life™ 3.0 Cardiac Module (PedsQL-CM) and measurement invariance across adolescents with CHD and their parents; and (2) investigate the adolescent-parent agreement in HRQoL. METHODS A total of 162 adolescents and 162 parents were recruited. Internal consistency was examined using Cronbach's alpha and McDonald's Omega. The criterion-related validity was evaluated with intercorrelations between the PedsQL-CM and PedsQL™ 4.0 Generic Core (PedsQL-GC) Scale. The construct validity was examined by second-order confirmatory factor analysis (CFA). Measurement invariance was evaluated using the multi-group CFA. The adolescent-parent agreement was analyzed with the intraclass correlation (ICC), paired t-tests, and Bland-Altman plots. RESULTS PedsQL-CM showed acceptable internal consistency (self-reports 0.88, proxy-reports 0.91). The intercorrelations were medium to large effect size (self-reports 0.34-0.77, proxy-reports 0.46-0.68). The CFA supported the construct validity (CFI = 0.967, TLI = 0.963, RMSEA = 0.036, 90% CI = 0.026-0.046, SRMR = 0.065). The multi-group CFA proved scalar invariance between self and parent proxy-reports. Parents significantly underestimated their adolescents' HRQoL in cognitive problems (Cohen's d = 0.21) and communication (Cohen's d = 0.23) subscales, while there was a negligible difference in total HRQoL (Cohen's d = 0.16). ICCs were poor to moderate effect size with the highest and lowest agreement in heart problems and treatment subscale (ICC = 0.70) and communication subscale (ICC = 0.27), respectively. The Bland-Altman plots showed lesser variability in the heart problem and treatment subscale and the total scale. CONCLUSION The traditional Chinese version of PedsQL-CM has acceptable psychometric properties to measure disease-specific HRQoL in adolescents with CHD. Parents may be proxies for adolescents with CHD to rate total HRQoL. When the patient-reported score is the primary outcome, the proxy-reported score could serve as a secondary outcome for research and clinical evaluation.
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Affiliation(s)
- Yong-Chen Huang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Yueh-Chih Chen
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan
| | - Bih-Shya Gau
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan
| | - Shu-Hui Chang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, No. 1 Jen-Ai Road, Section 1, Taipei City, 100, Taiwan.
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan.
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Tseng WC, Wu MH, Lu CW, Wu KL, Wang JK, Lin MT, Chen CA, Chiu SN. Combination of Slow Pathway Late Activation Maps and Voltage Gradient Maps in Guidance of Atrioventricular Nodal Reentry Tachycardia Cryoablation. Heart Rhythm 2023:S1547-5271(23)02105-7. [PMID: 37075960 DOI: 10.1016/j.hrthm.2023.04.006] [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: 02/12/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The optimal strategy for electroanatomic mapping-guided cryoablation of atrioventricular nodal reentry tachycardia (AVNRT) remains unclear. OBJECTIVE To investigate the effectiveness of slow pathway late activation mapping (SPLAM) and voltage gradient mapping for AVNRT cryoablation. METHODS From June 2020 to February 2022, all consecutive patients with AVNRT underwent SPLAM to define the wave collision point and voltage gradient mapping to define the low voltage bridge (LVB). Conventional procedures performed from August 2018 to May 2020 served as control. RESULTS The study and control groups comprised 36 (aged 16.5±8.2 years) and 37 patients (aged 15.5±7.3 years), respectively. Total procedural times were comparable, and acute success rates were 100% in both groups. Compared to controls, number of cryomapping attempts (median 3 vs. 5, p=0.012) and cryoablation applications (median 1 vs. 2, p<0.001) were significantly lower in the study group. At a median follow-up of 14.6 and 18.3 months, recurrence rates were 5.6% (2 patients) and 10.8% (4 patients) in the study and control groups (p=0.402), respectively. Mapping of Koch's triangle took 11.8±3.6 min, in which 1562±581 points were collected. In SPLAM, wave collision points were defined and compatible with the final successful lesion sites in all patients, including those with multiple slow pathways. LVB could not be defined in 6 patients (16.7%), and LVB was not compatible with the final successful lesion in another 6 (16.7%). CONCLUSIONS For AVNRT cryoablation, SPLAM could effectively guide the localization of slow pathway ablation sites and was particularly beneficial in patients with multiple slow pathways.
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan; Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Kun-Lang Wu
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan. No. 320, Xuguang Rd., Changhua City, Changhua County 500, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan.
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12
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Wang PY, Tseng WC, Wu ET, Lu FL, Chen SJ, Chiu SN, Wu MH, Wang JK, Wang CC. The implications of airway anomalies on children with congenital heart disease and bronchiolitis. Pediatr Pulmonol 2023; 58:1194-1200. [PMID: 36650613 DOI: 10.1002/ppul.26320] [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: 08/18/2022] [Revised: 12/26/2022] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bronchiolitis is a common airway infection in young children. Hemodynamically significant congenital heart disease (CHD) predicts a more complicated course. However, the role of airway anomalies remains unknown. METHODS We retrospectively reviewed the records of patients under 2 years old, diagnosed with CHD, and admitted between January 2011 and December 2013, before the palivizumab era. Records of bronchiolitis admissions were also extracted. Patients were grouped according to CHD condition and airway anomalies. RESULTS A total of 230 patients with CHD were enrolled. A total of 180 (78%) and 71 (31%) patients had hemodynamically significant CHD and airway anomalies, respectively. A total of 52 (22.6%) patients were admitted for bronchiolitis 78 times. Among them, 33 (63.5%) had hemodynamically significant CHD, and 28 (53.8%) had airway anomalies. In patients with bronchiolitis admissions, the mean ventilator use, intensive care unit stay, and hospital stay were 1.08, 4.08, and 15.19 days, respectively. When compared, the mean hospital stay for bronchiolitis patients with airway anomalies was significantly longer than that of those without airway anomalies (19.8 vs. 9.9 days, p = 0.008). When further divided the patients by the presence hemodynamic significance, patients with hemodynamically significant CHD and airway anomaly had longer hospital stay than those who had neither. (21.7 vs. 8.3 days, p = 0.004) Airway anomaly was a significant risk factor for longer hospital stay in linear regression model (p = 0.007). CONCLUSIONS Airway anomalies are common in children with CHD and are associated with longer hospital stays on bronchiolitis admission. An active survey for airway anomalies and adequate prophylaxis for bronchiolitis infection might be important in the care of children with CHD associated with airway anomalies.
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Affiliation(s)
- Po-Yuan Wang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Wei-Chieh Tseng
- Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan.,Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Frank Leigh Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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13
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Tsao PC, Chiang SH, Shiau YS, Chen HY, Lin HL, Ho HC, Chen MR, Chang JK, Wang JK, Chiu SN, Jeng MJ, Hsiao KJ. Comparing Strategies for Critical Congenital Heart Disease Newborn Screening. Pediatrics 2023; 151:190704. [PMID: 36815269 DOI: 10.1542/peds.2022-057862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES An extended newborn critical congenital heart disease (CCHD) screening program using oximetry has been implemented in Taipei, Taiwan since April 2014. This study was conducted to investigate the test accuracy and efficiency of this screening protocol. METHODS This study analyzed data from 30 birthing facilities representing 87.9% of live births in Taipei. Positive screening was defined as oxygen saturation <95% in either extremity or a preductal-postductal oxygen saturation difference of >3%. This study cohort was used to retrospectively estimate outcomes on the basis of different CCHD screening protocols. RESULTS During the study period, 93 058 of 94 204 (98.8%) infants who had no prenatal suspicion were screened. The referral rate was 0.17% (156/93 058), and up to 90% of test-positive infants were referred within 48 hours of life. Forty-two CCHD cases without prenatal suspicion were detected and 97.6% were diagnosed within 72 hours of life. Of the screened newborns, 4 CCHD cases passed the screening. The false positive and false negative rates were 0.12% and 0.04%, respectively. In addition, applying our database to Spanish and updated American Academy of Pediatrics screening strategies led to more CCHD case detection. CONCLUSIONS The Taipei protocol provided an efficient and effective screening referral system in a community setting. For optimal efficiency, we advocated the updated American Academy of Pediatrics algorithm/Spanish recommendation with a modification of immediate referral if oxygen saturation ≤90% in either extremity. The updated protocol would be practicable for nationwide screening in Taiwan and could also be applied to other regions with similar medical care systems.
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Affiliation(s)
- Pei-Chen Tsao
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics.,Department of Pediatrics
| | - Szu-Hui Chiang
- Preventive Medicine Foundation, Taipei, Taiwan, Republic of China
| | - Yu-Shih Shiau
- Preventive Medicine Foundation, Taipei, Taiwan, Republic of China
| | - Hsing-Yi Chen
- Wenshan District Health Center, Taipei City, Taipei, Taiwan, Republic of China
| | - Hsueh-Lan Lin
- Department of Health, Taipei City Government, Taipei, Taiwan, Republic of China
| | - Hui-Chen Ho
- Taipei Institute of Pathology, Taipei, Taiwan, Republic of China
| | - Ming-Ren Chen
- Pediatric Department, MacKay Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Jia-Kan Chang
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Mei-Jy Jeng
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics.,Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Kwang-Jen Hsiao
- Department of Medical Research, Taipei Veterans General Hospital, Taiwan, Republic of China.,Preventive Medicine Foundation, Taipei, Taiwan, Republic of China.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan, Republic of China
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14
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Chiu SN, Chen YS, Hsu CC, Hua YC, Tseng WC, Lu CW, Lin MT, Chen CA, Wu MH, Chen YT, Chien TCH, Tseng CL, Wang JK. Changes of ECG parameters after BNT162b2 vaccine in the senior high school students. Eur J Pediatr 2023; 182:1155-1162. [PMID: 36602621 PMCID: PMC9813456 DOI: 10.1007/s00431-022-04786-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 01/06/2023]
Abstract
The purpose of this study is to determine the ECG parameter change and the efficacy of ECG screening for cardiac adverse effect after the second dose of BNT162b2 vaccine in young population. In December 2021, in cooperation with the school vaccination system of Taipei City government, we performed a ECG screening study during the second dose of BNT162b2 vaccines. Serial comparisons of ECGs and questionnaire survey were performed before and after vaccine in four male-predominant senior high schools. Among 7934 eligible students, 4928 (62.1%) were included in the study. The male/female ratio was 4576/352. In total, 763 students (17.1%) had at least one cardiac symptom after the second vaccine dose, mostly chest pain and palpitations. The depolarization and repolarization parameters (QRS duration and QT interval) decreased significantly after the vaccine with increasing heart rate. Abnormal ECGs were obtained in 51 (1.0%) of the students, of which 1 was diagnosed with mild myocarditis and another 4 were judged to have significant arrhythmia. None of the patients needed to be admitted to hospital and all of these symptoms improved spontaneously. Using these five students as a positive outcome, the sensitivity and specificity of this screening method were 100% and 99.1%, respectively. Conclusion: Cardiac symptoms are common after the second dose of BNT162b2 vaccine, but the incidences of significant arrhythmias and myocarditis are only 0.1%. The serial ECG screening method has high sensitivity and specificity for significant cardiac adverse effect but cost effect needs further discussed. What is Known: • The incidence of cardiac adverse effects was reported to be as high as 1.5 per 10 000 persons after the second dose BNT162b2 COVID-19 vaccine in the young male population based on the reporting system. What is New: • Through this mass ECG screening study after the second dose of BNT162b2 vaccine we found: (1) The depolarization and repolarization parameters (QRS duration and QT interval) decreased significantly after the vaccine with increasing heart rate; (2) the incidence of post-vaccine myocarditis and significant arrhythmia are 0.02% and 0.08%; (3) The serial ECG screening method has high sensitivity and specificity for significant cardiac adverse effect.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chia-Chen Hsu
- Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan
| | - Yu-Chuan Hua
- Cardiac Children's Foundation Taiwan, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | | | | | | | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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15
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Wang JK, Zheng L, Cheng NS, Li FY. [Whole view of the immune microenvironment of biliary tract cancer]. Zhonghua Wai Ke Za Zhi 2023; 61:291-296. [PMID: 36822585 DOI: 10.3760/cma.j.cn112139-20221212-00526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Biliary tract cancer is a group of malignancies which originate from biliary epithelium, and adenocarcinoma is the main pathological type. Although surgical resection is the only radical treatment strategy, most biliary tract cancer patients are diagnosed at locally advanced stage or with distant metastasis. Biliary tract cancer is highly resistant to the conventional chemoradiotherapy and the emerging immunotherapy including immune checkpoint inhibitors, owing to the suppressive immune microenvironment. In a whole view, this paper discussed the anti-tumor and tumor-promoting immune responses of the various immune cells and stromal cells in the immune microenvironment of biliary tract cancer, as well as their correlation with prognosis. The understanding of the whole view of immune microenvironment in biliary tract cancer patients could further inform the design of clinical trials of immunotherapy or combination therapy.
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Affiliation(s)
- J K Wang
- Department of Biliary Surgery,West China Hospital,Sichuan University,Chengdu 610041,China
| | - L Zheng
- The Pancreatic Cancer Precision Medicine Center of Excellence Program,Johns Hopkins University School of Medicine,Baltimore 21287,USA
| | - N S Cheng
- Department of Biliary Surgery,West China Hospital,Sichuan University,Chengdu 610041,China
| | - F Y Li
- Department of Biliary Surgery,West China Hospital,Sichuan University,Chengdu 610041,China
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Liao YF, Tseng WC, Wang JK, Chen YS, Chen CA, Lin MT, Lu CW, Wu MH, Chiu SN. Management of cardiovascular symptoms after Pfizer-BioNTech COVID-19 vaccine in teenagers in the emergency department. J Formos Med Assoc 2022:S0929-6646(22)00443-0. [PMID: 36564302 PMCID: PMC9744679 DOI: 10.1016/j.jfma.2022.12.004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular complications after Pfizer-BioNTech COVID-19 (BNT) vaccination are a concern, especially in adolescents. We analyzed the risk factors for myocarditis after BNT vaccination. METHODS We used a special evaluation protocol for all patients aged 12-18 years who presented to our emergency department with cardiovascular symptoms after BNT vaccination. RESULTS A total of 195 patients (109 boys and 86 girls) were enrolled. Eleven (5.6%) patients presented with arrhythmia (arrhythmia group), 14 (7.2%) had a diagnosis of pericarditis/myocarditis (the peri/myocarditis group), and the remaining 170 were controls (no cardiac involvement). Chest pain (77.6%) was the most common symptom. The median time from vaccination to symptom onset was 3 days. In the peri/myocarditis group (13 myocarditis and 1 pericarditis), the median time to the peak troponin T level was 5 days after vaccination. Abnormal electrocardiographic changes, including ST-T changes and conduction blocks, were more commonly detected in the peri/myocarditis group (85.7% vs. 12.4% in the control group, p < 0.01). Echocardiography revealed normal ventricular function in all patients. Symptoms were resolved before discharge in all, with the median duration of hospital stay being 4 days. The electrocardiography was the most appropriate screening tool for myocarditis, with a sensitivity and specificity of 85.7% and 87.6%, respectively. CONCLUSION Pericarditis or myocarditis was diagnosed in 7.2% of adolescents presenting to the emergency department with cardiovascular symptoms after BNT vaccination. In addition to the troponin T level, ECG change listed above can be used as a screening tool for vaccine-induced cardiac complications.
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Affiliation(s)
- Ying-Feng Liao
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Wei-Chieh Tseng
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University,Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University,Corresponding author. Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100 Taiwan. Fax: +886 2 23147450
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17
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Yu HP, Zheng Y, Lu LX, He YJ, Liang ZJ, Zhang LX, Wang JK, Qin JW, Li B, Li CY, Wang P, Dang Z, Zhang JC, Yu XH. [Preliminary study on the expression of MIF in HCC tissues and its relationship with ERK1/2 signaling pathway]. Zhonghua Nei Ke Za Zhi 2022; 61:1228-1233. [PMID: 36323564 DOI: 10.3760/cma.j.cn112138-20220502-00334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the expression of Macrophage migration-inhibitory factors (MIF) in hepatocellular carcinoma (HCC) tissues and its interaction with ERK1/2 signaling pathway, so as to establish a theoretical basis for further studying the molecular mechanism of MIF promoting HCC. Methods: From February 2020 to August 2021, 52 cases of hepatocellular carcinoma (HCC) tissues based on hepatitis B cirrhosis (HBV-LC) and 52 cases of adjacent tissues in Tianjin Medical University Cancer Hospital and 940th Hospital of Joint Logistic Support Force of PLA were collected as the experimental group, including 39 males and 13 females, aged 35-65 years. And 20 cases of normal liver tissue were selected as the control group. Immunohistochemistry was used to detect the expression of MIF, ERK1/2 and p-ERK1/2 proteins in liver tissues of the two groups, and in situ hybridization was used to detect the expression of ERK1/2 nucleic acid in liver tissues of the two groups.HepG2 HCC cells and L-02 normal hepatocytes were co-cultured with different concentrations of rMIF, the expression and phosphorylation levels of ERK1/2 and JNK1 proteins in the two kinds of liver cells were detected by Western-blot, and the expression levels of ERK1/2 nucleic acids in the two kinds of liver cells were detected by RT-PCR. One-way ANOVA was used for measurement data and χ2 test was used for counting data. Results: The expressions of MIF, ERK1/2, p-ERK1/2 and ERK1/2 mRNA were significantly increased in HCC and para-cancer tissues (the expression of MIF in HCC group was 78.8%, and that in adjacent group was 75.0%; ERK1/2 80.8% in HCC group and ERK1/2 71.8% in paracancerous group. The expression of p-ERK1/2 75.0 % in HCC group and 46.2% in paracancerous group were respectively detected. ERK1/2 mRNA was expressed in HCC group 76.9%, ERK1/2 mRNA expression in paracancerous group 78.8%), and the differences were statistically significant compared with normal liver tissues (P<0.05), but there was no significant difference between HCC and para-cancer tissues (P>0.05). The expressions of ERK1/2, p-ERK1/2 and ERK1/2 mRNA in HepG2 HCC cells were significantly increased with the increase of rMIF concentration, and the increase was most obvious when rMIF concentration was 200 ng/ml, and the difference was statistically significant compared with L-02 normal hepatocytes (P<0.05). Conclusion: MIF, ERK1/2 and p-ERK1/2 are highly expressed in HCC tissues and HepG2 HCC cells, suggesting that MIF promotes the occurrence and development of hepatocellular carcinoma through ERK1/2 signaling pathway.
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Affiliation(s)
- H P Yu
- Department of Interventional Therapy, Cancer Hospital of Tianjin Medical University, National Clinical Medical Research Center for Cancer, Tianjin Municipal Key Laboratory of Cancer Prevention and Therapy, Tianjin Municipal Clinical Medical Research Center for Cancer, Tianjin 300060, China
| | - Y Zheng
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - L X Lu
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - Y J He
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - Z J Liang
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - L X Zhang
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - J K Wang
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - J W Qin
- Liver and Gallbladder Surgery, the 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou 730050, China
| | - B Li
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - C Y Li
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - P Wang
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - Z Dang
- Liver and Gallbladder Surgery, the 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou 730050, China
| | - J C Zhang
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
| | - X H Yu
- Department of Gastroenterology, the 940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050, China
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18
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Wu MH, Wang JK, Chiu SN, Lu CW, Lin MT, Chen CA, Tseng WC. Long-term outcome of repaired tetralogy of Fallot: Survival, tachyarrhythmia, and impact of pulmonary valve replacement. Heart Rhythm 2022; 19:1856-1863. [PMID: 35781043 DOI: 10.1016/j.hrthm.2022.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/14/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pulmonary valve replacement (PVR) is recommended for severe pulmonary regurgitation in repaired tetralogy of Fallot (rTOF). OBJECTIVE The purpose of this study was to investigate the event rate and effectiveness of PVR. METHODS A retrospective study of tetralogy of Fallot patients who survived total repair from 1970 to 2020 was conducted. RESULTS We identified 1744 rTOF patients; 86.6% with classic rTOF, 11.5% with pulmonary atresia, 0.8% with endocardial cushion defect, and 1.1% with absent pulmonary valve. Annual risks of tachyarrhythmia/sudden cardiac arrest (SCA) increased to 0.295% and 1.338% in patients aged 10-30 and 30-60 years, respectively, without sex predominance. PVR (223 surgical and 39 percutaneous) event rate was 34.7% ± 2.1% by 30 years after repair (annual risk: 1.57% between 10 and 30 years after repair). The second PVR rate was 9.9% ± 4.1% by 20 years after the first PVR. Tachyarrhythmia/SCA risk was higher in PVR patients than in No PVR patients and was reduced in PVR patients without tachyarrhythmia/SCA before PVR. However, survival in patients with ventricular tachyarrhythmia/SCA still was better after PVR. At PVR, 13% of patients had tachyarrhythmia/SCA, which was the major predictor of events after PVR. Before PVR, although the ventricular tachyarrhythmia/SCA risks included QRS duration >160 ms and New York Heart Association functional class III or IV, supraventricular tachyarrhythmia was associated with PVR age ≥28 years and N-terminal pro-brain natriuretic peptide >450 pg/mL. CONCLUSION Tachyarrhythmia/SCA occurrence and the need for PVR increased with age during young adulthood. PVR reduced subsequent arrhythmias only in those patients without arrhythmias before PVR.
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Affiliation(s)
- Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Sheunn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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19
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Lue HC, Wu MH, Wang JK, Lin MT, Lu CW, Chiu SN, Chen CA, Wu ET, Wang CC, Fu CM, Tseng WC, Chang WH, Lee MC. Normal ECG standards and percentile charts for infants, children and adolescents. Pediatr Neonatol 2022; 64:256-273. [PMID: 36464585 DOI: 10.1016/j.pedneo.2022.07.013] [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: 03/15/2022] [Revised: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Normal ECG standards in newborns, infants, children and adolescents have been collected and published by many authors. Only those by Davignon et al., Rijinbeek et al. and our two studies covered all ages from birth to adolescence. The standards reflecting the growth and development of the heart in infants, children and adolescents remained to be studied and explored. METHODS We selected from our ECG database, after discussions and consultation, 15 key ECG parameters and analyzed for their age- and sex-specific mean, standard deviation and 2nd to 98th percentiles and their percentile charts were constructed. RESULTS The ranges and distributions of the normal ECG standards, means and 2nd to 98th percentiles of 15 key parameters were established. CONCLUSION A complete set of normal ECG standards of 15 key parameters from birth to adolescents is available for clinicians and researchers.
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Affiliation(s)
- Hung-Chi Lue
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Mei-Hwan Wu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - En-Ting Wu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Wei-Chieh Tseng
- National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Wei-Hsuan Chang
- National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Meng-Chang Lee
- National Taiwan University Children's Hospital, Taipei, Taiwan
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20
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Clift P, Berger F, Sondergaard L, Antonova P, Disney P, Nicolarsen J, Thambo JB, Tomkiewicz Pajak L, Wang JK, Schophuus Jensen A, Burgess G, Efficace M, Friberg M, Lassen C, d'Udekem Y. The efficacy and safety of macitentan in Fontan-palliated patients: results of the 52-week randomised, placebo-controlled RUBATO trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The clinical utility and long-term effects of endothelin receptor antagonists (ERAs) in Fontan-palliated patients remain unclear and there are currently no approved therapies. A decline in peak VO2 between consecutive cardiopulmonary exercise tests (CPETs) is highly prognostic for death or transplant in adult Fontan patients, hence its use as a primary endpoint in clinical trials of ERAs in patients with Fontan circulation.
Purpose
The RUBATO trial aimed to assess the efficacy and safety of macitentan, an endothelin receptor antagonist, in Fontan-palliated patients over 52 weeks.
Methods
In the multicentre, double-blind, randomised, placebo-controlled, phase 3 RUBATO trial, Fontan-palliated patients were randomised 1:1 to macitentan 10 mg once-daily or placebo for 52 weeks. Eligible patients were aged ≥12 years, in New York Heart Association functional class II or III, had no limitations for CPET (including no pacemakers), had undergone lateral tunnel or extracardiac conduit Fontan (total cavopulmonary connection) >1 year before screening and showed no signs of Fontan failure or clinical deterioration within 3 months before screening. Primary efficacy endpoint was change in peak VO2 from baseline to week 16. Secondary endpoints were change in peak VO2 from baseline over 52 weeks and change in mean count per minute of daily physical activity from baseline to week 16 as measured by an accelerometer. Adverse events were also assessed.
Results
137 patients were randomised to macitentan (n=68) or placebo (n=69). 92.7% of patients completed 52 weeks of double-blind treatment: 7 and 3 patients prematurely discontinued study treatment in macitentan and placebo arms, respectively. Patient baseline characteristics are shown in Table 1. At week 16, the mean (SD) change from baseline in peak VO2 was –0.16 (2.86) with macitentan vs –0.67 (2.66) mL/kg/min with placebo (median unbiased estimate of the difference between macitentan and placebo: 0.62 mL/kg/min [99% repeated confidence interval –0.62; 1.85], p=0.1930). No treatment effect was observed in the two secondary endpoints (Table 2): mean (SD) count per minute of daily physical activity decreased from baseline to week 16 by 3.02 (92.44) with macitentan and by 14.34 (117.56) with placebo (p=0.4512). The most common AEs were headache (10.3% vs 8.7% on placebo), nasopharyngitis (5.9% vs 4.3%), and pyrexia (5.9% vs 4.3%). AEs leading to treatment discontinuation were reported in 3 (4.4%) and 1 (1.4%) of macitentan and placebo patients.
Conclusion
The 52-week RUBATO trial provides an important addition to data on the clinical utility of ERAs in Fontan-palliated patients. The primary efficacy endpoint was not met and no treatment effect was observed for the two secondary endpoints. Macitentan was well tolerated; safety findings were consistent with the known safety profile of macitentan 10 mg.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Actelion Pharmaceuticals Ltd., a Janssen pharmaceutical company of Johnson & Johnson.
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Affiliation(s)
- P Clift
- Queen Elizabeth Hospital Birmingham, Adult Congenital Heart Disease Unit , Birmingham , United Kingdom
| | - F Berger
- German Heart Center Berlin, Department of Congenital Heart Disease/Pediatric Cardiology , Berlin , Germany
| | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - P Antonova
- Charles University in Prague, Motol University Hospital, Department of Cardiovascular Surgery, 2nd Faculty of Medicine , Motol , Czechia
| | - P Disney
- Royal Adelaide Hospital, Department of Cardiology , Adelaide , Australia
| | - J Nicolarsen
- Providence Sacred Heart Medical Center and Children's Hospital, Providence Adult and Teen Congenital Heart Program (PATCH) , Spokane , United States of America
| | - J B Thambo
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology , Pessac , France
| | - L Tomkiewicz Pajak
- Jagiellonian University Medical College, John Paul II Hospital, Department of Cardiac and Vascular Diseases, Institute of Cardiology , Krakow , Poland
| | - J K Wang
- National Taiwan University Hospital, Department of Pediatrics , Taipei , Taiwan
| | - A Schophuus Jensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Burgess
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | | | - M Friberg
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - C Lassen
- Actelion Pharmaceuticals Ltd. , Allschwil , Switzerland
| | - Y d'Udekem
- Children's National Hospital, Washington , D.C. , United States of America
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21
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Van Bulck L, Kovacs AH, Goossens E, Luyckx K, Zaidi A, Wang JK, Yadeta D, Windram J, Van De Bruaene A, Thomet C, Thambo JB, Taunton M, Sasikumar N, Sandberg C, Saidi A, Rutz T, Ortiz L, Mwita JC, Moon JR, Menahem S, Mattsson E, Mandalenakis Z, Mahadevan VS, Lykkeberg B, Leye M, Leong MC, Ladouceur M, Ladak LA, Kim Y, Khairy P, Kaneva A, Johansson B, Jackson JL, Giannakoulas G, Gabriel H, Fernandes SM, Enomoto J, Demir F, de Hosson M, Constantine A, Coats L, Christersson C, Cedars A, Caruana M, Callus E, Brainard S, Bouchardy J, Boer A, Baraona Reyes F, Areias ME, Araujo JJ, Andresen B, Amedro P, Ambassa JC, Amaral F, Alday L, Moons P. Rationale, design and methodology of APPROACH-IS II: International study of patient-reported outcomes and frailty phenotyping in adults with congenital heart disease. Int J Cardiol 2022; 363:30-39. [PMID: 35780933 DOI: 10.1016/j.ijcard.2022.06.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND In recent years, patient-reported outcomes (PROs) have received increasing prominence in cardiovascular research and clinical care. An understanding of the variability and global experience of PROs in adults with congenital heart disease (CHD), however, is still lacking. Moreover, information on epidemiological characteristics and the frailty phenotype of older adults with CHD is minimal. The APPROACH-IS II study was established to address these knowledge gaps. This paper presents the design and methodology of APPROACH-IS II. METHODS/DESIGN APPROACH-IS II is a cross-sectional global multicentric study that includes Part 1 (assessing PROs) and Part 2 (investigating the frailty phenotype of older adults). With 53 participating centers, located in 32 countries across six continents, the aim is to enroll 8000 patients with CHD. In Part 1, self-report surveys are used to collect data on PROs (e.g., quality of life, perceived health, depressive symptoms, autonomy support), and explanatory variables (e.g., social support, stigma, illness identity, empowerment). In Part 2, the cognitive functioning and frailty phenotype of older adults are measured using validated assessments. DISCUSSION APPROACH-IS II will generate a rich dataset representing the international experience of individuals in adult CHD care. The results of this project will provide a global view of PROs and the frailty phenotype of adults with CHD and will thereby address important knowledge gaps. Undoubtedly, the project will contribute to the overarching aim of improving optimal living and care provision for adults with CHD.
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Affiliation(s)
- Liesbet Van Bulck
- KU Leuven - University of Leuven, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | | | - Eva Goossens
- KU Leuven - University of Leuven, Leuven, Belgium; University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven - University of Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Ali Zaidi
- Mount Sinai Heart, New York, NY, USA
| | - Jou-Kou Wang
- National Taiwan University Hospital, Taipei City, Taiwan
| | | | | | | | - Corina Thomet
- Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | | | | | | | - Arwa Saidi
- University of Florida Health, Gainesville, FL, USA
| | - Tobias Rutz
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lucia Ortiz
- Hospital San Juan De Dios De La Plata, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | - Yuli Kim
- Penn Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | | | | | | | | | - Susan M Fernandes
- Lucile Packard Children's Hospital and Stanford Health Care, Stanford, CA, USA
| | - Junko Enomoto
- Chiba Cerebral and Cardiovascular Center, Chiba, Japan; Toyo University, Tokyo, Japan
| | - Fatma Demir
- Ege University Health Application and Research Center, Bornova/İZMİR, Turkey
| | | | - Andrew Constantine
- Royal Brompton Hospital, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise Coats
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ari Cedars
- University of Southwestern Medical Center, TX, Dallas, USA; Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Edward Callus
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; University of Milan, Milan, Italy
| | - Sarah Brainard
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Judith Bouchardy
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Anna Boer
- University Medical Center Groningen, Groningen, the Netherlands
| | - Fernando Baraona Reyes
- Pontificia Universidad Católica de Chile and Instituto Nacional Del Torax, Santiago, Chile
| | - Maria Emília Areias
- UnIC@RISE, University of Porto, Porto, Portugal; Centro Hospitalar Universitário de S. João, Porto, Portugal
| | | | | | - Pascal Amedro
- Hôpital cardiologique Haut-Leveque, Bordeaux, France; Montpellier University Hospital, Montpellier, France
| | | | | | | | - Philip Moons
- KU Leuven - University of Leuven, Leuven, Belgium; University of Gothenburg, Gothenburg, Sweden; University of Cape Town, Cape Town, South Africa.
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22
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Lin HC, Huang SC, Wu MH, Wang JK, Lin MT, Chen CA, Lu CW, Chen YS, Chiu SN. Preoperative N-terminal pro-brain natriuretic peptide is associated with Fontan outcomes. J Thorac Cardiovasc Surg 2022; 164:770-780.e3. [PMID: 35031137 DOI: 10.1016/j.jtcvs.2021.11.082] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The role of preoperative N-terminal pro-brain natriuretic peptide level in patient outcomes after the Fontan operation remains unclear. METHODS The medical records of all patients who underwent their first Fontan operation from June 2011 to October 2019 in our tertiary referral pediatric cardiac center were retrospectively reviewed. Preoperative hemodynamic factors and N-terminal pro-brain natriuretic peptide were analyzed to test the association of mortality and morbidity. RESULTS We enrolled 110 patients (men/women 62/48; median age, 4.1 [3.4, 5.8] years; median follow-up period, 4.28 [2.31, 6.71] years). Almost all operations were extracardiac conduits (98.2%). Primary outcomes of death, Fontan takedown, and heart transplantation were observed in 9 patients (8.2%). Abnormal ventricular contractility, elevated preoperative pulmonary artery pressure, high pulmonary vascular resistance index, and high log10 N-terminal pro-brain natriuretic peptide level were associated with poor outcomes. SECONDARY OUTCOMES atrioventricular valve regurgitation moderate or greater, elevated pulmonary artery pressure, high pulmonary vascular resistance index, and high log10 N-terminal pro-brain natriuretic peptide level were associated with rehospitalization due to heart failure. Multivariable Cox regression analysis revealed that log10 N-terminal pro-brain natriuretic peptide was the only significant predictor of all primary and secondary outcomes. A scoring system including factors of pulmonary artery pressure, pulmonary vascular resistance index, and N-terminal pro-brain natriuretic peptide was established, and the risk stratification is associated with outcomes after the Fontan operation. CONCLUSIONS High preoperative N-terminal pro-brain natriuretic peptide was associated with poor outcomes after the Fontan operation.
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Affiliation(s)
- Hsin-Chia Lin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
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23
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Lu CW, Wang JK, Yang HL, Kovacs AH, Luyckx K, Ruperti-Repilado FJ, Van De Bruaene A, Enomoto J, Sluman MA, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Apers S, Moons P. Heart Failure and Patient-Reported Outcomes in Adults With Congenital Heart Disease from 15 Countries. J Am Heart Assoc 2022; 11:e024993. [PMID: 35470715 PMCID: PMC9238599 DOI: 10.1161/jaha.121.024993] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Heart failure (HF) is the leading cause of mortality and associated with significant morbidity in adults with congenital heart disease. We sought to assess the association between HF and patient‐report outcomes in adults with congenital heart disease. Methods and Results As part of the APPROACH‐IS (Assessment of Patterns of Patient‐Reported Outcomes in Adults with Congenital Heart disease—International Study), we collected data on HF status and patient‐reported outcomes in 3959 patients from 15 countries across 5 continents. Patient‐report outcomes were: perceived health status (12‐item Short Form Health Survey), quality of life (Linear Analogue Scale and Satisfaction with Life Scale), sense of coherence‐13, psychological distress (Hospital Anxiety and Depression Scale), and illness perception (Brief Illness Perception Questionnaire). In this sample, 137 (3.5%) had HF at the time of investigation, 298 (7.5%) had a history of HF, and 3524 (89.0%) had no current or past episode of HF. Patients with current or past HF were older and had a higher prevalence of complex congenital heart disease, arrhythmias, implantable cardioverter‐defibrillators, other clinical comorbidities, and mood disorders than those who never had HF. Patients with HF had worse physical functioning, mental functioning, quality of life, satisfaction with life, sense of coherence, depressive symptoms, and illness perception scores. Magnitudes of differences were large for physical functioning and illness perception and moderate for mental functioning, quality of life, and depressive symptoms. Conclusions HF in adults with congenital heart disease is associated with poorer patient‐reported outcomes, with large effect sizes for physical functioning and illness perception. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT02150603.
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Affiliation(s)
- Chun-Wei Lu
- Department of Pediatrics National Taiwan University Hospital Taipei Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics National Taiwan University Hospital Taipei Taiwan
| | - Hsiao-Ling Yang
- School of Nursing College of Medicine National Taiwan University Taipei Taiwan.,Department of Nursing National Taiwan University Hospital Taipei Taiwan
| | - Adrienne H Kovacs
- Toronto Adult Congenital Heart Disease ProgramPeter Munk Cardiac CenterUniversity Health NetworkUniversity of Toronto Toronto Canada.,Knight Cardiovascular InstituteOregon Health & Science University Portland OR
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context KU Leuven Leuven Belgium.,UNIBSUniversity of the Free State Bloemfontein South Africa
| | - Francisco Javier Ruperti-Repilado
- Center for Congenital Heart Disease Department of Cardiology Inselspital - Bern University HospitalUniversity of Bern Bern Switzerland
| | - Alexander Van De Bruaene
- Division of Congenital and Structural Cardiology University Hospitals Leuven Leuven Belgium.,KU Leuven Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | | | - Maayke A Sluman
- Coronel Institute of Occupational HealthAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands.,Department of Cardiology Jeroen Bosch Hospital's Hertogenbosch The Netherlands
| | - Jamie L Jackson
- Center for Biobehavioral Health Nationwide Children's Hospital Columbus OH
| | - Paul Khairy
- Adult Congenital Heart CenterMontreal Heart InstituteUniversité de Montréal Montreal Canada
| | - Stephen C Cook
- Indiana University Health Adult Congenital Heart Disease Program Indianapolis IN
| | - Shanthi Chidambarathanu
- Pediatric Cardiology Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation) Chennai India
| | - Luis Alday
- Division of Cardiology Hospital de Niños Córdoba Argentina
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease ProgramPeter Munk Cardiac CenterUniversity Health NetworkUniversity of Toronto Toronto Canada
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center Oslo University Hospital - Rikshospitalet Oslo Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit Sahlgrenska University Hospital/Östra Gothenburg Sweden.,Institute of Medicine The Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden.,Centre for Person-Centred Care (GPCC) University of Gothenburg Gothenburg Sweden
| | - Malin Berghammer
- Department of Health Sciences University West Trollhättan Sweden.,Department of Paediatrics Queen Silvia Children's HospitalSahlgrenska University Hospital Gothenburg Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Andrew S Mackie
- Division of Cardiology Stollery Children's HospitalUniversity of Alberta Edmonton Canada
| | - Samuel Menahem
- Monash HeartMonash Medical CentreMonash University Melbourne Australia
| | - Maryanne Caruana
- Department of Cardiology Mater Dei Hospital Birkirkara Bypass Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease CenterCincinnati Children's Hospital Medical Center Cincinnati OH
| | - Alexandra Soufi
- Department of Cardiac Rehabilitation Médipôle Lyon-Villeurbanne Lyon France
| | - Susan M Fernandes
- Adult Congenital Heart Program at StanfordLucile Packard Children's Hospital and Stanford Health Care Palo Alto CA
| | - Kamila White
- Adult Congenital Heart Disease CenterWashington University and Barnes Jewish Heart & Vascular CenterUniversity of Missouri Saint Louis MO
| | - Edward Callus
- Clinical Psychology Service IRCCS Policlinico San Donato Milan Italy.,Department of Biomedical Sciences for Health University of Milan Milan Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of NebraskaMedical Center/Children's Hospital and Medical Center Omaha NE.,Taussig Heart CenterJohns Hopkins School of Medicine Baltimore MD
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care KU Leuven Leuven Belgium
| | - Philip Moons
- Centre for Person-Centred Care (GPCC) University of Gothenburg Gothenburg Sweden.,KU Leuven Department of Public Health and Primary Care KU Leuven Leuven Belgium.,Institute of Health and Care Sciences University of Gothenburg Gothenburg Sweden.,Department of Paediatrics and Child Health University of Cape Town Cape Town South Africa
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24
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Wang JK, Chen QM. [Diagnostic strategies for oral mucosal diseases]. Zhonghua Kou Qiang Yi Xue Za Zhi 2022; 57:208-214. [PMID: 35152661 DOI: 10.3760/cma.j.cn112144-20211215-00551] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- J K Wang
- Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Chengdu 610041, China
| | - Q M Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
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25
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Liao HJ, Wang JK, Chen YS, Huang JH, Chen CA. Misdiagnosis of anomalous left coronary artery from the pulmonary artery as coronary cameral fistulae in an adult. Eur Heart J Case Rep 2022; 6:ytac033. [PMID: 35233489 PMCID: PMC8874840 DOI: 10.1093/ehjcr/ytac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/11/2021] [Accepted: 01/20/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Hsiao-Ju Liao
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
- Department of Cardiology, National Taiwan University Children’s Hospital, No. 8, Chung-Shan South Road, Taipei 100, Taiwan
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jou-Hsuan Huang
- Department of Radiology and Medical Imaging, Medical College, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
- Department of Cardiology, National Taiwan University Children’s Hospital, No. 8, Chung-Shan South Road, Taipei 100, Taiwan
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Lee ML, Liao CY, Chang MC, Wang JK. Stridor as a Harbinger of Congenital Cardiovascular Anomaly. Acta Cardiol Sin 2021; 37:608-617. [PMID: 34812234 PMCID: PMC8593490 DOI: 10.6515/acs.202111_37(6).20210619a] [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] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is an intimate spatial relationship between the cardiovascular and airway structures. Central airway compression related to congenital cardiovascular anomalies should be considered in neonates, infants, and young children presenting with stridor. METHODS From July 31, 1990 to December 31, 2018, 24 pediatric patients, including 18 males and 6 females, aged 1 day to 11.3 years old, presenting with stridor and/or lip cyanosis were enrolled in this study. At presentation, none of the patients had a known history of congenital heart disease. Patients with congenital bronchopulmonary vascular/foregut malformations, congenital pulmonary venolobar syndrome, congenital pulmonary malinosculations, Eisenmenger syndrome, secondary pulmonary hypertension, and idiopathic pulmonary arterial hypertension were excluded from this study. Available profiles of 24 patients were reviewed and the underlying congenital cardiovascular anomalies contributing to the clinical manifestation of stridor were analyzed, including chart recordings, chest radiograms, echocardiograms, computerized tomography, electrocardiograms, esophagograms, cardiac catheterization, magnetic resonance imaging, and bronchography. RESULTS Stridor was an early sign of congenital cardiovascular anomalies, including double aortic arch, right aortic arch (RAA) with Kommerell diverticulum, mirror-image right aortic arch with aortic diverticulum, anomalous right innominate artery, left pulmonary artery sling, RAA with tetralogy of Fallot and persistent fifth aortic arch, a vertical patent ductus arteriosus from a transverse left aortic arch, and absent pulmonary valve syndrome. Notably, chest radiography provided the first clue of RAA in 18 of the 24 patients. CONCLUSIONS Stridor can be a harbinger of congenital cardiovascular anomalies causing central airway compression in pediatric patients.
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Affiliation(s)
- Meng-Luen Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Changhua Christian Children’s Hospital, Changhua
- School of Medicine, Kaohsiung Medical University, Kaohsiung
| | | | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua
- Department of Medical Imaging and Radiological Science and Technology, Taichung
| | - Jou-Kou Wang
- Departments of Pediatrics; College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
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27
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Leibold A, Eichler E, Chung S, Moons P, Kovacs AH, Luyckx K, Apers S, Thomet C, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, White K, Callus E, Kutty S, Fernandes SM. Pain in adults with congenital heart disease - An international perspective. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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28
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Lin PJ, Fanjiang YY, Wang JK, Lu CW, Lin KC, Cheong IM, Pan KY, Chen CW. Long-term effectiveness of an mHealth-tailored physical activity intervention in youth with congenital heart disease: A randomized controlled trial. J Adv Nurs 2021; 77:3494-3506. [PMID: 34151444 DOI: 10.1111/jan.14924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/25/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022]
Abstract
AIMS To evaluate the long-term effectiveness of the Care & Organize Our Lifestyle (COOL) programme, a self-regulation theory-based mHealth programme, on improving disease knowledge and physical activity in youth with congenital heart disease (CHD). DESIGN A three-arm parallel-group randomized controlled trial. METHODS A total 143 participants with simple and moderate CHD aged 15-24 years were recruited from June 2016 to February 2018. The 12-month programme compared two active intervention groups to a standard-care control group (n = 47). Participants in one active intervention group (n = 49) were provided with COOL Passport, a mobile healthcare application. Those in the other group (n = 47) were provided with access to the Health Promotion Cloud system and use of game-based interactive platforms along with COOL Passport. Outcomes were the Leuven Knowledge Questionnaire for Congenital Heart Disease and the International Physical Activity Questionnaire-Taiwan Show-Card Version. RESULTS After 12 months, 103 participants remained; the overall attrition rate was 28%. No significant differences were observed between the groups in any domain of disease knowledge after 6 months or 1 year. Neither active group exhibited significantly greater physical activity intensity than the standard-care control group in any month during the 1 year. CONCLUSION The mHealth-tailored intervention of the COOL programme did not improve disease knowledge or physical activity in young adults with CHD. IMPACT The application of the COOL Passport and Health Promotion Cloud system and use of game-based interactive platforms must be modified and verified in future studies and may have clinical potential. TRIAL REGISTRATION The registry of clinical trials was ClinicalTrials.gov: NCT04264650.
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Affiliation(s)
- Pei-Jung Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yong-Yi Fanjiang
- Department of Computer Science and Information Engineering, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - In-Mei Cheong
- Department of Dietetics, Macau Yin Kui Hospital, Macau, Macao
| | - Kuan-You Pan
- Taiwanese Society of Suicidology, Taipei, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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29
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Chin CY, Huang SC, Wang JK, Chen CA. A bleeding Blalock-Taussig shunt. Eur Heart J 2021; 42:2022. [PMID: 33205149 DOI: 10.1093/eurheartj/ehaa887] [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: 11/13/2022] Open
Affiliation(s)
- Chia-Yi Chin
- Department of Cardiology, National Taiwan University Children's Hospital, No. 8, Chung-Shan South Road, Taipei 100, Taiwan.,Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan
| | - Shu-Chien Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan South Road, Taipei 100, Taiwan
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, No. 8, Chung-Shan South Road, Taipei 100, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, No.1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
| | - Chun-An Chen
- Department of Cardiology, National Taiwan University Children's Hospital, No. 8, Chung-Shan South Road, Taipei 100, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, No.1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
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Wang JK, Chiu SN, Lin MT, Chen CA, Lu CW, Wu MH. Transcatheter Closure of Atrial Septal Defect Associated With Pulmonary Artery Hypertension using Fenestrated Devices. Am J Cardiol 2021; 147:122-128. [PMID: 33667439 DOI: 10.1016/j.amjcard.2021.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
In patients with pulmonary artery hypertension (PAH) associated with atrial septal defect (ASD), closure of ASD may carry significant risks. We aimed to evaluate the safety and efficacy of transcatheter closure of ASD in selected patients with PAH using a fenestrated device followed by pulmonary vasodilator therapy. During the 14.8-year period, 51 ASD patients (10 males, age 46 ± 18 years) with a mean pulmonary artery pressure (PAP) ≥ 35 mm Hg and/or systolic PAP ≥ 60 mm Hg, underwent closure with a fenestrated device. Of them, mean Qp/Qs ratio, systolic PAP and mean PAP were 2.6 ± 1.2, 73 ± 14 mm Hg, and 44 ± 8 mm Hg, respectively. A total of 35 patients received pulmonary vasodilator therapy. The New York Heart Association (NYHA) functional class improved at 3 to 6 months follow-up. (p < 0.001) Nineteen patients underwent repeated catheterization. A comparison of the hemodynamic parameters between baseline and repeated catheterization revealed significant decreases in both systolic and mean PAP (77 ± 11 vs 55 ± 14 mm Hg, p < 0.0001 & 48 ± 7 vs 37 ± 8 mm Hg, p = 0.001, respectively), pulmonary vascular resistance (PVR) (5.1 ± 2.3 vs 4.0 ± 1.7 WU, p = 0.011) and PVRi (7.7 ± 3.3 vs 6.2 ± 2.4 WU*m2, p = 0.024). After a follow-up period of 84 ± 45 months, 6 mortalities were noted in which 2 were due to cardiac causes. In conclusion, catheter closure of ASD in patients with PAH using a fenestrated device followed by vasodilator therapy is safe and effective.
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Wang CC, Weng WC, Chang LY, Chang HY, Wu MH, Wang JK, Lu CW, Lin MT, Chen CA, Chiu SN. Increased prevalence of inattention-related symptoms in a large cohort of patients with congenital heart disease. Eur Child Adolesc Psychiatry 2021; 30:647-655. [PMID: 32394091 DOI: 10.1007/s00787-020-01547-y] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
Abstract
The objective of this study is to assess the prevalence and risk factors for attention-deficit hyperactivity disorder (ADHD) in a large cohort of patients with congenital heart disease (CHD). Patients (n = 695) with CHD who were aged 6-15 years and visited the outpatient clinics in our hospital from June 2015 to May 2017 were enrolled. Their medical records were collected, and the Chinese version of the Swanson, Nolan, and Pelham rating scale (SNAP-IVc) and a questionnaire about neuropsychiatric care-seeking behavior were completed by parents and counselors. Of the 695 patients, the overall prevalence of ADHD was 12.4%, including 3.2% for the combined subtype, 6.8% for the inattentive-predominant subtype, and 2.4% for the hyperactivity/impulsive-predominant subtype. Only the inattention-predominant subtype was significantly more prevalent than in the general population. The prevalence of the inattention-predominant subtype was highest in the patients with cyanotic CHD, high severity index, and in those who had received surgery or cardiopulmonary bypass. Multivariate regression analysis indicated that the risk factors for inattention-related symptoms included postoperative seizure and previous cardiopulmonary bypass (odds ratio: 3.22 and 3.82; P = 0.027 and < 0.001, respectively). Only 58.7% of the patients with probable ADHD ever sought neuropsychiatric care, and only 27% regularly attended neuropsychiatric clinics. The inattention-predominant subtype of ADHD was more prevalent in our CHD patients, especially in those with cyanotic CHD, higher disease severity index, and in those who had undergone a surgical intervention. The percentage of patients receiving regular neuropsychiatric clinic follow-up was low.
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Affiliation(s)
- Chia-Ching Wang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Ling-Yin Chang
- Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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Moons P, Apers S, Kovacs AH, Thomet C, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Oechslin E, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Luyckx K. Sense of coherence in adults with congenital heart disease in 15 countries: Patient characteristics, cultural dimensions and quality of life. Eur J Cardiovasc Nurs 2021; 20:48-55. [PMID: 32524857 DOI: 10.1177/1474515120930496] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/20/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have found that sense of coherence (SOC) is positively related to quality of life (QoL) in persons with chronic conditions. In congenital heart disease (CHD), the evidence is scant. AIMS We investigated (i) intercountry variation in SOC in a large international sample of adults with CHD; (ii) the relationship between demographic and clinical characteristics and SOC; (iii) the relationship between cultural dimensions of countries and SOC; and (iv) variation in relative importance of SOC in explaining QoL across the countries. METHODS APPROACH-IS was a cross-sectional, observational study, with 4028 patients from 15 countries enrolled. SOC was measured using the 13-item SOC scale (range 13-91) and QoL was assessed by a linear analog scale (range 0-100). RESULTS The mean SOC score was 65.5±13.2. Large intercountry variation was observed with the strongest SOC in Switzerland (68.8±11.1) and the lowest SOC in Japan (59.9±14.5). A lower SOC was associated with a younger age; lower educational level; with job seeking, being unemployed or disabled; unmarried, divorced or widowed; from a worse functional class; and simple CHD. Power distance index and individualism vs collectivism were cultural dimensions significantly related to SOC. SOC was positively associated with QoL in all participating countries and in the total sample, with an explained variance ranging from 5.8% in Argentina to 30.4% in Japan. CONCLUSION In adults with CHD, SOC is positively associated with QoL. The implementation of SOC-enhancing interventions might improve QoL, but strategies would likely differ across countries given the substantial variation in explained variance.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Adrienne H Kovacs
- Toronto Congenital Cardiac Center for Adults, University Health Network, University of Toronto, Canada
- Knight Cardiovascular Institute, Oregon Health & Science University, USA
| | - Corina Thomet
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital - Bern University Hospital, University of Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- KU Leuven Department of Cardiovascular Sciences, KU Leuven, Belgium
| | | | - Maayke A Sluman
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, the Netherlands
- Department of Cardiology, Jeroen Bosch Hospital, the Netherlands
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Argentina
| | - Erwin Oechslin
- Toronto Congenital Cardiac Center for Adults, University Health Network, University of Toronto, Canada
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sweden
- Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Malin Berghammer
- Department of Health Sciences, University West, Sweden
- Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Australia
| | | | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, France
| | - Susan M Fernandes
- Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/Children's Hospital and Medical Center, USA
- Taussig Heart Center, Johns Hopkins School of Medicine, USA
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven, Belgium
- UNIBS, University of the Free State, South Africa
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Callus E, Pagliuca S, Boveri S, Ambrogi F, Luyckx K, Kovacs AH, Apers S, Budts W, Enomoto J, Sluman MA, Wang JK, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Kutty S, Moons P. Phenotypes of adults with congenital heart disease around the globe: a cluster analysis. Health Qual Life Outcomes 2021; 19:53. [PMID: 33568120 PMCID: PMC7877115 DOI: 10.1186/s12955-021-01696-x] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To derive cluster analysis-based groupings for adults with congenital heart disease (ACHD) when it comes to perceived health, psychological functioning, health behaviours and quality of life (QoL). METHODS This study was part of a larger worldwide multicentre study called APPROACH-IS; a cross sectional study which recruited 4028 patients (2013-2015) from 15 participating countries. A hierarchical cluster analysis was performed using Ward's method in order to group patients with similar psychological characteristics, which were defined by taking into consideration the scores of the following tests: Sense Of Coherence, Health Behavior Scale (physical exercise score), Hospital Anxiety Depression Scale, Illness Perception Questionnaire, Satisfaction with Life Scale and the Visual Analogue Scale scores of the EQ-5D perceived health scale and a linear analogue scale (0-100) measuring QoL. RESULTS 3768 patients with complete data were divided into 3 clusters. The first and second clusters represented 89.6% of patients in the analysis who reported a good health perception, QoL, psychological functioning and the greatest amount of exercise. Patients in the third cluster reported substantially lower scores in all PROs. This cluster was characterised by a significantly higher proportion of females, a higher average age the lowest education level, more complex forms of congenital heart disease and more medical comorbidities. CONCLUSIONS This study suggests that certain demographic and clinical characteristics may be linked to less favourable health perception, quality of life, psychological functioning, and health behaviours in ACHD. This information may be used to improve psychosocial screening and the timely provision of psychosocial care.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Silvana Pagliuca
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Adrienne H Kovacs
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada.,Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Education, Toyo University, Tokyo, Japan
| | - Maayke A Sluman
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden.,Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Susan M Fernandes
- Adult Congenital HeartProgram at Stanford, Lucile Packard Children's Hospital Stanford and Stanford Health Care, Palo Alto, CA, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA.,Taussig Heart Center, Johns Hopkins School of Medicine, Baltimore, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden. .,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Lin HC, Wu MH, Wang JK, Lin MT, Chen CA, Lu CW, Chen YS, Huang SC, Chiu SN. Perioperative outcomes of Fontan operation: Impact of heterotaxy syndrome. J Formos Med Assoc 2021; 121:89-97. [PMID: 33549407 DOI: 10.1016/j.jfma.2021.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE Fontan operation is the standard surgical procedure for achieving long-term survival in single-ventricular complex congenital heart diseases (SV-CHD). We aim to identify the perioperative outcomes and impact of heterotaxy syndrome (HS) after Fontan operation in a tertiary pediatric cardiology center. METHODS Medical records were reviewed for all patients who received Fontan operation and who were born between 1997 and 2017 in our institution. Preoperative, operative, and postoperative risk factors for perioperative mortality and morbidity were analyzed. RESULTS Totally, 154 patients were enrolled (103 SV-CHD and 51 HS), and the male to female ratio was 92:62. The mean age of Fontan operation was 5.1 years, and extracardiac conduit comprised the majority (90.9%) of Fontan operation. Overall perioperative event-free survival to discharge was 91.6% (84.3% in HS and 95.1% in other SV-CHD, P = 0.032). For secondary outcomes, length of intensive care stay and duration of pleural effusion drainage were not significantly different between patients with HS and other SV-CHD, but postoperative arrhythmia was more common in HS group (31.4% vs. 12.6%, P = 0.005). In multivariable regression analysis, preoperative risk factors including operation year before 2007 and high PAP and postoperative factors of elevated postoperative CVP were associated with worse outcomes. HS was not a predictor of worse outcome after adjusting for preoperative PAP and operation era. CONCLUSION Surgical outcome has improved much in current era. Perioperative outcome is poorer in patients with HS than other SV-CHD, but HS is not a predictor of perioperative mortality after adjusting for hemodynamic factors.
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Affiliation(s)
- Hsin-Chia Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
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Huang SW, Lee PL, Fan PC, Kuo MF, Chen CA, Chiu SN, Lin MT, Lu CW, Wang JK, Wu MH. Diffuse midline glioma presenting with central sleep apnea and pulmonary hypertension in a 4-year-old patient: a case report. J Clin Sleep Med 2021; 17:325-328. [PMID: 33006310 DOI: 10.5664/jcsm.8854] [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] [Indexed: 11/13/2022]
Abstract
NONE Central sleep apnea is a rare disorder in the pediatric population with various initial presentations and is secondary to many underlying diseases. We report on a 4-year-old boy with episodes of syncope. He also had pulmonary hypertension and cardiomegaly. Polysomnography showed the finding for central sleep apnea with a high apnea-hypopnea index (up to 138.1 events/h). Brain magnetic resonance imaging showed an ill-defined area near the medulla oblongata and lower pons. The lesion from a brainstem biopsy confirmed the diagnosis of low-grade glioma. Conservative medical follow-up was suggested, and brain magnetic resonance imaging 6 months later showed no obvious tumor progression. To our best knowledge, this is the first case report that workup on the cause of syncope and pulmonary hypertension led to the final diagnosis of central sleep apnea and a brain neoplasm.
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Affiliation(s)
- Szu-Wei Huang
- Department of Emergency Medicine, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Pei-Lin Lee
- Department of Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Pi-Chuan Fan
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Meng-Fai Kuo
- Department of Surgery, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Wang PY, Tseng WC, Fu CM, Wu MH, Wang JK, Chen YS, Chou NK, Wang SS, Chiu SN, Lin MT, Lu CW, Chen CA. Long-Term Outcomes and Prognosticators of Pediatric Primary Dilated Cardiomyopathy in an Asian Cohort. Front Pediatr 2021; 9:771283. [PMID: 34796157 PMCID: PMC8593174 DOI: 10.3389/fped.2021.771283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Dilated cardiomyopathy (DCM) is the most common childhood cardiomyopathy. The epidemiological profiles and prognosticators of clinical outcomes in Asian populations are not well elucidated. Methods: Data of 104 children aged <18 years with a diagnosis of primary DCM from January 1990 to December 2019 in our institutional database were retrospectively investigated. Relevant demographic, echocardiographic, and clinical variables were recorded for analysis. A P <0.05 was considered statistically significant. Results: The median age at diagnosis was 1.4 years (interquartile range = 0.3-9.1 years), and 52.9% were males. During a median follow-up duration of 4.8 years, 48 patients (46.2%) were placed on the transplantation waitlist, and 52.1% of them eventually received heart transplants. An exceptionally high overall waitlist mortality rate was noted (27.1%), which was even higher (43.5%) if the diagnostic age was <3 years. The 1-, 5-, and 10-year transplant-free were 61.1, 48.0, and 42.8%. Age at diagnosis >3 years and severe mitral regurgitation at initial diagnosis were independent risk factors for death or transplantation (hazard ratios = 2.93 and 3.31, respectively; for both, P <0.001). In total, 11 patients (10.6%) experienced ventricular function recovery after a median follow-up of 2.5 (interquartile range = 1.65-5) years. Younger age at diagnosis was associated a higher probability of ventricular function recovery. Conclusions: Despite donor shortage for heart transplantation and subsequently high waitlist mortality, our data from an Asian cohort indicated that transplant-free long-term survival was comparable with that noted in reports from Western populations. Although younger patients had exceptionally higher waitlist mortality, lower diagnostic age was associated with better long-term survival and higher likelihood of ventricular function recovery.
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Affiliation(s)
- Po-Yuan Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Pediatrics, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shoei-Shen Wang
- Department of Cardiovascular Surgery, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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Chiu SN, Wang CC, Lin MT, Chen CA, Lu CW, Hua YC, Wu JM, Wu MH, Wang JK. Reappraisal of the Subtropical Guidelines on Palivizumab Prophylaxis in Congenital Heart Disease. Front Pediatr 2021; 9:756787. [PMID: 35071127 PMCID: PMC8767946 DOI: 10.3389/fped.2021.756787] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To define the impact of associated abnormalities on the efficacy of the novel subtropical guidelines for palivizumab prophylaxis on respiratory syncytial virus (RSV)-related hospitalizations in patients with hemodynamically significant congenital heart disease (hsCHD). Method: This prospective study enrolled every patient seen at a tertiary care center for hsCHD, who was born between 2014 and 2018 and received at least 1 dose of palivizumab, according to the subtropical guidelines. The patients were followed until the age of 2 years. Results: A total of 772 patients (49% male) were enrolled. Cyanotic CHD was seen in 46% of patients, of whom 23% had associated abnormalities. Lung/airway abnormalities (14%) were the most common followed by the genetic syndromes associated with CHD (7.3%). Among the 772 patients, RSV-related hospitalizations occurred in 3.2 and 2.2% children aged ≤ 12 and 13-24 months, respectively. Most of the RSV infections occurred in patients no longer satisfying the criteria for palivizumab prophylaxis. The patients with associated abnormalities but not the type of CHD, patient age, and patient sex were risk factors for RSV-related hospitalizations. The rates of RSV-related hospitalizations, admission to the intensive care unit, and endotracheal intubation were higher for patients with associated anomalies than for other patients before 24 months of age (10.2 vs. 4.0%, 67 vs. 33%, and 39 vs. 4.2%, p = 0.004, 0.06, 0.013, respectively). Conclusion: Children with abnormalities, especially genetic syndromes and lung/airway problems associated with CHD, are at high risk for RSV-related hospitalization. Our current subtropical guidelines for palivizumab prophylaxis in patients with hsCHD, should be revised to include the results of this study.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
| | - Yu-Chuan Hua
- Cardiac Children's Foundation Taiwan, Taipei, Taiwan
| | - Jing-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Medical College, National Taiwan University, Taipei, Taiwan
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Tseng WC, Huang CN, Chiu SN, Lu CW, Wang JK, Lin MT, Chen CA, Wu MH. Long-term outcomes of arrhythmia and distinct electrophysiological features in congenitally corrected transposition of the great arteries in an Asian cohort. Am Heart J 2021; 231:73-81. [PMID: 33098810 DOI: 10.1016/j.ahj.2020.10.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
Congenitally corrected transposition of the great arteries (ccTGA) is associated with various types of arrhythmia, including supraventricular tachycardia (SVT) and complete atrioventricular block (cAVB). Our study aims to characterize the arrhythmia burden, associated risk factors, arrhythmia mechanisms, and the long-term follow-up results in patients with ccTGA in a large Asian cohort. METHODS We enrolled 104 patients (43 women and 61 men) diagnosed with ccTGA at our institution. The mean age at last follow-up was 20.8 years. RESULTS For 40 patients (38%) with tachyarrhythmia, paroxysmal SVT (PSVT) and atrial arrhythmia were observed in 17 (16%) and 27 (26%) patients, respectively, with 4 patients (4%) having both types of SVT. The 20-year and 30-year SVT-free survival rates were 68% and 54%, respectively. Seven patients (7%) developed cAVB: 2 (2%) developed spontaneously, and the other 5 (5%) was surgically complicated (surgical risk of cAVB: 7%, all associated with ventricular septal defect repair surgery). PSVT was mostly associated with accessory pathways (5/9) but also related to twin atrioventricular nodal reentry tachycardia (3/9) and atrioventricular nodal reentry tachycardia (1/9). Most of the accessory pathways were located at tricuspid valve (9/10). Catheter ablation successfully eliminated all PSVT substrates (10/10) and most of the atrial arrhythmia substrates (3/5), with low recurrence rate. CONCLUSIONS The arrhythmia burden in patients with ccTGA is high and increases over time. However, cAVB incidence was relatively low and kept stationary in this Asian cohort. The mechanisms of SVT are complicated and can be controlled through catheter ablation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/surgery
- Atrioventricular Block/epidemiology
- Atrioventricular Block/mortality
- Atrioventricular Block/physiopathology
- Atrioventricular Block/surgery
- Child
- Child, Preschool
- Congenitally Corrected Transposition of the Great Arteries/epidemiology
- Congenitally Corrected Transposition of the Great Arteries/mortality
- Congenitally Corrected Transposition of the Great Arteries/physiopathology
- Congenitally Corrected Transposition of the Great Arteries/surgery
- Electrocardiography
- Female
- Follow-Up Studies
- Heart Septal Defects, Ventricular/surgery
- Humans
- Incidence
- Infant
- Male
- Middle Aged
- Risk Factors
- Survival Rate
- Tachycardia, Atrioventricular Nodal Reentry/epidemiology
- Tachycardia, Atrioventricular Nodal Reentry/mortality
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/mortality
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Taiwan
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No. 1 Jen Ai Rd Section 1, Taipei City, Taiwan
| | - Chi-Nan Huang
- Department of Pediatrics, Taipei, City Hospital Heping Fuyou Branch, No. 12, Fuzhou St, Zhongzheng District, Taipei City, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan.
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
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Huang CN, Wu FF, Chang YM, Huang HC, Lin MT, Wang JK, Wu MH. Comparison of risk scores for predicting intravenous immunoglobulin resistance in Taiwanese patients with Kawasaki disease. J Formos Med Assoc 2020; 120:1884-1889. [PMID: 33358267 DOI: 10.1016/j.jfma.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/PURPOSE Kawasaki disease (KD) is the most common type of acquired heart disease in children, and intravenous immunoglobulin (IVIG) therapy is the preferred treatment. Several risk scoring systems have been developed to predict IVIG resistance, which is important in KD management, including the Kobayashi, Egami, and Formosa scores. We evaluated the performance of these scoring systems with a KD patient cohort from Taiwan. METHODS We retrospectively analyzed the medical records of all KD patients admitted to our institution from 2012 to 2017. We compared the characteristics of IVIG-resistant and non-resistant patients and evaluated the predictive ability of the scoring systems for IVIG resistance. RESULTS We included 84 patients, with 73 receiving IVIG therapy. Eight patients were unresponsive to the first IVIG course. Compared to those with good response to therapy or spontaneous improvement, IVIG-resistant patients had a higher C-reactive protein level (16.1 mg/dL vs. 8.6 mg/dL, p < 0.001), higher percentage of segmented leukocytes (75.7% vs. 61.7%, p = 0.008), and lower albumin level (2.98 mg/dL vs. 3.78 mg/dL, p = 0.001). In determining IVIG resistance, the sensitivity and specificity varied among scoring systems (Kobayashi, 37.5% and 86.8%; Egami, 37.5% and 84.2%; and Formosa, 87.5% and 73.7%, respectively). The positive and negative predictive values of the Formosa score were 25.9% and 98.2%, respectively. CONCLUSION The Formosa score had the highest sensitivity in determining IVIG resistance. Although the positive predictive value was low, the negative predictive value could reach 98.2%. The Formosa score was superior to other scoring systems in predicting IVIG resistance in Taiwanese KD patients.
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Affiliation(s)
- Chi-Nan Huang
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Fen-Fen Wu
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Ya-Mei Chang
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Hsin-Chung Huang
- Department of Pediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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Liu YH, Huang SC, Wang JK, Chen CA. Misleading Echocardiographic Diagnosis of an Infant With Dilated Cardiomyopathy: A Rare Intramural Anomalous Origin of Left Coronary Artery From the Pulmonary Artery. Circ Cardiovasc Imaging 2020; 14:e011075. [PMID: 33356407 DOI: 10.1161/circimaging.120.011075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yu-Hsuan Liu
- Department of Pediatrics, Hualien Tzu Chi Hospital, Hualien, Taiwan (Y.-H.L.)
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei (Y.-H.L., J.-K.W., C.-A.C.)
| | - Shu-Chien Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (S.-C.H.)
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei (Y.-H.L., J.-K.W., C.-A.C.)
- Department of Pediatrics, Medical College, National Taiwan University, Taipei (J.-K.W., C.-A.C.)
| | - Chun-An Chen
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei (Y.-H.L., J.-K.W., C.-A.C.)
- Department of Pediatrics, Medical College, National Taiwan University, Taipei (J.-K.W., C.-A.C.)
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Wu MH, Wang JK, Chiu SN, Tseng WC, Lu CW, Lin HC, Lin MT, Chen CA. Twin atrioventricular nodes, arrhythmias, and survival in pediatric and adult patients with heterotaxy syndrome. Heart Rhythm 2020; 18:605-612. [PMID: 33321198 DOI: 10.1016/j.hrthm.2020.12.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heterotaxy syndrome is likely to involve arrhythmias from associated conduction system abnormalities, which are distinct in different subtypes of isomerism and may change further after interventions and remodeling. OBJECTIVE The purpose of this study was to understand the risk of arrhythmias and its relation to isomerism subtypes. METHODS Patients diagnosed between 1980 and 2019 as having heterotaxy syndrome were enrolled and grouped as right atrial isomerism (RAI), left atrial isomerism (LAI), or indeterminate isomerism. RESULTS Of the 366 patients enrolled, 326 (89.1%) had RAI, 35 (9.6%) LAI, and 5 (1.4%) indeterminate isomerism; 71 (19.4%) patients were adults. Arrhythmias occurred in 37.2% of patients (109 supraventricular tachycardia [SVT], 8 atrial fibrillation/flutter, 12 ventricular tachycardia, and 14 paced bradycardia). Freedom from arrhythmias by the age of 1, 5, 10, 20, and 40 years was 0.849, 0.680, 0.550, 0.413, and 0.053, respectively. Twin atrioventricular nodes were identified in 51.5% of patients with RAI, 8.7% of patients with LAI, and 40.0% of patients with indeterminate isomerism and were the key predictors of SVT. Indeterminate isomerism was also a risk factor for SVT. Other forms of tachycardia appeared relatively late. Sinus bradycardia with junctional rhythm was common in LAI (48.7%) and less in indeterminate isomerism (20.0%), with none occurring in RAI. Only in patients with RAI who showed the poorest survival, ventricular tachycardia worsened the long-term survival. CONCLUSION RAI was the predominant subtype of heterotaxy in this cohort. Collectively, the median RAI/LAI ratio was 0.731 and 5.450 in Western and East Asian studies, respectively. Arrhythmias, tachycardia, or paced bradycardia were common, but the spectrum was distinct among subtypes.
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Affiliation(s)
- Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Sheunn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Pediatrics, Yuan-Lin Branch, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hsin-Chia Lin
- Department of Pediatrics, Yuan-Lin Branch, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Liu HW, Huang LW, Chiu SN, Lue HC, Wu MH, Chen MR, Wang JK. Cardiac Screening for High Risk Sudden Cardiac Death in School-Aged Children. Acta Cardiol Sin 2020; 36:641-648. [PMID: 33235421 DOI: 10.6515/acs.202011_36(6).20200515a] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Sudden cardiac death (SCD) is an uncommon but significant cause of death in the young. Citywide cardiac screening of school-aged children has been performed in Taipei since 1989. In this study, we investigate the efficacy of this screening method for identifying those at high risk of SCD. Methods This study analyzed the data from the results of cardiac screening for school-aged children in Taipei from 2003 to 2014. The cardiac screening included: Stage I, questionnaire surveys, simplified phonocardiography test and simplified electrocardiography (ECG) test; Stage II, physical examination and auscultation by a pediatric cardiologist for all children who had abnormal findings in stage I screening; Stage III, referral to a pediatric cardiologist for further examinations. Logistic regression and decision tree analyses were performed. Results A total of 566,447 students were screened, of whom 685 were identified as being at high risk of SCD. The most common causes of being at high risk of SCD included Wolff-Parkinson-White syndrome, long QT syndrome, cardiomyopathy and Marfan's syndrome. Using logistic regression analysis, the simplified ECG test was identified as being the most effective tool (odds ratio = 16.4, p < 0.001) and past history as the second most crucial factor (odds ratio = 3.95, p < 0.001) for detecting a high risk of SCD. Decision tree analysis showed that serial studies with a past history and the simplified ECG test could accurately identify those at high risk of SCD. Conclusions Questionnaire survey and simplified electrocardiography test-based cardiovascular screening in school-aged children can identify those at high risk of SCD.
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Affiliation(s)
- Hsiu-Wen Liu
- Department of Business Administration, Soochow University
| | | | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Hung-Chi Lue
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Ming-Ren Chen
- Department of Pediatrics, MacKay Memorial Hospital and Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
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Lin MT, Chen CA, Chen SJ, Chiu SN, Lu CW, Wu MH, Wang JK. Prognostic markers in patients undergoing transcatheter implantation of Venus P-valve: Experience in Taiwan. J Formos Med Assoc 2020; 120:1202-1211. [PMID: 33158698 DOI: 10.1016/j.jfma.2020.10.006] [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: 05/27/2020] [Revised: 08/09/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND/PURPOSE Prognostic factors remain unclear in patients undergoing transcatheter implantation of Venus P-valve for their severe pulmonary regurgitation associated with native right ventricular (RV) outflow tract. METHOD Between January 2017 and October 2018, we prospectively collected data of patient characteristics, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) before and 6-12 months after valve graft implantation. RESULTS Fifteen patients (male: 8, median age: 24.8 years) were enrolled. The procedure success rate was 100%. The median follow-up was 16.3 months without any dysfunction of the valve graft. The cohort demonstrated a significant improvement in cardiac index (from 3.3 to 3.9 L/min/m2) and increase of percentage of New York Heart Association functional class I (P < 10-3), reduction in RV end-diastolic volume index (P = 0.008), and reductions in NT-proBNP levels (from 78.9 to 45.8 pg/mL, P = 0.040). However, the peak oxygen consumption (VO2) dropped from 50.2% to 48.5% of the predicted value. Interestingly, we determined that patients with NT-proBNP levels below 70 pg/mL and left ventricular end-diastolic pressure (LVEDP) below 11 mmHg had a significantly higher chance of exhibiting improvement in peak VO2 compared with those without (3/4 vs 1/10, P = 0.041). CONCLUSION In the small cohort with severe pulmonary regurgitation, implantation of a Venus P-valve led to promising reductions in RV volume. However, no definite improvement in cardiopulmonary exercise capacity or RV ejection fraction was achieved. Levels of NT-proBNP and LVEDP may be helpful for refining the indications of the Venus P-valve implantation.
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Affiliation(s)
- Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Radiology, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
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Chiu SN, Weng KP, Lin MC, Wang JN, Hwang BT, Dai ZK, Lin SM, Chang JS, Lin IC, Wu MH, Lu CW, Lin MT, Chen CA, Hua YC, Wu JM, Wang JK. Congenital heart disease with pulmonary artery hypertension in an Asian cohort-initial report from TACHYON (TAiwan congenital heart disease associated with pulmonarY arterial hypertension) registry. Int J Cardiol 2020; 317:49-55. [PMID: 32522677 DOI: 10.1016/j.ijcard.2020.05.086] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/06/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prospective registry studies of congenital heart disease (CHD)-associated pulmonary artery hypertension (PAH) are rare. We established a multicenter registry of CHD-PAH: the TACHYON (TAiwan Congenital Heart disease associated with pulmonarY arterial hypertension) registry. METHODS The prospective TACHYON registry was initiated in January 2016. Nine pediatric cardiology centers with 99 patients were included. Using this database, we evaluated clinical characteristics and outcomes. RESULTS Twelve patients with incomplete data were excluded. For the remaining 87 patients, mean age of enrollment was 37.4(SD 18.2) years, and the male to female ratio was 60:27. PAH after defect closure accounted for 46 (52.9%) and Eisenmenger syndrome for 30 (34.5%) cases. Atrial septal defect was the most common (48.3%) disease, followed by ventricular septal defect. Mean pulmonary artery pressure was 56.7 (SD 19.4) mmHg. PAH-targeted therapy was used in 95.4% of patients. Sildenafil and bosentan were the most common drugs. After mean 23.9 months of follow-up, the 2-year Kaplan-Meier survival rate was 93.2%. According to univariate Cox regression analysis, significant risk factors included right heart failure signs, symptom progression, high-risk baseline N-terminal pro-brain natriuretic peptide (BNP)/BNP, high-risk baseline 6-min walking distance (6MWD), and high baseline hemoglobin/hematocrit level. Using the three noninvasive parameters (functional class, 6MWD, NT-pro BNP/BNP) proposed by the European Society of Cardiology, the total number of high-risk criteria predicted survival rate reliably. CONCLUSIONS Using the TACHYON registry is feasible, but the physicians' adherences to guidelines are unsatisfactory. Midterm outcomes of PAH-target therapy are favorable and predictable using noninvasive parameters.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ken-Pen Weng
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Chih Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Be-Tau Hwang
- Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Shan-Miao Lin
- Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jeng-Sheng Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - I-Chun Lin
- Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | | | - Jing-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
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Tsai KH, Wang WC, Cheng CH, Tsai CY, Wang JK, Lin TH, Fang SH, Chen LC, Tsao Y. Blind Monaural Source Separation on Heart and Lung Sounds Based on Periodic-Coded Deep Autoencoder. IEEE J Biomed Health Inform 2020; 24:3203-3214. [PMID: 32795973 DOI: 10.1109/jbhi.2020.3016831] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Auscultation is the most efficient way to diagnose cardiovascular and respiratory diseases. To reach accurate diagnoses, a device must be able to recognize heart and lung sounds from various clinical situations. However, the recorded chest sounds are mixed by heart and lung sounds. Thus, effectively separating these two sounds is critical in the pre-processing stage. Recent advances in machine learning have progressed on monaural source separations, but most of the well-known techniques require paired mixed sounds and individual pure sounds for model training. As the preparation of pure heart and lung sounds is difficult, special designs must be considered to derive effective heart and lung sound separation techniques. In this study, we proposed a novel periodicity-coded deep auto-encoder (PC-DAE) approach to separate mixed heart-lung sounds in an unsupervised manner via the assumption of different periodicities between heart rate and respiration rate. The PC-DAE benefits from deep-learning-based models by extracting representative features and considers the periodicity of heart and lung sounds to carry out the separation. We evaluated PC-DAE on two datasets. The first one includes sounds from the Student Auscultation Manikin (SAM), and the second is prepared by recording chest sounds in real-world conditions. Experimental results indicate that PC-DAE outperforms several well-known separation works in terms of standardized evaluation metrics. Moreover, waveforms and spectrograms demonstrate the effectiveness of PC-DAE compared to existing approaches. It is also confirmed that by using the proposed PC-DAE as a pre-processing stage, the heart sound recognition accuracies can be notably boosted. The experimental results confirmed the effectiveness of PC-DAE and its potential to be used in clinical applications.
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Chien YH, Wang HH, Lin MT, Lin HC, Lu CW, Chiu SN, Wu MH, Wang JK, Chen CA. Device deformation and left pulmonary artery obstruction after transcatheter patent ductus arteriosus closure in preterm infants. Int J Cardiol 2020; 312:50-55. [DOI: 10.1016/j.ijcard.2020.02.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/15/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
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Chen CA, Wang JK, Lin MT, Chiu HH, Hsu JY, Lin SM, Chang YM, Chiu SN, Lu CW, Wu MH, Yang MC. Exercise Capacity and Ventricular Remodeling After Transcatheter Ventricular Septal Defect Closure in Asymptomatic or Minimally Symptomatic Adolescents and Adults. Circ Cardiovasc Interv 2020; 13:e008813. [PMID: 32519889 DOI: 10.1161/circinterventions.119.008813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcatheter ventricular septal defect (VSD) closure is a safe and efficacious alternative to surgery. However, its benefits in asymptomatic or minimally symptomatic patients remain unknown. METHODS Sixty patients with VSD aged 12 to 60 years underwent cardiopulmonary exercise test and echocardiography 1 day before transcatheter VSD closure and 6 months after intervention (closure group). Thirty patients who did not receive the intervention underwent the same evaluations over 6 months (observation group). RESULTS No significant change in exercise function was observed after VSD closure, except for increased peak oxygen (O2) pulse (absolute increase: 0.4±1.4 mL/beat). Left ventricular end-diastolic dimension and mitral peak early filling velocity-to-early diastolic annular velocity ratio decreased (absolute decrease: 0.3±0.6 cm and 0.7±1.9, respectively). Despite unchanged overall peak O2 consumption, 33% of closure group patients exhibited clinically significant improvements in peak O2 consumption (>10% increase relative to baseline). This was not related to the pulmonary flow-to-systemic flow ratio or baseline exercise capacity. By contrast, all exercise function parameters deteriorated significantly in the observation group. Subgroup analysis revealed that patients with a baseline left ventricular end-diastolic dimension Z score of >2 exhibited a significantly greater improvement in peak O2 consumption, peak O2 pulse, and oxygen uptake efficiency slope than did the observation group. CONCLUSIONS Compared with conservative management, transcatheter VSD closure prevents deterioration in exercise capacity and promotes left ventricular reverse remodeling in asymptomatic or minimally symptomatic patients. These benefits are most prominent in patients whose left ventricular end-diastolic dimension Z score before intervention is >2, irrespective of baseline peak O2 consumption and pulmonary flow/systemic flow ratio. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03127748.
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Affiliation(s)
- Chun-An Chen
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Ming-Tai Lin
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, Taipei Tzu Chi Hospital, New Taipei City, Taiwan (H.-H.C.)
| | - Hsin-Hui Chiu
- Department of Pediatrics, Taipei Tzu Chi Hospital, New Taipei City, Taiwan (H.-H.C.)
| | - Jui-Yu Hsu
- Dianthus MFM clinic, Taipei, Taiwan (J.-Y.H., Y.-M.C.)
| | - Shu-Man Lin
- Department of Anesthesiology, National Yang-Ming University, Taipei, Taiwan (S.-M.L.)
| | - Ya-Mei Chang
- Dianthus MFM clinic, Taipei, Taiwan (J.-Y.H., Y.-M.C.)
| | - Shuenn-Nan Chiu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Chun-Wei Lu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Mei-Hwan Wu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.).,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei (C.-A.C., J.-K.W., M.-T.L., S.-N.C., C.-W.L., M.-H.W.)
| | - Ming-Chun Yang
- Department of Pediatrics, E-DA Hospital, Kaoshiung, Taiwan (M.-C.Y.).,College of Medicine, I-SHOU University, Kaohsiung, Taiwan (M.-C.Y.)
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48
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Yang HL, Chang NT, Wang JK, Lu CW, Huang YC, Moons P. Comorbidity as a mediator of depression in adults with congenital heart disease: A population-based cohort study. Eur J Cardiovasc Nurs 2020; 19:732-739. [PMID: 32429700 DOI: 10.1177/1474515120923785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The population of adults with congenital heart disease (CHD) has increased dramatically with a high prevalence of acquired cardiac and non-cardiac comorbidities. However, the relationship among congenital heart disease, physical comorbidities, and psychological health in this population is not well studied. AIMS The purpose of this study was to investigate (a) the association between adult congenital heart disease and the occurrence of depression and (b) whether physical comorbidities mediated the association between congenital heart disease and the occurrence of depression. METHODS This retrospective cohort study was followed from 1 January 2010-31 December 2013, based on the data from the National Health Insurance Research Database 2010 in Taiwan. We used mediation analysis in survival data to assess the mediated effect. The hazard ratios were adjusted by age, sex, area of residence, and estimated propensity scores. RESULTS We recruited 2122 adult congenital heart disease patients and 8488 matched controls. Nearly half of patients diagnosed with simple congenital heart disease, 39.0% had complex congenital heart disease, and 11.2% had unclassified congenital heart disease. Adult congenital heart disease patients had a significantly higher risk of depression than matched controls (adjusted hazard ratio = 1.43 and 1.48, for all and complex congenital heart disease, respectively, p<0.05). Coronary artery disease and chronic obstructive pulmonary disease were the significant comorbidities mediating the relationship between adult congenital heart disease and depression, the proportions mediated by coronary artery disease or chronic obstructive pulmonary disease were 35.5% and 12.9%, respectively. CONCLUSIONS Helping patients to prevent psychological and physical acquired disease is imperative. Coronary artery disease is a potent mediator between congenital heart disease and depression, especially for patients with complex congenital heart disease.
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Affiliation(s)
- Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taiwan
| | - Jou-Kou Wang
- National Taiwan University Children's Hospital, Taiwan
| | - Chun-Wei Lu
- National Taiwan University Children's Hospital, Taiwan
| | - Yong-Chen Huang
- School of Nursing, College of Medicine, National Taiwan University, Taiwan.,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taiwan
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
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Lin HC, Lin MT, Chen CA, Hsu JY, Lin SM, Wu MH, Wang JK. Safety and efficacy of transcatheter closure of outlet-type ventricular septal defects in children and adults with Amplatzer Duct Occluder II. J Formos Med Assoc 2020; 120:180-188. [PMID: 32402520 DOI: 10.1016/j.jfma.2020.04.015] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/26/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND/PURPOSE Outlet-type VSD is frequently associated with aortic valve prolapse that surgery is frequently required. The literature regarding outcomes of transcatheter closure of outlet-type VSDs is scant. This study was conducted to know the safety and efficacy of transcatheter closure of outlet-type ventricular septal defects (VSDs) with Amplatzer Duct Occluder II (ADO II). METHODS Medical records of patients underwent attempted transcatheter closure of outlet-type VSD with ADO II between October 2013 and August 2019 were retrospectively reviewed. RESULTS Among 49 patients, transcatheter closure was successful in 45 (91.8%; 33 males and 12 females; mean [± standard deviation] age and body weight: 15.8 (±17.7) years and 36.6 (±23.3) kg, respectively). The median VSD diameter was 4.0 mm (range: 1.2-6.0 mm). Device closure failed in four because the sheath could not be advanced through a prograde or retrograde route in one patient, occluder embolization in the two patients, and failed right ventricular disc anchoring in one patient. After a mean follow-up of 22.7 months (range: 0.3-51.1 months), only nine (20.0%) patients had increased severity in aortic regurgitation (AR) on the echocardiography. Preprocedural AR decreased in severity or even disappeared in 11 (24.4%) patients. No heart block or device failure occurred during follow-up. A trivial-to-small residual shunt was detected in 19 patients (42.2%) in the most recent echocardiography. CONCLUSION Transcatheter closure of outlet-type VSDs with ADO II is feasible. Although no significant aggravation of AR was observed in the short-to-mid-term follow-up, long-term follow-up is mandatory.
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Affiliation(s)
- Hsin-Chia Lin
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Douliu, Yunlin, Taiwan
| | - Ming-Tai Lin
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jui-Yu Hsu
- Department of Pediatrics, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Su-Man Lin
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan.
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Zhu JZ, Zhao TT, Chen YY, Zhang R, Wang JK, Zhang SH, Liu KC. Liver failure promotes gastrointestinal dysfunction by changing cholinergic and nitrergic nerves and Cajal interstitial cells in gastric antrum. J BIOL REG HOMEOS AG 2020; 33:1803-1809. [PMID: 31989809 DOI: 10.23812/19-243-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J Z Zhu
- Department of Hepatal-Gastroenterology, Meng chao Hepato-biliary Hospital of Fujian Medical University, Fuzhou, China
| | - T T Zhao
- Institute for Laboratory Medicine, 900 Hospital of the Joint Logistics Team, Dongfang Hospital, Fuzhou, Fujian, China.,School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Y Y Chen
- Institute for Laboratory Medicine, 900 Hospital of the Joint Logistics Team, Dongfang Hospital, Fuzhou, Fujian, China.,School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - R Zhang
- Institute for Laboratory Medicine, 900 Hospital of the Joint Logistics Team, Dongfang Hospital, Fuzhou, Fujian, China
| | - J K Wang
- School of Life Science, Xiamen University, Xiamen, Fujian, China
| | - S H Zhang
- School of Life Sciences, Central South University, Changsha, Hunan, China.,School of Life Sciences, University of Dundee, Nethergate, Dundee, Scotland, UK
| | - K C Liu
- Institute for Laboratory Medicine, 900 Hospital of the Joint Logistics Team, Dongfang Hospital, Fuzhou, Fujian, China.,School of Medicine, Xiamen University, Xiamen, Fujian, China
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