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Patel D, Avesani M, Johnson MR, Di Salvo G, Savvidou MD. Maternal cardiovascular adaptation to pregnancy in obese pregnant women. Acta Obstet Gynecol Scand 2024; 103:907-916. [PMID: 38238936 PMCID: PMC11019532 DOI: 10.1111/aogs.14777] [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] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Obesity is known to be associated with cardiovascular compromise and a major risk factor for the development of hypertensive disorders in pregnancy. However, little is known about the effect of obesity on maternal cardiac function. The aim of this study was to investigate the effect of obesity on the maternal cardiovascular system. MATERIAL AND METHODS This was a prospective, observational, longitudinal study. Pregnant women with booking body mass index (BMI) ≥30 kg/m2 were compared with pregnant women with normal booking BMI 20-24.9 kg/m2. Participants were seen at three time points during pregnancy; 12-14, 20-24 and 30-32 weeks. At all visits, maternal blood pressure (BP) was measured, and cardiac geometry and function were assessed using two-dimensional trans-thoracic echocardiography. Multilevel linear mixed-effects models were used for all the comparisons. RESULTS Fifty-nine pregnant women with obesity were compared with 14 pregnant women with normal BMI. In women with obesity, the maternal BP, heart rate and cardiac output were higher and peripheral vascular resistance was lower (p < 0.01 for all comparisons) compared with normal BMI women. Women with obesity had altered cardiac geometry with higher left ventricular end diastolic diameter, intraventricular septal thickness, posterior wall diameter, relative wall thickness and left ventricular mass (p < 0.001 for all comparisons). There was also evidence of impaired diastolic indices in the obese group with a lower E/A ratio, tissue Doppler imaging E' lateral and medial and higher left atrial volume (p < 0.01 for all comparisons). Finally, women with obesity had reduced longitudinal function, as assessed by mitral plane annular systolic excursion, between the second and third trimester of pregnancy, indicating possible early cardiac dysfunction in this group. CONCLUSIONS Obesity is associated with maternal hyperdynamic circulation, altered cardiac geometry and suboptimal diastolic function, compared with normal BMI pregnant women, and these factors may contribute to the increased risk of complications in obese pregnant women.
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Affiliation(s)
- Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, Department of MetabolismDigestion and Reproduction, Imperial CollegeLondonUK
| | - Martina Avesani
- Royal Brompton HospitalRoyal Brompton and Harefield NHS Foundation trustLondonUK
| | - Mark R. Johnson
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, Department of MetabolismDigestion and Reproduction, Imperial CollegeLondonUK
| | - Giovanni Di Salvo
- Royal Brompton HospitalRoyal Brompton and Harefield NHS Foundation trustLondonUK
| | - Makrina D. Savvidou
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, Department of MetabolismDigestion and Reproduction, Imperial CollegeLondonUK
- Fetal Medicine UnitChelsea & Westminster HospitalLondonUK
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Avesani M, Sabatino J, Borrelli N, Cattapan I, Leo I, Pelaia G, Moscatelli S, Bianco F, Bassareo P, Martino F, Leonardi B, Oreto L, Guccione P, Di Salvo G. The mechanics of congenital heart disease: from a morphological trait to the functional echocardiographic evaluation. Front Cardiovasc Med 2024; 11:1301116. [PMID: 38650919 PMCID: PMC11033364 DOI: 10.3389/fcvm.2024.1301116] [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: 09/24/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Advances in pediatric cardiac surgery have resulted in a recent growing epidemic of children and young adults with congenital heart diseases (CHDs). In these patients, congenital defects themselves, surgical operations and remaining lesions may alter cardiac anatomy and impact the mechanical performance of both ventricles. Cardiac function significantly influences outcomes in CHDs, necessitating regular patient follow-up to detect clinical changes and relevant risk factors. Echocardiography remains the primary imaging method for CHDs, but clinicians must understand patients' unique anatomies as different CHDs exhibit distinct anatomical characteristics affecting cardiac mechanics. Additionally, the use of myocardial deformation imaging and 3D echocardiography has gained popularity for enhanced assessment of cardiac function and anatomy. This paper discusses the role of echocardiography in evaluating cardiac mechanics in most significant CHDs, particularly its ability to accommodate and interpret the inherent anatomical substrate in these conditions.
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Affiliation(s)
- Martina Avesani
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
| | - Jolanda Sabatino
- Paediatric Cardiology and Congenital Heart Disease Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, Naples, Italy
| | - Irene Cattapan
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Giulia Pelaia
- Paediatric Unit, Department of Science of Health, Magna Graecia University, Catanzaro, Italy
| | - Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Francesco Bianco
- Department of Pediatrics and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
| | - PierPaolo Bassareo
- Department of Cardiology, Mater Misericordiae University Hospital and Our Lady’s Children’s Hospital, University College of Dublin, Crumlin, Ireland
| | - Francesco Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesu Children’s Hospital and Research Institute, IRCCS, Rome, Italy
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesu Children’s Hospital and Research Institute, IRCCS, Rome, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
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Avesani M, Jalal Z, Friedberg MK, Villemain O, Venet M, Di Salvo G, Thambo JB, Iriart X. Adverse remodelling in tetralogy of Fallot: From risk factors to imaging analysis and future perspectives. Hellenic J Cardiol 2024; 75:48-59. [PMID: 37495104 DOI: 10.1016/j.hjc.2023.07.008] [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: 02/20/2023] [Revised: 05/29/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
Although contemporary outcomes of initial surgical repair of tetralogy of Fallot (TOF) are excellent, the survival of adult patients remains significantly lower than that of the normal population due to the high incidence of heart failure, ventricular arrhythmias, and sudden cardiac death. The underlying mechanisms are only partially understood but involve an adverse biventricular response, so-called remodelling, to key stressors such as right ventricular (RV) pressure-and/or volume-overload, myocardial fibrosis, and electro-mechanical dyssynchrony. In this review, we explore risk factors and mechanisms of biventricular remodelling, from histological to electro-mechanical aspects, and the role of imaging in their assessment. We discuss unsolved challenges and future directions to better understand and treat the long-term sequelae of this complex congenital heart disease.
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Affiliation(s)
- Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Pessac, France; Paediatric Cardiology Unit, Department of Woman's and Child's Health, University-Hospital of Padova, University of Padua, Padua, Italy
| | - Zakaria Jalal
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Pessac, France
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Olivier Villemain
- Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maeyls Venet
- Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Department of Woman's and Child's Health, University-Hospital of Padova, University of Padua, Padua, Italy
| | - Jean-Benoît Thambo
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Pessac, France
| | - Xavier Iriart
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Pessac, France.
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4
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Leo I, Sabatino J, Avesani M, Moscatelli S, Bianco F, Borrelli N, De Sarro R, Leonardi B, Calcaterra G, Surkova E, Di Salvo G. Non-Invasive Imaging Assessment in Patients with Aortic Coarctation: A Contemporary Review. J Clin Med 2023; 13:28. [PMID: 38202035 PMCID: PMC10779918 DOI: 10.3390/jcm13010028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Coarctation of the aorta (CoA) is a congenital abnormality characterized by a narrowing of the aortic lumen, which can lead to significant morbidity and mortality if left untreated. Even after repair and despite significant advances in therapeutic management, these patients have overall reduced long-term survival due to the consequences of chronic afterload increase. Cardiovascular imaging is key from the first diagnosis to serial follow-up. In recent years, novel imaging techniques have emerged, increasing accessibility to advanced imaging modalities and enabling early and non-invasive identification of complications after repair. The aim of this paper is to provide a comprehensive review of the role of different imaging techniques in the evaluation and management of patients with native or repaired CoA, highlighting their unique strengths and limitations.
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Affiliation(s)
- Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (I.L.)
- CMR Unit, Royal Brompton and Harefield Hospitals, London SW3 5NP, UK;
| | - Jolanda Sabatino
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (I.L.)
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
| | - Sara Moscatelli
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital, London WC1N 3JH, UK;
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Rosalba De Sarro
- Department of Experimental and Clinical Medicine, University of Messina, 98166 Messina, Italy;
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | | | - Elena Surkova
- CMR Unit, Royal Brompton and Harefield Hospitals, London SW3 5NP, UK;
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
- Paediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy
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5
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Moscatelli S, Pergola V, Motta R, Fortuni F, Borrelli N, Sabatino J, Leo I, Avesani M, Montanaro C, Surkova E, Mapelli M, Perrone MA, di Salvo G. Multimodality Imaging Assessment of Tetralogy of Fallot: From Diagnosis to Long-Term Follow-Up. Children (Basel) 2023; 10:1747. [PMID: 38002838 PMCID: PMC10670209 DOI: 10.3390/children10111747] [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] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common complex congenital heart disease with long-term survivors, demanding serial monitoring of the possible complications that can be encountered from the diagnosis to long-term follow-up. Cardiovascular imaging is key in the diagnosis and serial assessment of TOF patients, guiding patients' management and providing prognostic information. Thorough knowledge of the pathophysiology and expected sequalae in TOF, as well as the advantages and limitations of different non-invasive imaging modalities that can be used for diagnosis and follow-up, is the key to ensuring optimal management of patients with TOF. The aim of this manuscript is to provide a comprehensive overview of the role of each modality and common protocols used in clinical practice in the assessment of TOF patients.
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Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Valeria Pergola
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Raffaella Motta
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
- Department of Cardiology, Leiden University Medical Center, 2300 Leiden, The Netherlands
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas's NHS Foundation Trust, London SW3 5NP, UK
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Elena Surkova
- Department of Echocardiography, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Marco Alfonso Perrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Division of Cardiology and Cardio Lab, Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giovanni di Salvo
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
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6
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Di Salvo G, Cattapan I, Fumanelli J, Pozza A, Moscatelli S, Sabatino J, Avesani M, Reffo E, Sirico D, Castaldi B, Cerutti A, Biffanti R, Pergola V. Childhood Obesity and Congenital Heart Disease: A Lifelong Struggle. J Clin Med 2023; 12:6249. [PMID: 37834891 PMCID: PMC10573337 DOI: 10.3390/jcm12196249] [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: 07/31/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Congenital heart disease (CHD) affects approximately one in every one hundred infants worldwide, making it one of the most prevalent birth abnormalities globally. Despite advances in medical technology and treatment choices, CHD remains a significant health issue and necessitates specialized care throughout an individual's life. Childhood obesity has emerged as a novel global epidemic, becoming a major public health issue, particularly in individuals with lifelong conditions such as CHD. Obesity has profound effects on cardiac hemodynamics and morphology, emphasizing the importance of addressing obesity as a significant risk factor for cardiovascular health. Obesity-induced alterations in cardiac function can have significant implications for cardiovascular health and may contribute to the increased risk of heart-related complications in obese individuals. Moreover, while diastolic dysfunction may be less apparent in obese children compared to adults, certain parameters do indicate changes in early left ventricular relaxation, suggesting that obesity can cause cardiac dysfunction even in pediatric populations. As most children with CHD now survive into adulthood, there is also concern about environmental and behavioral health risk factors in this particular patient group. Addressing obesity in individuals with CHD is essential to optimize their cardiovascular health and overall quality of life. This review aims to succinctly present the data on the impact of obesity on CHD and to enhance awareness of this perilous association among patients, families, and healthcare providers.
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Affiliation(s)
- Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Irene Cattapan
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Jennifer Fumanelli
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Alice Pozza
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Sara Moscatelli
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Jolanda Sabatino
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Martina Avesani
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Elena Reffo
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Domenico Sirico
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Biagio Castaldi
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Alessia Cerutti
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Roberta Biffanti
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Valeria Pergola
- Cardiology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy;
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Pergola V, Avesani M, Reffo E, Da Pozzo S, Cavaliere A, Padalino M, Vida V, Motta R, Di Salvo G. Unveiling the gothic aortic arch and cardiac mechanics: insights from young patients after arterial switch operation for d-transposition of the great arteries. Monaldi Arch Chest Dis 2023; 94. [PMID: 37768214 DOI: 10.4081/monaldi.2023.2712] [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: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The arterial switch operation (ASO) has become the standard surgical treatment for patients with d-transposition of the great arteries. While ASO has significantly improved survival rates, a subset of patients develop a unique anatomical anomaly known as the gothic aortic arch (GAA). Understanding cardiac mechanics in this population is crucial, as altered mechanics can have profound consequences for cardiac function and exercise capacity. The GAA has been associated with changes in ventricular function, hemodynamics, and exercise capacity. Studies have shown a correlation between the GAA and decreased ascending aorta distensibility, loss of systolic wave amplitude across the aortic arch, and adverse cardiovascular outcomes. Various imaging techniques, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, play a crucial role in assessing cardiac mechanics and evaluating the GAA anomaly. Despite significant advancements, gaps in knowledge regarding the prognostic implications and underlying mechanisms of the GAA anomaly remain. This review aims to explore the implications of the GAA anomaly on cardiac mechanics and its impact on clinical outcomes in young patients after ASO. Advancements in imaging techniques, such as computational modeling, offer promising avenues to enhance our understanding of cardiac mechanics and improve clinical management.
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Affiliation(s)
- Valeria Pergola
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | - Elena Reffo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | | | | | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Raffaella Motta
- Radiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua.
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
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Avesani M, Sabatino J, Sirico D, Di Salvo G. Unusual case of severe aortic regurgitation in a child with bicuspid aortic valve. Monaldi Arch Chest Dis 2023. [PMID: 37675920 DOI: 10.4081/monaldi.2023.2713] [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] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
Aortic regurgitation (AR) is common after aortic balloon valvuloplasty in children and it has been associated with large balloon/annulus ratio, abnormal valve morphology and aortic valve prolapse. We present a rare case of severe AR after aortic balloon valvuloplasty due to aortic strands rupture, causing prolapse of the co-joined cusp. These findings were identified by 3D echocardiography, highlighting the importance of this imaging technique even in pediatric patients.
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Affiliation(s)
- Martina Avesani
- Department of Women's and Children's Health, University of Padua; Paediatric Research Institute (IRP), Foundation Città Della Speranza, Padua.
| | - Jolanda Sabatino
- Department of Women's and Children's Health, University of Padua; Paediatric Research Institute (IRP), Foundation Città Della Speranza, Padua.
| | - Domenico Sirico
- Department of Women's and Children's Health, University of Padua; Paediatric Research Institute (IRP), Foundation Città Della Speranza, Padua.
| | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua; Paediatric Research Institute (IRP), Foundation Città Della Speranza, Padua.
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Borrelli N, Di Salvo G, Ciriello GD, Sabatino J, Avesani M, Leo I, Barracano R, Scognamiglio G, Russo MG, Sarubbi B. Myocardial work in children with Wolff-Parkinson-White syndrome. Int J Cardiovasc Imaging 2023; 39:1697-1705. [PMID: 37244886 DOI: 10.1007/s10554-023-02883-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardial deformation, and when left ventricular dysfunction is present, catheter ablation of the accessory pathway may be required, even in asymptomatic patients. We aimed to evaluate the diagnostic value of non-invasive myocardial work in predicting subtle abnormalities in myocardial performance in children with WPW.Seventy-five paediatric patients (age 8.7 ± 3.5 years) were retrospectively recruited for the study: 25 cases with manifest WPW and 50 age- and sex- matched controls (CTR). Global myocardial work index (MWI) was measured as the area of the left ventricle (LV) pressure-strain loops. From MWI, global Myocardial Constructive Work (MCW), Wasted Work (MWW), and Work Efficiency (MWE) were estimated. In addition, standard echocardiographic parameters of LV function were evaluated. Despite normal LV ejection fraction (EF) and global longitudinal strain (GLS), children with WPW had worse MWI, MCW, MWW, and MWE. At multivariate analysis, MWI and MCW were associated with GLS and systolic blood pressure, and QRS was the best independent predictor of low MWE and MWW. In particular, a QRS > 110 ms showed good sensitivity and specificity for worse MWE and MWW values. In children with WPW, myocardial work indices were found significantly reduced, even in the presence of normal LV EF and GLS. This study supports the systematic use of myocardial work during the follow-up of paediatric patients with WPW. Myocardial work analysis may represent a sensitive measure of LV performance and aid in decision-making.
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Affiliation(s)
- Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Giovanni Domenico Ciriello
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Jolanda Sabatino
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Isabella Leo
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Maria Giovanna Russo
- Division of Paediatric Cardiology, University of Campania 'Luigi Vanvitelli', AO Dei Colli, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
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10
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Piperata A, Van den Eynde J, Pernot M, Avesani M, Seguy B, Bonnet G, Ben Ali W, Leroux L, Labrousse L, Modine T. Impact of Valve Academic Research Consortium 3 (VARC-3) minor access site vascular complications in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2023; 64:ezad255. [PMID: 37410123 DOI: 10.1093/ejcts/ezad255] [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: 02/15/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the impact of Valve Academic Research Consortium 3 minor access site vascular complications (VCs) in patients who underwent percutaneous transfemoral (TF) transcatheter aortic valve implantation (TAVI). METHODS This single-centre retrospective study included consecutive patients who underwent percutaneous TF-TAVI from 2009 to 2021. A propensity score-matched analysis was performed to compare early and long-term clinical results between patients with VC and without VC (nVC). RESULTS A total of 2161 patients were included, of whom 284 (13.1%) experienced access site VC. Propensity score analysis allowed to match 270 patients from the VC group with 727 patients from the nVC group. In the matched cohorts, the VC group showed longer operative times (63.5 vs 50.0 min, P < 0.001), higher operative and in-hospital mortality (2.6% vs 0.7%, P = 0.022; and 6.3% vs 3.2%, P = 0.040, respectively), longer hospital length of stay (8 vs 7 days, P = 0.001) and higher rates of blood transfusion (20.4% vs 4.3%, P < 0.001) and infectious complications (8.9% vs 3.8%, P = 0.003). Overall survival during follow-up was significantly lower in the VC group (hazard ratio 1.37, 95% CI 1.03-1.82, P = 0.031) with 5-year survival rates being 58.0% (95% CI 49.5-68.0%) and 70.7% (95% CI 66.2-75.5%) for the VC and nVC groups, respectively. CONCLUSIONS This retrospective study observed that minor access site VCs during percutaneous TF-TAVI can be serious events affecting early and long-term outcomes.
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Affiliation(s)
- Antonio Piperata
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Mathieu Pernot
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Martina Avesani
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Seguy
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Guillaume Bonnet
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
| | - Lionel Leroux
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Louis Labrousse
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
| | - Thomas Modine
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France
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11
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Sirico D, Spigariol G, Mahmoud HT, Basso A, Cuppini E, Avesani M, Sabatino J, Castaldi B, Di Salvo G. Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study. J Clin Med 2023; 12:4344. [PMID: 37445378 DOI: 10.3390/jcm12134344] [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: 05/13/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Pulmonary valve stenosis determines multiple effects on the right ventricular dimension and function. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages. However, little is known regarding right ventricular function immediate changes after percutaneous balloon dilation. Pediatric patients with isolated pulmonary valve stenosis represent a pure clinical model of chronic RV pressure overload not affected by other confounders or comorbidities. AIM OF THE STUDY This study seeks to explore right ventricle (RV) mechanics in pediatric patients early after percutaneous balloon pulmonary valvuloplasty (BPV) for valvar pulmonary stenosis (PS). MATERIALS AND METHODS Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years old, with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent standard transthoracic echocardiography (TTE), and speckle-tracking echocardiography (STE) with an analysis of right ventricle free-wall longitudinal strain (RVFWLS) one day before and one day after the procedure. For each patient, we collected invasive parameters during the interventional procedure before and after BPV. RESULTS After the procedure, there was an immediate significant reduction in both peak-to-peak transpulmonary gradient (peak-to-peak PG) and ratio between the right ventricle and aortic systolic pressure (RV/AoP) with a drop of ∆29.3 ± 14.67 mmHg and ∆0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (∆50 ± 32.23 and ∆31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, affecting 29% of our patients post-BPV (p = 0.007). The analysis of right ventricular mechanics showed a significant improvement of fractional area change (FAC) immediately after BPV (40.11% vs. 44.42%, p = 0.01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE and global RVFWLS, did not improve significantly after intervention. The segmental analysis of the RVFWLS showed a significant regional increase in the myocardial deformation of the apical segments. CONCLUSIONS Percutaneous BPV represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. The analysis of the right ventricular function on echocardiography demonstrated an immediate global systolic function improvement, while longitudinal systolic function was persistently impaired 24 h after intervention, possibly due to the necessity of a longer recovery time.
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Affiliation(s)
- Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Giulia Spigariol
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Heba Talat Mahmoud
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Alessia Basso
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Elena Cuppini
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Martina Avesani
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
- Experimental Cardiology, Paediatric Research Institute (IRP), Città della Speranza, University of Padova, 35122 Padua, Italy
| | - Biagio Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
- Experimental Cardiology, Paediatric Research Institute (IRP), Città della Speranza, University of Padova, 35122 Padua, Italy
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12
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Piperata A, Van Den Eynde J, Pernot M, Busuttil O, Avesani M, Bottio T, Lafitte S, Modine T, Labrousse L. Long-term outcomes of concomitant suture bicuspidization technique to treat mild or moderate tricuspid regurgitation in patients undergoing mitral valve surgery. Eur J Cardiothorac Surg 2023:7174144. [PMID: 37208162 DOI: 10.1093/ejcts/ezad201] [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: 01/04/2023] [Revised: 04/19/2023] [Accepted: 05/18/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES To investigate the long-term outcomes of concomitant suture bicuspidization to treat mild or moderate tricuspid regurgitation at the time of mitral valve surgery. METHODS Data from patients who underwent mitral valve surgery for degenerative mitral valve regurgitation with mild or moderate tricuspid regurgitation and annular dilatation between January 2009 and December 2017 were analyzed. The cohort was divided into 2 groups: mitral valve surgery alone and mitral valve surgery with concomitant tricuspid valve repair. RESULTS A total of 196 patients were included in the study. Mitral valve surgery alone and mitral valve surgery with concomitant tricuspid valve repair were performed in 91 (46.4%) and 105 (53.6%) patients, respectively. Propensity score matching analysis identified 54 pairs. In the matched cohort, 30-day mortality (0.0% vs 1.9%, P = 1.0) and new permanent pacemaker implantation (11.1% vs 7.4%, P = 0.740) did not differ significantly between groups. After a mean follow-up of 6.0 (2.8) years, mitral valve surgery with concomitant tricuspid valve repair was not associated with increased mortality risk compared to mitral valve surgery alone (hazard ratio 1.04, 95% confidence interval 0.47-2.28, P = 0.927) with 10-year overall survival rates of 69.9% and 77.2%, respectively. Furthermore, mitral valve surgery with concomitant tricuspid valve repair was associated with a significantly reduced progression of tricuspid valve regurgitation (P < 0.001). CONCLUSION Patients undergoing mitral valve surgery with concomitant tricuspid valve repair had similar 30-day and long-term survival, similar permanent pacemaker implantation rate, and reduced progression of tricuspid valve regurgitation compared to those undergoing mitral valve surgery alone.
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Affiliation(s)
- Antonio Piperata
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, 33604, France
| | - Jef Van Den Eynde
- Department of Cardiovascular Sciences, KU Leuven, Belgium
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, United States
| | - Mathieu Pernot
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, 33604, France
| | - Olivier Busuttil
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, 33604, France
| | - Martina Avesani
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, 33604, France
| | - Tomaso Bottio
- Cardiac surgery unit, department of emergency and organ transplant, University of Bari. Piazza Umberto I, 70121, Bari, Italy
| | - Stephane Lafitte
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, 33604, France
| | - Thomas Modine
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, 33604, France
| | - Louis Labrousse
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, 33604, France
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13
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Vasile CM, Bouteiller XP, Avesani M, Velly C, Chan C, Jalal Z, Thambo JB, Iriart X. Exploring the Potential of Artificial Intelligence in Pediatric Echocardiography-Preliminary Results from the First Pediatric Study Using AI Software Developed for Adults. J Clin Med 2023; 12:3209. [PMID: 37176649 PMCID: PMC10179538 DOI: 10.3390/jcm12093209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: Transthoracic echocardiography is the first-line non-invasive investigation for assessing pediatric patients' cardiac anatomy, physiology, and hemodynamics, based on its accessibility and portability, but complete anatomic and hemodynamic assessment is time-consuming. (2) Aim: This study aimed to determine whether an automated software developed for adults could be effectively used for the analysis of pediatric echocardiography studies without prior training. (3) Materials and Methods: The study was conducted at the University Hospital of Bordeaux between August and September 2022 and included 45 patients with normal or near normal heart architecture who underwent a 2D TTE. We performed Spearman correlation and Bland-Altman analysis. (4) Results: The mean age of our patients at the time of evaluation was 8.2 years ± 5.7, and the main reason for referral to our service was the presence of a heart murmur. Bland-Altman analysis showed good agreement between AI and the senior physician for two parameters (aortic annulus and E wave) regardless of the age of the children included in the study. A good agreement between AI and physicians was also achieved for two other features (STJ and EF) but only for patients older than 9 years. For other features, either a good agreement was found between physicians but not with the AI, or a poor agreement was established. In the first case, maybe proper training of the AI could improve the measurement, but in the latter case, for now, it seems unrealistic to expect to reach a satisfactory accuracy. (5) Conclusion: Based on this preliminary study on a small cohort group of pediatric patients, the AI soft originally developed for the adult population, had provided promising results in the evaluation of aortic annulus, STJ, and E wave.
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Affiliation(s)
- Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Xavier Paul Bouteiller
- IHU Liryc—Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, 33600 Pessac, France
- Department of Cardiology, Rythmology, CHU of Bordeaux, 33600 Pessac, France
| | - Martina Avesani
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padua, 235122 Padova, Italy
| | - Camille Velly
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Camille Chan
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
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Femenia V, Pommier V, Huguet H, Iriart X, Picot MC, Bredy C, Lorca L, De La Villeon G, Guillaumont S, Pasquie JL, Matecki S, Roubertie F, Leobon B, Thambo JB, Jalal Z, Thomas J, Mouton JB, Avesani M, Amedro P. Correlation between three-dimensional echocardiography and cardiopulmonary fitness in patients with univentricular heart: A cross-sectional multicentre prospective study. Arch Cardiovasc Dis 2023; 116:202-209. [PMID: 36966111 DOI: 10.1016/j.acvd.2023.02.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND The prognosis of patients with a functional single ventricle has improved, with better cardiopulmonary fitness, health-related quality of life and survival. Conventional echocardiography remains the first-line technique in single ventricle follow-up. Three-dimensional (3D) echocardiography has shown recent value in congenital cardiology, but its ability to predict functional status in patients with a single ventricle remains unknown. AIM To evaluate, in patients with a single ventricle, the association between 3D echocardiography variables and functional status determined by cardiopulmonary fitness. METHODS Children and adults with a functional single ventricle were prospectively enrolled in this multicentre study. Cardiopulmonary fitness was assessed by cardiopulmonary exercise test, with measures of maximum oxygen uptake (VO2max) and ventilatory efficiency (VE/VCO2 slope). 3D echocardiography was performed with off-line reproducibility analyses, using TomTec Arena™ software. Health-related quality of life was assessed using the SF-36 questionnaire. RESULTS A total of 33 patients were screened, and 3D echocardiography analyses were feasible in 22 subjects (mean age 28±9years). 3D echocardiography ejection fraction correlated with percent-predicted VO2max (r=0.64, P<0.01), VE/VCO2 slope (r=-0.41, P=0.05), two-dimensional echocardiography ejection fraction (r=0.55, P<0.01) and health-related quality of life physical functioning dimension (r=0.56, P=0.04). 3D echocardiography indexed end-systolic volume correlated with percent-predicted VO2max (r=-0.45, P=0.03) and VE/VCO2 slope (r=0.65, P<0.01). 3D echocardiography reproducibility was good. CONCLUSIONS Single ventricle ejection fraction and volumes measured by 3D echocardiography correlated with cardiopulmonary fitness, as determined by two main prognostic cardiopulmonary exercise test variables: VO2max and VE/VCO2 slope. Despite good reproducibility, 3D echocardiography feasibility remained limited. 3D echocardiography may be of value in single ventricle follow-up, provided that the technique and analysis software are improved.
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Affiliation(s)
- Valentin Femenia
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France
| | - Victor Pommier
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, 34250 Palavas-Les-Flots, France
| | - Helena Huguet
- Department of Clinical Research, Biostatistics and Epidemiology, CHU Montpellier, University of Montpellier, 34295 Montpellier, France
| | - Xavier Iriart
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Inserm 1045, University of Bordeaux, 33604 Pessac, France
| | - Marie-Christine Picot
- Department of Clinical Research, Biostatistics and Epidemiology, CHU Montpellier, University of Montpellier, 34295 Montpellier, France
| | - Charlene Bredy
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France
| | - Laura Lorca
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, 34250 Palavas-Les-Flots, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, 34250 Palavas-Les-Flots, France
| | - Jean-Luc Pasquie
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; PhyMedExp, CNRS, Inserm, University of Montpellier, 34090 Montpellier, France
| | - Stefan Matecki
- PhyMedExp, CNRS, Inserm, University of Montpellier, 34090 Montpellier, France; Department of Physiology, University Hospital, 34295 Montpellier, France
| | - François Roubertie
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Inserm 1045, University of Bordeaux, 33604 Pessac, France
| | - Bertrand Leobon
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Inserm 1045, University of Bordeaux, 33604 Pessac, France
| | - Jean-Benoît Thambo
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Inserm 1045, University of Bordeaux, 33604 Pessac, France
| | - Zakaria Jalal
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Inserm 1045, University of Bordeaux, 33604 Pessac, France
| | - Julie Thomas
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France
| | - Jean-Baptiste Mouton
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France
| | - Martina Avesani
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France
| | - Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Inserm 1045, University of Bordeaux, 33604 Pessac, France.
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15
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Moreau J, Socchi F, Renoux MC, Requirand A, Abassi H, Guillaumont S, Matecki S, Huguet H, Avesani M, Picot MC, Amedro P. Cardiopulmonary fitness in children with asthma versus healthy children. Arch Dis Child 2023; 108:204-210. [PMID: 36446481 DOI: 10.1136/archdischild-2021-323733] [Citation(s) in RCA: 1] [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: 12/18/2021] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To evaluate, with a cardiopulmonary exercise test (CPET), the cardiopulmonary fitness of children with asthma, in comparison to healthy controls, and to identify the clinical and CPET parameters associated with the maximum oxygen uptake (VO2max) in childhood asthma. DESIGN This cross-sectional controlled study was carried out in CPET laboratories from two tertiary care paediatric centres. The predictors of VO2max were determined using a multivariable analysis. RESULTS A total of 446 children (144 in the asthma group and 302 healthy subjects) underwent a complete CPET. Mean VO2max was significantly lower in children with asthma than in controls (38.6±8.6 vs 43.5±7.5 mL/kg/min; absolute difference (abs. diff.) of -4.9 mL/kg/min; 95% CI of (-6.5 to -3.3) mL/kg/min; p<0.01) and represented 94%±9% and 107%±17% of predicted values, respectively (abs. diff. -13%; 95% CI (-17 to -9)%; p<0.01). The proportion of children with an impaired VO2max was four times higher in the asthma group (24% vs 6%, p<0.01). Impaired ventilatory efficiency with increased VE/VCO2 slope and low breathing reserve (BR) were more marked in the asthma group. The proportion of children with a decreased ventilatory anaerobic threshold (VAT), indicative of physical deconditioning, was three times higher in the asthma group (31% vs 11%, p<0.01). Impaired VO2max was associated with female gender, high body mass index (BMI), FEV1, low VAT and high BR. CONCLUSION Cardiopulmonary fitness in children with asthma was moderately but significantly altered compared with healthy children. A decreased VO2max was associated with female gender, high BMI and the pulmonary function. TRIAL REGISTRATION NUMBER NCT04650464.
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Affiliation(s)
- Johan Moreau
- Unit of Paediatric Pulmonology and Cardiology, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM 1046, University of Montpellier, Montpellier, France
| | - Floriane Socchi
- Unit of Paediatric Pulmonology and Cardiology, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiopulmonary Rehabilitation Centre, Saint-Pierre Institute, Palavas-les-Flots, France
| | - Marie Catherine Renoux
- Unit of Paediatric Pulmonology and Cardiology, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Anne Requirand
- Unit of Paediatric Pulmonology and Cardiology, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Unit of Paediatric Pulmonology and Cardiology, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM 1046, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Unit of Paediatric Pulmonology and Cardiology, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiopulmonary Rehabilitation Centre, Saint-Pierre Institute, Palavas-les-Flots, France
| | - Stefan Matecki
- Unit of Paediatric Pulmonology and Cardiology, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM 1046, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Department of Epidemiology and Biostatistics, Montpellier University Hospital, Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National CHD Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Marie-Christine Picot
- Department of Epidemiology and Biostatistics, Montpellier University Hospital, Montpellier, France.,CIC 1411, INSERM, University of Montpellier, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National CHD Reference Centre, Bordeaux University Hospital, Bordeaux, France .,IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France
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Bredy C, Deville F, Huguet H, Picot MC, De La Villeon G, Abassi H, Avesani M, Begue L, Burlet G, Boulot P, Fuchs F, Amedro P. Which risk score best predicts cardiovascular outcome in pregnant women with congenital heart disease? Eur Heart J Qual Care Clin Outcomes 2023; 9:177-183. [PMID: 35472215 DOI: 10.1093/ehjqcco/qcac019] [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] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/03/2022] [Accepted: 04/23/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Management of pregnancy and risk stratification in women with congenital heart diseases (CHD) are challenging, especially due to physiological haemodynamic modifications that inevitably occur during pregnancy. AIMS To compare the accuracy of the existing pregnancy cardiovascular risk scores in prediction of maternal complications during pregnancy in CHD patients. METHOD AND RESULTS From 2007 to 2018, all pregnant women with a CHD who delivered birth after 20 weeks of gestation were identified. The discriminating power and the accuracy of the five existing pregnancy cardiovascular risk scores [CARPREG, CARPREG II, HARRIS, ZAHARA risk scores, and modified WHO (mWHO)] were evaluated.Out of 104 pregnancies in 65 CHD patients, 29% experienced cardiovascular complications during pregnancy or post-partum. For the five scores, the observed rate of cardiovascular events was higher than the expected risk. The values of area under the ROC curve were 0.75 (0.62-0.88) for mWHO, 0.65 (0.53-0.77) for CARPREG II, 0.60 (0.40-0.80) for HARRIS, 0.59 (0.47-0.72) for ZAHARA, and 0.58 (0.43-0.73) for CARPREG. CONCLUSION The modified WHO classification appeared to better predict cardiovascular outcome in pregnant women with CHD than the four other existing risk scores.Clinical Trial Registration: Clinicaltrials.gov: NCT04221048.
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Affiliation(s)
- Charlene Bredy
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Fanny Deville
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, 34295 Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, 34295 Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, 33 604 Bordeaux, France
| | - Laetitia Begue
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Gilles Burlet
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Pierre Boulot
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Florent Fuchs
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, 33 604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Av. du Haut Lévêque, 33600 Pessac, France
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Gavotto A, Dubard V, Avesani M, Huguet H, Picot MC, Abassi H, Guillaumont S, De La Villeon G, Haouy S, Sirvent N, Sirvent A, Theron A, Requirand A, Matecki S, Amedro P. Impaired aerobic capacity in adolescents and young adults after treatment for cancer or non-malignant haematological disease. Pediatr Res 2023:10.1038/s41390-023-02477-6. [PMID: 36709386 DOI: 10.1038/s41390-023-02477-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Childhood cancer survivors are at increased risk for cardiovascular disease. Maximal oxygen uptake (VO2max) is a major determinant of cardiovascular morbidity. The aim of this study was to compare aerobic capacity, measured by cardiopulmonary exercise test (CPET), of adolescents and young adults in remission with that of healthy controls and to identify the predictors of aerobic capacity in this population. METHOD This is a controlled cross-sectional study. RESULTS A total of 477 subjects (77 in remission and 400 controls), aged from 6 to 25 years, were included, with a mean delay between end of treatment and CPET of 2.9 ± 2.3 years in the remission group. In this group, the mean VO2max was significantly lower than in controls (37.3 ± 7.6 vs. 43.3 ± 13.1 mL/kg/min, P < 0.01, respectively), without any clinical or echocardiographic evidence of heart failure. The VAT was significantly lower in the remission group (26.9 ± 6.0 mL/kg/min vs. 31.0 ± 9.9 mL/kg/min, P < 0.01, respectively). A lower VO2max was associated with female sex, older age, higher BMI, radiotherapy, and hematopoietic stem cell transplantation. CONCLUSION Impaired aerobic capacity had a higher prevalence in adolescents and young adults in cancer remission. This impairment was primarily related to physical deconditioning and not to heart failure. TRIAL REGISTRY NCT04815447. IMPACT In childhood cancer survivors, aerobic capacity is five times more impaired than in healthy subjects. This impairment mostly reflects early onset of physical deconditioning. No evidence of heart failure was observed in this population.
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Affiliation(s)
- Arthur Gavotto
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Vincent Dubard
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Centre, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Centre, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Stephanie Haouy
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Nicolas Sirvent
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Anne Sirvent
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Alexandre Theron
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Anne Requirand
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Stefan Matecki
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France. .,IHU Liryc, INSERM 1045, Bordeaux University, Bordeaux, France.
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Gavotto A, Ladeveze M, Avesani M, Huguet H, Guillaumont S, Picot MC, Requirand A, Matecki S, Amedro P. Aerobic fitness change with time in children with congenital heart disease: A retrospective controlled cohort study. Int J Cardiol 2023; 371:140-146. [PMID: 36181952 DOI: 10.1016/j.ijcard.2022.09.068] [Citation(s) in RCA: 3] [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: 04/22/2022] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To evaluate the change in aerobic fitness (VO2max), measured by cardio-pulmonary exercise test (CPET), in children with congenital heart disease (CHD), compared to matched healthy controls, and identify predictors of VO2max change with time in this specific population. METHOD This longitudinal retrospective multicentre cohort study was carried out from 2010 to 2020. We included CHD paediatric patients from the cohort of a previous cross-sectional study, who had a second CPET at least 1 year after the first one, during their follow-up. RESULTS We included 936 children, 296 in the CHD group and 640 controls. Mean time between baseline and final CPET was 4.4 ± 1.7 years. After matching on age and gender and adjustment for age and BMI, the mean VO2max group difference was 10.5% ± 1.0% of percent-predict VO2max at baseline and increased to 19.1% ± 1.3% at final assessment. In the CHD group, the proportion of children with impaired aerobic fitness was significantly higher at final than at baseline CPET assessment (51.4% vs 20.3%; P < 0.01). The mean annual VO2max decrease was significantly worse in the CHD group than in controls (-1.88% ± 0.19% of percent-predict VO2max/year vs. -0.44% ± 0.27% of percent-predict VO2max/year, P < 0.01, respectively). In multivariate analyse, male gender, a high initial VO2max, a high BMI, and the number of cardiac surgical procedures ≥2, were predictors of the VO2max decrease with time. CONCLUSION The VO2max decrease with time is more pronounced in children with CHD compared to healthy matched controls. This study highlighted the importance of serial CPET assessment in children with CHD. Trial registration NCT04815577.
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Affiliation(s)
- Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Manon Ladeveze
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France; Clinical Investigation Centre, INSERM U1411, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France; Clinical Investigation Centre, INSERM U1411, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France; Paediatric Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, University of Bordeaux, Bordeaux, France.
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Souilla L, Avesani M, Boisson A, Requirand A, Matecki S, Vincenti M, Werner O, De La Villeon G, Pommier V, Pasquie JL, Guillaumont S, Amedro P. Cardiorespiratory fitness, muscle fitness, and physical activity in children with long QT syndrome: A prospective controlled study. Front Cardiovasc Med 2023; 9:1081106. [PMID: 36712265 PMCID: PMC9874118 DOI: 10.3389/fcvm.2022.1081106] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Background In children with congenital long QT syndrome (LQTS), the risk of arrhythmic events during exercise commonly makes it difficult to balance exercise restrictions versus promotion of physical activity. Nevertheless, in children with LQTS, cardiorespiratory fitness, muscle fitness, and physical activity, have been scarcely explored. Materials and methods In this prospective, controlled, cross-sectional study, 20 children with LQTS (12.7 ± 3.7 years old) and 20 healthy controls (11.9 ± 2.4 years old) were enrolled. All participants underwent a cardiopulmonary exercise test, a muscular architecture ultrasound assessment, (cross-sectional area on right rectus femoris and pennation angle), a handgrip muscular strength evaluation, and a standing long broad jump test. The level of physical activity was determined using with a waist-worn tri-axial accelerometer (Actigraph GT3X). Results Peak oxygen uptake (VO2peak) and ventilatory anaerobic threshold (VAT) were lower in children with LQTS than in healthy controls (33.9 ± 6.2 mL/Kg/min vs. 40.1 ± 6.6 mL/Kg/min, P = 0.010; 23.8 ± 5.1 mL/Kg/min vs. 28.8 ± 5.5 mL/Kg/min, P = 0.007, respectively). Children with LQTS had lower standing long broad jump distance (119.5 ± 33.2 cm vs. 147.3 ± 36.1 cm, P = 0.02) and pennation angle (12.2 ± 2.4° vs. 14.3 ± 2.8°, P = 0.02). No differences in terms of moderate-to-vigorous physical activity were observed (36.9 ± 12.9 min/day vs. 41.5 ± 18.7 min/day, P = 0.66), but nearly all children were below the WHO guidelines. Conclusion Despite similar physical activity level, cardiorespiratory fitness and muscle fitness in children with LQTS were lower than in healthy controls. The origin of this limitation seemed to be multifactorial, involving beta-blocker induced chronotropic limitation, physical and muscle deconditioning. Cardiovascular rehabilitation could be of interest in children with LQTS with significant physical limitation.
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Affiliation(s)
- Luc Souilla
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Martina Avesani
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Pessac, France
| | - Aymeric Boisson
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
| | - Anne Requirand
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France,Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Marie Vincenti
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Oscar Werner
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Victor Pommier
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Jean-Luc Pasquie
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Sophie Guillaumont
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France,Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Pessac, France,Inserm, U1045, Institut Hospitalo-Universitaire (IHU) Liryc, Bordeaux Cardio-Thoracic Research Centre, Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France,*Correspondence: Pascal Amedro,
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Gozzi A, Cuppini E, Cattapan I, Basso A, Fumanelli J, Candia AD, Avesani M, Sirico D, Castaldi B, Reffo E, Cerutti A, Biffanti R, Salvo GD. 966 ADVANCED ECHOCARDIOGRAPHIC AND CMR FEATURES OF PATIENTS WITH REPAIRED TETRALOGY OF FALLOT IN THE LONG-TERM FOLLOW-UP. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.264] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Advanced echocardiographic and CMR features of patients with repaired Tetralogy of Fallot in the long-term follow-up.
Anna Gozzi1, Jolanda Sabatino1, Elena Cuppini1, Irene Cattapan1, Alessia Basso1, Jennifer Fumanelli1, Angela Di Candia1, Martina Avesani1, Domenico Sirico1, Biagio Castaldi1, Elena Reffo1, Alessia Cerutti1, Roberta Biffanti1, Giovanni Di Salvo1
1Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolo` Giustiniani, 2, 35128 Padova, Italy
Background
Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease and the population of ToF repair survivors is growing rapidly. Children and, more frequently young adults, with repaired ToF develop late complications. Sudden cardiac death and life-threatening ventricular arrhythmia remain a concern in patients with repaired tetralogy of Fallot.
The aim of this study was to describe and analyse advanced echocardiographic and CMR features of patients with repaired ToF in the long-term follow-up and to find non-invasive predictors of adverse prognosis.
Methods
This is a retrospective cohort study. Consecutive 200 patients with repaired ToF who did not undergo pulmonary valve replacement were included. Mean age of all patients was 19 ± 8. The electrocardiographic (ECG), cardiopulmonary exercise testing (CPET), echocardiographic and cardiac magnetic resonance (CMR) data were reviewed retrospectively. Right myocardial work index (RWI) was calculated as the area of the right ventricular pressure strain loops. From RWI, Right Constructive Work (RCW), Wasted Work (RWW) and Work Efficiency (RWE) were estimated.
Patients were screened according the age at surgery (<12 months and >12 months) and the time since the repair (< 25 years and ≥ 25 years).
A composite end-point of major adverse cardiovascular events (sudden cardiac death, sustained and non-sustained ventricular tachycardia, resuscitated sudden cardiac death, or syncope) was used.
Results
CPET values were not significantly different in patients with more than 25 years since the corrective surgery. Left ventricular ejection fraction measured either by CMR or echocardiography were slightly but significantly reduced in patients with more than 25 years since the corrective surgery.
Patients with older age at surgery (>12 months) have significantly reduced V02max at CPET, larger RA and LA areas and larger RV basal diameter.
During a median follow-up of 2.9 years, 1 patient died suddenly, 5 had documented ventricular tachycardia, and other 4 had syncope. On univariate analysis, echocardiographic left atrial area/BSA (P=0.044) and right ventricular longitudinal strain (P=0.010) were significantly related to the combined end point. Patients with reported VT at Holter ECG presented significantly reduced right ventricular function in terms of CMR-EF, echocardiographic FAC and RWI.
Finally, TOF patients with borderline/impaired predicted VO2 max at CPET presented with significantly reduced RV freewall longitudinal strain and right ventricular myocardial work index.
Conclusion
Long-term survival and clinical condition after surgical correction of ToF in infancy is generally good and the late functional status in ToF - operated patients could be excellent up to 25 years after the repair. However, patients with older age at surgery have relative reduced functional status compared with those undergoing early repair. The echocardiographic and CMR evaluation of RV function are usually related to worse prognosis, recurrency of VT and reduced functional status in patients with repaired TOF.
Right ventricular myocardial work index is feasible in patients with repaired TOF; disadvantageous right ventricular work may be a more sensitive indicator of right ventricular impairment compared with standard echocardiographic parameters, and is able to predict exercise capacity.
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Affiliation(s)
- Anna Gozzi
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Elena Cuppini
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Irene Cattapan
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Alessia Basso
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Jennifer Fumanelli
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Angela Di Candia
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Martina Avesani
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Domenico Sirico
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Biagio Castaldi
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Elena Reffo
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Alessia Cerutti
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Roberta Biffanti
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
| | - Giovanni Di Salvo
- Department For Women’s And Children’s Health, University Hospital Of Padova , Pediatric And Congenital Cardiology Unit , Italy
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Moscatelli S, Borrelli N, Sabatino J, Leo I, Avesani M, Montanaro C, Di Salvo G. Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation. Children (Basel) 2022; 9:children9121875. [PMID: 36553321 PMCID: PMC9777137 DOI: 10.3390/children9121875] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Since its first description in 1971, the Fontan procedure and its modifications have led to a substantial improvement in the survival rates of patients with a variety of types of complex Congenital Heart Disease (CHD) characterised by the presence of a single, dominant ventricle. However, despite the significant improvement of the prognosis over the years, Fontan patients are still exposed to several cardiovascular and systemic complications. It is, therefore, important to fully understand the pitfalls hidden behind a Fontan anatomy and the potential predictors of ventricular failure. Cardiovascular imaging plays a key role in this context, allowing for the early identification of complications with important prognostic implications. Echocardiography remains the first-line imaging modality for serial evaluation of Fontan patients. However, there is a growing role of cardiovascular magnetic resonance and cardiac computed tomography from pre-operative assessment to longitudinal follow-up. The aim of this paper will be to provide a comprehensive overview of the role, strengths, and weaknesses of each imaging modality in the assessment of congenital cardiac conditions palliated with the Fontan procedure.
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Affiliation(s)
- Sara Moscatelli
- Paediatric Cardiology Department, Royal Brompton Hospital Harefield NHS Foundation Trust, London SW3 5NP, UK
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital Padua, 35128 Padua, Italy
- Paediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy
| | - Isabella Leo
- Department of Medical and Surgical Sciences, Magna Grecia University, 88100 Catanzaro, Italy
- Cardiac Magnetic Resonance Department, Royal Brompton Hospital Harefield NHS Foundation Trust, London SW3 5NP, UK
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital Padua, 35128 Padua, Italy
| | - Claudia Montanaro
- Adult Congenital Department, Royal Brompton Hospital & Harefield NHS Foundation Trust, London SW3 5NP, UK
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital Padua, 35128 Padua, Italy
- Paediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy
- Correspondence:
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22
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Guariento A, Schiena CA, Cattapan C, Avesani M, Doulamis IP, Padalino MA, Castaldi B, di Salvo G, Vida V. Pulmonary valve preservation during tetralogy of Fallot repair: midterm functional outcomes and risk factors for pulmonary regurgitation. Eur J Cardiothorac Surg 2022; 62:6644955. [PMID: 35848949 DOI: 10.1093/ejcts/ezac365] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Many centres have recently adopted pulmonary valve (PV) preservation (PVP) during tetralogy of Fallot (ToF) repair. We sought to identify the midterm functional outcomes and risk factors for pulmonary regurgitation after this procedure. METHODS All patients undergoing PVP during transatrial-transpulmonary repair for ToF with PV stenosis at our institution between January 2007 and December 2020 were reviewed. RESULTS Overall, 73 patients were included. At the index surgery, the body surface area was 0.31 ± 0.04 m2, the age was 4.9 ± 2.9 months and the preoperative PV z-score was -3.02 ± 1.11. At a mean follow-up of 5.3 ± 2.7 years, the fractional area change of the right ventricle (RV) was 47.1 ± 5.2%, and the tricuspid annular plane systolic excursion z-score was -3.31 ± 1.89%. The 5-year freedom from moderate/severe PV regurgitation was 61.3% [95% confidence interval (CI): 48, 73%]. There was a significant correlation between RV function and moderate/severe PR at follow-up (R2: 0.08; P = 0.03). A comparison with a group of patients undergoing a transannular patch procedure (N = 33) showed superior outcomes for patients with PVP. The preoperative PV z-score and the degree of PR at discharge were risk factors for the early development of moderate/severe PR at follow-up [hazard ratio (HR): 0.64; 95% CI: 0.48, 0.86, P = 0.01 and HR: 2.31; 95% CI: 1.00, 5.36, P = 0.04, respectively]. A preoperative PV annulus z-score ≤ -2.85 was found to be predictive for moderate/severe PR at 5 years after PVP (HR: 2.56; 95% CI: 1.31, 5.01, P = 0.002). CONCLUSIONS A pulmonary valve preservation strategy during tetralogy of Fallot repair should always be attempted. However, a preoperative PV annulus z-score < -2.85 and moderate/severe regurgitation upon discharge are risk factors for midterm pulmonary regurgitation.
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Affiliation(s)
- Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Chiara A Schiena
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Martina Avesani
- Pediatric Cardiology Unit, Departments of Women's and Children's Health, University of Padua, Padua, Italy
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Massimo A Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biagio Castaldi
- Pediatric Cardiology Unit, Departments of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giovanni di Salvo
- Pediatric Cardiology Unit, Departments of Women's and Children's Health, University of Padua, Padua, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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23
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Pommier V, Abassi H, Lavastre K, Calderon J, Guillaumont S, Dulac Y, Auriol F, Ovaert C, Blondelon A, Hascoet S, Lecerf F, Jore C, Avesani M, Thambo JB, Amedro P. Impact of COVID-19 disease on clinical research in pediatric and congenital cardiology. Arch Pediatr 2022; 29:347-353. [PMID: 35523633 PMCID: PMC9020482 DOI: 10.1016/j.arcped.2022.03.004] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/21/2022] [Accepted: 03/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 triggered an unprecedented crisis affecting society at every level. Research in pediatric and congenital cardiology is currently in full development and may have been disrupted. The aim of the study was to determine the impact of COVID-19 on pediatric and congenital cardiology clinical research and to analyze decision-making and adaptation processes, from a panel of ongoing academic and industry-sponsored research at the time of the pandemic. METHODS This observational study was carried out in April 2020, from a CHD clinical research network involving five tertiary care pediatric and congenital cardiology centers. Investigators and clinical research assistants from each participating research center completed an online survey questionnaire, and each principal investigator underwent a 1-h web-based videoconference interview. RESULTS A total of 34 study questionnaires were collected, reporting that 18 studies were totally suspended. Upon the investigator's decision, after discussion on ethical issues and with facilitating support from health authorities, 16 studies were resumed. The rate of study suspension in interventional research (53%) was similar to that in non-interventional research (56%). Logistical problems were predominantly reported in both continued and suspended trials. Research protocols were adapted, largely thanks to telemedicine, which in some cases even improved the course of the study. CONCLUSION The impact of the COVID-19 pandemic on clinical research in pediatric and congenital cardiology has been limited by a rapid adaptation of all research structures and an extensive use of telemedicine at all stages of the studies.
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Affiliation(s)
- V. Pommier
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France
| | - H. Abassi
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - K. Lavastre
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France
| | - J. Calderon
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France,Cardiac Neurodevelopmental Program, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - S. Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France,Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Y. Dulac
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse CIC 1436, France
| | - F. Auriol
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse CIC 1436, France
| | - C. Ovaert
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, APHM La Timone University Hospital, Marseille, France
| | - A. Blondelon
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, APHM La Timone University Hospital, Marseille, France
| | - S. Hascoet
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Centre Medico-Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France
| | - F. Lecerf
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Centre Medico-Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France
| | - C. Jore
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France
| | - M. Avesani
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France
| | - J.-B. Thambo
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
| | - P. Amedro
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France,Corresponding author
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24
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Cattapan C, Della Barbera M, Dedja A, Pavan P, Di Salvo G, Sabatino J, Avesani M, Padalino M, Guariento A, Basso C, Vida V. Mechanical and Structural Adaptation of the Pulmonary Root after Ross Operation in a Murine Model. J Clin Med 2022; 11:jcm11133742. [PMID: 35807025 PMCID: PMC9267924 DOI: 10.3390/jcm11133742] [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] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023] Open
Abstract
Background: The major limitation to the Ross operation is a progressive autograft dilation, possibly leading to reoperations. A murine model was created to evaluate pulmonary artery graft (PAG) adaptation to pressure overload. Methods: Lewis rats (n = 17) underwent heterotopic surgical implantation of a PAG, harvested from syngeneic animals (n = 17). A group of sham animals (n = 7) was used as a control. Seriated ultrasound studies of the PAG were performed. Animals were sacrificed at 1 week (n = 5) or 2 months (n = 15) and the PAG underwent mechanical and histopathological analyses. Results: Echography showed an initial increase in diameter (p < 0.001) and a decrease in peak systolic velocity (PSV). Subsequently, despite no change in diameter, an increase in PSV was observed (p < 0.01). After 1 week, the stiffness of the PAG and the aorta were similar, while at 2 months, the PAG appeared more rigid (p < 0.05). PAG’s histological analysis at 2 months revealed intimal hyperplasia development. The tunica media showed focal thinning of the elastic lamellae and normally distributed smooth muscle cells. Conclusions: We demonstrated a stiffening of the PAG wall after its implantation in systemic position; the development of intimal hyperplasia and the thinning of the elastic lamellae could be the possible underlying mechanism.
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Affiliation(s)
- Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35121 Padua, Italy; (C.C.); (A.D.); (M.P.); (A.G.)
| | - Mila Della Barbera
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35121 Padua, Italy; (M.D.B.); (C.B.)
| | - Arben Dedja
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35121 Padua, Italy; (C.C.); (A.D.); (M.P.); (A.G.)
| | - Piero Pavan
- Department of Industrial Engineering, University of Padua, 35131 Padua, Italy;
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Children and Woman’s Health, University of Padua, 35121 Padua, Italy; (G.D.S.); (J.S.); (M.A.)
| | - Jolanda Sabatino
- Pediatric Cardiology Unit, Department of Children and Woman’s Health, University of Padua, 35121 Padua, Italy; (G.D.S.); (J.S.); (M.A.)
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Children and Woman’s Health, University of Padua, 35121 Padua, Italy; (G.D.S.); (J.S.); (M.A.)
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35121 Padua, Italy; (C.C.); (A.D.); (M.P.); (A.G.)
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35121 Padua, Italy; (C.C.); (A.D.); (M.P.); (A.G.)
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35121 Padua, Italy; (M.D.B.); (C.B.)
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35121 Padua, Italy; (C.C.); (A.D.); (M.P.); (A.G.)
- Correspondence: ; Tel.: +39-049-821-2410
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25
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Piperata A, d'Ostrevy N, Busuttil O, Avesani M, Modine T, Lorenzoni G, Azzolina D, Labrousse L, Pernot M. Evaluation of the “release and perfuse technique” for aortic arch surgery. J Card Surg 2022; 37:2633-2639. [DOI: 10.1111/jocs.16640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/27/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Antonio Piperata
- Department of Cardiology and Cardio‐Vascular Surgery, Hôpital Cardiologique de Haut‐Lévèque Bordeaux University Hospital Pessac France
| | - Nicolas d'Ostrevy
- Department of Cardiology and Cardio‐Vascular Surgery, Hôpital Cardiologique de Haut‐Lévèque Bordeaux University Hospital Pessac France
| | - Olivier Busuttil
- Department of Cardiology and Cardio‐Vascular Surgery, Hôpital Cardiologique de Haut‐Lévèque Bordeaux University Hospital Pessac France
| | - Martina Avesani
- Department of Cardiology and Cardio‐Vascular Surgery, Hôpital Cardiologique de Haut‐Lévèque Bordeaux University Hospital Pessac France
| | - Thomas Modine
- Department of Cardiology and Cardio‐Vascular Surgery, Hôpital Cardiologique de Haut‐Lévèque Bordeaux University Hospital Pessac France
| | - Giulia Lorenzoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health University of Padova Padova Italy
| | - Danila Azzolina
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health University of Padova Padova Italy
| | - Louis Labrousse
- Department of Cardiology and Cardio‐Vascular Surgery, Hôpital Cardiologique de Haut‐Lévèque Bordeaux University Hospital Pessac France
| | - Mathieu Pernot
- Department of Cardiology and Cardio‐Vascular Surgery, Hôpital Cardiologique de Haut‐Lévèque Bordeaux University Hospital Pessac France
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26
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Sabatino J, Leo I, Strangio A, Bella SL, Borrelli N, Avesani M, Josen M, Paredes J, Piccinelli E, Sirico D, Pergola V, Fraisse A, De Rosa S, Indolfi C, Di Salvo G. Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study. Front Cardiovasc Med 2022; 9:792622. [PMID: 35548421 PMCID: PMC9081714 DOI: 10.3389/fcvm.2022.792622] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
Aims This international multi-center study aimed to demonstrate the feasibility and reliability of non-invasive myocardial work (MW) parameters in the pediatric population, and to provide normal reference ranges for this useful echocardiographic tool in this specific subset of patients. Methods and Results In this retrospective multi-center study involving three pediatric laboratories, 150 healthy children and adolescents (mean age of 10.6 ± 4.5, 91 males) were enrolled. A complete echocardiographic examination has been performed, including global longitudinal strain (GLS) assessment. The following parameters of non-invasive MW have been obtained through a dedicated software: global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE), using left ventricular (LV) strain loops and non-invasive brachial artery cuff pressure values. The lowest expected values were for GWI 1,723 mmHg% in males and 1,682 mmHg% in females, for GCW 2,089 and 2,106 mmHg%, for GWE 95.9 and 95.5% whereas the highest expected value for GWW was 78 mmHg% in men and 90 mmHg% in women. The univariable and multivariable analysis showed significant associations between either GWI or GCW with SBP (β coefficient = 0.446, p < 0.001; β coefficient = 0.456, p < 0.001, respectively) and LV GLS (β coefficient = −0.268, p = 0.001; β coefficient = −0.233, p = 0.003, respectively). Inter- and intra-observer variability showed good reproducibility of non-invasive MW parameters. Conclusion Non-invasive MW parameters were feasible and reliable in the pediatric population. This study provided normal reference ranges of these useful echocardiographic indices.
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Affiliation(s)
- Jolanda Sabatino
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
- Pediatric Research Institute (IRP) “Città della Speranza”, Padua, Italy
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
- Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Isabella Leo
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Antonio Strangio
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Sabrina La Bella
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Nunzia Borrelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Manjit Josen
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Josefa Paredes
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Enrico Piccinelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Domenico Sirico
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Valeria Pergola
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
- Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
- Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
- Pediatric Research Institute (IRP) “Città della Speranza”, Padua, Italy
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- *Correspondence: Giovanni Di Salvo
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27
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Dedja A, Cattapan C, Di Salvo G, Avesani M, Sabatino J, Guariento A, Vida V. A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position. J Vis Exp 2022. [DOI: 10.3791/63179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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28
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Avesani M, Silini A, Valdeolmillos E, Jalal Z, Thambo JB, Iriart X. Vector flow mapping analysis in a child with a cardiac resynchronization device. Rev Esp Cardiol (Engl Ed) 2022; 75:269-271. [PMID: 34635469 DOI: 10.1016/j.rec.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Martina Avesani
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.
| | - Alexandre Silini
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France
| | - Estibaliz Valdeolmillos
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Institut national de la santé et de la recherche médicale (INSERM), Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Institut national de la santé et de la recherche médicale (INSERM), Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Institut national de la santé et de la recherche médicale (INSERM), Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
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29
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Avesani M, Calvo G, Sabatino J, Sirico D, Castaldi B, Reffo E, Cerutti A, Biffanti R, Borrelli N, Piccinelli E, Fraisse A, Padalino M, Vida V, Di Salvo G. Exercise stress echocardiography in paediatric and adolescent patients. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.285] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
Exercise stress echocardiography (ESE) is still underused in paediatric patients, and very little data is available for congenital heart diseases (CHDs).
PURPOSE
To describe the current application of ESE in our Paediatric Cardiology Departments.
METHODS
Data from patients who underwent ESE in our Centres, including baseline and under stress symptoms, vital parameters, ECG, and echocardiograms were retrospectively analyzed and compared, as well as clinical management plans formulated based on ESEs results.
RESULTS
Forty-five patients from Centre 1 (median age 16 years), including 87% of patients with CHDs, and 20 patients from Centre 2 (median age 11 years), mainly tested to rule out myocardial ischemia, were included. Among patients from Centre 1, 28 had previously been treated surgically, 6 percutaneously and 11 were under follow-up. Indications for ESE/patients’ native diagnosis are illustrated in the picture.
Centre 1: Exercise was maximal in 17 patients, with 2 of them having symptoms at the peak of exercise. It was stopped beforehand in 28 patients because of dyspnea (3) and muscle fatigue (25). No arrhythmia was detected. ESE was considered as positive in 14 patients; after that, 3 patients underwent percutaneous interventions, 2 underwent cardiac surgery, 3 received indication for cardiac catheterization, 4 for advanced cardiac imaging and 2 for exercise restriction and medical therapy.
Centre 2: Fifteen patients (75%) completed the exercise, and none of them developed symptoms. In the remaining 25%, exercise was stopped because of muscle exhaustion. No arrhythmia was detected, and all the ESEs were negative.
Comparing the cohorts, no significant differences in terms of ejection fraction were noticed at rest and under stress. Patients in cohort 1 were older (p = 0,002), they achieved lower average maximal heart rate (p = 0,0001), performed less lasting exercise (p = 0,05) and ESE was maximal less frequently (p = 0,005). Lastly, they had significant changes in clinical decisions (p = 0,004).
CONCLUSIONS
ESE is a feasible and promising technique in paediatric cardiology, particularly in children with congenital heart diseases, and could influence significantly clinical management plans. Abstract Figure.
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Affiliation(s)
- M Avesani
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - G Calvo
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - J Sabatino
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - D Sirico
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - B Castaldi
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - E Reffo
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - A Cerutti
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - R Biffanti
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
| | - N Borrelli
- Royal Brompton Hospital, Paediatric Cardiology Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - E Piccinelli
- Royal Brompton Hospital, Paediatric Cardiology Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - A Fraisse
- Royal Brompton Hospital, Paediatric Cardiology Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - M Padalino
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - V Vida
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - G Di Salvo
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, Padua, Italy
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Amedro P, Vincenti M, Abassi H, Lanot N, De La Villeon G, Guillaumont S, Gamon L, Mura T, Lopez-Perrin K, Haouy S, Sirvent A, Cazorla O, Vergely L, Lacampagne A, Avesani M, Sirvent N, Saumet L. Use of speckle tracking echocardiography to detect late anthracycline-induced cardiotoxicity in childhood cancer: A prospective controlled cross-sectional study. Int J Cardiol 2022; 354:75-83. [DOI: 10.1016/j.ijcard.2022.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/09/2022] [Accepted: 02/10/2022] [Indexed: 01/10/2023]
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Jalal Z, Gewillig M, Boudjemline Y, Guérin P, Pilati M, Butera G, Malekzadeh-Milani S, Avesani M, Thambo JB. Transcatheter interventions in patients with a Fontan circulation: Current practice and future developments. Front Pediatr 2022; 10:965989. [PMID: 36110107 PMCID: PMC9468446 DOI: 10.3389/fped.2022.965989] [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: 06/10/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
The Fontan operation represents the last of multiple steps that are offered a wide range of congenital cardiac lesions with a single ventricle (SV) physiology. Nowadays this surgical program consists of a total cavopulmonary connection (TCPC), by anastomosing systemic veins to the pulmonary arteries (PAs), excluding the right-sided circulation from the heart. As a result of imaging, surgical, percutaneous, and critical care improvements, survival in this population has steadily increased. However, the Fontan physiology chronically increases systemic venous pressure causing systemic venous congestion and decreased cardiac output, exposing patients to the failure of the Fontan circulation (FC), which is associated with a wide variety of clinical complications such as liver disease, cyanosis, thromboembolism, protein-losing enteropathy (PLE), plastic bronchitis (PB), and renal dysfunction, ultimately resulting in an increased risk of exercise intolerance, arrhythmias, and premature death. The pathophysiology of the failing Fontan is complex and multifactorial; i.e., caused by the single ventricle dysfunction (diastolic/systolic failure, arrhythmias, AV valve regurgitation, etc.) or caused by the specific circulation (conduits, pulmonary vessels, etc.). The treatment is still challenging and may include multiple options and tools. Among the possible options, today, interventional catheterization is a reliable option, through which different procedures can target various failing elements of the FC. In this review, we aim to provide an overview of indications, techniques, and results of transcatheter options to treat cavopulmonary stenosis, collaterals, impaired lymphatic drainage, and the management of the fenestration, as well as to explore the recent advancements and clinical applications of transcatheter cavopulmonary connections, percutaneous valvular treatments, and to discuss the future perspectives of percutaneous therapies in the Fontan population.
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Affiliation(s)
- Zakaria Jalal
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Patrice Guérin
- Interventional Cardiology Unit, Inserm UMR 1229, L'Institut du Thorax, University Hospital of Nantes, Nantes, France
| | - Mara Pilati
- Medical and Surgical Department of Pediatric Cardiology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Gianfranco Butera
- Medical and Surgical Department of Pediatric Cardiology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Pediatric Cardiology, Paris, France
| | - Martina Avesani
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
| | - Jean-Benoit Thambo
- University Hospital of Bordeaux - Department of Pediatric and Adult Congenital Cardiology, Pessac, France.,IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Pessac, France
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32
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Avesani M, Kang SL, Jalal Z, Thambo JB, Iriart X. Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging. Front Pediatr 2022; 10:894472. [PMID: 35664875 PMCID: PMC9160663 DOI: 10.3389/fped.2022.894472] [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: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Percutaneous interventions have completely refashioned the management of children with congenital heart diseases (CHD) and the use of non-invasive imaging has become the gold standard to plan and guide these procedures in the modern era. We are now facing a dual challenge to improve the standard of care in low-risk patients, and to shift our strategies from the classic open chest surgery to imaging-guided percutaneous interventions in high-risk patients. Such rapid evolution of ultrasound technologies over the last 20 years have permitted the integration of transthoracic, transesophageal and intracardiac echocardiography into the interventional workflow to improve image guidance and reduce radiation burden from fluoroscopy and angiography. Specifically, miniaturization of transesophageal probe and advances in three-dimensional (3D) imaging techniques have enabled real-time 3D image guidance during complex interventional procedure, In addition, multimodality and fusion imaging techniques harness the strengths of different modalities to enhance understanding of anatomical and spatial relationship between different structures, improving communication and coordination between interventionalists and imaging specialists. In this review, we aim to provide an overview of 3D imaging modalities and multimodal fusion in procedural planning and live guidance of percutaneous interventions. At the present times, 3D imaging can no longer be considered a luxury but a routine clinical tool to improve procedural success and patient outcomes.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Sok-Leng Kang
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Zakaria Jalal
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Xavier Iriart
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
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33
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Avesani M, Calvo G, Sabatino J, Sirico D, Castaldi B, Reffo E, Cerutti A, Biffanti R, Borrelli N, Piccinelli E, Fraisse A, Padalino M, Vida V, Di Salvo G. 122 Exercise stress echocardiography in paediatric and adolescent patients: what is the role? Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab133] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
To describe the current application of exercise stress echocardiography (ESE) in our Paediatric Cardiology Departments.
Methods and results
Baseline and under stress symptoms, vital parameters, ECG, and echocardiograms from patients who underwent ESE in our centres, were retrospectively analysed and compared, as well as clinical management plans formulated based on ESEs results. Forty-five patients from Centre 1 (median age 16 years), including 87% of patients with congenital heart diseases (CHDs), and 20 patients from Centre 2 (median age 11 years), mainly tested to rule out myocardial ischemia, were included. Among patients from Centre 1, 28 had previously been treated surgically, 6 percutaneously, and 11 were under follow-up. Indications for ESE/patients’ native diagnosis are illustrated in the picture. Centre 1: Exercise was maximal in 17 patients, with 2 of them having symptoms at the peak of exercise. It was stopped beforehand in 28 patients because of dyspnoea (3) and muscle fatigue (25). No arrhythmia was detected. ESE was considered as positive in 14 patients; after that, 3 patients underwent percutaneous interventions, 2 underwent cardiac surgery, 3 received indication for cardiac catheterization, 4 for advanced cardiac imaging, and 2 for exercise restriction and medical therapy. Centre 2: 15 patients (75%) completed the exercise, and none of them developed symptoms. In the remaining 25%, exercise was stopped because of muscle exhaustion. No arrhythmia was detected, and all the ESEs were negative. Comparing the cohorts, no differences in terms of ejection fraction were noticed at rest and under stress. Patients in cohort 1 were older (P = 0.002), they achieved lower average maximal heart rate (P = 0.0001), performed less lasting exercise (P = 0.05), and ESE was maximal less frequently (P = 0.005). Lastly, they had significant changes in clinical decisions (P = 0.004).
Conclusions
In paediatric cardiology, particularly in children with CHDs, ESE is a promising technique and could influence significantly clinical management plans.
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Affiliation(s)
- Martina Avesani
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Giacomo Calvo
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Jolanda Sabatino
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Domenico Sirico
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Elena Reffo
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Alessia Cerutti
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Roberta Biffanti
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
| | - Nunzia Borrelli
- Department of Paediatric Cardiology, Royal Brompton and Harefield Hospital, London, UK
| | - Enrico Piccinelli
- Department of Paediatric Cardiology, Royal Brompton and Harefield Hospital, London, UK
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton and Harefield Hospital, London, UK
| | - Massimo Padalino
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Italy
| | - Vladimiro Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Departments of Women’s and Children’s Health, University Hospital of Padua, Italy
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34
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Ciriello GD, Borrelli N, Di Salvo G, Sabatino J, Bucciarelli V, Avesani M, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Romeo E, Colonna D, Palma M, Scognamiglio G, Russo MG, Sarubbi B. 276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome.
Methods and results
Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global constructive work (MCW), wasted work (MWW), and work efficiency (MWE) were estimated. Despite normal LV systolic function by standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls.
Conclusions
WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.
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Affiliation(s)
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | | | | | | | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | - Maria Giovanna Russo
- University of Campania Luigi Vanvitelli, Naples, Italy
- Paediatric Cardiology Unit, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
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35
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Avesani M, Calvo G, Sirico D, Castaldi B, Reffo E, Cerutti A, Biffanti R, Di Candia A, Sabatino J, Borrelli N, Piccinelli E, Fraisse A, Padalino M, Vida V, Di Salvo G. Exercise stress echocardiography in children and teenagers with congenital heart diseases. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1890] [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
Exercise Stress Echocardiography (ESE) is currently applied to paediatric patients mainly to detect myocardial ischemia and few data is available for congenital heart diseases (CHDs).
Purpose
The aim of this study is to describe the current application of ESE in our Departments.
Methods
Data from patients who underwent ESE in our two centres were retrospectively analysed, as well as clinical management plans formulated based on ESEs results.
Results
Fifty-five patients (median age 15 years) were included. Among them, 19 had been previously treated surgically, 6 percutaneously and 30 were under follow-up.
Indications for ESE were: hypertension and/or evaluation of aortic arch gradient in patients treated surgically (5) or percutaneously (1) for aortic coarctation (ACo); aortic/subaortic gradient in bicuspid aortic valve (BAV) after balloon valvuloplasty (4), Ross (1), or under follow up (1); right ventricular and pulmonary valve function in Tetralogy of Fallot (3) and after percutaneous treatment of pulmonary atresia (1); atrio-ventricular valves gradient (1 for tricuspid dysplasia and 1 for left cor triatriatum); single ventricle function (1); pulmonary artery gradient (2) and myocardial ischemia (6) after Arterial Switch; rule out myocardial ischemia in coronary anomalies (4), chest pain (9), Kawasaki disease (KD 9), syncope (1) and in patients with ectopic beats under exercise (2); rule out dynamic obstruction in hypertrophic cardiomyopathy (HCM, 3).
The exercise was maximal in 28 patients, with 2 of them having symptoms at the peak of exercise. In the other patients, peak heart rate ranged from 52% to 84% of targeted values. Mean exercise duration and reached Watts were 10 minutes and 112, respectively. Reasons for ending exercise were muscle fatigue in 25 patients and dyspnoea in 2 patients. No arrhythmia was detected.
Clinical management changed in 10 of patients after ESE (20%), all having CHDs. Three patients underwent percutaneous interventions; 1 aortic balloon valvuloplasty, 1 stent dilation and 1 pulmonary valve replacement; 2 underwent surgery (1 aortic valve replacement and 1 subaortic membrane resection), 4 underwent further imaging including cardiac computed tomography (1), cardiac magnetic resonance (2) and cardiac catheterization (1); 1 received indication for restriction from intense physical activities.
Conclusions
ESE has an important clinical role in patients with congenital heart diseases, impacting clinical management.
Funding Acknowledgement
Type of funding sources: None. Indications for ESEChangements in clinical management
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Affiliation(s)
- M Avesani
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - G Calvo
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - D Sirico
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - B Castaldi
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - E Reffo
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - A Cerutti
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - R Biffanti
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - A Di Candia
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
| | - J Sabatino
- Royal Brompton and Harefield Hospital, Department of Paediatric Cardiology, London, United Kingdom
| | - N Borrelli
- Royal Brompton and Harefield Hospital, Department of Paediatric Cardiology, London, United Kingdom
| | - E Piccinelli
- Royal Brompton and Harefield Hospital, Department of Paediatric Cardiology, London, United Kingdom
| | - A Fraisse
- Royal Brompton and Harefield Hospital, Department of Paediatric Cardiology, London, United Kingdom
| | - M Padalino
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - V Vida
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - G Di Salvo
- University Hospital of Padova, Paediatric Cardiology Unit, Departments of Women's and Children's Health, Padua, Italy
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36
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Piperata A, Caraffa R, Bifulco O, Avesani M, Gerosa G, Bottio T. Heart transplantation in the new era of extended donor criteria. J Card Surg 2021; 36:4828-4829. [PMID: 34558118 DOI: 10.1111/jocs.16018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Piperata
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Raphael Caraffa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Olimpia Bifulco
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Martina Avesani
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
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37
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Avesani M, Martin A, Thomas-Chabaneix J, Thambo JB, Iriart X. A Heart Elsewhere: The Unusual Diagnosis of a Congenital Ventricular Diverticulum in the Abdomen. JACC Case Rep 2021; 3:1453-1455. [PMID: 34557691 PMCID: PMC8446024 DOI: 10.1016/j.jaccas.2021.06.028] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
Congenital left ventricular (LV) diverticulum is a rare condition characterized by the presence of a contractile appendix originating usually from the cardiac apex, but with high variability in location, dimension, and clinical presentation. We describe the diagnostic process and clinical management of an isolated apical diverticulum discovered during fetal life. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, Pessac, France
| | - Amandine Martin
- Department of Pediatric and Adult Congenital Surgery, Bordeaux University Hospital, Pessac, France
| | - Julie Thomas-Chabaneix
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, Pessac, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, Pessac, France.,Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, Pessac, France.,Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
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38
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Piperata A, Caraffa R, Bifulco O, Avesani M, Apostolo A, Gerosa G, Bottio T. Marginal donors and organ shortness: concomitant surgical procedures during heart transplantation: a literature review. J Cardiovasc Med (Hagerstown) 2021; 23:167-175. [PMID: 34420009 DOI: 10.2459/jcm.0000000000001233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heart transplantation represents the gold standard for end-stage heart failure. However, due to the increasing demand and the shortage of available organs, donor supply remains the main limitation. Marginal donor hearts in high-risk candidates who do not meet standard listing criteria are the only alternative when life expectancy is limited, but their use is still debated. Surgical correction of detected coronary lesions or valvular heart defects allows further enlargement of the number of available organs. In this article, we offer a literature review on this topic and report two marginal donor hearts with angiography evidence of coronary stenosis and preserved ventricular function, which underwent concomitant myocardial revascularization during heart implantation.
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Affiliation(s)
- Antonio Piperata
- Department of Cardiac, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova Cardiological Unit, Monzino Hospital, University of Milan, Milan, Italy
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Borrelli N, Brida M, Cader A, Sabatino J, Czerwińska-Jelonkiewicz K, Shchendrygina A, Wood A, Allouche E, Avesani M, Gok G, Marchenko O, Calvieri C, Baritussio A, Ilardi F, Caglar N, Moscatelli S, Kotlar I, Trêpa M, Rubini MG, Chrysohoou C, Jovovic L, Prokšelj K, Simkova I, Babazade N, Siller-Matula J, Chikhi F, Kovačević-Preradović T, Srbinovska E, Johnson V, Farrero M, Moharem-Elgamal S, Gimelli A. Women leaders in Cardiology. Contemporary profile of the WHO European region. European Heart Journal Open 2021; 1:oeab008. [PMID: 35919091 PMCID: PMC9242062 DOI: 10.1093/ehjopen/oeab008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/02/2021] [Accepted: 07/10/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Women’s participation is steadily growing in medical schools, but they are still not sufficiently represented in cardiology, particularly in cardiology leadership positions. We present the contemporary distribution of women leaders in cardiology departments in the World Health Organization European region.
Methods and results
Between August and December 2020, we applied purposive sampling to collect data and analyse gender distribution of heads of cardiology department in university/third level hospitals in 23 countries: Austria, Azerbaijan, Belgium, Bosnia-Herzegovina, Croatia, France, Germany, Greece, Italy, North Macedonia, Morocco, Poland, Portugal, Russia, Serbia, Slovakia, Slovenia, Spain, Switzerland, Tunisia, Turkey, Ukraine, and the UK. Age, cardiology subspecialty, and number of scientific publications were recorded for a subgroup of cardiology leaders for whom data were available. A total of 849 cardiology departments were analysed. Women leaders were only 30% (254/849) and were younger than their men counterpart (♀ 52.2 ± 7.7 years old vs. ♂ 58.1 ± 7.6 years old, P = 0.00001). Most women leaders were non-interventional experts (♀ 82% vs. ♂ 46%, P < 0.00001) and had significantly fewer scientific publications than men {♀ 16 [interquartile range (IQR) 2–41] publications vs. ♂ 44 (IQR 9–175) publications, P < 0.00001}.
Conclusion
Across the World Health Organization European region, there is a significant gender disparity in cardiology leadership positions. Fostering a diverse and inclusive workplace is a priority to achieve the full potential and leverage the full talents of both women and men.
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Affiliation(s)
- Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AORN Dei Colli—Monaldi Hospital , Via Leonardo Bianchi, snc, Naples 80131, Italy
| | - Margarita Brida
- Division for Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kišpatićeva ul. 12, 10000, Zagreb , Croatia
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney St, SW3 6NP, London , United Kingdom
| | - Aaysha Cader
- Ibrahim Cardiac Hospital & Research Institute, 122 Kazi Nazrul Islam Ave, Dhaka 1000 , Bangladesh
| | - Jolanda Sabatino
- Magna Graecia University, Viale Europa, 88100, Catanzaro , Italy
| | - Katarzyna Czerwińska-Jelonkiewicz
- Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Kraków , Poland
- Harefield Hospital, Hill End Rd, Harefield, Uxbridge UB9 6JH, Royal Brompton & Harefield NHS Foundation Trust, London , United Kingdom
| | - Anastasia Shchendrygina
- Department of Hospital Therapy No. 1, I.M., Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 2, стр. 4, Moscow , Russia
| | - Alice Wood
- University of Leicester, University Rd, Leicester LE1 7RH , United Kingdom
| | - Emna Allouche
- Cardiology Departement, Charles Nicolle Hospital Tunis, Faculté de Médecine, Tunis-El Manar University, Bd du 9 Avril 1938 , Tunisia
| | - Martina Avesani
- University of Padua, Via Giustiniani, 2 - 35128, Padua , Italy
| | - Gulay Gok
- Department of Cardiology, Medipol University hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No:, D:1, 34214, İstanbul , Turkey
| | - Oksana Marchenko
- Ukrainian Children’s Cardiac Center, Clinic for Adults, Shuliavka, 02000, Kyiv , Ukraine
- Shupyk National Healthcare University of Ukraine, 9, Dorohozhytska St, 04112, Kyiv , Ukraine
| | - Camilla Calvieri
- Bambino Gesù Children’s Hospital, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome , Italy
- Department of Internal Clinical Sciences, Anesthesiology and Cardiology, “La Sapienza” University of Rome, Piazzale Aldo Moro, 5, 00185, Rome , Italy
| | - Anna Baritussio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedale Università Padova, Via Giustiniani, 2, 35128, Padua , Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via Sergio Pansini, 5, 80131, Naples , Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122, Naples , Italy
| | - Nihan Caglar
- Cardiology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Cd No:11, 34147, Istanbul , Turkey
| | - Sara Moscatelli
- Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 6, 16132 , Italy
| | - Irina Kotlar
- University Clinic of Cardiology, Мајка Тереза 17, Mother Teresa 17, Skopje , Republic of North Macedonia
| | - Maria Trêpa
- Cardiology Department, Porto University Hospital Centre, Largo do Prof. Abel Salazar, 4099-001, Porto , Portugal
| | - Maria Gimenez Rubini
- Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Strümpellstraße 39, 04289, Leipzig , Germany
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel , Switzerland
| | - Christina Chrysohoou
- First Cardiology Clinic, Hippokration Hospital, School of Medicine, University of Athens, 114 Vass Sofias Ave, 11527, Athens , Greece
| | - Ljiljana Jovovic
- Faculty of Medicine, University of Belgrade, dr Subotića starijeg 8, 11000, Belgrade , Serbia
| | - Katja Prokšelj
- Department of Cardiology, University Medical Center, Zaloška cesta 7, 1000, Ljubljana , Slovenia
| | - Iveta Simkova
- ACHD Centre, Department of Cardiology and Angiology of Medical Faculty, Slovak Medical University and National Institute of Cardiovascular Diseases, 831 01, Bratislava , Slovakia
| | | | - Jolanta Siller-Matula
- Department of Cardiology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna , Austria
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-091, Warsaw , Poland
| | - Fatima Chikhi
- Cardiology “B” Department, Ibn Sina Hospital Med V University, 62, Jbran Khalil Jbran Street, Souissi, Rabat , Morocco
| | - Tamara Kovačević-Preradović
- School of Medicine, University of Banja Luka, Save Mrkalja 14, Banja Luka, 78000, Republic of Srpska , Bosnia and Herzegovina
| | | | - Victoria Johnson
- Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen , Germany
| | - Marta Farrero
- Heart Failure and Heart Transplant Unit, Cardiology, Hospital Clínic, C. de Villarroel, 170, 08036, Barcelona , Spain
| | - Sarah Moharem-Elgamal
- Cardiology Department, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE , United Kingdom
- Cardiology Department, National Heart Institute, 5 Ibn Nafise Square, Mit Akaba, Agouza, Giza , Egypt
| | - Alessia Gimelli
- CNR—Regione Toscana, Fondazione Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa , Italy
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Piperata A, Watanabe M, Pernot M, Metras A, Kalscheuer G, Avesani M, Barandon L, Peltan J, Lorenzoni G, Jorgji V, Gregori D, Takahashi S, Labrousse L, Gerosa G, Bottio T. Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a multicentre study. Eur J Cardiothorac Surg 2021; 61:828-835. [PMID: 34302165 DOI: 10.1093/ejcts/ezab341] [Citation(s) in RCA: 9] [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: 12/16/2020] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection. METHODS Data from 646 patients who underwent surgical repair of thoracic type A aortic dissection using unilateral and bilateral ACP with moderate hypothermic circulatory arrest in 3 cardiac surgical institutions between 2008 and 2018 were analysed. Propensity matching was performed to assess which technique ensured better outcomes. RESULTS Unilateral and bilateral ACP techniques were performed in 250 (39%) and in 396 (61%) patients, respectively. Propensity score analysis identified 189 matched pairs. In the matched cohort, the lowest core temperature was 27.5°C and 28°C in the bilateral and unilateral groups, respectively (P < 0.001). The unilateral technique required significantly shorter aortic cross-clamp and cardiopulmonary bypass times than bilateral technique [82 min vs 100 min (P < 0.001); 170 min vs 195 min (P < 0.001)]. The 30-day mortality was comparable (P = 0.325). The bilateral group reported a significantly higher incidence of permanent neurologic deficits (P < 0.001), left brain hemisphere stroke (P = 0.007) and all-combined complications (P < 0.001). Ten-year survival was comparable (P = 0.45). CONCLUSIONS Unilateral and bilateral ACP are both valid brain protection strategies in the landscape of aortic arch surgery. While admitting all the study limitations, unilateral technique could offer some clinical advantages. CLINICAL REGISTRATION NUMBER 76049.
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Affiliation(s)
- Antonio Piperata
- Department of Cardiology, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy.,Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Masazumi Watanabe
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Mathieu Pernot
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Alexandre Metras
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Gregory Kalscheuer
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Martina Avesani
- Department of Cardiology, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy
| | - Laurent Barandon
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Julien Peltan
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Vjola Jorgji
- Hacohen Lab, Massachusetts General Hospital, Boston, MA, USA
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Louis Labrousse
- Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Gino Gerosa
- Department of Cardiology, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiology, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy
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Avesani M, Degrelle B, Di Salvo G, Thambo JB, Iriart X. Vector flow mapping: A review from theory to practice. Echocardiography 2021; 38:1405-1413. [PMID: 34259359 DOI: 10.1111/echo.15154] [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: 02/15/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The interest in intra-cardiac blood flow analysis is rapidly growing, and it has encouraged the development of different non-invasive imaging techniques. Among these, Vector Flow Mapping (VFM), combing Color-Doppler imaging and speckle tracking data, seems to be a promising approach, feasible in adult and children population. AIM OF THE REVIEW The aim of this review is to give a historical perspective on the development of VFM method and a summary of the current algorithms and parameters potentially evaluable. Then, we will present the current state-of-the-art of VFM with an overview of clinical studies and applications of this technique.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Bastien Degrelle
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France
| | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
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42
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Sabatino J, Borrelli N, Fraisse A, Herberg J, Karagadova E, Avesani M, Bucciarelli V, Josen M, Paredes J, Piccinelli E, Spada M, Krupickova S, Indolfi C, Di Salvo G. Abnormal myocardial work in children with Kawasaki disease. Sci Rep 2021; 11:7974. [PMID: 33846402 PMCID: PMC8042008 DOI: 10.1038/s41598-021-86933-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Kawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7 ± 5 years) were included: 45 children with KD and CADL (KD/CADL) (Z-score > 2.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD/CADL patients had lower MWI (1433.2 ± 375.8 mmHg% vs 1752.2 ± 265.7 mmHg%, p < 0.001), MCW (1885.5 ± 384.2 mmHg% vs 2175.9 ± 292.4 mmHg%, p = 0.001) and MWE (994.0 ± 4.8% vs 95.9 ± 2.0%, p = 0.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3 ± 361.7 mmHg%; KD vs CTRL p = 0.028) and was comparable between KD/CADL and KD groups (KD/CADL vs KD p = 0.896). Moreover, KD/CADL patients with normal GLS (n = 38) preserved significant differences in MWI and MCW in comparison with CTRL. MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.
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Affiliation(s)
- Jolanda Sabatino
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK. .,National Heart and Lung Institute, Imperial College, London, UK.
| | - Nunzia Borrelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Jethro Herberg
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Elena Karagadova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Martina Avesani
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Valentina Bucciarelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Manjit Josen
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Josefa Paredes
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Enrico Piccinelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Maraisa Spada
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, URT-CNR, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK. .,National Heart and Lung Institute, Imperial College, London, UK.
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43
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Piperata A, Bottio T, Avesani M, Gerosa G. Sutureless and rapid deployment bioprosthetic valves: New perspectives. J Card Surg 2021; 36:2187-2188. [PMID: 33713472 DOI: 10.1111/jocs.15489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Antonio Piperata
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Martina Avesani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
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44
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Piperata A, Bottio T, Avesani M, Gerosa G. Innominate artery dissection during cerebral perfusion: The exception that proves the rule. J Card Surg 2021; 36:1581. [PMID: 33586275 DOI: 10.1111/jocs.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Antonio Piperata
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Martina Avesani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
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45
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Piccinelli E, Sabatino J, Krupickova S, Fraisse A, Prota C, Bucciarelli V, Avesani M, Borrelli N, Delle Donne G, Josen M, Paredes J, Sirico D, Indolfi C, Daubeney P, Di Salvo G. LV twist predicts prognosis in children and adolescents with non-compaction cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.185] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular non-compaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood, with heart failure, arrhythmias, and embolic events as main clinical manifestations. LV twist has recently been demonstrated having good predictive value in diagnosing LVNC in young patients. However, how LV twist may influence long-term clinical outcome of LVNC children and adolescents is still unknown.
The aim of this study was to analyse a set of echocardiographic parameters to find imaging predictors of worse clinical outcomes in a long-term follow-up of LVNC children and young patients.
Methods
Children and adolescents, followed from May 2012 to June 2020, were enrolled in a retrospective study. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging (1.5 Tesla) at our Institution’s first evaluation.
Death, heart failure hospitalization, aborted sudden cardiac death, ventricular arrhythmias (sustained and non-sustained ventricular tachycardia), and embolisms (i.e. stroke, peripheral arterial embolism and/or pulmonary thromboembolism) were registered and referred to as major adverse cardiovascular events (MACEs).
Results
Recruited for the study were 47 children (mean age: 11.1± 5; age range: 0–18 years). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group (LVHT).
They were followed for 4.9 ± 1.0 years, and MACEs were registered. Thirteen children (56% of LVNC, 28% of total) had at least one MACE. Global longitudinal, circumferential and radial strains (GLS, GCS, GRS), LV twist and LVEF resulted being significantly reduced in children with MACEs at follow-up. A multivariable analysis was performed by combining four parameters: LV ejection fraction, GLS, GCS, LV twist. These independent variables were chosen according to univariable analyses and clinical relevance. The results from the analysis demonstrated that LV twist was the only independent predictor (P = 0.033, coeff. B 0.726) of worse clinical outcomes in young patients with LVNC.
Conclusions
LV twist is a promising tool to stratify and predict prognosis in LVNC young patients. Our findings show the importance of LV twist assessment to detect the severity of LVNC and to plan for early clinical intervention.
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Affiliation(s)
- E Piccinelli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sabatino
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - S Krupickova
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Fraisse
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Prota
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - V Bucciarelli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Avesani
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - N Borrelli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - G Delle Donne
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Josen
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Paredes
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Sirico
- University of Padua, Padova, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - P Daubeney
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Avesani M, Guariento A, Schiena CA, Reffo E, Castaldi B, Padalino M, Vida V, Di Salvo G. Echocardiographic comparison between pulmonary valve preservation and transannular patch techniques in children with repaired Tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.415] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
Many centers have recently adopted pulmonary valve (PV) preservation procedures to prevent the detrimental long-term effects of chronic pulmonary regurgitation after tetralogy of Fallot (ToF) repair.
PURPOSE
The aim of our study was to investigate pulmonary valve (PV) and right ventricular function by echocardiography in paediatric patients with repaired Tetralogy of Fallot (ToF), comparing PV preservation surgical strategies to standard transannular patch (TAP) repair.
METHODS
All patients undergoing transatrial-transpulmonary repair for ToF at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 main groups, according to the different techniques used: patients undergoing a PV preservation strategy and patients undergoing TAP repair. All patients underwent standard echo-Doppler study including RV end-diastolic area (RVEDA), end-systolic area (RVESA), fractional area change (FAC) and TAPSE; PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT) and pulmonary regurgitation (PR) index. By speckle tracking we measured also, in a subgroup of patients, right atrial strain (RAS), RV and left ventricle (LV) global longitudinal strain (RVGLS, LVGLS) and their time to peak (TTP) values.
RESULTS
Overall, 82 patients underwent a successful PV preservation strategy while 34 underwent a standard TAP repair. At index surgery, BSA (0.31 ± 0.1 m2, P = 0.3), age (4.8 ± 0.3 months, P = 0.5) and preoperative PV Z-score (-3.20 ± 0.1, P = 0.1) did not different between groups. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p = 0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at follow up (HR: 1.85, 95% CI: 1.09, 3.15; p = 0.02). At a mean follow-up of 6.9 ± 0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9 ± 0.8% vs 42.5 ± 1.7%, P < 0.001) and tricuspid annular plane systolic excursion (TAPSE) z-score (-3.36 ± 0.3% vs -4.7 ± 0.4%, P = 0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9 ± 1.2% vs 82.7 ± 2.4%, P = 0.02). At speckle tracking subanalysis, patients undergoing PV preservation (n= 23), compared to the TAP group (n = 13) showed also higher values of RAS (37.5 ± 6.0% vs 29.3 ± 8.2% , P < 0.006), shorter right TTP (319 ± 39ms vs 357.5 ± 45.2 ms, P < 0.01) and higher values of LVGLS (-20,6 ± 4,2% vs -17.5 ± 3.0, P < 0.03).
CONCLUSIONS
Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible.
Abstract Figure. Degree of pulmonary regurgitation
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Affiliation(s)
- M Avesani
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
| | - A Guariento
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - CA Schiena
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - E Reffo
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
| | - B Castaldi
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
| | - M Padalino
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - V Vida
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - G Di Salvo
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
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Sabatino J, Leo I, Borrelli N, Avesani M, La Bella S, Josen M, Paredes J, Sirico D, Piccinelli E, Delle Donne G, Brida M, Indolfi C, Fraisse A, Di Salvo G. Non-invasive myocardial work normal reference ranges in healthy children. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.037] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Myocardial work (MW) estimation by pressure-strain loops (PSL) allows a non-invasive evaluation of myocardial performance, as recently demonstrated in adult patients.
Aim of this study is to provide the reference values for global myocardial work index (MWI), constructive work (MCW), wasted work (MWW), and work efficiency (MWE) in a group of healthy children.
METHODS
Assessment of MW was performed using a commercially available software package (Echopac, GE). MW was measured from PSLs areas, derived from non-invasive LVP curves combined with strain acquired speckle tracking echocardiography (STE).
After calculating GLS, values of brachial blood pressure were inserted and the time of valvular events by echocardiography were indicated, then the software was able to measure non-invasive PSLs.
RESULTS
Two-dimensional (2D) standard and speckle-tracking echocardiography were performed in 90 healthy children (mean age 9.9 ±4.9 [1-17] years, females: 57%) together with the assessment of MW by means of PSLs.
Mean ± standard deviation, 5° and 95° percentile values for global MWI, MCW, MWW, and MWE in the whole population were 1769 ± 254 mm Hg, (1354-2193); 2201 ± 290 mm Hg, (1657-2658); 78 ± 47 (29-163) mm Hg%; 96 ± 1.8 (92-99)%, respectively.
CONCLUSIONS
The assessment of MW is feasible in healthy children. This study provides useful 2-dimensional echocardiographic reference ranges for novel indices of non-invasive MW.
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Affiliation(s)
- J Sabatino
- Magna Graecia University of Catanzaro, Medical and Surgical Science, Catanzaro, Italy
| | - I Leo
- Magna Graecia University of Catanzaro, Medical and Surgical Science, Catanzaro, Italy
| | - N Borrelli
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Avesani
- University of Padua, Pediatric Cardiology, Padova, Italy
| | - S La Bella
- University of Padua, Pediatric Cardiology, Padova, Italy
| | - M Josen
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J Paredes
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - D Sirico
- University of Padua, Pediatric Cardiology, Padova, Italy
| | - E Piccinelli
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - G Delle Donne
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Brida
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - C Indolfi
- Magna Graecia University of Catanzaro, Medical and Surgical Science, Catanzaro, Italy
| | - A Fraisse
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - G Di Salvo
- University of Padua, Pediatric Cardiology, Padova, Italy
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Borrelli N, Avesani M, Sabatino J, Ibrahim A, Josen M, Paredes J, Di Salvo G. Blood speckle imaging: A new echocardiographic approach to study fluid dynamics in congenital heart disease. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sabatino J, Moscatelli S, Rustamova Y, Kotlar I, Avesani M, Brida M, Gök G, Borrelli N, Marchenko O, Calvieri C, Czerwińska-Jelonkiewicz K, Moharem-Elgamal S, Grapsa J, Kemaloğlu Öz T. Women's perspective on the COVID-19 pandemic: Walking into a post-peak phase. Int J Cardiol 2021; 323:29-33. [PMID: 32800917 PMCID: PMC7423508 DOI: 10.1016/j.ijcard.2020.08.025] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/03/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of Novel Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has provoked hundreds of thousands of deaths, resulting in catastrophe for humans. Although some insights have been garnered in studies on women, children and young adults infected with COVID-19, these often remain fragmented in literature. Therefore, we discussed the impact of COVID-19 pandemic on women, children and young patients, particularly those with underlying cardiovascular comorbidities or congenital heart disease. Furthermore, we gathered and distilled the existing body of literature that describes their cardiovascular complications and the recommended actions in favour of those patients toward the post-peak pandemic period. Although many questions still require answers, this article is sought to help the practicing clinician in the understanding and management of the threatening disease in special populations.
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Affiliation(s)
- Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy.
| | - Sara Moscatelli
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Yasmin Rustamova
- Department of Internal Medicine 1/Cardiology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Irina Kotlar
- University Clinic of Cardiology, Skopje, Macedonia
| | - Martina Avesani
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Margarita Brida
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom; Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia
| | - Gülay Gök
- Department of Cardiology, Medipol University Hospital, Istanbul, Turkey
| | - Nunzia Borrelli
- Paediatric Cardiology Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Oksana Marchenko
- Ukrainian Children's Cardiac Center, Clinic for adults, Kyiv, Ukraine; Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Camilla Calvieri
- Paediatric Cardiology Department, Bambino Gesù Children Hospital, Rome, Italy; Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, "La Sapienza" University of Rome, Italy
| | - Katarzyna Czerwińska-Jelonkiewicz
- Andrzej Frycz Modrzewski Krakow University, Kraków, Poland; Intensive Therapy Unit, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Sarah Moharem-Elgamal
- Cardiology Department, Bristol Heart Institute-, Bristol, United Kingdom; Cardiology Department, National Heart Institute, Giza, Egypt
| | - Julia Grapsa
- Cardiology Department, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom
| | - Tugba Kemaloğlu Öz
- Liv Hospital Ulus, Cardiology Department, Istanbul, Turkey; Istinye University, Faculty of medicine, Istanbul, Turkey.
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50
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Borrelli N, Sabatino J, Avesani M, Paredes J, Josen M, Fraisse A, Guccione P, Michielon G, Di Salvo G. Longitudinal Evaluation of Right Ventricle Function after Right Ventricle- Pulmonary Artery Shunt vs. Blalock-Taussig Shunt. CONGENIT HEART DIS 2021. [DOI: 10.32604/chd.2021.012526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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