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Rao PS. Balloon pulmonary valvuloplasty: A systematic review. Indian Heart J 2023:S0019-4832(23)00476-5. [PMID: 38147974 DOI: 10.1016/j.ihj.2023.12.007] [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: 09/11/2023] [Revised: 11/09/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023] Open
Abstract
There is conclusive evidence for relief of pulmonary valve obstruction immediately after balloon pulmonary valvuloplasty (BPV) and at follow-up. Development of infundibular obstruction is seen in more severe PS cases and in older subjects. Reappearance of PS was observed in approximately 10 % of patients following BPV. The reasons for recurrence were found to be balloon/annulus ratio less than 1.2 and immediate post-BPV pulmonary valve peak gradients greater than 30 mmHg. Recurrent stenosis is successfully addressed by repeating BPV with lager balloons than used initially. Long-term results revealed continue relief of obstruction, but with development of pulmonary insufficiency, some patients requiring replacement of the pulmonary valve. It was concluded that BPV is the treatment of choice in the management valvar PS and that balloon/annuls ratio used for BPV should be lowered to 1.2 to 1.25. It was also suggested that strategies should be developed to prevent/reduce pulmonary insufficiency at long-term follow-up.
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Affiliation(s)
- P Syamasundar Rao
- Children's Heart Institute, University of Texas-Houston McGovern Medical School, Children's Memorial Hermann Hospital, Houston, TX, USA.
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2
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Joosen RS, Breur JMPJ, Wessels JN, Krings GJ, Voskuil M, de Man FS, van de Veerdonk MC. Right ventricular to pulmonary arterial coupling in patients with repaired tetralogy of Fallot: a case series. Eur Heart J Case Rep 2023; 7:ytad583. [PMID: 38046648 PMCID: PMC10691650 DOI: 10.1093/ehjcr/ytad583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
Background In repaired tetralogy of Fallot (ToF) patients with residual right ventricular (RV) outflow tract obstructions (RVOTO), risk stratification and timing of re-interventions are based on RVOTO gradients. However, this might be insufficient to prevent RV dysfunction. Instead, assessment of RV to pulmonary arterial (RV-PA) coupling allows integrated assessment of RV function in relationship to its afterload and could be of additional value in clinical decision-making. Case summary Two patients with repaired ToF and residual RVOTO without pulmonary regurgitation underwent right heart catheterization (RHC) and cardiac magnetic resonance imaging. We determined RV end-systolic elastance (Ees), arterial elastance (Ea) and RV-PA coupling (Ees/Ea) using single-beat RV pressure-volume analysis. Patient 1 was asymptomatic despite severely increased RV pressures and a left pulmonary artery (LPA) stenosis (invasive gradient 20 mmHg). Right ventricular volumes and function were preserved. The Ea and Ees were increased but RV-PA coupling was relatively maintained. Of interest, RV end-diastolic pressure and RV diastolic stiffness were increased. After LPA plasty, RV function was preserved during long-term follow-up. Patient 2 was symptomatic despite mildly elevated RV pressures and a supravalvular RV-PA conduit stenosis (invasive gradient 30 mmHg). The RV showed severe RV dilatation and dysfunction. The Ea was increased but Ees was decreased leading to RV-PA uncoupling. Despite balloon angioplasty, RV function was unchanged during long-term follow-up. Discussion Development of RV dysfunction might be insufficiently predicted by RVOTO severity in patients with repaired ToF. Assessment of RV remodelling and function in relationship to its afterload might help to optimize risk stratification.
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Affiliation(s)
- Renée S Joosen
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen N Wessels
- PHEniX laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frances S de Man
- PHEniX laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Marielle C van de Veerdonk
- Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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Fazelifar AF, Talebian F, Ghaffarinejad Z, Habibi MA, Pasebani Y, Mazloomi AA, Fazelifar AF, Khajali Z. Electrocardiographic manifestations of pulmonary stenosis versus pulmonary hypertension. J Electrocardiol 2023; 81:117-122. [PMID: 37688841 DOI: 10.1016/j.jelectrocard.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Right ventricular hypertrophy can be caused by conditions such as pulmonary stenosis and pulmonary hypertension. ECG is a readily available and affordable test, the aim of this study was the evaluation of the electrocardiographic aspects of pulmonary stenosis, and pulmonary hypertension. METHODS A list of patients diagnosed with isolated pulmonary stenosis and pulmonary hypertension patients hospitalized and treated between 2019 and 2021 were extracted from the hospital archives. Furthermore, the ECG of the patients was analyzed in terms of the prevalence of the variables in the study using FECG Caliper software. Finally, the data of 93 patients (in both groups) were analyzed. RESULTS In this study, 46 patients were in the severe pulmonary stenosis group, and 49 were in the severe or moderate-to-severe pulmonary hypertension group. The heart rate in the pulmonary hypertension group was significantly higher. R/S > 1 in precordial leads differs between the two groups and higher amplitude R wave in V1(p-value = 0.05). in the pulmonary stenosis group. While in the pulmonary hypertension group, R wave growth occurs later, and this ratio is greater than one after V4. Bundle block in the form of RBBB(p-value <0.001) and maximum QRS duration is more in the pulmonary stenosis group(p-value = 0.001). CONCLUSION Our findings show the different strains of the right ventricle in two groups. It can be concluded that the effects of severe pulmonary stenosis on the ECG are more on the QRS wave and in the form of a block, while severe pulmonary hypertension affects the ST segment and T wave.
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Affiliation(s)
- Amir Farjam Fazelifar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Talebian
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghaffarinejad
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Yeganeh Pasebani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aram Amir Mazloomi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Faraz Fazelifar
- Rouzbeh High School Educational Complex, North Seikh Bahaie, First Street, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Sofi NU, Sachan M, Sinha SK, Jha MJ, Pandey U, Razi M, Sharma AK, Shukla P, Aggarwal P, Himanshu K, Sharma P, Thakur R. Accura balloon dilatation catheter for percutaneous balloon pulmonary valvuloplasty among adult patients-its protean use. Am J Cardiovasc Dis 2023; 13:152-161. [PMID: 37469531 PMCID: PMC10352819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Percutaneous balloon pulmonary valvuloplasty (PBPV) is the treatment of choice for hemodynamically significant pulmonary stenosis (PS). Currently, the Tyshak balloon is preferred but requires multiple dilatations because of its instability across the valve leading to a watermelon seeding effect. Accura balloon (Vascular Concept, UK) offers an advantage in its self-positioning configuration, variable diameter, and rapid inflation-deflation sequence which shortens the procedural time and valve injury. METHOD 43 patients with severe pulmonary valve stenosis underwent PBPV using an Accura balloon at LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, India from March 2018 to February 2022. The procedure was carried out using the standard technique but the metallic straightener was removed when the catheter reached the right atrium to facilitate its delivery across the pulmonary valve. Patients were followed up by 2D echo at 24 hours and 6 months. RESULT Successful BPV was done in all 43 patients [with mean age 21.9 (range 18-41); 31 males and 12 females] among which 5 patients had dysplastic valves. The mean diameter of the annulus was 18.5 (range 15-21) mm. Immediate hemodynamic improvement was observed in 38 patients (88%) as peak systolic gradient reduced from 84±13 to 22±12 mmHg (P<0.005) while 5 patients (12%) had <50% reduction of resting gradient, though it came down significantly at 6 months. Fluoroscopy and procedural time were 5.2±1.9 min and 22.6±3.4 min respectively. Major complications (death, cardiac perforation, tamponade, tricuspid regurgitation, requirement of blood transfusion) were none. Minor complications (transient hypotension, ventricular premature contraction, transient bradycardia) were reported in all patients. Accura balloon being bulky were delivered over left atrial and super stiff Amplatz wire in 36 and 7 patients respectively. CONCLUSION PBPV using Accura balloon is safe and effective for both stenosed and dysplastic valves. In a few patients, maximal effect will be observed over a period of 6 months.
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Affiliation(s)
- Najeeb Ullah Sofi
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Santosh K Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Mukesh J Jha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Mahmodullah Razi
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Awadhesh K Sharma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Praveen Shukla
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Puneet Aggarwal
- Department of Cardiology, ABVIMS and Dr. RML HospitalNew Delhi, India
| | - Kumar Himanshu
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Prachi Sharma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical CollegeKanpur, Uttar Pradesh, India
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Brizard CP. One size does not fit all. Eur J Cardiothorac Surg 2023:7194136. [PMID: 37307080 DOI: 10.1093/ejcts/ezad214] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/11/2023] [Indexed: 06/13/2023] Open
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Cai M, Guo N, Fu M, Chen Y, Liang B, Que Y, Ji Q, Huang H, Xu L, Lin N. Prenatal diagnosis of genetic aberrations in fetuses with pulmonary stenosis in southern China: a retrospective analysis. BMC Med Genomics 2023; 16:119. [PMID: 37248535 DOI: 10.1186/s12920-023-01548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The genetic etiology of congenital pulmonary stenosis (PS) in fetuses remains inadequately studied. We used karyotype analysis and chromosomal microarray analysis (CMA) to investigate the genetic aberrations associated with PS in human fetuses. METHODS A retrospective analysis was performed on 84 fetuses with congenital PS in southern China. Fetal amniotic fluid and umbilical cord blood samples were obtained for chromosomal karyotype analysis and CMA. RESULTS The rate of pathogenic copy number variation (CNV) was 15.5% (13/84) after karyotyping and CMA. An abnormal karyotype was detected in five cases (6.0%, 5/84) via karyotyping, whereas pathogenic CNVs were detected in 13 cases (15.5%, 13/84) via CMA. In addition to the five abnormal karyotypes detected using karyotype analysis, eight additional chromosomal microduplications and microdeletions were detected using CMA, comprising three cases of 22q11.21 microdeletion; two cases of 16p11.2 microdeletion; one case of simultaneous 18q23 microdeletion and 22q13.33 microduplication; one case of 15q24.1q24.2 microdeletion; and one case of 1q21.1q21.2 microduplication. The rate of pathogenic CNV occurrence was 11.5% in fetuses with isolated PS and 17.2% in fetuses with PS combined with other ultrasound abnormalities. This difference between the two experimental groups was statistically significant. Among 84 fetuses with PS, 39 pregnancies were terminated, and five were lost to follow-up. CONCLUSIONS CMA was not only conducive to detect PS-related pathogenic genomic abnormalities but also to accurately evaluate fetal prognosis in genetic counseling. The early detection of PS and genomic abnormalities will exerta positive impact on fetal intervention and the related prognosis of PS in perinatal infants.
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Affiliation(s)
- Meiying Cai
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Nan Guo
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Meimei Fu
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Yuqing Chen
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Bin Liang
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Yanting Que
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Qingqiang Ji
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Hailong Huang
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China.
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China.
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China.
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Korça E, Veres G, Szabó G. Case report: Aortic valve endocarditis and recurrent pulmonary valve stenosis. J Cardiothorac Surg 2023; 18:89. [PMID: 36944991 PMCID: PMC10029201 DOI: 10.1186/s13019-023-02184-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND We discuss a rare case of an adult patient with different pathologies involving the aortic and pulmonary valves in need of surgery. CASE PRESENTATION The patient had a history of congenital PV stenosis and surgical valvuloplasty. Almost 50 years later the patient underwent a complex second heart surgery due to infective endocarditis of the aortic valve and high-grade restenosis of the pulmonary valve. Replacement of the aortic and pulmonary valve, as well as reconstruction of the RVOT and closure of a persistent foramen ovale, followed. Postoperative course was uneventful and the patient was discharged home a week after surgery. CONCLUSION Simultaneous surgery of pulmonary and aortic valves due to different pathologies is rare but can be performed successfully even in advanced age and can improve quality of life.
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Affiliation(s)
- Edina Korça
- Department of Cardiac Surgery, Middle German Heart Centre, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Gábor Veres
- Department of Cardiac Surgery, Middle German Heart Centre, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, Middle German Heart Centre, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Nakamura M, Kanno K, Nishioka M. Comprehensive outcomes after primary arterial switch operation. Gen Thorac Cardiovasc Surg 2022:10.1007/s11748-022-01902-7. [PMID: 36583825 DOI: 10.1007/s11748-022-01902-7] [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: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To report the long-term outcomes of the arterial switch operation for transposition of the great arteries. METHODS The data of 35 patients who underwent an arterial switch operation between April 2006 and May 2021 were retrospectively examined; five had double-outlet right ventricles, three had side-by-side transposition, and 27 had d-transposition. The punch-out technique was the basic method for coronary transplantation; however, if coronary artery kinking after additional peeling was a concern, the trap-door technique was used. In aortic reconstruction, the caliber difference between the neoascending aorta and the native pulmonary artery was fixed using the pulmonary artery flap. In pulmonary reconstruction, the pulmonary artery was bilaterally exposed over the second branch. RESULTS The median age at operation and follow-up duration were 10.0 (8.0-12.5) days and 72.9 (40.7-139.5) months, respectively. Thirty-four patients survived, and one was lost to follow-up ([coronary transplantation]: right coronary artery, punch-out = 31, trap-door = 2; left coronary artery, punch-out = 28, trap-door = 7; [aortic regurgitation]: no-slight = 27, mild = 6, moderate = 1; [pulmonary regurgitation]: no-slight = 22, mild = 11, moderate = 1). Slight coronary bending occurred in two patients; ischemia was not observed. Catheter stent placement was performed in one of three patients with stenosis at the pulmonary artery bifurcation. Catheter balloon dilation was performed in one patient with supravalvular pulmonary stenosis. There were no cases of coronary, aortic, or pulmonary artery reoperations. The 15-year cumulative reintervention avoidance rate was 91.0%. CONCLUSIONS There were no deaths or reoperations during the long-term follow-up period, and arterial switch operation outcomes at our hospital were satisfactory.
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Affiliation(s)
- Makoto Nakamura
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, 118-1, Arakawa, Haebaru-Cho, Okinawa, 901-1193, Japan.
| | - Kazuyoshi Kanno
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, 118-1, Arakawa, Haebaru-Cho, Okinawa, 901-1193, Japan
| | - Masahiko Nishioka
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, 118-1, Arakawa, Haebaru-Cho, Okinawa, 901-1193, Japan
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Arunamata A, Goldstein BH. Right ventricular outflow tract anomalies: Neonatal interventions and outcomes. Semin Perinatol 2022; 46:151583. [PMID: 35422353 DOI: 10.1016/j.semperi.2022.151583] [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] [Indexed: 11/29/2022]
Abstract
Right ventricular outflow tract (RVOT) anomalies comprise a wide spectrum of congenital heart disease, typically characterized by obstruction to flow from the right ventricle to pulmonary arteries. This review highlights important considerations surrounding management strategy as well as clinical outcomes for the neonate with RVOT anomaly, including: pulmonary atresia with intact ventricular septum, congenital pulmonary valve stenosis, tetralogy of Fallot, and Ebstein anomaly with anatomic or physiologic RVOT obstruction.
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Affiliation(s)
- Alisa Arunamata
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine.
| | - Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine
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Siagian SN, Haas NA, Prakoso R. Transcatheter pulmonary balloon valvuloplasty of severe valvar pulmonary stenosis and atrial septal defect in patient with severe cyanosis and very low ventricle ejection fractions: a bailout procedure. Cardiol Young 2021; 31:2028-30. [PMID: 34016212 DOI: 10.1017/S1047951121001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most cases of severe or critical pulmonary stenosis are detected early and interventional management is routine within the first days of life. We present a case of a thirteen-year-old boy diagnosed with pulmonary stenosis and atrial septal defect with low ventricle ejection fraction. The patient underwent staged pulmonary balloon valvuloplasty and interventional atrial septal defect closure with good results.
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Affiliation(s)
- Emre Belli
- Marie Lannelongue Hospital, GHPSJ, Paris-Saclay University, Le Plessis-Robinson, France
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12
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Maeda K, Lui GK, Zhang Y, Maskatia SA, Romfh A, Yarlagadda VV, Hanley FL, McElhinney DB. Durability of Pulmonary Valve Replacement with Large Diameter Stented Porcine Bioprostheses. Semin Thorac Cardiovasc Surg 2021; 34:994-1000. [PMID: 33971298 DOI: 10.1053/j.semtcvs.2021.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
There is limited information about durability of large diameter porcine bioprostheses implanted for pulmonary valve replacement (PVR). We studied patients who underwent surgical PVR from 2002-2019 with a stented porcine bioprosthetic valve (BPV) with a labeled size ≥27 mm. The primary outcome was freedom from reintervention. During the study period, 203 patients underwent PVR using a porcine BPV ≥27 mm, 94% of whom received a Mosaic valve (Medtronic Inc., Minneapolis, MN). Twenty patients underwent reintervention from 3.4-12.0 years after PVR: 5 surgical and 15 transcatheter PVR procedures. The indication for reintervention was regurgitation in 13 patients, stenosis in 2, mixed disease in 4, and endocarditis in 1. Estimated freedom from reintervention was 97±1% at 5 years and 82±4% at 10 years, and freedom from prosthesis dysfunction (moderate or severe regurgitation and/or a maximum Doppler gradient ≥50 mm Hg) over time was 91±2% at 5 years and 74±4% at 10 years. Younger age and smaller true valve diameter were associated with shorter freedom from reintervention, but valve oversizing was not. The durability of large stented porcine bioprostheses in the pulmonary position is generally excellent, particularly in adolescents and adults, similar to various other types of BPV. In the current study, relative valve size was not associated with valve longevity, although the low event-rate in this population was a limiting factor.
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Affiliation(s)
- Katsuhide Maeda
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | - George K Lui
- Cardiovascular Medicine, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine
| | - Yulin Zhang
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | | | - Anitra Romfh
- Cardiovascular Medicine, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine
| | | | - Frank L Hanley
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Doff B McElhinney
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine.
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Choi ES, Kim DH, Kwon BS, Park CS, Yun TJ. Growth of the Branch Pulmonary Arteries After Employing 'Shunt-Only' Strategy for Neonates With Pulmonary Atresia or Stenosis. Semin Thorac Cardiovasc Surg 2021; 33:1095-1102. [PMID: 33971299 DOI: 10.1053/j.semtcvs.2021.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022]
Abstract
We sought to determine the impact of juxtaductal stenosis (JDS) on branch pulmonary artery (PA) growth after systemic-to-pulmonary shunt (SPS) placement without pulmonary arterioplasty (ie the 'shunt-only' strategy). This was a retrospective review of 91 patients, 54 (59.3%) with pulmonary atresia and 27 (29.7%) with a functionally single ventricle, who underwent neonatal SPS placement without pulmonary arterioplasty between 2008 and 2017. The median age and body weight at SPS procedure were 16 day's (interquartile range [IQR], 11-22) and 3.10 kg (IQR: 2.85-3.40), respectively. All patients had pre-SPS computed tomography (CT) followed by post-SPS CT at a median interval of 5.8 months' (IQR: 4.5-7.2). The ratio of the diameters of the juxtaductal PA over the non-SPS-side hilar PA (JD and/or PA) on preoperative CT-a surrogate for JDS severity-was 0.93 (IQR: 0.67-1.09). The median diameter (Z) of the SPS-side and non-SPS-side PA on postoperative CT were 1.0 (IQR: -0.07-1.73) and 0.99 (IQR: -0.45-1.70), respectively. The pulmonary artery index (Nakata index) increased significantly from 124.0 ± 50.2 mm2/m2 to 240.8 ± 88.7 mm2/m2 (P < .001). Unplanned surgical interventions on the non-SPS-side PA were performed on 7 patients. Logistic regression identified lower preoperative JD and/or PA as a risk factor for unplanned intervention on the non-SPS-side PA (odds ratio, 1.27 per 0.1 decrease; 95% confidence interval, 1.10-2.16, P = 0.025). PA growth on the non-SPS side is generally adequate without pulmonary arterioplasty among patients with JDS. However, unplanned interventions for the non-SPS-side PA are caveats for 'shunt-only' strategy in neonates with significant JDS.
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Affiliation(s)
- Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hee Kim
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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An K, Li S, Yan J, Wang X, Hua Z. Transposition of the Great Arteries, Ventricular Septal Defect, and Pulmonary Stenosis: Modified REV versus Rastelli. Pediatr Cardiol 2021; 42:762-767. [PMID: 33507334 DOI: 10.1007/s00246-021-02538-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate and compare the results of the modified réparation à l'ètage ventriculaire (REV) and the Rastelli operation for the treatment of transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS). Records of 38 patients who underwent the modified REV (n = 16) or the Rastelli operation (n = 22) for the treatment of TGA, VSD, and PS between 2010 and 2019 were reviewed. The median age was 2.2 years (range 0.6-8.0 years) and the median weight was 11.3 kg (range 6.4-22.0 kg). No in-hospital death occurred and there were 4 early reoperations (two in each group). Overall survival at 10 years was 97.4% (100% in Modified REV group and 95.5% in Rastelli group, P = 0.39). Freedom from left ventricular outflow tract (LVOT) reoperation was 100% in both groups. Freedom from right ventricular outflow tract (RVOT) reoperation was 100% in Modified REV group and 75.4% in Rastelli group (P = 0.073). Event-free survival was 100% in Modified REV group and 72.0% in Rastelli group (P = 0.048). The most recent echocardiography showed that LVOT peak gradient was less than 10 mmHg in all patients. In Modified REV group, 30.8% of patients (4/13) had either RVOT obstruction (RVOT peak gradient more than 40 mmHg) or moderate or severe pulmonary insufficiency, while conduit stenosis (peak gradient more than 40 mmHg) was found in 25.0% of patients (3/12) in Rastelli group. The modified REV and the Rastelli operation provide satisfactory early results, as well as long-term survival and LVOT performance. However, the modified REV has better RVOT performance.
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Affiliation(s)
- Kang An
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 North Lishi Rd, Beijing, People's Republic of China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 North Lishi Rd, Beijing, People's Republic of China
| | - Jun Yan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 North Lishi Rd, Beijing, People's Republic of China
| | - Xu Wang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 North Lishi Rd, Beijing, People's Republic of China
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 North Lishi Rd, Beijing, People's Republic of China.
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Hirai K, Baba K, Goto T, Ousaka D, Kondo M, Eitoku T, Kotani Y, Kasahara S, Ohtsuki S, Tsukahara H. Outcomes of Right Ventricular Outflow Tract Reconstruction in Children: Retrospective Comparison Between Bovine Jugular Vein and Expanded Polytetrafluoroethylene Conduits. Pediatr Cardiol 2021; 42:100-108. [PMID: 32968822 DOI: 10.1007/s00246-020-02458-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
Bovine jugular vein (BJV) and expanded polytetrafluoroethylene (ePTFE) conduits have been described as alternatives to the homograft for right ventricular outflow tract (RVOT) reconstruction. This study compared RVOT reconstructions using BJV and ePTFE conduits performed in a single institution. The valve functions and outcomes of patients aged < 18 years who underwent primary RVOT reconstruction with a BJV or ePTFE conduit between 2013 and 2017 were retrospectively investigated. 44 patients (20 and 24 with BJV and ePTFE conduits, respectively) met the inclusion criteria. The mean follow-up time was 4.5 ± 1.5 years. No significant differences in peak RVOT velocity (1.8 ± 0.9 m/s vs 2.1 ± 0.9 m/s, P = 0.27), branch pulmonary stenosis (P = 0.50), or pulmonary regurgitation (P = 0.44) were found between the BJV and ePTFE conduit groups, respectively. Aneurysmal dilatation of the conduit was observed in 25.0% of the patients in the BJV conduit group but not in the ePTFE conduit group (P = 0.011). All the cases with aneurysmal dilatation of the BJV conduit were complicated with branch pulmonary stenosis up to 3.0 m/s (P = 0.004). No conduit infections occurred during the follow-up period, and no significant difference in conduit replacement (20.0% vs 8.3%, P = 0.43) was found between the BJV and ePTFE conduit groups, respectively. The outcomes of the RVOT reconstructions with BJV and ePTFE conduits were clinically satisfactory. Aneurysmal dilatation was found in the BJV conduit cases, with branch pulmonary stenosis as the risk factor.
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Affiliation(s)
- Kenta Hirai
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Kenji Baba
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan.
| | - Takuya Goto
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Daiki Ousaka
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Maiko Kondo
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Takahiro Eitoku
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Shinichi Ohtsuki
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
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Bahena-López E, Loya-Centurión J. Left main coronary artery compression by the right pulmonary artery in a patient with congenital pulmonic stenosis. Arch Cardiol Mex 2020; 90:55-57. [PMID: 31996858 DOI: 10.24875/acm.190000149] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Congenital pulmonary stenosis (PS) can be associated with pulmonary artery (PA) dilatation. In some cases, this can cause compression of nearby structures including the left main coronary artery (LMCA). This compression causes angina and is considered an indication for surgical treatment. We present the case of a patient with PS and angina secondary to LMCA compression by the right PA and review the main indications and options for surgical treatment.
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Affiliation(s)
- Eduardo Bahena-López
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Jorge Loya-Centurión
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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17
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Hara H, Kanemitsu N, Hori Y, Hirao S. Surgical treatment for a pulmonary artery aneurysm with stenosis of the quadricuspid pulmonary valve. Eur J Cardiothorac Surg 2020; 59:ezaa300. [PMID: 32949125 DOI: 10.1093/ejcts/ezaa300] [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: 04/12/2020] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 11/14/2022] Open
Abstract
We report a case of pulmonary artery aneurysm and pulmonary stenosis with a quadricuspid pulmonary valve in a 64-year-old woman. While pulmonary artery disease had been found as a child, she needed no treatment because of the absence of symptoms and her normal physical development. She began experiencing dyspnoea on exertion 3 years ago. Echocardiography showed pulmonary artery aneurysm and severe pulmonary stenosis with a quadricuspid valve. Computed tomography showed a pulmonary artery aneurysm extending from its main trunk to the bilateral branches. The pulmonary valve was replaced, and the pulmonary trunk and its bilateral branch were reconstructed. The patient's postoperative course was uneventful.
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Affiliation(s)
- Hiroyuki Hara
- Department of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Yuki Hori
- Department of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Shingo Hirao
- Department of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama, Japan
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18
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Li VWY, Wong JYL, Wang C, Chow PC, Cheung YF. Tricuspid Regurgitation in Adults after Repair of Right Ventricular Outflow Obstructive Lesions. Pediatr Cardiol 2020; 41:1153-1159. [PMID: 32394061 DOI: 10.1007/s00246-020-02366-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
We determined the prevalence and factors associated with tricuspid regurgitation (TR) in adults with repair of right ventricular (RV) outflow obstruction. A total of 256 patients (128 males) were studied at 25.7 ± 7.2 years after surgery, of whom 179 had repaired tetralogy of Fallot (TOF), 31 had pulmonary atresia with intact ventricular septum (PAIVS), and 46 had pulmonary stenosis (PS). The mitral and tricuspid annulus diameters, maximum right atrial (RA) area, RV end-systolic and end-diastolic areas, and tricuspid and pulmonary regurgitation were assessed using echocardiography. The prevalence of moderate-to-severe TR was 20.7%. Subgroup analysis revealed that prevalence was greater in patients with repaired TOF (20.7%) and PAIVS (35.5%) than PS patients (10.9%). As a group, severity of TR was found to be correlated with RA area (r = 0.35, p < 0.001), RV end-diastolic (r = 0.28, p < 0.001) and end-systolic (r = 0.22, p = 0.001) areas, and tricuspid valve annulus diameter (r = 0.15, p = 0.022). Moderate-to-severe TR was associated with development of cardiac arrhythmias with an odds ratio of 2.9 (95% CI 1.1 to 8.1, p = 0.031). Multivariate analysis revealed maximum RA area (β = 0.36, p = 0.016) as an independent determinant of severity of TR. Moderate-to-severe TR occurs in about one-fifth of adults with repaired TOF, PAVIS, and PS and is associated with RA dilation and risk of development of cardiac arrhythmias.
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Affiliation(s)
- Vivian Wing-Yi Li
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Jasmine Yan-Lam Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pak-Cheong Chow
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Yiu-Fai Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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19
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Bahena-López E, Loya-Centurión J. Left main coronary artery compression by the right pulmonary artery in a patient with congenital pulmonic stenosis. Arch Cardiol Mex 2020. [PMID: 31996858 DOI: 10.24875/acm.19000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Congenital pulmonary stenosis (PS) can be associated with pulmonary artery (PA) dilatation. In some cases, this can cause compression of nearby structures including the left main coronary artery (LMCA). This compression causes angina and is considered an indication for surgical treatment. We present the case of a patient with PS and angina secondary to LMCA compression by the right PA and review the main indications and options for surgical treatment.
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Affiliation(s)
- Eduardo Bahena-López
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Jorge Loya-Centurión
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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20
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Guerin P, Fresse KW, Razafimahatratra O. [Percutaneous treatment of the pulmonary valve]. Ann Cardiol Angeiol (Paris) 2019; 68:474-479. [PMID: 31694766 DOI: 10.1016/j.ancard.2019.10.003] [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: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
Right ventricular outflow tract diseases are historically outcomes of surgical reconstruction for heart defects in neonates or children (Tetralogy of Fallot, Ross surgery). This kind of surgery performed during childhood lead often to dysfunctional right ventricular outflow tract (stenosis, leak) in older infants or young adults. In this case, reintervention on the right ventricular outflow tract would be associated with a high surgical risk. Development of the first percutaneous valves in the year 2000 paved the way for the pulmonary revalvulation. This percutaneous procedure has emerged as a credible alternative to the surgery for multioperated high risk patients with congenital cardiopathies. Two valves are currently available on the French market (Melody®, Sapien®); they cover all therapy indications, except the example of very wide outflow tracts which remain a surgical issue. Medical teams in charge of these young patients have to be enough trained in order to limit risks during the procedure. To this end, several teams promote the percutaneous pulmonary revalvulation over surgical revalvulation, this latter becoming limited only to cases in which percutaneous treatment is not feasible.
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Affiliation(s)
- P Guerin
- Centre cardio-thoracique de Monaco, 11, bis avenue d'Ostende, B.P. 223, 98004 Monaco cedex, France.
| | - K Warin Fresse
- Imagerie cardio-vasculaire, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France
| | - O Razafimahatratra
- Centre cardio-thoracique de Monaco, 11, bis avenue d'Ostende, B.P. 223, 98004 Monaco cedex, France
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21
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Murata S, Nakata M, Sugino N. Prevalence of right ventricular outflow tract abnormalities among recipients in twin-twin transfusion syndrome after fetoscopic laser surgery in 90 consecutive cases. J Med Ultrason (2001) 2020; 47:117-21. [PMID: 31641903 DOI: 10.1007/s10396-019-00982-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Right ventricular outflow tract obstruction (RVOTO) is a severe complication in recipients in twin-twin transfusion syndrome (TTTS). This study investigated the prevalence of RVOTO in TTTS after laser surgery and examined the risk factors for RVOTO. METHODS This retrospective study evaluated 90 patients who had undergone laser surgery and been followed for 6 months after birth. The diagnosis of RVOTO was made based on postnatal echocardiography findings. Ultrasound and clinical records, including maternal and neonatal data, were retrieved from our database. Risk factors for developing RVOTO were compared between recipients with and without RVOTO in a statistical analysis. RESULTS Six surviving recipients were diagnosed with RVOTO. Three recipients had developed severe pulmonary stenosis (PS) that required percutaneous transluminal pulmonary valvuloplasty or balloon pulmonary angioplasty. A total of 6.7% of recipients (6/90) had RVOTO, consisting of PS and tricuspid regurgitation (TR), and 3.3% of recipients (3/90) required invasive treatment. The characteristic factors did not differ significantly between recipients with and without RVOTO. CONCLUSION This study revealed that 6.7% of recipients with TTTS had PS, and 3.3% required invasive treatment for PS. However, no significant association was noted between RVOTO development in recipients and maternal clinical data and fetal ultrasound examination findings. It is difficult to predict RVOTO development in recipients using only preoperative ultrasound and clinical information.
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Borenstein N, Chetboul V, Passavin P, Morlet A, Fernandez-Parra R, Carazo Arias LE, Giannettoni G, Saponaro V, Poissonnier C, Ghazal S, Lefort S, Trehiou-Sechi E, Marchal CR, Delle Cave J, Vannucci E, Behr L, Verwaerde P. Successful transcatheter pulmonary valve implantation in a dog: first clinical report. J Vet Cardiol 2019; 26:10-18. [PMID: 31785529 DOI: 10.1016/j.jvc.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/10/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
Transcatheter pulmonary valve (TPV) implantation is a therapeutic approach approved by the United States Food and Drug Administration for human patients with failing pulmonary conduits in 2010 and for failing bioprosthetic surgical pulmonary valves in 2017. We report here the first successful transcatheter implantation of a stented valve in a pulmonary position in a dog with congenital pulmonary valve disease. A 3-year-old, 10.9 kg, client-owned Beagle dog was referred for a follow-up visit after a percutaneous balloon valvuloplasty performed 22 months before for treatment of a severe type A valvular pulmonary stenosis. The Doppler-derived peak pressure gradient was 348 mmHg before the procedure and 66 mmHg 24 h after. The dog was lethargic. Echocardiography revealed a mild pulmonary stenosis (pressure gradient-43 mmHg), severe pulmonary regurgitation, and secondary severe right ventricular and right atrial dilation. Worsening of right heart dilation was observed 2 months later despite medical therapy. A TPV implantation was performed using a prestented Melody bovine jugular bioprosthetic valve. The dog recovered uneventfully and was discharged 10 days after the procedure. Right heart dilation resolved within 15 days. The dog was doing well 7 months after valve implantation. This case demonstrates that TPV implantation with a stented valve is technically feasible in dogs with severe pulmonary valve disease. Stringent postoperative care, with particular attention to thrombosis and infectious endocarditis, and appropriate sizing and positioning of the valve stent are keys to the success of this procedure.
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Affiliation(s)
- N Borenstein
- IMMR 42 Boulevard Jourdan, 74014, Paris, France.
| | - V Chetboul
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie D'Alfort, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France; INSERM, (Institut national de la santé et de la recherche médicale), U955, Equipe 03, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - P Passavin
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie D'Alfort, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - A Morlet
- IMMR 42 Boulevard Jourdan, 74014, Paris, France
| | - R Fernandez-Parra
- INSERM, (Institut national de la santé et de la recherche médicale), U955, Equipe 03, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Pôle Anesthésie-Réanimation-Urgence-Soins Intensifs, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | | | - G Giannettoni
- Centre Hospitalier Vétérinaire ADVETIA, 9 Avenue Louis Breguet, 78140, Vélizy-Villacoublay, France
| | - V Saponaro
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie D'Alfort, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - C Poissonnier
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie D'Alfort, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - S Ghazal
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie D'Alfort, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - S Lefort
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie D'Alfort, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - E Trehiou-Sechi
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie D'Alfort, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - C R Marchal
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Pôle Anesthésie-Réanimation-Urgence-Soins Intensifs, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - J Delle Cave
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Pôle Anesthésie-Réanimation-Urgence-Soins Intensifs, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - E Vannucci
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Pôle Anesthésie-Réanimation-Urgence-Soins Intensifs, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - L Behr
- IMMR 42 Boulevard Jourdan, 74014, Paris, France
| | - P Verwaerde
- INSERM, (Institut national de la santé et de la recherche médicale), U955, Equipe 03, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France; Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Pôle Anesthésie-Réanimation-Urgence-Soins Intensifs, Centre Hospitalier Universitaire Vétérinaire D'Alfort (CHUVA), 7 avenue du Général de Gaulle, 94704, Maisons-Alfort Cedex, France
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Kumar V, Mahajan S, Jaswal V, Thingnam SKS. Surgical outcome of isolated congenital supravalvular pulmonary stenosis: a case series. Eur Heart J Case Rep 2019; 3:5475806. [PMID: 31449596 PMCID: PMC6601161 DOI: 10.1093/ehjcr/ytz012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 04/12/2019] [Indexed: 11/16/2022]
Abstract
Background Supravalvular stenosis of main pulmonary artery is a rare anomaly characterized by the presence of constriction band just above the pulmonary valve. It is mostly acquired after intervention on the pulmonary trunk or less commonly is congenital in origin associated with complex congenital cardiac malformations and very rarely can present as an isolated native congenital supravalvular pulmonary stenosis (SPS). Case summary We present a series of four cases of isolated congenital SPS who underwent surgical correction at our tertiary care institute over 8 years. Mean age of the patients was 2.25 ± 0.96 years with all of them being males. Mean peak systolic gradient across the stenosis was 82 ± 21.48 mmHg ranging from 60 mmHg to 110 mmHg. There was no early and medium-term mortality with 100% survival at mean follow-up of 31 months (range 7–85 months). Discussion Surgical correction of congenital SPS carries excellent early and mid-term results with almost no mortality and very low risk of re-intervention for restenosis.
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Affiliation(s)
- Vikas Kumar
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Mahajan
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Jaswal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Kumar Singh Thingnam
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Nadolny KE, Kellihan HB, Scansen BA, Tjostheim SS, Grint KA, Forrest LJ, Stepien RL. Cor triatriatum dexter in 17 dogs. J Vet Cardiol 2019; 23:129-141. [PMID: 31174723 DOI: 10.1016/j.jvc.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The objective of this study was to report the signalment, presentation, clinical and imaging findings, interventions, and outcomes in a group of dogs with cor triatriatum dexter (CTD). ANIMALS Seventeen client-owned dogs. METHODS Medical records were reviewed retrospectively for signalment, history, physical examination findings, imaging and diagnostic findings, presence of concurrent congenital cardiac defects, description of interventional procedures, therapy information, and outcomes. RESULTS Age at presentation ranged from two to 110 months, with 10 of 17 dogs (59%) aged <12 months. There was an equal distribution between the sexes. Peritoneal effusion was the most common presenting complaint, in 10 of 17 dogs (59%). The CTD was an isolated finding in 3 of 17 dogs (18%); the remaining 14 of 17 (82%) dogs had concurrent cardiac disease, with congenital anomalies present in 12 of 17 (70%). All except one of these 12 dogs had at least one additional condition affecting the right heart. Tricuspid valve dysplasia was the most common congenital comorbidity, present in 9 of 17 dogs (53%). Seven dogs (41%) underwent interventional treatment of their CTD. In 7 of 17 (41%) cases, the CTD was considered to be incidental and the dogs were asymptomatic; therefore, no interventions were performed. The remaining three cases were euthanized or lost to follow-up. CONCLUSIONS Cor triatriatum dexter in dogs is commonly seen in association with other right-sided congenital cardiac anomalies and may be an incidental finding. Dogs with CTD obstructing right atrial inflow can have a good outcome after intervention. Dogs with no clinical signs associated with the CTD may remain asymptomatic into adulthood.
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Affiliation(s)
- K E Nadolny
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - H B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA.
| | - B A Scansen
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, 300 W Drake Rd. Fort Collins, CO 80525, USA; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 1900 Coffey Rd., Columbus, OH 43210, USA
| | - S S Tjostheim
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - K A Grint
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - L J Forrest
- Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - R L Stepien
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
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Cheng AL, Kaslow AM, Pruetz JD, Lu JC, Wood JC, Detterich JA. Differences in Right Ventricular Physiologic Response to Chronic Volume Load in Patients with Repaired Pulmonary Atresia Intact Ventricular Septum/Critical Pulmonary Stenosis Versus Tetralogy of Fallot. Pediatr Cardiol 2019; 40:526-36. [PMID: 30353312 DOI: 10.1007/s00246-018-2009-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis (PAIVS/CPS) have wide variation in right ventricle (RV) size, systolic function, and diastolic function at birth. Establishment of antegrade pulmonary blood flow creates the potential for RV dilation from chronic pulmonary insufficiency. Future surgical decisions are based on RV size and function, largely supported by longitudinal studies of patients with Tetralogy of Fallot (TOF). Given potential differences in RV physiology and lack of similar data in PAIVS/CPS, the objective of this study was to determine differences in RV size, systolic function, and diastolic function between patients with PAIVS/CPS versus TOF. METHODS We retrospectively collected cardiovascular magnetic resonance (CMR) data in 27 patients with PAIVS/CPS (ages 13.3 ± 8.8 years) and 78 with TOF (11.4 ± 5.4 years). RV volumes, ejection fraction (EF), regurgitant fraction, end-diastolic forward flow across the pulmonary valve, and right atrial cross-sectional area were calculated. RESULTS There was no difference between the groups in RV end-diastolic volume (RVEDVi), RVEF, or pulmonary regurgitation. RVEF tended to decrease in TOF when RVEDVi exceeded 164 ml/m2. In PAIVS/CPS, RVEDVi less frequently reached 164 ml/m2 and was not associated with RVEF. There was worse RV diastolic dysfunction in PAIVS/CPS, with 1.5 times larger right atrial area and two times higher pulmonary end-diastolic forward flow (p < 0.0001). CONCLUSIONS Patients with PAIVS/CPS have similar RV size, systolic function, and pulmonary regurgitation as TOF. However, impaired RV diastolic function may limit extremes of RV dilatation and impact long-term management of PAIVS/CPS.
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Shi JZ, Chow PC, Li W, Kwok SY, Wong WH, Cheung YF. Fifty-Five Years Follow-Up of 111 Adult Survivors After Biventricular Repair of PAIVS and PS. Pediatr Cardiol 2019; 40:374-83. [PMID: 30539241 DOI: 10.1007/s00246-018-2041-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
There is paucity of long-term data on adult survivors after biventricular repair of pulmonary atresia with intact ventricular septum (PAIVS) and pulmonary stenosis (PS). This study aimed to determine the cardiac and non-cardiac outcomes of adult survivors after biventricular repair of PAIVS and PS. The cardiac, neurodevelopmental and liver problems of 111 adults, 40 with PAIVS and 71 with PS, were reviewed. The median follow-up duration of our patients was 26.5 years (range 14.8-55 years). The freedom from reintervention at 30 years was 17.4% and 73.3% for PAIVS and PS patients (p < 0.001), respectively. Compared with PS patients, PAIVS patients had significantly greater prevalence of right atrial and right ventricular (RV) dilatation, and moderate to severe tricuspid and pulmonary regurgitation (all p < 0.05), and cardiac arrhythmias (22.5% vs. 8.5%, p = 0.047). The freedom from development of cardiac arrhythmias at 30 years of 68.4% and 91.6%, respectively, in PAIVS and PS patients (p = 0.03). Cox proportional hazards model identified PAIVS as an independent risk factor for reintervention (HR 4.0, 95% CI 2.1-7.6, p < 0.001) and development of arrhythmias (HR 4.1, 95% CI 1.1-14.4, p = 0.03). Neurodevelopmental problems were found in 17.5% of PAIVS patients and 7.0% of PS patients (p = 0.11). Liver problems occurred in 2 (5%) PAIVS patients, both of whom required conversion to 1.5 ventricular repair. In conclusion, long-term problems, including the need for reinterventions, cardiac arrhythmias, RV dilation, pulmonary regurgitation, and neurodevelopmental and liver issues are more prevalent in adult PAIVS than PS survivors.
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Hemmati P, Dearani JA, Daly RC, King KS, Ammash NM, Cetta F, Schaff HV. Early Outcomes of Cardiac Surgery in Patients with Noonan Syndrome. Semin Thorac Cardiovasc Surg 2018; 31:507-513. [PMID: 30576779 DOI: 10.1053/j.semtcvs.2018.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 11/11/2022]
Abstract
There is a paucity of cardiac surgery outcomes data for patients with Noonan syndrome (NS). Our objective was to evaluate early results in these patients. Between January 1999 and December 2015, 29 patients (18 males, 62%) with NS underwent cardiac surgery at our institution. Mean age was 23 ± 17.9 years; 12 (41%) were under 18 years of age. Fourteen patients (48%) had prior sternotomies. The primary operations for the main diagnosis were pulmonary valve/conduit replacement/repair (n = 14, 48%), septal myectomy for obstructive hypertrophic cardiomyopathy (n = 7, 24%), aortic valve replacement/repair (n = 4, 14%), atrial septal defect (ASD) repair (n = 2, 7%), and cardiac transplantation (n = 2, 7%). Concomitant procedures were performed in 24 patients (83%), most commonly right ventricular outflow tract reconstruction (n = 13, 45%), mitral valve repair/replacement (n = 7, 24%), and ASD repair (n = 6, 21%). Mean bypass and cross-clamp times were 88.8 ± 51 minutes and 54.7 ± 67 minutes, respectively. There was 1 early death (3%). Postoperative morbidity occurred in 18 patients (62%), most commonly arrhythmias (n = 14, 48%) or respiratory insufficiency/pneumonia (n = 6, 21%). There were 2 early reoperations and 4 early readmissions. Univariate factors associated with morbidity included male gender (P = 0.03) and longer cross-clamp time (P = 0.02). Median length of hospital stay was 6 days (interquartile range 5-10.5 days). Patients with NS frequently have multiple cardiac lesions requiring a broad spectrum of operations. Early mortality is low despite procedure complexity. Although early postoperative morbidity is common, patients overall do well with reasonable hospital lengths of stay. Additional studies are needed to evaluate long-term outcomes and quality of life.
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Affiliation(s)
- Pouya Hemmati
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Katherine S King
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Naser M Ammash
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Frank Cetta
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Mouws EMJP, de Groot NMS, van de Woestijne PC, de Jong PL, Helbing WA, van Beynum IM, Bogers AJJC. Tetralogy of Fallot in the Current Era. Semin Thorac Cardiovasc Surg 2018; 31:496-504. [PMID: 30395964 DOI: 10.1053/j.semtcvs.2018.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 10/04/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
Only few studies have reported long-term outcome of the transatrial-transpulmonary approach in the current era of management of tetralogy of Fallot (ToF). We investigated 15-year outcome of correction via a transatrial-transpulmonary approach in a large cohort of successive patients operated in the 21st century. All infant ToF patients undergoing transatrial-transpulmonary ToF correction between 2000 and 2015 were included (N = 177, 106 male, median follow-up 7.1 (interquartile range 3.0-10.9) years. Data regarding postoperative complications, reinterventions, development of atrial and ventricular arrhythmia, cardiac function, and survival were evaluated. Prior shunting was performed in 10 patients (6%). The transatrial-transpulmonary approach resulted in valve-sparing surgery in 57 patients (32%). Postoperative surgical complications included junctional ectopic tachycardia (N = 12, 7%), pericardial (N = 10, 6%) or pleural effusion (N = 7, 3%), chylothorax (N = 7, 4%), bleeding requiring reoperation (N = 4, 3%), and superficial wound infection (N = 1). Fifty-one patients underwent 68 reinterventions, mainly due to pulmonary restenosis (PS) (N = 57). ToF correction at age <2 months and double outlet or double-chambered right ventricle variants of the ToF spectrum were independent predictors for reintervention. Patients undergoing valve-sparing ToF correction had a significant longer PR-free survival than those with a transannular patch (8.5 [95% confidence interval 6.8-10.3] years vs 1.1 [95% confidence interval 0.8-1.5] years; P < 0.001). Overall mortality was 2.8%; mortality rates were higher in premature/dysmature newborns (0.7% vs 9.5%; P < 0.001). Although the 15-year outcome of the transatrial-transpulmonary approach in terms of postoperative complications and mortality rates is excellent, the high incidence of moderate and severe PR is worrisome. Valve-sparing surgery was associated with a substantially lower incidence of PR, yet was surgically not possible in the majority of patients.
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Affiliation(s)
- Elisabeth M J P Mouws
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Peter L de Jong
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wim A Helbing
- Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Georgiev S, Tanase D, Ewert P, Meierhofer C, Hager A, von Ohain JP, Eicken A. Percutaneous pulmonary valve implantation in patients with dysfunction of a "native" right ventricular outflow tract - Mid-term results. Int J Cardiol 2018; 258:31-35. [PMID: 29544952 DOI: 10.1016/j.ijcard.2017.11.091] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 11/05/2017] [Accepted: 11/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND To investigate the feasibility and mid-term results of percutaneous pulmonary valve implantation (PPVI) in patients with conduit free or "native" right ventricular outflow tracts (RVOT). METHODS AND RESULTS We identified all 18 patients with conduit free or "native" right ventricular outflow tract, who were treated with percutaneous pulmonary valve implantation (PPVI) in our institution. They were divided into two groups - these in whom the central pulmonary artery was used as an anchoring point for the preparation of the landing zone (n=10) for PPVI and these, in whom a pulmonary artery branch was used for this purpose (n=8). PPVI was performed successfully in all patients with significant immediate RVOT gradient and pulmonary regurgitation grade reduction. Four patients had insignificant paravalvular regurgitation. In one patient the valve was explanted after 4months because of bacterial endocarditis. A follow-up of 19 (4-60) months showed sustained good function of the other implanted valves. The MRI indexed right ventricular end diastolic volume significantly decreased from 108(54-174) ml/m2 before the procedure to 76(60-126) ml/m2 six months after PPVI, p=0.01. CONCLUSIONS PPVI is feasible with good mid-term results in selected patients with a "native" RVOT without a previously implanted conduit. Creating a stable landing zone with a diameter less than the largest available valve (currently 29mm) is crucial for the technical success of the procedure. Further studies and the development of new devices could widen the indications for this novel treatment.
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Affiliation(s)
- Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany.
| | - Daniel Tanase
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | - Christian Meierhofer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | | | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
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Wang ES, Fan XS, Xiang L, Li SJ, Zhang H. Surgical outcome after complete repair of tetralogy of Fallot with absent pulmonary valve: comparison between bovine jugular vein-valved conduit and monocusp-valve patch. World J Pediatr 2018; 14:510-519. [PMID: 30062647 DOI: 10.1007/s12519-018-0169-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. METHODS Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n = 10), homograft-valved conduit implantation (n = 2), or monocusp-valve patch (n = 10). Health-related quality of life (QOL) was evaluated during follow-up. RESULTS The overall survival at 5 and 10 years was 86.4 ± 7.3% (confidence interval 69.4-97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P = 0.0003, log-rank test). The survival of patients aged > 6 months was higher than those ≤ 6 months (100 vs. 40%, P = 0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV-PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P < 0.05). No reoperation was performed during follow-up. CONCLUSIONS Bronchial stenosis and lower age (≤ 6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV-PA restenosis; thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.
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Affiliation(s)
- En-Shi Wang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xue-Song Fan
- Department of Clinical Laboratory Center, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Li Xiang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shou-Jun Li
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Hao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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Broda CR, Shugh SB, Parikh RB, Wang Y, Schlingmann TR, Noel CV. Post-operative Assessment of the Arterial Switch Operation: A Comparison of Magnetic Resonance Imaging and Echocardiography. Pediatr Cardiol 2018; 39:1036-1041. [PMID: 29564521 DOI: 10.1007/s00246-018-1858-z] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/03/2018] [Indexed: 11/25/2022]
Abstract
After an arterial switch operation (ASO), serial imaging is necessary to monitor for maladaptive changes. We compared cardiac magnetic resonance imaging (CMR) to 2-D transthoracic echocardiography (TTE) in assessing post-operative ASO patients. We performed a retrospective review of patients at a single tertiary care center who underwent an ASO and subsequently had a CMR performed from 7/2010 to 7/2016. Those with single ventricle anatomy, congenitally corrected transposition of the great arteries, or previous atrial switch operation were excluded. TTE obtained within 6 months of the CMR was used for comparison. Parameters compared included ventricular size and systolic function, semilunar valve regurgitation, neo-aortic root dimension, and the presence of branch pulmonary artery (PA) stenosis (on CMR by the Nakata index or right/left flow differential; on TTE by peak velocity > 2 m/s or PA diameter Z score < - 2). Forty-seven patients with 90 CMR and 86 TTE studies met inclusion criteria. CMR and TTE assessment of right ventricular (RV) and left ventricular function did not statistically differ. RV dilation was overdetected by TTE (p = 0.046). Right pulmonary artery and left pulmonary artery (LPA) visualization by TTE was worse than CMR (p < 0.01). There was no statistically significant difference between CMR and TTE assessment of branch PA stenosis; however, there was poor agreement between the use of Z score and velocity when determining branch PA stenosis by TTE (κ < 0). Assessment of neo-pulmonary regurgitation (PR) and neo-aortic regurgitation (AR) was significantly different between CMR and TTE (p < 0.05). Assessment for delayed enhancement was performed in 18% of CMR studies (n = 16), with perfusion defects appreciated in three patients. Substantial differences between CMR and TTE exist when examining the post-operative ASO patient. CMR was superior for evaluation of the branch PAs, which commonly require re-intervention. TTE failed to recognize altered ventricular function in several cases. Differences between TTE and CMR could alter management is some cases. Incorporation of CMR into the routine surveillance of patients who received an ASO is warranted.
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Affiliation(s)
- Christopher R Broda
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Svetlana B Shugh
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Rohan B Parikh
- Department of Internal Medicine, Western Reserve Health Education, Youngstown, OH, USA
| | - YunFei Wang
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Tobias R Schlingmann
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA
| | - Cory V Noel
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St. MC 19345C, Houston, TX, 77030, USA.
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Abstract
UNLABELLED Pulmonary valve stenosis is common in patients with Noonan's syndrome. The response to balloon valvoplasty varies.We assessed the correlation between re-intervention rate, immediate response, and the progress of the valve gradient over time after intervention. METHODS This is a retrospective study conducted from 1995 to 2014. RESULTS Of 14 patients identified, seven had re-intervention 28±54 months (range 3-149, median 3.3) after valvoplasty. These patients did not have a significant decrease in gradient after intervention. Their gradient subsequently decreased during follow-up and then became static before increasing years after intervention. In contrast, the gradient of patients not requiring further intervention continually reduced over time. Demographics did not differ between these groups. CONCLUSION We could not identify predisposing factors for long-term success of pulmonary valvoplasty in Noonan's patients, but the trajectory of gradients differs significantly between patients needing re-intervention from those who remain free from re-intervention.
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Abstract
PURPOSE OF REVIEW The past couple of decades have brought tremendous advances to the field of pediatric and adult congenital heart disease (CHD). Percutaneous valve interventions are now a cornerstone of not just the congenital cardiologist treating patients with congenital heart disease, but also-and numerically more importantly-for adult interventional cardiologists treating patients with acquired heart valve disease. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. This review aims to summarize (1) the current state of the art for tPVR, (2) the expanding indications, and (3) the technological obstacles to optimizing tPVR. RECENT FINDINGS Since its introduction in 2000, more than ten thousands tPVR procedures have been performed worldwide. Although the indications for tPVR have been adapted earlier from those accepted for surgical intervention, they remain incompletely defined. The new imaging modalities give better assessment of cardiac anatomy and function and determine candidacy for the procedure. The procedure has been shown to be feasible and safe when performed in patients who received pulmonary conduit and or bioprosthetic valves between the right ventricle and the pulmonary artery. Fewer selected patients post trans-annular patch repair for tetralogy of Fallot may also be candidates for this technology. Size restrictions of the currently available valves limit deployment in the majority of patients post trans-annular patch repair. Newer valves and techniques are being developed that may help such patients. Refinements and further developments of this procedure hold promise for the extension of this technology to other patient populations.
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Bhatt SM, Goldmuntz E, Cassedy A, Marino BS, Mercer-Rosa L. Quality of Life is Diminished in Patients with Tetralogy of Fallot with Mild Residual Disease: A Comparison of Tetralogy of Fallot and Isolated Valvar Pulmonary Stenosis. Pediatr Cardiol 2017; 38:1645-53. [PMID: 28856395 DOI: 10.1007/s00246-017-1709-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/09/2017] [Indexed: 01/17/2023]
Abstract
The objective of this study is to compare quality of life (QOL) in patients with mild pulmonary insufficiency (PI) after Tetralogy of Fallot (TOF) repair or after balloon dilation for isolated valvar pulmonary stenosis (VPS). A cross-sectional study of patients with TOF (n = 12) and VPS (n = 19), ages 8-18 years, who underwent cardiac magnetic resonance (CMR) and cardiopulmonary exercise test (CPET) was conducted. Patients with genetic syndromes were excluded. The groups were matched by severity and duration of PI using propensity scores. PI was greater than mild if the regurgitant fraction by CMR was >20%. Health status and QOL assessment included Child Health Questionnaire Child Self-Report (CHQ-CF87), Child Health Questionnaire Parent Report (CHQ-PF50), and Pediatric Cardiac QOL Instrument (parent and patient). QOL scores were compared between groups. Due to propensity matching, the groups had, at worst, mild PI and normal right ventricular ejection fraction on CMR. Parental perception of QOL was significantly worse in TOF as compared to VPS in the domains of general perception of health (P = 0.03), physical functioning (PF; P = 0.004), and family cohesion (P = 0.048). There were no differences in self-reported QOL between groups. There was no association between QOL and right ventricular function on CMR or percent-predicted maximal oxygen consumption on CPET in both groups. Parent-perceived QOL, in the domains of general health perception, PF, and family cohesion, is significantly reduced in patients with TOF with mild residual disease suggesting that the psychosocial impact of congenital heart disease may be significant even with successful repair and satisfactory medical status.
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Syamasundar Rao P. The Journey of an Indian Pediatric Cardiologist : Dr. K. C. Chaudhuri Lifetime Achievement Award/Oration at AIIMS, New Delhi, September 2017. Indian J Pediatr 2017; 84:848-858. [PMID: 28956269 DOI: 10.1007/s12098-017-2452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/28/2022]
Abstract
The life journey of an Indian pediatric cardiologist, who bestowed considerable attention to the development of new knowledge and train/teach physicians around the world while providing care of patients with heart disease over a 45-y period, is reviewed. This appraisal focuses particular attention on the scientific contributions to the literature. These include spontaneous closure of physiologically advantageous ventricular septal defects, various issues related to a congenital heart defect namely, tricuspid atresia and transcatheter and, interventional pediatric cardiac procedures.
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Affiliation(s)
- P Syamasundar Rao
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas-Houston McGovern Medical School/Children's Memorial Hermann Hospital, 6410 Fannin Street, UTPB Suite # 425, Houston, TX, 77030, USA.
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Parent JJ, Ross MM, Bendaly EA, Breinholt JP. Results of pulmonary balloon valvuloplasty persist and improve at late follow-up in isolated pulmonary valve stenosis. Cardiol Young 2017; 27:1566-70. [PMID: 28651667 DOI: 10.1017/S1047951117000804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pulmonary balloon valvuloplasty is a safe and effective treatment for children with pulmonary valve stenosis. A few studies evaluate the long-term outcomes of the procedure, particularly the degree of pulmonary regurgitation. We evaluated the outcomes of children >1 year following valvuloplasty for pulmonary valve stenosis. METHODS A retrospective analysis of children with pulmonary valve stenosis following pulmonary balloon valvuloplasty at a single institution was performed. Clinic summaries, catheterisation data, and echocardiographic data were reviewed. Inclusion criteria were isolated pulmonary valve stenosis, age <19 years at the time of intervention, and at least one echocardiogram performed at least 1 year after valvuloplasty. RESULTS A total of 53 patients met inclusion criteria. The median age at valvuloplasty was 0.4 years (0.01-10.6 years). The last follow-up was 4.8±2.3 years following valvuloplasty. The pre-valvuloplasty peak instantaneous gradient by echocardiography was 60.6±14.6 mmHg. The peak gradient at the first postoperative echocardiography was reduced to 25.5±12 mmHg (p<0.001), and further decreased to 14.8±15.8 mmHg (p<0.001) at the most recent follow-up. The degree of regurgitation increased from before valvuloplasty to after valvuloplasty (p<0.001) but did not progress at the most recent follow-up (p=0.17). Only three patients (5.7%) required re-intervention for increasing pulmonary stenosis (two surgical; one repeat balloon). No significant procedural complications occurred. CONCLUSIONS Pulmonary balloon valvuloplasty remains a safe and effective treatment for children with isolated pulmonary valve stenosis, with excellent long-term outcomes and no mortality. A few patients require further intervention. Long-term follow-up demonstrates decreased, residual stenosis. Patients have a small, acute increase in pulmonary regurgitation following valvuloplasty, but no long-term progression.
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Kadle RL, Phoon CKL. Estimating pressure gradients by auscultation: How technology (echocardiography) can help improve clinical skills. World J Cardiol 2017; 9:693-701. [PMID: 28932358 PMCID: PMC5583542 DOI: 10.4330/wjc.v9.i8.693] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/29/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To extend our previously-published experience in estimating pressure gradients (PG) via physical examination in a large patient cohort.
METHODS From January 1, 1997 through December 31, 2009, an attending pediatric cardiologist compared clinical examination (EXAM) with Doppler-echo (ECHO), in 1193 patients with pulmonic stenosis (PS, including tetralogy of Fallot), aortic stenosis (AS), and ventricular septal defect (VSD). EXAM PG estimates were based primarily on a murmur’s pitch, grade, and length. ECHO peak instantaneous PG was derived from the modified Bernoulli equation. Patients were 0-38.4 years old (median 4.8).
RESULTS For all patients, EXAM correlated highly with ECHO: ECHO = 0.99 (EXAM) + 3.2 mmHg; r = +0.89; P < 0.0001. Agreement was excellent (mean difference = -2.9 ± 16.1 mmHg). In 78% of all patients, agreement between EXAM and ECHO was within 15 mmHg and within 5 mmHg in 45%. Clinical estimates of PS PG were more accurate than of AS and VSD. A palpable precordial thrill and increasing loudness of the murmur predicted higher gradients (P < 0.0001). Weight did not influence accuracy. A learning curve was evident, such that the most recent quartile of patients showed ECHO = 1.01 (EXAM) + 1.9, r = +0.92, P < 0.0001; during this time, the attending pediatric cardiologist had been > 10 years in practice.
CONCLUSION Clinical examination can accurately estimate PG in PS, AS, or VSD. Continual correlation of clinical findings with echocardiography can lead to highly accurate diagnostic skills.
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Affiliation(s)
- Rohini L Kadle
- Division of Pediatric Cardiology, Hassenfeld Children’s Hospital of New York at NYU Langone, Fink Children’s Center, New York, NY 10016, United States
| | - Colin K L Phoon
- Division of Pediatric Cardiology, Hassenfeld Children’s Hospital of New York at NYU Langone, Fink Children’s Center, New York, NY 10016, United States
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Yoon H, Kim J, Nahm SS, Eom K. Anatomic, histopathologic, and echocardiographic features in a dog with an atypical pulmonary valve stenosis with a fibrous band of tissue and a patent ductus arteriosus. Acta Vet Scand 2017; 59:45. [PMID: 28697788 PMCID: PMC5505141 DOI: 10.1186/s13028-017-0314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/07/2017] [Indexed: 11/23/2022] Open
Abstract
Background Congenital pulmonary valve stenosis and patent ductus arteriosus are common congenital heart defects in dogs. However, concurrence of atypical pulmonary valve stenosis and patent ductus arteriosus is uncommon. This report describes the anatomic, histopathologic, and echocardiographic features in a dog with concomitant pulmonary valve stenosis and patent ductus arteriosus with atypical pulmonary valve dysplasia that included a fibrous band of tissue. Case presentation A 1.5-year-old intact female Chihuahua dog weighing 3.3 kg presented with a continuous grade VI cardiac murmur, poor exercise tolerance, and an intermittent cough. Echocardiography indicated pulmonary valve stenosis, a thickened dysplastic valve without annular hypoplasia, and a type IIA patent ductus arteriosus. The pulmonary valve was thick line-shaped in systole and dome-shaped towards the right ventricular outflow tract in diastole. The dog suffered a fatal cardiac arrest during an attempted balloon pulmonary valvuloplasty. Necropsy revealed pulmonary valve dysplasia, commissural fusion, and incomplete opening and closing of the pulmonary valve because of a fibrous band of tissue causing adhesion between the right ventricular outflow tract and the dysplastic intermediate cusp of the valve. Conclusions A fibrous band of tissue between the right ventricular outflow track and the pulmonary valve should be considered as a cause of pulmonary valve stenosis. Pulmonary valve stenosis and patent ductus arteriosus can have conflicting effects on diastolic and systolic dysfunction, respectively. Therefore, beta-blockers should always be used carefully, particularly in patients with a heart defect where there is concern about left ventricular systolic function.
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Abstract
Tetralogy of Fallot can be corrected with very low mortality at any age, even in neonates, but this does not necessarily mean that it should be corrected in the neonatal period. Although there are many advantages to early correction, a high proportion of these neonates have residual stenosis or pulmonary regurgitation that impairs ventricular function and may require further surgery or implantation of a pulmonary valve. Before we had the ability to correct this anomaly with low mortality in small children, a variety of palliative procedures had to be performed. Today, with better understanding of the anatomy of tetralogy of Fallot, we should consider what forms of palliation will increase growth of the right ventricular outflow tract in order to reduce the complications of very early surgery.
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Mahfouz RA, Moustafa TM, Gouda M, Gad M. Longitudinal function and ventricular dyssynchrony are restored in children with pulmonary stenosis after percutaneous balloon pulmonary valvuloplasty. Int J Cardiovasc Imaging 2017; 33:533-8. [PMID: 27943062 DOI: 10.1007/s10554-016-1036-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
The aim of this study was to evaluate the impact of balloon pulmonary valvuloplasty on longitudinal ventricular dysfunction and cardiac dyssynchrony in children with congenital moderately severe pulmonary stenosis (PS). Forty-eight children with congenital moderately severe valvular pulmonary stenosis and 36 age-matched normal children were included. Successful percutaneous balloon pulmonary valvuloplasty was performed for children with PS. Longitudinal Cardiac function and myocardial synchrony was assessed by echocardiography with tissue Doppler imaging (TDI). Mitral annular plane excursion (MAPSE), tricuspid annular plane excursion (TAPSE), left ventricular systolic wave (LVs), right ventricular systolic wave (RVs) and myocardial synchrony was assessed by echocardiography with TDI. TAPSE, RVs, TAPSE/MAPSE ratio and RVs/LVs ratio were significantly lower in children with PS compared to control subjects: (P < 0.001, P < 0.001, P < 0.001 and P < 0.001). All these parameters were significantly improved after balloon valvuloplasty in children with PS. Intra& inter-ventricular dyssynchrony were significantly increased in PS patients than in control group, (P < 0.03, <0.001 and 0.02 respectively). All these variables were significantly reduced after pulmonary valvuloplasty. In children with valvular PS, balloon valvuloplasty restored longitudinal function and cardiac Synchrony. This gives good insights for the importance of early intervention in children with PS to prevent the progression for cardiac deformation.
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Hou B, Zheng L, Niu G, Wu L, Qiao Y, Sun W, Ding L, Chen G, Zhang S, Liew R, Yao Y. Catheter ablation for ventricular tachycardia following surgical treatment of pulmonary stenosis with intact ventricular septum. Europace 2016; 18:1829-1836. [PMID: 27733459 DOI: 10.1093/europace/euv372] [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: 08/11/2015] [Accepted: 10/13/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS This study was aimed to report the characteristics and treatment of ventricular tachycardia (VT) following surgical treatment of pulmonary stenosis with intact ventricular septum. METHODS AND RESULTS Five patients underwent radiofrequency catheter ablation for sustained monomorphic left bundle branch block (LBBB) type VT who previously underwent surgical treatment of pulmonary stenosis. Except stimulation, voltage and activation mapping was performed using three-dimensional (3D) electro-anatomic mapping and ablation was applied accordingly. Four VTs were induced during EP study. Two VTs were focal and the earliest activity was targeted in the right ventricular apex (RVA). The other two VTs were reentrant and the critical isthmus located in the mid-lateral wall and anterior wall of right ventricle, respectively. Ablation abolished all inducible VTs in four patients. In the patient whose VT was non-inducible, radiofrequency (RF) energy was delivered to the RVA where pacing mapping matched the clinical VT. One focal VT recurred 60 months after the initial RF ablation. Repeat mapping and ablation was performed and no VT recurred over a 24-month period. CONCLUSIONS The mechanism of VT following surgical treatment of pulmonary stenosis can be either focal or reentrant. Ablation of this subgroup of VT is feasible.
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Affiliation(s)
- Bingbo Hou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China.,Zhongshan Hospital affiliated to Xiamen University, Xiamen 361004, People's Republic of China
| | - Lihui Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Guodong Niu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Lingmin Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Yu Qiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Wei Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Ligang Ding
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Gang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
| | - Reginald Liew
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China
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Ortiz JU, Masoller N, Gómez O, Bennasar M, Eixarch E, Lobmaier SM, Crispi F, Gratacos E, Martinez JM. Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome. Fetal Diagn Ther 2016; 41:191-196. [PMID: 27455050 DOI: 10.1159/000448075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the rate of pulmonary stenosis and functional pulmonary atresia (PS/PA) in recipient twins prior to fetal surgery for twin-twin transfusion syndrome (TTTS) and their pre- and postnatal outcomes. METHODS We carried out a prospective study including 260 cases of TTTS. Echocardiography was performed before laser surgery to detect the presence of PS/PA. The outcomes of recipients with and without PS/PA were compared. The need of postnatal cardiac interventions and the survival rate at 6 months of age were also evaluated. RESULTS PS was observed in 16/260 (6.2%) of recipient twins and PA in 12/260 (4.6%). After fetal surgery, 10/28 (35.7%) recipients died, 9/28 (32.1%) showed in utero regression, and 9/28 (32.1%) had persistence of PS/PA. Postnatally, seven recipients underwent percutaneous balloon pulmonary valvuloplasty, one required surgical valvotomy and one palliative surgery. Pregnancies with recipient twins with PS/PA had lower survival of at least one twin (67.9 vs. 83.6%, p = 0.045) and lower overall survival (57.1 vs. 72.8%, p = 0.015) at 6 months of age. CONCLUSION PS and PA were observed in 10.8% of recipients. Among these, about one third showed persistence of pulmonary valve pathology after delivery, which stresses the need for strict follow-up.
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Affiliation(s)
- Javier U Ortiz
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
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Abstract
BACKGROUND Surgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention. The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000. RESULTS The total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage. CONCLUSION Surgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.
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Atik T, Aykut A, Hazan F, Onay H, Goksen D, Darcan S, Tukun A, Ozkinay F. Mutation Spectrum and Phenotypic Features in Noonan Syndrome with PTPN11 Mutations: Definition of Two Novel Mutations. Indian J Pediatr 2016; 83:517-21. [PMID: 26817465 DOI: 10.1007/s12098-015-1998-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/16/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the spectrum of PTPN11 gene mutations in Noonan syndrome patients and to study the genotype-phenotype associations. METHODS In this study, twenty Noonan syndrome patients with PTPN11 mutations were included. The patients underwent a detailed clinical and physical evaluation. To identify inherited cases, parents of all mutation positive patients were analyzed. RESULTS Thirteen different PTPN11 mutations, two of them being novel, were detected in the study group. These mutations included eleven missense mutations: p.G60A, p.D61N, p.Y62D, p.Y63C, p.E69Q, p.Q79R, p.Y279C,p.N308D, p.N308S, p.M504V, p.Q510R and two novel missense mutations: p.I56V and p.I282M. The frequency of cardiac abnormalities and short stature were found to be 80 % and 80 %, respectively. Mental retardation was not observed in patients having exon 8 mutations. No significant correlations were detected between other phenotypic features and genotypes. CONCLUSIONS By identifying genotype-phenotype correlations, this study provides information on phenotypes observed in NS patients with different PTPN11 mutations.
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Affiliation(s)
- Tahir Atik
- Division of Genetics, Department of Pediatrics, School of Medicine, Ege University, 35100, Bornova, Izmir, Turkey.
| | - Ayca Aykut
- Department of Medical Genetics, School of Medicine, Ege University, Izmir, Turkey
| | - Filiz Hazan
- Department of Medical Genetics, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, School of Medicine, Ege University, Izmir, Turkey
| | - Damla Goksen
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Ege University, Izmir, Turkey
| | - Sukran Darcan
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Ege University, Izmir, Turkey
| | - Ajlan Tukun
- Department of Genetics, School of Medicine, Ankara University, Ankara, Turkey
| | - Ferda Ozkinay
- Division of Genetics, Department of Pediatrics, School of Medicine, Ege University, 35100, Bornova, Izmir, Turkey.,Department of Medical Genetics, School of Medicine, Ege University, Izmir, Turkey
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Abstract
There is a growing appreciation for the adverse long-term impact of right-sided valvular dysfunction in patients with congenital heart disease. Although right-sided valvular stenosis and/or regurgitation is often better tolerated than left-sided valvular dysfunction in the short and intermediate term, the long-term consequences are numerous and include, but are not limited to, arrhythmias, heart failure, and multi-organ dysfunction. Surgical right-sided valve interventions have been performed for many decades, but the comorbidities associated with multiple surgeries are a concern. Transcatheter right-sided valve replacement is safe and effective and is being performed at an increasing number of centers around the world. It offers an alternative to traditional surgical techniques and may potentially alter the decision making process whereby valvular replacement is performed prior to the development of long-term sequelae of right-sided valvular dysfunction.
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Boutsikou M, Uebing A, Kilner P, Li W, Kempny A, Gatzoulis MA. Brock procedure: 52 years of effective palliation for Tetralogy of Fallot. Int J Cardiol 2015. [PMID: 26197408 DOI: 10.1016/j.ijcard.2015.07.050] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- M Boutsikou
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
| | - A Uebing
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - P Kilner
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - W Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - A Kempny
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - M A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
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Efe SÇ, Kahveci G, Bakal RB, Akpinar SH, Unkun T, Ozdemir N. Severe biventricular hypertrophy mimicking infiltrative cardiomyopathy in old man with pulmonary stenosis and systemic hypertension. Indian Heart J 2015; 67:375-6. [PMID: 26304573 DOI: 10.1016/j.ihj.2015.04.020] [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: 04/17/2014] [Revised: 02/24/2015] [Accepted: 04/25/2015] [Indexed: 11/25/2022] Open
Abstract
Hypertrophic biventricular cardiomyopathy is a rare finding and generally caused by systemic infiltrative diseases. Its association with pulmonary stenosis in same patient is even rarer. We report a case report of male patient with biventricular hypertrophy coexisting with pulmonary valve stenosis and systemic hypertension.
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Affiliation(s)
- Süleyman Çağan Efe
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Gokhan Kahveci
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ruken Bengi Bakal
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Tuba Unkun
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Nihal Ozdemir
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Lurz P, Riede FT, Taylor AM, Wagner R, Nordmeyer J, Khambadkone S, Kinzel P, Derrick G, Schuler G, Bonhoeffer P, Giardini A, Daehnert I. Impact of percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction on exercise recovery kinetics. Int J Cardiol 2014; 177:276-80. [PMID: 25499392 DOI: 10.1016/j.ijcard.2014.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/27/2014] [Accepted: 09/15/2014] [Indexed: 01/15/2023]
Abstract
The recovery of cardiopulmonary variables from peak exercise in patients with pulmonary stenosis (PS) or regurgitation (PR) is delayed, but the impact of treating PS or PR on exercise recovery kinetics is unknown. 43 patients (median age 14 years) with PS (n = 23) or PR (n = 20) after repair of congenital heart disease underwent successful percutaneous pulmonary valve implantation (PPVI). Cardiopulmonary exercise tests (CPET) were performed both before and within 1 month after PPVI. Apart from peak oxygen uptake (VO2), the constant decay of VO2, CO2 output (VCO2), minute ventilation (VE), and heart rate (HR) and oxygen pulse were calculated for the first minute of recovery as the first-degree slope of a single linear relation. PPVI led to a significant improvement in NYHA functional class in the PS and PR groups (p<0.001 and p=0.0015, respectively). On CPET, peak VO2 improved post-PPVI only in the PS (25.6 ± 6.2 vs. 27.8 ± 7.9 ml/kg/min; p = 0.01) but not PR group (29.0 ± 9.8 vs. 28.6 ± 8.9 ml/kg/min; p = 0.6). However, VO2 slope improved in the PS (0.40 ± 0.23 vs. 0.65 ± 0.27, p < 0.001) as well as in the PR group (0.56 ± 0.37 vs. 0.67 ± 0.37, p = 0.003) as did VCO2 slope (0.39 ± 0.2 vs. 0.55 ± 0.24, p = 0.002 and 0.42 ± 0.33 vs. 0.53 ± 0.35, p = 0.02: for the PS and PR groups, respectively). The VE and HR slopes did not change after PPVI. Despite the lack of improvement in exercise capacity in the PR group, treatment of PS and PR by PPVI induces significant and similar improvements in the ability of recovering from maximal exercise in the 2 groups.
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Affiliation(s)
- Philipp Lurz
- Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
| | - Frank T Riede
- Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Andrew M Taylor
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK; Cardiovascular Unit, UCL Institute of Child Health, London, UK
| | - Robert Wagner
- Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sachin Khambadkone
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK; Cardiovascular Unit, UCL Institute of Child Health, London, UK
| | - Peter Kinzel
- Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Graham Derrick
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
| | - Gerhard Schuler
- Dept. of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Philipp Bonhoeffer
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
| | - Alessandro Giardini
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK; Cardiovascular Unit, UCL Institute of Child Health, London, UK
| | - Ingo Daehnert
- Dept. of Paediatric Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
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Mohanty S, Pandit BN, Tyagi S. Balloon pulmonary valvotomy--not just a simple balloon dilatation. Indian Heart J 2014; 66:462-5. [PMID: 25173207 DOI: 10.1016/j.ihj.2014.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/13/2014] [Indexed: 10/25/2022] Open
Abstract
Balloon pulmonary valvotomy is the preferred mode of treatment in patients with isolated pulmonary valvar stenosis and has shown good long term results. It is generally considered a safe procedure with few complications. There have been however, case reports of potentially fatal acute severe pulmonary edema occurring after the procedure in some patients. The cause of this complication and its pathophysiology is still not clear. Its occurrence is also infrequent with less than 5 cases reported till now. We report a case of pulmonary valvar stenosis which developed acute severe refractory pulmonary edema immediately after balloon pulmonary valvotomy.
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Affiliation(s)
- Subhendu Mohanty
- Assistant Professor, Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi 110002, India.
| | - Bhagya Narayan Pandit
- Senior Resident, Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi 110002, India
| | - Sanjay Tyagi
- Professor and Head, Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi 110002, India
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Williams-Phillips S. Truncus arteriosus 5th decade transesophageal and transthoracic echocardiogram features. J Cardiol Cases 2014; 10:25-30. [PMID: 30534217 DOI: 10.1016/j.jccase.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/22/2014] [Accepted: 04/03/2014] [Indexed: 11/22/2022] Open
Abstract
Persistent truncus arteriosus in the 5th decade is a rare entity as the only physical anomaly. Truncus arteriosus consists of a single great arterial trunk with the systemic, pulmonary, and coronary circulation, with no atretic aortic or pulmonary vessel. The complex cardiac anatomy can be delineated with transesophageal and transthoracic echocardiography, as is illustrated the case of our patient, who was diagnosed in infancy, at 5 months of age. This is the oldest documented case report of Type 3 truncus arteriosus with balanced biventricular anatomy, whose survival was secondary to an innate severe branch pulmonary artery stenosis. <Learning objective: This case report documents the echocardiographic features of a rare congenital cardiac anatomy of truncus arteriosus where survival for the majority is only in infancy but those with pulmonary hypertension can survive to their 4th decade. This is the oldest documented case report of Type 3 truncus arteriosus with balanced biventricular anatomy and one of the eight cases documented survival after 30 years of age. The transthoracic and transesophageal echocardiographic images are the focused feature in this paper, confirming clearly defined structural anatomy in complex structural congenital heart disease.>.
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