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Taksaudom N, Thuropathum P, Tepsuwan T, Tantraworasin A, Sittiwangkul R, Phothikun A, Woragidpoonpol S. Comparison of Right Ventricular Outflow Tract Reconstruction Techniques on Mid-Term Pulmonic Valve Fate. World J Pediatr Congenit Heart Surg 2024:21501351241237957. [PMID: 38676333 DOI: 10.1177/21501351241237957] [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: 04/28/2024]
Abstract
Introduction: The pulmonic valve-sparing technique (PVS) is an emerging approach of right ventricular outflow tract reconstruction in tetralogy of Fallot (TOF) correction aimed at reducing the incidence of pulmonic regurgitation (PR) and the need for subsequent reintervention. This study aims to compare the long-term occurrence of moderate to severe PR/stenosis (PR/PS) between three different approaches. Patients and Methods: We conducted a retrospective cohort study involving 173 patients who underwent TOF correction at Chiang Mai University hospital between January 2006 and December 2016. The patients were divided into three groups: transannular patch (TAP; n = 88, 50.9%), monocusp insertion (MCI; n = 40, 23.1%), and PVS (n = 45, 26%). The study assessed freedom from moderate to severe PR/PS. Results: The median overall follow-up time was 79.8 months (interquartile range: 50.7-115.5 months. The PVS exhibited larger PV Z-score (-2.6 ± 2.3 mm, P < .001), with predominantly tricuspid morphology (64.4%). The PVS had significantly shorter median ventilator time, intensive care unit stay, hospital stay, and longer median follow-up time. Postoperative moderate-severe PR was lower in the PVS group (P < .001), with no significant difference in PS (P = .356) and complications among the groups. Freedom from moderate-severe PR/PS was longer in the MCI group (2.8, 0.2-42.3 months vs 30.9, 0.2-50.9 months, respectively). Multivariable analysis showed TAP and MCI had a higher risk of developing moderate-severe PR (hazard ratio [HR] 2.51; 95% confidence interval [CI] 1.23-5.13 vs HR 1.41; 95%CI 0.59-3.38) but lower risk of moderate-severe PS (HR 0.14; 95%CI 0.02-0.9 vs HR 0.39; 95%CI 0.05-3.19). Conclusion: Pulmonic valve-sparing reconstruction showed promise in preventing late moderate-severe PR in patients with favorable PV anatomy. However, it should be noted that this technique is associated with a higher incidence of PS.
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Affiliation(s)
- Noppon Taksaudom
- Cardiovascular Thoracic Surgery Unit, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Pradchaya Thuropathum
- Cardiovascular Thoracic Surgery Unit, Department of Surgery, Mongkutwattana Hospital, Bangkok, Thailand
| | - Thitipong Tepsuwan
- Cardiovascular Thoracic Surgery Unit, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
- General Thoracic Surgery Unit, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Chiang Mai University, Chiang Mai, Thailand
| | - Rekwan Sittiwangkul
- Pediatric Cardiology Unit, Department of Pediatrics, Chiang Mai University, Chiang Mai, Thailand
| | - Amarit Phothikun
- Cardiovascular Thoracic Surgery Unit, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Woragidpoonpol
- Cardiovascular Thoracic Surgery Unit, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
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Aronowitz DI, Geoffrion TR, Piel S, Benson EJ, Morton SR, Starr J, Melchior RW, Gaudio HA, Degani RE, Widmann NJ, Weeks MK, Ko TS, Licht DJ, Hefti M, Gaynor JW, Kilbaugh TJ, Mavroudis CD. Early Impairment of Cerebral Bioenergetics After Cardiopulmonary Bypass in Neonatal Swine. World J Pediatr Congenit Heart Surg 2024:21501351241232077. [PMID: 38646826 DOI: 10.1177/21501351241232077] [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: 04/23/2024]
Abstract
Objectives: We previously demonstrated cerebral mitochondrial dysfunction in neonatal swine immediately following a period of full-flow cardiopulmonary bypass (CPB). The extent to which this dysfunction persists in the postoperative period and its correlation with other markers of cerebral bioenergetic failure and injury is unknown. We utilized a neonatal swine model to investigate the early evolution of mitochondrial function and cerebral bioenergetic failure after CPB. Methods: Twenty piglets (mean weight 4.4 ± 0.5 kg) underwent 3 h of CPB at 34 °C via cervical cannulation and were followed for 8, 12, 18, or 24 h (n = 5 per group). Markers of brain tissue damage (glycerol) and bioenergetic dysfunction (lactate to pyruvate ratio) were continuously measured in cerebral microdialysate samples. Control animals (n = 3, mean weight 4.1 ± 1.2 kg) did not undergo cannulation or CPB. Brain tissue was extracted immediately after euthanasia to obtain ex-vivo cortical mitochondrial respiration and frequency of cortical microglial nodules (indicative of cerebral microinfarctions) via neuropathology. Results: Both the lactate to pyruvate ratio (P < .0001) and glycerol levels (P = .01) increased in cerebral microdialysate within 8 h after CPB. At 24 h post-CPB, cortical mitochondrial respiration was significantly decreased compared with controls (P = .046). The presence of microglial nodules increased throughout the study period (24 h) (P = .01, R2 = 0.9). Conclusion: CPB results in impaired cerebral bioenergetics that persist for at least 24 h. During this period of bioenergetic impairment, there may be increased susceptibility to secondary injury related to alterations in metabolic delivery or demand, such as hypoglycemia, seizures, and decreased cerebral blood flow.
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Affiliation(s)
- Danielle I Aronowitz
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tracy R Geoffrion
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah Piel
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emilie J Benson
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah R Morton
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan Starr
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard W Melchior
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hunter A Gaudio
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rinat E Degani
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicholas J Widmann
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Katie Weeks
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tiffany S Ko
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel J Licht
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marco Hefti
- Department of Pathology, University of Iowa Health Care, Iowa City, IA, USA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Todd J Kilbaugh
- Resuscitation Science Center of Emphasis, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Constantine D Mavroudis
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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de Silva GNJ, Gamage GP. Queens of hearts: Exploring the lived experiences of mothers caring for infants with complex congenital heart disease in Sri Lanka. J Health Psychol 2024:13591053241233382. [PMID: 38384242 DOI: 10.1177/13591053241233382] [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: 02/23/2024] Open
Abstract
This qualitative study explored the lived experiences of eight Sri Lankan mothers of infants with complex congenital heart disease (CCHD) using semi-structured interviews. Four themes were generated as: illness perception, communication with medical staff, challenges faced, and coping mechanisms. These provided insight into the multi-faceted nature of mothers' experiences, importance of medical-caregiver communications and their need for psychosocial services. The findings enhance the limited knowledge of South-Asian primary CCHD caregiver experiences and will help in improving psychosocial support services in Sri Lanka.
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Wei Y, Su Y, Cao S, He Z, Wang R, Qin X, Feng Y, Yang C, Jiang H. Experimental study of the bilateral asymmetric single-rivet occluder device for transcatheter patent foramen ovale closure with reserved interatrial septal puncture area. Front Cardiovasc Med 2024; 10:1301412. [PMID: 38250032 PMCID: PMC10796624 DOI: 10.3389/fcvm.2023.1301412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To evaluate a noval bilateral asymmetric single-rivet occluder with reserved interatrial septal puncture area for treating patent foramen ovale (PFO). Materials and methods The study established a pig model of patent foramen ovale (PFO) by puncturing the oval fossa and then performing high-pressure balloon dilation. A specially designed bilateral asymmetric occluder for the reserved interatrial septal puncture area was then. used to close the PFO through catheter-based intervention. The pigs were kept for 3 months before undergoing a second catheter-based intervention, involving interatrial septal puncture using a newly developed occluder in the reserved interatrial septal puncture area. During 6 months, the experimental pigs underwent assessment using digital subtraction angiography (DSA), echocardiography, and histological evaluation. Results A patent foramen ovale (PFO) model was successfully established in 6 pigs using the puncture atrial septum high-pressure balloon dilation method. The diameter of the unclosed PFO was measured (3.56 ± 0.25 mm). Using the newly developed occluder device, all 6 pigs with unclosed PFO underwent successful catheter-based closure surgeries, with intraoperative and postoperative transesophageal echocardiography showing excellent device positioning and complete closure without residual shunting. After 3 months of implantation, the catheter-based interatrial septal puncture was performed through the reserved interatrial septal puncture area, and all procedures were successful. Immediately following euthanasia, a histological examination revealed intact and undamaged occluder devices with visible puncture holes in the reserved interatrial septal puncture area. No fracture of the nitinol wire was observed, and the surface of the occluder device showed coverage of endothelial and connective tissues. Utilizing a bilateral asymmetric single-rivet occluder device implanted through the reserved interatrial septal puncture area has proven effective in closing PFO. After implantation, the occluder device allows subsequent interatrial septal puncture procedures through the reserved area. Conclusion The novel occluder device demonstrated excellent closure performance, biocompatibility, and puncturability in the experiment. This indicates the feasibility of conducting further catheter-based interventions on the interatrial septum.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Haibin Jiang
- Department of Cardiology, Wuxi No.2 People's Hospital (Jiangnan University Medical Center), Wuxi, Jiangsu, China
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Eerdekens GJ, Van Beersel D, Rex S, Gewillig M, Schrijvers A, Al Tmimi L. The patient with congenital heart disease in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:421-436. [PMID: 37938087 DOI: 10.1016/j.bpa.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
The number of patients with congenital heart disease (CHD) undergoing ambulatory surgery is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists' Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator. Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.
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Affiliation(s)
- Gert-Jan Eerdekens
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Dieter Van Beersel
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - An Schrijvers
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Layth Al Tmimi
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
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Al-Ata JA, Abdelmohsen GA, Bahaidarah SA, Alkhushi NA, Abdelsalam MH, Bekheet SB, Al-Radi OO, Jamjoom AA, Elmahrouk AF, Alata AJ, Yousef AA, Dohain AM. Percutaneous coronary stent implantation in children and young infants following surgical repair of congenital heart disease. Cardiovasc Diagn Ther 2023; 13:638-649. [PMID: 37675094 PMCID: PMC10478021 DOI: 10.21037/cdt-23-54] [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: 02/15/2023] [Accepted: 07/12/2023] [Indexed: 09/08/2023]
Abstract
Background Coronary artery stent implantation (CSI) in the pediatric population is rare. Only a few reports were published on managing postoperative coronary artery obstruction using coronary stents following surgical repair of congenital heart diseases (CHD). This study aimed to analyze the feasibility, indications, procedural technique, risk factors, and short-term outcomes of CSI after pediatric cardiac surgery. Methods In this retrospective cohort study, we reviewed all pediatric patients who underwent surgical repair of CHD requiring postoperative CSI in two cardiac centers (King Abdulaziz University Hospital and King Faisal Specialist Hospital and Research Center) between 2012 and 2022. Survival to hospital discharge was the study's primary outcome. The secondary outcomes included procedural success, duration of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, need for coronary reintervention, and late mortality. A descriptive analysis was performed for the collected data from the patients' medical records. Results Eleven patients who underwent postoperative CSI were identified. The most common anatomic diagnosis was congenital aortic valve stenosis. All patients underwent cardiac catheterization on extracorporeal membrane oxygenation support except one patient, who presented with chest pain after cardiac surgery. Procedural success was achieved in all patients with excellent revascularization documented by post-procedural angiograms. Both patients who had late coronary events after cardiac surgery survived hospital discharge. There was no in-hospital mortality among the two patients who required stenting of only the right coronary artery. The four patients who required more than 120 minutes to complete the procedure had early mortality. After CSI, the median duration of mechanical ventilation and ICU stay was 12 and 17 days, respectively. Six patients (54.5%) survived hospital discharge post-CSI; they did not require re-intervention during the follow-up period (38-1,695 days). Conclusions CSI in pediatric patients can be performed with excellent procedural success for treating coronary artery stenosis after cardiac surgery. It could be considered a potential treatment strategy for this population.
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Affiliation(s)
- Jameel A. Al-Ata
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Gaser A. Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Saud A. Bahaidarah
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naif A. Alkhushi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohamed H. Abdelsalam
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Samia B. Bekheet
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Osman O. Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A. Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F. Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Abdulaziz J. Alata
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Aly A. Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed M. Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
- Pediatric Critical Care Unit, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Harris AG, Iacobazzi D, Caputo M, Bartoli-Leonard F. Graft rejection in paediatric congenital heart disease. Transl Pediatr 2023; 12:1572-1591. [PMID: 37692547 PMCID: PMC10485650 DOI: 10.21037/tp-23-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023] Open
Abstract
Congenital heart disease (CHD) affects around 1.35 million neonates worldwide per annum, and surgical repair is necessary in approximately 25% of cases. Xenografts, usually of bovine or porcine origin, are often used for the surgical reconstruction. These xenografts elicit an immune response due to significant immunological incompatibilities between host and donor. Current techniques to dampen the initial hyperacute rejection response involve aldehyde fixation to crosslink xenoantigens, such as galactose-α1,3-galactose and N-glycolylneuraminic acid. While this temporarily masks the epitopes, aldehyde fixation is a suboptimal solution, degrading over time, resulting in cytotoxicity and rejection. The immune response to foreign tissue eventually leads to chronic inflammation and subsequent graft failure, necessitating reintervention to replace the defective bioprosthetic. Decellularisation to remove immunoincompatible material has been suggested as an alternative to fixation and may prove a superior solution. However, incomplete decellularisation poses a significant challenge, causing a substantial immune rejection response and subsequent graft rejection. This review discusses commercially available grafts used in surgical paediatric CHD intervention, looking specifically at bovine jugular vein conduits as a substitute to cryopreserved homografts, as well as decellularised alternatives to the aldehyde-fixed graft. Mechanisms of biological prosthesis rejection are explored, including the signalling cascades of the innate and adaptive immune response. Lastly, emerging strategies of intervention are examined, including the use of tissue from genetically modified pigs, enhanced crosslinking and decellularisation techniques, and augmentation of grafts through in vitro recellularisation or functionalisation with human surface proteins.
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Affiliation(s)
- Amy G. Harris
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Dominga Iacobazzi
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Francesca Bartoli-Leonard
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
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Xue C, Gu X, Han J, Zhao Y, Zhang Y, He Y. Echocardiographic features and influencing factors of pulmonary hypertension of total anomalous pulmonary venous connection in adults. J Thorac Dis 2023; 15:3791-3799. [PMID: 37559638 PMCID: PMC10407536 DOI: 10.21037/jtd-22-1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/16/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Patients with total anomalous pulmonary venous connection (TAPVC) generally have symptoms during the neonatal period and infancy, and the fatality rate is extremely high. Most patients do not survive to adulthood. This study analyzed the clinical and transthoracic echocardiographic (TTE) manifestations of adult patients with TAPVC, summarized the echocardiographic characteristics of TAPVC, and identified the factors influencing pulmonary hypertension. METHODS Data from adult patients with TAPVC from Beijing Anzhen Hospital, China, were retrospectively collected for analyses, including sex, age, history of gestation, clinical manifestations, echocardiographic parameters, and blood oxygen levels. Patients were grouped for comparative analyses based on their pulmonary artery systolic pressure (PASP) (≥60 vs. <60 mmHg); 32 atrial septal defect (ASD) patients were included as a control group. RESULTS (I) Sixteen patients were identified with TAPVC (11 women and 5 men; mean age: 32.2±9.5 years), including 8, 4, and 4 patients with supra-cardiac, mixed, and intracardiac type TAPVC, respectively. Furthermore, 10 patients had moderate or severe tricuspid regurgitation, and 6 had a PASP of ≥60 mmHg. Echocardiography misdiagnosed 2 patients with an ASD. (II) The TAPVC group patients had a smaller left atrium (LA) and a lower aorta/pulmonary artery ratio than ASD-only group patients. However, the right ventricular diameter (RVd) and right atrium were larger in patients with TAPVC than in those with only ASD. (III) The RVd was larger and the LA was smaller in patients with a PASP of ≥60 mmHg than in those with a PASP of <60 mmHg. (IV) Of those with a PASP of ≥60 mmHg, TAPVC patients had a smaller LA and a larger RVd than those with only ASD. (V) Pregnancy affected the PASP (adjusted odds ratio: 15.000, 95% confidence interval: 1.031-218.300, P=0.047). (VI) Echocardiography indicated that TAPVC patients with ASD had a right to left shunt at the atrial level and the pulmonary vein (PV) was not connected to the LA. CONCLUSIONS Searching for the PV by TTE is necessary for patients with ASDs, which may help avoid misdiagnosis. Moreover, pregnancy affects the PASP. Patients with TAPVC may present with a larger right heart, smaller LA, and lower aorta/pulmonary artery ration than those with only ASD.
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Affiliation(s)
- Chao Xue
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Xiaoyan Gu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Jiancheng Han
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Ying Zhao
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Ye Zhang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Yihua He
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
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Wacker J, Joye R, Genecand L, Lador F, Beghetti M. Pulmonary vascular disease as a complication of pediatric congenital heart diseases. Transl Pediatr 2023; 12:1041-1052. [PMID: 37305723 PMCID: PMC10248925 DOI: 10.21037/tp-23-64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
Congenital and acquired heart diseases can cause pulmonary hypertension (PH) in children, either by increasing pulmonary blood flow (PBF), left atrial pressure (LAp), and/or pulmonary vascular resistance (PVR). Pathophysiological process of pulmonary vascular disease (PVD) in different types of congenital heart diseases (CHDs) are reviewed hereafter. As with other types of PH, a rigorous diagnostic evaluation is mandatory to characterize the etiology of the PH, rule out other or additional causes of PH, and establish a risk profile. Cardiac catheterization remains the gold standard exam for PH diagnosis. Treatment of pulmonary arterial hypertension (PAH) associated with CHD (PAH-CHD) can then be started according to the recent guidelines recommendations, although most of the evidence is extrapolated from studies on other causes of PAH. PH in pediatric heart disease is often multifactorial, and sometimes unclassifiable, making the management of these patients complicated. The operability of patients with a prevalent left-to-right shunt and increase of PVR, the management of children with PH associated with left-sided heart disease, the challenges of pulmonary vascular disorders in children with univentricular heart physiology and the role of vasodilator therapy in failing Fontan patients are some of the hot topics discussed in this review.
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Affiliation(s)
- Julie Wacker
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique (CURCCCP), University of Geneva, Geneva, Switzerland
| | - Raphael Joye
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique (CURCCCP), University of Geneva, Geneva, Switzerland
| | - Leon Genecand
- Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Lador
- Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique (CURCCCP), University of Geneva, Geneva, Switzerland
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Hardman G, Zacharias J. Minimal-Access Atrial Septal Defect (ASD) Closure. J Cardiovasc Dev Dis 2023; 10:jcdd10050206. [PMID: 37233173 DOI: 10.3390/jcdd10050206] [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: 03/28/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/27/2023] Open
Abstract
Progress towards the development and adoption of minimally invasive techniques in cardiac surgery has been slower than that seen in other surgical specialties. Congenital heart disease (CHD) patients represent an important population within cardiac disease, of which atrial septal defect (ASD) is one of the most common diagnoses. Management of ASD encompasses a range of minimal-access and minimally invasive approaches, including transcatheter device closure, mini-sternotomy, thoracotomy, video-assisted, endoscopic, and robotic approaches. In this article, we will discuss the pathophysiology of ASD, along with diagnosis, management, and indications for intervention. We will review the current evidence supporting minimally invasive and minimal-access surgical ASD closure in the adult and paediatric patient, highlighting peri-operative considerations and areas for further research.
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Affiliation(s)
- Gillian Hardman
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
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11
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Verrall CE, Patel S, Travitz L, Tchieu J, Dale RC, Kasparian NA, Winlaw DS, Blue GM. Biological and structural phenotypes associated with neurodevelopmental outcomes in congenital heart disease. Transl Pediatr 2023; 12:768-786. [PMID: 37181016 PMCID: PMC10167385 DOI: 10.21037/tp-22-687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Neurodevelopmental disability (NDD) is recognised as one of the most common comorbidities in children with congenital heart disease (CHD) and is associated with altered brain structure and growth throughout the life course. Causes and contributors underpinning the CHD and NDD paradigm are not fully understood, and likely include innate patient factors, such as genetic and epigenetic factors, prenatal haemodynamic consequences as a result of the heart defect, and factors affecting the fetal-placental-maternal environment, such as placental pathology, maternal diet, psychological stress and autoimmune disease. Additional postnatal factors, including the type and complexity of disease and other clinical factors such as prematurity, peri-operative factors and socioeconomic factors are also expected to play a role in determining the final presentation of the NDD. Despite significant advances in knowledge and strategies to optimise outcomes, the extent to which adverse neurodevelopment can be modified remains unknown. Understanding biological and structural phenotypes associated with NDD in CHD are vital for understanding disease mechanisms, which in turn will advance the development of effective intervention strategies for those at risk. This review article summarises our current knowledge surrounding biological, structural, and genetic contributors to NDD in CHD and describes avenues for future research; highlighting the need for translational studies that bridge the gap between basic science and clinical practice.
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Affiliation(s)
- Charlotte E. Verrall
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shrujna Patel
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Leksi Travitz
- Division of Developmental Biology and the Center for Stem Cell and Organoid Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jason Tchieu
- Division of Developmental Biology and the Center for Stem Cell and Organoid Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Russel C. Dale
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nadine A. Kasparian
- Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - David S. Winlaw
- Cardiothoracic Surgery, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gillian M. Blue
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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12
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Wasiak A, Jaworski R, Pastuszko A, Birbach M, Kozlowski M, Mirkowicz-Malek M, Friedman-Gruszczynska J, Maruszewski B, Kansy A. Outcomes of Transannular Repair of Tetralogy of Fallot With a Contegra ® Monocuspid Patch. World J Pediatr Congenit Heart Surg 2023:21501351231162902. [PMID: 37097897 DOI: 10.1177/21501351231162902] [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: 04/26/2023]
Abstract
BACKGROUND Surgical repair of tetralogy of Fallot (ToF) depends on the anatomical variations of the heart defect. A group of patients with a hypoplastic pulmonary valve annulus required a transannular patch. This study aimed to evaluate the early and late outcomes of ToF repair with a transannular Contegra® monocuspid patch in a single center. METHODS A retrospective review of medical records was conducted. This study included 224 children with a median age of 13 months who underwent ToF repair with a Contegra® transannular patch in over 20 years of observation. The primary outcomes were hospital mortality and need for early reoperations. The secondary outcomes were late death and event-free survival. RESULTS The hospital mortality in our group was 3.1%, whereas two patients required early reoperation. Three patients were excluded from the study because follow-up data were not available. In the remaining group of patients (212 patients), the median follow-up was 116 (range, 1-206) months. One patient died because of sudden cardiac arrest at home six months after surgery. Event-free survival was observed in 181 patients (85.4%), whereas the remaining 30 patients (14.1%) required graft replacement. The median time to reoperation was 99 (range, 4-183) months. CONCLUSIONS Although surgical treatment of ToF has been performed for more than 60 years worldwide, the optimal approach in children with a hypoplastic pulmonary valve annulus remains debatable. Among options, the Contegra® monocuspid patch can be effectively used in transannular repair of ToF with good long-term results.
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Affiliation(s)
- Aleksandra Wasiak
- Department of Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Radoslaw Jaworski
- Department of Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Pastuszko
- Department of Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Mariusz Birbach
- Department of Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Michal Kozlowski
- Department of Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | | | | | - Bohdan Maruszewski
- Department of Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Andrzej Kansy
- Department of Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
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13
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Liem DA, Cadeiras M, Setty SP. Insights and perspectives into clinical biomarker discovery in pediatric heart failure and congenital heart disease-a narrative review. Cardiovasc Diagn Ther 2023; 13:83-99. [PMID: 36864972 PMCID: PMC9971290 DOI: 10.21037/cdt-22-386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023]
Abstract
Background and Objective Heart failure (HF) in the pediatric population is a multi-factorial process with a wide spectrum of etiologies and clinical manifestations, that are distinct from the adult HF population, with congenital heart disease (CHD) as the most common cause. CHD has high morbidity/mortality with nearly 60% developing HF during the first 12 months of life. Hence, early discovery and diagnosis of CHD in neonates is pivotal. Plasma B-type natriuretic peptide (BNP) is an increasingly popular clinical marker in pediatric HF, however, in contrast to adult HF, it is not yet included in pediatric HF guidelines and there is no standardized reference cut-off value. We explore the current trends and prospects of biomarkers in pediatric HF, including CHD that can aid in diagnosis and management. Methods As a narrative review, we will analyze biomarkers with respect to diagnosis and monitoring in specific anatomical types of CHD in the pediatric population considering all English PubMed publications till June 2022. Key Content and Findings We present a concise description of our own experience in applying plasma BNP as a clinical biomarker in pediatric HF and CHD (tetralogy of fallot vs. ventricular septal defect) in the context of surgical correction, as well as untargeted metabolomics analyses. In the current age of Information Technology and large data sets we also explored new biomarker discovery using Text Mining of 33M manuscripts currently on PubMed. Conclusions (Multi) Omics studies from patient samples as well as Data Mining can be considered for the discovery of potential pediatric HF biomarkers useful in clinical care. Future research should focus on validation and defining evidence-based value limits and reference ranges for specific indications using the most up-to-date assays in parallel to commonly used studies.
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Affiliation(s)
- David A. Liem
- Department of Medicine, Division of Cardiovascular Disease, University of California, Davis, CA, USA
| | - Martin Cadeiras
- Department of Medicine, Division of Cardiovascular Disease, University of California, Davis, CA, USA
| | - Shaun P. Setty
- Department of Pediatric and Adult Congenital Cardiac Surgery, Miller Children’s and Women’s Hospital and Long Beach Memorial Hospital, Long Beach, CA, USA
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14
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Kim S, Seshadrinathan S, Jenkins KJ, Murala JS. Can the Public-Private Business Model Provide a Sustainable Quality Pediatric Cardiac Surgery Program in Low- and Middle-Income Countries? World J Pediatr Congenit Heart Surg 2023; 14:316-325. [PMID: 36788012 PMCID: PMC10115927 DOI: 10.1177/21501351221151057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Over 90% of the world's children with congenital heart disease do not have access to cardiac care. Although many models provide pediatric cardiac surgery in low- and middle-income countries, sustainability poses a barrier. We explore one model providing care for the underserved in Chennai, India, that came into existence through trial and error over 30 years across three phases. Phase 1 was a Tamilnadu state government-sponsored program that soon became unsustainable with unmet demands. Phase 2 utilized a grassroots foundation of a public-private partnership (PPP) with few donors and a hospital with suboptimal infrastructure. Phase 3 is the ongoing fine-tuning of the PPP model, with upgraded infrastructure and a well-trained team. Through indigenization, an average cardiac surgery costs Rupees (Rs.) 1,80,000 ($2400). The government funds Rs. 60,000 to 80,000 ($800-$1066.67), and the rest is funded through the fund pool. The goal is to perform 100 free surgeries annually by maintaining a fund pool of Rs. 50 lakhs ($66,666.67), which supplements government funds. This ensures equitable distribution of funds with no compromise on resources (disposables, single-use cannulas, etc). Our model ensures the dignity of the patient, fair compensation for workers, and is practical, affordable, and easily adaptable. Thus far, this model provided free cardiac surgery for 357 children from Risk Adjusted Congenital Heart Surgery Score of 1 to 4, with an overall mortality of 2.73%. The prerequisites for this model are having a "spark plug," a dedicated surgical team, a partnership with state-of-the-art infrastructure, and a steady flow of funds.
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Affiliation(s)
- Stephany Kim
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sreemathi Seshadrinathan
- Department of Cardiovascular and Thoracic Surgery, Public Health Centre, Chennai, Tamil Nadu, India
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - John S Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Zamariolli M, Dantas AG, Nunes N, Moysés-Oliveira M, Sgardioli IC, Soares DCQ, Gil-Da-Silva-Lopes VL, Kim CA, Melaragno MI. Phenotypic heterogeneity in 22q11.2 deletion syndrome: Copy Number Variants as genetic modifiers for congenital heart disease in a Brazilian cohort. Am J Med Genet A 2023; 191:1273-1281. [PMID: 36751694 DOI: 10.1002/ajmg.a.63145] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
The clinical heterogeneity in 22q11.2 deletion syndrome (22q11.2DS) underlies complex genetic mechanisms including variants in other regions of the genome, known as genetic modifiers. Congenital heart disease (CHD) is one of the most relevant phenotypes in the syndrome and copy number variants (CNVs) outside the 22q11.2 region could play a role in its variable expressivity. Since those described loci account for a small proportion of the variability, the CNV analysis in new cohorts from different ancestry-based populations constitutes a valuable resource to identify a wider range of modifiers. We performed SNP-array in 117 Brazilian patients with 22q11.2DS, with and without CHD, and leveraged genome-wide CNV analysis. After quality control, we selected 50 CNVs in 38 patients for downstream analysis. CNVs' genetic content and implicated biological pathways were compared between patients with and without CHD. CNV-affected genes in patients with CHD were enriched for several functional terms related to ubiquitination, transcription factor binding sites and miRNA targets, highlighting the complexity of the phenotype's expressivity. Cardiac-related genes were identified in both groups of patients suggesting that increasing risk and protective mechanisms could be involved. These genes and enriched pathways could indicate new modifiers to the cardiac phenotype in 22q11.2DS patients.
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Affiliation(s)
- M Zamariolli
- Genetic Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - A G Dantas
- Genetic Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - N Nunes
- Genetic Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - I C Sgardioli
- Department of Translational Medicine, Area of Medical Genetics and Genomic Medicine, Universidade Estadual de Campinas, Campinas, Brazil
| | - D C Q Soares
- Genetics Unit, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
| | - V L Gil-Da-Silva-Lopes
- Department of Translational Medicine, Area of Medical Genetics and Genomic Medicine, Universidade Estadual de Campinas, Campinas, Brazil
| | - C A Kim
- Genetics Unit, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
| | - M I Melaragno
- Genetic Division, Universidade Federal de São Paulo, São Paulo, Brazil
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16
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Oettgen F, Shehu N, Stern H, Ewert P, Meierhofer C. Safety of intrahospital transport for MR or CT scans in ventilated pediatric intensive care patients with congenital heart disease. Cardiovasc Diagn Ther 2022; 12:779-786. [PMID: 36605079 PMCID: PMC9808113 DOI: 10.21037/cdt-22-384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022]
Abstract
Background MR or CT scans are often required in the treatment of pediatric intensive care patients. During the therefore needed intrahospital transport continuous ventilation of the patient must be maintained. Intrahospital transport is considered safe regarding changes in hemodynamics or adverse events (AEs). As those studies cover inhomogeneous patient groups, we analyzed the safety for ventilated pediatric patients with congenital heart disease (CHD) focusing on differences between manual and mechanical ventilation during transport and examination. Methods Retrospective monocentric case-control study covering a 10 years' period in a tertiary cardiac center for CHD. Sixty-three critically ill ventilator-dependent patients, median 2 (0-37) months, were included. Fifty-one patients got ventilated manually and 12 patients got ventilated with a mobile ventilator. The data include vital parameters and blood gas data, as well as catecholamine support, occurrence of AEs and total duration of transport and examination. Results In both groups we found minor changes of vital parameters or blood gas data. Regarding the HR we found a drop from median 135/min before leaving the ICU to 130/min after returning to the ICU (P=0.0072) in the manually ventilated group and a drop from median 133/min to 123/min (P=0.0703) in the mechanically ventilated group. The median transport time including scan was higher in the manually ventilated group (P=0.0098) with a median duration of transport and scan time of 100 minutes (30-245 minutes) in the manually ventilated group and of 97.5 minutes (60-224 minutes) in the mechanically ventilated group. A total of 9 AEs was recorded, 7 (13.7%) of them in the manually and 2 (16.7%) in the mechanically ventilated group with a drop of the mean arterial pressure (MAP) and an increase in catecholamine support. Conclusions We consider both manual ventilation and mechanical ventilation for intrahospital transport safe for pediatric intensive care patients with CHD. Using a mechanical ventilator might have the advantage to react faster to changes in hemodynamics.
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Affiliation(s)
- Fabienne Oettgen
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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17
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Geoffrion TR, Fuller SM. High-Risk Anatomic Subsets in Hypoplastic Left Heart Syndrome. World J Pediatr Congenit Heart Surg 2022; 13:593-599. [PMID: 36053102 DOI: 10.1177/21501351221111390] [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: 11/16/2022]
Abstract
Despite overall improvements in outcomes for patients with hypoplastic left heart syndrome, there remain anatomic features that can place these patients at higher risk throughout their treatment course. These include severe preoperative obstruction to pulmonary venous return, restrictive atrial septum, coronary fistulae, severe tricuspid regurgitation, smaller ascending aorta diameter (especially if <2 mm), and poor ventricular function. The risk of traditional staged palliation has led to the development of alternative strategies for such patients. To further improve the outcomes, we must continue to diligently examine and study anatomic details in HLHS patients.
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Affiliation(s)
- Tracy R Geoffrion
- Division of Cardiothoracic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephanie M Fuller
- Division of Cardiothoracic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Cardiothoracic Surgery, Department of Surgery, 14640Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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18
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Spanaki A, Kabir S, Stephenson N, van Poppel MPM, Benetti V, Simpson J. 3D Approaches in Complex CHD: Where Are We? Funny Printing and Beautiful Images, or a Useful Tool? J Cardiovasc Dev Dis 2022; 9:269. [PMID: 36005432 PMCID: PMC9410138 DOI: 10.3390/jcdd9080269] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Echocardiography, CT and MRI have a crucial role in the management of congenital heart disease (CHD) patients. All of these modalities can be presented in a 2D or a 3D rendered format. The aim of this paper is to review the key advantages and potential limitations, as well as the future challenges of a 3D approach in each imaging modality. The focus of this review is on anatomic rather than functional assessment. Conventional 2D echocardiography presents limitations when imaging complex lesions, whereas 3D imaging depicts the anatomy in all dimensions. CT and MRI can visualise extracardiac vasculature and guide complex biventricular repair. Three-dimensional printed models can be used in depicting complex intracardiac relationships and defining the surgical strategy in specific lesions. Extended reality imaging retained dynamic cardiac motion holds great potential for planning surgical and catheter procedures. Overall, the use of 3D imaging has resulted in a better understanding of anatomy, with a direct impact on the surgical and catheter approach, particularly in more complex cases.
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Affiliation(s)
- Adriani Spanaki
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Saleha Kabir
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Natasha Stephenson
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
| | - Milou P. M. van Poppel
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
| | - Valentina Benetti
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
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19
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Ma Y, Zhao L, Wei J, Wang Z, Lui S, Song B, Gong Q, Wang P, Wu M. Comparing near-infrared spectroscopy-measured cerebral oxygen saturation and corresponding venous oxygen saturations in children with congenital heart disease: a systematic review and meta-analysis. Transl Pediatr 2022; 11:1374-1388. [PMID: 36072542 PMCID: PMC9442204 DOI: 10.21037/tp-22-345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) is a non-invasive approach that measures cerebral regional oxygen saturation (rScO2). In this study, we evaluated the evidence on the validity of NIRS and the interchangeability between NIRS and common invasive approaches by exploring the correlation and consistency and comparing the mean and standard deviation between the NIRS rScO2 and jugular bulb venous oxygen saturation (SjvO2) as well as central venous oxygen saturation (ScvO2) in the perioperative period of children with congenital heart disease (CHD). METHODS We searched electronic bibliographic databases (PubMed, The Cochrane Library and Embase) and screened the studies that met the inclusion criteria. We included cross-sectional studies of CHD pediatric patients in the perioperative period receiving both tests for NIRS rScO2 and SjvO2 or NIRS rScO2 and ScvO2. Methodological quality assessment and heterogeneity analyses were performed. We qualitatively summarized the results of Bland-Altman's analysis. Meta-regression, subgroup analyses, and sensitivity analyses were carried out to explore the causes of heterogeneity. RESULTS There was no significant difference in Cohen's d between rScO2 and ScvO2 or between rScO2 and SjvO2 (Cohen's d =0.06, 95% CI: -0.16 to 0.28; Cohen's d =0.03, 95% CI: -0.25 to 0.31, respectively) and notable heterogeneity existed (I2=76.0%, P<0.001; I2=73.6%, P<0.001, respectively). A positive linear correlation was present between rScO2 and ScvO2 or between rScO2 and SjvO2 (r=0.58, 95% CI: 0.54 to 0.63; r=0.60, 95% CI: 0.54 to 0.66, respectively) and the heterogeneity was not significant (I2=36.7%, P=0.065; I2=12.7%, P=0.328, respectively). In most studies, the 95% limits of agreements of Bland-Altman's analysis were large. No evidence of publication bias was observed. CONCLUSIONS The rScO2 measured by NIRS reflected the SjvO2 and ScvO2 monitored by invasive measurements in the perioperative period of children with CHD to some extent. However, wide limits of agreements between rScO2 and SjvO2 as well as ScvO2 indicated that NIRS and SjvO2 as well as ScvO2 are not interchangeable. Whether NIRS plays a prominent role in monitoring cerebral oxygen saturation in children with CHD needs further research.
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Affiliation(s)
- Yiqi Ma
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Lihong Zhao
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ziwei Wang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Su Lui
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Hospital of Sun Yat-Sen University, Shenzhen, China.,Guangdong Engineering Technology Research Center for Rehabilitation Medicine and Clinical Translation, Guangzhou, China
| | - Min Wu
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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20
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Decreasing Mortality for STAT 4 and 5 Neonatal Heart Surgeries Concurrent With Improving Prenatal Detection: The Nevada Experience. World J Pediatr Congenit Heart Surg 2022; 13:361-365. [PMID: 35446211 DOI: 10.1177/21501351221087700] [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: 11/16/2022]
Abstract
Objective: Our objective was to investigate whether a relationship existed between our center's STAT 4 and 5 category surgical mortality and general-population prenatal detection rates in Nevada. Methods: We identified patients who underwent STAT 4 and 5 neonatal index cardiovascular surgeries at our center between October 2012 and September 2021. Additionally, we calculated prenatal detection rates for each of the 9 retrospective study years. We used descriptive statistics and nonparametric testing, including the Spearman Rho correlation (R) and the Mann-Whitney U-tests, with a significant P-value set at < .05. Results: We identified 356 patients. We noted a statistically significant increasing trend in prenatal detection percentages (rho = 0.79, P = .01), concurrent with a statistically significant decreasing trend in surgical mortality (rho = -0.82, P = .007). Conclusions: Despite encouraging results, we could not establish a cause-and-effect relationship between concurrent decreased surgical mortality and increased prenatal detection rates for patients undergoing STAT 4 and 5 surgical procedures at our center.
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Affiliation(s)
- William N Evans
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
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21
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Reddy C, Kaskar A, Karthick E, Siddaiah S, Kiran VS, Suresh P. Surgical Management of Aortopulmonary Window and its Associated Cardiac Lesions. World J Pediatr Congenit Heart Surg 2022; 13:334-340. [PMID: 35446205 DOI: 10.1177/21501351221077888] [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: 11/16/2022]
Abstract
Background: The aim of this study was to review our institutional experience with patients who underwent surgical repair of aortopulmonary window, either as an isolated lesion or in association with other cardiac anomalies. Methods: Between January 2006 and December 2020, 183 patients underwent surgical repair of aortopulmonary window at our institute. Sixty-three patients had associated lesions (Group 1); 120 patients had isolated aortopulmonary window (Group 2). Median age was 7 months. Results: The early mortality in Group 1 was significantly higher (12.7%) compared to Group 2 (0.8%) (P = .001). The most common associated anomaly was ventricular septal defect (29 patients). On univariable analysis, cardiopulmonary bypass time (P < .001), aortic cross-clamp time (P < .001), delayed chest closure (P = .02), sepsis (P = .006), tracheostomy (P = .002), extracorporeal membrane oxygenation (P < .001), associated lesions (P = .001), pulmonary artery hypertensive crisis (P < .001) were predictors for early mortality. On multivariable analysis only pulmonary artery hypertensive crisis was identified as predictor for early mortality (P = .03; odds ratio = 24). Survival at both 5 years and 8 years was 77% ± 6.5 in Group 1 and 98.8% ± 1.2 in Group 2 (P≤.001). Freedom from reintervention at both 5 years and 8 years was 92.4% ± 5.2 in Group 1 and 100% in Group 2 (P = .055). Conclusion: Early outcomes of aortopulmonary window repair are excellent among patients in which this is an isolated lesion, as compared to those with associated lesions. Long-term outcomes in terms of freedom from reoperation are excellent in both the groups.
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Affiliation(s)
- Chinnaswamy Reddy
- Department of Cardiothoracic Surgery, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Ameya Kaskar
- Department of Cardiothoracic Surgery, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Eswara Karthick
- Department of Cardiothoracic Surgery, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Satheesh Siddaiah
- Department of Pediatric Cardiology, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Viralam S Kiran
- Department of Pediatric Cardiology, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - PujarVenkateshauarya Suresh
- Department of Pediatric Cardiology, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
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22
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Su D, Huang Y, Liu D, Huang Y, Ye B, Qin S, Chen C, Pang Y. Bioinformatic analysis of dysregulated circular RNAs in pediatric pulmonary hypertension linked congenital heart disease. Transl Pediatr 2022; 11:715-727. [PMID: 35685074 PMCID: PMC9173884 DOI: 10.21037/tp-22-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Circular RNAs (circRNAs) may play important roles in the progression of pulmonary arterial hypertension. However, the potential roles they play in childhood pulmonary arterial hypertension associated congenital heart disease (CHD) progression remains unclear. METHODS Thirteen human plasma samples including eight from pulmonary arterial hypertension secondary to CHD patients and five from a control group were analyzed using the Arraystar Human circRNA array. The relative expression levels of five differentially expressed circRNAs in pulmonary arterial hypertension were detected using real-time polymerase chain reaction (PCR) analysis. In parallel, these levels were also taken on control samples from 32 CHD patients. We used miRanda and TargetScan software packages to predict potential microRNA (miRNA)targets, which were then combined into a circRNA-miRNA-messenger RNA (mRNA) network. RESULTS Twenty-seven circRNAs (three upregulated and 24 downregulated) were differentially expressed between the pulmonary arterial hypertension and control groups. Compared to control group levels, circ_003416 expression in the pulmonary arterial hypertension group was significantly downregulated, while circ_005372 expression, in contrast, was significantly upregulated. The differential expression of these circRNAs was mainly linked to variation in levels of oxidative phosphorylation and tight junction signaling. CONCLUSIONS We identified one overexpressed and one underexpressed circRNA in plasma samples from children with CHD associated pulmonary arterial hypertension. Bioinformatic analysis indicated these dysregulated circRNAs might be associated with the occurrence and regulation of pulmonary arterial hypertension.
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Affiliation(s)
- Danyan Su
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanyun Huang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dongli Liu
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuqin Huang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingbing Ye
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Suyuan Qin
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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23
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Janjua D, Singh J, Agrawal A. Pulse oximetry as a screening test for congenital heart disease in newborns. J Mother Child 2022; 26:1-9. [PMID: 35853444 PMCID: PMC10032324 DOI: 10.34763/jmotherandchild.20222601.d-21-00033] [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] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/22/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) can be fatal if not diagnosed at the early phases of life. Available diagnostic tools for screening critical CHD are mostly invasive and costly. AIM The current study aimed to validate the use of pulse oximetry as a non-invasive and cost-effective tool to screen critical CHD. MATERIAL AND METHODS This observational study was conducted in a tertiary care teaching institute. A total of 1,082 asymptomatic term neonates (aged 2-24 h) were screened by pulse oximetry and clinical examination for the detection of critical CHD. Neonates with abnormal pulse oximetry and clinical examination findings were subjected to confirm the presence of CHD. RESULTS The incidence of critical CHD in asymptomatic newborns was found to be 0.5% (5/1000 live births). Echocardiography confirmed five cases of critical CHD. Pulse oximetry alone could detect 80%, and clinical examination alone could detect 60% of the CHD cases, while combining both methods gave 100% detection rate. CONCLUSION Pulse oximetry is a simple, cost-effective, and reliable tool to diagnose critical CHD. In majority of the newborns who have not undergone fetal echocardiography, the underlying critical CHD can be missed, and in such cases, pulse oximetry screening offers an effective way to minimise the undiagnosed discharge risk.
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Affiliation(s)
- Dalwinder Janjua
- Department of Neonatology, Al Jalila Children's Hospital, Dubai, UAE
| | | | - Amit Agrawal
- Department of Paediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India
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24
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Talwar S, Harshavardhan N, Kapoor PM, Makhija N, Rajashekar P, Sreenivas V, Upadhyay AD, Sahu MK, Choudhary SK. Plasmalyte-A Based del Nido Cardioplegia Versus Plain Ringer Based del Nido Cardioplegia: Double-Blind Randomized Trial. World J Pediatr Congenit Heart Surg 2022; 13:187-195. [PMID: 35238704 DOI: 10.1177/21501351211073610] [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: 11/16/2022]
Abstract
Background: In this prospective randomized controlled trial, we compared the standard del Nido cardioplegia solution (SDN) with the modified del Nido cardioplegia solution (MDN) in which the base solution was the plain Ringer solution. Methods: A total of 80 patients aged < 12 years undergoing intracardiac repair of Tetralogy of Fallot were randomized into SDN (n = 39) or MDN (n = 41) groups. The primary outcome was a change in cardiac index (CI). Secondary outcomes were ventricular arrhythmias after the release of aortic-cross clamp, postoperative inotropic score (IS), time to peripheral rewarming, duration of mechanical ventilation, intensive care unit (ICU) length of stay, and hospital length of stay, and electron microscopic differences between the 2 groups. Cardiac Troponin-I, inflammatory markers tumor necrosis factor-α (TNF-α), and interleukin-L (IL-6) were measured. Results: Applying the noninferiority confidence interval approach, the difference between the changes in CI between the 2 groups was -0.093 L/min/m2 (95% CI: -0.46-0.27 L/min/m2) which was within the noninferiority threshold of -0.5 indicating that CI was similar in both SDN and MDN. Ventricular arrhythmias postclamp release (P = .91), IS (P = .09), duration of mechanical ventilation (P = .27), ICU length of stay (P = .50), hospital length of stay (P = .57), IL-6 (P = .19), TNF-α (P = .17), Troponin-I (P = .15), electron microscopy changes (P > .05) were not different between groups. Conclusion: MDN was shown to be noninferior to the SDN cardioplegia in terms of preservation of cardiac index. In addition, other metrics indicative of myocardial protection were similar between groups. In developing nations where SDN is not available or is expensive, MDN cardioplegia is an acceptable alternative.
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Affiliation(s)
- Sachin Talwar
- 422637All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre, New Delhi, India
| | | | - Poonam M Kapoor
- 28730All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- 28730All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Manoj K Sahu
- 422637All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre, New Delhi, India
| | - Shiv K Choudhary
- 422637All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre, New Delhi, India
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25
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Landry M, Katers M, Olson E, Cern L, Nelson TJ, Campbell KA. Identifying gaps in parental support for families of children with hypoplastic left heart syndrome. Cardiol Young 2022; 32:215-22. [PMID: 33966677 DOI: 10.1017/S1047951121001736] [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: 11/06/2022]
Abstract
PURPOSE The purpose of this study is to identify gaps in support for parents of children with Hypoplastic Left Heart Syndrome. DESIGN AND METHODS Using a mixed-methods approach, the researchers first studied the parental and care team experience through interviews of Hypoplastic Left Heart Syndrome mothers and members of the inter-professional care team and then conducted an international survey of 690 Hypoplastic Left Heart Syndrome primary caregivers to validate the qualitative findings. RESULTS Parental and care team interviews revealed three main gaps in parental support, including lack of open communication, unrealistic parental expectations, and unclear inter-professional team roles. Survey results found that parents whose children were diagnosed with Hypoplastic Left Heart Syndrome after birth indicated significant dissatisfaction with the care team's open communication and welcoming of feedback (p = 0.008). As parents progress through the stages of surgical intervention, they also indicate significant dissatisfaction with the care team's anticipation of parental emotional needs and provision of coping resources (p = 0.003). CONCLUSIONS Parental support interventions should focus on providing resources to help parents cope, helping the care team model open communication, and welcoming feedback on the parental experience. PRACTICE IMPLICATIONS Interventions should be piloted with parents who are in the later stages of the surgical intervention timeline or whose children were diagnosed after birth as they are the populations who perceived the least support within this study.
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26
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Calderon J, Newburger JW, Rollins CK. Neurodevelopmental and Mental Health Outcomes in Patients With Fontan Circulation: A State-of-the-Art Review. Front Pediatr 2022; 10:826349. [PMID: 35356444 PMCID: PMC8959547 DOI: 10.3389/fped.2022.826349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Children, adolescents and adults living with Fontan circulation face numerous neurological and developmental challenges. As the population with complex CHD increases thanks to outstanding improvement in medical and surgical care, the long-term developmental and mental health sequelae have become a public health priority in pediatric and congenital cardiology. Many patients with a Fontan circulation experience difficulty in areas of cognition related to attention and executive functioning, visual spatial reasoning and psychosocial development. They are also at high risk for mental health morbidities, particularly anxiety disorders and depression. Several hemodynamic risk factors, beginning during the fetal period, may influence outcomes and yield to abnormal brain growth and development. Brain injury such as white matter lesions, stroke or hemorrhage can occur before, during, or after surgery. Other sociodemographic and surgical risk factors such as multiple catheterizations and surgeries and prolonged hospital stay play a detrimental role in patients' neurodevelopmental prognosis. Prevention and intervention to optimize long-term outcomes are critical in the care of this vulnerable population with complex CHD.
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Affiliation(s)
- Johanna Calderon
- PhyMedExp, Université de Montpellier, National Institute of Health and Medical Research (INSERM), CNRS, Montpellier, France.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Caitlin K Rollins
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States
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27
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Abstract
Numerous congenital or secondary diseases, including, heart disease, respiratory disease, sepsis and many others, can lead to neonatal death. B-type natriuretic peptide (BNP) is a peptide hormone secreted by ventricular cells following an increase in ventricular wall tension. BNP functions to promote vasodilation, diuresis, and sodium release to regulate blood pressure. BNP is a sensitive index reflecting ventricular function, which may aid the diagnosis and monitoring of various neonatal diseases. In neonates, there is currently no consensus on a reference BNP level, as the plasma BNP concentration of healthy newborns varies with age, peaks in the first week after birth, and then gradually decreased to a stable level. In disease states, the correlation between the plasma BNP concentration and the results of echocardiography is good, which is of great significance in the screening, monitoring, and prognosis evaluation of neonatal cardiovascular diseases, including congenital heart disease, patent ductus arteriosus, etcetera. It also facilitates the judgment of the efficacy of treatment and perioperative management. Moreover, the monitoring of plasma BNP concentration provides guidance for the diagnosis, evaluation, and treatment selection of certain neonatal respiratory diseases and neonatal sepsis. This review summarizes the normal BNP values and discusses the application value of BNP in relation to physiological and pathological aspects in neonates.
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Affiliation(s)
| | | | | | - Xinlin Hou
- Department of Neonatal Ward, Peking University First Hospital, Beijing, China
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28
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Jaschinski C, Knetsch V, Parzer P, Meyr J, Schroeder B, Fonseca E, Karck M, Kaess M, Loukanov T. Psychosocial Impact of Congenital Heart Diseases on Patients and Their Families: A Parent's Perspective. World J Pediatr Congenit Heart Surg 2021; 13:9-15. [PMID: 34860617 DOI: 10.1177/21501351211044127] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Currently, over 90% of children with congenital heart disease (CHD) survive into adulthood. As a consequence the psychosocial impact on children and their families has become an important outcome measure. Therefore, the goal of this study was to assess the psychosocial impact from a parent's perspective and to identify possible predictors. METHODS We included all parents of children who underwent open-heart surgery in the years 2010 and 2011 at the Department of Cardiothoracic Surgery at University Hospital Heidelberg and invited them to complete standardized questionnaires. Psychosocial outcome was measured via parent self- and proxy reporting of family burden (Family Burden Questionnaire, FaBel), health-related quality of life (KidScreen-10), developmental problems (Five-to-Fifteen, FTF), and mental health problems (Strength and Difficulties Questionnaire, SDQ). RESULTS In total, 113 families returned the questionnaires completely (71.5%). The Aristotle Basic Complexity score and the STAT 2020 Score overall did not predict the psychosocial impact, whereas the number of surgical operations did significantly predict psychosocial impact across all domains in this study cohort. CONCLUSIONS These data suggest that the number of surgical operations might be a relevant predictor for the long-term psychosocial impact on families suffering from CHD and a potential connecting factor for specialized psychological support. When setting up screening instruments or support programs the entire family must be considered.
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Affiliation(s)
- Christoph Jaschinski
- 27178Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Vivien Knetsch
- 27178Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Department of Child and Adolescent Psychiatry, Center of Psychosocial Medicine, 27178University Hospital Heidelberg, Heidelberg, Germany
| | - Juliane Meyr
- 27178Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Brian Schroeder
- 27178Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Elizabeth Fonseca
- 27178Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- 27178Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center of Psychosocial Medicine, 27178University Hospital Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tsvetomir Loukanov
- 27178Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
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29
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Ye B, Wu Y, Chen J, Yang Y, Niu J, Wang H, Wang Y, Cheng W. The diagnostic value of the early extended fetal heart examination at 13 to 14 weeks gestational age in a high-risk population. Transl Pediatr 2021; 10:2907-2920. [PMID: 34976757 PMCID: PMC8649590 DOI: 10.21037/tp-21-255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common congenital malformation that affects high-risk populations. A more definite heart diagnosis in the first trimester should be provided to guide clinical treatment. The study aim was to evaluate the diagnostic precision of the early extended fetal heart examination (EFHE) that includes abdominal situs view, four-chamber view (4CV), left ventricular outflow tract view (LVOT), right ventricular outflow tract view (RVOT), 3-vessel and tracheal view (3VT), ductal arch view, and the aortic arch view in the detection of CHD at the gestational age (GA) 13 to 14 weeks in a population with high risks. METHODS This study was a diagnostic test study. EFHE was performed by transabdominal sonography in women at GA 13 to 14 weeks with singleton pregnancies who were at high risk for CHD. The risk of CHD was determined by family history of CHD, rubella infection, metabolic disorders, exposure to teratogens, conception by in-vitro fertilization (IVF), increased nuchal translucency (NT) thickness, abnormal obstetric ultrasound, etc. The operator had more than 5 years of experience in first-trimester scans and fetal echocardiography. Early scans were compared with a fetal echocardiography in the second trimester (16-24 weeks). RESULTS EFHE was performed, and the pregnancy outcomes were obtained in 234 single pregnancies with a high risk of CHD. The average crown-rump length (CRL) was (76.17±7.09) mm. CHD was diagnosed in 43 cases by EFHE; 10 of these cases were misdiagnosed, and 2 cases were missed. Four cases were inconsistent in the main diagnosis of CHD. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient (Ko) value of EFHE in diagnosing CHD by type and severity was 84.6% [95% confidence interval (CI), 69.5-94.1%], 96.9% (95% CI, 93.4-98.9%), 84.6% (95% CI, 69.5-94.1%), 96.9% (95% CI, 93.4-98.9%), and 0.82 (P<0.001), respectively. CONCLUSIONS EFHE can work as a diagnose examination for most major CHD cases at GA 13 to 14 weeks by an experienced operator; Therefore, this diagnostic system for fetal CHD may be applied in the first trimester. The study has been registered in the Chinese Clinical Trial Registry (www.chictr.org.cn). The registration number is ChiCTR2000038451.
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Affiliation(s)
- Baoying Ye
- Department of Ultrasonography, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yi Wu
- Department of Prenatal Diagnostic Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiong Chen
- Department of Ultrasonography, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Yang
- Department of Ultrasonography, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianmei Niu
- Department of Ultrasonography, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Wang
- Department of Ultrasonography, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanlin Wang
- Department of Prenatal Diagnostic Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Cheng
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Department of Obstetrics and Gynecology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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30
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Gorenflo M, Ziesenitz VC. Treatment of pulmonary arterial hypertension in children. Cardiovasc Diagn Ther 2021; 11:1144-1159. [PMID: 34527540 DOI: 10.21037/cdt-20-912] [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: 11/05/2020] [Accepted: 04/27/2021] [Indexed: 11/06/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a devastating illness causing already significant morbidity in childhood. Currently approved treatment options for children comprise the endothelin receptor antagonist bosentan, as well as the phosphodiesterase-5 inhibitor sildenafil. But PAH treatment has advanced significantly over the past decade, and new classes of targeted drug therapies, such as stimulators of the soluble guanylate cyclase (riociguat) or prostacyclin receptor agonists (selexipag), are currently evaluated regarding their efficacy and safety in children, in order to limit off-label use. Due to the different etiologies in children, such as PAH-CHD, there is no evidence that initial combination therapy in children is superior to a mono-therapy with respect to survival. Special attention should also be paid to the pharmacology of PAH drugs in children, which might be impacted by ontogeny or drug-drug-interactions. Therapeutic drug monitoring may be useful in pediatric patients. There is a clear need for more controlled studies of PAH medications, alone or in combination therapy in the pediatric age group. Data from clinical trials as well as from patient registries should be pooled to optimize drug development and evaluation, trial design, and evidence-based pharmacotherapy in pediatric patients with PAH. In this review, the current treatment options of pediatric PAH are summarized, and an overview of new treatment concepts, which are already evaluated in adults, is presented.
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Affiliation(s)
- Matthias Gorenflo
- Department of Pediatric Cardiology and Congenital Heart Diseases, Centre of Child and Adolescent Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Victoria C Ziesenitz
- Department of Pediatric Cardiology and Congenital Heart Diseases, Centre of Child and Adolescent Health, University Hospital Heidelberg, Heidelberg, Germany
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31
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Varenbut J, Vanderlaan RD, Lam CZ, Honjo O. Anterior Translocation of the Right Pulmonary Artery to Relieve Bronchial Compression in Truncus Arteriosus With Interrupted Aortic Arch. World J Pediatr Congenit Heart Surg 2021; 13:111-113. [PMID: 34519557 DOI: 10.1177/21501351211037320] [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: 11/16/2022]
Abstract
We report an anterior translocation of the right pulmonary artery procedure to relieve severe left bronchial obstruction that was caused by right pulmonary artery stent placement in a 1-year-old patient with truncus arteriosus and interrupted aortic arch. After neonatal repair, the patient re-presented with severe truncal valve regurgitation, right pulmonary artery stenosis, and severe biventricular dysfunction, which was treated with truncal valve repair and right pulmonary artery plasty. The patient suffered from left bronchial compression from right pulmonary artery stent placement, which was successfully treated by the translocation procedure. Bronchial stenosis was successfully relieved by the translocation procedure. Indications, advantages, and disadvantages of this procedure are discussed.
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Affiliation(s)
- Jaymie Varenbut
- 70384Schulich School of Medicine & Dentistry, London, Canada.,Labatt Family Heart Centre, 7979The Hospital for Sick Children, Toronto, Canada
| | - Rachel D Vanderlaan
- Labatt Family Heart Centre, 7979The Hospital for Sick Children, Toronto, Canada
| | - Christopher Z Lam
- 7979The Hospital for Sick Children, Toronto, Canada.,7938University of Toronto, Toronto, Canada
| | - Osami Honjo
- Labatt Family Heart Centre, 7979The Hospital for Sick Children, Toronto, Canada.,7938University of Toronto, Toronto, Canada
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32
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Kovacevic A, Elsässer M, Fluhr H, Müller A, Starystach S, Bär S, Gorenflo M. Counseling for fetal heart disease-current standards and best practice. Transl Pediatr 2021; 10:2225-2234. [PMID: 34584893 PMCID: PMC8429860 DOI: 10.21037/tp-20-181] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/05/2020] [Indexed: 11/06/2022] Open
Abstract
Congenital heart disease (CHD) is the most common cause of major congenital anomalies affecting newborns. Prenatal detection of CHD has been improving continuously during the last two decades due to technical advances and thus optimized fetal cardiac imaging. Besides the in-utero diagnosis of CHD effective parental counseling is an integral part of any Fetal Cardiology Program. However, studies on the most effective techniques are scarce, as well as data on empirical assessment of counseling and its effectiveness. In this review article, we summarize current guidelines from different international associations and societies. We provide an updated literature overview evaluating current standards of counseling with regard to parental needs. This includes ethical aspects, counseling for univentricular disease and in-utero cardiac interventions. We discuss our method to assess counseling success for fetal heart defects by exploring different analytical dimensions that may be considered helpful in order to improve efficacy. Finally, we present a proposal of how to optimize a setting for counseling based on the current literature and our own data. In summary, parental counseling for fetal heart disease is complex and multidimensional. Significant expertise in fetal cardiology and physiology, potential progression of CHD, postnatal treatment strategies and knowledge of long-term sequelae is necessary. A structured approach, together with continuous improvement of communicative skills, may lead to more effective counseling for parents following a diagnosis of CHD in the fetus.
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Affiliation(s)
- Alexander Kovacevic
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Elsässer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Herbert Fluhr
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Müller
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Starystach
- Max Weber Institute for Sociology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Stefan Bär
- Max Weber Institute for Sociology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Matthias Gorenflo
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, Heidelberg, Germany
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Abstract
Following the improvements in the clinical management of patients with congenital heart disease (CHD) and their increased survival, neurodevelopmental outcome has become an emerging priority in pediatric cardiology. Large-scale efforts have been made to protect the brain during the postnatal, surgical, and postoperative period; however, the presence of brain immaturity and injury at birth suggests in utero and peripartum disturbances. Over the past decade, there has been considerable interest and investigations on fetal brain growth in the setting of CHD. Advancements in fetal brain imaging have identified abnormal brain development in fetuses with CHD from the macrostructural (brain volumes and cortical folding) down to the microstructural (biochemistry and water diffusivity) scale, with more severe forms of CHD showing worse disturbances and brain abnormalities starting as early as the first trimester. Anomalies in common genetic developmental pathways and diminished cerebral substrate delivery secondary to altered cardiovascular physiology are the forefront hypotheses, but other factors such as impaired placental function and maternal psychological stress have surfaced as important contributors to fetal brain immaturity in CHD. The characterization and timing of fetal brain disturbances and their associated mechanisms are important steps for determining preventative prenatal interventions, which may provide a stronger foundation for the developing brain during childhood.
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Affiliation(s)
- Fu-Tsuen Lee
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mike Seed
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Liqun Sun
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Davide Marini
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Abstract
The importance of prenatal diagnosis and fetal intervention has been increasing as a preventative strategy for improving the morbidity and mortality in congenital heart disease (CHD). The advancements in medical imaging technology have greatly enhanced our understanding of disease progression, assessment, and impact in those with CHD. In particular, there has been a growing focus on improving the morbidity and mortality of fetuses diagnosed with left-sided lesions. The disruption of fetal hemodynamics resulting from poor structural developmental of the left outflow tract during cardiogenesis is considered a major factor in the progressive lethal underdevelopment of the left ventricle (LV). This positive feedback cycle of inadequate flow and underdevelopment of the LV leads to a disrupted fetal circulation, which has been described to impact fetal brain growth where systemic outflow is poor and, in some cases, the fetal lungs in the setting of a restrictive interatrial communication. For the past decade, maternal hyperoxygenation (MH) has been investigated as a diagnostic tool to assess the pulmonary vasculature and a therapeutic agent to improve the development of the heart and brain in fetuses with CHD with a focus on left-sided cardiac defects. This review discusses the findings of these studies as well as the utility of acute and chronic administration of MH in CHD.
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Affiliation(s)
- Fu-Tsuen Lee
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Davide Marini
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mike Seed
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Liqun Sun
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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35
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Abstract
Congenital heart disease (CHD) remains the most common birth defect in infants, and critical CHD is associated with significant rates of morbidity and mortality. With the advent of powerful yet noninvasive advanced fetal imaging, it is becoming increasingly evident that the presence of CHD in utero disrupts typical development and contributes to the lifelong morbidity in this population. Across healthy and high-risk populations, intrauterine influences can permanently alter fetal development that may manifest in complex morbidities later in life, the so-called fetal-onset-of-adult-disease (FOAD) phenomenon. The placenta plays a critical role in not only supporting fetal development, but also by adapting to specific intrauterine conditions. The role of placental health, adaptation and dysfunction, however, in CHD is not well understood. In this article, we will review current evidence relating placental health in CHD, appraise existing knowledge-gaps in the field and highlight promising new avenues to better understand the impact of placental function on fetal well-being. We will review evidence of ex vivo human placental studies that describe abnormal placental findings in pregnancies complicated by CHD, as well evidence for in vivo assessments of the human placenta. While overall clinical in vivo assessments of placental development are rather limited, we will also review emerging evidence from advanced quantitative and functional magnetic resonance imaging that are bringing new insights into placental structure and function throughout gestation. By providing novel information about placental development, we can now explore the maternal-fetal-placental connection in greater detail, and better understand the multi-factorial mechanisms that may contribute to adverse outcomes seen in survivors of CHD.
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Affiliation(s)
- Nickie N Andescavage
- Division of Neonatology, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - Catherine Limperopoulos
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.,Division of Diagnostic Imaging & Radiology, Children's National Health System, Washington, DC, USA.,Department of Radiology, George Washington University School of Medicine, Washington, DC, USA
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Prabhu NK, Zhu A, Meza JM, Hill KD, Fleming GA, Chamberlain RC, Lodge AJ, Turek JW, Andersen ND. Transition to Ductal Stenting for Single Ventricle Patients Led to Improved Survival: An Institutional Case Series. World J Pediatr Congenit Heart Surg 2021; 12:518-526. [PMID: 34278866 DOI: 10.1177/21501351211007808] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of systemic-to-pulmonary shunts (SPS) in neonates with single ventricle heart defects and ductal-dependent pulmonary blood flow (ddPBF) was historically associated with high morbidity and mortality at our center. As a result, we transitioned to the preferential use of ductus arteriosus stents (DS) when feasible. This report describes our initial results with this strategy. METHODS A single-center study of single ventricle patients that received DS or SPS from 2015 to 2019 was performed to assess whether DS was associated with decreased in-hospital morbidity and increased survival to stage II palliation. RESULTS A total of 34 patients were included (DS = 11; SPS = 23). Underlying cardiac anomalies were similar between groups and included pulmonary atresia, unbalanced atrioventricular septal defect, and tricuspid atresia. Procedure success was similar between groups (82% vs 83%). Two DS patients were converted to SPS, due to ductal vasospasm or pulmonary artery obstruction, and four SPS patients required surgical shunt revision. In DS patients, postprocedure mechanical ventilation duration was shorter (one vs three days, P = .009) and fewer required postprocedure extracorporeal membrane oxygenation (9% vs 39%, P = .11). A higher proportion of DS patients survived to stage II palliation (100% vs 64%, P = .035), and the probability of one-year survival was higher in DS patients (100% vs 61%, P = .02). CONCLUSIONS At our center, patients with single ventricle heart defects and ddPBF that received DS experienced reduced in-hospital morbidity and increased survival to stage II palliation compared to SPS.
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Affiliation(s)
- Neel K Prabhu
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,22957Duke University School of Medicine, Durham, NC, USA
| | - Alexander Zhu
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,22957Duke University School of Medicine, Durham, NC, USA
| | - James M Meza
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Kevin D Hill
- Division of Pediatric Cardiology, Department of Pediatrics, 22957Duke University Medical Center, Durham, NC, USA
| | - Gregory A Fleming
- Division of Pediatric Cardiology, Department of Pediatrics, 22957Duke University Medical Center, Durham, NC, USA
| | - Reid C Chamberlain
- Division of Pediatric Cardiology, Department of Pediatrics, 22957Duke University Medical Center, Durham, NC, USA
| | - Andrew J Lodge
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Joseph W Turek
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Nicholas D Andersen
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
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Zhang QL, Xie WP, Lei YQ, Cao H, Chen Q. Telemedicine usage via WeChat for children with congenital heart disease preoperatively during COVID-19 pandemic: a retrospective analysis. Int J Qual Health Care 2021; 33:6218833. [PMID: 33835158 PMCID: PMC8083340 DOI: 10.1093/intqhc/mzab066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/22/2021] [Accepted: 04/09/2021] [Indexed: 12/01/2022] Open
Abstract
Objective During the COVID-19 pandemic, parents of infants having medical problem face challenges of insufficient medical resources at home. The purpose of this study was to investigate the effect of WeChat-based telehealth services on the preoperative follow-up of infants with congenital heart disease (CHD) during the COVID-19 pandemic. Methods This study retrospectively analyzed the medical records of 190 infants with CHD who underwent remote follow-up via WeChat from December 2019 to May 2020 in Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University. In addition, the psychological benefits of WeChat on the parents of these infants were analyzed. Results In total, 190 infants were involved in this study, including 72 cases of ventricular septal defects, 42 cases of patent ductus arteriosus, 55 cases of atrial septal defects, 3 cases of tetralogy of Fallot, 2 cases of endocardial cushion defects, 12 cases of pulmonary stenosis, 2 cases of total anomalous pulmonary venous connection and 2 cases of aortic arch constriction. During the follow-up period, 48 infants who received surgical indications were hospitalized in time for surgical treatment. It was recommended that 10 infants with respiratory tract infections be treated in local hospitals through the WeChat platform. We provided feeding guidance to 28 infants with dysplasia through the WeChat platform. The psychological evaluation results of parents showed that the median score and range of Self-Rating Depression Scale scores were 42 and 32–58, respectively. Nine parents (4.7%) were clinically depressed, while the majority had mild depression. The median score and range of Self-Rating Anxiety Scale scores were 44 and 31–59, respectively. Twenty parents (10.5%) had clinical anxiety, while the rest had mild anxiety. Conclusion During the COVID-19 pandemic, follow-up management and health services for infants with CHD prior to surgery through the WeChat platform were useful in identifying the state of an infant’s condition as well as in identifying and relieving care pressure, anxiety and depression in the parents.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road Fuzhou, Fujian 350014, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road Fuzhou, Fujian 350014, China
| | - Yu-Qing Lei
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road Fuzhou, Fujian 350014, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road Fuzhou, Fujian 350014, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, No.18 of Danshan Road Fuzhou, Fujian 350001, China.,Fujian Branch of Shanghai Children's Medical Center, No.966 of Hengyu Road Fuzhou, Fujian 350014, China.,Fujian Children's Hospital, No.966 of Hengyu Road Fuzhou, Fujian 350014, China
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Abstract
BACKGROUND Stented bioprosthesis implant at surgical pulmonary valve replacement (PVR) ideally should be 25 to 27 mm to facilitate future percutaneous PVR. This often requires accommodating 35 to 37 mm diameter sewing ring in the pulmonary position and requires anterior patch augmentation of the right ventricular outflow tract (RVOT). We present a novel "interposition" technique of PVR that allows upsizing the valve without RVOT patch augmentation. METHODS Using standard cardiopulmonary bypass, the main pulmonary artery (MPA) is dissected and transected at an appropriate level. The remnants of pulmonary valve leaflets are excised. The valve stent posts are telescoped into distal MPA, the MPA continuity is restored by end-to-end anastomosis of the proximal and distal MPA, with the interposed prosthetic valve sewing ring in the suture line between the two edges of the MPA with the bulk of the sewing ring extravascular. RESULT A total of seven patients (tetralogy of Fallot, three; congenital pulmonary stenosis, four; age range: 15-33 years) underwent the procedure. No patient required RVOT patch augmentation, all patients were extubated in the operating room and were fast-tracked to recovery. Our proposed technique of PVR has the following advantages: accommodate larger size valve, eliminates risk of a paravalvar leak, coronary compression, and anterior tilting of the prosthesis. CONCLUSION The valve interposition technique avoids the need for RVOT patch, allows implantation of an adequate sized prosthetic valve, maintains native geometry of the pulmonary artery without the risk of tilting of the prosthesis, and eliminates the risk of paravalvular regurgitation and left coronary compression.
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Affiliation(s)
- Lok Sinha
- Division of Cardiovascular Surgery, 8404Children's National Health System, Washington, DC, USA
| | - Josue Chery
- Division of Cardiovascular Surgery, 8404Children's National Health System, Washington, DC, USA
| | - Richard A Jonas
- Division of Cardiovascular Surgery, 8404Children's National Health System, Washington, DC, USA
| | - Pranava Sinha
- Division of Cardiovascular Surgery, 8404Children's National Health System, Washington, DC, USA
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39
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Bashford GR, Truemper EJ, Twedt MH, Hage BD, Hammel JM, Ibrahimye AN, Shukry M, Qadeer A, Eskridge KM. The Complex Nature of Emboli Detection During Cardiac Procedures. World J Pediatr Congenit Heart Surg 2021; 12:563. [PMID: 33888028 DOI: 10.1177/21501351211007787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Max H Twedt
- 14719University of Nebraska-Lincoln, NE, USA
| | | | - James M Hammel
- 12284University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Mohanad Shukry
- 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Ahsan Qadeer
- 12284University of Nebraska Medical Center, Omaha, NE, USA
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Neidenbach R, Achenbach S, Andonian C, Bauer UMM, Ewert P, Freilinger S, Gundlach U, Kaemmerer AS, Nagdyman N, Nebel K, Oberhoffer R, Pieper L, Reinhard W, Sanftenberg L, von Scheidt F, Schelling J, Seidel L, Weyand M, Kaemmerer H. Systematic assessment of health care perception in adults with congenital heart disease in Germany. Cardiovasc Diagn Ther 2021; 11:481-491. [PMID: 33968627 PMCID: PMC8102265 DOI: 10.21037/cdt-20-825] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The number of adults with congenital heart disease (ACHD) is steadily rising due to increased survival rate and improved medical resources. Accordingly, more than 330,000 ACHD are currently living in Germany. Almost all of them require lifelong specialized medical follow-up for their chronic heart disease, often accompanied by residua, sequelae, or comorbidities. Primary care physicians (PCPs) are a crucial factor in directing patients to ACHD specialists or specialized institutions, but despite all efforts, the number of ACHD under specialized care is low, the lost-to-follow-up rate is high, and the morbidity and mortality is substantial. The present cross-sectional study was designed to systematically characterize the health care of ACHD from a patient perspective, including (I) use of medical care by ACHD, (II) medical counselling needs, and (III) perceived satisfaction with health care. METHODS The German-wide analysis was based on a 25-item questionnaire designed to address different aspects of medical status and health issues of ACHD from their own perspective, performed between May of 2017 and July of 2020. RESULTS A total of 4,008 ACHD (52% female; mean age 41.9±17.2 years) completed the questionnaire. The majority of ACHD (3,524, 87.9%) reported, that they consulted their PCP for non-cardiac health problems, and 49.7% (n=1,991) consulted their PCP also for medical problems associated with the underlying CHD. Almost all ACHD reported a need for medical advice concerning exercise capacity and daily life activities, occupational skills, pregnancy, rehabilitation, genetic counselling, insurance, and retirement. A total of 1,840 (45.9%) patients were not aware of the existence of certified ACHD specialists or centers. Moreover, 2,552 (67.6%) of those surveyed were uninformed about patient organizations for ACHD. CONCLUSIONS The present study demonstrates that ACHD are largely uninformed about the ACHD care structures available nationwide, although the patients have a great need for specialized follow-up, advice, and care.
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Affiliation(s)
- Rhoia Neidenbach
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
- Department of Sports Medicine, Exercise Physiology and Prevention, Institute of Sport Science, University of Vienna, Austria
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Caroline Andonian
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Ulrike M. M. Bauer
- Competence Network for Congenital Heart Defects, National Register for Congenital Heart Defects, Berlin, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Ulrike Gundlach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Ann-Sophie Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Kathrin Nebel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Renate Oberhoffer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
- Department of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Lars Pieper
- Department of Behavioral Epidemiology, Technical University of Dresden, Germany
| | - Wibke Reinhard
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Germany
| | - Linda Sanftenberg
- Institute of General Practice, Ludwig-Maximilians-University Munich, Germany
| | - Fabian von Scheidt
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | | | - Lavinia Seidel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Germany
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Loureiro P, Georgiev S, Ewert P, Tanase D, Eicken A, Kammer B, Dalla-Pozza R. Successful percutaneous treatment with the Konar MF™-VSD Occluder in an infant with Abernethy syndrome-case report. Cardiovasc Diagn Ther 2021; 11:631-636. [PMID: 33968640 DOI: 10.21037/cdt-20-380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cyanosis persisting after surgical repair of complex congenital heart disease (CHD) may be related to the underlying disease. However, extracardiac causes should be also considered. We report on a patient with heterotaxy syndrome and double outlet right ventricle, in whom postoperative cyanosis was associated with an Abernethy malformation type II causing a hepatopulmonary syndrome. Despite this complex anatomy, interventional closure of the portosystemic shunt was done with a Konar MF™-VSD Occluder. The patient recovered rapidly with relief of cyanosis within one month. This case highlights the importance of a careful diagnostic assessment in patients with complex CHD, who presents cyanoses after surgical repair. In addition, it shows the feasibility and safety of a percutaneous approach with complete closure of the vascular malformation in a patient with a complex anatomy.
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Affiliation(s)
- Petra Loureiro
- Department of Pediatric Cardiology and Congenital Heart Disease, Hospital de Santa Marta, Nova University Lisbon, Lisbon, Portugal
| | - Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Daniel Tanase
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Birgit Kammer
- Department of Pediatric Radiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Robert Dalla-Pozza
- Department of Pediatric Cardiology, Ludwig-Maximilians-Universität München, Munich, Germany
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Tuite GC, Quintessenza JA, Asante-Korang A, Ghazarian SR, Wisotzkey BL, Shah S, Stapleton GE, Decker JA, Herbert CE, Kartha V, Alexander P, Carapellucci J, Krasnopero D, Hanson J, Goldenberg NA, Do NL, Mavroudis C, Karl TR, Boucek RJ, Kutty S, Vricella LA, van Gelder HM, Jacobs JP. Heart Transplantation for Pediatric and Congenital Cardiac Disease: A Comparison of Two Eras over 23 Years and 188 Transplants at a Single Institution. World J Pediatr Congenit Heart Surg 2021; 12:17-26. [PMID: 33407028 DOI: 10.1177/2150135120954149] [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: 11/16/2022]
Abstract
BACKGROUND To assess changes in patterns of practice and outcomes over time, we reviewed all patients who underwent heart transplantation (HTx) at our institution and compared two consecutive eras with significantly different immunosuppressive protocols (cohort 1 [80 HTx, June 1995-June 2006]; cohort 2 [108 HTx, July 2006-September 2018]). METHODS Retrospective study of 180 patients undergoing 188 HTx (June 1995-September 2018; 176 first time HTx, 10 second HTx, and 2 third HTx). In 2006, we commenced pre-HTx desensitization for highly sensitized patients and started using tacrolimus as our primary postoperative immunosuppressive agent. The primary outcome was mortality. Survival was modeled by the Kaplan-Meier method. Univariable and multivariable Cox proportional hazard models were created to identify prognostic factors for survival. RESULTS Our 188 HTx included 18 neonates, 85 infants, 83 children, and 2 adults (>18 years). Median age was 260.0 days (range: 5 days-23.8 years). Median weight was 7.5 kg (range: 2.2-113 kg). Patients in cohort 1 were less likely to have been immunosensitized preoperatively (12.5% vs 28.7%, P = .017). Nevertheless, Kaplan-Meier analysis suggested superior survival in cohort 2 (P = .0045). Patients in cohort 2 were more likely to be alive one year, five years, and ten years after HTx. Multivariable analysis identified the earlier era (hazard ratio [HR] [95% confidence interval] for recent era = 0.32 [0.14-0.73]), transplantation after prior Norwood operation (HR = 4.44 [1.46-13.46]), and number of prior cardiac operations (HR = 1.33 [1.03-1.71]) as risk factors for mortality. CONCLUSIONS Our analysis of 23 years of pediatric and congenital HTx reveals superior survival in the most recent 12-year era, despite the higher proportion of patients with elevated panel reactive antibody in the most recent era. This improvement was temporally associated with changes in our immunosuppressive strategy.
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Affiliation(s)
- Genevieve C Tuite
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | | | | | | | | | - Shawn Shah
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | - Gary E Stapleton
- Pediatric Interventional Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Jamie A Decker
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | - Carrie E Herbert
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vyas Kartha
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | - Plato Alexander
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | | | - Diane Krasnopero
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Jade Hanson
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | - Neil A Goldenberg
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | - Nhue L Do
- Division of Pediatric Cardiac Surgery, Vanderbilt University, Nashville, TN, USA
| | | | - Tom R Karl
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, FL, USA
| | | | - Shelby Kutty
- Division of Pediatric Cardiology, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Luca A Vricella
- Division of Pediatric Cardiac Surgery, 2462University of Chicago, IL, USA
| | - Hugh M van Gelder
- Cardiac Surgery, US Department of Veteran Affairs, Tampa, Florida, USA
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
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Manhem S, Hanséus K, Berggren H, Ekman-Joelsson BM. Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden. World J Pediatr Congenit Heart Surg 2021; 12:27-34. [PMID: 33407024 DOI: 10.1177/2150135120958641] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients born with pulmonary atresia and intact ventricular septum represent a challenge to pediatric cardiologists. Our objective was to study changes in survival with respect to morphology in all children born with pulmonary atresia and intact ventricular septum in Sweden during 36 years. METHODS A retrospective, descriptive study based on medical reports and echocardiographic examinations consisting of those born between 1980 and 1998 (early group) and those born between 1999 and 2016 (late group). RESULTS The cohort consists of 171 patients (early group, n = 86 and late group, n = 85) yielding an incidence of 4.35 and 4.46 per 100,000 live births, respectively. One-year survival in the early group was 76% compared to 92% in the late group (P = .0004). For patients with membranous atresia, one-year survival increased from 78% to 98%, and for muscular pulmonary atresia, from 68% to 85%. In patients with muscular pulmonary atresia and ventriculocoronary arterial communications, there was no significant increase in survival. Risk factors for death were being born in the early time period hazard ratio (HR), 6; 95% CI (2.33-14.28) P = .0002, low birth weight HR, 1.26; 95% CI (1.14-1.4) P < .0001 and having muscular pulmonary atresia HR, 3.74; 95% CI (1.71-8.19) P = .0010. CONCLUSION The incidence of pulmonary atresia and intact ventricular septum remained unchanged during the study period. Survival has improved, especially for patients with membranous pulmonary atresia, while being born with muscular pulmonary atresia is still a risk factor for death. To further improve survival, greater focus on patients with muscular pulmonary atresia and ventriculocoronary arterial communications is required.
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Affiliation(s)
- Stina Manhem
- Department of Pediatrics, Institution for Clinical Sciences. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Hanséus
- Department of Pediatric Cardiology, 59564Skåne University Hospital, Lund, Sweden
| | - Håkan Berggren
- Department of Pediatrics, Institution for Clinical Sciences. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Britt-Marie Ekman-Joelsson
- Department of Pediatrics, Institution for Clinical Sciences. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Vervoort D, Zheleva B, Jenkins KJ, Dearani JA. Children at the Heart of Global Cardiac Surgery: An Advocacy Stakeholder Analysis. World J Pediatr Congenit Heart Surg 2021; 12:48-54. [PMID: 33407026 DOI: 10.1177/2150135120955189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One in a hundred babies, or 1.3 million per year around the world, are born with congenital heart defects (CHD), of which over 70% will require medical or surgical treatment within their first year of life. In low- and middle-income countries, the majority does not receive the treatment they need or receive suboptimal care. Despite a higher pediatric cardiac surgical disease burden, low-income countries only have 0.07 pediatric cardiac surgeons per million pediatric population, compared to 9.51 per million in high-income countries. Here, we perform a stakeholder analysis of existing advocacy bodies within the field of pediatric global cardiac surgery and identify gaps and opportunities in advocating for cardiac care for children with CHD. We propose a framework to optimize civil society messaging in order to more effectively advocate domestically and internationally to hold national and international policy makers accountable for existing gaps and disparities in CHD care around the world.
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Affiliation(s)
- Dominique Vervoort
- 222464Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathy J Jenkins
- Department of Cardiology, 1862Boston Children's Hospital, Boston, MA, USA
| | - Joseph A Dearani
- Department of Cardiac Surgery, 6915Mayo Clinic, Rochester, MN, USA
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45
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Herrmann JL, Clark AJ, Colgate C, Rodefeld MD, Hoyer MH, Turrentine MW, Brown JW. Surgical Valvuloplasty Versus Balloon Dilation for Congenital Aortic Stenosis in Pediatric Patients. World J Pediatr Congenit Heart Surg 2021; 11:444-451. [PMID: 32645785 DOI: 10.1177/2150135120918774] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND For children with congenital aortic stenosis (AS) who are candidates for biventricular repair, valvuloplasty can be achieved by surgical aortic valvuloplasty (SAV) or by transcatheter balloon aortic dilation (BAD). We aimed to evaluate the longer term outcomes of SAV versus BAD at our institution. METHODS We retrospectively reviewed the outcomes of 2 months to 18 years old patients who underwent SAV or BAD at our institution between January 1990 and July 2018. Baseline and follow-up characteristics were assessed by echocardiography. Long-term survival, freedom from reintervention, freedom from aortic valve replacement (AVR), and aortic regurgitation were evaluated. RESULTS A total of 212 patients met inclusion criteria (SAV = 123; BAD = 89). Age, sex, aortic insufficiency (AI), and aortic valve gradient were similar between the groups. At 10 years, 27.9% (19/68) of SAV patients and 58.3% (28/48) of BAD patients had moderate or worse AI (P = .001), and reintervention occurred in 39.2% (29/74) of SAV patients and 78.6% (44/56) of BAD patients (P < .001). Kaplan-Meier analysis revealed overall survival was 96.8% (119/123) for SAV and 95.5% (85/89) for SAV (P = .87). At 10 years, 35% (23/66) of SAV patients and 54% (23/43) of BAD patients underwent AVR (P = .213). CONCLUSIONS Surgical aortic valvuloplasty demonstrated greater gradient reduction, less postoperative and long-term AI, and a lower reintervention rate at 10 years than BAD. There was no difference in survival or AVR reintervention rate. Surgical aortic valvuloplasty is a durable and efficacious intervention and should continue to be considered a favorable choice for palliation of valvular AS.
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Affiliation(s)
- Jeremy L Herrmann
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Children's Health at IU Health, Indianapolis, IN, USA
| | - Aaron J Clark
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cameron Colgate
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark D Rodefeld
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Children's Health at IU Health, Indianapolis, IN, USA
| | - Mark H Hoyer
- Riley Children's Health at IU Health, Indianapolis, IN, USA.,Section of Pediatric Cardiology, Department of Pediatrics, Indianapolis, IN, USA
| | - Mark W Turrentine
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Children's Health at IU Health, Indianapolis, IN, USA
| | - John W Brown
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Children's Health at IU Health, Indianapolis, IN, USA
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Abstract
Pediatric heart failure is a complex, heterogenous syndrome that occurs relatively rarely in children, but carries a high burden of morbidity and mortality. This article reflects on the current state of medical therapy for both acute and chronic pediatric heart failure, based on expert consensus guidelines, and the extrapolation of data from trials performed in adults. For the management of acute heart failure specifically, we rely on an initial assessment of the perfusion and volume status of a patient, to guide medical therapy. This paradigm was adapted from adult studies that demonstrated increased morbidity and mortality in heart failure patients whose hemodynamics or examination findings were consistent with a PCWP >18 mmHg and a CI ≤2.2 L/min/m2. The cornerstone of treatment in the acute setting therefore relies on achieving a euvolemic state with adequate cardiac output. In the chronic setting, patients are typically maintained on a regimen of an angiotensin converting enzyme inhibitor, a beta-blocker, and spironolactone. For those with refractory heart failure, intravenous milrinone therapy has become a mainstay of bridging children to cardiac transplantation. The pediatric-specific data driving these clinical practices are limited and often times, conflicting. The future of pediatric heart failure depends on collaboration, quality improvement, and a commitment to pediatric-specific indications for new medical and device therapies.
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Affiliation(s)
- Humera Ahmed
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christina VanderPluym
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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47
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Kreutzer C, Bastianelli G, Chiostri B, Gutierrez G, Klinger DA, Vaccarino G. CABG With Internal Thoracic Artery in Children With Congenital Heart Defects: A Good Option When It Is the Only One. World J Pediatr Congenit Heart Surg 2020; 11:748-752. [PMID: 33164689 DOI: 10.1177/2150135120940151] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Coronary complications may present during or after repair of congenital heart defects. We report coronary artery bypass grafting (CABG) by internal thoracic artery (ITA) grafts to either coronary artery in children with congenital anomalies. METHODS Four cases who underwent CABG with ITA grafts from March 2016 to March 2020 were retrospectively reviewed. RESULTS At the time of operation, patient's ages and weight were 7 and 20 months old and 14 and 15 years old and 6.5, 10, 40, and 45 kg, respectively. Diagnosis were anomalous origin of the left coronary artery from the pulmonary artery with leftward lateral ostial origin (n = 1), neopulmonary annulus hypoplasia post arterial switch with contiguous right coronary artery (RCA) arising from the left facing sinus (n = 1), RCA stenosis after the Ross procedure (n = 1), and right coronary ostial obstruction after aortic valve replacement in truncus arteriosus (n = 1). Procedures included left ITA to left coronary ostium (n = 1), right ventricular outflow tract (RVOT) enlargement with pulmonary valve replacement with left ITA to RCA (n = 1), RVOT enlargement with pulmonary valve replacement with right ITA to RCA (n = 1), and aortic valve re-replacement, pulmonary valve replacement, and right ITA to RCA (n = 1). At last follow-up, all four patients were asymptomatic, with normal ventricular function, and all grafts were patent. CONCLUSIONS The use of CABG in children is valuable alternative when dealing with complex coronary anatomy not suitable for classic repairs. In children, graft patency is required to be longer than 50 years; therefore, use of arterial grafts seems mandatory.
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Affiliation(s)
- Christian Kreutzer
- Division of Pediatric Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Gustavo Bastianelli
- Division of Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Benjamin Chiostri
- Division of Pediatric Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Guillermo Gutierrez
- Division of Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Daniel Alberto Klinger
- Division of Pediatric Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Guillermo Vaccarino
- Division of Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
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48
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Layton GR, Koulouroudias M, Issa E, Jepson S, Corno AF, Dennison AR. Unligated vertical vein presenting as a large atrio-portal shunt in adulthood: a case report. J Surg Case Rep 2020; 2020:rjaa377. [PMID: 33101639 PMCID: PMC7568959 DOI: 10.1093/jscr/rjaa377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
A 28-year-old male with infra-cardiac totally anomalous pulmonary venous connection (TAPVC) repaired as new-born presented in adulthood with right heart strain and very large left atrium to portal vein vessel. Residual connections from pulmonary veins to systemic circulation are believed to represent persistent ‘vertical veins’ (VV) not ligated at the time of the initial surgery. In our patient, since endovascular occlusion was not judged suitable, the anomalous vessel was surgically ligated and resected. A review of the literature failed to find such a procedure reported in an adult patient and analyzed the intra-operative ligation of VV during repair of TAPVC.
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Affiliation(s)
- Georgia R Layton
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Marinos Koulouroudias
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Eyad Issa
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Steve Jepson
- Department of Radiology, Leicester General Hospital, Leicester, UK
| | - Antonio F Corno
- University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Ashley R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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49
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Chacon-Portillo MA, Mossad EB, Zea-Vera R, Beckerman Z, Binsalamah ZM, Adachi I, Mery CM, Imamura M, Heinle JS, Fraser CD. Sickle Cell-Related Complications in Patients Undergoing Cardiopulmonary Bypass. World J Pediatr Congenit Heart Surg 2020; 11:565-571. [PMID: 32853076 DOI: 10.1177/2150135120926991] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to describe our experience with patients with sickle cell trait (SCT) and undergoing surgery on cardiopulmonary bypass (CPB). METHODS Data on all patients with SCT or sickle-α thalassemia who underwent surgery on CPB were collected (1996-2017). RESULTS Overall, 46 patients were included, 37 (80%) had SCT and 9 (20%) had sickle-α thalassemia. A total of 4 (9%) developed a potential sickle cell-related complication. Patients with sickle cell-related complications were significantly older (median 14 years vs 14 months, P = .037) and heavier (median 54 kg vs 9 kg, P = .041). Complications occurred, although without statistical significance, in patients who underwent longer median CPB times (249 minutes vs 137 minutes, P = .069), lower median temperature (31.7 °C vs 33.3 °C, P = .094), and a higher percentage underwent deep hypothermic circulatory arrest (50% vs 7%, P = .053). A total of 30 (65%) patients underwent exchange transfusion (ET) pre-bypass. Patients who underwent ET were significantly older (median 4 years vs 7 months, P = .003) and heavier (median 16 kg vs 6 kg, P = .015) than patients who did not undergo ET. The incidence of complications was comparable between patients who underwent ET (10%) and those who did not (6%). CONCLUSIONS In this retrospective, single-center study, it has been shown that cardiac surgery requiring CPB in patients with SCT and sickle-α thalassemia had a low risk for sickle cell-associated complications. In this cohort of patients, older age, longer CPB times, lower median temperature, and the utilization of deep hypothermic circulatory arrest appear to play an important role in the development of complications.
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Affiliation(s)
- Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Emad B Mossad
- Division of Pediatric Cardiovascular Anesthesia, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Iki Adachi
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
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50
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Protopapas EM, Rito ML, Vida VL, Sarris GE, Tchervenkov CI, Maruszewski BJ, Tobota Z, Zheleva B, Zhang H, Jacobs JP, Dearani JA, Stephens EH, Tweddell JS, Sandoval NF, Bacha EA, Austin EH, Sakamoto K, Talwar S, Kurosawa H, Halees ZYA, Jatene MB, Iyer KS, Lee C, Sharma R, Hirata Y, Edwin F, Cervantes JL, O'Brien J, St Louis J, Kirklin JK. Early Impact of the COVID-19 Pandemic on Congenital Heart Surgery Programs Across the World: Assessment by a Global Multi-Societal Consortium. World J Pediatr Congenit Heart Surg 2020; 11:689-696. [PMID: 32844725 PMCID: PMC7450206 DOI: 10.1177/2150135120949462] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic currently gripping the globe is impacting the entire health care system with rapidly escalating morbidities and mortality. Although the infectious risk to the pediatric population appears low, the effects on children with congenital heart disease (CHD) remain poorly understood. The closure of congenital heart surgery programs worldwide to address the growing number of infected individuals could have an unintended impact on future health for COVID-19-negative patients with CHD. Pediatric and congenital heart surgeons, given their small numbers and close relationships, are uniquely positioned to collectively assess the impact of the pandemic on surgical practice and care of children with CHD. We present the results of an international survey sent to pediatric and congenital heart surgeons characterizing the early impact of COVID-19 on the care of patients with CHD.
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Affiliation(s)
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, 9308University of Padua, Padua, Italy
| | | | - Christo I Tchervenkov
- Division of Pediatric Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bohdan J Maruszewski
- Pediatric Cardiothoracic Surgery Department, Children's Memorial Health Institute, Warsaw, Poland
| | - Zdzislaw Tobota
- Pediatric Cardiothoracic Surgery Department, Children's Memorial Health Institute, Warsaw, Poland
| | | | - Hao Zhang
- Department of Cardiothoracic Surgery, Heart Center, Shanghai Children Medical Center, National Center for Children Health, Shanghai, China
| | - Jeffery P Jacobs
- Division of thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | | | | | - James S Tweddell
- University of Cincinnati, Department of Cardiac Surgery, OH, USA
| | - Nestor F Sandoval
- Congenital Heart Institute, Fundacion Cardioinfantil-Instituto de Cardiologia, Bogota, Colombia
| | - Emile A Bacha
- Department of Surgery, Section of Pediatric and Congenital Heart Surgery, Columbia University New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA
| | - Erle H Austin
- Department of Cardiovascular Surgery, University of Louisville, KY, USA
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka City, Japan
| | - Sachin Talwar
- Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Zohair Y Al Halees
- Heart Center, King Faisal Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Krishna S Iyer
- Pediatric & Congenital Heart Surgery, Fortis-Escorts Heart Institute, New Delhi, India
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Rajesh Sharma
- Pediatric Cardiac Surgery, Jaypee Hospital, Noida, India
| | - Yasutaka Hirata
- Department of Cardiac Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Frank Edwin
- Professor & Head of Cardiothoracic Surgery National Cardiothoracic Centre, Accra, Ghana
| | - Jorge L Cervantes
- Department of Pediatric Cardiac and Congenital Heart Disease Surgery, 42705Instituto Nacional de Cardiologia Ignacio Chavez, Mexico
| | - James O'Brien
- Division of Cardiac Surgery, 4204Children's Mercy Kansas City, MO, USA
| | - James St Louis
- Division of Cardiac Surgery, 4204Children's Mercy Kansas City, MO, USA
| | - James K Kirklin
- Division of Cardiothoracic Surgery, 9968University of Alabama at Birmingham, AL, USA
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