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Alemany VS, Crawford A, Gauvreau K, Bucholz EM, del Nido PJ, Schidlow DN, Nathan M. Early and long-term outcomes following cardiac surgery for patients with heterotaxy syndrome. JTCVS Open 2024; 18:167-179. [PMID: 38690436 PMCID: PMC11056491 DOI: 10.1016/j.xjon.2024.02.011] [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] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/17/2023] [Accepted: 02/06/2024] [Indexed: 05/02/2024]
Abstract
Objective Heterotaxy syndrome is a complex multisystem abnormality historically associated with high morbidity and mortality. We sought to evaluate the early and long-term outcomes after cardiac surgery in heterotaxy syndrome. Methods This is a single-center retrospective review of patients with heterotaxy syndrome undergoing single-ventricle palliation or primary or staged biventricular repair from 1998 to 2018. Patients were stratified by single ventricle versus biventricular physiology, and the severity of atrioventricular valve regurgitation. Demographics, anatomic characteristics, and early and late outcomes, including the length of stay, mortality, and surgical or catheter reinterventions, were analyzed. Results Among 250 patients, 150 (60%) underwent biventricular repair. In-hospital mortality was 7.6% (n = 19). Median follow-up was 5.2 (range, 0-16) years. Among survivors to discharge, mortality was 19% (n = 44) and reintervention was 52% (n = 120). Patients with moderate/severe atrioventricular valve regurgitation were older (32 vs 16 months, P = .02), were more likely to experience adverse events during their index surgical admission (72% vs 46%, P < .001), and had longer in-hospital length of stay (20 vs 12 days, P = .009). Among patients with moderate to severe atrioventricular valve regurgitation, single-ventricle palliation is associated with a greater risk of unplanned reintervention compared with patients undergoing biventricular repair (hazard ratio, 2.13; CI, 1.10-4.12; P = .025). Conclusions There was no significant difference in early or late outcomes in single-ventricle versus biventricular repair strategies in heterotaxy. In the subgroup of patients with moderate/severe atrioventricular valve regurgitation, patients who underwent single-ventricle palliation were 2.5 times more likely to need a late reintervention compared with those undergoing biventricular repair.
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Affiliation(s)
- Victor S. Alemany
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Alexis Crawford
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
- Department of Biostatistics, Harvard School of Public Health, Boston, Mass
| | - Emily M. Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Pedro J. del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
| | - David N. Schidlow
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
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Iskafi RA, Abugharbieh Y, Ahmad I, Shweki H, Dwaik HA. Heterotaxy Syndrome With Right Isomerism and Interrupted Inferior Vena Cava: A Case Report and Literature Review. Cureus 2024; 16:e55698. [PMID: 38586636 PMCID: PMC10998656 DOI: 10.7759/cureus.55698] [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] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Heterotaxy syndrome (HS) occurs in developing embryos due to an inability to establish the normal anatomy, which manifests as abnormal symmetry and malposition of the thoracoabdominal viscera and vasculature, including cardiac and extracardiac anomalies. It is classified as right or left atrial isomerism. This classification depends on the atrial appendage morphology and the extracardiac defect associated with it. Right isomerism usually presents with right atrial appendages (RAA), asplenia, total anomalous pulmonary venous return, and severe pulmonary stenosis. In contrast, left isomerism usually presents with left atrial appendages, polysplenia, and an interrupted inferior vena cava (IVC). The interrupted IVC feature has never been reported with the right isomerism. Diagnosis of HS may take place prenatally or a few days postnatally due to the severe cardiac defect, whereas a left isomerism diagnosis may be delayed until adulthood. Despite the popularity of the HS classification, we reported a rare presentation of an interrupted IVC, dextrocardia, a right-sided aortic arch, and a total anomalous pulmonary venous return, which occurred along with the right isomerism major components (asplenia syndrome).
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Affiliation(s)
| | | | - Ibtihal Ahmad
- Medicine, Palestine Polytechnic University, Hebron, PSE
| | - Hidaya Shweki
- Medicine, Palestine Polytechnic University, Hebron, PSE
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Tanaka N, Matsui K, Harada M, Fukunaga H, Takahashi K, Kishiro M, Shimizu T. Emergency pacing via the umbilical vein of a neonate with congenital complete atrioventricular block: a report of two cases. Cardiol Young 2023; 33:2104-2109. [PMID: 37095716 DOI: 10.1017/s1047951123000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
We report two cases of successful emergency pacing via the umbilical vein in neonates with congenital complete atrioventricular block. The first patient, a neonate with normal cardiac anatomy, underwent emergency temporary pacing via the umbilical vein under echocardiographic guidance. The patient underwent permanent pacemaker implantation on postnatal day 4. The second patient, a neonate with heterotaxy syndrome, underwent emergency temporary pacing through the umbilical vein under fluoroscopic guidance. The patient underwent permanent pacemaker implantation on postnatal day 17.
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Affiliation(s)
- Noboru Tanaka
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo City, Tokyo, Japan
| | - Kotoko Matsui
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo City, Tokyo, Japan
| | - Mana Harada
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo City, Tokyo, Japan
| | - Hideo Fukunaga
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo City, Tokyo, Japan
| | - Ken Takahashi
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo City, Tokyo, Japan
| | - Masahiko Kishiro
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo City, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo City, Tokyo, Japan
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Wu Q, Guo S, Huang B, Ling W, Peng L, Ma H, Chen F, Lyu G, Liu M, Qiu X, Weng Z. Characterization of ultrasound and postnatal pathology in fetuses with heterotaxy syndrome. Front Cardiovasc Med 2023; 10:1195191. [PMID: 37485264 PMCID: PMC10359725 DOI: 10.3389/fcvm.2023.1195191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Background To explore the diagnostic clues and abnormality spectrum of heterotaxy syndrome by prenatal ultrasonography and postnatal verification. Methods The prenatal ultrasonic data of 88 heterotaxy syndrome fetuses were analyzed retrospectively as left isomerism (LI) and right isomerism (RI). Prenatal ultrasound compared with the anatomical casting of the fetal body after labor induction, and the confirmatory postnatal diagnosis after delivery. Results Fetal LI showed typical malformations of gastric vesicles on different sides from the heart, absence of hepatic segment of the inferior vena cava (IVC), abdominal aorta (AO) parallel with the azygos vein (AV), bilateral left bronchus, bilateral left atrial appendages, and polysplenia; intracardiac malformations of AV septal defects (AVSD), single atrium (SA), left ventricular outflow tract obstruction (LVOTO), and double-outlet right ventricle (DORV); and cardiac conduction abnormalities of sinus bradycardia and AV blockage. Fetal RI reported typical malformations of gastric vesicles on different sides from the heart, juxtaposition of the IVC with AO, anomalous pulmonary venous connection (APVC), asplenia, and bilateral right atrial appendages; intracardiac malformations of AVSD, SA, single ventricle, pulmonary atresia and stenosis, and DORV. The postnatal verification revealed 3 malformations misdiagnoses and 4 malformations missed diagnoses in LI fetuses and 10 misdiagnoses and 8 missed diagnoses in RI fetuses. Conclusions The proposed five-step prenatal ultrasonography has an important diagnostic value for the identification and classification of heterotaxy syndrome. The different sides of gastric vesicles and cardiac apex are important diagnostic clues for heterotaxy syndrome, featuring disconnected or hypoplastic IVC, typical complex cardiac malformation, and atrioventricular block in fetal LI, and shown APVC, juxtaposition of IVC and AO, and intracardiac malformations such as AVSD, DORV, and LVOTO in fetal RI.
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Affiliation(s)
- Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Biying Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Longzhuang Peng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Fa Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Guorong Lyu
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiuqing Qiu
- Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Martins de Carvalho M, Vasconcelos M, Carvalho A, Cruz C, Macedo F. A puzzling CHD: a late diagnosis of left atrial isomerism. Cardiol Young 2023; 33:479-81. [PMID: 35801268 DOI: 10.1017/S1047951122002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present a case of a 41-year-old patient with an unknown complex cardiac anatomy, who was previously submitted to two cardiac surgeries. Using multimodality imaging, a retrospective diagnosis was established, revealing a heterotaxy syndrome (left isomerism).
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Lalchandani A, Maurya A, Rizvi SFM, Yadav A. Agenesis of the Dorsal Pancreas: A Rare Cause of Diabetes and Recurrent Upper Abdominal Pain. Cureus 2023; 15:e34689. [PMID: 36909095 PMCID: PMC9994769 DOI: 10.7759/cureus.34689] [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] [Accepted: 02/05/2023] [Indexed: 02/08/2023] Open
Abstract
Agenesis of the dorsal pancreas is a rare congenital disorder with only a handful of cases described in the literature. It presents a diagnostic dilemma. Cross-sectional imaging is the cornerstone for diagnosis. It could have a syndromic association with polysplenia and cardiac anomalies. Pancreas divisum and chronic pancreatitis may present with similar symptoms and must be ruled out. We present a case of a 55-year-old male with recurrent non-specific abdominal pain and diabetes mellitus. He was managed with insulin and painkillers for symptomatic relief. We also reviewed approximately 68 cases described in the literature to date.
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Affiliation(s)
- Ankit Lalchandani
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Ajeet Maurya
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | | | - Amit Yadav
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
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Forrest K, Barricella AC, Pohar SA, Hinman AM, Amack JD. Understanding laterality disorders and the left-right organizer: Insights from zebrafish. Front Cell Dev Biol 2022; 10:1035513. [PMID: 36619867 PMCID: PMC9816872 DOI: 10.3389/fcell.2022.1035513] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Vital internal organs display a left-right (LR) asymmetric arrangement that is established during embryonic development. Disruption of this LR asymmetry-or laterality-can result in congenital organ malformations. Situs inversus totalis (SIT) is a complete concordant reversal of internal organs that results in a low occurrence of clinical consequences. Situs ambiguous, which gives rise to Heterotaxy syndrome (HTX), is characterized by discordant development and arrangement of organs that is associated with a wide range of birth defects. The leading cause of health problems in HTX patients is a congenital heart malformation. Mutations identified in patients with laterality disorders implicate motile cilia in establishing LR asymmetry. However, the cellular and molecular mechanisms underlying SIT and HTX are not fully understood. In several vertebrates, including mouse, frog and zebrafish, motile cilia located in a "left-right organizer" (LRO) trigger conserved signaling pathways that guide asymmetric organ development. Perturbation of LRO formation and/or function in animal models recapitulates organ malformations observed in SIT and HTX patients. This provides an opportunity to use these models to investigate the embryological origins of laterality disorders. The zebrafish embryo has emerged as an important model for investigating the earliest steps of LRO development. Here, we discuss clinical characteristics of human laterality disorders, and highlight experimental results from zebrafish that provide insights into LRO biology and advance our understanding of human laterality disorders.
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Affiliation(s)
- Kadeen Forrest
- Department of Cell and Developmental Biology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Alexandria C. Barricella
- Department of Cell and Developmental Biology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Sonny A. Pohar
- Department of Cell and Developmental Biology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Anna Maria Hinman
- Department of Cell and Developmental Biology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Jeffrey D. Amack
- Department of Cell and Developmental Biology, State University of New York Upstate Medical University, Syracuse, NY, United States,BioInspired Syracuse: Institute for Material and Living Systems, Syracuse, NY, United States,*Correspondence: Jeffrey D. Amack,
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8
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Chen W, Lu Y, Ma L, Yang S, Zou M, Li W, Chen X. Outcomes of treatment for right atrial isomerism with functional single ventricle and extracardiac total anomalous pulmonary venous connection beyond neonatal period: Delayed surgical treatment, improving outcomes. Front Cardiovasc Med 2022; 9:914609. [PMID: 36606284 PMCID: PMC9808073 DOI: 10.3389/fcvm.2022.914609] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Total anomalous pulmonary venous connection (TAPVC) is frequently associated with right atrial isomerism (RAI), which is commonly complicated with an unbalanced atrioventricular canal with contralateral hypoplasia, complex systemic and pulmonary venous anatomy, and conotruncal abnormalities, resulting in increased risk of mortality. This study aimed to review the outcomes of delayed surgical treatment for patients with RAI complicated with functional single ventricle (FSV) and TAPVC at a single center. Methods In this retrospective study, we reviewed the medical records of 24 consecutive patients with RAI complicated with FSV and TAPVC who underwent initial surgical palliation after 5-month old between September 2008 and June 2019. Demographic data, concomitant anomalies, age at initial palliation, and surgical interventions were extracted and analyzed using the Cox proportional hazard model to assess risk factors for mortality and the Kaplan-Meier method to assess survival. Results The in-hospital mortality was 12.5% (three out of 24). The causes of death were pulmonary arterial hypertension and low cardiac output syndrome. Average follow-up was 65.2 ± 40.3 months (7-137 months). Another 4 patients died during the follow-up due to low cardiac output syndrome, protein-losing enteropathy and pulmonary arterial hypertension, respectively. Kaplan-Meier estimated survival at 1 and 5 years were 83.1 and 69.4%, respectively. Fontan completion was 45.8% (11/24). The mortality for patients with pulmonary venous obstruction (PVO) was 66.7% (4/6). Cox multivariate regression analysis indicated that preoperative PVO was the only risk factor for mortality (p = 0.032; hazard ratio, 10.000; CI 1.222-81.811). Conclusion Outcomes of delayed surgical treatment for patients with RAI complicated with FSV and TAPVC have improved significantly. The survival and Fontan completion were higher. However, preoperative PVO was still the risk factor for mortality.
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Weng Y, Gong Y, Yang Y, Chen J, Wu S. Successful biventricular repair in a 14-year-old patient of asplenia with congenital heart disease syndrome. J Card Surg 2022; 37:5626-5629. [PMID: 36378927 DOI: 10.1111/jocs.17171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Heterotaxy syndrome is a rare disease, and asplenia with congenital heart disease syndrome, also known as Ivemark syndrome, is a special form of heterotaxy syndrome. These patients usually have severe cardiovascular malformations and a poor prognosis. Their surgical outcomes are rarely satisfactory. We report the case of a 14-year-old patient who underwent successful corrective surgery treatment.
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Affiliation(s)
- Yujie Weng
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yibo Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jinlan Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sijie Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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10
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Pidvalna U, Mangov A, Mirchuk M. HETEROTAXY SYNDROME IN COVID-19 PATIENT WITH PULMONARY EMBOLISM AND AORTIC ANEURYSM: A RARE ACCIDENTAL COMBINATION (RADIOLOGICAL ASSESSMENT). Probl Radiac Med Radiobiol 2022; 27:495-503. [PMID: 36582111 DOI: 10.33145/2304-8336-2022-27-495-503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 12/29/2022]
Abstract
With limited time for analysing computed tomography (CT) data in medical emergencies, radiologists and clinicians are not always aware of congenital pathologies, especially in asymptomatic cases. We present a case report of heterotaxy syndrome detected incidentally in a 62-year-old female with massive pulmonary embolism, local saccular aneurysm of the aortic arch and COVID-19. The presented case describes an unusual combination of life-threatening conditions and congenital anomalies. Using the CT angiography, we reported the preserved topography and morphology of the heart chambers. The superior and inferior venae cavae were located on the left, draining into a significantly dilated coronary sinus. Disordered abdominal organ arrangement included midline liver, right-sided stomach, the central location of the short pancreas, malrotation of the intestine, polysplenia, and atypical rise of visceral branches of the abdominal aorta. A comprehensive assessment of CT images promoted verification of undiagnosed congenital anomalies. Prompt recognition of heterotaxy syndrome in life-threatening conditions significantly impacts treatment tactics and should be the course of diagnostic and cautious interventions to reduce further complications.
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Affiliation(s)
- U Pidvalna
- Danylo Halytsky Lviv National Medical University, 69 Pekarska St., Lviv, 79010, Ukraine Ukrainian-Polish Heart Center Lviv, 7 Chernihivska St., Lviv, 79010, Ukraine
| | - A Mangov
- Ukrainian-Polish Heart Center Lviv, 7 Chernihivska St., Lviv, 79010, Ukraine European Radiological Center, 8/10 Darvina St., Kharkiv, 61002, Ukraine Kharkiv Medical Academy of Postgraduate Education, 58 Amosova St., Kharkiv, 61176, Ukraine
| | - M Mirchuk
- Danylo Halytsky Lviv National Medical University, 69 Pekarska St., Lviv, 79010, Ukraine Ukrainian-Polish Heart Center Lviv, 7 Chernihivska St., Lviv, 79010, Ukraine
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11
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Wang CC, Wu MH, Wu ET, Lu F, Chen SJ. Clinical implications of airway anomalies and stenosis in patients with heterotaxy syndrome. Pediatr Pulmonol 2022; 57:2074-2081. [PMID: 35582940 DOI: 10.1002/ppul.25981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 11/12/2022]
Abstract
In heterotaxy syndrome, bronchopulmonary situs usually reflects atrial situs, resulting in either right (RAI) or left atrial isomerism (LAI). This study determines airway anomalies and its implications in patients with heterotaxy. This retrospective study included 223 patients with heterotaxy syndrome who received an integrated cardiac computed tomography evaluation. Patient database from 1995 to 2020 was reviewed. The patients were examined by a congenital heart disease team comprising pediatric cardiologists, radiologists, pulmonologists, and cardiovascular surgeons. Among the 223 patients, 189 (84.8%, M/F = 1.66) had RAI and 29 had LAI (13.0%, M/F = 0.71). Five patients had indeterminate isomerism (2.2%, M/F = 1.5). Discordant bronchopulmonary and atrial situs occurred in 4% patients, while discordant bronchopulmonary, atrial, and splenic situs occurred in 23.2% patients. Lower airway stenosis was observed in 61 patients (27.4%), including 27.5%, 20.7%, and 60% RAI, LAI, and indeterminate isomerism patients, respectively (p = 0.189). One patient had an intrinsic long segment lower tracheal stenosis and received slide tracheoplasty. Initial cardiac operation was performed in 213 patients. Higher surgical mortality occurred in patients with RAI (19.5% vs. none for LAI and indeterminate isomerism, p = 0.038). In patients with RAI, lower airway anomaly/stenosis increased the duration of ventilator usage (p = 0.030) but did not affect surgical mortality. Total anomalous pulmonary venous return to systemic veins and pulmonary venous stenosis were major surgical risk factors. Bronchopulmonary isomerism shares a similar isomeric pattern to cardiac atrial appendage. Lower airway anomalies/stenosis was common in patients with heterotaxy, resulting in prolonged ventilator therapy in patients with RAI.
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Affiliation(s)
- Ching-Chia Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Frank Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Radiology, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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12
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Basgoze S, Temur B, Guvenc O, Aydin S, Guzelmeric F, Onalan MA, Erek E. Analysis of outcomes in patients with abnormal laterality undergoing congenital heart surgery. Cardiol Young 2022; 32:1129-35. [PMID: 34593080 DOI: 10.1017/S1047951121003899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Laterality anomalies are almost always associated with severe cardiac anomalies. Demographic properties, type of the procedures, associated anomalies, and early and mid-term prognosis of four types of laterality anomalies were analysed. METHODS A total of 64 consecutive patients with laterality anomalies were enrolled between July 2014 and July 2020. We grouped the patients as situs solitus dextrocardia (SSD) (n = 12; 18.7%); situs inversus (SI) (n = 16; 25%); right atrial isomerism (RAI) (n = 29; 45.3%); and left atrial isomerism (LAI) (n = 7; 10.9%). TAPVC was only present in the RAI group (31%). Incidence of mitral or tricuspid atresia was higher in the SSD group (25%). All the patients were followed up with a mean of 19.06 ± 17.6 (0.1-72) months. RESULTS Early postoperative mortality was 17 patients, among 107 procedures (15.8%). Twelve patients were in the neonatal period. All ten patients survived after isolated ductal stenting. Fourteen of the deaths were in the RAI group (48.3%). The 3-year survival rates were 85% in LAI, 78.7% in SI, 55.8% in SSD, and 38% in RAI groups. According to the multivariable Cox regression model, mechanical ventilation, kidney injury, RAI, and complex surgery in the neonatal period were independent risk factors for early mortality. CONCLUSION Laterality anomalies are one of the most challenging patients who commonly had univentricular physiology. The most prevalent anomaly was RAI, and RAI had the worst outcome and survival. Ductal stent is an acceptable first intervention during the neonatal period in suitable patients. Complex procedures may carry a high risk of death in the neonatal period.
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Tortigue M, Nield LE, Karakachoff M, McLeod CJ, Belli E, Babu-Narayan SV, Prigent S, Boet A, Conway M, Elder RW, Ladouceur M, Khairy P, Kowalik E, Kalfa DM, Barron DJ, Mussa S, Hiippala A, Temple J, Abadir S, Le Gloan L, Lachaud M, Sanatani S, Thambo JB, Gronier CG, Amedro P, Vaksmann G, Charbonneau A, Koutbi L, Ovaert C, Houeijeh A, Combes N, Maury P, Duthoit G, Hiel B, Erickson CC, Bonnet C, Van Hare GF, Dina C, Karsenty C, Fournier E, Le Bloa M, Pass RH, Liberman L, Happonen JM, Perry JC, Romefort B, Benbrik N, Hauet Q, Fraisse A, Gatzoulis MA, Abrams DJ, Dubin AM, Ho SY, Redon R, Bacha EA, Schott JJ, Baruteau AE. Familial Recurrence Patterns in Congenitally Corrected Transposition of the Great Arteries: An International Study. Circ Genom Precis Med 2022; 15:e003464. [PMID: 35549293 DOI: 10.1161/circgen.121.003464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenitally corrected transposition of the great arteries (ccTGA) is a rare disease of unknown cause. We aimed to better understand familial recurrence patterns. METHODS An international, multicentre, retrospective cohort study was conducted in 29 tertiary hospitals in 6 countries between 1990 and 2018, entailing investigation of 1043 unrelated ccTGA probands. RESULTS Laterality defects and atrioventricular block at diagnosis were observed in 29.9% and 9.3%, respectively. ccTGA was associated with primary ciliary dyskinesia in 11 patients. Parental consanguinity was noted in 3.4% cases. A congenital heart defect was diagnosed in 81 relatives from 69 families, 58% of them being first-degree relatives, including 28 siblings. The most prevalent defects in relatives were dextro-transposition of the great arteries (28.4%), laterality defects (13.6%), and ccTGA (11.1%); 36 new familial clusters were described, including 8 pedigrees with concordant familial aggregation of ccTGA, 19 pedigrees with familial co-segregation of ccTGA and dextro-transposition of the great arteries, and 9 familial co-segregation of ccTGA and laterality defects. In one family co-segregation of ccTGA, dextro-transposition of the great arteries and heterotaxy syndrome in 3 distinct relatives was found. In another family, twins both displayed ccTGA and primary ciliary dyskinesia. CONCLUSIONS ccTGA is not always a sporadic congenital heart defect. Familial clusters as well as evidence of an association between ccTGA, dextro-transposition of the great arteries, laterality defects and in some cases primary ciliary dyskinesia, strongly suggest a common pathogenetic pathway involving laterality genes in the pathophysiology of ccTGA.
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Affiliation(s)
- Marine Tortigue
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Lynne E Nield
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | | | | | - Emre Belli
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Sonya V Babu-Narayan
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Solène Prigent
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Angèle Boet
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Miriam Conway
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Robert W Elder
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT (R.W.E.)
| | - Magalie Ladouceur
- Department of Adult Congenital Heart Diseases, M3C Hôpital Européen Georges Pompidou, Paris, France (M.L.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland (E.K.)
| | - David M Kalfa
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - David J Barron
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | - Shafi Mussa
- Department of Congenital Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, United Kingdom (S.M.)
| | - Anita Hiippala
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - Joel Temple
- Department of Pediatrics, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE (J.T.)
| | - Sylvia Abadir
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
- Division of Cardiology, CHU Mère-Enfant Sainte-Justine, University of Montreal, Quebec, Canada (S.A.)
| | - Laurianne Le Gloan
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Department of Cardiology, CHU Nantes, Nantes, France (L.L.G.)
| | | | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada (S.S.)
| | | | - Céline Grunenwald Gronier
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Pascal Amedro
- Department of Cardiology, CHU Bordeaux, France (J.-B.T., P.A.)
- PhyMedExp, CNRS, INSERM, University of Montpellier, France (P.A.)
| | - Guy Vaksmann
- Department of Pediatric Cardiology, Hôpital Privé de La Louvière, Lille, France (G.V.)
| | - Anne Charbonneau
- Department of Pediatric and Congenital Cardiology, American Memorial Hospital, CHU Reims, France (A.C.)
| | - Linda Koutbi
- Department of Cardiology (L.K.), La Timone Hospital, CHU Marseille, France
| | - Caroline Ovaert
- Department of Pediatric Cardiology (C.O.), La Timone Hospital, CHU Marseille, France
- Marseille Medical Genetics, Inserm UMR 1251, Aix-Marseille University, France (C.O.)
| | - Ali Houeijeh
- Department of Pediatric Cardiology, CHRU Lille, France (A.H.)
| | - Nicolas Combes
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
- Department of Cardiology, Pasteur Clinic, Toulouse, France (N.C.)
| | | | - Guillaume Duthoit
- Department of Cardiology, Groupe Hospitalier Pitié Salpétrière, Sorbonne Université, Paris, France (G.D.)
| | - Bérengère Hiel
- Department of Pediatric Cardiology, CHU Amiens, France (B.H.)
| | - Christopher C Erickson
- UDivision of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE (C.C.E.)
| | | | - George F Van Hare
- Division of Pediatric Cardiology, St Louis Children's Hospital, Washington University School of Medicine (G.F.V.H.)
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
| | - Clément Karsenty
- Department of Pediatric and Congenital Cardiology, Children's Hospital (C.K.), CHU Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR 1048, Université de Toulouse, France (C.K.)
| | - Emmanuelle Fournier
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Mathieu Le Bloa
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Switzerland (M.L.B.)
| | - Robert H Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, NY (R.H.P.)
| | - Leonardo Liberman
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Juha-Matti Happonen
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - James C Perry
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego (J.C.P.)
| | - Bénédicte Romefort
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Nadir Benbrik
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Quentin Hauet
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Alain Fraisse
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Michael A Gatzoulis
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (D.J.A.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Stanford University, Palo Alto, CA (A.M.D.)
| | - Siew Yen Ho
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Richard Redon
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Emile A Bacha
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
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14
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Tsubura M, Osaki M, Motono K, Hamamoto N. Risk factors for prolonged ventilation after the modified Fontan procedure. Cardiol Young 2022; 32:969-74. [PMID: 34429179 DOI: 10.1017/S1047951121003498] [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: 11/05/2022]
Abstract
OBJECTIVE To investigate the risk factors associated with prolonged ventilation after Fontan surgery. DESIGN Retrospective case series. SETTING Tertiary childrens hospital. PATIENTS We included 123 children who underwent Fontan surgery without delayed sternal closure or extracorporeal membrane oxygenation between 2011 and 2017. INTERVENTION Fontan surgery. MEASUREMENTS AND MAIN RESULTS Prolonged ventilation was defined as intubation for more than 24 hours after surgery. Preoperative, intraoperative, and perioperative data were collected retrospectively from medical records. Multivariate logistic regression analysis was used to identify risk factors for prolonged ventilation. The median age and weight of patients were 2.2 years and 10.0 kg, respectively. Seventeen per cent of the patients (n = 21) received prolonged mechanical ventilation, and the median intubation period was 2.9 days. There were no 90-day or in-hospital deaths. The independent predictors of prolonged ventilation identified were fenestration (p < 0.01), low pulmonary artery index (p = 0.02), and advanced atrioventricular regurgitation (p < 0.01). The duration of ICU stay was significantly longer in the prolonged ventilation group than in the early extubation group (10 days versus 6 days, p < 0.01). CONCLUSION Fenestration, low pulmonary artery index, and significant atrioventricular regurgitation are risk factors for prolonged ventilation after Fontan surgery. Careful preoperative and perioperative management that considers the risk factors for prolonged ventilation in each individual is important.
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15
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Yi T, Sun H, Fu Y, Hao X, Sun L, Zhang Y, Han J, Gu X, Liu X, Guo Y, Wang X, Zhou X, Zhang S, Yang Q, Fan J, He Y. Genetic and Clinical Features of Heterotaxy in a Prenatal Cohort. Front Genet 2022; 13:818241. [PMID: 35518361 PMCID: PMC9061952 DOI: 10.3389/fgene.2022.818241] [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: 11/19/2021] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: Some genetic causes of heterotaxy have been identified in a small number of heterotaxy familial cases or animal models. However, knowledge on the genetic causes of heterotaxy in the fetal population remains scarce. Here, we aimed to investigate the clinical characteristics and genetic spectrum of a fetal cohort with heterotaxy. Methods: We retrospectively investigated all fetuses with a prenatal diagnosis of heterotaxy at a single center between October 2015 and November 2020. These cases were studied using the genetic testing data acquired from a combination of copy number variation sequencing (CNV-seq) and whole-exome sequencing (WES), and their clinical phenotypes were also reviewed. Result: A total of 72 fetuses diagnosed with heterotaxy and complete clinical and genetic results were enrolled in our research. Of the 72 fetuses, 18 (25%) and 54 (75%) had left and right isomerism, respectively. Consistent with the results of a previous study, intracardiac anomalies were more severe in patients with right atrial isomerism than in those with left atrial isomerism (LAI) and mainly manifested as atrial situs inversus, bilateral right atrial appendages, abnormal pulmonary venous connection, single ventricles or single atria, and pulmonary stenosis or atresia. In 18 fetuses diagnosed with LAI, the main intracardiac anomalies were bilateral left atrial appendages. Of the 72 fetuses that underwent CNV-seq and WES, 11 (15.3%) had positive genetic results, eight had definitive pathogenic variants, and three had likely pathogenic variants. The diagnostic genetic variant rate identified using WES was 11.1% (8/72), in which primary ciliary dyskinesia (PCD)-associated gene mutations (CCDC40, CCDC114, DNAH5, DNAH11, and ARMC4) accounted for the vast majority (n = 5). Other diagnostic genetic variants, such as KMT2D and FOXC1, have been rarely reported in heterotaxy cases, although they have been verified to play roles in congenital heart disease. Conclusion: Thus, diagnostic genetic variants contributed to a substantial fraction in the etiology of fetal heterotaxy. PCD mutations accounted for approximately 6.9% of heterotaxy cases in our fetal cohort. WES was identified as an effective tool to detect genetic causes prenatally in heterotaxy patients.
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Affiliation(s)
- Tong Yi
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Lab for Cardiovascular PrecisionMedicine, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Hairui Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yuwei Fu
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Xiaoyan Hao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong Guo
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Siyao Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Fan
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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16
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Ahmed S, Sohaib M. Letter to the Editor: Cardiac surgery in patients with atrial isomerism: Long-term results and outcomes. J Card Surg 2022; 37:1796. [PMID: 35365903 DOI: 10.1111/jocs.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Ahmed
- Shalamar Medical College, Lahore, Pakistan
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17
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Anwar A, Jubin J, Raza S, Mirza ZK. A Rare Case of Recurrent Pneumonia in Heterotaxy Syndrome, Polysplenia/Left Isomerism. Cureus 2021; 13:e19055. [PMID: 34858743 PMCID: PMC8614211 DOI: 10.7759/cureus.19055] [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] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Heterotaxy syndrome (HS) or situs ambiguous refers to the abnormal arrangement of viscera across the body axis, and abnormalities arise depending on the isomerism of the right or left atrial appendage. The cause remains unexplained and is attributed to a combination of genetic mutations and environmental factors. It is a rare condition and may remain undiagnosed for a long time. In this report, we aim to highlight an unusual presentation and aggravation of an infection due to the underlying isomerism of the left atrial appendage. We discuss the case of a female patient who presented with symptoms of fever and cough. The patient underwent prolonged antibiotic treatment, and her recovery was slow. The presence of bilobed lungs, vertical left-bronchus, and polysplenia on CT scan explained the left-sided aspiration pneumonia. The hypofunctioning spleen (polysplenia) caused her to have a weak immunological response, necessitating prolonged antibiotic use. She was followed up over time and had a recurrence of pneumonia within a few months. The condition is associated with high morbidity and mortality, and the role of early diagnosis and reporting to prevent complications is paramount. The recurrent pneumonia observed in the patient also raises questions related to long-term antibiotic use and immunization in the case of polysplenia in this patient population.
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Affiliation(s)
- Ayesha Anwar
- Department of Medicine, Allama Iqbal Medical College/Jinnah Hospital, Lahore, PAK
| | - Jacob Jubin
- Radiology, Olean General Hospital/University at Buffalo, Olean, USA
| | - Shafi Raza
- Hospital Medicine, Olean General Hospital/University at Buffalo, Olean, USA
| | - Zafar K Mirza
- Gastroenterology and Hepatology, Olean General Hospital/University at Buffalo, Olean, USA
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18
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Moore JP, Gallotti RG, Shannon KM, Blais BA, DeWitt ES, Chiu SN, Spar DS, Fish FA, Shah MJ, Ernst S, Khairy P, Kanter RJ, Chang PM, Pilcher T, Law IH, Silver ES, Wu MH. Multicenter Outcomes of Catheter Ablation for Atrioventricular Reciprocating Tachycardia Mediated by Twin Atrioventricular Nodes. JACC Clin Electrophysiol 2021; 8:322-330. [PMID: 34600852 DOI: 10.1016/j.jacep.2021.08.004] [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: 05/21/2021] [Revised: 07/07/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to describe the electrophysiologic properties and catheter ablation outcomes for T-AVRT. BACKGROUND Although catheter ablation for atrioventricular (AV) reciprocating tachycardia via twin AV nodes (T-AVRT) is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure. METHODS An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT. RESULTS Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years [interquartile range, 4.4-17.0 years]; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava-to-azygous vein continuation (P = 0.11). CONCLUSIONS T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning.
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Affiliation(s)
- Jeremy P Moore
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA.
| | - Roberto G Gallotti
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA
| | - Kevin M Shannon
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA
| | - Benjamin A Blais
- Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA
| | - Elizabeth S DeWitt
- Division of Cardiac Electrophysiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - David S Spar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Frank A Fish
- Department of Pediatrics, Division of Cardiology, Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maully J Shah
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabine Ernst
- Cardiology Department, National Heart and Lung Institute, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Disease Center, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Ronald J Kanter
- Department of Cardiology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Philip M Chang
- University of Florida Health Congenital Heart Center, Gainesville, Florida, USA
| | - Thomas Pilcher
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Ian H Law
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Eric S Silver
- Division of Cardiology, Department of Pediatrics, Columbia University Medical Center/Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, New York, USA
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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19
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Ortega-Zhindón DB, Calderón-Colmenero J, García-Montes JA, Sandoval JP, Minakata-Quiroga MA, Cervantes-Salazar JL. Cardiac surgery in patients with atrial isomerism: Long-term results and outcomes. J Card Surg 2021; 36:4476-4484. [PMID: 34494321 DOI: 10.1111/jocs.15982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of the study was to identify, determine, and analyze the clinical and surgical outcomes of patients with atrial isomerism (AI) undergoing cardiac surgery. METHODS A retrospective study was carried out. Patients with diagnosis of AI undergoing cardiac surgery at the National Institute of Cardiology Ignacio Chávez, from January 1, 2010 and March 31, 2020 were included; demographic characteristics and perioperative conditions of the patients were considered. RESULTS Sixty-five patients were included, with an average age of 6.4 ± 4.9 years, 50.8% males. Thirty-eight (58.5%) had right atrial isomerism (RAI) and 27 (41.5%) had left atrial isomerism (LAI); univentricular physiology (78.5%) predominated. Atrioventricular septal defect (AVSD) in RAI and septal defects in LAI were identified as the main associated defects. The most common surgical procedures performed were modified Blalock-Taussig shunt (MBTS) (27.6%), MBTS with total anomalous pulmonary venous connection (TAPVC) repair (15.3%) and total cavopulmonary connection (TCPC) with an extracardiac conduit fenestrated (10.8%); 100% RAI required a univentricular approach, while in LAI it was 48.1%. Overall survival was 92.3%, with 100% survival in LAI with biventricular physiology and 86.8% in RAI with univentricular physiology. CONCLUSIONS The survival of our institution is similar to that of other referral centers, where patients with LAI had a better evolution than RAI; in addition, the univentricular approach was required in all with RAI. Patients with AI must undergo a rigorous evaluation to determine an adequate repair strategy, considering univentricular RAI with a high possibility of morbidity and mortality.
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Affiliation(s)
- Diego B Ortega-Zhindón
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - Juan Calderón-Colmenero
- Department of Pediatric Cardiology, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - José A García-Montes
- Department of Interventional Cardiology in Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - Juan P Sandoval
- Department of Interventional Cardiology in Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - María A Minakata-Quiroga
- Department of Cardiac Anesthesia, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - Jorge L Cervantes-Salazar
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
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20
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Struksnæs C, Blaas HGK, Eik-Nes SH, Tegnander E, Vogt C. Postmortem Assessment of Isolated Congenital Heart Defects Remains Essential Following Termination of Pregnancy. Pediatr Dev Pathol 2021; 24:422-429. [PMID: 33993792 DOI: 10.1177/10935266211016184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate the correlation between prenatal ultrasound (US) and autopsy findings in pregnancies terminated due to isolated congenital heart defects (CHDs), including CHDs associated with heterotaxy syndrome. MATERIALS AND METHODS The material consists of 67 fetuses with prenatally detected isolated CHDs or CHDs associated with heterotaxy syndrome at a tertiary center in Norway between 1985 and 2014. The main CHDs were categorized into subdiagnoses of CHDs in accordance with ICD-10. The US and autopsy findings were categorized according to degree of concordance. RESULTS Gestational age at termination was 12 + 0-22 + 6 weeks. Hypoplastic left heart syndrome was the most common main diagnosis among the 67 fetuses (32.8%). There was full agreement between US and autopsy findings in 97.4% (222/228) of all subdiagnoses. The discrepant findings in three fetuses had no influence on the decision to terminate the pregnancy. CONCLUSIONS The correlation was high between prenatal US and postmortem findings in fetuses with isolated CHDs. Meticulous assessment of cardiac anatomy is particularly necessary when the decision to terminate relies on isolated CHDs. The trend of earlier termination challenges verification of diagnoses at autopsy. Consequently, the fetus should be examined at a tertiary center with fetal medicine specialists, pediatric cardiologists and perinatal pathologists.
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Affiliation(s)
- Camilla Struksnæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Harm-Gerd K Blaas
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sturla H Eik-Nes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eva Tegnander
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Christina Vogt
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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21
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Moreau de Bellaing A, Bonnet D, Houyel L. Abnormal origin of the left pulmonary artery from the descending aorta and heterotaxy syndrome: an undescribed phenotypic association. Cardiol Young 2021; 31:1193-6. [PMID: 34082847 DOI: 10.1017/S1047951121002183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Extensive screening in a newborn with prenatal suspicion of VACTERL syndrome identified an anomalous origin of the left pulmonary artery from the descending aorta with an arterial duct and left aortic arch, and normal intra-cardiac anatomy. Other anatomical anomalies suggested heterotaxy syndrome. At one-month-old, re-implantation of the 3.5 mm left pulmonary artery was performed by direct tension-low anastomosis. Post-operative course was complicated by severe left pulmonary atelectasis, and the patient died 20 days later.
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22
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Acharya D, Singh J, Das D, Barik RC, Ranjan Behera D, Mahanta DS. Dual atrio ventricular node in heterotaxy syndrome. J Arrhythm 2021; 37:701-702. [PMID: 34141027 PMCID: PMC8207373 DOI: 10.1002/joa3.12525] [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: 01/16/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
Our interesting electrocardiogram has two qRS morphology without features of preexcitation suggesting two atrio ventricular node conduction system. All cardiologists should be aware of this feature in heterotaxy syndrome as reentrant supraventricular tachycardia may develop in these patients.
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Affiliation(s)
- Debasis Acharya
- Department of CardiologyAll India Institute of Medical SciencesBhubaneswarIndia
| | - Jogendra Singh
- Department of CardiologyAll India Institute of Medical SciencesBhubaneswarIndia
| | - Debasish Das
- Department of CardiologyAll India Institute of Medical SciencesBhubaneswarIndia
| | - Rama Chandra Barik
- Department of CardiologyAll India Institute of Medical SciencesBhubaneswarIndia
| | - Dibya Ranjan Behera
- Department of CardiologyAll India Institute of Medical SciencesBhubaneswarIndia
| | - Dibya S. Mahanta
- Department of CardiologyAll India Institute of Medical SciencesBhubaneswarIndia
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23
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Fainstein IA, Ivanov YV, Ishchenko RV, Panchenkov DN, Smirnov AV, Stankevich VR. [Cancer of terminal part of common bile duct in a patient with heterotaxy syndrome]. Khirurgiia (Mosk) 2021:58-63. [PMID: 33759470 DOI: 10.17116/hirurgia202104158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Case report is devoted to successful pancreatectomy for cancer of terminal part of common bile duct in a patient with heterotaxy syndrome. The main difficulties during dissection of pancreaticoduodenal complex arose due to anatomical disorientation and the lack of standard topographic and anatomical landmarks. Preoperative computed tomography with assessment of visceral vessel anatomy is essential in all patients with biliopancreaticoduodenal tumors. If heterotaxy syndrome is suspected, additional examination is required to detect other potential abnormalities and prepare for unusual situation.
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Affiliation(s)
- I A Fainstein
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Yu V Ivanov
- Federal Research and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - R V Ishchenko
- Federal Research and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - D N Panchenkov
- Federal Research and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Smirnov
- Federal Research and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - V R Stankevich
- Federal Research and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
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24
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Bhojwani R, Jain N. Thoracoscopic oesophago-oesophagostomy in the prone position for oesophageal stenosis caused by dilated azygos vein in polysplenia-associated heterotaxy. J Minim Access Surg 2021; 17:395-398. [PMID: 33605935 PMCID: PMC8270037 DOI: 10.4103/jmas.jmas_313_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Heterotaxy syndrome is associated with a plethora of cardiovascular and other multi-system anomalies with a high childhood mortality. A dilated azygos vein as part of the polysplenia variant of heterotaxy syndrome may cause oesophageal stenosis owing to a prolonged compression. We describe our technique of extramediastinal oesophago-oesophagostomy in the prone position for this rare congenital syndromic malformation with an excellent outcome. Patients and Methods: A 17-year-old boy with heterotaxy syndrome presented with intermittent dysphagia and postprandial emesis with failure to thrive. Despite the presence of diverse anatomic abnormalities, it was only his symptom of dysphagia due to oesophageal stricture that merited surgical intervention. He underwent an azygos-preserving extramediastinal oesophago-oesophagostomy in the prone position without segmental resection with the establishment of continuity using a modified Collard-type anastomosis. Results: The patient had an uneventful convalescence, with imaging after 1 year showing no re-stenosis. After a follow-up of 3 years, the patient is free of symptoms and has gained weight. Conclusion: Oesophageal stenosis may result from prolonged compression by anomalous vasculature. An isolated correctable anatomic derangement, young age with good functional reserve, other associated anomalies not causing any symptoms, the physiological advantages of executing the surgery in a prone position and availability of expertise in minimally invasive surgery ensured excellent outcomes. The hitherto unreported technique may open up avenues for further research regarding the behaviour of the oesophageal muscular tube with transection and re-anastomosis for rare benign abnormalities.
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Affiliation(s)
- Rajesh Bhojwani
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital Cum Medical Research Center, Jaipur, Rajasthan, India
| | - Nikhil Jain
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital Cum Medical Research Center, Jaipur, Rajasthan, India
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25
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Ma ACH, Mak CCY, Yeung KS, Pei SLC, Ying D, Yu MHC, Hasan KMM, Chen X, Chow PC, Cheung YF, Chung BHY. Monoallelic Mutations in CC2D1A Suggest a Novel Role in Human Heterotaxy and Ciliary Dysfunction. Circ Genom Precis Med 2020; 13:e003000. [PMID: 33196317 PMCID: PMC7748040 DOI: 10.1161/circgen.120.003000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Human heterotaxy is a group of congenital disorders characterized by misplacement of one or more organs according to the left-right axis. The genetic causes of human heterotaxy are highly heterogeneous. METHODS We performed exome sequencing in a cohort of 26 probands with heterotaxy followed by gene burden analysis for the enrichment of novel rare damaging mutations. Transcription activator-like effector nuclease was used to generate somatic loss-of-function mutants in a zebrafish model. Ciliary defects were examined by whole-mount immunostaining of acetylated α-tubulin. RESULTS We identified a significant enrichment of novel rare damaging mutations in the CC2D1A gene. Seven occurrences of CC2D1A mutations were found to affect 4 highly conserved amino acid residues of the protein. Functional analyses in the transcription activator-like effector nuclease-mediated zebrafish knockout models were performed, and heterotaxy phenotypes of the cardiovascular and gastrointestinal systems in both somatic and germline mutants were observed. Defective cilia were demonstrated by whole-mount immunostaining of acetylated α-tubulin. These abnormalities were rescued by wild-type cc2d1a mRNA but not cc2d1a mutant mRNA, strongly suggesting a loss-of-function mechanism. On the other hand, overexpression of cc2d1a orthologous mutations cc2d1a P559L and cc2d1a G808V (orthologous to human CC2D1A P532L and CC2D1A G781V) did not affect embryonic development. CONCLUSIONS Using a zebrafish model, we were able to establish a novel association of CC2D1A with heterotaxy and ciliary dysfunction in the F2 generation via a loss-of-function mechanism. Future mechanistic studies are needed for a better understanding of the role of CC2D1A in left-right patterning and ciliary dysfunction.
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Affiliation(s)
- Alvin Chun Hang Ma
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrate Region, China (A.C.H., K.M.M.H.)
| | - Christopher Chun Yu Mak
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
| | - Kit San Yeung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
| | - Steven Lim Cho Pei
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
| | - Dingge Ying
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
| | - Mullin Ho Chung Yu
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
| | - Kazi Md Mahmudul Hasan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrate Region, China (A.C.H., K.M.M.H.)
| | - Xiangke Chen
- Laboratory of Neurodegenerative Diseases, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (X.C.)
| | - Pak Cheong Chow
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
| | - Yiu Fai Cheung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
| | - Brian Hon Yin Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Kong Kong, Hong Kong Special Administrate Region, China (C.C.Y.M., K.S.Y., S.L.C.P., D.Y., M.H.C.Y., P.C.C., Y.F.C., B.H.Y.C.)
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26
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Koenig ZA, Verhoeven A, Rosen D, Petrone AB. Lateral Heterotaxy Syndrome in a Newborn Caucasian Male. Cureus 2020; 12:e11205. [PMID: 33269136 PMCID: PMC7704025 DOI: 10.7759/cureus.11205] [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] [Indexed: 12/03/2022] Open
Abstract
Heterotaxy syndrome is a varied spectrum of rearrangements of thoracic and abdominal organs that present many unique complications. Among all congenital deformities, heterotaxy syndrome is rare although this is likely an underestimate without routine imaging due to the benign nature of some defects. Numerous genes have been identified that play a role in its pathogenesis, and it has been hypothesized that heterotaxy syndrome is a consequence of both genetic and environmental impacts on the body axis. This case report also demonstrates the fundamental role of cardiac catheterization and imaging in further specifying the subtype of heterotaxy. Furthermore, it highlights the inconsistency of laterality with functional asplenia, visceral situs ambiguus, double-outlet right ventricle, and a left-sided inferior vena cava apart from other anomalies in a newborn male.
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Affiliation(s)
- Zachary A Koenig
- Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Alex Verhoeven
- Pediatrics, West Virginia University School of Medicine, Morgantown, USA
| | - David Rosen
- Anesthesiology, West Virginia University School of Medicine, Morgantown, USA
| | - Ashley B Petrone
- Pathology, Anatomy, Laboratory Medicine, West Virginia University School of Medicine, Morgantown, USA
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27
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Jose D, Babu S, Jeevan R, Ramanan S, Kramadhari H, Sukesan S. Intraoperative Transesophageal Echocardiographic Diagnosis of an Unobstructed Supracardiac Total Anomalous Pulmonary Venous Connection in a Case of Single Ventricle Palliative Repair. J Cardiothorac Vasc Anesth 2020; 35:2132-2136. [PMID: 32723587 DOI: 10.1053/j.jvca.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Don Jose
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Ram Jeevan
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sowmya Ramanan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Harshith Kramadhari
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Subin Sukesan
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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28
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Miyazaki A, Matsutani H, Nakano Y, Ikeda T, Uemura H, Doi H. CRT in a congenital heart disease patient with interventricular dyssynchrony due to an RV conduction delay. Pacing Clin Electrophysiol 2020; 43:1051-1057. [PMID: 32519349 DOI: 10.1111/pace.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/22/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022]
Abstract
We encountered a unique pattern of cardiac dyssynchrony in a patient with complex congenital heart disease (heterotaxy syndrome) with a biventricular physiology and systemic left ventricle (LV). On speckle tracking echocardiography, dyssynchrony was not detected within the LV, but was noted in an interventricular fashion between the LV and right ventricle (RV). An electrophysiologic study revealed a conduction delay in the subpulmonary RV. Cardiac resynchronization therapy provided reverse cardiac remodeling and an excellent result in our patient by placing the pacing leads around the dyssynchronous lesion.
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Affiliation(s)
- Aya Miyazaki
- Congenital Heart Disease Center Tenri Hospital, Tenri, Japan.,Congenital Heart Disease Center, Nara Medical University, Nara, Japan.,Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Yuta Nakano
- Department of Clinical Engineering, Tenri Hospital, Tenri, Japan
| | - Tadashi Ikeda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan
| | - Hiraku Doi
- Congenital Heart Disease Center Tenri Hospital, Tenri, Japan
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29
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Kops SA, Kylat RI, Bhatia S, Seckeler MD, Barber BJ, Bader MY. Genetic Characterization of a Model Ciliopathy: Bardet-Biedl Syndrome. J Pediatr Genet 2020; 10:126-130. [PMID: 33996183 DOI: 10.1055/s-0040-1708844] [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: 01/06/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Bardet-Biedl syndrome (BBS) is a rare ciliopathy affecting multiple organ systems. Patients with BBS are usually diagnosed later in childhood when clinical features of the disease become apparent. In this article, we presented a case of BBS discovered by whole genome sequencing in a newborn with heterotaxy, duodenal atresia, and complex congenital heart disease. Early diagnosis is important not only for prognostication but also to explore ways to mitigate the cone-rod dysfunction and for exploring newer therapies. Our case highlights the importance of a high index of suspicion and the utility of advanced genetic testing to provide an early diagnosis for a rare disease.
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Affiliation(s)
- Samantha A Kops
- Department of Pediatrics, Banner University Medical Center, Arizona, United States
| | - Ranjit I Kylat
- Department of Pediatrics, Banner University Medical Center, Arizona, United States.,Department of Pediatrics, University of Arizona College of Medicine, Arizona, United States
| | - Shanti Bhatia
- Department of Pediatrics, Banner University Medical Center, Arizona, United States
| | - Michael D Seckeler
- Department of Pediatrics, Banner University Medical Center, Arizona, United States.,Department of Pediatrics, University of Arizona College of Medicine, Arizona, United States
| | - Brent J Barber
- Department of Pediatrics, Banner University Medical Center, Arizona, United States.,Department of Pediatrics, University of Arizona College of Medicine, Arizona, United States
| | - Mohammad Y Bader
- Department of Pediatrics, Banner University Medical Center, Arizona, United States.,Department of Pediatrics, University of Arizona College of Medicine, Arizona, United States
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30
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Abstract
Heterotaxy syndrome (Situs ambiguus) is a condition in which the internal organs are abnormally arranged in the chest and abdomen. Individuals with this condition have complex birth defects affecting the heart, lungs, liver, spleen, intestines, and other organs. Unlike situs inversus, it often causes serious health problems. This report describes a case of a 49-year-old Hispanic female with a significant medical history of situs ambiguous diagnosed at birth in Cuba. She has had little to no follow-up in adulthood due to being “healthy.” She presented to the emergency room with intractable pain in the left lower quadrant and left flank for two days. Heterotaxy syndrome was found incidentally on CT scan of the abdomen/pelvis (plain). She was further evaluated with chest X-ray, magnetic resonance imaging of abdomen/pelvis without and with contrast, transvaginal ultrasonography, renal/bladder ultrasonography, left upper quadrant (LUQ) ultrasonography, esophagogastroduodenoscopy (EGD) with biopsy, 2D echocardiogram, and pertinent laboratory tests. Certain unusual findings included azygos continuation of the inferior vena cava (IVC), numerous spleens, atrophic pancreas, dilatation of duodenal C sweep, pelvic mass (possibly arising from right ovary), multiple nabothian cysts, and cardiac dysfunctions (such as severe mitral regurgitation). This report further aims to identify anatomic variants, previously established or otherwise not, in heterotaxy syndrome. Also, there seems to be a lack of identifiable anomalies or associations in regard to female anatomy, particular to this case being the female pelvic anatomy. As previous reports and research have stated, identification of anomalies in this syndrome is key for adequate and optimal management.
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Affiliation(s)
| | - Melanie Moises
- Internal Medicine, Larkin Community Hospital, Hialeah, USA
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31
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Bebawy CM, Gordon BM, Bock MJ. Elective left pulmonary artery embolisation for pulmonary arteriovenous malformations secondary to cavopulmonary anastomoses not responsive to heart transplantation: a case report. Cardiol Young 2019; 29:1404-6. [PMID: 31514756 DOI: 10.1017/S1047951119002130] [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: 11/05/2022]
Abstract
A 10-year-old female with heterotaxy-asplenia and complex CHD developed pulmonary arteriovenous malformations with associated cyanosis after Fontan completion. She underwent orthotopic heart transplantation, but her pulmonary arteriovenous malformations persisted with progressive worsening cyanosis. Elective transcatheter left pulmonary artery embolisation was performed 2 years post-transplant, which successfully normalised her oxygen saturation without a significant increase in pulmonary artery pressure.
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Broda CR, Salciccioli KB, Lopez KN, Ermis PR, Moodie DS, Dickerson HA. Outcomes in adults with congenital heart disease and heterotaxy syndrome: A single-center experience. CONGENIT HEART DIS 2019; 14:885-894. [PMID: 31617655 DOI: 10.1111/chd.12856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heterotaxy syndrome (HS) is a condition in which the thoracoabdominal organs demonstrate an abnormal lateral arrangement and is often associated with congenital heart disease (CHD). Little is known about the adult HS population with CHD. OBJECTIVE To describe the outcomes and sociodemographics of the adult CHD population with HS. METHODS Records of patients 18 years of age or older with diagnoses of both CHD and HS at Texas Children's Hospital from 1964 to 2018 were reviewed. RESULTS Sixty-two patients met inclusion criteria. Median age was 22.7 [IQR 19.6-30.0] years; 26 (42%) were female; and 13 (21%) of patients had a gap in care of >3 years. Median follow-up time in adulthood was 2.9 [IQR 1.3-8.2] years. Forty-three (69%) of patients had single ventricle heart disease, 31 (71%) of whom completed Fontan circulation. A total of 36 interventions occurred in 24 patients which included 16 cardiac catherization interventions, 13 electrophysiology-related procedures, and 18 surgical procedures including 2 orthotopic heart transplants. The median age for death or heart transplant was 45.3 (95%CI 34.3-56.1) years. Heart failure-free survival was 80.8 ± 5.2%, 58.7 ± 11.0%, and 31.1 ± 15.7% at 20, 30, and 40 years old, respectively. Cerebrovascular accident-free survival was 84.3 ± 5.1%, 54.2 ± 11.3%, and 40.6 ± 14.5% at 20, 30, and 40 years old, respectively. Tachyarrhythmia-free survival was 54.0 ± 7.1%, 29.2 ± 8.3%, and 19.5 ± 9.7% at 20, 30, and 40 years old and bradyarrhythmia-free survival was 66.0 ± 6.3%, 41.7 ± 9.4%, and 33.4 ± 10.6% at ages 20, 30, and 40 years, respectively. CONCLUSIONS At a tertiary referral center, adult patients with CHD and HS have high rates of comorbidities and early death or heart transplant. Longitudinal surveillance and further exploration into factors associated with improved survival in this population are warranted.
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Affiliation(s)
- Christopher R Broda
- Department of Pediatrics, Section of Pediatric and Adult Congenital Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Katherine B Salciccioli
- Department of Pediatrics, Section of Pediatric and Adult Congenital Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Keila N Lopez
- Department of Pediatrics, Section of Pediatric and Adult Congenital Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Peter R Ermis
- Department of Pediatrics, Section of Pediatric and Adult Congenital Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Douglas S Moodie
- Department of Pediatrics, Section of Pediatric and Adult Congenital Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Heather A Dickerson
- Department of Pediatrics, Section of Pediatric and Adult Congenital Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Yim D, Nagata H, Lam CZ, Grosse-Wortmann L, Seed M, Jaeggi E, Yoo SJ. Disharmonious Patterns of Heterotaxy and Isomerism: How Often Are the Classic Patterns Breached? Circ Cardiovasc Imaging 2019; 11:e006917. [PMID: 29444810 DOI: 10.1161/circimaging.117.006917] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND It is advocated that heterotaxy should be segregated into right or left isomerism according to atrial appendage morphology. However, atrial situs determination is often based on the pattern of associated findings rather than on atrial morphology itself, which can be difficult to define. The objective was to assess how often concordant patterns of isomerism classified by atrial appendage morphology, bronchopulmonary pattern, and splenic status are breached using cardiac magnetic resonance or computed tomography. The secondary objective was to determine the feasibility of defining atrial appendage morphology using cardiac magnetic resonance or computed tomography. METHODS AND RESULTS Retrospective review of 114 pediatric patients (median, 2.4 years; range, 1 day-17.9 years) with heterotaxy who underwent cardiac magnetic resonance or computed tomography was performed to evaluate atrial appendage, bronchopulmonary, and visceral organ arrangements. Atrial appendage and splenic anatomy were not definable in 17 of 114 (15%) and 4 of 114 (3.5%) patients, respectively. In the remaining 93 patients, 39% had classic right isomerism (bilateral right atrial appendages, right bronchopulmonary pattern, and asplenia) and 40% had classic left isomerism (bilateral left atrial appendages, left bronchopulmonary pattern, and polysplenia). Classic pattern of isomerism was breached in 20 of 93 (21.5%) patients: 13 (65%) displayed incongruent abdominal situs, 5 (25%) incongruent bronchial situs, 1 (5%) had discrepant appendage morphology, and 1 (5%) incongruent situs at all levels. CONCLUSIONS Atrial appendage morphology is difficult to assess and not always indicative of bronchopulmonary or abdominal situs. Discordance between bronchopulmonary branching, atrial appendage arrangement, and splenic status was identified in >20% patients with heterotaxy. Independent description of each organ system is required when arrangements are disharmonious among different organ systems.
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Affiliation(s)
- Deane Yim
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Hazumu Nagata
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Christopher Z Lam
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Lars Grosse-Wortmann
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Mike Seed
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Edgar Jaeggi
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Shi-Joon Yoo
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.).
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Iwai S, Yamauchi S, Tominaga Y, Kugo Y, Hasegawa M, Kawata H. Valve mobilization and augmentation in systemic atrioventricular valve plasty. Asian Cardiovasc Thorac Ann 2019; 27:691-694. [PMID: 31032617 DOI: 10.1177/0218492319846786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Repair of the systemic atrioventricular valve before a bidirectional cavopulmonary shunt is challenging. We describe a novel approach to atrioventricular valve repair in an infant who had severe regurgitation associated with right isomerism and a single ventricle. The atrioventricular valve showed downward displacement with tethering. Atrioventricular valve plasty using our valve mobilization technique and pulmonary artery banding were performed at age 3 months. Posterior leaflet augmentation was performed 1 month later for the remaining moderate regurgitation. The severity of regurgitation was reduced to less than mild. After the Glenn and Fontan operations, reintervention was unnecessary.
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Affiliation(s)
- Shigemitsu Iwai
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Sanae Yamauchi
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yuji Tominaga
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yosuke Kugo
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Moyu Hasegawa
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Hiroaki Kawata
- Department of Cardiovascular Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
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Affiliation(s)
- Niraj Kumar Dipak
- Department of Peds and Neonatology, Dr L H Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Suyodhan Reddy
- Department of Pediatric Surgery, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Kunal Kumar Jaiswal
- Department of Peds and Neonatology, Dr L H Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Abnish Kumar
- Department of Pediatrics and Neonatology, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
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Routhu M, Mohammad IA. Pre natal evaluation of heterotaxy syndrome by fetal echocardiography and correlating with autopsy. Ultrasound 2019; 27:111-121. [PMID: 31037095 DOI: 10.1177/1742271x19836259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 02/12/2019] [Indexed: 11/15/2022]
Abstract
Introduction Heterotaxy syndrome/ isomerism is characterized by an abnormal symmetry of the viscera that are normally dissimilar due to abnormal lateralization of thoracic and abdominal viscera and is frequently associated with complex cardiac anomalies. Isomerism may be of right or left. Materials and methods This article describes the morphological characteristics of heterotaxy and suggests an approach in evaluating the spectrum of abnormalities associated with this syndrome. This study is based on 12 cases diagnosed on antenatal ultrasound as heterotaxy syndrome. Results of the examinations were re-evaluated and compared by fetal autopsy. Result Based on the following echocardiographic criteria, a diagnosis of left isomerism was made if there was viscerocardiac heterotaxy associated with an interruption of inferior vena cava or with bilateral finger-like atrial appendages or if it was associated with heart block. If there was evidence of viscerocardiac heterotaxy with complex cardiac anomalies then it was diagnosed as right atrial isomerism or visceral heterotaxy syndrome. We diagnosed 6/12 as left isomerism and rest of the cases as right isomerism/visceral heterotaxy syndrome. In Autopsy we evaluated visceral situs and morphology of the lungs and the main bronchi, the state of the liver, spleen, bowel, and the precise anatomy of the heart and confirmed 4/12 as left isomerism 4/12 as right isomerism and two cases as visceral heterotaxy syndrome (VHS). Rest of the two cases were included in the study despite missing autopsy data, as the combination of abnormal situs with interrupted inferior vena cava, and cardiac malformation allowed a diagnosis of left isomerism with high probability. Conclusion In this study, we aimed to find common features of heterotaxy syndrome on prenatal ultrasound as well as on fetal autopsy. This syndrome should be accurately diagnosed in the prenatal period in order to allow appropriate counseling of parents.
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Zhang Y, Sun C, Jiang C, Zhao W, Wang W, Cao Q, Ge S. Prenatal diagnosis of caudal regression with heterotaxy syndrome: "A mermaid with a broken heart". Echocardiography 2019; 36:415-418. [PMID: 30685882 DOI: 10.1111/echo.14250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 11/27/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare congenital malformation with varying degrees of early gestational developmental failure. It is characterized by agenesis of the sacrum and lumbar spine, with lower limb neurological deficit and accompanying deformities of the pelvis, lower extremities, genitourinary, and gastrointestinal systems. We report a case of CRS associated with rare complex congenital heart defect, that is, heterotaxy syndrome, diagnosed prenatally.
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Affiliation(s)
- Yanhong Zhang
- Department of Ultrasound, The Shijiazhuang Maternity Hospital, Shijiazhuang, China
| | - Congxin Sun
- Department of Ultrasound, The Shijiazhuang Maternity Hospital, Shijiazhuang, China
| | - Caixia Jiang
- Department of Ultrasound, The Shijiazhuang Maternity Hospital, Shijiazhuang, China
| | - Wei Zhao
- Department of Ultrasound, The Shijiazhuang Maternity Hospital, Shijiazhuang, China
| | - Weijing Wang
- Department of Ultrasound, The Shijiazhuang Maternity Hospital, Shijiazhuang, China
| | - Qingying Cao
- Department of Prenatal Diagnosis, Shijiazhuang Maternity Hospital, Shijiazhuang, Hebei Province, China
| | - Shuping Ge
- The Heart Center, St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, Pennsylvania
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Lively-Endicott H, Lara DA. Successful Palliation via Kawashima Procedure of an Infant With Heterotaxy Syndrome and Left-Atrial Isomerism. Ochsner J 2018; 18:406-12. [PMID: 30559629 DOI: 10.31486/toj.18.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Heterotaxy is a condition of abnormal lateralization of organs across the body's left-right axis, causing multiple congenital malformations. The anatomic manifestations of heterotaxy syndrome generally follow one of two patterns, referred to as right atrial isomerism (with two similar right atria and duplication of right-sided features of multiple organs) and left atrial isomerism (with two similar left atria and duplication of left-sided features of multiple organs). Cardiac surgical intervention for patients with heterotaxy syndrome depends on ventricular physiology and circulatory balance. For patients with single-ventricle physiology, a Fontan operation, which directs systemic venous return to the pulmonary arteries, is the definitive intervention. Prior to a Fontan operation, many patients require one or more palliative surgeries (eg, a Blalock-Taussig-Thomas shunt or bidirectional Glenn/Kawashima procedure) to prepare them for definitive correction. Case Report We present the case of a term female neonate who was transferred to our pediatric cardiovascular intensive care unit for management of suspected congenital cardiac disease. Echocardiography confirmed the diagnosis of heterotaxy syndrome with left atrial isomerism, an interrupted inferior vena cava with azygos continuation, and a hypoplastic left ventricle with single-ventricle physiology. At 11 months of age, she underwent a Kawashima procedure with subtotal pulmonary artery ligation. She tolerated the procedure well and is anticipated to remain stable for the near future, possibly without the need for further cardiac surgery. Conclusion Patients with heterotaxy syndrome have congenital malformations in several organ systems, requiring lifelong coordination of care among health providers across multiple disciplines.
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Omer A, Haddad D, Pisinski L, Krauthamer AV. The Missing Link: A Case of Absent Pituitary Infundibulum and Ectopic Neurohypophysis in a Pediatric Patient with Heterotaxy Syndrome. J Radiol Case Rep 2018; 11:28-34. [PMID: 29299107 DOI: 10.3941/jrcr.v11i9.3046] [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] [Indexed: 11/15/2022] Open
Abstract
We report a case of absent pituitary infundibulum and ectopic neurohypophysis in a 4-year-old patient presenting clinically with hypopituitarism as well as heterotaxy syndrome complicated by global developmental delay and growth retardation. The clinical and laboratory workup of our patient suggested underlying hypopituitarism related to either congenital or acquired pathology, necessitating MRI to distinguish between them. We explain the various structural causes of hypopituitarism and detail how to predict the MRI findings and treatment, based on a fundamental understanding of the anatomy and pathophysiology of the hypothalamic pituitary axis and distinguishing anterior versus posterior pituitary hormone derangements. We also discuss two important theories widely acknowledged in the literature to explain congenital hypopituitarism: 1. Head trauma typically during birth resulting in a stretch injury to the infundibulum. 2. Congenital fetal maldevelopment of midline structures.
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Affiliation(s)
- Adil Omer
- Department of Radiology, Harlem Hospital Center, New York, USA
| | - Dana Haddad
- Department of Radiology, Harlem Hospital Center, New York, USA
- Northwell Health Imaging at the Center for Advanced Medicine, New York, USA
| | - Leszek Pisinski
- Department of Radiology, Harlem Hospital Center, New York, USA
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Moradi B, Moosavi NS, Kazemi MA, Tahmasebpour AR, Fattahi Masrour F. A case of prenatally detected left isomerism and hemiazygos continuation of inferior vena cava. J Clin Ultrasound 2017; 45:430-433. [PMID: 28256002 DOI: 10.1002/jcu.22464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/06/2017] [Accepted: 01/22/2017] [Indexed: 06/06/2023]
Abstract
Heterotaxy syndromes are defined as the disorders that involve abnormal arrangement of viscera. We present a case of prenatally diagnosed left isomerism in a 30-year-old primigravida woman referred to our hospital for complex cardiac abnormality. Sonographic findings included heart block, unbalanced atrioventricular septal defect, interruption of the inferior vena cava with hemiazygos continuation, double superior vena cava, a right-sided stomach, and biliary atresia. The hemiazygos vein drained into the right atrium by the persistent left superior vena cava. This type of inferior vena cava interruption and continuation is rarely reported in prenatally detected cases of left isomerism. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:430-433, 2017.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Najme-Sadat Moosavi
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Ali Kazemi
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
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Catana A, Apostu AP. The determination factors of left-right asymmetry disorders- a short review. ACTA ACUST UNITED AC 2017; 90:139-146. [PMID: 28559696 PMCID: PMC5433564 DOI: 10.15386/cjmed-701] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/02/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022]
Abstract
Laterality defects in humans, situs inversus and heterotaxy, are rare disorders, with an incidence of 1:8000 to 1:10 000 in the general population, and a multifactorial etiology. It has been proved that 1.44/10 000 of all cardiac problems are associated with malformations of left-right asymmetry and heterotaxy accounts for 3% of all congenital heart defects. It is considered that defects of situs appear due to genetic and environmental factors. Also, there is evidence that the ciliopathies (defects of structure or function) are involved in development abnormalities. Over 100 genes have been reported to be involved in left-right patterning in model organisms, but only a few are likely to candidate for left-right asymmetry defects in humans. Left-right asymmetry disorders are genetically heterogeneous and have variable manifestations (from asymptomatic to serious clinical problems). The discovery of the right mechanism of left-right development will help explain the clinical complexity and may contribute to a therapy of these disorders.
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Affiliation(s)
- Andreea Catana
- Genetics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adina Patricia Apostu
- Genetics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Gottschalk I, Stressig R, Ritgen J, Herberg U, Breuer J, Vorndamme A, Strizek B, Willruth A, Geipel A, Gembruch U, Berg C. Extracardiac anomalies in prenatally diagnosed heterotaxy syndrome. Ultrasound Obstet Gynecol 2016; 47:443-449. [PMID: 25847110 DOI: 10.1002/uog.14871] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/29/2015] [Accepted: 03/31/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the incidence and impact of extracardiac anomalies on the prognosis of fetuses with heterotaxy syndrome. METHODS All fetuses diagnosed with heterotaxy syndrome by three experienced examiners over a period of 14 years (1999-2013) were reviewed retrospectively. RESULTS In total, 165 fetuses with heterotaxy syndrome were diagnosed in the study period. One hundred and fifty (90.9%) had cardiac defects; extracardiac anomalies that did not involve the spleen were present in 26/165 (15.8%) cases. Of the total study cohort, termination of pregnancy was performed in 49 (29.7%) cases, intrauterine death occurred in 11 (6.7%), postnatal death occurred in 38 (23.0%) and 67 (40.6%) were alive at the latest follow-up, resulting in a total perinatal and pediatric mortality of 59.4%. Among the 105 liveborn neonates, 15 (14.3%) had extracardiac anomalies with significant impact on the postnatal course: one neonate died following repair of an encephalocele, six had successful treatment for various types of intestinal malrotation and/or atresia and one underwent hiatal hernia repair; the remaining seven had biliary atresia, of which five died and the two survivors are awaiting liver transplantation. The status of the spleen was assessed in 93/105 liveborn children and was found to be abnormal in 84/93 (90.3%). There were three cases of lethal sepsis, all associated with asplenia. Of the 38 postnatal deaths, 29 (76.3%) had a cardiac cause, seven (18.4%) had an extracardiac cause and in two (5.2%) the reason was uncertain. CONCLUSIONS Although the leading causes of death in fetuses and children with heterotaxy syndrome are cardiac, a small subset of fetuses have extracardiac anomalies with significant impact on outcome. These anomalies often escape prenatal detection, and therefore neonates at risk should be monitored for bowel obstruction, biliary atresia and immune dysfunction in order to allow timely intervention through a multidisciplinary approach. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
| | - R Stressig
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
- Congenital Cardiac Center ('Deutsches Kinderherzzentrum'), Sankt Augustin, Germany
| | - J Ritgen
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - A Vorndamme
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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van Veenendaal NR, Kusters CDJ, Oostra RJ, Bergman JEH, Cobben JM. When the right (Drug) should be left: Prenatal drug exposure and heterotaxy syndrome. ACTA ACUST UNITED AC 2016; 106:573-9. [PMID: 26991659 DOI: 10.1002/bdra.23497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/15/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Recent studies reported an association between prenatal propylthiouracil exposure and birth defects, including abnormal arrangement across the left-right body axis, suggesting an association with heterotaxy syndrome. METHODS This case-control and case-finding study used data from 1981 to 2013 from the EUROCAT birth defect registry in the Northern Netherlands. First, we explored prenatal exposures in heterotaxy syndrome (cases) and Down syndrome (controls). Second, we describe the specific birth defects in offspring of mothers using propylthiouracil (PTU) prenatally. RESULTS A total of 66 cases with heterotaxy syndrome (incidence 12.1 per 100,000 pregnancies) and 783 controls with Down syndrome (143.3 per 100,000 pregnancies) were studied. No differences in intoxication use during pregnancy were found between cases and controls, including smoking (28.0% vs. 22.7%; p = 0.40), alcohol (14.0% vs. 26.9%; p = 0.052), and recreational drugs (0 vs. 0.3%; p = 1.00). We found an association between heterotaxy syndrome and prenatal drug exposure to follitropin-alfa (5.6% vs. 1.1%; p = 0.04), and drugs used in nicotine dependence (3.7% vs. 0.2%; p = 0.02). Five mothers used PTU during pregnancy and gave birth to a child with trisomy 18, renal abnormalities, or hypospadias and cardiac defects. CONCLUSION This study identified follitropin-alfa and drugs used in nicotine dependence as possible teratogens of heterotaxy syndrome. Our data suggest the possibility that there is an increased risk of birth defects (including renal, urological, and cardiac abnormalities) in children born among mothers taking PTU prenatally, but not for heterotaxy syndrome. Birth Defects Research (Part A) 106:573-579, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nicole R van Veenendaal
- Department of Pediatrics and Clinical Genetics, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Cynthia D J Kusters
- Eurocat Northern Netherlands, Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roelof-Jan Oostra
- Department of Anatomy, Embryology and Physiology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Jorieke E H Bergman
- Eurocat Northern Netherlands, Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Maarten Cobben
- Department of Pediatrics and Clinical Genetics, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
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Erdem SB, Genel F, Erdur B, Ozbek E, Gulez N, Mese T. Asplenia in children with congenital heart disease as a cause of poor outcome. Cent Eur J Immunol 2015; 40:266-9. [PMID: 26557043 DOI: 10.5114/ceji.2015.52841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/10/2015] [Indexed: 11/17/2022] Open
Abstract
The absence of a spleen is a well-known risk factor for severe bacterial infections, especially due to encapsulated bacteria. Congenital asplenia can be part of multiple congenital abnormalities as in heterotaxy including Ivemark syndrome with congenital anomalies of the heart or great vessels, or it can be isolated, which is extremely rare. In these cases, asplenia is an important factor effecting mortality. In this report, the clinical courses of five children with asplenia and concomitant minor or complex cardiac anomalies are presented. The ages of the children ranged between 1.5 and 17 months at the time of diagnosis. All of the cases had had a history of hospitalisation for infectious diseases before the diagnosis. The patient who was diagnosed at 17 months old had a history pneumonia, urinary tract infection, and bacterial meningitis beginning at five months old. Three children had complex cardiac anomalies, one child had ventricular septal defect, and one child had atrial septal defect. Howell-Jolly bodies were determined in peripheral blood smear in all of the patients. The diagnoses of asplenia were confirmed with spleen scintigraphy. One of the patients with complex cardiac anomalies died a short time after diagnosis, because of cardiac failure. The rest of the four patients were vaccinated for encapsulated bacteria and were taken under antibiotic prophylaxis. These children did not need hospitalisation for infectious diseases during the follow-up period (5-40 months). In asplenic children, early diagnosis, antibiotic prophylaxis, and immunisation for encapsulated bacteria can decrease the risk of morbidity and mortality.
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Abstract
Management of complex congenital heart disease in patients with Heterotaxy syndrome (HS) has steadily improved. However, there is an insufficient appreciation of various non-cardiac issues that might impact the overall status of these patients. This article briefly reviews the implications of gastrointestinal, immunologic, genitourinary, respiratory, and central nervous system involvement in HS patients with a view to aid in their comprehensive clinical management.
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Affiliation(s)
- Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Escobar-Diaz MC, Tworetzky W, Friedman K, Lafranchi T, Fynn-Thompson F, Alexander ME, Mah DY. Perinatal outcome in fetuses with heterotaxy syndrome and atrioventricular block or bradycardia. Pediatr Cardiol 2014; 35:906-13. [PMID: 24509635 PMCID: PMC4331180 DOI: 10.1007/s00246-014-0874-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
Congenital atrioventricular (AV) block is commonly associated with heterotaxy syndrome; together they have reportedly low survival rates (10-25%). However, information about perinatal outcome and predictors of non-survival after prenatal diagnosis of this association is scarce. Therefore, we studied fetuses with heterotaxy syndrome and bradycardia or AV-block diagnosed between 1995 and 2011, and analyzed pre and post-natal variables. The primary outcome was death and the secondary outcome was pacemaker placement. Of the 154 fetuses with heterotaxy syndrome, 91 had polysplenia syndrome, 22/91(24%) with bradycardia or AV-block. Thirteen (59%) patients had sinus bradycardia at diagnosis, 8 (36%) complete AV block, and 1 (5%) second-degree AV-block. Three patients elected for termination of pregnancy (3/22, 14%), 4 had spontaneous fetal demise (4/22, 18%), and 15 (15/22, 68%) were live-born. Of the fetuses with bradycardia/AV-block, 30% presented with hydrops, 20% had ventricular rates <55 beats/min, and 10% had cardiac dysfunction. Excluding termination of pregnancy, 15/19 fetuses (79%) survived to birth. Among the 15 live-born patients, 4 had bradycardia and 11 had AV-block. A further 3 patients died in infancy, all with AV-block who required pacemakers in the neonatal period. Thus, the 1-year survival rate, excluding termination of pregnancy, was 63% (12/19). Of the remaining 12 patients, 9 required pacemaker. Predictors of perinatal death included hydrops (p < 0.0001), ventricular dysfunction (p = 0.002), prematurity (p = 0.04), and low ventricular rates (p = 0.04). In conclusion, we found a higher survival rate (63%) than previously published in patients with heterotaxy syndrome and AV block or bradycardia diagnosed prenatally. Hydrops, cardiac dysfunction, prematurity and low ventricular rates were predictors of death.
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Affiliation(s)
- Maria C Escobar-Diaz
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA,
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Burton EC, Olson M, Rooper L. Defects in laterality with emphasis on heterotaxy syndromes with asplenia and polysplenia: an autopsy case series at a single institution. Pediatr Dev Pathol 2014; 17:250-64. [PMID: 24735181 DOI: 10.2350/13-11-1406-oa.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Heterotaxy is a rare disease with high morbidity and mortality. Controversy exists over how to classify these syndromes with most cases stratified into asplenia/polysplenia syndromes or right/left isomerism. In an effort to review comprehensively specific pheonotypes associated with heterotaxy syndromes, we reviewed published cases series, adopted a classification scheme based on spleen status, and evaluated autopsy cases retrospectively with abnormal laterality at our institution. We categorized 116 cases as situs inversus totalis, polysplenia, asplenia, and single right-sided spleen. Cardiovascular abnormalities occurred in 87.1% of polysplenia, 90.5% of asplenia, and all cases of single right-sided spleen. For polysplenia, 48.9% had bilateral bilobed lungs, 87% had right-sided stomach, 58.1% had midline symmetric liver, and 60.4% had malrotated intestines. For asplenia, 51.9% had bilateral trilobed lungs, 86.7% had right-sided stomach, 45.8% had symmetric liver, and 65.5% had malrotated intestines. Atrioventricular septal defects occurred in 91.2% of asplenia compared to 56.8% of polysplenia cases. Eight percent had pulmonary/aortic stenosis or atresia. Double outlet right ventricle was more common in polysplenia (32.6%) compared to asplenia (21.4%). Total anomalous systemic venous return was described in 55.6% of polysplenia and total anomalous pulmonary venous connections in 81% of asplenia cases. Greater than half of the cases had no heterotaxy diagnosis. Although, we found similar heterotaxy-associated characteristics, the frequencies differed from previous studies. We found great variation in how heterotaxy-associated defects were described, diagnosed, and reported. Although there are known associated characteristics with the polysplenia/asplenia syndromes, correct identification requires a standardized approach for diagnosis and reporting.
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Affiliation(s)
- Elizabeth C Burton
- 1 Johns Hopkins Medicine, Department of Pathology, Autopsy Division, Pathology building, Room B106, 600 N. Wolfe Street, Baltimore, MD 21287-6417
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Trost M, Shimada H. Hospitalists should have increased suspicion for primary ciliary dyskinesia in patients with congenital heart disease. Hosp Pediatr 2014; 4:109-12. [PMID: 24584982 DOI: 10.1542/hpeds.2013-0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hartog H, Mirza DF, Perera MTPR. Heterotaxy syndrome with malrotation of the gut and interrupted vena cava does not preclude safe procurement of multivisceral graft. Am J Transplant 2014; 14:724-8. [PMID: 24502412 DOI: 10.1111/ajt.12627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/13/2013] [Accepted: 12/13/2013] [Indexed: 01/25/2023]
Abstract
We report the first successful procurement and transplantation of a multivisceral graft from a pediatric donor with polysplenic heterotaxy syndrome, including intestinal malrotation, midline liver with left-sided gallbladder and an interrupted inferior vena cava with azygous continuation. Procurement of the graft presented a surgical challenge in the presence of above anomalies. Modified approach to standard organ procurement and minor technical adaptation enabled successful transplantation. In an era of severe organ shortage of pediatric multivisceral grafts, a valuable organ offer should not lightly be declined for reasons of anatomic imperfections that might be overcome.
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Affiliation(s)
- H Hartog
- Liver (Including Small Bowel Transplant) Unit, Birmingham Children's Hospital, Birmingham, United Kingdom; Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
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50
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Jacobs JP, Pasquali SK, Morales DLS, Jacobs ML, Mavroudis C, Chai PJ, Tchervenkov CI, Lacour-Gayet FG, Walters H, Quintessenza JA. Heterotaxy: lessons learned about patterns of practice and outcomes from the congenital heart surgery database of the society of thoracic surgeons. World J Pediatr Congenit Heart Surg 2011; 2:278-86. [PMID: 23804985 PMCID: PMC3695419 DOI: 10.1177/2150135110397670] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to The International Society for Nomenclature of Pediatric and Congenital Heart Disease (ISNPCHD), "Heterotaxy is synonymous with 'visceral heterotaxy' and 'heterotaxy syndrome'. Heterotaxy is defined as an abnormality where the internal thoraco-abdominal organs demonstrate abnormal arrangement across the left-right axis of the body. By convention, heterotaxy does not include patients with either the expected usual or normal arrangement of the internal organs along the left-right axis, also known as 'situs solitus', or patients with complete mirror-imaged arrangement of the internal organs along the left-right axis also known as `situs inversus'." or patients with complete mirror-image arrangement of the internal organs along the left-right axis, also known as situs inversus. The purpose of this article is to review the data about heterotaxy in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. The investigators examined all index operations in the STS Congenital Heart Surgery Database over 12 years from January 1, 1998 to December 31, 2009, inclusive. This analysis resulted in a cohort of 77 153 total index operations. Of these, 1505 operations (1.95%) were performed in patients with heterotaxy. Of the 1505 index operations performed in patients with heterotaxy, 1144 were in patients with asplenia and 361 were in patients with polysplenia. In every STS -EACTS Congenital Heart Surgery Mortality Category, discharge mortality is higher in patients with heterotaxy compared with patients without heterotaxy (EACTS = European Association for Cardio-Thoracic Surgery). Discharge mortality after systemic to pulmonary artery shunt is 6.6% in a cohort of all single-ventricle patients except those with heterotaxy, whereas it is 10.8% in single-ventricle patients with heterotaxy. Discharge mortality after Fontan is 1.8% in a cohort of all single-ventricle patients except those with heterotaxy, whereas it is 4.2% in single-ventricle patients with heterotaxy. The STS Congenital Heart Surgery Database is largest congenital heart surgery database in North America. This review of data from the STS Congenital Heart Surgery Database allows for unique documentation of practice patterns and outcomes. From this analysis, it is clear that heterotaxy is a challenging problem with increased discharge mortality in most subgroups.
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Affiliation(s)
- Jeffrey Phillip Jacobs
- The Congenital Heart Institute of Florida (CHIF), All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSAoF), Saint Petersburg and Tampa, FL, USA
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