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Fahy L, Rowe S, Nehme Z, Stub D, Zentner D, James P, Pflaumer A, Connell V, Semsarian C, Ingles J, La Gerche A, Paratz ED. Prevalence of atrial septal defects and patent foramen ovale in a cohort of sudden cardiac death patients undergoing autopsy. J Cardiol 2024; 83:390-393. [PMID: 37734655 DOI: 10.1016/j.jjcc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Patent foramen ovale (PFO) and atrial septal defects (ASD) have been described in up to 30 % of subjects in autopsy series but contemporary data are scarce. It is important to confirm the prevalence of ASD/PFO in the general population given the potential associated stroke risk and the increasing availability of intervention via PFO closure. METHODS A state-wide prospective out-of-hospital cardiac arrest registry (OHCA) identified all patients aged 1 to 50 years who experienced OHCA in Victoria, Australia from April 2019 to April 2022 and subsequently underwent autopsy with a cardiac cause of death identified. Autopsy was performed including visual description of any ASD and identification of probe patency of foramen ovale. RESULTS A total of 517 patients underwent autopsy in the setting of sudden cardiac death; 36 patients (6.9 %) had a probe-patent foramen ovale, 2 patients (0.4 %) had secundum ASD, and 2 patients (0.4 %) had both a PFO and ASD (1 of whom had undergone percutaneous repair of both lesions). Twelve patients (2.3 %) had a prior history of cerebrovascular accident either recorded on medical history or detected on neuropathological examination; however none of these patients had a PFO or ASD. CONCLUSIONS The combined rate of PFO and ASD in a cohort of 517 patients undergoing autopsy was 7.9 %. None of these patients had experienced a cerebrovascular accident. This rate of PFOs appears lower than earlier reports and raises the possibility that the relative risk of an associated stroke could be higher than previously estimated.
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Affiliation(s)
- Louise Fahy
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Stephanie Rowe
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Ziad Nehme
- Ambulance Victoria, Doncaster, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Cardiology, Alfred Hospital, Prahran, VIC, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Children's Research Institute and University of Melbourne, Parkville, VIC, Australia; Department of Population Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and University of Sydney, Sydney, NSW, Australia
| | - Jodie Ingles
- Department of Population Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, VIC, Australia
| | - Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, VIC, Australia
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Amin A, Augustine M, Shafique MA, Mustafa MS, Mian ZR, Jaimes DCC, Gaudani A, Shaukat B, Kumar S, Aulakh SS, Jami E, Sharifa M, Ahuja K, Maslamani ANJ, Bhudia S. Left Atrial Septal Pouch (LASP) and cryptogenic stroke risk: An updated systematic review and meta-analysis of observational studies. Curr Probl Cardiol 2024; 49:102400. [PMID: 38232917 DOI: 10.1016/j.cpcardiol.2024.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND The left atrial septal pouch (LASP) is a small anatomical septal recess in the heart that has been linked with cardioembolic events. A systematic appraisal of the existing literature is necessary to establish a better understanding of the risk as studies continue to indicate a correlation between LASPs and cryptogenic strokes. OBJECTIVES To determine the level of association between the presence of LASP and the risk of developing cryptogenic stroke. METHODS We searched PubMed, EMBASE and Scopus for studies comparing the prevalence of LASP in patients with cryptogenic stroke against non-cryptogenic stroke control groups from inception till December, 2023. The Newcastle Ottawa scale was used for quality assessment and Comprehensive Meta-Analysis Version 3.3 was used for data analysis with odds ratio (OR) as the effect measure. RESULTS Our review included a total of 10 retrospective, observational studies published between 2010 to 2022. A total of 683 cases of cryptogenic strokes were identified, out of which 33.1 % (n = 271) were associated with a LASP. Among the non-cryptogenic stroke controls (n = 2641), LASP was present in 20.6 % cases (n = 476). The aggregate OR for cryptogenic stroke was 1.618 times greater than non-cryptogenic stroke (p < 0.001) among LASP cases, CONCLUSION: The presence of a septal pouch in the left atrium is significantly linked to a higher risk of developing cryptogenic strokes. As a potential site of thrombus formation and subsequent dislodgement, further large-scale studies are necessary to establish the guidelines for management and prophylaxis to prevent embolic events.
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Affiliation(s)
- Aamir Amin
- Department of Cardiothoracic Surgery, Harefield Hospital, London, United Kingdom.
| | | | - Muhammad Ashir Shafique
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan 75510.
| | - Muhammad Saqlain Mustafa
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan 75510.
| | | | | | | | | | - Sanjeev Kumar
- Horbachevsky Ternopil National Medical University, Ukraine.
| | | | - Elhama Jami
- Herat University Faculty of Medicine, Afghanistan.
| | | | | | | | - Sunil Bhudia
- Consultant Cardiac Surgeon, Harefield Hospital, London, United Kingdom.
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Tanghöj G, Naumburg E. Risk factors for isolated atrial septal defect secundum morbidity. Sci Rep 2024; 14:4757. [PMID: 38413680 PMCID: PMC10899192 DOI: 10.1038/s41598-024-55446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 02/23/2024] [Indexed: 02/29/2024] Open
Abstract
Atrial septal defect secundum is a common type of congenital heart defect and even more common among children born premature. The aim of this study was to assess premature birth as a potential associated risk factors for cardiac morbidity in children with isolated ASD II. In this retrospective national registry-based case-control study all children born in Sweden between 2010 and 2015 with an isolated ASD II diagnosis were included. Association between premature birth and cardiac morbidity in children with isolated ASD II was assessed by different outcomes-models using conditional logistic regression and adjustments were made for confounding factors. Overall, 11% of children with an isolated ASD II received treatment for heart failure. Down syndrome was the only independent risk factors for associated with cardiac morbidity in children with ASD II (OR = 2.25 (95%CI 1.25-4.07). Preterm birth in children was not associated with an increased risk of ASD II cardiac morbidity.
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Affiliation(s)
- Gustaf Tanghöj
- Unit of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Estelle Naumburg
- Unit of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
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4
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Delgado C, Ullery MA, Zeng G, Simpson EA, Tanner JP, Kirby RS, Duclos C, Lowry J, Salemi JL. Elevated risk for developmental disabilities in children with congenital heart defects. Birth Defects Res 2023; 115:1708-1722. [PMID: 37681320 DOI: 10.1002/bdr2.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This study examined risk for developmental disabilities in preschool-aged children with a congenital heart defect (CHD) at the population level. METHODS Statewide birth, birth defects, and preschool developmental disability records were integrated. The final sample included 1,966,585 children (51.0% male). Children were grouped by type(s) of CHD: critical CHD, noncritical CHD, atrial septal defect, or no major birth defects (groups were mutually exclusive). RESULTS Children with a CHD (any type) were at increased risk for developmental disability (any type) (RR 2.08, 95% CI 2.03-2.14, P < .001). Children in the critical CHD, noncritical CHD, and atrial septal defect groups were at increased risk for developmental delay, intellectual disability, language impairment, other health impairment, and any disability. Children in the atrial septal defect group were at increased risk for autism spectrum disorder and speech impairment. For all CHD groups, risk was greatest for other health impairment and intellectual disability. CONCLUSIONS Increased risk for developmental disabilities was identified for children with less severe CHDs as well as for children with more severe (critical) CHDs. All children with CHDs should be closely monitored so that appropriate interventions can be initiated as early as possible to maximize learning outcomes.
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Affiliation(s)
- Christine Delgado
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Mary Anne Ullery
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Guangyu Zeng
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | | | - J P Tanner
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Chris Duclos
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Joseph Lowry
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Jason L Salemi
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
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Hashem A, Khalouf A, Mohamed MS, Ismayl M, Kashou A, Chaaya RGB, Nayfeh T, Rai D, Sulaiman S, Balla S. Outcomes of Percutaneous Atrial Septal Defect Closure With Mitral Transcatheter Edge-to-Edge Repair and Transseptal Mitral Valve Replacement (2015 to 2020). Am J Cardiol 2023; 204:92-95. [PMID: 37541153 DOI: 10.1016/j.amjcard.2023.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
Patients who underwent transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) have a transeptal access created by an iatrogenic atrial septal defect (ASD) which leads to significant complications requiring closure. Given limited data, we used the National Inpatient Sample between 2015 and 2020 to evaluate the clinical outcomes of percutaneous closure of ASD (PC-ASD) in TEER/TMVR hospitalizations. A total of 44,065 eligible weighted hospitalizations with either TEER (n = 39,625, 89.9%) or TMVR (n = 4,440, 10.1%) with a higher rate of PC-ASD in the TMVR group (10.7% vs 2.0%, p <0.01). The TEER with PC-ASD group were more likely to experience acute heart failure and right ventricular failure and had longer hospital stays but there was no difference in in-hospital mortality compared with the no PC-ASD group. In the TMVR group, there was no difference in the odds of acute heart failure, right ventricular failure, cardiogenic shock, or acute hypoxic respiratory failure, but the odds of mechanical circulatory support, in-hospital mortality, and length of stay were significantly higher in patients with PC-ASD in the TMVR group. In conclusion, rates of percutaneous closure of ASD after TEER were lower than after TMVR and associated with worse in-hospital mortality in TMVR but not in TEER. Further prospective clinical trials are needed to identify patients who would benefit from the closure of iatrogenic ASD.
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Affiliation(s)
- Anas Hashem
- Department of Medicine, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Amani Khalouf
- Department of Medicine, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Mohamed Salah Mohamed
- Department of Medicine, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Mahmoud Ismayl
- Cardiovascular Disease Department, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Anthony Kashou
- Cardiovascular Disease Department, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Rody G Bou Chaaya
- Cardiovascular Disease Department, Houston Methodist Hospital, Houston, Texas
| | - Tarek Nayfeh
- Evidence-Based Medicine Department, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Devesh Rai
- Cardiovascular Disease Department, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Samian Sulaiman
- Cardiovascular Disease Department, West Virginia University, Morgantown, West Virginia
| | - Sudarshan Balla
- Cardiovascular Disease Department, West Virginia University, Morgantown, West Virginia.
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Nielsen AKM, Ellesøe SG, Larsen LA, Hjortdal V, Nyboe C. Comparison of Outcome in Patients With Familial Versus Spontaneous Atrial Septal Defect. Am J Cardiol 2022; 173:128-131. [PMID: 35361477 DOI: 10.1016/j.amjcard.2022.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/18/2022]
Abstract
Patients with atrial septal defects (ASDs) have increased mortality and morbidity. This can only partly be explained by hemodynamic changes caused by the ASD, suggesting additional underlying causes. Patients with an ASD have an increased burden of pathogenic gene variants in ASD-related genes, indicating genetics as an important factor in etiology. Inheritance of genetic variants with high impact can cause ASD in relatives (familial ASD). This study aimed to investigate whether lifelong outcomes were different in patients with familial ASD compared with patients with sporadic ASD. We used health registries and a nationwide cohort of 2,151 patients with ASD to compare the incidences of atrial fibrillation or flutter (together abbreviated as AF), heart failure, and mortality between patients with familial and sporadic ASD using Cox proportional hazard ratio and Fine and Gray analysis. Patients with familial ASD experienced AF and heart failure earlier in life than patients with sporadic ASD, with hazard ratios of 1.6 and 1.7, respectively. Subdistribution hazard ratios showed an increased risk of AF and heart failure in patients with familial ASD compared with patients with sporadic ASDs (2.3 and 3.1, respectively). Our results suggest that genetic variants with high impact may influence the outcomes of patients with ASD. In conclusion, patients with familial ASD have an increased risk and an earlier onset of AF and heart failure compared with patients with sporadic ASD, hence clinical awareness of arrhythmias and heart failure in patients with familial ASD may lead to timely treatment.
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Affiliation(s)
| | | | - Lars Allan Larsen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Camilla Nyboe
- Cardiothoracic Anaesthesia, Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
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Muñoz M M, Kilchemmann F C, Román N A, Baeza W B. [Prevalence of congenital malformations in newborns in the Araucanía region]. Andes Pediatr 2022; 93:383-391. [PMID: 35857009 DOI: 10.32641/andespediatr.v93i3.3854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/04/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Annually, 7.9 million neonates in the world have developmental anomalies. Together with prema turity, they constitute the main causes of mortality during the first year of life in developed and de veloping countries. In Chile, the estimated prevalence is 3.9% of all live births. There are no reports on the prevalence of malformations in the Araucanía Region. OBJECTIVE to estimate the prevalence of congenital malformations at birth in neonates hospitalized in a Neonatology Service. PATIENTS AND METHOD cross-sectional study. Reference population: 54,241 live births at the Regional Hospi tal of Temuco over a 10-year period. Cases came from the neonatology hospital discharge database according to the ICD 10 classification, from January 1, 2009, to December 31, 2018. Descriptive and analytical statistics were performed with the STATA 15 software. RESULTS 949 neonates with one or more congenital malformations were identified. The overall prevalence of neonates with malforma tions was 1.7%, the most prevalent being ventricular septal defect 40.9 x 10,000 live newborns (LNB), atrial septal defect 21.5 x 10,000 LNB, cleft lip and palate 14.0 x 10,000 LNB, congenital hypertrophic cardiomyopathies 8.1 x 10,000 LNB, and congenital rectal atresia and stenosis or absence of the anus 7.9 x 10,000 LNB. CONCLUSIONS the overall prevalence of malformations is similar to that reported for the country. When analyzing by type, we found significantly higher incidences than those repor ted in previous studies.
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Michałowska I, Dudzińska K, Kowalik I, Kwiatek P, Piotrowski R, Kułakowski P, Baran J. Left Atrial Septal Pouch-Is it Really a New Risk Factor for Ischemic Stroke?: Subanalysis of the ASSAM Study. J Thorac Imaging 2022; 37:168-172. [PMID: 33595242 DOI: 10.1097/rti.0000000000000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The atrial septal pouch is an anatomic variant of the interatrial septum caused by incomplete fusion of the septum primum and secundum. It is debatable whether coexistence of septal pouch and atrial fibrillation (AF) increases the risk of stroke. Thus, the aim of the study was to evaluate the coexistence of left atrial septal pouch (LASP) and AF in patients with a history of stroke in comparison with those without an earlier history of stroke. MATERIALS AND METHODS We analyzed 145 patients with AF (68 in the study group, 77 in the control group). The study group consisted of patients with previous stroke and AF; control group consisted of patients scheduled for AF ablation. All patients underwent computed tomography with the assessment of atrial septum morphology and presence of LASP. The study was a subanalysis of the ASSAM (AssesSment of the left atrial appendage morphoLogy in patients aAfter ischaeMic Stroke) study. RESULTS The prevalence of LASP in the entire group was 38.6%. There were no significant differences in the prevalence of LASP between the study and control groups (33.8% vs. 42.9%, P=0.265). Mean longitudinal and transverse dimensions of LASP were 9.34±3.27 and 2.4±0.6 mm, respectively, and there was no significant difference between the study and controls. Patients from the stroke group were older (P<0.0001), had a higher CHA2DS2-VASc score (5.41±1.93 vs. 1.62±1.46, P<0.0001) compared with controls. CONCLUSIONS Presence of LASP is not more prevalent in patients with a history of stroke. Additional information on the presence of LASP do not improve accuracy of risk stratification for stroke in patients with AF.
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Affiliation(s)
| | - Katarzyna Dudzińska
- Department of Cardiology, Division of Clinical Electrophysiology, Centre of Postgraduate Medical Education, Grochowski Hospital
| | - Ilona Kowalik
- 2nd Department of Coronary Artery Disease, National Institute of Cardiology, Warsaw, Poland
| | - Paweł Kwiatek
- Department of Radiology, National Institute of Cardiology
| | - Roman Piotrowski
- Department of Cardiology, Division of Clinical Electrophysiology, Centre of Postgraduate Medical Education, Grochowski Hospital
| | - Piotr Kułakowski
- Department of Cardiology, Division of Clinical Electrophysiology, Centre of Postgraduate Medical Education, Grochowski Hospital
| | - Jakub Baran
- Department of Cardiology, Division of Clinical Electrophysiology, Centre of Postgraduate Medical Education, Grochowski Hospital
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Olesovsky C, Muthuppalaniappan A, Schneider H, Abrahamyan L, Meier L, Alnasser S, Shah A, Bach Y, Frankfurter C, Benson L, Osten M, Horlick EM. Routine Coronary Angiography in Adults Undergoing Percutaneous Atrial Septal Defect Closure: Implications for Practice Guidelines. J Invasive Cardiol 2021; 33:E777-E783. [PMID: 34559673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Secundum atrial septal defect (ASD) is a common adult congenital heart lesion for which percutaneous closure offers treatment in patients with suitable anatomy. We sought to determine the outcomes of coronary angiography in a population of adults >40 years of age who were undergoing percutaneous ASD closure. METHODS Patients >40 years of age who underwent ASD closure between 2009-2016 were included in this retrospective chart review. Coronary angiograms were reviewed by 2 independent reviewers to evaluate the presence and degree of coronary artery disease (CAD) and the resulting clinical sequelae. RESULTS A total of 398 patients underwent ASD closure, and 300 had coronary angiography at the time of closure. Mild CAD (10%-39% vessel stenosis) was found in 33 patients (11.0%), moderate CAD (40%-69% vessel stenosis) in 23 patients (7.7%), and severe CAD (≥70% vessel stenosis) in 25 patients (8.3%). Of the 48 patients with moderate to severe CAD, 24 had proximal vessel disease and 21 had multivessel disease. Four patients (8.3%) with moderate to severe CAD subsequently underwent percutaneous interventions, 16 patients (33.3%) had medication changes, 16 patients (33.3%) had perfusion testing followed by medication changes, and 12 patients (25%) had no changes in their medical management. CONCLUSIONS Given the prevalence of CAD in this population, routine coronary angiography at the time of ASD closure should be reserved for patients with an unfavorable cardiovascular risk profile, who have a higher likelihood of CAD. While patients with ASDs suffer from chest pain and dyspnea both before and after percutaneous closure, few have established CAD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Eric M Horlick
- Toronto General Hospital, 200 Elizabeth St, 6E - Room 249, Toronto, Ontario, M5G 2C4.
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Yan F, Liu H, Zhang H, Yi L, Wu Y, Deng C, Qiu Y, Ma X, Li Q, Yang F, Xu W, Tao J, Buonocore JJ, Zhan Y, Dai L. Association between maternal exposure to gaseous pollutants and atrial septal defect in China: A nationwide population-based study. Environ Res 2021; 200:111472. [PMID: 34097890 DOI: 10.1016/j.envres.2021.111472] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The association between maternal exposure to gaseous air pollutants and congenital heart defects (CHD) remains unclear. The concentration-response relationship and the time windows of susceptibility to gaseous pollutants may vary by pollutant species and CHD subtypes. OBJECTIVE We aimed to examine the relationship between maternal exposures to four species of gaseous pollutants (NO2, O3, SO2, and CO) and atrial septal defect (ASD), which is a common subtype of CHD, and to determine the critical time windows of susceptibility for each gaseous pollutant. METHODS Among 1,253,633 infants born between October 1, 2013 and December 31, 2016 in China, 1937 newborns were diagnosed with isolated ASD, a prevalence of 1.55‰. Maternal exposures to the gaseous pollutants were estimated by matching the geocoded maternal addresses with the gridded ambient concentrations. The adjusted odds ratios (aOR) between exposures and ASD were quantified by using mixed-effects logistic regression models. RESULTS We found significantly positive associations between ASD and maternal exposures to NO2, O3, SO2, and CO during entire pregnancy, first-, second-, and third-trimester. However, no statistically significant association was found between maternal exposure to PM2.5, PM2.5-10 and ASD risk (P > 0.05). In the fully adjusted model with respect to average exposure over entire pregnancy, the adjusted odds ratios (aOR) for each 10 μg/m3 increment of NO2, O3, SO2 were 1.33 (95% CI: 1.22-1.45), 1.13 (95% CI: 1.10-1.16), 1.28 (95% CI: 1.20-1.35), respectively; the aOR for each 100 μg/m3 increment of CO was 1.10 (95% CI: 1.06-1.15). The observed concentration-response relationships varied by exposure periods and pollutants, with the strongest association for NO2 during the 1st-8th embryology weeks, for O3 during the third trimester, for SO2 during the second trimester, and for CO without obvious variation. CONCLUSIONS The findings suggest an increased risk of ASD in association with maternal exposures to four common gaseous pollutants. From the perspective of birth defects prevention and ASD risk mitigation, it is critical to reduce maternal exposure to gaseous pollutants especially during the most susceptible time windows.
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Affiliation(s)
- Fangyuan Yan
- Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hanmin Liu
- Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hanyue Zhang
- Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China
| | - Ling Yi
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yangyang Wu
- Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China
| | - Changfei Deng
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yang Qiu
- Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China
| | - Xia Ma
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qi Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Fumo Yang
- Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; National Engineering Research Center for Flue Gas Desulfurization, Chengdu, Sichuan, 610065, China
| | - Wenli Xu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jing Tao
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jonathan J Buonocore
- Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health, Boston, MA, 02115, United States
| | - Yu Zhan
- Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; National Engineering Research Center for Flue Gas Desulfurization, Chengdu, Sichuan, 610065, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Li Dai
- The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China; National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, China.
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Sugimori H, Nakao T, Ikegaya Y, Iwahashi D, Tsuda S, Kume N, Onishi H, Nakamura S. Coronary sinus atrial septal defects in adults over the past 20 years at new Tokyo hospital: case series. J Cardiothorac Surg 2021; 16:150. [PMID: 34051799 PMCID: PMC8164258 DOI: 10.1186/s13019-021-01522-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/07/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND An isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed. CASE PRESENTATION The patients were three women and two men with an age range of 63-77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. CONCLUSIONS CS ASD (Kirklin and Barratt-Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.
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Affiliation(s)
| | - Tatsuya Nakao
- New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Yuki Ikegaya
- New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Daisuke Iwahashi
- New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Shoichi Tsuda
- New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Nao Kume
- New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Hirokazu Onishi
- New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Sunao Nakamura
- New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
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12
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Zikarg YT, Yirdaw CT, Aragie TG. Prevalence of congenital septal defects among congenital heart defect patients in East Africa: A systematic review and meta-analysis. PLoS One 2021; 16:e0250006. [PMID: 33886628 PMCID: PMC8062078 DOI: 10.1371/journal.pone.0250006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Congenital heart defects (CHDs) are the most common congenital defects and accounts for nearly one-third of all major congenital anomalies. It is the leading causes of birth defect-associated morbidity, mortality, and medical expenditures. Of all CHD types, ventricular septal defect (VSD) and atrial septal defect (ASD) accounted 51% of cases with an increasing trend over time. Objective The aim of this review is to estimate the pooled prevalence of ventricular septal defect and congenital atrial septal defect among congenital heart diseases patients in East African context. Methods Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence of Ventricular septal defect and atrial septal defect in East Africa, from Medline (PubMed), Cochrane Library, HINARI, and Google Scholar. A weighted inverse variance random-effects model was used to estimate the pooled prevalence of ventricular septal defect and atrial septal defect. Results A total of 2323 studies were identified; 1301 from PubMed, 12 from Cochrane Library, 1010 from Google Scholar and 22 from other sources. The pooled prevalence of ventricular septal defect and atrial septal defect in East Africa was found to be 29.92% (95% CI; 26.12–33.72; I2 = 89.2%; p<0.001), and 10.36% (95% CI; 8.05–12.68; I2 = 89.5%; p<0.001) respectively. Conclusions and future implications Based on this review, the pooled prevalence of VSD and ASD is still high and alarming; this signifies that the emphasis given for congenital heart defect in East African countries is limited. Special attention and efforts should be applied for early detection to prevent serious complications and for a better prognosis of all forms of CHD. A screening program for CHD should be instituted during the perinatal period. Furthermore, early referral of suspected cases of congenital cardiac anomalies is mandatory for better management till the establishment of cardiac centers in different regions of the continent.
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Affiliation(s)
- Yossef Teshome Zikarg
- College of Health Sciences, School of Medicine, Department of Anatomy, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Abstract
IMPORTANCE In early 2020, the United States declared a public health emergency in response to coronavirus disease 2019 (COVID-19) and implemented a variety of social distancing measures. The association between the COVID-19 pandemic and the number of pediatric admissions is unclear. OBJECTIVE To determine the changes in patterns of pediatric admissions in 2020 compared with the prior decade. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 49 US hospitals contributing to the Pediatric Health Information Systems database. Inpatient admissions were transformed into time-series data, and ensemble forecasting models were generated to analyze admissions across a range of diagnoses in 2020 compared with previous years. The setting was inpatient admissions. All patients discharged between January 1, 2010, and June 30, 2020, from an inpatient hospital encounter were included. MAIN OUTCOMES AND MEASURES Number of hospital admissions by primary diagnosis for each encounter. RESULTS Of 5 424 688 inpatient encounters among 3 372 839 patients (median [interquartile range] age, 5.1 [0.7-13.3] years; 2 823 748 [52.1%] boys; 3 171 224 [58.5%] White individuals) at 49 hospitals, 213 571 (3.9%) were between January 1, 2020, and June 30, 2020. There was a decrease in the number of admissions beginning in March 2020 compared with the period from 2010 to 2019. At the nadir, admissions in April 2020 were reduced 45.4% compared with prior years (23 798 in April 2020 compared with a median [interquartile range] of 43 550 [42 110-43 946] in April 2010-2019). Inflation-adjusted hospital charges decreased 27.7% in the second quarter of 2020 compared with prior years ($4 327 580 511 in 2020 compared with a median [interquartile range] of $5 983 142 102 [$5 762 690 022-$6 324 978 456] in 2010-2019). Seasonal patterns were evident between 2010 and 2019 for a variety of common pediatric conditions, including asthma, atrial septal defects, bronchiolitis, diabetic ketoacidosis, Kawasaki syndrome, mental health admissions, and trauma. Ensemble models were able to discern seasonal patterns in admission diagnoses and accurately predicted admission rates from July 2019 until December 2019 but not from January 2020 to June 2020. All diagnoses except for birth decreased below the model 95% CIs between January 2020 and June 2020. CONCLUSIONS AND RELEVANCE In this cross-sectional study, pediatric admissions to US hospitals decreased in 2020 across an array of pediatric conditions. Although some conditions may have decreased in incidence, others may represent unmet needs in pediatric care during the COVID-19 pandemic.
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Affiliation(s)
- Jonathan H. Pelletier
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaskaran Rakkar
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alicia K. Au
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana Fuhrman
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert S. B. Clark
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher M. Horvat
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Health Informatics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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14
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O'Neill L, Floyd CN, Sim I, Whitaker J, Mukherjee R, O'Hare D, Gatzoulis M, Frigiola A, O'Neill MD, Williams SE. Percutaneous secundum atrial septal defect closure for the treatment of atrial arrhythmia in the adult: A meta-analysis. Int J Cardiol 2020; 321:104-112. [PMID: 32679141 DOI: 10.1016/j.ijcard.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/24/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atrial arrhythmias are common in patients with atrial septal defects (ASD) but the effects of percutaneous closure on atrial arrhythmia prevalence is unclear. We investigated the effects of ASD device closure and the impact of age at time of closure on prevalent atrial arrythmia. METHODS Meta-analysis of studies reporting atrial arrhythmia prevalence in adult patients before and after percutaneous closure was performed. Primary outcomes were prevalence of 'all atrial arrhythmia' and atrial fibrillation alone post closure. Sub-group analysis examined the effects of closure according to age in patients; <40 years, ≥40 and ≥ 60 years. 25 studies were included. RESULTS Meta-analysis of all studies demonstrated no reduction in all atrial arrhythmia or atrial fibrillation prevalence post-closure (OR 0.855, 95% CI 0.672 to 1.087, P = .201 and OR 0.818, 95% CI 0.645 to 1.038, P = .099, respectively). A weak reduction in all atrial arrhythmia and atrial fibrillation was seen in patients ≥40 years (OR 0.77, 95% CI 0.616 to 0.979, P = .032 and OR 0.760, 95% CI 0.6 to 0.964, P = .024, respectively) but not ≥60 years (OR 0.822, 95% CI 0.593 to 1.141, P = .242 and OR 0.83, 95% CI 0.598 to 1.152, P = .266, respectively). No data were available in patients <40 years. This, and other limitations, prevents conclusive assessment of the effect of age on arrhythmia prevalence. CONCLUSIONS Overall, percutaneous ASD closure is not associated with a reduction in atrial arrhythmia prevalence in this meta-analysis. A weak benefit is seen in patients ≥40 years of age, not present in patients ≥60 years.
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Affiliation(s)
| | - Christopher N Floyd
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Iain Sim
- King's College London, London, United Kingdom
| | | | | | | | - Michael Gatzoulis
- Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | - Steven E Williams
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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15
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Christodoulos IN, Chyou TY, Nishtala PS. Safety of fluoxetine use in children and adolescents: a disproportionality analysis of the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Eur J Clin Pharmacol 2020; 76:1775-1776. [PMID: 32719920 DOI: 10.1007/s00228-020-02970-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Te-Yuan Chyou
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Prasad S Nishtala
- Department of Pharmacy & Pharmacology, University of Bath, Bath, BA2 7AY, UK.
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16
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Namuyonga J, Lubega S, Aliku T, Omagino J, Sable C, Lwabi P. Pattern of congenital heart disease among children presenting to the Uganda Heart Institute, Mulago Hospital: a 7-year review. Afr Health Sci 2020; 20:745-752. [PMID: 33163039 PMCID: PMC7609125 DOI: 10.4314/ahs.v20i2.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common congenital anomaly in children. Over half of the deaths due to CHD occur in the neonatal period. Most children with unrepaired complex heart lesions do not live to celebrate their first birthday. We describe the spectrum of congenital heart disease in Uganda. METHODS We retrospectively reviewed the data of children with CHD who presented to the Uganda Heart Institute (UHI), Mulago Hospital Complex from 2007 to 2014. RESULTS A total of 4621 children were seen at the UHI during the study period. Of these, 3526 (76.3%) had CHD; 1941(55%) were females. Isolated ventricular septal defect (VSD) was the most common CHD seen in 923 (27.2%) children followed by Patent ductus arteriosus (PDA) 760 (22%) and atrial septal defects (ASD) 332 (9.4%). Tetralogy of Fallot (TOF) and Truncus arteriosus were the most common cyanotic heart defects (7% and 5% respectively). Dysmorphic features were diagnosed in 185 children, of which 61 underwent genetic testing (Down syndrome=24, 22q11.2 deletion syndrome n=10). Children with confirmed 22q11.2 deletion had conotruncal abnormalities. CONCLUSION Isolated VSD and Tetralogy of Fallot are the most common acyanotic and cyanotic congenital heart defects. We report an unusually high occurrence of Truncus arteriosus.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/epidemiology
- Echocardiography
- Female
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/epidemiology
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Ventricular/diagnostic imaging
- Heart Septal Defects, Ventricular/epidemiology
- Humans
- Infant
- Infant, Newborn
- Male
- Prevalence
- Retrospective Studies
- Rubella Syndrome, Congenital
- Sex Distribution
- Tetralogy of Fallot/epidemiology
- Truncus Arteriosus/diagnostic imaging
- Uganda/epidemiology
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Affiliation(s)
- Judith Namuyonga
- Uganda Heart Institute
- Makerere University College of Health Sciences
| | | | | | | | - Craig Sable
- Children's National Medical Center, Washington DC
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17
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Boudiche S, Chatti S, Amroussia R, Mghaieth F, Ziadi J, Farhati A, Ben Hammamia M, Tekaya MA, Ouali S, Guedira F, Denguir R, Mourali MS. Atrial septal defect closure in adults: A ten-year experience. Tunis Med 2019; 97:1362-1369. [PMID: 32173806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Atrial septal defects (ASD) constitute the most frequent congenital heart disease in adults and ostium secundum (OS) the most common type. Benefit of its closure in adulthood has long been controversial. AIM To evaluate outcomes of OS-ASD closure in adults. METHODS Retrospective cohort study, over a ten-year period from 2008 to 2018. All adults (≥20 years old) who benefited from OS-ASD closure were included. Study endpoints were closure success rate, functional status evolution and incidence of new arrhythmias at 12 months. RESULTS Fifty patients were recruited. Dyspnea (≥ NYHA II) was noted in 58% and arrhythmia in 18% of patients. Feasibility of a percutaneous closure was 50%. Closure success rate was 100%. Surgery was associated with high postoperative morbidity with longer hospitalization stay (20 vs. 4 days, p <0.001). At 12 months, an improvement in functional status was observed in 79%. Incidence of new arrhythmias was 5%. A significant decrease in right cavities dilation as well as pulmonary arterial pressure has been reported. CONCLUSIONS Immediate results of OS-ASD closure in adults are satisfactory. Percutaneous closure is associated with reduced hospital morbidity. At 12 months, a significant improvement in functional status was observed however the possible occurrence of new arrhythmias imposes a close follow-up.
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18
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Mahmoud H, Nicolescu A, Filip C, Duica G, Nicolae G, Cinteza EE. Cocoon devices for transcatheter closure of atrial septal defect and patent ductus arteriosus in children: Single center experience. Medicine (Baltimore) 2019; 98:e14684. [PMID: 30855458 PMCID: PMC6417521 DOI: 10.1097/md.0000000000014684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Closure of the atrial septal defect (ASD) and patent ductus arteriosus (PDA) are among the most frequent cardiac interventional procedures. This was a prospective study, which started together with the implementation of a national program of pediatric interventional cardiology in Romania. We used Cocoon devices in 83 consecutive cases from 92 implantations for ASD and PDA. 27 cases were ASD closure and 56 cases PDA closure. Regarding the ASD closure, the median age was 8.5 years (range 3-25 years) and median weight 25 kg (range 11.5-63 kg). The mean follow-up was 17.4 ± 6.7 months (range 3-26 months). The mean ASD diameter by transesophageal echocardiography was 15.2 ± 4.1 mm (range 8-26 mm). The mean device diameter used was 17.3 ± 5.6 mm (range 8-32 mm). Regarding the PDA closure, the median age was 36 months (range 4-192 months) and median weight 14 kg (range 5-58 kg). The mean follow-up was 15 ± 8 months (range 3-28 months). The mean PDA minimum diameter was 2.5 ± 0.8 mm. The success implantation rate for both groups was 97.6% (2 cases of withdrawn for ASD and PDA), while the complication rate was 2.3% (including 2 ASD device embolization). In the first 24 hours, the closure rates were 96.3% for ASD, 98.2% for PDA, and 100% at 1-month follow-up for both procedures. On short and intermediate follow-up (3-28 months), no device-related complications were noted.The Cocoon devices are safe for transcatheter closure of both ASD and PDA, and the initial experience with their use in our emerging center is encouraging.
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Affiliation(s)
- Hyam Mahmoud
- “Marie Curie” Emergency Children's Hospital, Constantin Brâncoveanu Avenue, Bucharest, Romania
- Royal Manchester Children's Hospital, Oxford Road, Manchester, United Kingdom
| | - Alin Nicolescu
- “Marie Curie” Emergency Children's Hospital, Constantin Brâncoveanu Avenue, Bucharest, Romania
| | - Cristina Filip
- “Marie Curie” Emergency Children's Hospital, Constantin Brâncoveanu Avenue, Bucharest, Romania
| | - Gabriela Duica
- “Marie Curie” Emergency Children's Hospital, Constantin Brâncoveanu Avenue, Bucharest, Romania
| | - Georgiana Nicolae
- “Marie Curie” Emergency Children's Hospital, Constantin Brâncoveanu Avenue, Bucharest, Romania
| | - Eliza Elena Cinteza
- “Marie Curie” Emergency Children's Hospital, Constantin Brâncoveanu Avenue, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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19
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Kumar KR, Clark DA, Kim EM, Perry JD, Wright K, Thomas SA, Thompson EJ, Greenberg RG, Smith PB, Benjamin DK, Laughon MM, Clark RH, Hornik CP. Association of Atrial Septal Defects and Bronchopulmonary Dysplasia in Premature Infants. J Pediatr 2018; 202:56-62.e2. [PMID: 30172431 PMCID: PMC6317846 DOI: 10.1016/j.jpeds.2018.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/04/2018] [Accepted: 07/06/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the association between the presence of an atrial septal defect (ASD) and the odds of developing bronchopulmonary dysplasia (BPD) in premature infants. STUDY DESIGN We identified a cohort of infants that underwent at least one echocardiogram assessment, birth weight 501-1249 g, and gestational age 23-30 weeks discharged from the neonatal intensive care unit from 2004 to 2016. We used a BPD risk estimator to calculate the predicted risk of developing BPD at 6 postnatal ages within the first 28 days of life. We examined the association between the presence of an ASD and the development of BPD using 2 multivariable logistic regression models for each BPD risk severity on each postnatal day. The first model adjusted for predicted BPD risk and the second added therapeutic interventions for BPD. RESULTS Of 20 496 infants from 228 NICUs who met inclusion criteria, 8892 (43%) were diagnosed with BPD and 1314 (6%) had an ASD. BPD was present in 48% of infants with an ASD and 43% of infants without an ASD. In infants with an ASD, the OR of developing BPD was higher after adjusting for predicted risk of BPD plus therapeutic interventions, regardless of postnatal age or predicted BPD risk severity. CONCLUSIONS The presence of an ASD was associated with an increased odds of BPD in this cohort. Future trials should consider ASD as a potentially modifiable risk factor in this vulnerable population.
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Affiliation(s)
- Karan R Kumar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - David A Clark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Evan M Kim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Jasmine D Perry
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kaylyn Wright
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Sheikisha A Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Matthew M Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
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Abstract
The aim of the study was to compare transesophageal echocardiography (TEE) and fluoroscopy for percutaneous atrial septal defect (ASD) closure.This was a retrospective analysis of children who underwent percutaneous ASD closure. The procedure was guided by TEE without fluoroscopy in 130 patients (TEE group) and by fluoroscopy in 163 patients (fluoroscopy group). Baseline demographic/clinical characteristics were recorded. Patients were followed until hospital discharge. Outcomes were procedure duration, peri/postoperative complications, hospital stay, and costs.The TEE and fluoroscopy groups showed no significant differences in age (71.7 ± 40.7 vs 62.5 ± 38.8 months), male/female ratio (54/76 vs 66/97), weight (22.0 ± 12.0 vs 20.1 ± 9.0 kg), ASD diameter (9.9 ± 4.2 vs 9.3 ± 3.9 cm), distances to the superior vena cava (13.4 ± 4.6 vs 13.3 ± 4.2 cm), inferior vena cava (13.4 ± 4.3 vs 13.9 ± 4.1 cm) and atrial septal roof (12.1 ± 4.0 vs 12.3 ± 3.2 cm), or atrial septal size (38.2 ± 6.2 vs 39.4 ± 26.6 cm); distance to the mitral valve was greater in the TEE group (13.2 ± 4.4 vs 11.3 ± 3.9 cm; P < .001). The TEE and fluoroscopy groups showed no significant differences in occlusion device size (14.3 ± 4.6 vs 13.8 ± 4.0 cm) or sheath size (8.7 ± 1.8 vs 8.7 ± 0.9 cm), but procedure duration was shorter in the TEE group (21.5 ± 14.6 vs 28.6 ± 10.9 minutes; P < .001). Postoperative fever (>38°C) occurred less frequently in the TEE group than in the fluoroscopy group (0.8% vs 9.2%; P < .001); there were no significant differences for the other complications. No patient had postoperative residual shunt, occlusion device shedding/displacement, or pericardial effusion. The TEE group had longer hospital stay (3.2 ± 0.6 vs 2.9 ± 0.6 days; P < .001) and higher procedure cost (29,687 ± 4218 vs 28,530 ± 1668 CNY (China Yuan); P = .002) than the fluoroscopy group.TEE-guided percutaneous ASD closure can be used as an alternative to fluoroscopy-guided procedures and avoids the use of radiation or contrast agents.
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21
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Msaad H, Drissa M, Mahfoudhi H, Hakim K, Ouarda F. Particularities of neonatal isthmic aortic coarctation (A Tunisian study). Tunis Med 2018; 96:514-519. [PMID: 30430531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
METHODS This is a retrospective study including 47 patients with isthmic coarctation (CoA) diagnosed in ante et postnatal périod, hospitalized in pediatric cardiology departement of la Rabta Hospital-Tunisia during the period from 2000 to 2017. RESULTS They were 36 girls and 11 boys with an average age of 14 days. The diagnosis of CoA was suspected during the anténatalperiod in eight cases. In postnatal period heart failure was observed in (38.5%), abolition of femoral pulse (74%), a tension asymetry was found in all patients. Antenatal echocardiography suspected indicators of fetal coarctation especially ventriculo-arterial asymmetryechocardiography confirmed the diagnosis of CoA ,The ejection fraction was impaired in 31% of the cases.The abnormalities associated with coarctation were dominated by the patent ductus arteriosus (68%), atrial septal defect (55.5%), aortic hypoplasia, bicuspidia in respectively in 34% and 31% coarctation syndrome in (23.4%). Prostaglandin wasneccessary in (89.3%). forty two patients were operated with good immédiaterésults. the early postoperative mortality was 12.5%. In the long term, we deplored two late deaths, six cases of recoarctation with a follow-up of 14 months treated by percutaneous angioplasty with a result considered good in all cases. CONCLUSION Coarctation of the aorta in neonates is a special form of aorticcoarctaion that differs from the child and adult forms in clinical, echocardiographic, and therapeutic characteristics . His clinical diagnosis must be early, if possible in antenatal , to asssure optimal management.
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MESH Headings
- Angioplasty
- Aortic Coarctation/diagnosis
- Aortic Coarctation/epidemiology
- Aortic Coarctation/therapy
- Echocardiography
- Female
- Gestational Age
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Atrial/therapy
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/therapy
- Male
- Pregnancy
- Prenatal Diagnosis/statistics & numerical data
- Retrospective Studies
- Tunisia/epidemiology
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22
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Chughtai M, Perfetti DC, Khlopas A, Sultan AA, Sodhi N, Newman JM, Gwam CU, Maheshwari AV, Mont MA. Does Atrial Septal Defect Increase the Risk of Stroke Following Total Hip and Knee Arthroplasty? Surg Technol Int 2017; 31:177-181. [PMID: 29310146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Atrial septal defect (ASD) is a common asymptomatic congenital heart condition that predisposes patients to paradoxical emboli in the cerebral vasculature. In this study, we evaluated the prevalence of ASD and risk of stroke for patients with ASD undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). MATERIALS AND METHODS We used the New York Statewide Planning and Research Cooperative System to identify 258,911 elective primary THA/TKA between 2005 and 2014, including 140 patients with ASD. Logistic regression models calculated odds ratios (OR) and 95% confidence intervals (CI) and controlled for demographic and medical risk factors for stroke. RESULTS The prevalence of ASD was 54 per 100,000 patients undergoing THA/TKA. The rate of stroke within 30 days of surgery was 5.7% (95% CI: 2.5%, 11.0%) for patients with ASD, and 0.1% (95% CI: 0.1%, 0.1%) for all other patients. In regression models, the risk of stroke was 70 times greater (OR: 70.0, 95% CI: 32.9, 148.9) for patients with ASD compared to patients without this condition (p<0.001). CONCLUSIONS Patients with ASD undergoing THA and TKA are predisposed to stroke in the postoperative period. Orthopaedic surgeons indicating patients for surgery and internists performing preoperative medical clearance should be aware of these risks and discuss them prior to surgery. The efficacy of pharmacological and surgical measures to reduce postoperative stroke within this patient population should be topics of future investigation.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Female
- Heart Septal Defects, Atrial/epidemiology
- Humans
- Male
- Middle Aged
- Postoperative Complications/epidemiology
- Prevalence
- Retrospective Studies
- Risk Factors
- Stroke/epidemiology
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Affiliation(s)
- Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Dean C Perfetti
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jared M Newman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Chukwuweike U Gwam
- Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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23
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Fogleman ND, Apers S, Moons P, Morrison S, Wittekind SG, Tomlin M, Gosney K, Sluman MA, Johansson B, Enomoto J, Dellborg M, Lu CW, Subramanyan R, Luyckx K, Budts W, Jackson J, Kovacs A, Soufi A, Eriksen K, Thomet C, Berghammer M, Callus E, Fernandes SM, Caruana M, Cook SC, Mackie AS, White KS, Khairy P, Kutty S, Veldtman G. Regional variation in quality of life in patients with a Fontan circulation: A multinational perspective. Am Heart J 2017; 193:55-62. [PMID: 29129255 DOI: 10.1016/j.ahj.2017.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Impaired quality of life (QOL) is associated with congenital heart disease (CHD) and country of residence; however, few studies have compared QOL in patients with differing complexities of CHD across regional populations. The current study examined regional variation in QOL outcomes in a large multinational sample of patients with a Fontan relative to patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). METHODS From the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study (APPROACH-IS), 405 patients (163 Fontan and 242 ASD/VSD) across Asia, Europe, and North America provided consent for access to their medical records and completed a survey evaluating QOL (0 to 100 linear analog scale). Primary CHD diagnosis, disease complexity, surgical history, and documented history of mood and anxiety disorders were recorded. Differences in QOL, medical complications, and mood and anxiety disorders between Fontan and ASD/VSD patients, and across geographic regions, were examined using analysis of covariance. Hierarchical regression analyses were conducted to identify variables associated with the QOL ratings. RESULTS Patients with a Fontan reported significantly lower QOL, and greater medical complications and mood and anxiety disorders relative to patients with ASD/VSD. Inpatient cardiac admissions, mood disorders, and anxiety disorders were associated with lower QOL among patients with a Fontan, and mood disorders were associated with lower QOL among patients with ASD/VSD. Regional differences for QOL were not observed in patients with a Fontan; however, significant differences were identified in patients with ASD/VSD. CONCLUSIONS Regional variation of QOL is commonplace in adults with CHD; however, it appears affected by greater disease burden. Among patients with a Fontan, regional variation of QOL is lost. Specific attempts to screen for QOL and mood and anxiety disorders among CHD patients may improve the care of patients with the greatest disease burden.
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Affiliation(s)
- Nicholas D Fogleman
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | - Silke Apers
- KU Leuven Department of Public Health and Primary Care, Leuven, Belgium; KU Leuven Department of Development and Regeneration, Leuven, Belgium
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, Leuven, Belgium; The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Stacey Morrison
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Martha Tomlin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kathy Gosney
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maayke A Sluman
- Academic Medical Center, Department of Cardiology, Amsterdam, the Netherlands
| | | | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | - Mikael Dellborg
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Koen Luyckx
- School Psychology and Child and Adolescent Development, KU Leuven, Leuven, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Jamie Jackson
- Columbus Ohio Adult Congenital Heart Disease Program, Nationwide Children's Hospital, The Ohio State College of Medicine, Columbus, OH
| | - Adrienne Kovacs
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | | | | | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Department of Health Science, University West, Trollhättan, Sweden
| | - Edward Callus
- Clinical Psychology Services IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Stephen C Cook
- Adult Congenital Heart Disease Center, Heart Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | | | - Kamila S White
- Washington University and Barnes Jewish Heart & Vascular Center, and University of Missouri, Saint Louis, MO
| | - Paul Khairy
- Congenital Heart Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Shelby Kutty
- University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, NE
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24
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Tucker NR, Mahida S, Ye J, Abraham EJ, Mina JA, Parsons VA, McLellan MA, Shea MA, Hanley A, Benjamin EJ, Milan DJ, Lin H, Ellinor PT. Gain-of-function mutations in GATA6 lead to atrial fibrillation. Heart Rhythm 2017; 14:284-291. [PMID: 27756709 DOI: 10.1016/j.hrthm.2016.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 08/11/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The genetic basis of atrial fibrillation (AF) and congenital heart disease remains incompletely understood. OBJECTIVE We sought to determine the causative mutation in a family with AF, atrial septal defects, and ventricular septal defects. METHODS We evaluated a pedigree with 16 family members, 1 with an atrial septal defect, 1 with a ventricular septal defect, and 3 with AF; we performed whole exome sequencing in 3 affected family members. Given that early-onset AF was prominent in the family, we then screened individuals with early-onset AF, defined as an age of onset <66 years, for mutations in GATA6. Variants were functionally characterized using reporter assays in a mammalian cell line. RESULTS Exome sequencing in 3 affected individuals identified a conserved mutation, R585L, in the transcription factor gene GATA6. In the Massachusetts General Hospital Atrial Fibrillation (MGH AF) Study, the mean age of AF onset was 47.1 ± 10.9 years; 79% of the participants were men; and there was no evidence of structural heart disease. We identified 3 GATA6 variants (P91S, A177T, and A543G). Using wild-type and mutant GATA6 constructs driving atrial natriuretic peptide promoter reporter, we found that 3 of the 4 variants had a marked upregulation of luciferase activity (R585L: 4.1-fold, P < .0001; P91S: 2.5-fold, P = .0002; A177T; 1.7-fold, P = .03). In addition, when co-overexpressed with GATA4 and MEF2C, GATA6 variants exhibited upregulation of the alpha myosin heavy chain and atrial natriuretic peptide reporter activity. CONCLUSION Overall, we found gain-of-function mutations in GATA6 in both a family with early-onset AF and atrioventricular septal defects as well as in a family with sporadic, early-onset AF.
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Affiliation(s)
| | | | | | | | | | | | | | - Marisa A Shea
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Preventive Medicine and Cardiovascular Medicine Sections, Department of Medicine; Cardiology Division, Department of Medicine
| | - David J Milan
- Cardiovascular Research Center and; Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Honghuang Lin
- Computational Biomedicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Patrick T Ellinor
- Cardiovascular Research Center and; Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts.
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25
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Skride A, Sablinskis K, Lejnieks A, Rudzitis A. Pulmonary hypertension in adults with congenital heart disease: First data from Latvian PAH registry. Eur J Intern Med 2016; 36:e20-e21. [PMID: 27637857 DOI: 10.1016/j.ejim.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
MESH Headings
- Adult
- Aged
- Echocardiography
- Eisenmenger Complex/diagnostic imaging
- Eisenmenger Complex/epidemiology
- Eisenmenger Complex/physiopathology
- Female
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Septal Defects/diagnostic imaging
- Heart Septal Defects/epidemiology
- Heart Septal Defects/physiopathology
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Ventricular/diagnostic imaging
- Heart Septal Defects, Ventricular/epidemiology
- Heart Septal Defects, Ventricular/physiopathology
- Humans
- Hypertension, Pulmonary/diagnostic imaging
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/physiopathology
- Latvia/epidemiology
- Male
- Middle Aged
- Prospective Studies
- Pulmonary Wedge Pressure/physiology
- Registries
- Vascular Resistance/physiology
- Walk Test
- Young Adult
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Affiliation(s)
- Andris Skride
- Riga Stradins University, 16 Dzirciema str., Riga LV-1007, Latvia; Pauls Stradins Clinical University Hospital, 13 Pilsonu str., Riga LV-1012, Latvia
| | | | - Aivars Lejnieks
- Riga Stradins University, 16 Dzirciema str., Riga LV-1007, Latvia; Riga East University Hospital, 2 Hipokrata str., Riga LV-1038, Latvia
| | - Ainars Rudzitis
- Pauls Stradins Clinical University Hospital, 13 Pilsonu str., Riga LV-1012, Latvia.
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26
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Abstract
Several studies have shown that the prevalence of a cardial right-to-left shunt (RLS) in patients with migraine with aura is significantly higher than in patients without migraine. To assess the strength of the possible relationship between RLS and migraine, the literature concerning this subject was systematically reviewed. We identified seven relevant studies. Among patients with RLS migraine with aura was 3.5 times more prevalent than among subjects without RLS [Mantel–Haenszel odds ratio (ORMH) 3.5; 95% confidence interval (CI) 2.1, 5.8]. In patients with ischaemic stroke migraine was more than two times more prevalent in patients with RLS than in patients without RLS (ORMH 2.1; 95% CI 1.6, 2.9). Our review shows that there is a clear association between RLS and migraine, especially migraine with aura. The relationship between RLS and migraine is further substantiated by the observations of disappearance and improvement of migraine symptoms after closure of the foramen ovale. However, the mechanism as well as the question about causality of this association has to be further elucidated.
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27
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Abstract
BACKGROUND Congenital heart diseases cause significant childhood morbidity and mortality. Several restricted studies have been conducted on the epidemiology in Nigeria. No truly nationwide data on patterns of congenital heart disease exists. OBJECTIVES To determine the patterns of congenital heart disease in children in Nigeria and examine trends in the occurrence of individual defects across 5 decades. METHOD We searched PubMed database, Google scholar, TRIP database, World Health Organisation libraries and reference lists of selected articles for studies on patterns of congenital heart disease among children in Nigeria between 1964 and 2015. Two researchers reviewed the papers independently and extracted the data. Seventeen studies were selected that included 2,953 children with congenital heart disease. RESULTS The commonest congenital heart diseases in Nigeria are ventricular septal defect (40.6%), patent ductus arteriosus (18.4%), atrial septal defect (11.3%) and tetralogy of Fallot (11.8%). There has been a 6% increase in the burden of VSD in every decade for the 5 decades studied and a decline in the occurrence of pulmonary stenosis. Studies conducted in Northern Nigeria demonstrated higher proportions of atrial septal defects than patent ductus arteriosus. CONCLUSIONS Ventricular septal defects are the commonest congenital heart diseases in Nigeria with a rising burden.
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MESH Headings
- Child, Preschool
- Developing Countries
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/epidemiology
- Ductus Arteriosus, Patent/surgery
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Atrial/surgery
- Heart Septal Defects, Ventricular/diagnosis
- Heart Septal Defects, Ventricular/epidemiology
- Heart Septal Defects, Ventricular/surgery
- Humans
- Incidence
- Infant
- Infant, Newborn
- Male
- Nigeria/epidemiology
- Survival Rate
- Tetralogy of Fallot/diagnosis
- Tetralogy of Fallot/epidemiology
- Tetralogy of Fallot/surgery
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Affiliation(s)
- Mohammed Abdulkadir
- Department of Paediatrics and Child Health, University of Ilorin/ University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Zainab Abdulkadir
- Department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
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28
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Bryndza M, Wasilewski G, Pfitzner R, Kapelak B. Atrial septal defect surgery in adults--populational and epidemiological analysis. Pol Merkur Lekarski 2015; 39:77-80. [PMID: 26319379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Atrial septal defect (ASD) is one of the most common congenital heart diseases found in adolescents and adults. Shunt may lead to serious further complications, such as pulmonary hypertension and right heart chambers overload. The aim of this study was the analysis of the population of adult patients with ASD together with the frequency of the annuloplasty tricuspid ring implantation in ASD II and the necessity of anterior mitral valve cusp suturing due to the cleft accompanying ASD I. MATERIALS AND METHODS The study group consisted of 58 males and 122 females aged 17 to 77. Individuals were divided into three age brackets: 17-30 years old--22%; 31-50--38,5% and 51-77--39,5%. RESULTS In 92,8% of cases median sternotomy was performed. Other approaches were: right mini- thoracotomy 5%, 2,2% underwent lower hemisternotomy. There were 16 annuloplasties accompanying ASD closure: 13 in ASD II patients, 1 in PFO patient, 2 in ASD I patients. Average size of the pericardiac patch used to ASD type II correction was bigger in patients, who also underwent annuloplasty tricuspid ring implantation (Mann- Whitney U test: -2,25, p=0,024). CONCLUSION Repair of ostium secundum and sinus venosus ASD can be performed safely via minithoracotomy endoscopic approach with similar outcomes as sternotomy. Beside the mitral cleft suturing in ASD I patients, annuloplasty tricuspid ring implantation is the most common additional procedure. ASD II patients, who had undergone such annuloplasties needed the bigger pericardial patches.
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Affiliation(s)
- Magdalena Bryndza
- Department Of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College; John Paul II Hospital in Cracow, Poland
| | - Grzegorz Wasilewski
- Department Of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College; John Paul II Hospital in Cracow, Poland
| | - Roman Pfitzner
- Department Of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College; John Paul II Hospital in Cracow, Poland
| | - Bogusław Kapelak
- Department Of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College; John Paul II Hospital in Cracow, Poland
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29
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Atashband A, Lakkis N. First Comprehensive Analysis of Outcomes in Adult Patients after Percutaneous Closure of Isolated Secundum Atrial Septal Defects. Cardiovasc Hematol Agents Med Chem 2015; 13:63-69. [PMID: 26245662 DOI: 10.2174/187152571301150730115936] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/06/2015] [Accepted: 03/31/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Secundum atrial septal defect (ASD) is a common congenital heart defect in adults. If untreated, ASD leads to right ventricular (RV) failure, atrial arrhythmias, and pulmonary hypertension. The aim of this study is to analyze published data on outcomes and complications of percutaneous ASD closure in adults. METHODS PubMed searches performed for published literature on percutaneous ASD closure using the terms ASD, ASD closure or repair, and percutaneous or transcatheter closure. RESULTS A total of 23 studies, 1958 patients, were analyzed. Baseline characteristics showed mean age of 49.1 ± 1.7 years, Qp:Qs of 2.2 ± 0.05, defect size 19.4 ± 1 and device size 24.0 ± 0.7. The percentage of patients in NYHA class I, II and III was 42.4 ± 6.3, 40.0 ± 6.5, and 9.3 ± 3.0, respectively. Mean follow-up was 12.6 ± 4.9 months with a closure rate of 96.9% ± 1.4. Echocardiographic parameters of improvement included decrease in RV volume from 157.2 to 100.2 mL (p = 0.02), RV end-diastolic dimensions from 40.8 to 32.4 mm (p < 0.0001) and pulmonary artery systolic pressures from 42.2±2.2 to 34.4±2.4 (p < 0.0001). The percentage of patients in NYHA class II and III decreased from 55±7.5 to 15.9±4.4 (p = 0.0013). At the end of follow-up, complications included 1% mortality rate, 0.8% device embolization, 5.8% new onset arrhythmias and 1.2% need for surgical closure. CONCLUSION Our study confirms that percutaneous ASD closure in adults with moderate pulmonary hypertension and RV dilation is safe and effective with reverse remodeling and better functional capacity. Prospective studies are needed to evaluate efficacy of percutaneous ASD closure in adults with large defects, higher shunt ratios, and severe pulmonary hypertension.
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Affiliation(s)
| | - Nasser Lakkis
- Baylor College of Medicine, Ben Taub General Hospital, Section of Cardiology, 1504 Taub Loop, Houston, TX 77030, USA.
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30
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Abstract
Congenital heart defect (CHD) is common in infants with Down syndrome (DS), which is the principle cause of mortality. However, there is no data available for the frequency and types of CHD in infants with DS in Korea. We investigated the frequency of CHD in infants with DS in Korea. After the survey on birth defects was conducted throughout the country, the prevalence of CHD in DS in 2005-2006 was calculated. This study was conducted based on the medical insurance claims database of the National Health Insurance Corporation. The number of total births in Korea was 888,263 in 2005-2006; of them, 25,975 cases of birth defects were identified. The prevalence of DS was 4.4 per 10,000 total births, accounting for 1.5% of all birth defects. Of the 394 infants with DS, 224 (56.9%) had a CHD. Atrial septal defect was the most common defect accounting for 30.5% of DS followed by ventricular septal defect (19.3%), patent duct arteriosus (17.5%), and atrioventricular septal defect (9.4%). Our study will be helpful to demonstrate the current status of DS and to identify the distribution of CHD in infants with DS in Korea.
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Affiliation(s)
- Min-A Kim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - You Sun Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Nan Hee Yee
- Health Policy Research Division, Korea Institute for Health and Social Affairs, Seoul, Korea
| | - Jeong Soo Choi
- Health Policy Research Division, Korea Institute for Health and Social Affairs, Seoul, Korea
| | - Jung Yun Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Seo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
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31
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Vereczkey A, Gerencsér B, Czeizel AE, Szabó I. Association of certain chronic maternal diseases with the risk of specific congenital heart defects: a population-based study. Eur J Obstet Gynecol Reprod Biol 2014; 182:1-6. [PMID: 25216447 DOI: 10.1016/j.ejogrb.2014.08.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/18/2014] [Accepted: 08/16/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previous epidemiological studies have evaluated cases with all congenital heart defects (CHDs), rather than analysing different types of CHD. The objective of this study was to evaluate the possible association of certain chronic maternal diseases with the risk of different types of CHD, because the role of possible environmental factors in the origin of CHDs is unclear in the vast majority of patients. STUDY DESIGN Different types of CHD, diagnosed after lethal outcome (autopsy report) or after surgical intervention (catheter or correction), were evaluated in order to estimate the possible role of chronic maternal diseases in their origin. This analysis was based on the rates of medically recorded chronic maternal diseases in 3562 live-born cases with CHDs, 38,151 population controls without any birth defects, and 16,602 malformed controls with other isolated congenital abnormalities, using the data set of the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities (1980-1996). RESULTS Maternal epilepsy treated with carbamazepine and migraine were found to be associated with higher risk of ventricular septal defect; panic disorders were associated with higher risk of hypoplastic left heart; type I diabetes mellitus was associated with higher risk of coarctation of the aorta; chronic hypertension was associated with higher risk of ventricular septal defect, common atrioventricular canal and common truncus; and paroxysmal supraventricular tachycardia was associated with higher risk of atrial septal defect secundum, common atrioventricular canal and ventricular septal defect. CONCLUSION In conclusion, certain chronic maternal diseases were found to be associated with higher risk of specific CHDs. Appropriate treatment of these diseases may help to prevent these CHDs.
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Affiliation(s)
- A Vereczkey
- Versys Clinics, Human Reproduction Institute, Budapest, Hungary.
| | - B Gerencsér
- Alfréd Rényi Institute of Mathematics, Hungarian Academy of Sciences, Budapest, Hungary
| | - A E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Budapest, Hungary
| | - I Szabó
- Department of Obstetrics and Gynaecology, University of Pécs, Pécs, Hungary
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32
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Bain J, Benjamin DK, Hornik CP, Benjamin DK, Clark R, Smith PB. Risk of necrotizing enterocolitis in very-low-birth-weight infants with isolated atrial and ventricular septal defects. J Perinatol 2014; 34:319-21. [PMID: 24434778 PMCID: PMC3969778 DOI: 10.1038/jp.2013.174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 07/01/2013] [Revised: 10/31/2013] [Accepted: 11/20/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Necrotizing enterocolitis (NEC) is associated with a significant morbidity and mortality in premature infants. We sought to identify the frequency of NEC in very-low-birth-weight infants with isolated ventricular septal defects (VSDs) or atrial septal defects (ASDs) using a large multicenter database. STUDY DESIGN We identified a cohort of infants with birth weight <1500 g cared for in 312 neonatal intensive care units (NICUs) managed by the Pediatrix Medical Group between 1997 and 2010. We examined the association between the presence of an ASD or a VSD with development of NEC using logistic regression to control for small-for-gestational age status, antenatal steroid use, antenatal antibiotic use, gestational age, sex, race, Apgar score at 5 min and method of delivery. RESULT Of the 98 523 infants who met inclusion criteria, 1904 (1.9%) had an ASD, 1943 (2.0%) had a VSD and 146 (0.1%) had both. The incidence of NEC was 6.2% in infants without septal defects, 9.3% in those with an ASD, 7.8% in those with a VSD, and 10.3% in infants with both an ASD and a VSD. Compared with infants without septal defects, the adjusted odds ratios for developing NEC for each group-ASD alone, VSD alone and ASD with VSD-were 1.26 (95% confidence interval 1.07 to 1.49), 1.27 (1.07 to 1.51) and 1.79 (1.03 to 3.12), respectively. CONCLUSION The presence of an ASD or a VSD was associated with NEC in this cohort of premature infants.
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Affiliation(s)
- Jesse Bain
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | | | - Reese Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
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Khan ZA, Arif RA, Sultan M. Device closure of atrial septal defect with amplatzer septal occluder in adults- safety and outcome. J Ayub Med Coll Abbottabad 2013; 25:48-49. [PMID: 25226739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Secundum atrial septal defect is a common congenital heart disease. Amplatzer septal occluder has become the most commonly used device for its closure. This study was conducted to determine the safety and outcome of atrial septal defect closure with the Amplatzer septal occlude (ASO). METHODS This Case-series was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from July 2010-11, on a total of 41 patients, out of these 41 patients, 18 (44%) patients underwent general anaesthesia while 23 (56%) patients were given local anaesthesia for the procedure. Trans-esophageal echocardiogram was done in all patients before procedure. RESULTS In 37 patients, ASD device closure was successfully done and size of ASD devices were 14-36 mm. Trans-oesophageal echocardiography guided ASD Device closure was done in 16 patients and rest of them done under transthoracic echocardiography. Size of ASD ranged from 11-36 mm (mean 22 mm). Mean floro time was 10 minutes. Four (10%) patients did not undergo the procedure due to inadequate rim. CONCLUSION Device closure of Atrial Septal Defect with amplatzer septal occluder is convenient and safe.
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Sun T, Tian H, Wang C, Yin P, Zhu Y, Chen X, Tang Z. A survey of congenital heart disease and other organic malformations associated with different types of orofacial clefts in Eastern China. PLoS One 2013; 8:e54726. [PMID: 23349958 PMCID: PMC3549991 DOI: 10.1371/journal.pone.0054726] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 12/14/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A high incidence of orofacial clefts is reported in China, but no data has shown the relation between cleft types and the incidence of other defects so far. The aim of this study is to assess the incidence of congenital heart diseases and other organic defects associated with different types of orofacial clefts. METHODOLOGY AND PRINCIPAL FINDINGS All children with orofacial clefts, which were sought out from the Health Information System of Shanghai Ninth People's Hospital between 1(st) Jan 2009 and 30(th) Dec 2011, were enrolled in this study. All subjects underwent a thorough examination and grouped by the cleft phenotype. The numbers and types of other organic defects were recorded and analyzed statistically using SPSS 17.0. Of 2180 cases reported as having orofacial clefts, 657 (30.1%) had other congenital abnormalities, which were significantly more common in cleft palate (47.9% (329/687)) than that in cleft lip (10.6% (80/755)) or cleft lip and palate (33.6% (248/738)) (P<0.01). In subgroups, unilateral cleft lip and palate had a statistically higher incidence of associated abnormalities than bilateral cleft lip and palate (P<0.01). The most common malformation was congenital heart disease, which counted 45.1% (296/657) of all malformations. Disorders of the central nervous system (14.3%(94/657)) and Skeletal anomalies (13.1%(86/657)) were also frequently associated. Additionally, the most common defect in heart was atrial septal defect, which was 39.7% (118/296) of all congenital heart diseases. CONCLUSIONS AND SIGNIFICANCE As the high incidence of heart defects and other organic abnormalities in the children with cleft palate in Eastern China, special attention should be paid to them and echocardiography should be a proposed examination in the evaluation of children with cleft palate before any surgical correction being executed.
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MESH Headings
- Abnormalities, Multiple/epidemiology
- Abnormalities, Multiple/physiopathology
- Brain/abnormalities
- Child
- Child, Preschool
- China
- Cleft Lip/complications
- Cleft Lip/epidemiology
- Cleft Lip/physiopathology
- Cleft Palate/complications
- Cleft Palate/epidemiology
- Cleft Palate/physiopathology
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/epidemiology
- Humans
- Incidence
- Infant
- Limb Deformities, Congenital/complications
- Limb Deformities, Congenital/epidemiology
- Limb Deformities, Congenital/physiopathology
- Male
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Affiliation(s)
- Ting Sun
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
- * E-mail: (TS); (CW)
| | - Hua Tian
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Changqian Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
- * E-mail: (TS); (CW)
| | - Ping Yin
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Yaqin Zhu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Xianghua Chen
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Zhengde Tang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
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Yu AL, Cai XZ, Gao XJ, Zhang ZW, Ma ZS, Ma LL, Wang LX. Determinants of immediate extubation in the operating room after total thoracoscopic closure of congenital heart defects. Med Princ Pract 2013; 22:234-8. [PMID: 23296121 PMCID: PMC5586751 DOI: 10.1159/000345844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 11/13/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study was designed to assess the factors that influence immediate extubation following totally thoracoscopic closure of congenital heart defects. SUBJECTS AND METHODS Clinical and operational data of 216 patients (87 males, average age 13.6 ± 10.9 years) were retrospectively analyzed. Atrial (ASD, n = 90) or ventricular septal defects (VSD, n = 126) were closed via a totally thoracoscopic approach. Ultra-fast-track anesthesia (UFTA) was used in all patients. RESULTS Immediate extubation in the operating room was successfully performed in 156 (72.2%) patients. A delayed extubation was completed in the intensive care unit in the remaining 60 (27.8%) patients. There was no significant difference in the age, sex, body weight, or type of congenital heart defect between the immediate and delayed extubation groups (p > 0.05). However, more patients in the delayed extubation group had severe preoperational pulmonary hypertension [8 (13.3%) vs. 4 (2.3%), p < 0.05]. The cardiopulmonary bypass time, aortic clamp time, and total duration of the surgery in the immediate extubation group were shorter than in the delayed extubation group (p < 0.05). Multivariate logistic regression analysis showed that preoperational pulmonary hypertension, duration of the surgery or cardiopulmonary bypass, and dosage of fentanyl used during the surgery were independent predictors for immediate extubation. CONCLUSIONS UFTA and immediate extubation in the operating room was feasible and safe in the majority of patients undergoing totally thoracoscopic closure of ASD or VSD. Preoperational pulmonary hypertension, duration of the surgery, and the dosage of fentanyl used for UFTA were the determining factors for immediate extubation.
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Affiliation(s)
- Ai-Lan Yu
- Department of Anesthesiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China, Australia
| | - Xing-Zhi Cai
- Department of Anesthesiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China, Australia
| | - Xiu-Juan Gao
- Department of Anesthesiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China, Australia
| | - Zong-Wang Zhang
- Department of Anesthesiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China, Australia
| | - Zeng-Shan Ma
- Department of Cardiac Surgery, Liaocheng People's Hospital of Shandong University, Liaocheng, China, Australia
| | - Long-Le Ma
- Department of Cardiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China, Australia
- Department of School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, N.S.W., Australia
| | - Le-Xin Wang
- Department of Cardiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China, Australia
- Department of School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, N.S.W., Australia
- *Prof. Lexin Wang, School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, (Australia), E-Mail
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Polen KND, Rasmussen SA, Riehle-Colarusso T, Reefhuis J. Association between reported venlafaxine use in early pregnancy and birth defects, national birth defects prevention study, 1997-2007. Birth Defects Res A Clin Mol Teratol 2013; 97:28-35. [PMID: 23281074 PMCID: PMC4484721 DOI: 10.1002/bdra.23096] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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] [Received: 08/10/2012] [Revised: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few epidemiologic studies have investigated the use of venlafaxine (Effexor XR capsules, Product Monograph, Wyeth, Montreal, Canada), an antidepressant used to treat major depression and anxiety disorders in adults, during pregnancy. Our objective was to determine whether use of venlafaxine during pregnancy is associated with specific birth defects. METHODS We used data from the National Birth Defects Prevention Study (NBDPS), a population-based, case-control study in the United States. Our analysis included mothers with pregnancies affected by one of 30 selected birth defects (cases) and babies without birth defects (controls) with estimated dates of delivery between 1997 and 2007. Exposure was any reported use of venlafaxine from 1 month preconception through the third month of pregnancy. We calculated adjusted odds ratios (aORs) and 95% Fisher Exact confidence intervals (CIs) for 24 birth defect groups for which at least 400 case mothers were interviewed. Our adjusted analyses controlled for maternal age and race/ethnicity. RESULTS Among the 27,045 NBDPS participants who met inclusion criteria, 0.17% (14/8002) of control mothers and 0.40% (77/19,043) of case mothers reported any use of venlafaxine from 1 month preconception through the third month of pregnancy. Statistically significant associations were found for anencephaly, atrial septal defect (ASD) secundum, or ASD not otherwise specified, coarctation of the aorta, cleft palate, and gastroschisis. CONCLUSIONS Our data suggest associations between periconceptional use of venlafaxine and some birth defects. However, sample sizes were small, CIs were wide, and additional studies are needed to confirm these results.
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Affiliation(s)
- Kara N D Polen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Abstract
We investigated the livebirths prevalence and occurrence pattern of birth defects in Korea. After the survey on birth defects was done in 2,348 medical institutions around the nation, the birth defect prevalence of livebirths in 2005-2006 was calculated. This study was based on the medical insurance claims database of the National Health Insurance Corporation. The number of livebirths in Korea was 883,184 from 2005-2006, and 25,335 cases of birth defects were notified to our study, equivalent to a prevalence of 286.9 per 10,000 livebirths. Anomalies of the circulatory system were the most common defects, accounting for 43.4% of birth defects with a prevalence of 124.5 per 10,000 livebirths. It was followed by the musculoskeletal system anomalies, the digestive system anomalies, and the urinary system anomalies. The five major birth defects based on the ranking of prevalence were atrial septal defect, ventricular septal defect, hydronephrosis, patent ductus arteriosus, and cleft lip/palate. Birth defects in livebirths were associated with a high proportion of low birthweight, prematurity, multiple births and advanced maternal age. The prevalence of birth defects in Korea is similar to or lower than those reported in developed countries. Our study suggests baseline data to explain the current status of birth defects and to establish a registry system of birth defects in Korea.
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Affiliation(s)
- Min-A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nan Hee Yee
- Health Policy Research Division, Korea Institute for Health and Social Affairs, Seoul, Korea
| | - Jeong Soo Choi
- Health Policy Research Division, Korea Institute for Health and Social Affairs, Seoul, Korea
| | - Jung Yun Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Seo
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Qi SG, Jin XH, Chen QH, Qi GR, Lu L, Yang L. [Risk factors of pulmonary arterial hypertension in patients with atrial septal defect at high altitude area]. Zhonghua Xin Xue Guan Bing Za Zhi 2012; 40:874-877. [PMID: 23302678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To analyze risk factors of pulmonary arterial hypertension (PAH) in patients with atrial septal defect (ASD) patients living at above 2000 m high altitude area. METHODS We retrospectively analyzed the incidence of PAH in 526 ASD patients out of 1178 congenital heart disease patients who were hospitalized in Qinghai cardiovascular hospital between January 2007 to December 2009 and explored the risk factors including gander, age, altitude, defect size and nationalities for developing PAH in ASD patients using binary logistic regression. RESULTS PAH prevalence was 68.4% (360/526) in ASD patients. The risk factors of developing PAH in these ASD patients were defect size (OR: 1.200, 95%CI: 1.156 - 1.246, P = 0.000), age (OR: 1.027, 95%CI: 1.003 - 1.052, P = 0.025) and altitude (OR: 1.389, 95%CI: 1.001 - 1.637, P = 0.043) while gender and nationality were not risk factors for PAH. The incidence of developing PAH increased with aging (P = 0.000). The standardized ratio of PAH at ≥ 3500 m was 74.8% which was significantly higher than that at 2000 - 2499 m altitude (66.2%, P = 0.005) and at 2500 - 3499 m altitude (66.9%, P = 0.005). CONCLUSIONS The risk for developing PAH is high in patients living at high altitude area. The risk factors of developing PAH in ASD patients living at high altitude are defect size, age and altitude.
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Affiliation(s)
- Sheng-gui Qi
- Qinghai Cardio-Cerebrovascular Disease Special Hospital, Xining, China
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Salazar M, Villalba G, Mateus H, Villegas V, Fonseca D, Núñez F, Caicedo V, Pachón S, Bernal JE. [Analysis of microdeletions in 22q11 in Colombian patients with congenital heart disease]. Invest Clin 2011; 52:334-343. [PMID: 22523843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cardiac defects are the most frequent congenital malformations, with an incidence estimated between 4 and 12 per 1000 newborns. Their etiology is multifactorial and might be attributed to genetic predispositions and environmental factors. Since 1990 these types of pathologies have been associated with 22q11 microdeletion. In this study, the frequency of microdeletion 22q11 was determined in 61 patients with non-syndromic congenital heart disease. DNA was extracted from peripheral blood and TUPLE1 and STR D10S2198 genes were amplified by multiplex PCR and visualized in agarose gels. Gene content was quantified by densitometry. Three patients were found with microdeletion 22q11, representing a 4.9% frequency. This microdeletion was associated with two cases of Tetralogy of Fallot and a third case with atrial septal defect (ASD). In conclusion, the frequency for microdeletion 22q11 in the population analyzed was 4.9%. The cases that presented Teratology of Fallot had a frequency for this microdeletion of 7.4% and for ASD of 11.1%.
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Affiliation(s)
- Marleny Salazar
- Programa de Licenciatura en Biología y Educación Ambiental, Universidad del Quindío, Armenia, Colombia.
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Modrzejewska M, Lachowicz E, Karczewicz D. [Cases of congenital eye malformations in children]. Ann Acad Med Stetin 2011; 57:17-25. [PMID: 22593986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE The aim of this work was to present a clinical picture of congenital defects in the anterior and posterior segment of the eye and coexisting systemic developmental anomalies in a group of children during the infantile period. MATERIAL AND METHODS We performed a retrospective analysis in a group of 1507 infants seen at our outpatient ophthalmology clinic in 2006-2010. Attention was focused on case histories of nine children (0.6%) with congenital defects of the eye. A routine ophthalmologic examination was done and photographs of the anterior and posterior segment of the eye were archived with the Ret - Cam II apparatus. Maternal risk factors during pregnancy and the perinatal period were analyzed, as well as genetic, familial, infectious, traumatic, metabolic, and toxic factors, and drugs which could have contributed to the pathology of the organ of vision. Additionally, congenital polydysplasia was confirmed using ultrasonography, radiography, and imaging techniques (USG, X-ray, MRI). RESULTS Congenital anomalies of the anterior and posterior segment of the eye were identified in the study group. Abnomalities of the anterior segment of the eye in four infants were in the form of congenital corneal anomalies (keratopathy, microcornea, sclerocornea, congenital mesenchymal dysgenesis), coloboma of the iris, and aniridia. Additionally, ectopic pupil, congenital cataract, aplasia of the lacrimal point, and palpebral coloboma were observed. Developmental anomalies of the posterior segment of the eye in the form of persistent hyperplastic primary vitreous body or primary fetal vasculature syndrome (PHVB or PFVS), choroid coloboma, coloboma of the optic nerve, and optic disc fovea were recognized in eight children. Anomalies of the anterior and posterior segment of the eye were observed in three children and were associated with microphthalmia, nystagmus, and strabismus. Moreover, systemic anomalies coexisting with ophthalmologic defects were confirmed in 6 children. They were seen in the heart (patent ductus arteriosus (PDA), patent foramen ovale (Pfo), atrial septal defect (ASD), nervous system (aplasia of the corpus callosum, hydrocephalus), osteoarticular system (talipes equinovarus, bifurcate rib, butterfly vertebra, dysmorphic splanchnocranium, contracture of the fingers), genitourinary system (cryptorchism, Wilms' tumor, vesicoureteral reflux grade IV), auditory organ (microtia, aplasia of the external auditory meatus, tympanic cavity, and internal ear), and skin (telangiectasia, syndactyly, appendages, and vegetations). Genetic tests revealed one case of an abnormal karyotype (49, XXXXX). Infections, metabolic disorders, and intoxications were excluded as the background for the anomalies. CONCLUSIONS The finding of a congenital eye anomaly should be followed by a search for other systemic anomalies. Developmental anomalies of the eye and other organs will require a multidisciplinary approach to treatment and care.
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Affiliation(s)
- Monika Modrzejewska
- Katedra i Klinika Okulistyki Pomorskiego Uniwersytetu Medycznego w Szczecinie, al. Powstańców Wlkp. 72, 70-111 Szczecin
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Chiosac AAA, Gorduza EV, Stamatin M, Novac O, Ivan A. [Clinical epidemiological retro prospective studies on the incidence and prevalence of cardiac congenital abnormalities in a group of 1570 children, born in Iaşi between 2000-2009]. Rev Med Chir Soc Med Nat Iasi 2010; 114:1125-1129. [PMID: 21500469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
MATERIAL AND METHOD The study has been conducted on a period of ten years and it included 1570 children with congenital abnormalities (CA), of which 371 (24%) were cardiac abnormalities, 312 (20%) were skeletal abnormalities, 55 (3%) were Down Syndrome and 832 (53%) were other pathologies. RESULTS 48% of the 371 children that were diagnosed with cardiac CA were males, while 52% were females; 52% of the children were from the city, while 48% were from the country-side; 42% of the children have been born prematurely, while 58% of them have been born at normal term. 38% of the children had an APGAR score lower than 7 and 62% of them had an APGAR score higher than 7. Of the total number of births, 72% were caesarian births and 28% were natural births. The different types of Cardiac CA that have been encountered in the study were atrioventricular canal (56%), transposition of the great vessels (18%), common arterial trunk (10%), atrial septal defect (8%), ventricular septal defect (5%) and tetralogy of Fallot (3%). 66% of the total number of deaths were represented by those with cardiac pathology, 21% were caused by hydrocephalus, 7% were caused by diaphragmatic hernia, 4% had renal CA, while 2% were caused by other pathologies.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Abnormalities, Multiple/surgery
- Adolescent
- Bone and Bones/abnormalities
- Child
- Child, Preschool
- Down Syndrome/epidemiology
- Ductus Arteriosus, Patent/epidemiology
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Ventricular/epidemiology
- Humans
- Incidence
- Infant
- Infant, Newborn
- Male
- Prevalence
- Prospective Studies
- Retrospective Studies
- Romania/epidemiology
- Rural Population/statistics & numerical data
- Tetralogy of Fallot/epidemiology
- Transposition of Great Vessels/epidemiology
- Urban Population/statistics & numerical data
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Al-Ani ZR. Association of consanguinity with congenital heart diseases in a teaching hospital in Western Iraq. Saudi Med J 2010; 31:1021-1027. [PMID: 20844815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To study the association of consanguinity as a risk factor for congenital heart diseases (CHDs). METHODS Patients with suggestive signs of CHD admitted to the Al-Ramadi Maternity and Children Hospital, Al-Anbar Governorate, Iraq from January 2009 to January 2010 were subject to diagnostic investigations. Case data includes: name, age, gender, and cause of admission. Parents data includes: age, residence, degree of consanguinity, and history of family recurrent CHDs. Three controls to one case (3:1) were selected to compare their consanguinity with the CHD cases. Odds ratio was used for the measurement of consanguinity and other variable risks on CHD occurrence. RESULTS The CHD cases were 86. Selected controls were 258 non-CHD cases. The most recorded subtypes were ventricular septal defect (VSD), atrial septal defect (ASD), and tetralogy of fallot (ToF). Consanguinity was found in 78% of cases and 43.3% in controls. First cousin consanguinity comprised 66.2% in cases and 35.6% in controls from all their marriages. Consanguinity was found a significant risk factor, more affecting the VSD and ASD than ToF subtypes, while parental age and infant gender were not found as risk factors. CONCLUSION Consanguinity proved to be a risk factor for CHD. Further social education of the risks of consanguineous marriages in this tribal population is needed to reduce the prevalence of these morbid and mortal anomalies.
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Affiliation(s)
- Zaid R Al-Ani
- Department of Pediatrics, Medical College, Al-Anbar University, Al-Ramadi, Iraq.
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Miller A, Siffel C, Lu C, Riehle-Colarusso T, Frías JL, Correa A. Long-term survival of infants with atrioventricular septal defects. J Pediatr 2010; 156:994-1000. [PMID: 20227717 DOI: 10.1016/j.jpeds.2009.12.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 10/26/2009] [Accepted: 12/08/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the variation in survival in infants with atrioventricular septal defects (AVSD) with demographic factors and clinical characteristics, including the presence of Down syndrome. STUDY DESIGN We selected infants with all types of AVSD with Down syndrome (n = 177) and without Down syndrome (n = 161), born between Jan 1, 1979, and Dec 31, 2003 and identified through the Metropolitan Atlanta Congenital Defects Program (MACDP). Infants were classified by the complexity of their cardiac defects and presence of major non-cardiac malformations. Deaths (n = 111) were identified through 2004 with linkage with state vital records and the National Death Index. Kaplan-Meier survival probabilities and adjusted hazard ratios (HRs) were calculated in relation to demographic and clinical characteristics. RESULTS Children with AVSD and Down syndrome had a similar overall survival probability (70%) as those without Down syndrome (69%). Mortality was higher in children with a complex AVSD (adjusted HR = 7.0; 95% CI, 3.1-15.5) and in children with > or =2 major non-cardiac malformations (adjusted HR = 3.4; 95% CI, 1.8-6.5) and was lower in children in the 1992 to 2003 birth cohort (adjusted HR = 0.6; 95% CI, 0.4-0.998). CONCLUSIONS Down syndrome was not a prognostic factor. Our findings might be helpful in assessing the long-term prognosis of infants with AVSD.
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Affiliation(s)
- Assia Miller
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Atlanta, GA.
| | - Csaba Siffel
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; Computer Sciences Corporation, Atlanta, GA
| | - Chengxing Lu
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; Merck Research Laboratories, Upper Gwynedd, PA
| | - Tiffany Riehle-Colarusso
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jaime L Frías
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; McKing Consulting Corporation, Fairfax, VA
| | - Adolfo Correa
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Wagdi P. Incidence and predictors of atrial fibrillation following transcatheter closure of interatrial septal communications using contemporary devices. Clin Res Cardiol 2010; 99:507-10. [PMID: 20352436 PMCID: PMC2911532 DOI: 10.1007/s00392-010-0149-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 03/11/2010] [Indexed: 11/25/2022]
Abstract
Background Transcatheter closure of interatrial septal communications (IASC) is being increasingly performed, while less is known about predictors and incidence of new onset atrial fibrillation (AF) after device closure. Hitherto, most studies have only analyzed some parameters potentially influencing the occurrence of AF, variously omitting others and thus limiting interpretation of results. Methods Descriptive, single author, observational study with 68 consecutive patients [aged 53.6 ± 15.1 years; 32 females (47%)] undergoing IASC closure, being followed up for 16.8 (±9.9; 6–42) months. Two patients with AF previous to device implantation had been excluded. Parameters analyzed included age and gender as well as presence of coronary artery disease, hypertension, atrial size, body mass index, device size, and presence of residual shunt. Device size was normalized to maximal disk diameter as declared by the manufacturer. Results The incidence of new onset AF was 10.3% in the first 6 months after IASC closure. The only two predictors linked to AF were device size (P = 0.002) and, although not reaching significance level, right atrial dilatation (P = 0.08). Conclusion Occluder size was the only significant predictor of post-procedural AF, especially after PFO closure. Although there may be constraints (defect size, presence of an atrial septal aneurysm) that may dictate implantation of a larger device, it is reasonable to implant them “as large as necessary, as small as possible”. The influence of atrial dimensions on post-procedural onset of AF must be further investigated.
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Affiliation(s)
- Philipp Wagdi
- Interventional Cardiology, HerzZentrum Hirslanden, Zurich, Switzerland.
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Winston JB, Erlich JM, Green CA, Aluko A, Kaiser KA, Takematsu M, Barlow RS, Sureka AO, LaPage MJ, Janss LL, Jay PY. Heterogeneity of genetic modifiers ensures normal cardiac development. Circulation 2010; 121:1313-21. [PMID: 20212279 PMCID: PMC2953850 DOI: 10.1161/circulationaha.109.887687] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mutations of the transcription factor Nkx2-5 cause pleiotropic heart defects with incomplete penetrance. This variability suggests that additional factors can affect or prevent the mutant phenotype. We assess here the role of genetic modifiers and their interactions. METHODS AND RESULTS Heterozygous Nkx2-5 knockout mice in the inbred strain background C57Bl/6 frequently have atrial and ventricular septal defects. The incidences are substantially reduced in the Nkx2-5(+/-) progeny of first-generation (F1) outcrosses to the strains FVB/N or A/J. Defects recur in the second generation (F2) of the F1 X F1 intercross or backcrosses to the parental strains. Analysis of >3000 Nkx2-5(+/-) hearts from 5 F2 crosses demonstrates the profound influence of genetic modifiers on disease presentation. On the basis of their incidences and coincidences, anatomically distinct malformations have shared and unique modifiers. All 3 strains carry susceptibility alleles at different loci for atrial and ventricular septal defects. Relative to the other 2 strains, A/J carries polymorphisms that confer greater susceptibility to atrial septal defect and atrioventricular septal defects and C57Bl/6 to muscular ventricular septal defects. Segregation analyses reveal that > or = 2 loci influence membranous ventricular septal defect susceptibility, whereas > or = loci and at least 1 epistatic interaction affect muscular ventricular and atrial septal defects. CONCLUSIONS Alleles of modifier genes can either buffer perturbations on cardiac development or direct the manifestation of a defect. In a genetically heterogeneous population, the predominant effect of modifier genes is health. (Circulation. 2010;121:1313-1321.)
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MESH Headings
- Animals
- Disease Models, Animal
- Female
- Genetic Predisposition to Disease/genetics
- Heart/embryology
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Atrial/genetics
- Heart Septal Defects, Ventricular/epidemiology
- Heart Septal Defects, Ventricular/genetics
- Homeobox Protein Nkx-2.5
- Homeodomain Proteins/genetics
- Incidence
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Inbred Strains
- Mice, Knockout
- Mutation/genetics
- Phenotype
- Risk Factors
- Transcription Factors/genetics
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Affiliation(s)
- Julia B Winston
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
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47
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Emiroğlu O, Eyileten Z, Uçar T, Ileri T. Pediatric cardiac surgery under cardiopulmonary bypass in factor VII deficiency. Turk J Pediatr 2010; 52:101-103. [PMID: 20402077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We present a case of an atrial septal defect repair under cardiopulmonary bypass in a child with factor VII deficiency. A four-year-old girl, with the diagnosis of secundum atrial septal defect, was referred to surgery. Coagulation tests showed an international normalized ratio of 2.4. Further investigations revealed deficiency of factor VII with 42% activity. Fifteen minutes before the induction of anesthesia, 20 microg/kg dose of recombinant factor VIIa concentrate was administrated. The atrial septal defect repair was performed uneventfully. Factor VII activity markedly improved to 174%, and international normalized ratio declined to 1.1 within 1.5 hours after the substitution therapy. In our case, under a low-dose substitution therapy with recombinant factor VIIa concentrate, atrial septal defect repair under cardiopulmonary bypass was performed safely in a child with moderate congenital factor VII deficiency.
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Affiliation(s)
- Ozan Emiroğlu
- Department of Cardiac Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
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Chéhab G, El-Rassi I, Abdo A, Fakhoury H, Chokor I, Haddad W, Saliba Z. [Atrioventricular septal defect characteristics in infants with and without Down's syndrome: a Lebanese study]. J Med Liban 2010; 58:3-7. [PMID: 20358852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Analyze the demographic and clinical characteristics of complete atrioventricular septal defect (AVSD), its association with Down's syndrome, with other cardiac and extra-cardiac anomalies, and finally the impact of consanguineous marriages on the incidence of AVSD. PATIENTS & METHODS The sample consisted of 2195 consecutive patients with congenital heart defect, entered in the National Register of Paediatric and Congenital Heart Disease, Lebanese Society of Cardiology, Beirut, between Jan 1999 and Dec 2007. 120 patients with AVSD were analyzed. The gathered data included age, sex, type of AVSD, mother's age, 1st and 2nd degree cousins, and other associated cardiac or extra-cardiac anomalies. RESULTS AVSD was diagnosed in 5.5% of all patients with congenital heart disease, with 81.7% (n = 98) being complete AVSD. Male sex was predominant (58%). More than half (57.5%) were also diagnosed with Down's syndrome. The mean maternal age was 30.4 years (+/- 4.7 years) and consanguinity found in 16.7% of the cases. Cardiac and extra-cardiac anomalies (all in the esophagus and intestine) were associated in 15% and 6.7% respectively. Complete AVSD was significantly associated with Down's syndrome: 94% of patients with Down's syndrome had a complete AVSD. Digestive anomalies were also significantly more frequent with Down's syndrome (10% versus 2%, p = 0.02). Other cardiac anomalies, however, were less frequent with Down's syndrome (33% versus 7.7%, p = 0.02). CONCLUSION Down's syndrome is more frequently associated with isolated and complete AVSD. Other anomalies may complicate the management of these patients. The cause of this probable genetic anomaly is still debated.
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Affiliation(s)
- Ghassan Chéhab
- Rafic Hariri University Hospital, Département de Pédiatrie, Beyrouth, Liban.
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Abstract
OBJECTIVE To present data on the epidemiology and spontaneous closure for septal defects (secundum atrial septal defect (ASD) and/or ventricular septal defect (VSD)). METHODS Data from the EUROCAT Registry of Congenital Malformations for Funen County, Denmark were analyzed. All infants born from 1986 to 1998, diagnosed with a secundum ASD and/or a VSD as the only cardiac malformation, were included. RESULTS There were 78 infants with an ASD, 195 with a VSD, and 19 had both an ASD and a VSD. The overall prevalence of septal defects was 4.1 per 1000 livebirths. Among the VSDs 45% were perimembranous and 55% were muscular defects. Associated non-cardiac malformations, syndromes, or karyotype anomalies were present in 54 cases (19% of total) but with a significantly lower proportion among cases with muscular VSDs (7%, p < 0.05). Eighty-one percent of the cases had an isolated cardiac malformation. Five of 61 cases (8%) with isolated ASD were closed surgically before five years of age and 43 (70%) closed spontaneously within the first five years of life. Of the 65 cases with isolated perimembranous VSDs, 13 were closed surgically (20%) and 13 closed spontaneously (20%). Of the 99 cases with isolated muscular VSDs no defects were closed by surgery and 64 (65%) closed spontaneously. The rate of spontaneous closure for perimembranous and muscular VSDs were significantly different (p < 0.0001). CONCLUSIONS Secundum ASD has a high rate of spontaneous closure. Perimembranous and muscular VSDs seem to be two different diseases with different epidemiology and natural history.
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Affiliation(s)
- Ester Garne
- Paediatric Cardiology Unit, Odense University Hospital, DK-5000, Odense C, Denmark.
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Abstract
This review focuses on the heart and vascular system in patients with Down syndrome. A clear knowledge on the wide spectrum of various abnormalities associated with this syndrome is essential for skillful management of cardiac problems in patients with Down syndrome. Epidemiology of congenital heart defects, cardiovascular aspects and thyroid-related cardiac impairment in patients with Down syndrome will be discussed.
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Affiliation(s)
- J C Vis
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
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