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Belhadjer Z, Ladouceur M, Soulat G, Legendre A, Gencer U, Dietenbeck T, Iserin L, Houyel L, Bonnet D, Mousseaux E. Increased aortic pressures and pulsatile afterload components promote concentric left ventricular remodeling in adults with transposition of the great arteries and arterial switch operation. Int J Cardiol 2024; 405:131969. [PMID: 38490269 DOI: 10.1016/j.ijcard.2024.131969] [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: 06/27/2023] [Revised: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Functional abnormalities of the ascending aorta (AA) have been mainly reported in young patients who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA). OBJECTIVES To compare systolic, diastolic brachial and central blood pressures (bSBP, bDBP, cSBP, cDBP), aortic biomechanical parameters, and left ventricular (LV) afterload criteria in adult ASO patients with healthy controls and to assess their relationships with LV remodeling and aortic size. MATERIALS AND METHODS Forty-one prospectively enrolled patients (16.8 to 35.8 years) and 41 age- and sex-matched healthy volunteers underwent cardiac MRI to assess LV remodeling with simultaneous brachial BP estimation. After MRI, carotid-femoral tonometry was performed to measure pulse wave velocity (cfPWV), cSBP and cDBP for further calculation of pulse pressure (cPP), AA distensibility (AAD), and AA and LV elastance (AAE, LVE). RESULTS bSBP, bDBP, cSBP,cDBP and cPP were all significantly higher in ASO group than in controls: cSBP (116.5 ± 13.8 vs 106.1 ± 12.0, p < 0.001), cDBP (72.5 ± 6.9 vs 67.1 ± 9.4, p = 0.002), cPP (44.0 ± 12.1 vs 39.1 ± 8.9, p = 0.003) and not related to aortic size. AAD were decreased in ASO patients vs controls (4.70 ± 2.72 vs 6.69 ± 2.16, p < 0.001). LV mass was correlated with bSBP, cSBP, cPP (ρ = 0.48; p < 0.001), while concentric LV remodeling was correlated with AAE (ρ = 0.60, p < 0.001) and LVE (ρ = 0.32, p = 0.04), but not with distensibility. CONCLUSION Even without reaching arterial hypertension, aortic sBP and PP are increased in the adult TGA population after ASO, altering the pulsatile components of afterload and contributing to LV concentric remodeling.
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Affiliation(s)
- Zahra Belhadjer
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Magalie Ladouceur
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Gilles Soulat
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Antoine Legendre
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Umit Gencer
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; PARCC, INSERM UMR970, Paris, France
| | - Thomas Dietenbeck
- SorbonneUniversite, CNRS, INSERM, Laboratoire d'Imagerie Biomedicale, LIB, Paris, France
| | - Laurence Iserin
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Lucile Houyel
- Assistance Publique Hôpitaux de Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France
| | - Damien Bonnet
- Assistance Publique Hôpitaux de Paris, France; Hôpital Necker, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015 Paris, France; Université Paris Cité, Paris, France
| | - Elie Mousseaux
- Assistance Publique Hôpitaux de Paris, France; Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France; PARCC, INSERM UMR970, Paris, France.
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Kavga M, Banjoko A, Poole E, Stickley J, Desai T, Miller P, Harris M, Crucean A, Khan N, Seale AN. Congenitally Corrected Transposition of the Great Arteries in Utero: Morphological Spectrum, Outcomes and Pitfalls in Fetal Diagnosis. Pediatr Cardiol 2024; 45:1089-1099. [PMID: 38512489 DOI: 10.1007/s00246-024-03468-y] [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: 11/04/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
Congenitally corrected transposition of the great arteries (ccTGA) is a rare malformation with diverse morphology. We assessed features of fetuses with ccTGA and evaluated neonatal and pediatric outcomes. This was a retrospective review of fetuses with ccTGA at Birmingham Women's and Children's Hospital born from 2005 to 2019. Of thirty-six fetuses identified, six had unavailable prenatal data, one was postnatally diagnosed with isomerism and 29 fetuses were evaluated. ccTGA without associated cardiac lesions was found in 28% (8/29), ccTGA with significant VSD in 31% (9/29), ccTGA with pulmonary obstruction in 24% (7/29) and ccTGA with complex anomalies in 17% (5/29). Tricuspid regurgitation (TR) was observed in 17% (5/29) and heart block (HB) in 10% (3/29) prenatally. Six, that is 21% underwent genetic testing of which one was abnormal. Five extra-cardiac anomalies were reported prenatally and postnatally. Pregnancy was discontinued in five, of which two had moderate TR. There were thirty-one liveborn. Coarctation of the aorta was found in five postnatally but not suspected prenatally. In one, pulmonary stenosis was underestimated; otherwise, prenatal morphology was confirmed. Cardiac interventions were performed in 77% (24/31) liveborn with 39% (12/31) undergoing neonatal intervention. Overall, 6/31 liveborn died including all three with prenatal heart block and one with TR. Estimated survival for all liveborn at 1, 5 and 10 years was 87% (95% CI 76-100%), 83% (95% CI 72-98%) and 80% (95% CI 66-96%) respectively. Accurate prenatal diagnosis of ccTGA is critical for counseling. Early outcomes are favorable with 77% of liveborn undergoing surgery. Fetuses with prenatal diagnosis of complex associated abnormalities, HB and TR appear to do less well.
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Affiliation(s)
- Maria Kavga
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK.
| | - Adeolu Banjoko
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Esther Poole
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - John Stickley
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Tarak Desai
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Paul Miller
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Michael Harris
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Adrian Crucean
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Natasha Khan
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Gottschalk I, Walter A, Menzel T, Weber EC, Wendt S, Sreeram N, Gembruch U, Berg C, Abel JS. D-Transposition of the great arteries with restrictive foramen ovale in the fetus: the dilemma of predicting the need for postnatal urgent balloon atrial septostomy. Arch Gynecol Obstet 2024; 309:1353-1367. [PMID: 36971845 PMCID: PMC10894161 DOI: 10.1007/s00404-023-06997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Restrictive foramen ovale (FO) in dextro-transposition of the great arteries (d-TGA) with intact ventricular septum may lead to severe life-threatening hypoxia within the first hours of life, making urgent balloon atrial septostomy (BAS) inevitable. Reliable prenatal prediction of restrictive FO is crucial in these cases. However, current prenatal echocardiographic markers show low predictive value, and prenatal prediction often fails with fatal consequences for a subset of newborns. In this study, we described our experience and aimed to identify reliable predictive markers for BAS. METHODS We included 45 fetuses with isolated d-TGA that were diagnosed and delivered between 2010 and 2022 in two large German tertiary referral centers. Inclusion criteria were the availability of former prenatal ultrasound reports, of stored echocardiographic videos and still images, which had to be obtained within the last 14 days prior to delivery and that were of sufficient quality for retrospective re-analysis. Cardiac parameters were retrospectively assessed and their predictive value was evaluated. RESULTS Among the 45 included fetuses with d-TGA, 22 neonates had restrictive FO postnatally and required urgent BAS within the first 24 h of life. In contrast, 23 neonates had normal FO anatomy, but 4 of them unexpectedly showed inadequate interatrial mixing despite their normal FO anatomy, rapidly developed hypoxia and also required urgent BAS ('bad mixer'). Overall, 26 (58%) neonates required urgent BAS, whereas 19 (42%) achieved good O2 saturation and did not undergo urgent BAS. In the former prenatal ultrasound reports, restrictive FO with subsequent urgent BAS was correctly predicted in 11 of 22 cases (50% sensitivity), whereas a normal FO anatomy was correctly predicted in 19 of 23 cases (83% specificity). After current re-analysis of the stored videos and images, we identified three highly significant markers for restrictive FO: a FO diameter < 7 mm (p < 0.01), a fixed (p = 0.035) and a hypermobile (p = 0.014) FO flap. The maximum systolic flow velocities in the pulmonary veins were also significantly increased in restrictive FO (p = 0.021), but no cut-off value to reliably predict restrictive FO could be identified. If the above markers are applied, all 22 cases with restrictive FO and all 23 cases with normal FO anatomy could correctly be predicted (100% positive predictive value). Correct prediction of urgent BAS also succeeded in all 22 cases with restrictive FO (100% PPV), but naturally failed in 4 of the 23 cases with correctly predicted normal FO ('bad mixer') (82.6% negative predictive value). CONCLUSION Precise assessment of FO size and FO flap motility allows a reliable prenatal prediction of both restrictive and normal FO anatomy postnatally. Prediction of likelihood of urgent BAS also succeeds reliably in all fetuses with restrictive FO, but identification of the small subset of fetuses that also requires urgent BAS despite their normal FO anatomy fails, because the ability of sufficient postnatal interatrial mixing cannot be predicted prenatally. Therefore, all fetuses with prenatally diagnosed d-TGA should always be delivered in a tertiary center with cardiac catheter stand-by, allowing BAS within the first 24 h after birth, regardless of their predicted FO anatomy.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - A Walter
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - T Menzel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - E C Weber
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - S Wendt
- Heartcenter, Department of Cardiac Surgery, Cardiothoracic Intensive Care and Thoracic Surgery, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - N Sreeram
- Department of Pediatric Cardiology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - J S Abel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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Mavroudis CD. Different Hearts, Same Problems: The Role of Right-Sided Mitral Valve Disease in Congenitally Corrected Transposition. Ann Thorac Surg 2024; 117:566-567. [PMID: 37633580 DOI: 10.1016/j.athoracsur.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Constantine D Mavroudis
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104.
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Sato K, Takamizawa K, Ogawa Y, Tanaka Y, Shiraga K, Masuda H, Matsui H, Inuzuka R, Senzaki H. Hemodynamic simulation of complete transposition of the great arteries for optimal treatment strategies based on its circulatory physiology. Am J Physiol Heart Circ Physiol 2024; 326:H812-H820. [PMID: 38276950 DOI: 10.1152/ajpheart.00668.2023] [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: 10/16/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 01/27/2024]
Abstract
Our study aimed to elucidate the role of different shunts and provide novel insights into optimal treatment approaches for complete transposition of the great arteries (TGA), which is characterized by unique and complicated circulatory dynamics. We constructed a computational cardiovascular TGA model and manipulated cardiovascular parameters, such as atrial septal defect (ASD) and patent ductus arteriosus (PDA) sizes, to quantify their effects on oxygenation and hemodynamics. In addition, ASD flow patterns were investigated as innovative indications for balloon atrial septostomy (BAS). Our model of TGA with an intact ventricular septum (TGA-IVS) showed that a large ASD can achieve sufficient mixing for survival without PDA, and the presence of PDA is detrimental to oxygen delivery. A treatment strategy for TGA-IVS that enlarges the ASD as much as possible by BAS and PDA closure would be desirable. In TGA with a ventricular septal defect (TGA-VSD), the VSD allows for higher oxygenation and reduces the detrimental effects of PDA on systemic circulation. In TGA-VSD, both strategies of enlarging the ASD by BAS with a closed PDA and adjusting the PDA in response to pulmonary vascular resistance (PVR) reduction without BAS may be effective. The simulated ASD flow patterns showed that the sharp peak left-to-right flow pattern in systole (σ-wave) reflected the hemodynamically significant ASD size, independent of PDA, VSD, and PVR. The ASD flow pattern visualized by Doppler echocardiography provides clinical insights into the significance of an ASD and indications for BAS, which are not readily apparent through morphological assessment.NEW & NOTEWORTHY Complete transposition of the great arteries (TGA) represents complex and unique circulation that is dependent on blood mixing through multiple interacting shunts. Consequently, the role of each shunt and the treatment strategy remain unclear. We developed a mathematical model of TGA circulation, revealing the significant influence of atrial septal defect (ASD) on oxygenation and hemodynamics. The blood flow pattern through the ASD reflects its hemodynamic impact and helps determine treatment strategies.
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Affiliation(s)
- Kaname Sato
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Koichi Takamizawa
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yosuke Ogawa
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yu Tanaka
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuhiro Shiraga
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hitomi Masuda
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hikoro Matsui
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hideaki Senzaki
- Comprehensive Support Center for Children's Happy Life and Future, Nihon Institute of Medical Science University, Saitama, Japan
- GK Choko: Comprehensive Support Center for Children's Happy lives and Futures, Saitama, Japan
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Weeda JA, Bokenkamp-Gramann R, Straver BB, Rammeloo L, Hahurij ND, Bertels RA, Haak MC, Te Pas AB, Hazekamp MG, Blom NA, van der Palen RLF. Balloon atrial septostomy for transposition of the great arteries: Safety and experience with the Z-5 balloon catheter. Catheter Cardiovasc Interv 2024; 103:308-316. [PMID: 38091308 DOI: 10.1002/ccd.30932] [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: 09/18/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Balloon atrial septostomy (BAS) is an emergent and essential cardiac intervention to enhance intercirculatory mixing at atrial level in deoxygenated patients diagnosed with transposition of the great arteries (TGA) and restrictive foramen ovale. The recent recall of several BAS catheters and the changes in the European legal framework for medical devices (MDR 2017/745), has led to an overall scarcity of BAS catheters and raised questions about the use, safety, and experience of the remaining NuMED Z-5 BAS catheter. AIMS To evaluate and describe the practice and safety of the Z-5 BAS catheter, and to compare it to the performance of other BAS catheters. METHODS A retrospective single-center cohort encompassing all BAS procedures performed with the Z-5 BAS catheter in TGA patients between 1999 and 2022. RESULTS A total of 182 BAS procedures were performed in 179 TGA-newborns at Day 1 (IQR 0-5) days after birth, with median weight of 3.4 (IQR 1.2-5.7) kg. The need for BAS was urgent in 90% of patients. The percentage of BAS procedures performed at bedside increased over time from 9.8% (before 2010) to 67% (2017-2022). Major complication rate was 2.2%, consisting of cerebral infarction (1.6%) and hypovolemic shock (0.5%). The rate of minor complications was 9.3%, including temporary periprocedural AV-block (3.8%), femoral vein thrombosis (2.7%), transient intracardiac thrombus (0.5%), and atrial flutter (2.2%). BAS procedures performed at bedside and in the cardiac catheterization laboratory had similar complication rates. CONCLUSIONS BAS using the Z-5 BAS catheter is both feasible and safe at bedside and at the cardiac catheterization laboratory with minimal major complications.
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Affiliation(s)
- Jesse A Weeda
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Regina Bokenkamp-Gramann
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Bart B Straver
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Lukas Rammeloo
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Nathan D Hahurij
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Robin A Bertels
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Monique C Haak
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Arjan B Te Pas
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Mark G Hazekamp
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Nico A Blom
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Roel L F van der Palen
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
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7
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Sengupta A, Carreon CK, Gauvreau K, Lee JM, Sanders SP, Colan SD, Del Nido PJ, Mayer JE, Nathan M. Growth of the Neo-Aortic Root and Prognosis of Transposition of the Great Arteries. J Am Coll Cardiol 2024; 83:516-527. [PMID: 37939977 DOI: 10.1016/j.jacc.2023.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Neo-aortic root dilatation can lead to significant late morbidity after the arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA). OBJECTIVES We sought to examine the growth of the neo-aortic root in d-TGA. METHODS A single-center, retrospective cohort study of patients who underwent the ASO between July 1, 1981 and September 30, 2022 was performed. Morphology was categorized as dextro-transposition of the great arteries with intact ventricular septum (d-TGA-IVS), dextro-transposition of the great arteries with ventricular septal defect (d-TGA-VSD), and double-outlet right ventricle-transposition of the great arteries type (DORV-TGA). Echocardiographically determined diameters and derived z scores were measured at the annulus, sinus of Valsalva, and sinotubular junction immediately before the ASO and throughout follow-up. Trends in root dimensions over time were assessed using linear mixed-effects models. The association between intrinsic morphology and the composite of moderate-severe aortic regurgitation (AR) and neo-aortic valve or root intervention was evaluated with univariable and multivariable Cox proportional hazards models. RESULTS Of 1,359 patients who underwent the ASO, 593 (44%), 666 (49%), and 100 (7%) patients had d-TGA-IVS, d-TGA-VSD, and DORV-TGA, respectively. Each patient underwent a median of 5 echocardiograms (Q1-Q3: 3-10 echocardiograms) over a median follow-up of 8.6 years (range: 0.1-39.3 years). At 30 years, patients with DORV-TGA demonstrated greater annular (P < 0.001), sinus of Valsalva (P = 0.039), and sinotubular junction (P = 0.041) dilatation relative to patients with d-TGA-IVS. On multivariable analysis, intrinsic anatomy, older age at ASO, at least mild AR at baseline, and high-risk root dilatation were associated with moderate-severe AR and neo-aortic valve or root intervention at late follow-up (all P < 0.05). CONCLUSIONS Longitudinal surveillance of the neo-aortic root is warranted long after the ASO.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Chrystalle Katte Carreon
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ji M Lee
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephen P Sanders
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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8
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Buendía-Fuentes F, Lozano-Edo S, Jover-Pastor P, Sánchez-Martínez JC, Martínez-Sole J, Rodríguez-Serrano M, Aguero J, Arnau-Vives MA, Osa-Sáez A, Martínez-Dolz LV, Rueda J. Left atrial strain in adults after the arterial switch operation for transposition of the great arteries. Echocardiography 2024; 41:e15750. [PMID: 38284674 DOI: 10.1111/echo.15750] [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: 07/17/2023] [Revised: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. METHODS A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. RESULTS LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13 ± 7.67 vs. 49.71 ± 8.38; LAS cd: -22.91 ± 5.69 vs. -34.55 ± 6.54; LASct: -8.14 ± 4.93 vs. -15.15 ± 6.07, p < .001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29 ± 2.68 vs. -21.98 ± 1.84, p < .001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38 ± 8.23 vs. 69.28 ± 5.92, p = .001) and 3D analysis (57.97% ± 4.16 vs. 60.67 ± 3.39, p = .011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. CONCLUSIONS LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.
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Affiliation(s)
- Francisco Buendía-Fuentes
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Silvia Lozano-Edo
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Pablo Jover-Pastor
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Julia Martínez-Sole
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Jaume Aguero
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel A Arnau-Vives
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Osa-Sáez
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luis V Martínez-Dolz
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Joaquín Rueda
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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9
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Baroutidou A, Ntiloudi D, Kasinos N, Nyktari E, Giannakoulas G. Multi-modality imaging of the systemic right ventricle in congenital heart disease. Echocardiography 2024; 41:e15749. [PMID: 38284684 DOI: 10.1111/echo.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/26/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
A comprehensive and structured imaging approach in the evaluation of the systemic right ventricle (sRV) in patients with complete transposition of the great arteries (TGA) after atrial switch procedure and congenitally corrected transposition of the great arteries (ccTGA) is a key for their optimal lifelong surveillance. Despite the improvements in cardiovascular imaging of adults with congenital heart disease (ACHD), the imaging of sRV remains an ongoing challenge due to its complex morphology and the difficulty in applying the existing knowledge for the systemic left ventricle. While cardiac magnetic resonance (CMR) is considered the gold standard imaging method, echocardiographic evaluation is primarily preferred in everyday clinical setting. Although qualitative assessment of its systolic function is primarily used, the introduction of advanced echocardiographic techniques, such as speckle tracking echocardiography (STE) and three-dimensional echocardiography (3DE), has provided new insights into the optimal assessment of the sRV. Standardized quantitative parameters remain to be elucidated, and morphometric and mechanistic studies are warranted to validate reference ranges for the sRV. This review highlights the challenges in the optimal evaluation of sRV and summarizes the available imaging tools. HIGHLIGHTS: CMR is the gold standard imaging method of sRV. Qualitative assessment of the systolic function of sRV is primarily used. Advanced echocardiographic techniques (STE and 3DE) provide optimal sRV assessment. Reference ranges for the sRV indices are warranted to be validated.
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Affiliation(s)
- Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Ntiloudi
- Department of Cardiology, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | - Nearchos Kasinos
- Department of Cardiology, Tzaneio General Hospital of Piraeus, Piraeus, Greece
- Echocardiography Laboratory, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | - Evangelia Nyktari
- Cardiovascular MRI Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Emani SM, Del Nido PJ. Systemic Atrioventricular Valve Regurgitation in Corrected Transposition of the Great Arteries: Where Are We? J Am Coll Cardiol 2023; 82:2209-2211. [PMID: 38030350 DOI: 10.1016/j.jacc.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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11
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Matthews B, Duddleston D, Hage FG. Myocardial perfusion imaging in congenitally corrected transposition of the great arteries. J Nucl Cardiol 2023; 30:2907-2910. [PMID: 37532961 DOI: 10.1007/s12350-023-03344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Benjamin Matthews
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Daniel Duddleston
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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12
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Kuźma J, Kuśmierczyk M, Szymańska-Beta K, Pietrasik A, Nossier R, Buczyński M. Aortic root aneurysm in a patient with Marfan syndrome and D-transposition of the great arteries. Kardiol Pol 2023; 82:237-238. [PMID: 37997852 DOI: 10.33963/v.kp.97719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Jacek Kuźma
- Cardiothoracic and Transplantology Department, Medical University of Warsaw, Warszawa, Poland.
| | - Mariusz Kuśmierczyk
- Cardiothoracic and Transplantology Department, Medical University of Warsaw, Warszawa, Poland
| | - Katarzyna Szymańska-Beta
- Department of Pediatric Anesthesiology and Intensive Therapy, Medical University of Warsaw, Warszawa, Poland
| | - Arkadiusz Pietrasik
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Razan Nossier
- Student Scientific Club, Cardiothoracic and Transplantology Department, Medical University of Warsaw, Warszawa, Poland
| | - Michał Buczyński
- Cardiothoracic and Transplantology Department, Medical University of Warsaw, Warszawa, Poland
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13
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Andescavage NN, Pradhan S, Gimovsky AC, Kapse K, Donofrio MT, Cheng JJ, Sharker Y, Wessel D, du Plessis AJ, Limperopoulos C. Magnetic Resonance Spectroscopy of Brain Metabolism in Fetuses With Congenital Heart Disease. J Am Coll Cardiol 2023; 82:1614-1623. [PMID: 37821172 DOI: 10.1016/j.jacc.2023.08.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) remains a significant risk factor for neurologic injury because altered fetal hemodynamics may be unable to support typical brain development during critical periods of growth and maturation. OBJECTIVES The primary objective was to assess differences in the cerebral biochemical profile between healthy fetuses and fetuses with complex CHD and to relate these with infant outcomes. METHODS Pregnant participants underwent fetal magnetic resonance imaging with cerebral proton magnetic resonance spectroscopy acquisitions as part of a prospective observational study. Cerebral metabolites of N-acetyl aspartate, creatine, choline, myo-inositol, scyllo-inositol, lactate, and relevant ratios were quantified using LCModel. RESULTS We acquired 503 proton magnetic resonance spectroscopy images (controls = 333; CHD = 170) from 333 participants (controls = 221; CHD = 112). Mean choline levels were higher in CHD compared with controls (CHD 2.47 IU [Institutional Units] ± 0.44 and Controls 2.35 IU ± 0.45; P = 0.02), whereas N-acetyl aspartate:choline ratios were lower among CHD fetuses compared with controls (CHD 1.34 ± 0.40 IU vs controls 1.44 ± 0.48 IU; P = 0.001). Cerebral lactate was detected in all cohorts but increased in fetuses with transposition of the great arteries and single-ventricle CHD (median: 1.63 [IQR: 0.56-3.27] in transposition of the great arteries and median: 1.28 [IQR: 0-2.42] in single-ventricle CHD) compared with 2-ventricle CHD (median: 0.79 [IQR: 0-1.45]). Cerebral lactate also was associated with increased odds of death before discharge (OR: 1.75; P = 0.04). CONCLUSIONS CHD is associated with altered cerebral metabolites in utero, particularly in the third trimester period of pregnancy, which is characterized by exponential brain growth and maturation, and is associated with survival to hospital discharge. The long-term neurodevelopmental consequences of these findings warrant further study.
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Affiliation(s)
- Nickie N Andescavage
- Department of Neonatology, Children's National Hospital, Washington, DC, USA; Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Subechhya Pradhan
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Mary T Donofrio
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Jenhao Jacob Cheng
- Department of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Yushuf Sharker
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - David Wessel
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Adre J du Plessis
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Prenatal Pediatric Institute, Children's National Hospital, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Radiology, Children's National Hospital, Washington, DC, USA; Department of Radiology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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14
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Singh R, Veettil ST, Kumar S, Ramakrishnan S. Anomalous drainage of great cardiac vein in left atrial appendage in a patient of transposition of the great arteries operated by switch operation with Lecompte manoeuvre. BMJ Case Rep 2023; 16:e256984. [PMID: 37844976 PMCID: PMC10583060 DOI: 10.1136/bcr-2023-256984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Affiliation(s)
- Resham Singh
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sreelal Thazhathu Veettil
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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15
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Negi SL, Chakorvarthy L, Gowda N, Kumar R. Role of transesophageal echocardiography in early detection of myocardial ischemia before electrocardiography changes post arterial switch operation. Ann Card Anaesth 2023; 26:451-453. [PMID: 37861584 PMCID: PMC10691568 DOI: 10.4103/aca.aca_161_22] [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: 09/21/2022] [Revised: 11/05/2022] [Accepted: 02/21/2023] [Indexed: 10/21/2023] Open
Abstract
Myocardial ischemia after arterial switch operation is most commonly associated with imperfect translocation of coronary arteries to the neoaorta. Early post-operative myocardial ischemia is the main cause of morbidity and mortality in these patients. We present a rare case of intra-operative myocardial ischemia after ASO, detected with transesophageal echocardiography before electrocardiography changes.
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Affiliation(s)
- Sunder L. Negi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Loganathan Chakorvarthy
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nischita Gowda
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Santens B, Van De Bruaene A, De Meester P, Claessen G, Moons P, Claus P, Goetschalckx K, Bogaert J, Budts W. Decreased cardiac reserve in asymptomatic patients after arterial switch operation for transposition of the great arteries. Int J Cardiol 2023; 388:131153. [PMID: 37433406 DOI: 10.1016/j.ijcard.2023.131153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/13/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Exercise capacity is impaired in patients after arterial switch operation (ASO) for complete transposition of the great arteries. Maximal oxygen consumption is related with outcome. OBJECTIVES This study assessed ventricular function by advanced echocardiography and cardiac magnetic resonance (CMR) imaging at rest and during exercise, to determine exercise capacity in ASO patients, and to correlate exercise capacity with ventricular function as potential early marker of subclinical impairment. METHODS Forty-four patients (71% male, mean age 25 ± 4 years - range 18-40 years) were included during routine clinical follow-up. Assessment involved physical examination, 12‑lead ECG, echocardiography, and cardiopulmonary exercise test (CPET) (day 1). On day 2 CMR imaging at rest and during exercise was performed. Blood was sampled for biomarkers. RESULTS All patients reported New York Heart Association class I, the overall cohort had an impaired exercise capacity (80 ± 14% of predicted peak oxygen consumption). Fragmented QRS was present in 27%. Exercise CMR showed that 20% of patients had abnormal contractile reserve (CR) of the left ventricle (LV) and 25% had reduced CR of the right ventricle (RV). CR LV and CR RV were significantly associated with impaired exercise capacity. Pathological patterns on myocardial delayed enhancement and hinge point fibrosis were detected. Biomarkers were normal. CONCLUSION This study found that in some asymptomatic ASO patients electrical, LV and RV changes at rest, and signs of fibrosis are present. Maximal exercise capacity is impaired and seems to be linearly related to the CR of the LV and the RV. Therefore, exercise CMR might play a role in detecting subclinical deterioration of ASO patients.
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Affiliation(s)
- Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | | | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium.
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Liu R, Li S, Yan J, Yan F, Pang K, Wang X, Hu S. Fate of transposition of the great arteries with pulmonary stenosis after double-root translocation, Rastelli, and Réparation à l'Etage Ventriculaire. J Thorac Cardiovasc Surg 2023; 166:1189-1199.e4. [PMID: 37295643 DOI: 10.1016/j.jtcvs.2023.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/07/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES For transposition of the great arteries with unrestricted ventricular septal defect and pulmonary stenosis, double-root translocation is reported to reconstruct ideal double artery roots with growth potential. However, prospective long-term studies describing the long-term outcomes are still scarce. Therefore, the aim was to assess development of double artery roots, hemodynamics, and freedom from death and heart failure 17 years after double-root translocation, Rastelli, and Réparation à l'Etage Ventriculaire procedures. METHODS In this prospective population-based study, 266 patients with transposition of the great arteries/ventricular septal defect/pulmonary stenosis (from July 2004 to August 2021) were consecutively included before surgery. All patients were divided into 3 groups based on the type of operation: double-root translocation (174), Rastelli (68), and Réparation à l'Etage Ventriculaire (24), who accepted postoperative evaluations annually. Generalized linear mixed model analysis was performed to determine growth potential of artery roots. RESULTS Longitudinal repeated computed tomography measurements show the pulmonary root has significantly increased diameter (0.62 [0.03] mm/y, P < .001) over time and an adequate Z-score (-0.18) at the last follow-up only in the double-root translocation group. The pressure gradients of double outflow tracts in the double-root translocation group were the least among 3 groups. The probabilities of freedom from death/heart failure at the 15th year were 73.1%, 59.3%, and 60.9% in the double-root translocation, Rastelli, and Réparation à l'Etage Ventriculaire groups, respectively (double-root translocation vs Rastelli, P = .026; double-root translocation vs Réparation à l'Etage Ventriculaire, P = .009; Rastelli vs Réparation à l'Etage Ventriculaire, P = .449). CONCLUSIONS By reconstructing ideal double artery roots, double-root translocation can provide postoperative long-term excellent hemodynamics and minimal death and heart failure for patients with transposition of the great arteries/ventricular septal defect/pulmonary stenosis.
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Affiliation(s)
- Rui Liu
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shoujun Li
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Yan
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fuxia Yan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kunjing Pang
- Department of Echocardiogram, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Cave DGW, Lillitos PJ, Lancaster R, Bentham JR, Barwick S. Out-of-hours versus in-hours delivery of antenatally diagnosed transposition of the great arteries: outcomes from a United Kingdom Tertiary Centre. Cardiol Young 2023; 33:1873-1878. [PMID: 36325964 DOI: 10.1017/s1047951122003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the impact of out-of-hours delivery on outcome for neonates with antenatally diagnosed transposition of the great arteries. SETTING Tertiary paediatric cardiology centre (Yorkshire, United Kingdom), with co-located tertiary neonatal unit. PATIENTS Neonates with antenatally diagnosed simple transposition of the great arteries delivered out-of-hours (Monday to Friday 17:00-08:00 and weekends) versus in-hours between 2015 and 2020. OUTCOME The primary outcome was survival to hospital discharge. Secondary outcomes included neurological morbidity, length of stay, and time to balloon atrial septostomy. RESULTS Of 51 neonates, 38 (75%) were delivered out-of-hours. All neonates born in the tertiary centre survived to discharge. Time to balloon atrial septostomy was slightly longer for out-of-hours deliveries compared to in-hours (median 130 versus 93 mins, p = 0.33). Neurological morbidity occurred for nine (24%) patients in the out-of-hours group and one (8%) in-hours (OR 3.72, 95% CI: 0.42-32.71, p = 0.24). Length of stay was also similar (18.5 versus 17.3 days, p = 0.59). Antenatal diagnosis of a restrictive atrial septum was associated with a lower initial pH (7.03 versus 7.13; CI: 0.03-0.17, p = 0.01), longer length of stay (22.6 versus 17.3 days; CI: 0.37-10.17, p = 0.04), and increased neurological morbidity (44% versus 14%; OR 4.80, CI 1.00-23.15, p = 0.05). A further three neonates were delivered in surrounding hospitals, with a mortality of 67% (versus 0 in tertiary centre; OR 172, CI 5-5371, p = 0.003). CONCLUSION Neonates with antenatally diagnosed transposition of the great arteries have similar outcomes when delivered out-of-hours versus in-hours. Antenatal diagnosis of restrictive atrial septum is a significant predictor of worse outcomes. In our region, delivery outside the tertiary cardiac centre had a significantly higher risk of mortality.
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Affiliation(s)
- Daniel G W Cave
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
- University of Leeds, Leeds, West Yorkshire, UK
| | - Peter J Lillitos
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - Rebecca Lancaster
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - James R Bentham
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - Shuba Barwick
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
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19
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Pergola V, Avesani M, Reffo E, Da Pozzo S, Cavaliere A, Padalino M, Vida V, Motta R, Di Salvo G. Unveiling the gothic aortic arch and cardiac mechanics: insights from young patients after arterial switch operation for d-transposition of the great arteries. Monaldi Arch Chest Dis 2023; 94. [PMID: 37768214 DOI: 10.4081/monaldi.2023.2712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The arterial switch operation (ASO) has become the standard surgical treatment for patients with d-transposition of the great arteries. While ASO has significantly improved survival rates, a subset of patients develop a unique anatomical anomaly known as the gothic aortic arch (GAA). Understanding cardiac mechanics in this population is crucial, as altered mechanics can have profound consequences for cardiac function and exercise capacity. The GAA has been associated with changes in ventricular function, hemodynamics, and exercise capacity. Studies have shown a correlation between the GAA and decreased ascending aorta distensibility, loss of systolic wave amplitude across the aortic arch, and adverse cardiovascular outcomes. Various imaging techniques, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, play a crucial role in assessing cardiac mechanics and evaluating the GAA anomaly. Despite significant advancements, gaps in knowledge regarding the prognostic implications and underlying mechanisms of the GAA anomaly remain. This review aims to explore the implications of the GAA anomaly on cardiac mechanics and its impact on clinical outcomes in young patients after ASO. Advancements in imaging techniques, such as computational modeling, offer promising avenues to enhance our understanding of cardiac mechanics and improve clinical management.
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Affiliation(s)
- Valeria Pergola
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | - Elena Reffo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | | | | | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Raffaella Motta
- Radiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua.
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
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20
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Ladouceur M. Congenitally corrected transposition of the great arteries: have we shifted the disease 'trajectory? Eur Heart J 2023; 44:3292-3294. [PMID: 37592741 DOI: 10.1093/eurheartj/ehad482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Affiliation(s)
- Magalie Ladouceur
- Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, APHP, Paris Descartes University, Centre de Recherche Cardiovasculaire de Paris, INSERM U970, 20 rue Leblanc, 75015 Paris, France
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21
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García-Cruz E, Manzur-Sandoval D, Toledo-Alemán EL, Angulo-Cruzado ST, Sánchez-López SV, Benita-Bordes A, Calderón-Colmenero J, Díaz-Gallardo LG, Aranda-Fraustro A, Mata-Salgado GD, Baranda-Tovar FM. Hypertrophic cardiomyopathy in the systemic right ventricle in a patient with congenitally corrected transposition of the great arteries: A case report. Echocardiography 2023; 40:1016-1020. [PMID: 37498200 DOI: 10.1111/echo.15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023] Open
Abstract
Congenitally corrected transposition of the great arteries is a rare clinical entity, which usually presents during adulthood with associated defects; atrioventricular block, heart failure, systemic valve failure, and arrhythmias usually complicate the clinical course. Even rarer is associated hypertrophic cardiomyopathy, which complicates the disease course and clinical decision-making. Herein, we present a patient with this condition who underwent heart transplantation, with adequate clinical resolution.
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Affiliation(s)
- Edgar García-Cruz
- Congenital Heart Disease Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Daniel Manzur-Sandoval
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | | | - Antonio Benita-Bordes
- Congenital Heart Disease Surgery Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan Calderón-Colmenero
- Congenital Heart Disease Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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22
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Li TG, Su XR, Wu WR, Zhang WD, Ma B. Prenatal diagnosis of fetal conotruncal defects by using 2D ultrasound and HD live flow combined with spatiotemporal image correlation. J Clin Ultrasound 2023; 51:1166-1171. [PMID: 36976169 DOI: 10.1002/jcu.23454] [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] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/04/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION To explore the diagnostic value of spatiotemporal image correlation (STIC) for different types of fetal conotruncal defects (CTDs). METHODS The clinical data and STIC images of 174 fetuses with CTDs diagnosed via prenatal ultrasound were analyzed retrospectively. RESULTS Among the 174 cases of CTDs, 58 were tetralogy of Fallot (TOF); 30, transposition of great arteries (TGA) (D-TGA, 23 cases; cc-TGA, 7 cases); 26, double outlet of the right ventricle (DORV); 32, persistent arterial trunk (PTA) (type A1, 15 cases; type A2, 11 cases; type A3, 5 cases; type A4, 1 case); and 28, pulmonary atresia (PA) (ventricular septal defect, 24 cases; ventricular septal integrity, 4 cases). Among the cases, 156 were complicated with complex congenital intracardiac and extracardiac malformations. The abnormal display rate of the four-chamber view of two-dimensional echocardiography was low. The display rate of the permanent arterial trunk was the highest (90.6%) in STIC imaging. CONCLUSIONS STIC imaging can be used in the diagnosis of different types of CTDs, especially in persistent arterial trunks, and thus has great value for the clinical treatment and prognosis of these defects.
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Affiliation(s)
- Tian-Gang Li
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu Province, China
| | - Xiao-Rong Su
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
| | - Wen-Rui Wu
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
| | - Wen-Dong Zhang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
| | - Bin Ma
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu Province, China
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23
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Grzyb A, Szymkiewicz-Dangel J. Cerebroplacental hemodynamics in fetuses with transposition of the great arteries and usefulness in predicting neonatal condition. Ultrasound Obstet Gynecol 2023; 62:414-421. [PMID: 37021693 DOI: 10.1002/uog.26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Literature on cerebroplacental hemodynamics in fetuses with transposition of the great arteries (TGA) is scarce and provides conflicting results regarding the presence of a brain-sparing effect. The aims of this study were to examine Doppler parameters in the middle cerebral artery (MCA) and umbilical artery (UA) in a large cohort of fetuses with TGA, and to assess their possible utility in predicting the need for urgent balloon atrial septostomy (BAS) in the neonate. METHODS This was a retrospective observational study of fetuses diagnosed with TGA between 2008 and 2022 and an age-matched cohort of normal fetuses, conducted in a single tertiary fetal cardiology center. Medical records and echocardiographic examinations were reviewed to collect demographic, sonographic and follow-up data. Selected Doppler parameters were compared between fetuses with TGA and normal fetuses, as well as between TGA fetuses with and those without an associated ventricular septal defect (VSD), to assess the impact of this congenital heart defect on cerebroplacental circulation. Additionally, Doppler indices in patients with a restrictive foramen ovale (FO) were analyzed to identify potential predictors of the need for urgent BAS. RESULTS A total of 541 examinations of 159 fetuses with TGA performed between 19 and 40 weeks' gestation and 1300 examinations of 1215 age-matched normal fetuses were included in the study. MCA pulsatility index (PI) and UA-PI followed expected trends throughout pregnancy, with slightly higher values observed in TGA fetuses, albeit within the limits for the normal population. Cerebroplacental ratio (CPR) values were similar in normal and TGA fetuses. The presence of a small VSD did not have a clinically significant impact on Doppler parameters. Peak systolic velocity (PSV) in the MCA increased gradually after 35 weeks' gestation, especially in fetuses that did not develop restriction of the FO after birth. MCA-PSV values below 1.16 multiples of the median measured at 38 weeks or later predicted the need for urgent BAS with 81.4% sensitivity and 52.4% specificity. CONCLUSIONS MCA-PI, UA-PI and CPR values in fetuses with TGA usually fall within normal limits throughout pregnancy. The presence of a small VSD does not affect the Doppler parameters significantly. MCA-PSV increases in TGA fetuses after 35 weeks, and its value measured at the last prenatal examination (ideally after 37 weeks) may serve as an additional predictive factor for the need for urgent BAS. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Grzyb
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - J Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
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24
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Furukawa Y, Cao Y, Ikarashi J, Tachibana T. [Left Main Trunk Orifice Reconstruction Using Aortic flap and Autologous Pulmonary Arterial Patch for Severe Left Main Trunk Stenosis After Arterial Switch Operation]. Kyobu Geka 2023; 76:681-684. [PMID: 37735724] [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: 09/23/2023]
Abstract
A 6-year-old boy with left main trunk (LMT) stenosis, who had undergone arterial switch operation (ASO) for transposition of the great arteries( TGA) before 6 years, underwent LMT orifice reconstruction. Coronary angiography showed severe stenosis of LMT, already when he was hospitalized with heart failure after 3 months of ASO. He was stable with oral treatment, therefore we performed the LMT reconstruction, before starting school, in terms of the risk of coronary ischemic event. We reconstructed the LMT ostium using an aortic flap and autologous pulmonary arterial patch. The postoperative computed tomography showed neither stenosis nor kinking at the repair site of LMT. He remains asymptomatic for over 6 months. We have reported that this method is effective to repair coronary artery anomalies (CAAs), since using an aortic flap. We could form a coronary artery floor, which is affixed to the aortic wall. This method allows us to change the coronary orifice position and the angle, so it is very useful method not for only CAAs, but also for coronary stenosis after ASO.
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Affiliation(s)
- Yurika Furukawa
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
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25
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Hongu H, Oda S, Maeda Y, Asada S, Fujita S, Yamashita E, Nagase T, Yamagishi M. A new predictor of the optimal pulmonary artery reconstruction method during the arterial switch operation. Eur J Cardiothorac Surg 2023; 64:ezad173. [PMID: 37140552 DOI: 10.1093/ejcts/ezad173] [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: 10/03/2022] [Revised: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES The aim of this study was to more accurately predict the optimal pulmonary artery (PA) reconstruction procedure (Lecompte manoeuvre or original Jatene procedure) during the arterial switch operation, we focused on the horizontal sectioning (HS) angle between the left hilum PA and the great arteries using preoperative computed tomography imaging. METHODS We defined the HS angle α (β) as the angle between the tangential line from the posterior (anterior) wall of the left PA at the hilum to the left anterior (right posterior) surface of the main PA and the tangential line from the left surface of the ascending aorta to the left anterior (right posterior) surface of the main PA. We identified 14 consecutive patients diagnosed with transposition of the great arteries or transposition of the great artery-type double-outlet right ventricle who underwent preoperative computed tomography imaging. The original Jatene or Lecompte procedure was used for 9 (OJ group) and 5 (L group) patients. Relationships of the great arteries of the OJ and L groups were side by side in 8 and 2 patients, oblique in 1 and 1 patient and anteroposterior in 0 and 2 patients, respectively. RESULTS In the OJ group, β was greater than α in all patients. The median α/β value was 0.618. In group L, α was greater than β in all patients. The median α/β was 1.307. Left PA stenosis caused by stretching was not observed in the L group. Coronary obstruction was not identified in the OJ group. Left PA stenosis behind the neo-ascending aorta was observed in 1 patient in the OJ group and required reoperation. CONCLUSIONS The HS angle may be a useful predictor of optimal intraoperative PA reconstruction during arterial switch operation, especially for side-by-side or oblique relationships.
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Affiliation(s)
- Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinichiro Oda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Nagase
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
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26
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Konstantinov IE, Davis A, Buratto E. Complex transposition of great arteries with dextrocardia. J Thorac Cardiovasc Surg 2023; 165:1218-1223. [PMID: 36402579 DOI: 10.1016/j.jtcvs.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
| | - Andrew Davis
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
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27
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Burkhart HM, Mir A, Nakamura Y. Commentary: Congenitally corrected transposition of the great arteries: Is anatomic repair the preferred approach? J Thorac Cardiovasc Surg 2023; 165:1216-1217. [PMID: 36207158 DOI: 10.1016/j.jtcvs.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Arshid Mir
- Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Yuki Nakamura
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
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28
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DeVore GR, Cuneo B, Sklansky M, Satou G. Abnormalities of the Width of the Four-Chamber View and the Area, Length, and Width of the Ventricles to Identify Fetuses at High-Risk for D-Transposition of the Great Arteries and Tetralogy of Fallot. J Ultrasound Med 2023; 42:637-646. [PMID: 35822424 DOI: 10.1002/jum.16060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The prenatal detection of D-Transposition of the great arteries (D-TGA) and tetralogy of Fallot (TOF) has been reported to be less than 50% to as high as 77% when adding the outflow tracts to the four-chamber screening protocol. Because many examiners still struggle with the outflow tract examination, this study evaluated whether changes in the size and shape of the heart in the 4CV as well as the ventricles occurred in fetuses with D-TGA and TOF could be used to screen for these malformations. METHODS Forty-four fetuses with the pre-and post-natal diagnosis of D-TGA and 44 with TOF were evaluated between 19 and 36 weeks of gestation in which the 4CV was imaged. Measurements of the end-diastolic width, length, area, and global sphericity index were measured for the four-chamber view and the right and left ventricles. Using z-score computed values, logistic regression was performed between the 88 study and 200 control fetuses using the hierarchical forward selection protocol. RESULTS Logistic regression identified 10 variables that correctly classified 83/88 of fetuses with TOF and TGA, for a sensitivity of 94%. Six of 200 normal controls were incorrectly classified for a false-positive rate of 3%. The area under the receiver operator classification curve was 98.1%. The true positive rate for D-TGA was 93.2%, with a false-negative rate to 6.8%. The true positive rate for TOF was 95.5%, with a false negative rate of 4.5%. CONCLUSIONS Measurements of the 4CV and of the RV and LV may help identify fetuses at risk for D-TGA or TOF.
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Affiliation(s)
- Greggory R DeVore
- Fetal Diagnostic Centers of Pasadena, Tarzana, and Lancaster, Los Angeles, California, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Bettina Cuneo
- The Heart Institute and the Colorado Fetal Care Center, Departments of Pediatrics and Obstetrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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29
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Toma D, Gabor-Miklosi D, Cerghit-Paler A, Șuteu CC, Cosma MC, Mărginean C, Iancu M, Gozar L. Impaired Speckle-Tracking-Derived Left Ventricular Longitudinal Strain Is Associated with Transposition of Great Arteries in Neonates: A Single-Center Study. Int J Environ Res Public Health 2022; 20:674. [PMID: 36612992 PMCID: PMC9820037 DOI: 10.3390/ijerph20010674] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
The transposition of great arteries (TGA) is one of the most frequent and severe congenital heart diseases. After newborn stabilization and while pending surgical correction, echocardiographic monitoring with a careful evaluation of left ventricle (LV) performance is warranted. In this study, our objectives were (i) to compare myocardial function, assessed via speckle-tracking echocardiography, between neonates with TGA and neonates without TGA and (ii) to identify a strain parameter with a good discriminatory ability for TGA. We conducted a retrospective, single-center study. A total of 90 neonates were examined, of whom 66 were included (16 comprised the TGA group and 50 comprised the control group). The results of a bivariate analysis showed that classic echocardiography parameters displayed no significant differences between the two studied groups (p = 0.785 for EF, p = 0.286 for MAPSE and p = 0.315 for TAPSE). We found a statistically significant difference between the two groups for the mean values of the LVpGLS parameter (adjusted p = 0.0047), with impaired LV myocardium function being observed in the TGA group after adjusting for other covariates. Regarding segmental strain, the mean medial and apical inter-ventricular septum strain values were found to be significantly lower in the neonates with TGA than in the controls (95% CI for difference in means: [-6.45, -0.65], [-8.56, -1.97]). The results of an ROC analysis showed that LVpGLS had a significant ability to differentiate between neonates with TGA and controls (AUC = 0.712, 95% CI: [0.52, 0.903], p = 0.011). In conclusion, LVpGLS is a parameter with a significant discriminatory ability for LV dysfunction, and it is useful in the evaluation of ventricular myocardial function in newborns with TGA.
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Affiliation(s)
- Daniela Toma
- Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
- Department of Pediatrics,”George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania
| | - Dorottya Gabor-Miklosi
- Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
| | - Andreea Cerghit-Paler
- Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
- Department of Pediatrics,”George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania
| | - Carmen Corina Șuteu
- Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
| | - Marius-Catalin Cosma
- Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology,”George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania
| | - Mihaela Iancu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400349 Cluj-Napoca, Romania
| | - Liliana Gozar
- Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
- Department of Pediatrics,”George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania
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30
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Gregov A, Hrabak Paar M. Magnetic Resonance Imaging Assessment of Right Ventricular Deformation in Patients With Transposition of the Great Arteries. J Thorac Imaging 2022; 37:W85-W91. [PMID: 35699673 DOI: 10.1097/rti.0000000000000662] [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: 11/25/2022]
Abstract
PURPOSE To detect changes of right ventricular (RV) myocardial deformation in patients with systemic RV (SRV) and transposition of the great arteries (TGA) as compared with individuals without structural heart disease. MATERIALS AND METHODS We performed a retrospective analysis of cine steady-state free precession cardiac magnetic resonance imaging sequences acquired using a 1.5 T scanner in short-axis and long-axis views in 25 patients with SRV (16 with atrial switch repair for D-TGA and 9 with congenitally corrected TGA; age range 19 to 68, 13 males). The control group consisted of 25 individuals without structural heart disease (age range 10 to 73, 14 males). Besides routine RV magnetic resonance imaging volumetry, mean longitudinal RV strain was measured on a 4-chamber view, and mean circumferential RV strain on 3 short-axis images (basal, midventricular, and apical) based on feature tracking. The strain parameters were statistically compared between patients with SRV and the control group. RESULTS Patients with SRV, compared with the control group, had significantly higher RV-indexed end-diastolic volume (122±40 vs. 70±9 mL/m 2 , P <0.001), lower RV ejection fraction (45±12% vs. 62±6%, P <0.001), and reduced mean longitudinal RV strain (-13.7±3.6% vs. -21.6±2.7%, P <0.001). There was no relevant difference between mean circumferential SRV strain in the basal and midventricular plane; however, in patients with SRV, mean circumferential strain was reduced at the apical level (-12.0±6.1% vs. -17.9±5.6%, P <0.001). CONCLUSIONS SRV failure could be explained by reduced longitudinal SRV strain caused by the longitudinal orientation of RV myocardial fibers. In patients with SRV, circumferential RV strain is only reduced in apical segments.
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Affiliation(s)
| | - Maja Hrabak Paar
- University of Zagreb School of Medicine
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
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31
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Shah A, Joshi AR, Allu RD, Jeswani H. Unusual case of complete situs inversus with congenitally corrected transposition of the great arteries with levocardia: imaging with MDCT. BMJ Case Rep 2022; 15:e245839. [PMID: 35428663 PMCID: PMC9013953 DOI: 10.1136/bcr-2021-245839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Anagha Rajeev Joshi
- Radiodiagnosis, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Ramya Devi Allu
- Radiodiagnosis, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Harsha Jeswani
- Radiodiagnosis, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Marathe SP, Chávez M, Schulz A, Sleeper LA, Marx GR, Emani SM, Del Nido PJ, Baird CW. Contemporary outcomes of the double switch operation for congenitally corrected transposition of the great arteries. J Thorac Cardiovasc Surg 2022; 164:1980-1990.e7. [PMID: 35688715 DOI: 10.1016/j.jtcvs.2022.01.049] [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: 07/15/2020] [Revised: 09/24/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the contemporary outcomes of the double switch operation (DSO) (ie, Mustard or Senning + arterial switch). METHODS A single-institution, retrospective review of all patients with congenitally corrected transposition of the great arteries undergoing a DSO. RESULTS Between 1999 and 2019, 103 patients underwent DSO with a Mustard (n = 93) or Senning (n = 10) procedure. Segmental anatomy was (S, L, L) in 93 patients and (I, D, D) in 6 patients. Eight patients had heterotaxy and 71 patients had a ventricular septal defect. Median age was 2.1 years (range, 1.8 months-40 years), including 34 patients younger than age 1 year (33%). Median weight was 10.9 kg (range, 3.4-64 kg). Sixty-one patients had prior pulmonary artery bands for a median of 1.1 years (range, 14 days-12.9 years; interquartile range, 0.7-3.1 years). Median intensive care unit and hospital lengths of stay were 5 and 10 days, respectively. Median follow-up was 3.4 years (interquartile range, 1-9.8 years) and 5.2 years (interquartile range, 2.3-10.7 years) in 79 patients with >1 year follow-up. At latest follow-up, aortic, mitral, tricuspid valve regurgitation, and left ventricle dysfunction was less than moderate in 96%, 98%, 96%, and 93%, respectively. Seventeen patients underwent reoperation: neoaortic valve intervention (n = 10), baffle revision (n = 5), and ventricular septal defect closure (n = 4). At latest follow-up, 17 patients (17%) had a pacemaker and 27 (26%) had cardiac resynchronization therapy devices. There were 2 deaths and 2 transplants. Transplant-free survival was 94.6% at 5 years. Risk factors for death or transplant included longer cardiopulmonary bypass time and older age at DSO. CONCLUSIONS The outcomes of the DSO are promising. Earlier age at operation might favor better outcomes. Progressive neoaortic regurgitation and reinterventions on the neo-aortic valve are anticipated problems.
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Affiliation(s)
- Supreet P Marathe
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Mariana Chávez
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Antonia Schulz
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lynn A Sleeper
- Harvard Medical School, Boston, Mass; Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Gerald R Marx
- Harvard Medical School, Boston, Mass; Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Ono R, Takaoka H, Ryuzaki S, Suzuki-Eguchi N, Kobayashi Y. Late presentation of congenitally corrected transposition of the great arteries. BMJ Case Rep 2022; 15:e248325. [PMID: 35241451 PMCID: PMC8895949 DOI: 10.1136/bcr-2021-248325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoko Ryuzaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Buca D, Winberg P, Rizzo G, Khalil A, Liberati M, Makatsariya A, Greco F, Nappi L, Acharya G, D'Antonio F. Prenatal risk factors for urgent atrial septostomy at birth in fetuses with transposition of the great arteries: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022; 35:598-606. [PMID: 32041458 DOI: 10.1080/14767058.2020.1725883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
MATERIAL AND METHODS Medline, Embase, and Cochrane databases were searched. The primary aim was to explore the differences in prenatal echocardiographic parameters among fetuses diagnosed with TGA that required urgent BAS within 24 h of birth due to life-threatening cyanosis compared to those who did not require such procedure. Random-effect meta-analyses were used to compute the data. RESULTS Six studies (292 fetuses) were included. Restrictive appearance of the FO was present in 64.5% (95% CI = 39.8-85.7) of fetuses with TGA requiring BAS at birth compared to 7.9% (95% CI = 2.1-16.8) not requiring such procedure (OR = 71.1; 95% CI = 8.3-608.5, p < .0001). Hypermobile appearance of the atrial septum was present in 39.1% (95% CI = 26.4-56.5) of fetuses requiring BAS at birth compared to 9.8% (95% CI = 1.4-24.3) of those which did (OR 3.6; 95% CI = 1.4-9.0, p = .05). There was no difference in the prevalence of redundant (p = .374) or fixed (p = .051) atrial septum, bidirectional flow in the DA (p = .26) or an abnormal size of the DA (p = .06) in fetuses requiring urgent BAS at birth compared to those which did not. Mean (±SD) size of the right atrium was smaller in the fetuses with TGA undergoing urgent BAS at birth (23.4 ± 6.7) compared to those which did not (29.2 ± 6.2, p = .01). The mean (±SD) ratio between the FO and the aortic valve diameters (1.01 ± 0.41 versus 1.41 ± 0.43, p = .009) and the mean (±SD) ratio between the FO diameter and the septal length (0.36 ± 0.13 versus 0.51 ± 0.14, p = .001) were significantly smaller in fetuses requiring compared to those not undergoing urgent BAS at birth. The diagnostic accuracy of each independent ultrasound marker of the need for urgent BAS showed an overall good specificity but a low sensitivity. CONCLUSION Fetal echocardiography prior to birth can stratify the risk of BAS in fetuses with TGA. Further studies are needed to validate these findings and build individualized multiparametric predictive models in order to more accurately identify those fetuses with TGA at a higher risk of urgent BAS after birth.
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Affiliation(s)
- Danilo Buca
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Per Winberg
- Department of Paediatric Cardiology, Astrid Lindgrens Children's Hospital/Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Rizzo
- Department of Maternal Fetal Medicine, Ospedale Cristo Re Roma, University of Rome "Tor Vergata", Rome, Italy
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Asma Khalil
- Fetal Medicine Unit, St. George's Hospital, London, UK
| | - Marco Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Alexander Makatsariya
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Francesca Greco
- Department of Obstetrics and Gynaecology, Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Obstetrics and Gynaecology, Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Ganesh Acharya
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø Norway
| | - Francesco D'Antonio
- Department of Obstetrics and Gynaecology, Ospedali Riuniti, University of Foggia, Foggia, Italy
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Jeon B, Choi ES, Kwon BS, Yun TJ, Cha SG, Baek JS, Yu JJ, Park CS. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:1106-1112. [PMID: 35356973 PMCID: PMC9159441 DOI: 10.1093/icvts/ivac073] [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] [Received: 10/24/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bobae Jeon
- Division of Cardiothoracic Surgery, GangNeung Asan Hospital, Gangwon-do, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seul Gi Cha
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Jin Yu
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Corresponding author. Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea, 05505. Tel: +82-2-3010-3583; fax: +82-2-3010-6966; e-mail: , (Chun Soo Park)
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Abstract
INTRO Transposition of the great arteries (TGA) is a rare cyanotic congenital heart defect (CHD) typically presenting the first month of life. Late presentations may occur in patients with associated cardiac anomalies allowing for mixing of oxygenated and deoxygenated blood, such as ventral septal defects or large atrial septal defects (ASD). We present a case of a late-presenting TGA with no ventral septal defect, and only small ASD and patent ductus arteriosus (PDA). CASE A 2-month-old female infant presented to a rural emergency department with respiratory distress for 1 day. On arrival, she was cyanotic with only mild improvement in oxygen saturations on 15-L non-rebreather. Grade IV/VI murmur was noted, and prostaglandin E was started. She required intubation after becoming apneic and was transported to the local pediatric referral hospital. There, echocardiography showed dextro-type TGA, with 8-mm ASD with minimal gradient, small PDA with left to right flow, and ventral septal bowing. She underwent balloon septostomy and then atrial switch, which was well tolerated. DISCUSSION Our case is unique because of the patient's late presentation and prior lack of symptoms, given minimal levels of blood mixing though small ASD and PDA. Most TGA cases are now identified during prenatal ultrasound or with CHD screening pulse oximetry before discharge from the newborn nursery; however rare cases of late-presenting TGA may exist. CONCLUSION Practitioners must maintain consideration of TGA, even after the newborn period, despite advances in newborn CHD screening in infants who present with new-onset respiratory distress without infection.
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Affiliation(s)
- Alissa Welsh
- From the Western Michigan University School of Medicine, Kalamazoo, MI
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Kavanal AJ, Singh H, Panda P, Vijay J, Parmar M, Mittal BR. Prominent aortic radiotracer activity on equilibrium radionuclide ventriculography (ERNV) due to anterior transposition of aorta: A clue to diagnosing levo-transposition of great arteries (L-TGA) ? J Nucl Cardiol 2021; 28:3096-3099. [PMID: 32557153 DOI: 10.1007/s12350-020-02218-w] [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: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
Levo-transposition of great arteries (L-TGA) is a rare acyanotic congenital heart anomaly characterized by transposition of morphological left and right ventricles along with their corresponding atrio-ventricular valves in addition to transposition of primary arteries. Many cases of L-TGA are asymptomatic and are diagnosed accidently in adulthood during workup of other conditions. We hereby report a patient with incidentally diagnosed L-TGA who was subjected to Equilibrium Radionuclide Ventriculography (ERNV) for assessment of ventricular function. Planar ERNV images in best septal view showed prominent tracer activity in the anteriorly transposed aorta which can be a helpful clue to raise the suspicion of L-TGA in an asymptomatic adult undergoing ERNV.
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Affiliation(s)
- Anwin Joseph Kavanal
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Prashant Panda
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyothi Vijay
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madan Parmar
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Stegeman R, Feldmann M, Claessens NHP, Jansen NJG, Breur JMPJ, de Vries LS, Logeswaran T, Reich B, Knirsch W, Kottke R, Hagmann C, Latal B, Simpson J, Pushparajah K, Bonthrone AF, Kelly CJ, Arulkumaran S, Rutherford MA, Counsell SJ, Benders MJNL. A Uniform Description of Perioperative Brain MRI Findings in Infants with Severe Congenital Heart Disease: Results of a European Collaboration. AJNR Am J Neuroradiol 2021; 42:2034-2039. [PMID: 34674999 PMCID: PMC8583253 DOI: 10.3174/ajnr.a7328] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE A uniform description of brain MR imaging findings in infants with severe congenital heart disease to assess risk factors, predict outcome, and compare centers is lacking. Our objective was to uniformly describe the spectrum of perioperative brain MR imaging findings in infants with congenital heart disease. MATERIALS AND METHODS Prospective observational studies were performed at 3 European centers between 2009 and 2019. Brain MR imaging was performed preoperatively and/or postoperatively in infants with transposition of the great arteries, single-ventricle physiology, or left ventricular outflow tract obstruction undergoing cardiac surgery within the first 6 weeks of life. Brain injury was assessed on T1, T2, DWI, SWI, and MRV. A subsample of images was assessed jointly to reach a consensus. RESULTS A total of 348 MR imaging scans (180 preoperatively, 168 postoperatively, 146 pre- and postoperatively) were obtained in 202 infants. Preoperative, new postoperative, and cumulative postoperative white matter injury was identified in 25%, 30%, and 36%; arterial ischemic stroke, in 6%, 10%, and 14%; hypoxic-ischemic watershed injury in 2%, 1%, and 1%; intraparenchymal cerebral hemorrhage, in 0%, 4%, and 5%; cerebellar hemorrhage, in 6%, 2%, and 6%; intraventricular hemorrhage, in 14%, 6%, and 13%; subdural hemorrhage, in 29%, 17%, and 29%; and cerebral sinovenous thrombosis, in 0%, 10%, and 10%, respectively. CONCLUSIONS A broad spectrum of perioperative brain MR imaging findings was found in infants with severe congenital heart disease. We propose an MR imaging protocol including T1-, T2-, diffusion-, and susceptibility-weighted imaging, and MRV to identify ischemic, hemorrhagic, and thrombotic lesions observed in this patient group.
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Affiliation(s)
- R Stegeman
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - N H P Claessens
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - N J G Jansen
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Department of Pediatrics (N.J.G.J.), Beatrix Children's Hospital, UMC Groningen, Groningen, the Netherlands
| | - J M P J Breur
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - L S de Vries
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T Logeswaran
- Pediatric Heart Center (T.L., B.R.), University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - B Reich
- Pediatric Heart Center (T.L., B.R.), University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - W Knirsch
- Division of Pediatric Cardiology (W.K.), Pediatric Heart Center
| | - R Kottke
- Department of Diagnostic Imaging (R.K.)
| | - C Hagmann
- Department of Neonatology and Pediatric Intensive Care (C.H.), University Children's Hospital Zurich, Zurich, Switzerland
| | - B Latal
- Child Development Center (M.F., B.L.)
| | - J Simpson
- Department of Pediatric Cardiology (J.S., K.P.), Evelina Children's Hospital London, London, UK
| | - K Pushparajah
- Department of Pediatric Cardiology (J.S., K.P.), Evelina Children's Hospital London, London, UK
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - A F Bonthrone
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - C J Kelly
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - S Arulkumaran
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - M A Rutherford
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - S J Counsell
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - M J N L Benders
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
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Kotecha MK, Choo JTL, Sundararaghavan S. Saline contrast echocardiography complements cardiac interventions in neonates with transposition of great arteries and abnormal ductus venosus anatomy. BMJ Case Rep 2021; 14:e244023. [PMID: 34479892 PMCID: PMC8420688 DOI: 10.1136/bcr-2021-244023] [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] [Accepted: 08/08/2021] [Indexed: 11/03/2022] Open
Abstract
We present a rare case of premature low birthweight neonate with right diaphragmatic hernia and transposition of great vessels requiring balloon atrial septostomy. Congenital diaphragmatic hernia poses a unique challenge to umbilical venous catheterisation. Based on the radiographic position of umbilical vein catheter, umbilical venous cannulation was attempted; however, the catheter could not be navigated to the right atrium. Saline contrast echocardiography was used to delineate the abnormal umbilical and ductus venosus drainage. Eventually, the procedure was successfully completed via the femoral venous approach. We emphasise the importance of defining ductus venosus anatomy and umbilical venous drainage using a simple tool like saline contrast echocardiography before performing catheterisation using the umbilical venous access in such cases.
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Peyvandi S, Lim JM, Marini D, Xu D, Reddy VM, Barkovich AJ, Miller S, McQuillen P, Seed M. Fetal brain growth and risk of postnatal white matter injury in critical congenital heart disease. J Thorac Cardiovasc Surg 2021; 162:1007-1014.e1. [PMID: 33185192 PMCID: PMC8012393 DOI: 10.1016/j.jtcvs.2020.09.096] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 03/25/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the hypothesis that delayed brain development in fetuses with d-transposition of the great arteries or hypoplastic left heart syndrome heightens their postnatal susceptibility to acquired white matter injury. METHODS This is a cohort study across 3 sites. Subjects underwent fetal (third trimester) and neonatal preoperative magnetic resonance imaging of the brain to measure total brain volume as a measure of brain maturity and the presence of acquired white matter injury after birth. White matter injury was categorized as no-mild or moderate-severe based on validated grading criteria. Comparisons were made between the injury groups. RESULTS A total of 63 subjects were enrolled (d-transposition of the great arteries: 37; hypoplastic left heart syndrome: 26). White matter injury was present in 32.4% (n = 12) of d-transposition of the great arteries and 34.6% (n = 8) of those with hypoplastic left heart syndrome. Overall total brain volume (taking into account fetal and neonatal scan) was significantly lower in those with postnatal moderate-severe white matter injury compared with no-mild white matter injury after adjusting for age at scan and site in d-transposition of the great arteries (coefficient: 14.8 mL, 95% confidence interval, -28.8 to -0.73, P = .04). The rate of change in total brain volume from fetal to postnatal life did not differ by injury group. In hypoplastic left heart syndrome, no association was noted between overall total brain volume and change in total brain volume with postnatal white matter injury. CONCLUSIONS Lower total brain volume beginning in late gestation is associated with increased risk of postnatal moderate-severe white matter injury in d-transposition of the great arteries but not hypoplastic left heart syndrome. Rate of brain growth was not a risk factor for white matter injury. The underlying fetal and perinatal physiology has different implications for postnatal risk of white matter injury.
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Affiliation(s)
- Shabnam Peyvandi
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif.
| | - Jessie Mei Lim
- Department of Pediatrics, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Davide Marini
- Department of Pediatrics, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Duan Xu
- Department of Radiology, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - V Mohan Reddy
- Department of Surgery, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - A James Barkovich
- Department of Radiology, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - Steven Miller
- Department of Neurology, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick McQuillen
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - Mike Seed
- Department of Pediatrics, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
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Popescu L, Diaconu R, Constantin A, Donoiu I. Isorhythmic atrioventricular dissociation in an adult with levo-transposition of the great arteries. BMJ Case Rep 2021; 14:e242437. [PMID: 34376412 PMCID: PMC8382269 DOI: 10.1136/bcr-2021-242437] [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] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old woman with levo-transposition of the great arteries presented for a programmed visit. She was asymptomatic and the clinical examination showed no signs of decompensated heart failure. Standard 12-lead ECG showed isorhythmic atrioventricular dissociation. A 24-hour ambulatory recording demonstrated sinus rhythm with intermittent periods of isorhythmic dissociation. This case highlights the association between two rare conditions.
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Affiliation(s)
- Lucian Popescu
- Cardiology, Craiova County Emergency Hospital, Craiova, Romania
| | - Rodica Diaconu
- Cardiology, Craiova County Emergency Hospital, Craiova, Romania
| | - Anca Constantin
- Cardiology, Craiova County Emergency Hospital, Craiova, Romania
| | - Ionut Donoiu
- Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Omer SO, Alhabshan FM, Jijeh AMZ, Caimbon NC, Enriquez CC, Männer J, Yelbuz TM. Is Transposition of the Great Arteries Associated With Shortening of the Intrapericardial Portions of the Great Arterial Trunks? An Echocardiographic Analysis on Newborn Infants With Simple Transposition of the Great Arteries to Explore an Animal Model-Based Hypothesis on Human Beings. J Am Heart Assoc 2021; 10:e019334. [PMID: 34278802 PMCID: PMC8475693 DOI: 10.1161/jaha.120.019334] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured: aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brachiocephalic artery, respectively. Pulmonary trunk length 1 (PTL-1) and pulmonary trunk length 2 (PTL 2) = distance between left and right pulmonary valve level and origin of left and right pulmonary artery, respectively. All measurements of the AoL were significantly shorter in TGA compared to normal hearts (AoL-1: 1.6±0.2 versus 2.05±0.1; P<0.0001; AoL-2: 1.55±0.2 versus 2.13±0.1; P<0.0001). With regard to the pulmonary trunk (PT), PTL-1 and PTL-2 were found to be shorter and longer, respectively, in TGA compared with normal hearts, reflecting the differences in the spatial arrangement of the PT between the 2 groups as in TGA the PT is showing a mirror image of the normal anatomy. However, the overall length of the PT between the 2 groups did not differ. Conclusions Our data demonstrate that, compared with normal newborns, the ascending aorta is significantly shorter in newborns with TGA whereas the overall length of the PT does not differ between the 2 groups. This finding is in accord with the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.
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Affiliation(s)
- Seham O. Omer
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Fahad M. Alhabshan
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Abdulraouf M. Z. Jijeh
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Natalia C. Caimbon
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Carmelita C. Enriquez
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Jörg Männer
- Institute for Anatomy and EmbryologyUMGGeorg‐August‐University of GöttingenGöttingenGermany
| | - Talat Mesud Yelbuz
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
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Riddle S, Divanovic A, Cnota J, Kingma P. Delivery Planning and Emergent Neonatal Intervention in Transposition of the Great Arteries. Neoreviews 2021; 22:e420-e424. [PMID: 34074650 DOI: 10.1542/neo.22-6-e420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Stefanie Riddle
- Cincinnati Children's Fetal Care Center, Cincinnati, OH
- Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Allison Divanovic
- Cincinnati Children's Fetal Care Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH
| | - James Cnota
- Cincinnati Children's Fetal Care Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH
| | - Paul Kingma
- Cincinnati Children's Fetal Care Center, Cincinnati, OH
- Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Vorisek CN, Enzensberger C, Willomeit S, Kurkevych A, Stessig R, Ritgen J, Degenhardt J, Mielke G, Bosselmann S, Krapp M, Slodki M, Respondek-Liberska M, Wolter A, Kawecki A, Goette M, Axt-Fliedner R. Prenatal Diagnosis and Outcome of Congenital Corrected Transposition of the Great Arteries - A Multicenter Report of 69 Cases. Ultraschall Med 2021; 42:291-296. [PMID: 31995816 DOI: 10.1055/a-1069-7698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Congenital corrected transposition of the great arteries (ccTGA) is a rare congenital cardiac anomaly which remains difficult to diagnose prenatally. We aim to investigate the natural history, associated anomalies and the outcome of patients in prenatally diagnosed ccTGA. METHOD This was an international multicenter retrospective analysis of fetuses with a diagnosis of ccTGA from 2002 to 2017. We reviewed clinical and echocardiographic databases of seven centers. Anatomic survey and fetal echocardiography were performed according to international guidelines of ISUOG. RESULTS We considered 69 fetuses with prenatally suspected ccTGA. There was an overall survival rate of 91 % among 54 patients with a confirmed diagnosis. Survival to live birth was 96 % (52/54) and survival on an intention-to-treat basis was 94 % (49/52). The mean gestational age at the time of diagnosis was 25.6 ± 5.9 weeks of gestation. In 7 out of 54 fetuses (13 %), ccTGA was an isolated finding. Dextro/mesocardia was present in 15 cases (27.8 %). Intracardiac anomalies were present in 46/54 cases (85.2 %) with the most frequent anomaly being a ventricular septal defect present in 41 fetuses (75.9 %). Complete heart block was diagnosed in 10 cases (18.5 %). Extracardiac anomalies were observed in 9 out of 54 cases (16.7 %). Prenatal karyotyping of the fetus was available in 30/54 (55.6 %) cases with chromosomal anomalies in 4/30 (13.3 %). CONCLUSION ccTGA is a rare cardiac anomaly often accompanied by a variable spectrum of further intracardiac abnormalities. Accurate diagnosis of ccTGA, which can be integrated into parental counselling, is feasible with a favorable short-term outcome for affected neonates.
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Affiliation(s)
- Carina Nina Vorisek
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Christian Enzensberger
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Steven Willomeit
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Andrii Kurkevych
- Fetal Cardiology Unit, Ukrainian Children's Hospital, Kyiv, UA, Kyiv, Ukraine
| | | | - Jochen Ritgen
- Prenatal Plus, Prenatal Care Center Cologne, Germany
| | | | - Gunther Mielke
- Prenatal Medicine, Prenatal Care Center Stuttgart, Germany
| | | | | | - Maciej Slodki
- Fetal Cardiology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Aline Wolter
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Andrea Kawecki
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Malena Goette
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
| | - Roland Axt-Fliedner
- Department of OB&GYN, Division of Prenatal Medicine, University-Hospitals Gießen and Marburg Campus Gießen, Germany
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Patey O, Carvalho JS, Thilaganathan B. Urgent neonatal balloon atrial septostomy in simple transposition of the great arteries: predictive value of fetal cardiac parameters. Ultrasound Obstet Gynecol 2021; 57:756-768. [PMID: 32730671 DOI: 10.1002/uog.22164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/06/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the impact of abnormal perinatal loading conditions on cardiac geometry and function in term fetuses and neonates with transposition of the great arteries with intact interventricular septum (simple TGA), and to explore the predictive value of fetal cardiac parameters for an urgent balloon atrial septostomy (BAS) after birth. METHODS This was a prospective longitudinal follow-up study of women delivering at term, including both uncomplicated pregnancies with normal outcome and pregnancies affected by fetal simple TGA. Conventional, spectral-tissue Doppler and speckle-tracking echocardiographic parameters were obtained within 1 week before delivery and within the first few hours after delivery. Neonates with simple TGA that required urgent BAS were assessed after the procedure and before corrective arterial switch surgery. Cardiac parameters were normalized by cardiac cycle length, ventricular end-diastolic length or end-diastolic dimension, as appropriate. Fetal and neonatal cardiac parameters were compared between simple-TGA cases and controls, and perinatal changes in the simple-TGA group were assessed. Receiver-operating-characteristics (ROC)-curve analysis was used to assess the predictive value of fetal cardiac parameters for urgent BAS after birth in the simple-TGA group. RESULTS A total of 67 pregnant women delivering at term were included in the study (54 normal pregnancies and 13 with a diagnosis of fetal simple TGA). Compared with normal term fetuses, term fetuses with simple TGA exhibited more globular hypertrophied ventricles, increased biventricular systolic function and diastolic dysfunction (right ventricular (RV) sphericity index (SI), 0.58 vs 0.54; left ventricular (LV)-SI, 0.55 vs 0.49; combined cardiac output (CCO), 483 vs 406 mL/min/kg; LV torsion, 4.3 vs 3.0 deg/cm; RV isovolumetric relaxation time (IVRT'), 127 vs 102 ms; P < 0.01 for all). Compared with normal neonates, neonates with simple TGA demonstrated biventricular hypertrophy, a more spherical right ventricle and altered systolic and diastolic functional parameters (RV-SI, 0.61 vs 0.43; RV myocardial performance index, 0.47 vs 0.34; CCO, 697 vs 486 mL/min/kg; LV-IVRT', 100 vs 79 ms; RV-IVRT', 106 vs 71 ms; P < 0.001 for all). Paired comparison of neonatal and fetal cardiac indices in the simple-TGA group showed persistence of the fetal phenotype, increased biventricular systolic myocardial contractility and CCO, and diastolic dysfunction (RV systolic myocardial velocity (S'), 0.31 vs 0.24 cm/s; LV-S', 0.23 vs 0.18 cm/s; CCO, 697 vs 483 mL/min/kg; LV torsion, 1.1 vs 4.3 deg/cm; P < 0.001 for all). Several fetal cardiac parameters in term fetuses with simple TGA demonstrated high predictive value for an urgent BAS procedure after birth. Our proposed novel fetal cardiac index, LV rotation-to-shortening ratio, as a potential marker of subendocardial dysfunction, for a cut-off value of ≥ 0.23, had an area under the ROC curve (AUC) of 0.94, sensitivity of 100% and specificity of 83%. For RV/LV end-diastolic area ratio ≥ 1.33, pulmonary-valve-to-aortic-valve-dimension ratio ≤ 0.89, RV/LV cardiac output ratio ≥ 1.38 and foramen-ovale-dimension-to-total-interatrial-septal-length ratio ≤ 0.27, AUC was 0.93-0.98, sensitivity was 86% and specificity was 83-100% for all. CONCLUSIONS Simple-TGA fetuses exhibited cardiac remodeling at term with more profound alterations in these cardiac parameters after birth, suggestive of adaptation to abnormal loading conditions and possible adaptive responses to hypoxemia. Perinatal adaptation in simple TGA might reflect persistence of the abnormal parallel arrangement of cardiovascular circulation and the presence of widely patent fetal shunts imposing volume load on the neonatal heart. The fetal cardiac parameters that showed high predictive value for urgent BAS after birth might reflect the impact of late-gestation pathophysiology and progressive hypoxemia on fetal cardiac geometry and function in simple TGA. If these findings are validated in larger prospective studies, detailed cardiac assessment of fetuses with simple TGA near term could facilitate improvements in perinatal management and refinement of the timing of postnatal intervention strategies to prevent adverse pregnancy outcomes. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- O Patey
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Brompton Centre for Fetal Cardiology, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK
| | - J S Carvalho
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Brompton Centre for Fetal Cardiology, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK
| | - B Thilaganathan
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
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Lachaud M, Dionne A, Brassard M, Charron MA, Birca A, Dehaes M, Raboisson MJ. Cardiac hemodynamics in fetuses with transposition of the great arteries and intact ventricular septum from diagnosis to end of pregnancy: longitudinal follow-up. Ultrasound Obstet Gynecol 2021; 57:273-281. [PMID: 31710736 DOI: 10.1002/uog.21920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/29/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Little is known about cardiac hemodynamics in the fetus with transposition of the great arteries and intact ventricular septum (TGA-IVS). Better understanding of the fetal physiology in TGA-IVS would help to provide insights into specific clinical complications observed after birth, in particular neonatal hypoxia and pulmonary hypertension. The aim of this study was to assess cardiac hemodynamics in fetuses with TGA-IVS by performing systematic longitudinal echocardiographic follow-up from diagnosis to delivery. METHODS This was a longitudinal retrospective study of fetuses referred between 2010 and 2018 to the Sainte-Justine University Hospital Centre. Complete assessment of cardiac hemodynamics was performed in fetuses with TGA-IVS at 18-22, 28-32 and 35-38 weeks' gestation, which were compared with normal fetuses matched for gestational age. The maximum diameter of the foramen ovale was measured using two-dimensional echocardiography under the guidance of color Doppler echocardiography. Fetal cardiac hemodynamics were analyzed according to postnatal preductal transcutaneous oxygen saturation (TcSO2 ) < 65% or ≥ 65%, as a neonatal outcome, in fetuses with TGA-IVS. RESULTS In total, 59 fetuses with TGA-IVS and 160 normal fetuses were included. Global cardiac output was significantly higher in fetuses with TGA-IVS than in controls, mainly owing to higher global pulmonary output, while global systemic cardiac output did not differ between TGA-IVS fetuses and controls throughout pregnancy. Aortic flow (right ventricular output in fetuses with TGA-IVS, left ventricular output in controls) was significantly higher in fetuses with TGA-IVS than in normal fetuses. Ductal flow was significantly lower in fetuses with TGA-IVS at every timepoint, and this difference increased considerably after 28-32 weeks. In parallel, the diameter of the foramen ovale was significantly smaller in fetuses with TGA-IVS at 28-32 and 35-38 weeks, with a stagnation in growth after 28 weeks, compared with continuous growth in normal fetuses. Most of these cardiac hemodynamic anomalies in fetuses with TGA-IVS were already present at 18-22 weeks, and the differences became greater at 28-32 weeks' gestation. TGA-IVS neonates with TcSO2 < 65% had lower fetal left ventricular output, higher diastolic ductal retrograde flow and smaller foramen ovale at 28-32 weeks, compared with fetal values in those with postnatal TcSO2 ≥ 65%. CONCLUSIONS Compared with normal fetuses, those with TGA-IVS undergo a complex redistribution of blood flow during the second half of pregnancy, with higher global pulmonary flow, lower ductal flow (with negative diastolic flow at the end of pregnancy) and a smaller foramen ovale. In addition, fetal cardiac hemodynamic anomalies observed at 28-32 weeks' gestation were associated with lower postnatal TcSO2 . These observations may provide a better understanding of premature closure of the foramen ovale and postnatal hypoxia that are specific to TGA-IVS physiology. © 2019 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Lachaud
- Department of Fetal and Pediatric Cardiology, Grenoble University Hospital, Grenoble, France
| | - A Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - M Brassard
- Division of Fetal and Pediatric Cardiology, University of Montreal, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - M A Charron
- Division of Fetal and Pediatric Cardiology, University of Montreal, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - A Birca
- Division of Neurology, University of Montreal, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - M Dehaes
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Centre, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - M-J Raboisson
- Division of Fetal and Pediatric Cardiology, University of Montreal, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
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Surkova E, Segura T, Dimopoulos K, Bispo D, Flick C, West C, Babu-Narayan SV, Senior R, Gatzoulis MA, Li W. Systolic dysfunction of the subpulmonary left ventricle is associated with the severity of heart failure in patients with a systemic right ventricle. Int J Cardiol 2021; 324:66-71. [PMID: 32987051 DOI: 10.1016/j.ijcard.2020.09.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 04/09/2020] [Revised: 08/27/2020] [Accepted: 09/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study aimed to assess the relation between echocardiographic parameters of subpulmonary left ventricular (LV) size and function, and the severity of heart failure in patients with a systemic right ventricle (SRV). METHODS AND RESULTS A total of 157 patients (89 post Mustard/Senning operations, 68 with congenitally corrected transposition of great arteries [ccTGA]) were included. The size and function of the SRV and subpulmonary LV were assessed on the most recent echocardiographic exam. Clinical data were collected from the electronic records. The majority (133, 84.7%) were in NYHA functional class 1-2. Median BNP concentration was 79.5[38.3-173.3] ng/l, and 100 (63.7%) patients were receiving heart failure therapy. Both LV and SRV fractional area change (FAC) differed significantly between patients with NYHA class 1-2 vs 3-4 (48[41.5-52.8]% vs 34[28.6-38.6]%, p < 0.0001 and 29.5[23-35]% vs 22[20-27]%, p < 0.0001, respectively), but LV FAC had a higher discriminative power for functional class >2 than SRV FAC (AUC 0.90, p < 0.0001 vs 0.79; p < 0.0001, respectively). A LV FAC cut-off value <39.2% had the highest accuracy in identifying patients with NYHA class 3-4 (sensitivity 83% and specificity 88%). In multivariable logistic regression analysis, LV FAC and SRV FAC independently associated to NYHA class 3-4 (OR 0.80 [95%CI 0.72-0.88], p < 0.0001 and OR 0.85 [95%CI 0.76-0.96], p = 0.007, respectively). CONCLUSIONS Subpulmonary LV systolic dysfunction is associated with NYHA functional class 3-4 in patients with ccTGA or after Mustard or Senning operation. Careful evaluation of the subpulmonary LV should be a part of the routine assessment of patients with a SRV.
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Affiliation(s)
- Elena Surkova
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom.
| | - Teresa Segura
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; University Hospital 12 de Octubre, 2ª Planta Residencia general, Madrid 28041, Spain
| | - Konstantinos Dimopoulos
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Daniela Bispo
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Caroline Flick
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Cathy West
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Sonya V Babu-Narayan
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Roxy Senior
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Wei Li
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
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48
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Casanova J. The arterial switch operation. Rev Port Cir Cardiotorac Vasc 2020; 27:157. [PMID: 33068503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jorge Casanova
- Serviço de Cirurgia Torácica, CHSJ; Departamento de Fisiologia e Cirurgia Cardiotorácica, FMUP, Portugal
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Minnella GP, Crupano FM, Syngelaki A, Zidere V, Akolekar R, Nicolaides KH. Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with increased nuchal translucency, tricuspid regurgitation and abnormal flow in ductus venosus. Ultrasound Obstet Gynecol 2020; 55:637-644. [PMID: 31875326 DOI: 10.1002/uog.21956] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 11/11/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To examine the association between fetal major heart defects and increased nuchal translucency thickness (NT), tricuspid regurgitation and abnormal flow in the ductus venosus in a large population of singleton pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation. METHODS This was a retrospective study of prospectively collected data from singleton pregnancies attending for a routine ultrasound scan at 11-13 weeks' gestation, which included examination of fetal anatomy, measurement of NT and assessment of blood flow across the tricuspid valve and in the ductus venosus, according to a standardized protocol. The incidence of fetal NT ≥ 95th and ≥ 99th percentiles, tricuspid regurgitation and reversed a-wave in the ductus venosus in fetuses with and those without a major heart defect was determined and the performance of each marker and their combination in the detection of major heart defects was calculated. RESULTS The study population of 93 209 pregnancies with no apparent chromosomal abnormality included 211 (0.23%) with a fetal major heart defect and 92 998 morphologically normal neonates. In 113 (53.6%) cases with a major heart defect, the diagnosis was made at the 11-13-week scan, in 82 (38.9%) at the 18-24-week scan, in 10 (4.7%) at the third-trimester scan and in six (2.8%) postnatally. At the 11-13-week scan, we diagnosed all cases of tricuspid or pulmonary atresia and polyvalvular dysplasia, > 90% of cases of hypoplastic left heart syndrome or atrioventricular septal defect, about 60% of complex heart defects and cases of left atrial isomerism (interrupted inferior vena cava with normal intracardiac anatomy), 30-40% of cases of tetralogy of Fallot and arch abnormalities, 25% of tricuspid valve abnormalities and about 15% of cases of transposition of the great arteries, but none of aortic or pulmonary stenosis or common arterial trunk. Fetal NT ≥ 95th or ≥ 99th percentile, tricuspid regurgitation or abnormal ductus venosus flow was observed in 77 (36.5%), 45 (21.3%), 61 (28.9%) and 58 (27.5%) fetuses with a major heart defect, respectively, and in 5678 (6.1%), 857 (0.9%), 1136 (1.2%) and 1644 (1.8%) of those without a heart defect. Any one of NT ≥ 95th percentile, tricuspid regurgitation or abnormal flow in the ductus venosus was found in 117 (55.5%; 95% CI, 48.5-62.3%) fetuses with a heart defect and in 8166 (8.8%; 95% CI, 8.6-9.0%) of those without a heart defect. Any one of NT ≥ 99th percentile or the other two markers was found in 99 (46.9%; 95% CI, 40.0-53.9%) fetuses with a heart defect and in 3517 (3.8%; 95% CI, 3.7-3.9%) of those without a heart defect. CONCLUSION At 11-13 weeks' gestation, measurement of fetal NT and assessment of flow across the tricuspid valve and in the ductus venosus can lead to early diagnosis of major heart defect. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G P Minnella
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - F M Crupano
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - V Zidere
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - R Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Li J, Wang H, Guo Y. Radiofrequency ablation for the pre-excitation syndrome of functionally corrected transposition of great arteries. J Card Surg 2020; 35:1100-1103. [PMID: 32176362 DOI: 10.1111/jocs.14514] [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] [Indexed: 11/26/2022]
Abstract
We reported a 57-year-old female patient who had functionally corrected transposition of the great arteries, severe tricuspid insufficiency, enlarged left atrium and functional right ventricle, which were successfully performed radiofrequency ablation.
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Affiliation(s)
- Jun Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Haixiong Wang
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Yanqing Guo
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
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