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Amedro P, Gavotto A, Huguet H, Souilla L, Huby AC, Matecki S, Cadene A, De La Villeon G, Vincenti M, Werner O, Bredy C, Lavastre K, Abassi H, Cohen S, Hascoet S, Dauphin C, Chalard A, Dulac Y, Souletie N, Bouvaist H, Douchin S, Lachaud M, Ovaert C, Soulatges C, Combes N, Thambo JB, Iriart X, Bajolle F, Bonnet D, Ansquer H, Delpey JG, Cohen L, Picot MC, Guillaumont S. Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial. Eur Heart J 2024; 45:1458-1473. [PMID: 38430485 PMCID: PMC11032713 DOI: 10.1093/eurheartj/ehae085] [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: 08/06/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND AND AIMS Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD. METHODS The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health. RESULTS The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P = .038; effect size 0.34], body mass index [mean difference -0.7 kg/m2 (95% CI -1.3; -0.1); P = .022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P = .044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P = .007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent. CONCLUSIONS This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease.
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Affiliation(s)
- Pascal Amedro
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Arthur Gavotto
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
| | - Luc Souilla
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne-Cecile Huby
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Stefan Matecki
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne Cadene
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
| | - Gregoire De La Villeon
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Oscar Werner
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Charlene Bredy
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Fontfroide Cardiac Rehabilitation Center, 1800 rue de Saint-Priest, 34097 Montpellier, France
| | - Kathleen Lavastre
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Sarah Cohen
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
| | - Sebastien Hascoet
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
| | - Claire Dauphin
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Aurelie Chalard
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Yves Dulac
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Nathalie Souletie
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Helene Bouvaist
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Stephanie Douchin
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Matthias Lachaud
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Grenoble University Hospital, Grenoble, France
| | - Caroline Ovaert
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital, Marseille, France
| | - Camille Soulatges
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, APHM La Timone Hospital, Marseille, France
| | - Nicolas Combes
- Pediatric and Congenital Cardiology Department, Pasteur Clinic, Toulouse, France
| | - Jean-Benoit Thambo
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
- IHU Liryc, INSERM 1045, University of Bordeaux, Avenue du Haut-Leveque, 33600 Pessac, France
| | - Xavier Iriart
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Fanny Bajolle
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital, Paris, France
| | - Damien Bonnet
- Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, APHP Necker Hospital, Paris, France
| | - Helene Ansquer
- Pediatric and Congenital Cardiology Department, Brest University Hospital, Brest, France
| | - Jean-Guillaume Delpey
- Pediatric and Congenital Cardiology Department, Brest University Hospital, Brest, France
| | - Laurence Cohen
- Fetal, Pediatric and Congenital Private Practice, 8 rue du Conseil de l'Europe, 91300 Massy, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, University of Montpellier, Montpellier, France
- Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
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Laurent-Lacroix C, Vincenti M, Matecki S, Mahé P, Moulis L, De La Villeon G, Guillaumont S, Requirand A, Moreau J, Lalande M, Picot MC, Amedro P, Gavotto A. Aerobic physical capacity and health-related quality of life in children with sickle cell disease. Pediatr Res 2024:10.1038/s41390-024-03143-1. [PMID: 38491141 DOI: 10.1038/s41390-024-03143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Aerobic fitness is a predictor of cardiovascular health which correlates with health-related quality of life in the general population. The aim is to evaluate the aerobic capacity by cardiopulmonary exercise test (CPET) in children with sickle cell disease in comparison with healthy matched controls. METHODS Controlled cross-sectional study. RESULTS A total of 72 children (24 with sickle cell disease and 48 healthy controls), aged 6-17 years old were enrolled. Children with sickle cell disease had a poor aerobic capacity, with median VO2max Z-score values significantly lower than matched controls (-3.55[-4.68; -2.02] vs. 0.25[-0.22; 0.66], P < 0.01, respectively), and a high proportion of 92% children affected by an impaired aerobic capacity (VO2max Z-score < -1.64). The VO2max decrease was associated with the level of anemia, the existence of a homozygote HbS/S mutation, restrictive lung disease and health-related quality of life. CONCLUSION Aerobic capacity is poor in children with sickle cell disease. VO2max decrease is associated with the level of anemia, the existence of a homozygote HbS/S mutation, lung function, and health-related quality of life. These results represent a signal in favor of early initiation of cardiac rehabilitation in patients with sickle cell disease. CLINICAL TRIALS NCT05995743. IMPACT Aerobic fitness is a predictor of cardiovascular health which correlates with health-related quality of life in the general population. Aerobic capacity (VO2max) is poor in children with sickle cell disease, despite the absence of any pattern of heart failure. VO2max decrease was associated with the level of anemia, the existence of a homozygote HbS/S mutation, restrictive lung disease, and health-related quality of life. These results are in favor of early initiation of cardiac rehabilitation in children with sickle cell disease.
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Affiliation(s)
- Corentin Laurent-Lacroix
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Marie Vincenti
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Perrine Mahé
- Pediatric Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, 34000, Montpellier, France
| | - Lionel Moulis
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, 34000, Montpellier, France
| | - Gregoire De La Villeon
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, 371 Avenue de l'Évêché de Maguelone, 34250, Palavas-Les-Flots, France
| | - Sophie Guillaumont
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, 371 Avenue de l'Évêché de Maguelone, 34250, Palavas-Les-Flots, France
| | - Anne Requirand
- Pediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Johan Moreau
- Pediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Department of Pediatric Pneumology, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Muriel Lalande
- Pediatric Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, 34000, Montpellier, France
| | - Marie-Christine Picot
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, 34000, Montpellier, France
- Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, 34000, Montpellier, France
| | - Pascal Amedro
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 1 Avenue Magellan, 33604, Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Avenue du Haut Lévêque, 33600, Pessac, France
| | - Arthur Gavotto
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.
- Pediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.
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Milesi C, Nogue E, Baleine J, Moulis L, Pouyau R, Gavotto A, Brossier D, Mortamet G, Cambonie G. ROX (Respiratory rate-OXygenation) index to predict early response to high-flow nasal cannula therapy in infants with viral bronchiolitis. Pediatr Pulmonol 2024. [PMID: 38197495 DOI: 10.1002/ppul.26860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION High-flow nasal cannula (HFNC) is commonly used as first step respiratory support in infants with moderate-to-severe acute viral bronchiolitis (AVB). This device, however, fails to effectively manage respiratory distress in about a third of patients, and data are limited on determinants of patient response. The respiratory rate-oxygenation (ROX) index is a relevant tool to predict the risk for HFNC failure in adult patients with lower respiratory tract infections. The primary objective of this study was to assess the relationship between ROX indexes collected before and 1 h after HFNC initiation, and HFNC failure occurring in the following 48 h in infants with AVB. METHOD This is an ancillary study to the multicenter randomized controlled trial TRAMONTANE 2, that included 286 infants of less than 6 months with moderate-to-severe AVB. Collection of physiological variables at baseline (H0), and 1 h after HFNC (H1), included heart rate (HR), respiratory rate (RR), fraction of inspired oxygen (FiO2 ), respiratory distress score (modified Wood's Clinical Asthma Score [mWCAS]), and pain and discomfort scale (EDIN). ROX and ROX-HR were calculated asSpO 2 FiO 2 RR $\frac{\left(\frac{{\mathrm{SpO}}_{2}}{{\mathrm{FiO}}_{2}}\right)}{\mathrm{RR}}$ and100 × ROX HR $100\times \frac{\mathrm{ROX}}{\mathrm{HR}}$ , respectively. Predefined HFNC failure criteria included increase in respiratory distress score or RR, increase in discomfort, and severe apnea episodes. The accuracies of ROX, ROX-HR indexes and clinical variable to predict HFNC failure were assessed using receiver operating curve analysis. We analyzed predictive factors of HFNC failure using multivariate logistic regressions. RESULT HFNC failure occurred in 111 of 286 (39%) infants, and for 56 (50% of the failure) of them within the first 6 h. The area under the curve of ROX indexes at H0 and H1 were, respectively, 0.56 (95% confidence interval [CI] 0.48-0.63, p = 0.14), 0.56 (95% CI 0.49-0.64, p = 0.09). ROX-HR performances were better but remained poorly discriminant. HFNC failure was associated with higher mWCAS score at H1 (p < 0.01) and lower decrease in EDIN scale during the first hour of HFNC delivery (p = 0.02). In the multivariate analyses, age and mWCAS score were were found to be independent factors associated with HFNC failure at H0. At H1, weight and mWCAS were associated factors. CONCLUSION In this study, neither ROX index, nor physiological variables usually collected in infants with AVB had early discriminatory capacity to predict HFNC failure.
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Affiliation(s)
- Christophe Milesi
- Pediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Julien Baleine
- Pediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Lionel Moulis
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Robin Pouyau
- Pediatric Intensive Care Unit, Woman-Mother-Child University Hospital, Lyon, France
| | - Arthur Gavotto
- Pediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - David Brossier
- Pediatric Intensive Care Unit, University Hospital Caen-Normandy, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble University Hospital, La Tronche, France
| | - Gilles Cambonie
- Pediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
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Amedro P, Mura T, Matecki S, Guillaumont S, Requirand A, Jeandel C, Kollen L, Gavotto A. Use of new paediatric VO2max reference equations to evaluate aerobic fitness in overweight or obese children with congenital heart disease. Eur J Prev Cardiol 2023; 30:1865-1873. [PMID: 37314435 DOI: 10.1093/eurjpc/zwad201] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
AIMS Overweight and obesity in children with congenital heart disease (CHD) represent an alarming cardiovascular risk. Promotion of physical activity and cardiac rehabilitation in this population requires assessing the level of aerobic fitness (VO2max) by a cardiopulmonary exercise test (CPET). Nevertheless, the interpretation of CPET in overweight/obese children with CHD remains challenging as VO2max is affected by both the cardiac condition and the body mass index (BMI). The new paediatric VO2max Z-score reference equations, based on a logarithmic function of VO2max, height and BMI, were applied to overweight/obese children with a CHD and compared with overweight/obese children without any other chronic condition. METHODS AND RESULTS In this cross-sectional controlled study, 344 children with a BMI > 85th percentile underwent a CPET (54% boys; mean age 11.5 ± 3.1 years; 100 CHD; 244 controls). Using the VO2max Z-score equations, aerobic fitness was significantly lower in obese/overweight CHD children than that in matched obese/overweight control children (-0.43 ± 1.27 vs. -0.01 ± 1.09; P = 0.02, respectively), and the proportion of children with impaired aerobic fitness was significantly more important in obese/overweight CHD children than in matched controls (17% vs.6%, P = 0.02, respectively). The paediatric VO2max Z-score reference equations also identified specific complex CHD at risk of aerobic fitness impairment (univentricular heart and right outflow tract anomalies). Using Cooper's weight- and height-based linear equations, similar matched-comparisons analyses found no significant group differences. CONCLUSIONS As opposed to the existing linear models, the new paediatric VO2max Z-score equations can discriminate the aerobic fitness of obese/overweight children with CHD from that of obese/overweight children without any chronic disease. REGISTRATION ClinicalTrials.gov NCT04815577.
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Affiliation(s)
- Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
| | - Thibault Mura
- INSERM, U1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, 39 Av. Charles Flahault, 34090, Montpellier, France
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Place du Professeur Debré, 30029, Nimes, France
| | - Stefan Matecki
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Claire Jeandel
- Paediatric Endocrine Unit, Department of Paediatrics, Hôpital A. de Villeneuve, CHU Montpellier, Montpellier Cedex 34295, France
| | - Laura Kollen
- Department of Paediatric gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Arthur Gavotto
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Giraud, Montpellier 34295, France
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Milesi C, Baleine J, Mortamet G, Apert J, Gavotto A, Cambonie G. Noninvasive Ventilation in Pediatric Acute Respiratory Distress Syndrome: "Another Dogma Bites the Dust". Pediatr Crit Care Med 2023; 24:783-785. [PMID: 37668500 DOI: 10.1097/pcc.0000000000003299] [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: 09/06/2023]
Affiliation(s)
- Christophe Milesi
- Pediatric Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Julien Baleine
- Pediatric Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - Juliette Apert
- Pediatric Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Arthur Gavotto
- Pediatric Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Pediatric Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Montpellier, France
- Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
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Amedro P, Matecki S, Pereira Dos Santos T, Guillaumont S, Rhodes J, Yin SM, Hager A, Hock J, De La Villeon G, Moreau J, Requirand A, Souilla L, Vincenti M, Picot MC, Huguet H, Mura T, Gavotto A. Reference Values of Cardiopulmonary Exercise Test Parameters in the Contemporary Paediatric Population. Sports Med Open 2023; 9:68. [PMID: 37528295 PMCID: PMC10393918 DOI: 10.1186/s40798-023-00622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The evaluation of health status by cardiopulmonary exercise test (CPET) has shown increasing interest in the paediatric population. Our group recently established reference Z-score values for paediatric cycle ergometer VO2max, applicable to normal and extreme weights, from a cohort of 1141 healthy children. There are currently no validated reference values for the other CPET parameters in the paediatric population. This study aimed to establish, from the same cohort, reference Z-score values for the main paediatric cycle ergometer CPET parameters, apart from VO2max. RESULTS In this cross-sectional study, 909 healthy children aged 5-18 years old underwent a CPET. Linear, quadratic, and polynomial mathematical regression equations were applied to identify the best CPET parameters Z-scores, according to anthropometric parameters (sex, age, height, weight, and BMI). This study provided Z-scores for maximal CPET parameters (heart rate, respiratory exchange ratio, workload, and oxygen pulse), submaximal CPET parameters (ventilatory anaerobic threshold, VE/VCO2 slope, and oxygen uptake efficiency slope), and maximum ventilatory CPET parameters (tidal volume, respiratory rate, breathing reserve, and ventilatory equivalent for CO2 and O2). CONCLUSIONS This study defined paediatric reference Z-score values for the main cycle ergometer CPET parameters, in addition to the existing reference values for VO2max, applicable to children of normal and extreme weights. Providing Z-scores for CPET parameters in the paediatric population should be useful in the follow-up of children with various chronic diseases. Thus, new paediatric research fields are opening up, such as prognostic studies and clinical trials using cardiopulmonary fitness outcomes. Trial registration NCT04876209-Registered 6 May 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04876209 .
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Affiliation(s)
- Pascal Amedro
- Department of Paediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 1 Avenue Magellan, 33604, Pessac, France.
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Avenue du Haut Lévêque, 33600, Pessac, France.
- Department of Paediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Leveque Hospital, Avenue de Magellan, 33604, Pessac Cedex, France.
| | - Stefan Matecki
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Paediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Taissa Pereira Dos Santos
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Place du Professeur Debré, 30029, Nimes, France
| | - Sophie Guillaumont
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, 371 Avenue de L'Évêché de Maguelone, 34250, Palavas-Les-Flots, France
| | - Jonathan Rhodes
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Suellen Moli Yin
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Alfred Hager
- Clinic for Paediatric Cardiology and Congenital Heart Diseases, German Heart Centre, Lazarettstrasse 36, 80636, Munich, Germany
| | - Julia Hock
- Clinic for Paediatric Cardiology and Congenital Heart Diseases, German Heart Centre, Lazarettstrasse 36, 80636, Munich, Germany
| | - Gregoire De La Villeon
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, 371 Avenue de L'Évêché de Maguelone, 34250, Palavas-Les-Flots, France
| | - Johan Moreau
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Anne Requirand
- Paediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Luc Souilla
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Marie Vincenti
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference CHD Centre, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Marie-Christine Picot
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, INSERM-CIC 1411, Clinical Investigation Centre, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, INSERM-CIC 1411, Clinical Investigation Centre, University of Montpellier, Montpellier, France
| | - Thibault Mura
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Place du Professeur Debré, 30029, Nimes, France
- INSERM, U1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, 39 Av. Charles Flahault, 34090, Montpellier, France
| | - Arthur Gavotto
- PhyMedExp, CNRS, INSERM, University of Montpellier, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
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Gavotto A, Amedro P, Cambonie G. Think out of the box: association of left congenital diaphragmatic hernia and abnormal origin of the right pulmonary artery : A train can hide another. BMC Pediatr 2023; 23:349. [PMID: 37434143 DOI: 10.1186/s12887-023-04164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND We report the occurrence of a severe pulmonary hypertension (PH) in a neonate affected by a left congenital diaphragmatic hernia (CDH). PH in this patient was associated with an abnormal origin of the right pulmonary artery from the right brachiocephalic artery. This malformation, sometimes named hemitruncus arteriosus, has to the best of our knowledge never been reported in association with a CDH. CASE PRESENTATION A male newborn was hospitalized from birth in the neonatal intensive care unit after prenatal diagnosis of a left CDH. Ultrasound examination at 34 weeks of gestational age evaluated the observed-to-expected lung-to-head ratio at 49%. Birth occurred at 38+ 5 weeks of gestational age. Soon after admission, severe hypoxemia, i.e., preductal pulse oximetry oxygen saturation (SpO2) < 80%, prompted therapeutic escalation including the use of high frequency oscillatory ventilation with fraction of inspired oxygen (FiO2) 100% and inhaled nitric oxide (iNO). Echocardiography assessment revealed signs of severe PH and normal right ventricle function. Despite administration of epoprostenolol, milrinone, norepinephrine, and fluid loadings with albumin and 0.9% saline, hypoxemia remained severe, preductal SpO2 inconsistently greater than or equal to 80-85% and post ductal SpO2 lower on average by 15 points. This clinical status remained unchanged during the first 7 days of life. The infant's clinical instability was incompatible with surgical intervention, while chest X-ray showed a relatively preserved lung volume, especially on the right side. This prompted an additional echocardiography, aimed at searching an explanation of this unusual evolution and found an abnormal origin of the right pulmonary artery, which was confirmed on computed tomography angiography subsequently. A change in the medical strategy was decided, with the suspension of pulmonary vasodilator treatments, the administration of diuretics, and the decrease in norepinephrine dose to decrease the systemic-to-pulmonary shunt. Progressive improvement in the infant respiratory and hemodynamic status enabled to perform CDH surgical repair 2 weeks after birth. CONCLUSIONS This case recalls the interest of systematic analysis of all potential causes of PH in a neonate with CDH, a condition frequently associated with various congenital malformations.
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Affiliation(s)
- Arthur Gavotto
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, INSERM 1045, Bordeaux University, Bordeaux, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
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Cambonie G, Desage C, Thaller P, Lemaitre A, de Balanda KB, Combes C, Gavotto A. Correction: Inulin diet uncovers complex diet-microbiota-immune cell interactions remodeling the gut epithelium. Microbiome 2023; 11:122. [PMID: 37259114 DOI: 10.1186/s40168-023-01579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Gilles Cambonie
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
- Pathogenesis and Control of Chronic Infection, UMR 1058, INSERM, University of Montpellier, Montpellier, France.
| | - Chloé Desage
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Pénélope Thaller
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Anne Lemaitre
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Karine Bertran de Balanda
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Clémentine Combes
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
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Cambonie G, Desage C, Thaller P, Lemaitre A, de Balanda KB, Combes C, Gavotto A. Context of a neonatal death affects parental perception of end-of-life care, anxiety and depression in the first year of bereavement. BMC Palliat Care 2023; 22:58. [PMID: 37173678 PMCID: PMC10182590 DOI: 10.1186/s12904-023-01183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Neonatal death is often preceded by end-of-life medical decisions. This study aimed to determine whether the context of death - after a decision of withholding or withdrawing life-sustaining treatment (WWLST) or despite maximum care - was associated with subsequent risk of parental anxiety or depression. The secondary objective was to assess parents' perceptions of end-of-life care according to death context. METHODS Prospective single center observational study of all neonatal deaths in a neonatal intensive care unit over a 5-year period. Data were collected during hospitalization and from face-to-face interviews with parents 3 months after the infant's death. Anxiety and depression were assessed using Hospital Anxiety and Depression Scale (HADS) questionnaires, completed by parents 5 and 15 months after death. RESULTS Of 179 deaths, 115 (64%) occurred after the WWLST decision and 64 (36%) despite maximum care. Parental satisfaction with newborn care and received support by professionals and relatives was higher in the first condition. Sixty-one percent of parents (109/179) attended the 3-month interview, with the distribution between groups very close to that of hospitalization. The completion rates of the HADS questionnaires by the parents who attended the 3-month interview were 75% (82/109) at 5 months and 65% (71/109) at 15 months. HADS scores at 5 months were consistent with anxiety in at least one parent in 73% (60/82) of cases and with depression in 50% (41/82). At 15 months, these rates were, respectively, 63% (45/71) and 28% (20/71). Risk of depression at 5 months was lower after a WWLST decision (OR 0.35 [0.14, 0.88], p = 0.02). Explicit parental agreement with the WWLST decision had an equivocal impact on the risk of anxiety at 5 months, being higher when expressed during hospitalization, but not at the 3-month interview. CONCLUSIONS Context of death has a significant impact on the emotional experience of parents after neonatal loss, which underlines the importance of systematic follow-up conversations with bereaved parents.
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Affiliation(s)
- Gilles Cambonie
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
- Pathogenesis and Control of Chronic Infection, UMR 1058, INSERM, University of Montpellier, Montpellier, France.
| | - Chloé Desage
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Pénélope Thaller
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Anne Lemaitre
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Karine Bertran de Balanda
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Clémentine Combes
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
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Mignot M, Huguet H, Cambonie G, Guillaumont S, Vincenti M, Blanc J, Ovaert C, Picot MC, Karsenty C, Amedro P, Kollen L, Gavotto A. Risk factors for early occurrence of malnutrition in infants with severe congenital heart disease. Eur J Pediatr 2023; 182:1261-1269. [PMID: 36633658 DOI: 10.1007/s00431-023-04812-9] [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: 09/07/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
To identify the risk factors of early occurrence of malnutrition in infants with severe congenital heart disease (CHD) during their first year of life. Retrospective longitudinal multicenter study carried out from January 2014 to December 2020 in two tertiary care CHD centers. Four CHD hemodynamic groups were identified. Malnutrition was defined by a Waterlow score under 80% and/or underweight under -2 standard deviations. A total of 216 infants with a severe CHD, e.g., requiring cardiac surgery, cardiac catheterization, or hospitalization for heart failure during their first year of life, were included in the study. Malnutrition was observed among 43% of the cohort, with the highest prevalence in infants with increased pulmonary blood flow (71%) compared to the other hemodynamic groups (p < 0.001). In multivariate analysis, low birthweight (OR 0.62, 95% CI 0.44-0.89, p = 0.009), CHD with increased pulmonary blood flow (OR 4.80, 95% CI 1.42-16.20, p = 0.08), heart failure (OR 9.26, 95% CI 4.04-21.25, p < 0.001), and the number of hospitalizations (OR 1.35, 95% CI 1.08 l-1.69, p = 0.009) during the first year of life were associated with malnutrition (AUC 0.85, 95% CI 0.79-0.90). Conclusions: In infants with a severe CHD, early occurrence of malnutrition during the first year of life affected a high proportion of subjects. CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations were risk factors for malnutrition. Further studies are required to identify optimal nutritional support in this population. What is Known: • Malnutrition is a known morbidity and mortality factor in children with severe congenital heart disease. What is New: • Early occurrence of malnutrition during the first year of life in infant severe congenital heart disease (CHD) was high (43%). • CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations during the first year of life were risk factors for malnutrition.
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Affiliation(s)
- Margot Mignot
- Department of Pediatric Gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
- Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, Montpellier, 34295, France
- Pathogenesis and Control of Chronic Infection, INSERM, UMR 1058, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Julie Blanc
- Pediatric and Congenital Cardiology Department, Timone Children Hospital, Aix-Marseille University, Marseille, France
| | - Caroline Ovaert
- Pediatric and Congenital Cardiology Department, Timone Children Hospital, Aix-Marseille University, Marseille, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
- Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Clement Karsenty
- Pediatric Cardiology Unit, Children Hospital, Toulouse Hospital, Toulouse, France
- Institut Des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, Toulouse, France
| | - Pascal Amedro
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
| | - Laura Kollen
- Department of Pediatric Gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, Montpellier, 34295, France.
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
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11
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Gavotto A, Mura T, Rhodes J, Yin SM, Hager A, Hock J, Guillaumont S, Vincenti M, De La Villeon G, Requirand A, Picot MC, Huguet H, Souilla L, Moreau J, Matecki S, Amedro P. Reference values of aerobic fitness in the contemporary paediatric population. Eur J Prev Cardiol 2023:7049938. [PMID: 36809338 DOI: 10.1093/eurjpc/zwad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 02/23/2023]
Abstract
AIMS There has been a growing interest in the use of markers of aerobic physical fitness (VO2max assessed by cardiopulmonary exercise testing (CPET)) in the follow-up of paediatric chronic diseases. The dissemination of CPET in paediatrics requires valid paediatric VO2max reference values to define the upper and lower normal limits. This study aimed to establish VO2max reference Z-scores values, from a large cohort of children representative of the contemporary paediatric population, including those with extreme weights. METHODS AND RESULTS In this cross-sectional study, 909 children aged 5 to 18-years-old from the general French population (development cohort), and 232 children from the general German and US populations (validation cohort) underwent a CPET, following the guidelines on high-quality CPET assessment. Linear, quadratic, and polynomial mathematical regression equations were applied to identify the best VO2max Z-score model. Predicted and observed VO2max values using the VO2maxZ-score model, and the existing linear equations were compared, in both development and validation cohorts. For both sexes, the mathematical model using natural logarithms of VO2max, height, and BMI was the best fit for the data. This Z-score model could be applied to normal and extreme weights and was more reliable than the existing linear equations, in both internal and external validity analyses (https://play.google.com/store/apps/details?id=com.d2l.zscore). CONCLUSION This study established reference Z-score values for paediatric cycloergometer VO2max using a logarithmic function of VO2max, height and BMI, applicable to normal and extreme weights. Providing Z-scores to assess aerobic fitness in the paediatric population should be useful in the follow-up of children with chronic diseases.
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Affiliation(s)
- Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Thibault Mura
- INSERM, University of Montpellier, U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Jonathan Rhodes
- Department of Cardiology, Boston Children's Hospital, Boston, USA
| | - Suellen Moli Yin
- Department of Cardiology, Boston Children's Hospital, Boston, USA
| | - Alfred Hager
- Clinic for Paediatric Cardiology and Congenital Heart Diseases, German Heart Centre, Munich, Germany
| | - Julia Hock
- Clinic for Paediatric Cardiology and Congenital Heart Diseases, German Heart Centre, Munich, Germany
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Marie-Christine Picot
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, INSERM-CIC 1411, Clinical Investigation Centre, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, INSERM-CIC 1411, Clinical Investigation Centre, University of Montpellier, Montpellier, France
| | - Luc Souilla
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Johan Moreau
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Stefan Matecki
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
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12
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Gavotto A, Dubard V, Avesani M, Huguet H, Picot MC, Abassi H, Guillaumont S, De La Villeon G, Haouy S, Sirvent N, Sirvent A, Theron A, Requirand A, Matecki S, Amedro P. Impaired aerobic capacity in adolescents and young adults after treatment for cancer or non-malignant haematological disease. Pediatr Res 2023:10.1038/s41390-023-02477-6. [PMID: 36709386 DOI: 10.1038/s41390-023-02477-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Childhood cancer survivors are at increased risk for cardiovascular disease. Maximal oxygen uptake (VO2max) is a major determinant of cardiovascular morbidity. The aim of this study was to compare aerobic capacity, measured by cardiopulmonary exercise test (CPET), of adolescents and young adults in remission with that of healthy controls and to identify the predictors of aerobic capacity in this population. METHOD This is a controlled cross-sectional study. RESULTS A total of 477 subjects (77 in remission and 400 controls), aged from 6 to 25 years, were included, with a mean delay between end of treatment and CPET of 2.9 ± 2.3 years in the remission group. In this group, the mean VO2max was significantly lower than in controls (37.3 ± 7.6 vs. 43.3 ± 13.1 mL/kg/min, P < 0.01, respectively), without any clinical or echocardiographic evidence of heart failure. The VAT was significantly lower in the remission group (26.9 ± 6.0 mL/kg/min vs. 31.0 ± 9.9 mL/kg/min, P < 0.01, respectively). A lower VO2max was associated with female sex, older age, higher BMI, radiotherapy, and hematopoietic stem cell transplantation. CONCLUSION Impaired aerobic capacity had a higher prevalence in adolescents and young adults in cancer remission. This impairment was primarily related to physical deconditioning and not to heart failure. TRIAL REGISTRY NCT04815447. IMPACT In childhood cancer survivors, aerobic capacity is five times more impaired than in healthy subjects. This impairment mostly reflects early onset of physical deconditioning. No evidence of heart failure was observed in this population.
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Affiliation(s)
- Arthur Gavotto
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Vincent Dubard
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Centre, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Centre, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Stephanie Haouy
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Nicolas Sirvent
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Anne Sirvent
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Alexandre Theron
- Paediatric Cancer Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Anne Requirand
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Stefan Matecki
- Paediatric Cardiology and Pulmonology Unit, Department of Paediatrics, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France. .,IHU Liryc, INSERM 1045, Bordeaux University, Bordeaux, France.
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13
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Gavotto A, Ladeveze M, Avesani M, Huguet H, Guillaumont S, Picot MC, Requirand A, Matecki S, Amedro P. Aerobic fitness change with time in children with congenital heart disease: A retrospective controlled cohort study. Int J Cardiol 2023; 371:140-146. [PMID: 36181952 DOI: 10.1016/j.ijcard.2022.09.068] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To evaluate the change in aerobic fitness (VO2max), measured by cardio-pulmonary exercise test (CPET), in children with congenital heart disease (CHD), compared to matched healthy controls, and identify predictors of VO2max change with time in this specific population. METHOD This longitudinal retrospective multicentre cohort study was carried out from 2010 to 2020. We included CHD paediatric patients from the cohort of a previous cross-sectional study, who had a second CPET at least 1 year after the first one, during their follow-up. RESULTS We included 936 children, 296 in the CHD group and 640 controls. Mean time between baseline and final CPET was 4.4 ± 1.7 years. After matching on age and gender and adjustment for age and BMI, the mean VO2max group difference was 10.5% ± 1.0% of percent-predict VO2max at baseline and increased to 19.1% ± 1.3% at final assessment. In the CHD group, the proportion of children with impaired aerobic fitness was significantly higher at final than at baseline CPET assessment (51.4% vs 20.3%; P < 0.01). The mean annual VO2max decrease was significantly worse in the CHD group than in controls (-1.88% ± 0.19% of percent-predict VO2max/year vs. -0.44% ± 0.27% of percent-predict VO2max/year, P < 0.01, respectively). In multivariate analyse, male gender, a high initial VO2max, a high BMI, and the number of cardiac surgical procedures ≥2, were predictors of the VO2max decrease with time. CONCLUSION The VO2max decrease with time is more pronounced in children with CHD compared to healthy matched controls. This study highlighted the importance of serial CPET assessment in children with CHD. Trial registration NCT04815577.
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Affiliation(s)
- Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Manon Ladeveze
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France; Clinical Investigation Centre, INSERM U1411, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France; Clinical Investigation Centre, INSERM U1411, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France; Paediatric Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, University of Bordeaux, Bordeaux, France.
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14
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Gavotto A, Vincenti M, Guillaumont S. Isolated Ventricular Inversion: A Rare Complex Congenital Heart Disease With Neonatal Cyanosis. JACC Case Rep 2022; 8:101642. [PMID: 36860565 PMCID: PMC9969543 DOI: 10.1016/j.jaccas.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
A 1-day-old girl was referred for a cardiology consultation for a mean saturation at 80% without respiratory distress. Echocardiography showed an isolated ventricular inversion. This entity is extremely rare, with fewer than 20 cases reported. This case report describes the clinical evolution and the complex surgical management of this pathology. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Arthur Gavotto
- Pediatric and Congenital Cardiology Department, M3C Regional Center, University Hospital, Montpellier, France,PhyMedExp, University of Montpellier, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Montpellier, France,Address for correspondence: Dr Arthur Gavotto, Pediatric and Congenital Cardiology, Department CHU Arnaud De Villeneuve, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Center, University Hospital, Montpellier, France,PhyMedExp, University of Montpellier, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Center, University Hospital, Montpellier, France
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15
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De La Villeon G, Gavotto A, Ledong N, Bredy C, Guillaumont S, Man J, Gouzi F, Hayot M, Mura T, Amedro P, Matecki S. Double gas transfer factors (DLCO-DLNO) at rest in patients with congenital heart diseases correlates with their ventilatory response during maximal exercise. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Gavotto A, Guillaumont S, Matecki S, Amedro P. Reference values of aerobic fitness in the contemporary paediatric population: VO2max Z-scores. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Gavotto A, Kollen L. Aerobic fitness in overweight/obese children with congenital heart disease: Benefit of adapted VO2 reference values. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Gavotto A, Guillaumont S, Matecki S, Amedro P. The VE/VCO2 slope: A useful tool to evaluate the physiological status of children with congenital heart disease. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Cambonie G, Theret B, Badr M, Fournier P, Combes C, Picaud JC, Gavotto A. Birth during on-call period: Impact of care organization on mortality and morbidity of very premature neonates. Front Pediatr 2022; 10:977422. [PMID: 36061390 PMCID: PMC9433924 DOI: 10.3389/fped.2022.977422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The evidence that risks of morbidity and mortality are higher when very premature newborns are born during the on-call period is inconsistent. This study aimed to assess the impact of this situation among other determinants of outcomes, particularly newborn characteristics and care organization. METHODS Observational study including all infants born < 30 weeks' gestation in a French tertiary perinatal center between 2007 and 2020. On-call period corresponded to weekdays between 6:30 p.m. and 8:30 a.m., weekends, and public holidays. The primary endpoint was survival without severe morbidity, including grade 3-4 intraventricular hemorrhage (IVH), cystic periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity. The relationship between admission and outcome was assessed by an adjusted odds ratio (aOR) on the propensity of being born during on-call period and expressed vs. weekday. Secondary analyses were carried out in extremely preterm newborns (<27 weeks' gestation), in cases of early death (within 7 days), and before (2007-2013, 51.5% of the cohort) vs. after (2014-2020, 48.5% of the cohort) the implementation of a pediatrician-nurse team dedicated to newborn care in the delivery room. RESULTS A total of 1,064 infants [27.9 (26.3; 28.9) weeks, 947 (760; 1,147) g] were included: 668 during the on-call period (63%) and 396 (37%) on weekdays. For infants born on weekdays, survival without severe morbidity was 54.5% and mortality 19.2%. During on-call, these rates were 57.3% [aOR 1.08 (0.84-1.40)] and 18.4% [aOR 0.93 (0.67-1.29)]. Comparable rates of survival without severe morbidity [aOR 1.42 (0.87-2.34)] or mortality [aOR 0.76 (0.47-1.22)] were observed in extremely preterm infants. The early death rate was 6.4% on weekdays vs. 8.2% during on-call [aOR 1.44 (0.84-2.48)]. Implementation of the dedicated team was associated with decreased rates of mortality [aOR 0.57 (0.38, 0.85)] and grade 3-4 IVH [aOR 0.48 (0.30, 0.75)], and an increased rate of severe BPD [aOR 2.16 (1.37, 3.41)], for infants born during on-call. CONCLUSION In this cohort, most births of very premature neonates occurred during the on-call period. A team dedicated to newborn care in the delivery room may have a favorable effect on the outcome of infants born in this situation.
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Affiliation(s)
- Gilles Cambonie
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
| | - Bénédicte Theret
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Maliha Badr
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Patricia Fournier
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Clémentine Combes
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Jean-Charles Picaud
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
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20
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Gavotto A, Rivière B, Degravi L. Gastrointestinal Bleeding and Acute Liver Failure. Gastroenterology 2021; 161:1811-1812. [PMID: 33839098 DOI: 10.1053/j.gastro.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Arthur Gavotto
- Department of Anesthesiology and Intensive Care (DAR B), Saint Eloi University Hospital, Montpellier, France; PhyMedExp, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, University of Montpellier, Montpellier, France.
| | - Benjamin Rivière
- Pathology Department, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Lauriane Degravi
- Department of Anesthesiology and Intensive Care (DAR B), Saint Eloi University Hospital, Montpellier, France
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21
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Gavotto A, Mura T, Guillaumont S, Matecki S, Amedro P. Reference values of aerobic fitness in the contemporary paediatric population: VO2max Z-scores. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Gavotto A, Mura T, Amedro P. Aerobic fitness in overweight/obese children with congenital heart disease: Benefit of adapted VO2 reference values. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Werner O, Gavotto A, Théron A. Disseminated Aspergillosis Complicated With a Myocardial Abscess in an Immunodeficient Child. J Pediatr Hematol Oncol 2021; 43:226-227. [PMID: 34133375 DOI: 10.1097/mph.0000000000002078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Aspergillosis infection is a major complication of acquired immunosuppression, and is associated with poor prognosis in its invasive form. Cardiac dissemination of invasive aspergillosis is a rare and usually fatal consequence of systemic mycosis. We describe a pediatric case of myocardial aspergillosis abscess in a 12-year-old girl diagnosed with multimodality cardiac imaging approach. The patient underwent prolonged antimycotic treatment and bone marrow transplant, which improved her immunity, and, for the first time in the literature, resulted in a favorable outcome.
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Affiliation(s)
- Oscar Werner
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference Center
- Departments of Pediatric Radiology
| | - Arthur Gavotto
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference Center
| | - Alexandre Théron
- Paediatric Oncology and Hematology, Montpellier University Hospital, Montpellier, France
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24
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Gavotto A, Gauthier A, Werner O. Cardiac abnormality in a prechemotherapy assessment for leukaemia in a 14-year-old girl. Heart 2021; 106:1406-1450. [PMID: 32847931 DOI: 10.1136/heartjnl-2020-317031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arthur Gavotto
- PhyMedExp, University of Montpellier, CNRS, INSERM, Monpellier, France
| | - Alice Gauthier
- Department of Pediatric and Congenital Cardiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Oscar Werner
- Department of Pediatric and Congenital Cardiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France.,Pediatric radiology, University hospital, Montpellier, France
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25
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Mounier S, Gavotto A, Tenenbaum J, Meyer P, Fila M, Baleine J. Hemolytic uremic syndrome related to Shiga-like toxin-producing Escherichia coli with encephalitis hiding a human herpesvirus-6 infection: a case report. J Med Case Rep 2021; 15:300. [PMID: 34034812 PMCID: PMC8152054 DOI: 10.1186/s13256-021-02873-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac and neurological involvement in hemolytic uremic syndrome are life-threatening complications. The most frequent complications of cardiac involvement in hemolytic uremic syndrome are myocarditis and cardiac dysfunction due to fluid overload. Pericarditis remains very rare in hemolytic uremic syndrome. To our knowledge, only five cases of cardiac tamponade associated with hemolytic uremic syndrome have been described in literature. A 27-month-old Caucasian girl presented with symptoms of nonbloody diarrhea and tonic-clonic seizures. The diagnosis of Shiga-like toxin-producing Escherichia coli hemolytic uremic syndrome with central nervous system involvement was made, and stool examination revealed infection with a Shiga-like toxin-producing Escherichia coli. She did not need renal replacement therapy but had severe neurological impairment. The patient's course was complicated by pericardial effusion. A pericardiocentesis was performed via an apical approach because the pericardial effusion was predominantly surrounding the left ventricle. Effusion analysis showed an exudate and positivity for human herpesvirus-6B on polymerase chain reaction with viremia. This finding was consistent with primary human herpesvirus-6 infection with encephalitis. CONCLUSION We report this uncommon case of Shiga-like toxin-producing Escherichia coli hemolytic uremic syndrome associated with a severe human herpesvirus-6 infection. Secondary isolated pericardial effusion and atypical neurological involvement are uncommon in Shiga-like toxin-producing Escherichia coli hemolytic uremic syndrome and should lead the physician to perform additional investigations.
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Affiliation(s)
- Sophie Mounier
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
| | - Arthur Gavotto
- Department of Pediatric Cardiology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
- CNRS, INSERM, University of Montpellier, PhyMedExpMontpellier, France
| | - Julie Tenenbaum
- Department of Pediatric Nephrology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Pierre Meyer
- CNRS, INSERM, University of Montpellier, PhyMedExpMontpellier, France
- Department of Pediatric Neurology, Gui de Chauliac Hospital, Montpellier University Hospital Center, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - Marc Fila
- Department of Pediatric Nephrology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
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Gavotto A, Feuillade V, Bresch S, Guevara N, Mondot L, Almairac F. Papilledema secondary to vestibular schwannoma: An atypical case without intracranial hypertension. Neurochirurgie 2021; 68:327-330. [PMID: 33989639 DOI: 10.1016/j.neuchi.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
In most cases, vestibular schwannomas with papilledema are associated with intracranial hypertension secondary to hydrocephalus (obstructive or communicating). We describe the atypical case of a 39-years-old man who presented with bilateral papilledema revealing a vestibular schwannoma, but without hydrocephalus and with normal intracranial pressure. Ophtalmologic signs were completely resolved after tumor removal. The pathophysiological mechanism generally described to explain bilateral papilledema in such cases is tumor-induced hyperproteinorachia. However, in the absence of hydrocephalus or intracranial hypertension, this case raises the question of the mechanisms involved in the visual impairment related to vestibular schwannoma.
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Affiliation(s)
- A Gavotto
- Service de neurochirurgie, hôpital Pasteur 2, CHU de Nice, 30, avenue de la voie romaine, 06000 Nice, France; Université Côte d'Azur, Nice, France
| | - V Feuillade
- Université Côte d'Azur, Nice, France; Service d'ophtalmologie, hôpital Pasteur 2, Nice, France
| | - S Bresch
- Université Côte d'Azur, Nice, France; Centre de ressources et de compétences Sclérose en Plaques (CRCSEP), hôpital Pasteur 2, Nice, France
| | - N Guevara
- Université Côte d'Azur, Nice, France; Service d'ORL, IUFC, Nice, France
| | - L Mondot
- Université Côte d'Azur, Nice, France; Service de radiologie, hôpital Pasteur 2, Nice, France
| | - F Almairac
- Service de neurochirurgie, hôpital Pasteur 2, CHU de Nice, 30, avenue de la voie romaine, 06000 Nice, France; Université Côte d'Azur, Nice, France.
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27
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Gavotto A, Vandenberghe D, Abassi H, Huguet H, Macioce V, Picot MC, Guillaumont S, Matecki S, Amedro P. Oxygen uptake efficiency slope: a reliable surrogate parameter for exercise capacity in healthy and cardiac children? Arch Dis Child 2020; 105:1167-1174. [PMID: 32732318 DOI: 10.1136/archdischild-2019-317724] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 03/30/2020] [Accepted: 06/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Cardiopulmonary exercise test (CPET) provides accurate evaluation of physical capacity and disease severity in children with congenital heart disease (CHD). However, full participation to obtain optimal measure of VO2max may be difficult. As an alternative, the oxygen uptake efficiency slope (OUES) is a reproducible and reliable parameter measured during CPET, which does not require a maximal exercise to be interpretable. This study aimed to evaluate the OUES of a large cohort of children with CHD, in comparison with healthy controls. We also intended to identify, in this specific population, the clinical and CPET variables associated with the OUES. METHODS This cross-sectional study was carried out between November 2010 and September 2015 in two tertiary care paediatric and congenital cardiology centres. RESULTS 709 children were included (407 CHD and 302 healthy controls). The association of clinical characteristics with weight-normalised OUES (OUESkg) was studied using a multivariable analysis. The mean OUESkg was significantly lower in CHD than in healthy controls (38.6±8.5 and 43.9±8.5; p<0.001, respectively), especially in the most severe CHD. The OUESkg correlated with VO2max (r=0.85, p<0.001), with cut-off values for normal exercise capacity of 38.4 in boys and 31.0 in girls. The decrease of OUESkg was associated with increased age, increased Body Mass Index, number of cardiac catheter or surgical procedures, female gender and decreased forced vital capacity (Z-score). CONCLUSION The OUES is significantly impaired in children with CHD and strongly correlates with VO2max. The OUES has the same clinical determinants as VO2max and therefore may be of interest in submaximal exercise. TRIAL REGISTRATION NUMBER NCT01202916.
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Affiliation(s)
- Arthur Gavotto
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France .,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - D'arcy Vandenberghe
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France.,Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, France, Montpellier, France
| | - Valerie Macioce
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France.,Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, France, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France.,Pediatric and Congenital Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Stefan Matecki
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France.,Pediatric Functional Exploration Laboratory, Physiology Department, Montpellier University Hospital, Montpellier, France
| | - Pascal Amedro
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
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Socchi F, Bigorre M, Normandin M, Captier G, Bessis D, Mondain M, Blanchet C, Akkari M, Amedro P, Gavotto A. Hemangiol in infantile haemangioma: A paediatric post-marketing surveillance drug study. Br J Clin Pharmacol 2020; 87:1970-1980. [PMID: 33118199 DOI: 10.1111/bcp.14593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 01/06/2023] Open
Abstract
AIM Infantile haemangioma (IH) is the most common benign tumour in children. Since 2014, propranolol has become the first-choice therapy and currently Hemangiol is the only approved drug for complicated haemangioma. This post-marketing study reports the use of Hemangiol for IH in paediatric practice. METHOD AND RESULTS From January 2014 to November 2018, 94 children (median age 4 [0; 21] months; 75% female) treated with Hemangiol for proliferative IH were enrolled in the study. The systematic paediatric cardiology consultation never contraindicated beta-blockers. Two Hemangiol initiation protocols were used: a conventional ambulatory 3-week titration phase protocol (n = 76, 80.9%), and a rapid initiation protocol with a 48-hour dose escalation in conventional hospitalization for severe proliferative or ulcerated IH (n = 18, 19.1%). In both protocols, the haemodynamic tolerance was good. The mean maintenance dose of Hemangiol was 2.7 ± 0.8 mg/kg/day, with a median treatment duration of 7 [1.5; 19] months. Adverse events (AEs) have been found in 25 (26,6%) patients, including 8 (8.5%) patients with serious AEs (uncontrolled bronchial hyperreactivity, n = 5; serious hypoglycaemia, n = 3). Some patients had one or more AEs, a total of 24 nonserious AEs was reported in 19 patients (sleep disturbances, n = 9; respiratory disorders, n = 5; digestive disorders, n = 6). No cardiac adverse event was reported. CONCLUSION This post-marketing surveillance drug study supports the good tolerance of Hemangiol in children with IH. A rapid initiation protocol is of interest when treatment is urgent. The pretherapeutic paediatric cardiology consultation should not be systematic but only indicated for specific patients. CLINICALTRIALS.GOV: NCT04105517.
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Affiliation(s)
- Floriane Socchi
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France
| | - Michele Bigorre
- Department of Paediatric Plastic Surgery, Montpellier University Hospital, Montpellier, France
| | - Marion Normandin
- Department of Clinical Pharmacy, Montpellier University Hospital, Montpellier, France
| | - Guillaume Captier
- Department of Paediatric Plastic Surgery, Montpellier University Hospital, Montpellier, France
| | - Didier Bessis
- Department of Dermatology, Montpellier University Hospital, Montpellier, France
| | - Michel Mondain
- Department of Paediatric ENT, Head and Neck Surgery, Montpellier University Hospital, Montpellier, France
| | - Catherine Blanchet
- Department of Paediatric ENT, Head and Neck Surgery, Montpellier University Hospital, Montpellier, France
| | - Mohamed Akkari
- Department of Paediatric ENT, Head and Neck Surgery, Montpellier University Hospital, Montpellier, France
| | - Pascal Amedro
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Arthur Gavotto
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, Clinical Investigation Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
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Abassi H, Huguet H, Picot MC, Vincenti M, Guillaumont S, Auer A, Werner O, De La Villeon G, Lavastre K, Gavotto A, Auquier P, Amedro P. Health-related quality of life in children with congenital heart disease aged 5 to 7 years: a multicentre controlled cross-sectional study. Health Qual Life Outcomes 2020; 18:366. [PMID: 33183312 PMCID: PMC7659069 DOI: 10.1186/s12955-020-01615-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background In the context of tremendous progress in congenital cardiology, more attention has been given to patient-related outcomes, especially in assessing health-related quality of life (HRQoL) of patients with congenital heart diseases (CHD). However, most studies have mainly focused on teenagers or adults and currently, few HRQoL controlled data is available in young children. This study aimed to evaluate HRQoL of children with CHD aged 5 to 7 y.o., in comparison with contemporary peers recruited in school, as well as the factors associated with HRQoL in this population. Methods This multicentre controlled prospective cross-sectional study included 124 children with a CHD (mean age = 6.0 ± 0.8 y, 45% female) during their outpatient visit and 125 controls (mean age = 6.2 ± 0.8 y, 54% female) recruited at school. A generic paediatric HRQoL instrument was used (PedsQL 4.0). Results Self-reported HRQoL in children with CHD was similar to controls, overall (73.5 ± 1.2 vs. 72.8 ± 1.2, P = 0.7, respectively), and for each dimension. Parents-reported HRQoL was significantly lower in the CHD group than in controls. HRQoL was predicted by the disease severity and by repeated invasive cardiac procedures (surgery or catheterization). Conclusion HRQoL in young children with CHD aged 5 to 7 years old was good and similar to controls. This study contributed to the growing body of knowledge on HRQoL in congenital cardiology and emphasized the need for child and family support in the most complex CHD. Trial registration This study was approved by the institutional review board of Montpellier University Hospital (2019_IRB-MTP_02-19) on 22 February 2019 and was registered on ClinicalTrials.gov (NCT03931096) on 30 April 2019, https://clinicaltrials.gov/ct2/show/NCT03931096.
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Affiliation(s)
- Hamouda Abassi
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Centre for Studies and Research On Health Services and Quality of Life, Public Health and Chronic Diseases Laboratory, Aix Marseille University, Marseille, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Epidemiology Department, University Hospital, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology Department, University Hospital, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Marie Vincenti
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Annie Auer
- Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Oscar Werner
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Kathleen Lavastre
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pascal Auquier
- Centre for Studies and Research On Health Services and Quality of Life, Public Health and Chronic Diseases Laboratory, Aix Marseille University, Marseille, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France. .,Centre for Studies and Research On Health Services and Quality of Life, Public Health and Chronic Diseases Laboratory, Aix Marseille University, Marseille, France. .,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
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Gavotto A, Huguet H, Picot MC, Guillaumont S, Matecki S, Amedro P. The V̇e/V̇co 2 slope: a useful tool to evaluate the physiological status of children with congenital heart disease. J Appl Physiol (1985) 2020; 129:1102-1110. [PMID: 32909919 DOI: 10.1152/japplphysiol.00520.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cardiopulmonary exercise test (CPET) is becoming a key examination to assess physical capacity and disease severity in pediatric cardiology. The V̇e/V̇co2 slope has been increasingly used as a surrogate marker for morbidity and mortality in adult heart failure, pulmonary arterial hypertension, and for adult patients with congenital heart disease (CHD). Nevertheless, the use of the V̇e/V̇co2 slope in children remains limited in the absence of reference values and clearly identified clinical determinants. This study aimed to compare the V̇e/V̇co2 slope in a pediatric cohort with CHD to that of age- and gender-adjusted healthy controls. We also intended to identify the clinical and CPET variables associated with V̇e/V̇co2 slope in this population. This cross-sectional study was carried out between November 2010 and September 2015 in two tertiary care pediatric cardiology reference centers. A total of 700 children were enrolled (399 CHD and 301 healthy controls). The mean V̇e/V̇co2 slope was significantly higher in the CHD subjects than in healthy subjects (31.6 ± 4.8 vs. 29.3 ± 4.8; P < 0.001). The V̇e/V̇co2 slope was higher in children with significant pulmonary regurgitation, tricuspid regurgitation, right ventricular hypertension, and right ventricle outflow tract (RVOT) obstacle. In the CHD group, V̇e/V̇co2 slope increase was associated with body mass index, the presence of a RVOT obstacle, the number of cardiac catheter procedures, as well as low age, forced vital capacity, tidal volume, and [Formula: see text]. Increased V̇e/V̇co2 slope was predominantly in children with single ventricle and/or residual right heart abnormalities, suggesting that maldistribution of pulmonary blood flow during exercise is an important CHD-unique determinant of V̇e/V̇co2 slope.NEW & NOTEWORTHY Using V̇e/V̇co2 slope is useful for children with congenital heart disease. V̇e/V̇co2 slope is sensitive to pulmonary blood flow maldistribution during exercise, this concerns congenital heart disease with pulmonary regurgitation, tricuspid regurgitation, right ventricular hypertension, and right ventricle outflow tract obstacle. V̇e/V̇co2 slope is a good parameter to follow single ventricles and right heart residual lesions (tetralogy of Fallot; pulmonary atresia; truncus arteriosus…).
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Affiliation(s)
- Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital of Montpellier, Montpellier, France.,Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital of Montpellier, Montpellier, France.,Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital of Montpellier, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Stefan Matecki
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.,Paediatric Functional Exploration Laboratory, Physiology Department, University Hospital of University of Montpellier, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital of Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.,Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France.,Paediatric Functional Exploration Laboratory, Physiology Department, University Hospital of University of Montpellier, Montpellier, France
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Habas F, Durand S, Milési C, Mesnage R, Combes C, Gavotto A, Picaud JC, Cambonie G. 15-Year trends in respiratory care of extremely preterm infants: Contributing factors and consequences on health and growth during hospitalization. Pediatr Pulmonol 2020; 55:1946-1954. [PMID: 32353220 DOI: 10.1002/ppul.24774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To review 15-year trends in respiratory care of extremely preterm infants managed in a tertiary perinatal center; to identify the factors contributing to their evolution; and to determine whether these changes had an impact on infant mortality, severe morbidity, and growth. METHODS Retrospective cohort study of infants born at 23 to 26 weeks' gestation between 2003 and 2017. Changes in respiratory care were assessed in three 5-year periods. Logistic regression was used to examine the factors associated with prolonged duration (ie, greater than the median) of invasive mechanical ventilation (IMV), noninvasive ventilation (NIV), and overall respiratory support (ORS), and those associated with adequate weight and head circumference growth. RESULTS Of the 396 actively treated neonates, 268 (68%) survived to discharge. Between the first and third periods, IMV duration decreased from 22 (6-37) to 4 (1-14.0) days (P < .001), that of NIV increased from 24 (14-34) to 56 (44-66) days (P < .001), and that of ORS from 50 (34-68) to 63 (52-77) days (P < .001). Study period (2003-2007 vs 2013-2017) was the main factor associated with prolonged IMV (P < .001). Use of high-flow nasal cannula was the main factor associated with prolonged NIV (P = .02) and ORS (P = .02). NIV duration was associated with adequate postnatal weight (P = .003) and head circumference (P = .03) growth. Severe morbidities in survivors, including bronchopulmonary dysplasia, and survival at hospital discharge were comparable across the study periods. CONCLUSIONS Respiratory management was characterized by a marked reduction in IMV. NIV withdrawal protocols are necessary to limit ORS duration while respecting postnatal growth requirements.
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Affiliation(s)
- Flora Habas
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Sabine Durand
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Christophe Milési
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Renaud Mesnage
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Clémentine Combes
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Jean-Charles Picaud
- Department of Neonatal Medicine, Croix-Rousse Hospital, Lyon University Hospital Center, Lyon, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
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Kollen L, Werner O, Gavotto A. Uncommon Cause of Chest Pain in a 9-Year-Old Boy With Crohn's Disease. Gastroenterology 2020; 158:2055-2057. [PMID: 32145218 DOI: 10.1053/j.gastro.2020.02.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/02/2022]
Affiliation(s)
- L Kollen
- Department of Pediatric gastroenterology, Montpellier University Hospital, Montpellier, France
| | - O Werner
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference Center, Montpellier University Hospital, Montpellier, France
| | - Arthur Gavotto
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference Center, Montpellier University Hospital, Montpellier, France; PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
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Amedro P, Gavotto A, Abassi H, Picot MC, Matecki S, Malekzadeh-Milani S, Levy M, Ladouceur M, Ovaert C, Aldebert P, Thambo JB, Fraisse A, Humbert M, Cohen S, Baruteau AE, Karsenty C, Bonnet D, Hascoet S. Efficacy of phosphodiesterase type 5 inhibitors in univentricular congenital heart disease: the SV-INHIBITION study design. ESC Heart Fail 2020; 7:747-756. [PMID: 32147955 PMCID: PMC7160497 DOI: 10.1002/ehf2.12630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/04/2020] [Accepted: 01/12/2020] [Indexed: 12/14/2022] Open
Abstract
Aims In univentricular hearts, selective lung vasodilators such as phosphodiesterase type 5 (PDE5) inhibitors would decrease pulmonary resistance and improve exercise tolerance. However, the level of evidence for the use of PDE5 inhibitors in patients with a single ventricle (SV) remains limited. We present the SV‐INHIBITION study rationale, design, and methods. Methods and results The SV‐INHIBITION trial is a nationwide multicentre, randomized, double blind, placebo‐controlled, Phase III study, aiming to evaluate the efficacy of sildenafil on the ventilatory efficiency during exercise, in teenagers and adult patients (>15 years old) with an SV. Patients with a mean pulmonary arterial pressure >15 mmHg and a trans‐pulmonary gradient >5 mmHg, measured by cardiac catheterization, will be eligible. The primary outcome is the variation of the VE/VCO2 slope, measured by a cardiopulmonary exercise test, between baseline and 6 months of treatment. A total of 50 patients are required to observe a decrease of 5 ± 5 points in the VE/VCO2 slope, with a power of 90% and an alpha risk of 5%. The secondary outcomes are clinical outcomes, oxygen saturation, 6 min walk test, SV function, NT‐proBNP, peak VO2, stroke volume, mean pulmonary arterial pressure, trans‐pulmonary gradient, SF36 quality of life score, safety, and acceptability. Conclusions The SV‐INHIBITION study aims to answer the question whether PDE5 inhibitors should be prescribed in patients with an SV. This trial has been built focusing on the three levels of research defined by the World Health Organization: disability (exercise tolerance), deficit (SV function), and handicap (quality of life).
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Affiliation(s)
- Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, CHU Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, CHU Montpellier, Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, CHU Montpellier, Montpellier, France
| | | | - Stefan Matecki
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, CHU Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Sophie Malekzadeh-Milani
- Paediatric Cardiology Department, AP-HP, Necker-Enfants malades, M3C National Reference Centre, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - Marilyne Levy
- Paediatric Cardiology Department, AP-HP, Necker-Enfants malades, M3C National Reference Centre, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Department of Cardiology, M3C National Reference Centre, European Hospital Georges Pompidou, Paris, France
| | - Caroline Ovaert
- Paediatric and Congenital Medico-Surgical Cardiology Department, M3C Regional Reference Centre, AP-HM, La Timone University Hospital, Marseille, France.,Laboratory of Medical Genetics, INSERM UMR 1251, Aix-Marseille University, Marseille, France
| | - Philippe Aldebert
- Paediatric and Congenital Medico-Surgical Cardiology Department, M3C Regional Reference Centre, AP-HM, La Timone University Hospital, Marseille, France
| | - Jean-Benoit Thambo
- Paediatric and Adult Congenital Heart Disease Department, Hôpital Cardiologique du Haut-Lévêque, M3C National Reference Centre, CHU de Bordeaux, Bordeaux, France
| | - Alain Fraisse
- Pediatric Cardiology Service, Royal Brompton and Harefield Hospital Trust, London, UK
| | - Marc Humbert
- Department of Pulmonology, PH National Reference Centre, APHP, Kremlin-Bicetre, Paris, France.,Paris-Sud Faculty of Medicine, INSERM U999, Marie-Lannelongue Hospital, M3C National Reference Centre, Paris-Sud University, Paris-Saclay, Le Plessis-Robinson, Paris, France
| | - Sarah Cohen
- Paris-Sud Faculty of Medicine, INSERM U999, Marie-Lannelongue Hospital, M3C National Reference Centre, Paris-Sud University, Paris-Saclay, Le Plessis-Robinson, Paris, France
| | - Alban-Elouen Baruteau
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, CHU Nantes, Nantes, France
| | - Clement Karsenty
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, CHU Toulouse, Toulouse, France
| | - Damien Bonnet
- Paediatric Cardiology Department, AP-HP, Necker-Enfants malades, M3C National Reference Centre, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - Sebastien Hascoet
- Paris-Sud Faculty of Medicine, INSERM U999, Marie-Lannelongue Hospital, M3C National Reference Centre, Paris-Sud University, Paris-Saclay, Le Plessis-Robinson, Paris, France
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Gavotto A, Werner O, Amedro P. Late infective endocarditis after transcatheter tricuspid valve-in-valve implantation: A pediatric case report. Arch Pediatr 2020; 27:107-109. [DOI: 10.1016/j.arcped.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/04/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
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Gavotto A, Vandenberghe D, Abassi H, Bertet H, Macioce V, Picot M, Guillaumont S, Matecki S, Amedro P. Oxygen uptake efficiency slope in children with congenital heart disease versus healthy children. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gavotto A, Abassi H, Rola M, Serrand C, Picot M, Iriart X, Thambo J, Iserin L, Ladouceur M, Bredy C, Amedro P. Factors associated with exercise capacity in patients with a systemic right ventricle. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Werner O, Amedro P, Guillaumont S, Abassi H, Gavotto A, Bredy C. Factors influencing the participation of adolescents and young adults with a congenital heart disease in a transition education program: A multicenter controlled study. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gavotto A, Ousselin A, Pidoux O, Cathala P, Costes-Martineau V, Rivière B, Pasquié JL, Amedro P, Rambaud C, Cambonie G. Respiratory syncytial virus-associated mortality in a healthy 3-year-old child: a case report. BMC Pediatr 2019; 19:462. [PMID: 31771554 PMCID: PMC6880595 DOI: 10.1186/s12887-019-1847-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is the most frequently identified pathogen in children with acute lower respiratory tract infection. Fatal cases have mainly been reported during the first 6 months of life or in the presence of comorbidity. Case presentation A 47-month-old girl was admitted to the pediatric intensive care unit following sudden cardiopulmonary arrest occurring at home. The electrocardiogram showed cardiac asystole, which was refractory to prolonged resuscitation efforts. Postmortem analyses detected RSV by polymerase chain reaction in an abundant, exudative pericardial effusion. Histopathological examination was consistent with viral myoepicarditis, including an inflammatory process affecting cardiac nerves and ganglia. Molecular analysis of sudden unexplained death genes identified a heterozygous mutation in myosin light chain 2, which was also found in two other healthy members of the family. Additional expert interpretation of the cardiac histology confirmed the absence of arrhythmogenic right ventricular dysplasia or hypertrophic cardiomyopathy. Conclusions RSV-related sudden death in a normally developing child of this age is exceptional. This case highlights the risk of extrapulmonary manifestations associated with this infection, particularly arrhythmia induced by inflammatory phenomena affecting the cardiac autonomic nervous system. The role of the mutation in this context is uncertain, and it is therefore necessary to continue to assess how this pathogenic variant contributes to unexpected sudden death in childhood.
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Affiliation(s)
- A Gavotto
- Pediatric and Congenital Cardiology Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.,CNRS UMR 9214, INSERM U1046, University of Montpellier, Montpellier, France
| | - A Ousselin
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - O Pidoux
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - P Cathala
- Department of Forensic Medicine, Lapeyronie Hospital, Montpellier University Hospital Center, Montpellier, France
| | - V Costes-Martineau
- Department of Pathology, Lapeyronie Hospital, Montpellier University Hospital Center, Montpellier, France
| | - B Rivière
- Department of Pathology, Lapeyronie Hospital, Montpellier University Hospital Center, Montpellier, France
| | - J L Pasquié
- Department of Cardiology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - P Amedro
- Pediatric and Congenital Cardiology Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.,CNRS UMR 9214, INSERM U1046, University of Montpellier, Montpellier, France
| | - C Rambaud
- Department of Pathology and Forensic Medicine, Raymond Poincaré Hospital, Garches University Hospital, Garches, France
| | - G Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
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Gavotto A, Abassi H, Rola M, Serrand C, Picot MC, Iriart X, Thambo JB, Iserin L, Ladouceur M, Bredy C, Amedro P. Factors associated with exercise capacity in patients with a systemic right ventricle. Int J Cardiol 2019; 292:230-235. [DOI: 10.1016/j.ijcard.2019.06.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 11/25/2022]
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Gavotto A, Abassi H, Rola M, Serrand C, Picot MC, Iriart X, Thambo JB, Iserin L, Ladouceur M, Bredy C, Amedro P. Factors associated with exercise capacity in patients with a systemic right ventricle. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lavilledieu D, Abassi H, Mercier G, Guiraud M, Chaffaut GD, Milesi C, Cambonie G, Gavotto A, Jeziorski E, Amedro P. Implementation of an organizational infrastructure paediatric plan adapted to bronchiolitis epidemics. J Infect Public Health 2019; 13:167-172. [PMID: 31378693 DOI: 10.1016/j.jiph.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/21/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Acute bronchiolitis epidemics are known to destabilize healthcare structures and stand as a major public health issue. Our tertiary care regional university hospital designed an organizational infrastructure paediatric plan (OIPP) to adapt to bronchiolitis epidemics. This study aimed to assess the impact of the OIPP on the length of stay and quality of care of children hospitalized for bronchiolitis. METHODS This epidemiological study analyzed data from 2 epidemic seasons before and after the OIPP implementation. The OIPP used a standardized algorithm of patient orientation and a 4-level stratification of care. RESULTS A total of 1636 children were included in the study, with 718 children before and 918 children after the OIPP implementation. The length of stay significantly decreased after the OIPP implementation, from 5.1±6.8 days to 3.9±3 days (P<0.001). The 30-day readmission for bronchiolitis remained stable (4.6% vs. 3.4%, P=0.2). The net annual patient service revenue increased from 1,292,532 € to 1,545,720 €. CONCLUSION The implementation of the OIPP resulted in a significant decrease in the average hospital length of stay. This plan improved patients' quality of care while maintained a balanced budget. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03663660.
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Affiliation(s)
- David Lavilledieu
- Pediatric Cardiology and Pulmonology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Pediatric Cardiology and Pulmonology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France; Self-Perceived Health Assessment Research Unit, EA3279, Public Health Department, Aix-Marseille University, Marseille, France
| | - Gregoire Mercier
- Medico-economic Research Laboratory, UMR 5112, CNRS, University of Montpellier, Department of Epidemiology and Biostatistics, Montpellier University Hospital, Montpellier, France
| | - Myriam Guiraud
- Hospital Management Department, Montpellier University Hospital, Montpellier, France
| | - Guillaume Du Chaffaut
- Hospital Management Department, Montpellier University Hospital, Montpellier, France
| | - Christophe Milesi
- Department of Paediatric and Neonatal Intensive Care, Montpellier University Hospital, Montpellier, France
| | - Gilles Cambonie
- Department of Paediatric and Neonatal Intensive Care, Montpellier University Hospital, Montpellier, France
| | - Arthur Gavotto
- Pediatric Cardiology and Pulmonology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France.
| | - Eric Jeziorski
- Department of Paediatrics, Montpellier University Hospital, Montpellier, France
| | - Pascal Amedro
- Pediatric Cardiology and Pulmonology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France; PHYMEDEXP, University of Montpellier, INSERM, CNRS, Montpellier, France
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Amedro P, Gavotto A, Legendre A, Lavastre K, Bredy C, De La Villeon G, Matecki S, Vandenberghe D, Ladeveze M, Bajolle F, Bosser G, Bouvaist H, Brosset P, Cohen L, Cohen S, Corone S, Dauphin C, Dulac Y, Hascoet S, Iriart X, Ladouceur M, Mace L, Neagu OA, Ovaert C, Picot MC, Poirette L, Sidney F, Soullier C, Thambo JB, Combes N, Bonnet D, Guillaumont S. Impact of a centre and home-based cardiac rehabilitation program on the quality of life of teenagers and young adults with congenital heart disease: The QUALI-REHAB study rationale, design and methods. Int J Cardiol 2019; 283:112-118. [DOI: 10.1016/j.ijcard.2018.12.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022]
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Abassi H, Gavotto A, Picot MC, Bertet H, Matecki S, Guillaumont S, Moniotte S, Auquier P, Moreau J, Amedro P. Impaired pulmonary function and its association with clinical outcomes, exercise capacity and quality of life in children with congenital heart disease. Int J Cardiol 2019; 285:86-92. [PMID: 30857849 DOI: 10.1016/j.ijcard.2019.02.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/30/2018] [Revised: 02/03/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Impaired pulmonary function is an independent predictor of mortality in adult congenital heart disease (CHD), but has been scarcely studied in the paediatric CHD population. AIMS To compare the pulmonary function of children with CHD to healthy controls, and evaluate its association with clinical outcomes, exercise capacity, and quality of life. METHODS Cross-sectional multicentre study among 834 children (555 CHD and 279 control subjects) who underwent a complete spirometry and a cardiopulmonary exercise test (CPET). The 5th centile (Z-score = -1.64) was used to define the lower limit of normal. The association of clinical and CPET variables with spirometry was studied using a multivariate analysis. Children and their parents filled in the Kidscreen health-related quality of life questionnaire. RESULTS Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) Z-scores values were lower in children with CHD than controls (-0.4 ± 1.5 vs. 0.4 ± 1.3, P < 0.001 and -0.5 ± 1.4 vs. 0.4 ± 1.2, P < 0.001, respectively), without any obstructive airway disorder. Restrictive pattern was more frequent in CHD patients than in controls (20% vs. 4%, P < 0.0001). FVC Z-scores were predominantly impaired in complex CHD, such as heterotaxy (-1.1 ± 0.6), single ventricle (-1.0 ± 0.2), and complex anomalies of the ventricular outflow tracts (-0.9 ± 0.1). In multivariate analysis, FVC was associated with age, body mass index, peak oxygen uptake, genetic anomalies, the number of cardiac surgery and cardiac catheter procedures. FVC and FEV1 correlated with self and proxy-related quality of life scores. CONCLUSION These results suggest that pulmonary function should be monitored early in life, from childhood, in the CHD population. TRIAL REGISTRATION NUMBER NCT01202916, post-results.
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Affiliation(s)
- Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France; Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France
| | - Marie Christine Picot
- Epidemiology Department, Montpellier University Hospital, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Helena Bertet
- Epidemiology Department, Montpellier University Hospital, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, University of Montpellier, INSERM, CNRS, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Stephane Moniotte
- Paediatric and Congenital Cardiology Department, St-Luc University Hospital, Brussels, Belgium
| | - Pascal Auquier
- Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - Johan Moreau
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France; Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille, France; PhyMedExp, University of Montpellier, INSERM, CNRS, France.
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Amedro P, Guillaumont S, Bredy C, Matecki S, Gavotto A. Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up. J Thorac Dis 2018; 10:S2864-S2873. [PMID: 30305946 DOI: 10.21037/jtd.2017.11.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nearly four decades ago, the World Health Organization stated that functional capacity explorations best reflected the impact of a chronic disease on quality of life. Today, cardio-pulmonary exercise test (CPET) is recommended in the follow-up of patients with congenital heart diseases (CHDs). Indeed, the maximum oxygen uptake (VO2max) and the ventilatory efficiency (VE/VCO2 slope) correlate with both the prognosis and the quality of life in this population. Atrial septal defects (ASDs) represent the second most frequent CHD and are usually considered as simple CHDs. However, the exercise capacity of ASD patients may be impaired. Therefore, the CPET provides important information in assessment and follow-up of patients with ASDs, for both children and adults. Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery). In most cases, the exercise capacity is nearly normal and CPET contributes to promote sports participation. In addition, a regular CPET follow-up is necessary to evaluate the occurrence, severity and physiological mechanisms of comorbidities, i.e., heart failure, pulmonary hypertension and arrhythmia. Furthermore, CPET follow-up in patients with ASDs may detect early onset of muscular deconditioning, for which cardiac rehabilitation may be considered.
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Affiliation(s)
- Pascal Amedro
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Charlene Bredy
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Stefan Matecki
- Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
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Amedro P, Gavotto A, Gelibert D, Fraysse V, De La Villeon G, Vandenberghe D, Bredy C. Feasibility of clinical hypnosis for transesophageal echocardiography in children and adolescents. Eur J Cardiovasc Nurs 2018; 18:163-170. [PMID: 30230358 DOI: 10.1177/1474515118803513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of hypnosis in children has been described more than two centuries ago, with a more recent research and clinical application. There is currently a good level of evidence for the efficacy of clinical hypnosis in children for minor surgery, medical procedures or pain management. The use of clinical hypnosis, in paediatric cardiology, for invasive procedures such as transesophageal echocardiography, has not been reported. AIMS This study evaluated the feasibility of clinical hypnosis in children undergoing transesophageal echocardiography. METHOD This prospective, non-randomised, cross-sectional study was carried out over 24 months in a paediatric cardiology referral centre. All children aged 10-18 years requiring a transesophageal echocardiography examination, outside the operating room and the catheterisation laboratory, were eligible for the study. Children and families could choose between transesophageal echocardiography under clinical hypnosis or under general anaesthesia (<15 years) or sedation (⩾15 years). RESULTS We included 16 children aged 11-18 years (seven girls, mean age 14.1±2.5 years). The hypnotic state was achieved for 15 out of the 16 participating children (94%). The transesophageal echocardiography examination could be completely achieved with a full diagnosis for 15 out of 16 children (94%). In all cases, a transesophageal echocardiography examination under clinical hypnosis provided a complete diagnosis. CONCLUSION This study demonstrated that hypnosis was feasible and effective for transesophageal echocardiography in adolescents and might be a good alternative to general anaesthesia. Further study with larger numbers of subjects and more diverse congenital cardiac conditions are needed to confirm the results in a more diverse sample.
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Affiliation(s)
- Pascal Amedro
- 1 Pediatric and Congenital Cardiology Department, CHU Montpellier, France.,2 PHYMEDEXP, CNRS, INSERM, University of Montpellier, France
| | - Arthur Gavotto
- 1 Pediatric and Congenital Cardiology Department, CHU Montpellier, France
| | | | | | | | | | - Charlene Bredy
- 1 Pediatric and Congenital Cardiology Department, CHU Montpellier, France
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Amedro P, Gavotto A, Guillaumont S, Bertet H, Vincenti M, De La Villeon G, Bredy C, Acar P, Ovaert C, Picot MC, Matecki S. Cardiopulmonary fitness in children with congenital heart diseases versus healthy children. Heart 2017; 104:1026-1036. [DOI: 10.1136/heartjnl-2017-312339] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 02/03/2023] Open
Abstract
ObjectiveWe aimed to compare the cardiopulmonary fitness of children with congenital heart diseases (CHD) with that of age-adjusted and gender-adjusted controls. We also intended to identify clinical characteristics associated with maximum oxygen uptake (VO2max) in this population.Methods and resultsWe included in a cross-sectional multicentre study a total of 798 children (496 CHD and 302 controls) who underwent a complete cardiopulmonary exercise test (CPET). The association of clinical characteristics with VO2max was studied using a multivariate analysis. Mean VO2max in the CHD group and control represented 93%±20% and 107%±17% of predicted values, respectively. VO2max was significantly lower in the CHD group, overall (37.8±0.3vs 42.6±0.4 mL/kg/min, P<0.0001) and for each group (P<0.05). The mean VO2max decline per year was significantly higher in CHD than in the controls overall (−0.84±0.10 vs −0.19±0.14 mL/kg/min/year, P<0.01), for boys (−0.72±0.14vs 0.11±0.19 mL/kg/min/year, P<0.01) and for girls (−1.00±0.13 vs −0.55±0.21 mL/kg/min/year, P=0.05). VO2max was associated with body mass index, ventilatory anaerobic threshold, female gender, restrictive ventilatory disorder, right ventricle systolic hypertension, tricuspid regurgitation, the number of cardiac catheter or surgery procedures, and the presence of a genetic anomaly.ConclusionsAlthough the magnitude of the difference was not large, VO2max among children with CHD was significantly lower than in normal children. We suggest performing CPET in routine follow-up of these patients.Trial registration numberClinicalTrials.gov NCT01202916; Post-results.
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Amedro P, Gavotto A, Bredy C, Guillaumont S. [Cardiac rehabilitation for children and adults with congenital heart disease]. Presse Med 2017; 46:530-537. [PMID: 28126509 DOI: 10.1016/j.lpm.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/27/2016] [Accepted: 12/20/2016] [Indexed: 01/02/2023] Open
Abstract
Advances in heart surgery over the past 30 years have significantly improved the prognosis of congenital heart diseases (CHD). Therefore, the epidemiology of CHD has changed dramatically with a shift of mortality from pediatrics to adulthood and an increased prevalence of complex CHD. Today, caregivers and patients focus their interests to new perspectives: improving the quality of life, practicing sports, improving psychosocial care. Cardiac rehabilitation is completely integrated in these new therapeutic strategies. The starting point is the cardiopulmonary exercise test (CPET), with the measurement of oxygen uptake, or "VO2". CPET is now recommended in the follow-up of the adults with CHD. Maximum oxygen uptake correlates to the quality of life of children and adults with CHD. The principles of the rehabilitation in patients with heart failure may usually be applied to CHD patients. Some studies in complex CHD showed improvement of VO2 and quality of life after rehabilitation, without any adverse events. However few physicians have the experience in rehabilitation among CHD patients, especially children. Randomized trials on cardiac rehabilitation in adult and pediatric CHD patients are essential to increase the level of evidence and lead to specific guidelines in this population.
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Affiliation(s)
- Pascal Amedro
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France.
| | - Arthur Gavotto
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France
| | - Charlène Bredy
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Clinique Fontfroide, service de réhabilitation cardiaque, Montpellier, France
| | - Sophie Guillaumont
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Institut-Saint-Pierre, unité d'évaluation et de réhabilitation en cardiologie pédiatrique, Palavas-Les-Flots, France
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Amedro P, Gavotto A, Guillaumont S, Vincenti M, De La Villeon G, Soulatges C, Bredy C, Matecki S. Cardiopulmonary exercise test among children with congenital heart diseases: a multicenter study. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gavotto A, Guillaumont S, Vincenti M, De La Villeon G, Soulatges C, Bredy C, Matecki S, Amedro P. Cardiopulmonary exercise test in children with congenital heart diseases: correlation between ventilatory parameters and maximum oxygen uptake. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gavotto A, Amedro P, Guillaumont S, Vincenti M, De La Villeon G, Soulatges C, Bredy C, Matecki S. Cardiopulmonary exercise test among children with congenital heart diseases: a multicenter study. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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