1
|
Pinto VC, Miana LA, Navarro FB, Rocha BDC, Assad RS, Oliveira MABD, Salum FS, Croti UA, Furlanetto BHS, Jatene MB, Caneo LF, Monteiro AJDO, Moraes FRD, Antoniali F, Salerno PR, Nina VJDS. Challenges of Congenital Heart Surgery in Brazil: It is Time to Designate Pediatric Congenital Heart Surgery Subspecialty. Braz J Cardiovasc Surg 2024; 39:e20240138. [PMID: 38771210 DOI: 10.21470/1678-9741-2024-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Congenital heart disease (CHD) affects eight to ten out of every 1,000 births, resulting in approximately 23,057 new cases in Brazil in 2022. About one in four children with CHD requires surgery or other procedures in the first year of life, and it is expected that approximately 81% of these children with CHD will survive until at least 35 years of age. Professionals choosing to specialize in CHD surgery face numerous challenges, not only related to mastering surgical techniques and the complexity of the diseases but also to the lack of recognition by medical societies as a separate subspecialty. Furthermore, families face difficulties when access to services capable of providing treatment for these children. To address these challenges, it is essential to have specialized hospitals, qualified professionals, updated technologies, sustainable industry, appropriate financing, quality assessment systems, and knowledge generation. The path to excellence involves specialization across all involved parties. As we reflect on the importance of Pediatric Cardiovascular Surgery and Congenital Heart Diseases establishing themselves as a subspecialty of Cardiovascular Surgery, it is essential to look beyond our borders to countries like the United States of America and United Kingdom, where this evolution is already a reality. This autonomy has led to significant advancements in research, education, and patient care outcomes, establishing a care model. By following this path in Brazil, we not only align our practice with the highest international standards but also demonstrate our maturity and the ability to meet the specific needs of patients with CHD and those with acquired childhood heart disease.
Collapse
Affiliation(s)
- Valdester Cavalcante Pinto
- Department of Pediatric Cardiovascular Surgery, Instituto de Coração de Fortaleza, Fortaleza, Ceará, Brazil
- Department of Pediatric Cardiovascular Surgery, Hospital de Messejana, Fortaleza, Fortaleza, Ceará, Brazil
| | - Leonardo Augusto Miana
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio Binhara Navarro
- Department of Pediatric Cardiovascular Surgery, Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
- Department of Cardiovascular Surgery, Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, Paraná, Brazil
| | - Bruno da Costa Rocha
- Department of Pediatric Cardiovascular Surgery, Hospital da Criança Martagão Gesteira, Salvador, Bahia, Brazil
| | - Renato Samy Assad
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Fábio Said Salum
- Departamento de Cirurgia Cardiovascular Pediátrica, Sociedade Brasileira de Cirurgia Cardiovascular, Brazil
| | - Ulisses Alexandre Croti
- CardioPedBrasil® - Centro do Coração da Criança, Hospital da Criança e Maternidade de São José do Rio Preto - Fundação Faculdade Regional de Medicina/Faculdade de Medicina de São José do Rio Preto (FUNFARME/FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Beatriz Helena Sanches Furlanetto
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
- Hospital Infantil Sabará, São Paulo, São Paulo, São Paulo, Brazil
| | - Marcelo Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Luiz Fernando Caneo
- Pediatric Cardiac Surgery Unit, Cardiovascular Division, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Andrey José de Oliveira Monteiro
- Department of Cardiovascular Surgery, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Pró-Criança, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Fernando Antoniali
- Hospital Celso Pierro, Pontifícia Universidade Católica (PUC) de Campinas, Campinas, São Paulo, Brazil
| | - Pedro Rafael Salerno
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico Universitário de Pernambuco Prof. Luiz Tavares (PROCAPE), Recife, Pernambuco, Brazil
| | | |
Collapse
|
2
|
Yilmaz M, Turkcan BS, Ecevit AN, Şahan YÖ, Atalay A. Comparative Analysis of Modified BT Shunt and Central Shunt in Pediatric Patients. Braz J Cardiovasc Surg 2024; 39:e20230376. [PMID: 38748885 PMCID: PMC11099994 DOI: 10.21470/1678-9741-2023-0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Cyanotic congenital heart diseases constitute 40-45% of all congenital heart diseases. In patients who are not suitable for primary repair, modified BT (MBT) shunt and central shunt (CS) procedures are still frequently used. METHODS This study included 62 pediatric patients who underwent MBT shunt or CS via median sternotomy. Patients' demographic, echocardiographic, operative, and postoperative data were collected retrospectively. The patients were classified as single ventricle and bi-ventricle according to their cardiac anatomy, and the presence of prematurity and heterotaxy was noted. Procedure details of the patients who underwent endovascular intervention prior to the surgery were investigated, and operation data were accessed from the surgery notes. Data regarding postoperative follow-ups were obtained and comparatively analyzed. RESULTS Of the total 62 patients, 32 (51.6%) were newborns and 16 (25.8%) had a body weight < 3 kg. MBT shunt was applied to 48 patients (77.4%), while CS was applied to 14 patients (22.6%). There was no significant difference between the two surgical procedures in terms of requirement for urgent shunt or cardiopulmonary bypass, additional simultaneous surgical intervention, need for high postoperative inotropes, and in-hospital mortality (P>0.05). The rate of congestive heart failure in patients with in-hospital mortality was determined as 66.7% and it was significantly higher than in patients without heart failure (P<0.001). CONCLUSION MBT shunt and CS are still frequently used in cyanotic patients. The use of small-diameter shunts, particularly when centrally located, can prevent the onset of congestive heart failure and lower mortality.
Collapse
Affiliation(s)
- Mustafa Yilmaz
- Department of Pediatric Cardiovascular Surgery, Ankara Bilkent City
Hospital, Ankara, Turkey
| | - Başak Soran Turkcan
- Department of Pediatric Cardiovascular Surgery, Ankara Bilkent City
Hospital, Ankara, Turkey
| | - Ata Niyazi Ecevit
- Department of Pediatric Cardiovascular Surgery, Ankara Bilkent City
Hospital, Ankara, Turkey
| | | | - Atakan Atalay
- Department of Pediatric Cardiovascular Surgery, Ankara Bilkent City
Hospital, Ankara, Turkey
| |
Collapse
|
3
|
Aksoy T, Arslan AH, Ugur M, Ustunsoy H. Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation. Braz J Cardiovasc Surg 2024; 39:e20230091. [PMID: 38426430 PMCID: PMC10903277 DOI: 10.21470/1678-9741-2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). METHODS Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. RESULTS There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). CONCLUSION Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.
Collapse
Affiliation(s)
- Tamer Aksoy
- Department of Anesthesiology and Reanimation, Anadolu Medical
Center, Kocaeli, Turkey
| | - Ahmet Hulisi Arslan
- Department of Cardiovascular Surgery, Anadolu Medical Center,
Kocaeli, Turkey
| | - Murat Ugur
- Department of Cardiovascular Surgery, University of Health
Sciences, Sancaktepe Sehit Professor Doctor Ilhan Varank Training and Research
Hospital, Istanbul, Turkey
| | - Hasim Ustunsoy
- Department of Cardiovascular Surgery, Anadolu Medical Center,
Kocaeli, Turkey
| |
Collapse
|
4
|
Adesanya AM, Best KE, Coats L, Rankin J. Predictors of Post-Operative Hospital Length of Stay Following Complete Repair of Tetralogy of Fallot in a Pediatric Cohort in the North of England. Pediatr Cardiol 2024; 45:92-99. [PMID: 37698700 PMCID: PMC10776676 DOI: 10.1007/s00246-023-03287-7] [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: 07/12/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
We sought to estimate the median post-operative length of stay (PLOS) and predictors of PLOS following tetralogy of Fallot (ToF) repair at a specialist surgical center in the North of England. The local National Congenital Heart Disease Audit dataset was used to identify patients aged < 2 years who underwent surgical repair for ToF between 1 January 1986 and 13 May 2022. Coefficients representing the median change in PLOS (days) according to predictors were estimated using Quantile regression. There were 224 patients (59.4% male, median age = 9 months, interquartile range (IQR) 5-13 months) with a median PLOS of 9 days (IQR 7-13). In the univariable regression, age (months) and weight (kg) at operation (β = - 0.17, 95% CI: - 0.33, - 0.01) and (β = - 0.53, 95% CI: - 0.97, - 0.10), previous (cardiac or thoracic) procedure (β = 5, 95% CI:2.38, 7.62), procedure urgency (elective vs urgent) (β = 2.8, 95% CI:0.39, 5.21), bypass time (mins) (β = 0.03, 95% CI:0.01, 0.05), cross-clamp time (mins) (β = 0.03, 95% CI:0.01, 0.06) and duration of post-operative intubation (days) (β = 0.81, 95% CI:0.67, 0.96), were significantly associated with PLOS. Previous procedure and intubation time remained significant in multivariable analyses. Some patient and operative factors can predict PLOS following complete ToF repair. Information on PLOS is important for health professionals to support parents in preparing for their child's discharge and to make any necessary practical arrangements. Health commissioners can draw on evidence-based guidance for resource planning. The small sample size may have reduced the power to detect small effect sizes, but this regional study serves as a foundation for a larger national study.
Collapse
Affiliation(s)
- Adenike M Adesanya
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Kate E Best
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise Coats
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK
- Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Rd, Newcastle Upon Tyne, NE2 4AX, UK
- NIHR Applied Research Collaboration North East and North Cumbria, Newcastle Upon Tyne, UK
| |
Collapse
|
5
|
Diogenes MSB, Valente AS, Rocha HAL. Adult Congenital Heart Disease: Report from a Public Reference Hospital in Northeastern Brazil. Braz J Cardiovasc Surg 2023; 38:e20230039. [PMID: 37801566 PMCID: PMC10550255 DOI: 10.21470/1678-9741-2023-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/10/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION The increasing worldwide number of adults with congenital heart disease (CHD) demands greater attention from health professionals. The purpose of this report is to describe the clinical demographic profile, frequency, and invasive treatment status of adults with CHD in a public reference hospital in northeastern Brazil. METHODS This is a retrospective cross-sectional study including 704 patients attended between August 2016 and August 2020. Data were collected from virtual database. RESULTS Patients' age varied from 17 to 81 years (mean 32±14; median 27 years); 294 (41.8%) patients were male, and 410 (58,2%) were female; 230 (32,7%) had diagnosis from age 18 and up. Cardiac complexity categories were "simple defects" (134 [19%] patients), "moderate complexity" (503 [71.5%]), and "great complexity" (67 [9.5%]). Atrial septal defect (ASD) was diagnosed in 216 (30.7%) patients, ventricular septal defect (VSD) in 101 (14.3%), tetralogy of Fallot in 93 (13.2%), and other CHD in 294 (41.8%). New York Heart Association (NYHA) functional classes were I (401 [57%]), II (203 [28.8%]), III (76 [10.8%]), and IV (24 [3.4%]). Complications were arrhythmias (173 [24%]) and severe pulmonary hypertension (69 [9.8%]). Invasive treatments were corrective surgery (364 (51.6%]), reoperation (28 [4.0%]), palliation (11 [1.6%]), interventional catheterization (12 [1.7%]), surgery plus interventional catheterization (5 [0.7%]), and preoperation (91 [12.9%]). Treatment was not required in 102 (14,5%) patients, and 91 (12.9%) were inoperable. CONCLUSION The leading diagnosis was ASD. Frequency of unrepaired patients was high, mainly ASD, due to late diagnosis, which favored complications and denotes a matter of great concern.
Collapse
Affiliation(s)
| | | | - Hermano Alexandre Lima Rocha
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza,
Ceará, Brazil
- Department of Public Health, Faculdade de Medicina, Universidade
Federal do Ceará, Fortaleza, Ceará, Brazil
| |
Collapse
|
6
|
Murakami AN, Croti UA, Borim BC, Marchi CHD, Murakami RMR, de Almeida MTG, Policarpo RDS, Avona FN, de Godoy MF. Use of Ozonized Water in the Prevention of Surgical Site Infection in Children Undergoing Cardiovascular Surgery. Braz J Cardiovasc Surg 2023; 38:e20230006. [PMID: 37797245 PMCID: PMC10549766 DOI: 10.21470/1678-9741-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/16/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Since the reduction of healthcare-associated infections has been a focus for quality patient care, this study aimed to evaluate the surgical site infection rate of children who underwent cardiovascular surgery after implementation of ozonized water system for hand and body hygiene allied to previously implemented preventive measures. METHODS Two uniformly comparable groups of pediatric patients underwent cardiovascular surgery. Group A (187) patients were operated prior to installation of ozonized water system (March 1 to August 31, 2019), and group B (214) patients were operated after installation of ozonized water system (October 1, 2019, to March 31, 2020). Ozonized water was used for professional hand hygiene and patient body hygiene. RESULTS There was statistical significance for surgical site infection reduction in group B (P=0.0289), with a relative risk of 0.560 (95% confidence interval = 0.298 to 0.920), inferring the risk of being diagnosed with surgical site infections in group B was 44% less than in group A. There was no statistical significance regarding mechanical ventilation time (P=0.1998) or mortality (P=0.4457). CONCLUSION Ozonized water for professional hand hygiene and patient body hygiene was an adjuvant combined with traditional preventive methods to reduce the risk of surgical site infection, although no impact on hospital stay or mortality was observed.
Collapse
Affiliation(s)
- Alexandre Noboru Murakami
- Department of Cardiovascular Surgery, Serviço de Cirurgia
Cardíaca do Norte do Paraná, Universidade Estadual de Londrina (UEL),
Londrina, Paraná, Brazil
| | - Ulisses Alexandre Croti
- Department of Pediatric Cardiology and Cardiovascular Surgery,
CardioPedBrasil® – Hospital da Criança e Maternidade de São
José do Rio Preto, São José do Rio Preto, São Paulo,
Brazil
| | - Bruna Cury Borim
- Department of Pediatric Cardiology and Cardiovascular Surgery,
CardioPedBrasil® – Hospital da Criança e Maternidade de São
José do Rio Preto, São José do Rio Preto, São Paulo,
Brazil
| | - Carlos Henrique De Marchi
- Department of Pediatric Cardiology and Cardiovascular Surgery,
CardioPedBrasil® – Hospital da Criança e Maternidade de São
José do Rio Preto, São José do Rio Preto, São Paulo,
Brazil
| | | | | | - Rafael da Silva Policarpo
- Department of Pediatric Cardiology and Cardiovascular Surgery,
CardioPedBrasil® – Hospital da Criança e Maternidade de São
José do Rio Preto, São José do Rio Preto, São Paulo,
Brazil
| | - Fabiana Nakamura Avona
- Department of Pediatric Cardiology and Cardiovascular Surgery,
CardioPedBrasil® – Hospital da Criança e Maternidade de São
José do Rio Preto, São José do Rio Preto, São Paulo,
Brazil
| | - Moacir Fernandes de Godoy
- Department of Infectious Diseases, Faculdade de Medicina de
São José do Rio Preto, São José do Rio Preto, São
Paulo, Brazil
| |
Collapse
|
7
|
Wu Y, Meng C, Liu J, Wei Y, Li Z. A Hospital-Based Study on Congenital Heart Defects - Haidian District, Beijing Municipality, China, 2013-2022. China CDC Wkly 2023; 5:808-813. [PMID: 37771623 PMCID: PMC10527402 DOI: 10.46234/ccdcw2023.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
What is already known about this topic? Congenital heart defects (CHDs) represent the most prevalent birth defects in China, exhibiting significant mortality and morbidity rates. Recent years have witnessed a steady increase in the occurrence of CHDs, highlighting a crucial need for rigorous research focus. What is added by this report? The cumulative birth prevalence of CHDs in Haidian District from 2013 to 2022 was 80.77 per 10,000 births, reflective of an upward trend primarily influenced by the diagnosis of minor, non-critical congenital defects (non-CCHDs). This increase can be attributed to advancements in diagnostic methodologies. Despite the progress in detection, the survival rate for CHDs did not correspondingly improve. What are the implications for public health practice? Policies need to be formulated to promote the graded management of CHDs. There should be timely updates to the diagnostic criteria to align with advancements in diagnostic techniques. Moreover, in instances where therapeutic abortion is not required, the provision of appropriate medical consultation post-diagnosis should be enhanced.
Collapse
Affiliation(s)
- Yaxian Wu
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Chao Meng
- Department of Maternal Health Care, Beijing Haidian Maternal and Child Health Hospital, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yuan Wei
- Department of Gynaecology and Obstetrics, Peking University Third Hospital, Beijing, China
| | - Zhiwen Li
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
8
|
Brun MM, Cardoso MR, Borim BC, Marchi CHD, Croti UA. Abernethy Malformation: Possible Diagnosis for Patients with Congenital Heart Disease and Persistent Cyanosis. Braz J Cardiovasc Surg 2023; 38:300-304. [PMID: 36259992 PMCID: PMC10069258 DOI: 10.21470/1678-9741-2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CLINICAL DATA Infant, nine months of age, female, diagnosed with congenital heart disease, with signs of heart failure associated with cyanosis and difficulty in gaining weight. CHEST RADIOGRAPHY Cardiomegaly with prevalence of pulmonary vascular network. ELECTROCARDIOGRAM Ectopic atrial rhythm with right ventricular overload and left anterosuperior divisional block. ECHOCARDIOGRAM Single atrium with absent interatrial septum, atrioventricular connection with a single valve and two orifices, with increased pulmonary pressure and high Qp/Qs. COMPUTED TOMOGRAPHY Absence of portal vein and intrahepatic segment of the inferior vena cava. Infrahepatic portion continuing with the azygos system at the level of the thoracic cavity, presence of mesenteric-caval communication associated with signs suggestive of hepatic peribiliary fibrosis. DIAGNOSIS Abernethy malformation is a rare condition and represents an extrahepatic portosystemic shunt that develops between the mesenteric-portal vasculature and the systemic veins. It may be associated with cardiac malformations and advance with pulmonary hypertension and even the need for liver transplantation. Persistent cyanosis after corrective surgery led to a deeper investigation and correct diagnosis of this malformation. OPERATION Sternotomy with 68 minutes of cardiopulmonary bypass and nine minutes of total circulatory arrest. In the postoperative period, persistence of cyanosis was evident, even though there were no immediate complications. Patient was discharged on the 10th postoperative day. An abdominal computed tomography angiography confirmed the diagnosis of Abernethy type I malformation, and the patient was transferred for liver transplantation after congenital heart disease treatment.
Collapse
Affiliation(s)
- Marilia Maroneze Brun
- Pediatric Cardiology and Cardiovascular Surgery, CardioPedBrasil - Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Mariana Rodero Cardoso
- Pediatric Cardiology and Cardiovascular Surgery, CardioPedBrasil - Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Bruna Cury Borim
- Pediatric Cardiology and Cardiovascular Surgery, CardioPedBrasil - Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Carlos Henrique De Marchi
- Pediatric Cardiology and Cardiovascular Surgery, CardioPedBrasil - Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Ulisses Alexandre Croti
- Pediatric Cardiology and Cardiovascular Surgery, CardioPedBrasil - Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| |
Collapse
|
9
|
Mojaddedi S, Jamil D, Mojadidi MK, Patel NK. Patent foramen Ovale-related paradoxical embolism after noncardiac surgery. J Cardiol Cases 2023; 27:113-5. [PMID: 36910042 DOI: 10.1016/j.jccase.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
Patent foramen ovale (PFO) is a remnant of the fetal circulation that remains in a significant portion of the adult population, predisposing to a higher risk of stroke. This risk is further elevated in the postoperative hypercoagulative period. Here we present a case where a patient underwent a total knee arthroplasty and presented with right-sided hemiparesis on post-operative day 2. Subsequently, the patient underwent percutaneous PFO closure with a 25-mm Amplatzer PFO Occluder (Abbott; Chicago, IL, USA). The patient has not had a stroke since the PFO closure. Recent randomized trials have demonstrated superiority of percutaneous PFO closure over standard-of-care medical therapy for secondary prevention of PFO-associated stroke. Since post-operative PFO-associated stroke is under-recognized in clinical practice, further large-cohort studies are needed to evaluate whether PFO screening and device closure would decrease post-operative stroke risk for noncardiac surgeries. Learning Objective Patent foramen ovale (PFO) is a remnant of the fetal circulation commonly found in the adult population, which can increase the risk of stroke. Stroke is a complication of PFO, yet closure of this remnant only occurs on a specific case-by-case basis. Further research in this area is required to determine whether a larger population would benefit from PFO closure.
Collapse
|
10
|
Yilmaz M, Atalay A. Direct Anastomosis of Persistent Left Superior Vena Cava to Right Superior Vena Cava in a Pediatric Patient with Tetralogy of Fallot: an Alternative Technique. Braz J Cardiovasc Surg 2023; 38:166-169. [PMID: 35436069 PMCID: PMC10010726 DOI: 10.21470/1678-9741-2021-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The presence of persistent left superior vena cava to the left atrium connection without an innominate vein may give rise to technical challenges during intracardiac repair. In this report, the end-to-side anastomosis technique of the persistent left superior vena cava to the right superior vena cava is discussed in a patient with tetralogy of Fallot associated with persistent left superior vena cava draining directly into the left atrium. A successful end-to-side anastomosis between the persistent left superior vena cava and the right superior vena cava was performed and short-term anastomosis patency was documented via angiography.
Collapse
Affiliation(s)
- Mustafa Yilmaz
- Department of Congenital Heart Surgery, Ankara State Hospital, Ankara, Turkey
| | - Atakan Atalay
- Department of Congenital Heart Surgery, Ankara State Hospital, Ankara, Turkey
| |
Collapse
|
11
|
Paolucci M, Vincenzi C, Romoli M, Amico G, Ceccherini I, Lattanzi S, Bersano A, Longoni M, Sacco S, Vernieri F, Pascarella R, Valzania F, Zedde M. The Genetic Landscape of Patent Foramen Ovale: A Systematic Review. Genes (Basel) 2021; 12:genes12121953. [PMID: 34946902 PMCID: PMC8700998 DOI: 10.3390/genes12121953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/06/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
Patent Foramen Ovale (PFO) is a common postnatal defect of cardiac atrial septation. A certain degree of familial aggregation has been reported. Animal studies suggest the involvement of the Notch pathway and other cardiac transcription factors (GATA4, TBX20, NKX2-5) in Foramen Ovale closure. This review evaluates the contribution of genetic alterations in PFO development. We systematically reviewed studies that assessed rare and common variants in subjects with PFO. The protocol was registered with PROSPERO and followed MOOSE guidelines. We systematically searched English studies reporting rates of variants in PFO subjects until the 30th of June 2021. Among 1231 studies, we included four studies: two of them assessed the NKX2-5 gene, the remaining reported variants of chromosome 4q25 and the GATA4 S377G variant, respectively. We did not find any variant associated with PFO, except for the rs2200733 variant of chromosome 4q25 in atrial fibrillation patients. Despite the scarceness of evidence so far, animal studies and other studies that did not fulfil the criteria to be included in the review indicate a robust genetic background in PFO. More research is needed on the genetic determinants of PFO.
Collapse
Affiliation(s)
- Matteo Paolucci
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
- Neurology Unit, “M. Bufalini” Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy; (M.R.); (M.L.)
- Correspondence:
| | - Chiara Vincenzi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; (C.V.); (F.V.); (M.Z.)
| | - Michele Romoli
- Neurology Unit, “M. Bufalini” Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy; (M.R.); (M.L.)
| | - Giulia Amico
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy; (G.A.); (I.C.)
- DINOGMI-Universite degli Studi di Genova, Largo P. Daneo,3, 16132 Genova, Italy
| | - Isabella Ceccherini
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy; (G.A.); (I.C.)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Marco Longoni
- Neurology Unit, “M. Bufalini” Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy; (M.R.); (M.L.)
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; (C.V.); (F.V.); (M.Z.)
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; (C.V.); (F.V.); (M.Z.)
| |
Collapse
|
12
|
Abstract
Introduction We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.
Collapse
Affiliation(s)
- Kahraman Yakut
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Zafer Ecevit
- Department of Pediatric Infectious Diseases, Baskent University School of Medicine, Ankara, Turkey
| | - Niyazi Kursad Tokel
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Birgul Varan
- Department of Pediatric Cardiology, Baskent University School of Medicine, Ankara, Turkey
| | - Murat Ozkan
- Department of Cardiovascular Surgery, Baskent University School of Medicine, Ankara, Turkey
| |
Collapse
|
13
|
Jawaid S, Strainic JP, Kim J, Ford MR, Thrane L, Karunamuni GH, Sheehan MM, Chowdhury A, Gillespie CA, Rollins AM, Jenkins MW, Watanabe M, Ford SM. Glutathione Protects the Developing Heart from Defects and Global DNA Hypomethylation Induced by Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2021; 45:69-78. [PMID: 33206417 DOI: 10.1111/acer.14511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is caused by prenatal alcohol exposure (PAE), the intake of ethanol (C2 H5 OH) during pregnancy. Features of FASD cover a range of structural and functional defects including congenital heart defects (CHDs). Folic acid and choline, contributors of methyl groups to one-carbon metabolism (OCM), prevent CHDs in humans. Using our avian model of FASD, we have previously reported that betaine, another methyl donor downstream of choline, prevents CHDs. The CHD preventions are substantial but incomplete. Ethanol causes oxidative stress as well as depleting methyl groups for OCM to support DNA methylation and other epigenetic alterations. To identify more compounds that can safely and effectively prevent CHDs and other effects of PAE, we tested glutathione (GSH), a compound that regulates OCM and is known as a "master antioxidant." METHODS/RESULTS Quail embryos injected with a single dose of ethanol at gastrulation exhibited congenital defects including CHDs similar to those identified in FASD individuals. GSH injected simultaneously with ethanol not only prevented CHDs, but also improved survival and prevented other PAE-induced defects. Assays of hearts at 8 days (HH stage 34) of quail development, when the heart normally has developed 4-chambers, showed that this single dose of PAE reduced global DNA methylation. GSH supplementation concurrent with PAE normalized global DNA methylation levels. The same assays performed on quail hearts at 3 days (HH stage 19-20) of development, showed no difference in global DNA methylation between controls, ethanol-treated, GSH alone, and GSH plus ethanol-treated cohorts. CONCLUSIONS GSH supplementation shows promise to inhibit effects of PAE by improving survival, reducing the incidence of morphological defects including CHDs, and preventing global hypomethylation of DNA in heart tissues.
Collapse
Affiliation(s)
- Safdar Jawaid
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Department of Biomedical Engineering, (SJ, MMS, AMR, MWJ), School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - James P Strainic
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jun Kim
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Lars Thrane
- Department of Biomedical Engineering, (SJ, MMS, AMR, MWJ), School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ganga H Karunamuni
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Megan M Sheehan
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Department of Biomedical Engineering, (SJ, MMS, AMR, MWJ), School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Amrin Chowdhury
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Brecksville-Broadview Heights High School, (AC), Broadview Heights, Ohio, USA
| | - Caitlyn A Gillespie
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Fisk University, (CAG), Nashville, Tennessee, USA
| | - Andrew M Rollins
- Department of Biomedical Engineering, (SJ, MMS, AMR, MWJ), School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael W Jenkins
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Department of Biomedical Engineering, (SJ, MMS, AMR, MWJ), School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michiko Watanabe
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Stephanie M Ford
- From the, Division of Pediatric Cardiology, (SJ, JPS, GHK, MMS, AC, CAG, MWJ, MW, SMF), Department of Pediatrics, The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
14
|
Van Bulck L, Goossens E, Luyckx K, Apers S, Oechslin E, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Moons P. Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries. BMC Health Serv Res 2020; 20:496. [PMID: 32493367 PMCID: PMC7268498 DOI: 10.1186/s12913-020-05361-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease. METHODS This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. RESULTS Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed. CONCLUSIONS This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn. TRIAL REGISTRATION ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
Collapse
Affiliation(s)
- Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven - University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Silke Apers
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Chun-Wei Lu
- National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Msida, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Susan M Fernandes
- Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, CA, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium. .,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | | |
Collapse
|
15
|
Abstract
Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are
incidentally diagnosed in aortic surgeries or autopsies and it usually appears
as an isolated anomaly. The most widely classification used is the one by
Hurwitz and Roberts[1], which
divides 7 alphabetical subtypes based on the cusps size. The aim of this report
is to describe three different anatomic presentations of this rare aortic valve
anomaly.
Collapse
Affiliation(s)
- Elinthon Tavares Veronese
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Carlos Manuel de Almeida Brandão
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Samuel Padovani Steffen
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Pablo Pomerantzeff
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| |
Collapse
|
16
|
Itiola AY, Animasahun BA, Njokanma OF. Serum Iron Status of Children with Cyanotic Congenital Heart Disease in Lagos, Nigeria. Sultan Qaboos Univ Med J 2019; 19:e345-e351. [PMID: 31897318 PMCID: PMC6930027 DOI: 10.18295/squmj.2019.19.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/30/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cyanotic congenital heart disease (CCHD) predisposes patients to iron deficiency due to compensatory secondary erythrocytosis. This study aimed to determine the serum iron status and prevalence of iron deficiency among children with cyanotic congenital heart disease attending the Paediatric Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. METHODS This cross-sectional case-control study took place between May and October 2015 at the Lagos State University Teaching Hospital. A total of 75 children with cyanotic congenital heart disease and 75 apparently healthy age-, gender- and socioeconomically-matched controls were analysed to determine serum iron status and the prevalence of iron deficiency as defined by the World Health Organization criteria. RESULTS The mean age of the children was 47.5 ± 2.9 months (range: 6-144 months old). Iron deficiency was significantly more frequent among CCHD patients compared to control subjects (9.3% versus 0%; P = 0.006). While latent iron deficiency was more prevalent among children in the control group compared to those with CCHD, this difference was not statistically significant (13.3% versus 9.3%; P = 0.303). No cases of iron deficiency anaemia were observed in the studied sample. CONCLUSION Neither the children in the control group nor those with CCHD had iron deficiency anaemia. However, iron deficiency was significantly more prevalent among children with CCHD in Lagos. Periodic serum iron status screening is therefore recommended for this population.
Collapse
Affiliation(s)
| | - Barakat A Animasahun
- Department of Paediatrics & Child Health, College of Medicine, Lagos State University, Lagos, Nigeria
| | | |
Collapse
|
17
|
Lister R, Chamberlain A, Einstein F, Wu B, Zheng D, Zhou B. Intrauterine Programming of Diabetes Induced Cardiac Embryopathy. Diabetes Obes Int J 2019; 4:202. [PMID: 32537569 PMCID: PMC7293196] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Maternal hyperglycemia is a well-recognized risk factor for fetal congenital heart disease. However, the underlying cellular and molecular mechanisms are not well characterized. We hypothesize that maternal hyperglycemia leading to congenital heart are linked to abnormal DNA methylation and mRNA expression at cardiac specific loci. METHODS Hyperglycemia was induced in normal 8-week old CD-1 female mice with a one-time intraperitoneal injection of 150 mg/kg of streptozotocin (STZ) 2 weeks prior to mating. Histological analysis of fetal cardiac morphology was evaluated for malformations on embryonic day (E) 16.5 of control pups and pups exposed to maternal hyperglycemia. We used a massively-parallel sequencing-based methylation sensitive restriction based assay to examine genome-wide cytosine methylation levels at >1.65 million loci in neonatal hearts on post-natal (P) day 0. Functional validation was performed with real time quantitative polymerase chain reaction (RT-qPCR). RESULTS Cardiac structural defects occurred in 28% of the pups (n=12/45) of hyperglycemic dams versus 7% (n=4/61) of controls. Notable phenotypes were hypoplastic left or right ventricle, double outlet right ventricle, ventricular septal defect, and left ventricular outflow tract obstruction. A 10-fold increase in DNA methylation of gene promoter regions was seen in many cardiac important genes in the experimental versus control P0 neonates and have corresponding decreases in gene expression in 21/32 genes functionally validated. CONCLUSION Maternal hyperglycemia alters DNA methylation and mRNA expression of some cardiac genes during heart development. Quantitative, genome-wide assessment of cytosine methylation can be used as a discovery platform to gain insight into the mechanisms of hyperglycemia-induced cardiac anomalies.
Collapse
Affiliation(s)
| | | | | | - Bingruo Wu
- MD Albert Einstein College of Medicine, USA
| | - DeYou Zheng
- Phd Albert Einstein College of Medicine, USA
| | - Bin Zhou
- MD Vanderbilt University Medical Center, USA
| |
Collapse
|
18
|
Samiei N, Dehghan H, Pourmojib M, Mohebbi A, Hosseini S, Rezaei Y. Isolated double-orifice mitral valve in a young girl. ARYA Atheroscler 2017; 13:295-298. [PMID: 29643925 PMCID: PMC5889921] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Double-orifice mitral valve (DOMV) is an extremely rare cardiac malformation. It has been found to be accompanied by congenital anomalies (CAs), however, it can be detected as an isolated anomaly. The clinical findings of a DOMV are variable and depend predominantly on the associated cardiac abnormalities, particularly atrioventricular septal defects or mitral valve (MV) regurgitation and/or stenosis. CASE REPORT In this regard, we describe an isolated DOMV in an 18-year-old young girl who complained of a short-term nonspecific chest pain. She underwent transthoracic and transesophageal echocardiographic examinations. The examinations revealed a DOMV without any valvular or structural malformations. Other examinations were unremarkable. The patient did need neither medical nor surgical interventions. CONCLUSION The isolated cases of DOMV do not need therapy and might be only followed up using echocardiographic examinations. However, a careful echocardiographic examination for detection of concomitant structural malformations would be of great importance in the management of such cases.
Collapse
Affiliation(s)
- Niloufar Samiei
- Associate Professor, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Dehghan
- Cardiologist, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Pourmojib
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mohebbi
- Professor, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Professor, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran,Correspondence to: Yousef Rezaei,
| |
Collapse
|
19
|
Tapia-Orihuela RKA, Huaringa-Marcelo J, Loja-Oropeza D. Tetralogy of Fallot and pheochromocytoma in a situs inversus totalis: An unusual association. J Cardiovasc Thorac Res 2016; 8:132-136. [PMID: 27777699 PMCID: PMC5075362 DOI: 10.15171/jcvtr.2016.27] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/28/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Situs inversus totalis is an uncommon anomaly which exist a complete transposition of organs and it’s occasionally associated with congenital heart diseases, such as tetralogy of fallot. Pheochromocytoma is a rare neuroendocrine tumor with an annual incidence of 2-8 cases per million people and for years has been studied its relationship with the hypoxic pathway.
Case Report: A 29 year old male with a history of tetralogy of fallot corrected at 10 years and situs inversus totalis. He was admitted to hospital with a progressive story of four months of constipation, palpitations, headache, dyspnea and sweating. Physical examination revealed a thinned man with peripheral cyanosis, clubbing and signs of decompensated congestive heart failure as hepatomegaly, legs edema, multifocal systodiastolic murmurs, abdominal distension and jugular venous distention. The echocardiogram shows severe right ventricular dysfunction and severe pulmonary hypertension. Furthermore, abdominal computed tomography shows right adrenal mass. Elevated metanephrines and catecholamines confirmed the diagnosis of pheochromocytoma. Surgical removal is decided and preoperative management begins with alpha-adrenergic blockade, however the patient had a hemodynamic decompensation with an unfavorable evolution.
Discussion: In conclusion, there are few reports of cyanotic congenital heart disease with pheochromocytoma. Several studies show a significant association between both of them due to chronic hypoxia leads sustained hyperresponsiveness in adrenal medulla and it would cause the tumor. Special preoperative management of pheochromocytoma is recommended when there underlying heart disease and congestive heart failure. We present the first international report of tetralogy of fallot and pheochromocytoma in a patient with situs inversus totalis.
Collapse
Affiliation(s)
- Rubén Kevin Arnold Tapia-Orihuela
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina de San Fernando, Lima, Perú ; Sociedad Científica de San Fernando, Lima, Perú
| | - Jorge Huaringa-Marcelo
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina de San Fernando, Lima, Perú ; Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - David Loja-Oropeza
- Hospital Nacional Arzobispo Loayza, Lima, Perú ; Universidad Nacional Federico Villarreal, Facultad de Medicina, Lima, Perú
| |
Collapse
|
20
|
Lizama Calvo M, Cerda Lorca J, Monge Iriarte M, Carrillo Mayanquer I, Clavería Rodríguez C, Castillo Moya A. [Hospital morbidity and mortality in children with Down's syndrome: Experience in a university hospital in Chile]. ACTA ACUST UNITED AC 2015; 87:102-9. [PMID: 26627695 DOI: 10.1016/j.rchipe.2015.06.026] [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: 10/07/2014] [Accepted: 06/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Children with Down's syndrome (DS) have a higher risk of congenital malformations and acute diseases, with increased risk of hospital admissions compared with the general population. This study describes patterns of hospital admissions for children and adolescents with DS. PATIENTS AND METHODS A retrospective study of hospital admissions of children with DS, younger than 15 years old, and cared for by the Paediatric Department of the Hospital Clínico Pontificia Universidad Católica de Chile, between 2008 and 2011. RESULTS There were 222 admissions of 161 patients with DS during the study period, of which 110 were girls. The median age was 8 months, and the median hospital stay was 6 days. Just over half (56.7%) of the hospital stays were in the Paediatric Critic Care Unit. Heart surgery was performed on 59.4%, and the principal congenital heart defect attended was atrioventricular canal. The principal diagnosis, other than heart surgery, was lower respiratory tract infection. In this series, 3 children died. CONCLUSIONS Children with DS are a relevant group for inpatient care, because their high incidence in Chile, their respiratory and cardiovascular risk, prolonged hospitalizations, high frequency of critical care days and mortality risk. This group has special and complex needs during their hospitalizations and it is necessary to create a multidisciplinary team with competences to take care the particular characteristics of this vulnerable group.
Collapse
Affiliation(s)
- Macarena Lizama Calvo
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro UC Síndrome de Down, Santiago, Chile.
| | - Jaime Cerda Lorca
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Monge Iriarte
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Servicio de Pediatría, Hospital Clínico Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Irene Carrillo Mayanquer
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Clavería Rodríguez
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Cardiología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Castillo Moya
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Paciente Crítico Pediátrico, Hospital Clínico Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
21
|
Sun J, Chen X, Chen H, Ma Z, Zhou J. Maternal Alcohol Consumption before and during Pregnancy and the Risks of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis. CONGENIT HEART DIS 2015; 10:E216-24. [PMID: 26032942 DOI: 10.1111/chd.12271] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Epidemiologic studies have reported conflicting results regarding maternal alcohol consumption before and during pregnancy, and the risk of congenital heart defects (CHDs). However, a systematic review and meta-analysis of the association between maternal alcohol consumption and CHDs in offspring has not been conducted. DESIGN We searched MEDLINE and EMBASE for articles catalogued between their inception and February 16, 2015; we identified relevant published studies that assessed the association between maternal alcohol consumption and CHD risk. Two authors independently assessed the eligibility of the retrieved articles and extracted data from them. Study-specific relative risk estimates were pooled by random-effects or fixed-effects models. RESULTS From the 1527 references, a total of 19 case-control studies and four cohort studies were enrolled in this meta-analysis. The summary of 23 studies related to CHDs indicated an overall pooled relative risk of 1.13 (95% confidence interval: 0.96, 1.29) among mothers drinking before or during pregnancy. Statistically significant heterogeneity was detected (Q = 196.61, P < .001, I(2) = 88.8%) with no publication bias (Egger's test: P = .157). We conducted stratified and meta-regression analyses to identify the origin of the heterogeneity among studies. CONCLUSION In summary, this meta-analysis provided no positive association between maternal alcohol consumption and risk of CHDs.
Collapse
Affiliation(s)
- Jian Sun
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Anesthesiology, Huai'an Maternal and Child Health Hospital, Huai'an, Jiangsu, China
| | - Xiaoling Chen
- Department of Nephrology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu, China
| | - Huajun Chen
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhengliang Ma
- Department of Anesthesiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jianwei Zhou
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
22
|
Tafreshi M, Aminolsharieh Najafi S, Hasheminejad R, Mirfazeli A, Shafiee A. Tessier number 30 clefts with congenital heart defects. Iran Red Crescent Med J 2015; 17:e19078. [PMID: 26019899 PMCID: PMC4441777 DOI: 10.5812/ircmj.19078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 09/08/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022]
Abstract
Introduction: Midline cleft of mandible, classified as Tessier 30 clefts is extremely rare, with less than 100 reported cases in the latest studies. Variations in severity and associated malformations have been reported before. Case Presentation: In this report, we present the first documented Iranian case of Tessier 30 with median cleft of lower lip and bifid tongue concomitant with congenital heart defects. Conclusions: We explain embryologic origin, differential diagnosis, other associated anomalies and its treatment by reviewing literature.
Collapse
Affiliation(s)
- Mona Tafreshi
- Department of Pediatrics and Neonatology, Taleghani Pediatrics Hospital, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Soroosh Aminolsharieh Najafi
- Department of Pediatrics and Neonatology, Taleghani Pediatrics Hospital, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Reyhaneh Hasheminejad
- Department of Pediatrics and Neonatology, Taleghani Pediatrics Hospital, Golestan University of Medical Sciences, Gorgan, IR Iran
- Corresponding Author: Reyhaneh Hasheminejad, Department of Pediatrics and Neonatology, Taleghani Pediatrics Hospital, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: + 98-9153018512, E-mail:
| | - Arezoo Mirfazeli
- Department of Pediatrics and Neonatology, Taleghani Pediatrics Hospital, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Akbar Shafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
23
|
Efe SÇ, Unkun T, Izci S, Cap M, Bakal RB, Acar RD, Geçmen C, Erdoğan E, Ozdemir N. Thrombus Formation on the Tricuspid Valve After De Vega's Annuloplasty and Repair of Endocardial Cushion Defect. J Cardiovasc Thorac Res 2014; 6:203-4. [PMID: 25320670 PMCID: PMC4195973 DOI: 10.15171/jcvtr.2014.012] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/17/2014] [Indexed: 11/09/2022] Open
Abstract
Endocardial cushion defect (ECD) can be partial (with two distinct valves) or complete (only one atrioventricular valve), and surgical therapy is usually required. The optimal surgical technique is controversial but De Vega's annuloplasty is widely performed. Tricuspid valve thrombosis are rarely seen after surgery. We present a 39-year-old male patient with tricuspid valve thrombosis after De Vega's annuloplasty without the use of a ring.
Collapse
Affiliation(s)
- Süleyman Çağan Efe
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Tuba Unkun
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Servet Izci
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Murat Cap
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Ruken Bengi Bakal
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Cetin Geçmen
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Emrah Erdoğan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
24
|
Elder RW, McCabe NM, Veledar E, Kogon BE, Jokhadar M, Rodriguez FH, McConnell ME, Book WM. Risk factors for major adverse events late after Fontan palliation. CONGENIT HEART DIS 2014; 10:159-68. [PMID: 25130602 DOI: 10.1111/chd.12212] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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] [Accepted: 07/04/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Risk factors for major adverse events late after Fontan palliation are unknown. Prior studies have suggested ventricular function and morphology as important risk factors. The aim of this study is to (1) characterize the late major adverse event profile in adult Fontan patients and (2) identify additional risk factors that may contribute to adverse outcomes. DESIGN AND SETTING A retrospective review of all adult patients >15 years post-Fontan seen at a tertiary academic center was conducted. Clinical, laboratory, cardiac data, and abdominal imaging were collected via chart review. Major adverse events (death, cardiac transplantation, or listing) were identified, and timing of events was plotted using Kaplan-Meier methods. Univariate and multivariate logistic regression was used to determine independent predictors of late-term events. RESULTS A total of 123 adult Fontan patients were identified (mean time post-Fontan 22.4 years [±4.4]). Major adverse events occurred in 19/123 patients (15%). In this 15-year survivor cohort, transplant-free survival rates were 94.6%, 82.9%, and 59.8% at 20, 25, and 30 years postoperation, respectively. Modes of death were Fontan failure with preserved function (4), congestive heart failure with decreased function (2), sudden death (2), thromboembolic event (1), post-Fontan conversion (2), and posttransplant (2). No differences in adverse outcomes were found based on morphology of the systemic ventricle, Fontan type, or systolic ventricular function. On the other hand, features of portal hypertension (OR 19.0, CI 4.7-77.3, P < .0001), presence of a pacemaker (OR 13.4, CI 2.6-69.8, P = .002), and systemic oxygen desaturation (OR 0.86, CI 0.75-0.98, P = .02) were risk factors for major adverse events in the multivariate analysis. CONCLUSIONS In adult Fontan patients surviving >15 years post-Fontan, portal hypertension, oxygen desaturation, and need for pacemaker were predictive of adverse events. Traditional measures may not predict late-term outcomes in adult survivors; further study of the liver's role in late outcomes is warranted.
Collapse
Affiliation(s)
- Robert W Elder
- Section of Cardiology, Pediatrics and Internal Medicine, Yale School of Medicine, New Haven, Conn, USA
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Thorsson T, Russell WW, El-Kashlan N, Soemedi R, Levine J, Geisler SB, Ackley T, Tomita-Mitchell A, Rosenfeld JA, Töpf A, Tayeh M, Goodship J, Innis JW, Keavney B, Russell MW. Chromosomal Imbalances in Patients with Congenital Cardiac Defects: A Meta-analysis Reveals Novel Potential Critical Regions Involved in Heart Development. CONGENIT HEART DIS 2014; 10:193-208. [PMID: 24720490 DOI: 10.1111/chd.12179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Congenital cardiac defects represent the most common group of birth defects, affecting an estimated six per 1000 births. Genetic characterization of patients and families with cardiac defects has identified a number of genes required for heart development. Yet, despite the rapid pace of these advances, mutations affecting known genes still account for only a small fraction of congenital heart defects suggesting that many more genes and developmental mechanisms remain to be identified. DESIGN In this study, we reviewed 1694 described cases of patients with cardiac defects who were determined to have a significant chromosomal imbalance (a deletion or duplication). The cases were collected from publicly available databases (DECIPHER, ISCA, and CHDWiki) and from recent publications. An additional 68 nonredundant cases were included from the University of Michigan. Cases with multiple chromosomal or whole chromosome defects (trisomy 13, 18, 21) were excluded, and cases with overlapping deletions and/or insertions were grouped to identify regions potentially involved in heart development. RESULTS Seventy-nine chromosomal regions were identified in which 5 or more patients had overlapping imbalances. Regions of overlap were used to determine minimal critical domains most likely to contain genes or regulatory elements involved in heart development. This approach was used to refine the critical regions responsible for cardiac defects associated with chromosomal imbalances involving 1q24.2, 2q31.1, 15q26.3, and 22q11.2. CONCLUSIONS The pattern of chromosomal imbalances in patients with congenital cardiac defects suggests that many loci may be involved in normal heart development, some with very strong and direct effects and others with less direct effects. Chromosomal duplication/deletion mapping will provide an important roadmap for genome-wide sequencing and genetic mapping strategies to identify novel genes critical for heart development.
Collapse
Affiliation(s)
- Thor Thorsson
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - William W Russell
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Nour El-Kashlan
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Rachel Soemedi
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA
| | - Jonathan Levine
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Sarah B Geisler
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| | - Todd Ackley
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Genetics, University of Michigan, Ann Arbor, Mich, USA
| | | | - Jill A Rosenfeld
- Signature Genomic Laboratories, PerkinElmer, Inc., Spokane, Wash, USA
| | - Ana Töpf
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marwan Tayeh
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Genetics, University of Michigan, Ann Arbor, Mich, USA
| | - Judith Goodship
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jeffrey W Innis
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Genetics, University of Michigan, Ann Arbor, Mich, USA.,Department of Human Genetics, University of Michigan, Ann Arbor, Mich, USA
| | - Bernard Keavney
- Institute of Cardiovascular Sciences, Central Manchester University, Manchester, United Kingdom
| | - Mark W Russell
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA
| |
Collapse
|
26
|
Parisi V, Ratto E, Silvestri C, Pastore F. Ventricular septal defect: the three-dimensional point of view. Transl Med UniSa 2013; 6:41-2. [PMID: 24251244 PMCID: PMC3829796] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This case highlights the clinical usefulness of three-dimensional (3D) echocardiography. The diagnosis of inter-ventricular septal defect associated with aortic regurgitation has been performed in a 50-year-old man using 3D echocardiography. This advanced echocardiography could accurately reproduce the anatomy of the defect and provide further insights in the mechanisms of aortic regurgitation showing an unusual non-coronary cusp prolapse. The routinely use of 3D echocardiography in clinics might allow a better characterization of cardiac anatomy, especially of aortic valve disorders.
Collapse
Affiliation(s)
- V Parisi
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples “Federico II”
,
Corresponding author: Valentina Parisi (
)
| | - E Ratto
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples “Federico II”
| | - C Silvestri
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples “Federico II”
| | - F Pastore
- Department of Cardiology, AOU “Maggiore Della Carità”, Novara
| |
Collapse
|
27
|
Habash S, Haas NA, Laser KT. Interventional therapy of supravalvular pulmonary stenosis via a mechanical valve in the pulmonary position. CONGENIT HEART DIS 2013; 9:E41-5. [PMID: 23601034 DOI: 10.1111/chd.12066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
There is an increasing number of patients with congenital heart disease and pathology of the right ventricular outflow tract in whom a mechanical pulmonary valve replacement is chosen for permanent palliation. Despite corrective surgery, some of these patients may have residual or secondary supravalvular pulmonary stenosis or peripheral pulmonary stenosis, which necessitate interventional therapy after valve replacement. There is a general understanding that interventional therapy via a mechanical valve in pulmonary position may induce mechanical valve dysfunction and should therefore be avoided. We report our experience in three patients with a St. Jude Medical mechanical valve in pulmonary position and supravalvular pulmonary stenosis or a peripheral pulmonary stenosis where we have safely performed standard interventions (i.e., balloon angioplasty and stent implantation) across the mechanical valve without any complications. Our specific technique using a long sheath as safety guard, which holds the mechanical valve open during the procedure but allows the positioning of all mechanical devices and catheters necessary for the procedures, is described. In all patients, the long-term follow-up of the valve function is excellent.
Collapse
Affiliation(s)
- Sheeraz Habash
- Department of Congenital Heart Defects and Pediatric Cardiology, Heart and Diabetes Centre NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | | |
Collapse
|