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Korsuize NA, Bakhuis W, van Wijk B, Grotenhuis HB, Ter Heide H, Cohen de Lara M, Fejzic Z, Schoof PH, Haas F, Steenhuis TJ. Truncus arteriosus from prenatal diagnosis to clinical outcome: a single-centre experience. Cardiol Young 2024:1-7. [PMID: 38738387 DOI: 10.1017/s1047951124025071] [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] [Indexed: 05/14/2024]
Abstract
BACKGROUND The aim of this study was to review our institution's experience with truncus arteriosus from prenatal diagnosis to clinical outcome. METHODS and results: We conducted a single-centre retrospective cohort study for the years 2005-2020. Truncus arteriosus antenatal echocardiographic diagnostic accuracy within our institution was 92.3%. After antenatal diagnosis, five parents (31%) decided to terminate the pregnancy. After inclusion from referring hospitals, 16 patients were offered surgery and were available for follow-up. Right ventricle-to-pulmonary artery continuity was preferably established without the use of a valve (direct connection), which was possible in 14 patients (88%). There was no early or late mortality. Reinterventions were performed in half of the patients at latest follow-up (median follow-up of 5.4 years). At a median age of 5.5 years, 13 out of 14 patients were still without right ventricle-to-pulmonary artery valve, which was well tolerated without signs of right heart failure. The right ventricle demonstrated preserved systolic function as expressed by tricuspid annular plane systolic excursion z-score (-1.4 ± 1.7) and fractional area change (44 ± 12%). The dimensions and function of the left ventricle were normal at latest follow-up (ejection fraction 64.4 ± 6.2%, fractional shortening 34.3 ± 4.3%). CONCLUSIONS This study demonstrates good prenatal diagnostic accuracy of truncus arteriosus. There was no mortality and favourable clinical outcomes at mid-term follow-up, with little interventions on the right ventricle-to-pulmonary artery connection and no right ventricle deterioration. This supports the notion that current perspectives of patients with truncus arteriosus are good, in contrast to the poor historic outcome series. This insight can be used in counselling and surgical decision-making.
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Affiliation(s)
- Nina A Korsuize
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Wouter Bakhuis
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Bram van Wijk
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Henriëtte Ter Heide
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Fetal Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Michelle Cohen de Lara
- Department of Gynecology and Obstetrics, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Zina Fejzic
- Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul H Schoof
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Felix Haas
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Trinette J Steenhuis
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Fetal Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Elgayar MM, Mostafa MM, Adel M, Hosny H. Successful Late Repair of Truncus Arteriosus: A Single Center Experience. World J Pediatr Congenit Heart Surg 2024:21501351241232572. [PMID: 38515378 DOI: 10.1177/21501351241232572] [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: 03/23/2024]
Abstract
Background: Truncus arteriosus is a rare congenital heart defect resulting from the failure of the truncus arteriosus to divide during fetal development. It leads to a single outflow tract from the heart and, if left untreated, can be fatal. Late presentation and repair can also increase the risk of pulmonary hypertensive crises, which can lead to morbidity and mortality after repair. Methods: We performed a retrospective study examining outcomes of late-presenting patients who were repaired for this anomaly at our institution. Results: We identified seven patients who underwent late repair of truncus arteriosus who were 3 to 11 years of age. There were six females and one male. Postoperatively, all patients showed improvement in symptoms and hemodynamic parameters, with no reported mortality. The median duration of stay in the intensive care unit was nine days and with a range from 3 to 18 days, while the median hospital stay was 29 days with a range from 21 to 60 days. Conclusion: These findings highlight the potential for successful outcomes even in cases of delayed diagnosis.
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Affiliation(s)
| | | | - Mohamed Adel
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
- Division of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt
| | - Hatem Hosny
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
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3
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Itoh T, Ishida Y, Kimura M, Tomita H. Use of a QDOT MICRO catheter to identify a premature ventricular contraction origin in the right ventricular anterior papillary muscle in a repaired truncus arteriosus. Pacing Clin Electrophysiol 2023; 46:1337-1340. [PMID: 37310085 DOI: 10.1111/pace.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
The ventricular papillary muscles (VPMs) can be a source of premature ventricular contractions (PVCs). Catheter ablation of VPM PVCs is challenging because of the anatomical complexity, such as the apical structures in proximity to the ventricular walls. The QDOT MICRO catheter (Biosense Webster, Diamond Bar, CA, USA) has microelectrodes embedded along the circumference of its distal tip and can provide information on which side of its tip myocardial activation is earlier. This repaired truncus arteriosus case demonstrates the usefulness of the microelectrode recording in identifying a PVC origin in a right VPM apex close to the right ventricular anterior wall.
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Affiliation(s)
- Taihei Itoh
- Department of Advanced Management of Cardiac Arrhythmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Advanced Management of Cardiac Arrhythmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Advanced Management of Cardiac Arrhythmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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4
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Hoashi T, Imai K, Okuda N, Komori M, Ono Y, Kurosaki K, Ichikawa H. Death, reoperation, and late cardiopulmonary function after truncus repair. JTCVS Open 2023; 14:407-416. [PMID: 37425460 PMCID: PMC10328806 DOI: 10.1016/j.xjon.2023.02.010] [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] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/17/2022] [Accepted: 01/30/2023] [Indexed: 07/11/2023]
Abstract
Objective To identify the late surgical outcomes of truncus arteriosus. Methods Fifty consecutive patients with truncus arteriosus who underwent surgery between 1978 and 2020 at our institute were enrolled in this retrospective, single institutional cohort study. The primary outcome was death and reoperation. The secondary outcome was late clinical status, including exercise capacity. The peak oxygen uptake was measured by a ramp-like progressive exercise test on a treadmill. Results Nine patients underwent palliative surgery, which resulted in 2 deaths. Forty-eight patients went on to truncus arteriosus repair, including 17 neonates (35.4%). The median age and body weight at repair were 92.5 days (interquartile range, 10-272 days) and 3.85 kg (interquartile range, 2.9-6.5 kg), respectively. The survival rate at 30 years was 68.5%. Significant truncal valve regurgitation (P = .030) was a risk factor for survival. Survival rates were similar between in the early 25 and late 25 patients (P = .452). The freedom from death or reoperation rate at 15 years was 35.8%. Significant truncal valve regurgitation was a risk factor (P = .001). The mean follow-up period in hospital survivors was 15.4 ± 12 years (maximum, 43 years). The peak oxygen uptake, which was performed in 12 long-term survivors at a median duration from repair of 19.7 years (interquartile range, 16.8-30.9 years), was 70.2% of predicted normal (interquartile range, 64.5%-80.4%). Conclusions Truncal valve regurgitation was a risk factor for both survival and reoperation, thus improvement of truncal valve surgery is essential for better life prognosis and quality of life. Slightly reduced exercise tolerance was common in long-term survivors.
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Affiliation(s)
- Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenta Imai
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naoki Okuda
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Motoki Komori
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshikazu Ono
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Kuroda Y, Saito Y, Enomoto Y, Naruto T, Mitsui J, Kurosawa K. PHACES-like syndrome with TMEM260 compound heterozygous variants. Am J Med Genet A 2023. [PMID: 37183566 DOI: 10.1002/ajmg.a.63245] [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] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/22/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
PHACES syndrome is a multiple congenital disorder with unknown etiology that is characterized by Posterior fossa anomalies, Hemangioma, Arterial lesions, Cardiac abnormalities/coarctation of the aorta, Eye anomalies, and Sternal cleft. Compound heterozygous or homozygous TMEM260 variants cause structural heart defects and renal anomalies syndrome (SHDRA). We describe a 10-year-old male patient with a PHACES-like syndrome and TMEM260 compound heterozygous variants who demonstrated overlapping phenotypes between the two syndromes. He presented with truncus arteriosus, supraumbilical raphe, ophthalmological abnormality, vertebral abnormality, borderline intellectual disability, and hearing loss. He had normal serum creatinine. In proband exome sequencing, compound heterozygous TMEM260 variants (NM_017799.4 c.1617delG p.(Trp539Cysfs*9)/c.1858C > T p.(Gln620*)) were identified. Twelve patients have been reported with TMEM260-related SHDRA: 10 had truncus arteriosus and 6 had renal failure. One previously reported patient had facial port wine nevus and another patient had supraumbilical raphe, which are the cardinal signs for PHACES syndrome. TMEM260-related SHDRA could share overlapping clinical features with PHACES syndrome. This report expands the phenotypic spectrum of a TMEM260-related disorder.
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Affiliation(s)
- Yukiko Kuroda
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yoko Saito
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yumi Enomoto
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takuya Naruto
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jun Mitsui
- Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Kurosawa
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
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Moharkar S, Bharati A. Coronaries from the Brachiocephalic Artery: Anomalous Origin of the Coronary Arteries in a Case of Situs Inversus and Truncus Arteriosus. Indian J Radiol Imaging 2023; 33:267-270. [PMID: 37123570 PMCID: PMC10132886 DOI: 10.1055/s-0043-1760745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Congenital anomalies of the coronary arteries are rare. In this article, we reported a case of 6-month-old female who was brought with breathing difficulty and poor weight gain. Echocardiography was done which showed dextrocardia and truncus arteriosus. A cardiac computed tomography confirmed these findings and additionally revealed that the coronary arteries originated from a common vascular channel from the brachiocephalic artery. This is a very rare occurrence. To our knowledge, only a few such cases have been reported in the literature.
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Affiliation(s)
- Swapnil Moharkar
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
- Address for correspondence Swapnil Moharkar, MBBS Department of Radiology, Seth GS Medical College and KEM HospitalParel, Mumbai, MaharashtraIndia
| | - Alpa Bharati
- Department of Radiology, Bai Jerbai Hospital for Children, Wadia Hospital, Mumbai, Maharashtra, India
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Banpurkar A, Wadile S, Kulkarni S. Use of 3D volume-rendered CT imaging in analysing the anatomy of an unusual type of common arterial trunk. Cardiol Young 2023; 33:473-5. [PMID: 36647705 DOI: 10.1017/S1047951122004231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A common arterial trunk with pulmonary dominance is rare. We report the use of 3D volume-rendered CT imaging to define common arterial trunk with pulmonary arterial dominance and associated abnormalities.
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Williams TR, Cianciulli AR, Wang Y, Lasso A, Pinter C, Pouch AM, Biko DM, Nuri M, Quartermain MD, Rogers LS, Chen JM, Jolley MA. Truncal Valve Repair: 3-Dimensional Imaging and Modeling to Enhance Preoperative Surgical Planning. Circ Cardiovasc Imaging 2022; 15:e014424. [PMID: 36093770 PMCID: PMC9772078 DOI: 10.1161/circimaging.122.014424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Trevor R Williams
- Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children's Hospital of Philadelphia, PA
| | - Alana R Cianciulli
- Department of Anesthesiology and Critical Care Medicine (A.R.C., M.A.J.), Children's Hospital of Philadelphia, PA
| | - Yan Wang
- Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children's Hospital of Philadelphia, PA
| | - Andras Lasso
- Laboratory for Percutaneous Surgery, Queens University, Kingston, Ontario, Canada (A.L.)
| | | | - Alison M Pouch
- Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia (A.M.P.)
| | - David M Biko
- Department of Radiology (D.M.B.), Children's Hospital of Philadelphia, PA
| | - Muhammad Nuri
- Division of Pediatric Cardiac Surgery (M.N., J.M.C.), Children's Hospital of Philadelphia, PA
| | - Michael D Quartermain
- Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children's Hospital of Philadelphia, PA
| | - Lindsay S Rogers
- Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children's Hospital of Philadelphia, PA
| | - Jonathan M Chen
- Division of Pediatric Cardiac Surgery (M.N., J.M.C.), Children's Hospital of Philadelphia, PA
| | - Matthew A Jolley
- Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children's Hospital of Philadelphia, PA
- Department of Anesthesiology and Critical Care Medicine (A.R.C., M.A.J.), Children's Hospital of Philadelphia, PA
- Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia (A.M.P.)
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Kollu R, Uligada S, Kotamraju S, Nethi Balingari BL, Dudekula A, Kumar P, Patil C, Gaddalay S, Gaddalay SL. Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT). Cureus 2022; 14:e32916. [PMID: 36699783 PMCID: PMC9873200 DOI: 10.7759/cureus.32916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/26/2022] Open
Abstract
Introduction Proximal interruption of pulmonary artery (PIPA) is a congenital anomaly presenting with aberrant termination of the pulmonary artery at the hilum. It results in a variety of radiological and clinical manifestations. Clinically, isolated PIPA can be asymptomatic till late adulthood or can present with dyspnoea, chest discomfort, hemoptysis and recurrent infections. PIPA can be associated with multiple cardiovascular anomalies such as tetralogy of Fallot (TOF), ventricular septal defects (VSD), and scimitar syndrome. We present a spectrum of cases with both isolated proximal interruption of the pulmonary artery and cases associated with other cardiovascular abnormalities. Typical chest radiographs and chest contrast-enhanced computed tomography (CECT) findings are discussed and demonstrated in detail. Proper and early diagnosis is a crucial step as it can significantly modify the treatment choice, thereby reducing morbidity. Objective To document the different presentations of the proximal arrest of pulmonary arteries, to document associations with cardiovascular and pulmonary manifestations, and to elaborate on and demonstrate the various radiological imaging findings. Material and methods All the cases that were reported with proximal interruption of pulmonary artery on the CECT studies conducted between 2019 and 2022 at a tertiary care hospital in Telangana, India. The demographic data, clinical presentation, chest radiographs, and chest CECT were collected retrospectively. Data analysis was done using Microsoft Excel 2019 to calculate descriptive statistics. A total of 22 cases were identified of which three cases were excluded of as they were previously operated and 19 cases were taken as the study population. Results Nineteen patients were included in the study. Demographic details, clinical history, CECT, and chest radiographs were collected wherever available. The majority of the cases belonged to the ≤ 10 yrs age group with the most common clinical presentation being a previous diagnosis of tuberculosis or recurrent upper respiratory tract infections. The predominant findings on chest radiographs were deviation of the trachea to the affected side, volume loss in the ipsilateral lung field, and compensatory hyperinflation of the contralateral lung field. On the CECT chest, the main findings were interrupted pulmonary artery, hypoplastic lung fields with bronchiectasis, or ground glassing. Associated cardiovascular and pulmonary malformations were identified with notable cases: TOF, right-sided aortic arch and scimitar syndrome. Their typical imaging findings have been elucidated and discussed in detail. Conclusions Patients with recurrent respiratory infections or hemoptysis having hypoplastic lung field with hyperinflation of the contralateral lung on chest radiographs should be evaluated for pulmonary artery interruptions. Chest CECT allows evaluation of the bronchial tree and lung parenchyma at the same time which helps distinguish pulmonary interruption from conditions such as Swyer-James-Macleod syndrome, pulmonary hypoplasia, thromboembolism and arteritis. Cases with PIPA can also be associated with cardiovascular and pulmonary anomalies such as TOF, partial anomalous pulmonary venous connection (PAPVC), and VSD. The knowledge of these associations is essential as they can influence the mode of treatment and can help reduce the long-term morbidity and mortality associated with the condition.
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Affiliation(s)
- Raja Kollu
- Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND
| | - Seema Uligada
- Radiodiagnosis, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Sai Kotamraju
- Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND
| | | | - Anees Dudekula
- Radiodiagnosis, East Point Medical College, Bengaluru, IND
| | - Prashanth Kumar
- Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND
| | | | | | - Saumya L Gaddalay
- Internal Medicine, Malla Reddy Medical College for Women, Hyderabad, IND
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Muacevic A, Adler JR, Russa DL, Ashwath R, Priya S. Imaging of the Rare Association of Truncus Arteriosus in a Neonate with the Ductal Origin of the Left Subclavian Artery Using Multidetector CT Angiography and 3D Rendering. Cureus 2022; 14:e32131. [PMID: 36601168 PMCID: PMC9805543 DOI: 10.7759/cureus.32131] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/04/2022] Open
Abstract
We present the unreported case of a rare association of truncus arteriosus with the ductal origin of the left subclavian artery. Understanding and preoperative identification of these aortic variations are essential to guide optimal surgical management. In this study, the role of advanced visualization 3D modeling techniques in imaging these complex anomalies is discussed.
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11
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Swartz MF, Yoshitake S, Cholette JM, Atallah-Yunes N, Wang H, Alfieris GM. A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperation. JTCVS Tech 2022; 16:196-211. [PMID: 36510535 PMCID: PMC9735427 DOI: 10.1016/j.xjtc.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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Maintaining adequate branch pulmonary arterial growth is critical in preventing early (<3 years) right ventricular outflow tract reoperation after the repair of truncus arteriosus. We hypothesized that a modified truncus arteriosus repair keeping the branch pulmonary arteries in situ would promote branch pulmonary arterial growth and limit early right ventricular outflow tract reoperation. Methods For infants requiring repair for type I and II truncus arteriosus, the truncal root was septated through a hockey stick incision keeping the branch pulmonary arteries in situ, the ventricular septal defect was closed, and a short aortic homograft was used to reconstruct the right ventricular outflow tract. Echocardiograms measured preoperative and follow-up branch pulmonary artery diameter. Results Between 1998 and 2020, 41 infants were repaired using the modified approach (type I, 28; type II, 13). With a median follow-up of 11.6 (interquartile range, 3.1-15.5) years, there was no significant change between preoperative left pulmonary artery and right pulmonary artery Z-scores and their corresponding follow-up measurement (left pulmonary artery: 0.97, interquartile range, 0.6-1.6 vs left pulmonary artery: 1.4, interquartile range, -0.3 to 1.9) (right pulmonary artery: 0.6, interquartile range, -0.4 to 1.7 vs right pulmonary artery: 0.3 interquartile range, 0.5-0.9). Only 7.3% (n = 2) of follow-up right pulmonary artery Z-scores were less than 2.5 Z-scores below preoperative measurements. Four children (9.8%) required early right ventricular outflow tract reoperation. On multivariable analysis, larger conduit Z-scores were associated with greater time to right ventricular outflow tract reoperation (hazard ratio, 0.55, confidence interval, 0.307-0.984; P = .043). Conclusions Maintaining the branch pulmonary arteries in situ at initial truncus arteriosus repair allows for branch pulmonary arterial growth, limiting early right ventricular outflow tract reoperation.
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Affiliation(s)
- Michael F. Swartz
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Address for reprints: Michael F. Swartz, PhD, Strong Memorial Hospital, Box Surg/Cardiac, 601 Elmwood Ave, Rochester, NY 14642.
| | - Shuichi Yoshitake
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY
| | - Jill M. Cholette
- Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Nader Atallah-Yunes
- Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY
| | - George M. Alfieris
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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12
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Pagnamenta AT, Jackson A, Perveen R, Beaman G, Petts G, Gupta A, Hyder Z, Chung BHY, Kan ASY, Cheung KW, Kerstjens-Frederikse WS, Abbott KM, Elpeleg O, Taylor JC, Banka S, Ta-Shma A. Biallelic TMEM260 variants cause truncus arteriosus, with or without renal defects. Clin Genet 2021; 101:127-133. [PMID: 34612517 DOI: 10.1111/cge.14071] [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: 08/18/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 12/01/2022]
Abstract
Only two families have been reported with biallelic TMEM260 variants segregating with structural heart defects and renal anomalies syndrome (SHDRA). With a combination of genome, exome sequencing and RNA studies, we identified eight individuals from five families with biallelic TMEM260 variants. Variants included one multi-exon deletion, four nonsense/frameshifts, two splicing changes and one missense change. Together with the published cases, analysis of clinical data revealed ventricular septal defects (12/12), mostly secondary to truncus arteriosus (10/12), elevated creatinine levels (6/12), horse-shoe kidneys (1/12) and renal cysts (1/12) in patients. Three pregnancies were terminated on detection of severe congenital anomalies. Six patients died between the ages of 6 weeks and 5 years. Using a range of stringencies, carrier frequency for SHDRA was estimated at 0.0007-0.007 across ancestries. In conclusion, this study confirms the genetic basis of SHDRA, expands its known mutational spectrum and clarifies its clinical features. We demonstrate that SHDRA is a severe condition associated with substantial mortality in early childhood and characterised by congenital cardiac malformations with a variable renal phenotype.
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Affiliation(s)
- Alistair T Pagnamenta
- NIHR Biomedical Research Centre, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Adam Jackson
- Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Rahat Perveen
- Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK
| | - Glenda Beaman
- Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK
| | - Gemma Petts
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | | | - Zerin Hyder
- Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK
| | - Brian Hon-Yin Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Anita Sik-Yau Kan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Kristin M Abbott
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Orly Elpeleg
- Department of Genetics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jenny C Taylor
- NIHR Biomedical Research Centre, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Siddharth Banka
- Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Asaf Ta-Shma
- Department of Pediatric Cardiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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13
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Li W, Li J, Chen X. A rare case of congenital heart disease: anomalous origin of coronary artery from innominate artery with coronary fistula and truncus arteriosus. Cardiol Young 2021; 31:1345-7. [PMID: 33597053 DOI: 10.1017/S1047951121000470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anomalous origin of a single coronary artery arising from the innominate artery associated with coronary artery fistula and truncus arteriosus is extremely rare. We found this anomaly in a 16-month-old infant-girl who received Rastelli procedure during the operation. The three defects described above are rarely found together; indeed, such a case as ours may be the first reported in the literature.
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14
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Ulm B, Dovjak GO, Scharrer A, Muin DA, Zimpfer D, Prayer D, Weber M, Berger-Kulemann V. Diagnostic quality of 3Tesla postmortem magnetic resonance imaging in fetuses with and without congenital heart disease. Am J Obstet Gynecol 2021; 225:189.e1-189.e30. [PMID: 33662361 DOI: 10.1016/j.ajog.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postmortem confirmation of prenatally diagnosed congenital heart disease after termination of pregnancy and evaluation of potential cardiac defects after spontaneous fetal or neonatal death are essential. Conventional autopsy rates are decreasing, and 1.5Tesla magnetic resonance imaging has demonstrated limited diagnostic accuracy for postmortem cardiovascular assessment. OBJECTIVE This study aimed to evaluate the feasibility and image quality of cardiac 3Tesla postmortem magnetic resonance imaging and to assess its diagnostic accuracy in detecting fetal heart defects compared with conventional autopsy. Secondarily, the study aimed to explore whether clinical factors affect the quality of 3Tesla postmortem magnetic resonance imaging. STUDY DESIGN A total of 222 consecutive fetuses between 12 and 41 weeks' gestation, who underwent 3Tesla postmortem magnetic resonance imaging and conventional autopsy after spontaneous death or termination of pregnancy for fetal malformations, were included. First, 3Tesla postmortem magnetic resonance imaging of each fetus was rated as diagnostic or nondiagnostic for fetal cardiac assessment by 2 independent raters. The image quality of individual cardiac structures was then further evaluated by visual grading analysis. Finally, the presence or absence of a congenital heart defect was assessed by 2 radiologists and compared with autopsy results. RESULTS Overall, 87.8% of 3Tesla postmortem magnetic resonance imaging examinations were rated as diagnostic for the fetal heart. Diagnostic imaging rates of individual cardiac structures at 3Tesla postmortem magnetic resonance imaging ranged from 85.1% (atrioventricular valves) to 94.6% (pericardium), with an interrater agreement of 0.82 (0.78-0.86). Diagnostic imaging of the fetal aortic arch and the systemic veins at 3Tesla postmortem magnetic resonance imaging was possible from 12+5 weeks' gestation onward in 90.1% and 92.3% of cases, respectively. A total of 55 fetuses (24.8%) had at least 1 cardiac anomaly according to autopsy, 164 (73.9%) had a normal heart, and in 3 fetuses (1.4%), autopsy was nondiagnostic for the heart. Considering all examinations rated as diagnostic, 3Tesla postmortem magnetic resonance imaging provided high diagnostic accuracy for the detection of fetal congenital heart defects with a sensitivity of 87.8%, a specificity of 97.9%, and concordance with autopsy of 95.3%. 3Tesla postmortem magnetic resonance imaging was less accurate in young fetuses (<20 weeks compared with ≥20 weeks; P<.001), in fetuses with low birthweight (≤100 g compared with >100 g; P<.001), in cases after spontaneous fetal death (compared with other modes of death; P=.012), in cases with increasing latency between death and 3Tesla postmortem magnetic resonance imaging (P<.001), and in cases in which there was a high degree of maceration (maceration score of 3 compared with a score from 0 to 2; P=.004). CONCLUSION Diagnostic 3Tesla postmortem magnetic resonance imaging assessment of the fetal heart is feasible in most fetuses from 12 weeks' gestation onward. In diagnostic images, sensitivity and, particularly, specificity in the detection of congenital heart disease are high compared with conventional autopsy. Owing to its high diagnostic accuracy, we suggest that 3Tesla postmortem magnetic resonance imaging may serve as a suitable imaging modality with which to direct a targeted conventional autopsy when pathology resources are limited or to provide a virtual autopsy when full autopsy is declined by the parents.
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Affiliation(s)
- Barbara Ulm
- Division of Obstetrics and Fetomaternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
| | - Gregor O Dovjak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anke Scharrer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Dana A Muin
- Division of Obstetrics and Fetomaternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Vanessa Berger-Kulemann
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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15
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Hazekamp MG, Barron DJ, Dangel J, Homfray T, Jongbloed MRM, Voges I. Consensus document on optimal management of patients with common arterial trunk. Cardiol Young 2021; 31:915-39. [PMID: 34016217 DOI: 10.1017/S1047951121001219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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16
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Ramamurthy HR, Walavalkar V, Siddaiah S, Maheshwari S. A comprehensive study of congenital unilateral absence of branch pulmonary artery associated with other congenital heart defects and ipsilateral non-unifocalizable major aorto-pulmonary collateral arteries: A single-center retrospective study. Ann Pediatr Cardiol 2021; 14:139-145. [PMID: 34103851 PMCID: PMC8174626 DOI: 10.4103/apc.apc_99_20] [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: 05/04/2020] [Revised: 10/20/2020] [Accepted: 12/13/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Congenital unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly with the complete absence of intrapericardial segment of one of the branch pulmonary arteries. Sixty percent are associated with other congenital heart defects (CHD) that often need correction. Aim To analyze the data of patients with UAPA and ipsilateral non-unifocalizable major aortopulmonary collateral arteries (MAPCAs) associated with other CHD to identify the commonly associated CHD, their management strategies and outcomes. Materials and Methods Retrospective data of patients admitted for congenital UAPA with other CHD was compiled from hospital records from 2002 to 2015. The associated CHD were categorized as group I with the decreased pulmonary flow and group II with increased pulmonary flow to the unaffected contralateral pulmonary artery. The determinants of their management were analyzed. Results Sixty-five patients of UAPA and ipsilateral non-unifocalizable MAPCAs associated with other CHD were identified. Group I had 41 patients and Group II had 24. The most common CHD associated with UAPA was tetralogy of Fallot (TOF) in 31 patients (47.7%). Fifty-three patients underwent surgery, 48 (73.8%) underwent single lung corrective surgery, 5 (7.6%) palliative surgery and 12 (18.4) received no surgery. Four operated patients died in the immediate postoperative period. The lowest Mc Goon ratio and Nakata index to undergo corrective surgery were 1.0 and 87.4 mm2/m2. A follow-up of 21 patients was done, among which 11 patients who underwent single-stage corrective surgery, all are in NYHA class II and saturating above 95%. Conclusions Congenital UAPA is a rare anomaly and associated with a variety of CHDs, TOF being the most common. Single lung corrective surgery in patients with ipsilateral non-unifocalizable MAPCAs has good immediate and long term survival.
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Affiliation(s)
- Harpanahalli Ravi Ramamurthy
- Department of Pediatric Cardiology & Grown Up Congenital Heart Diseases, Army Hospital (Research & Referral), New Delhi, India
| | - Varsha Walavalkar
- Department of Pediatric and Grown-Up Congenital Heart Diseases, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Satheesh Siddaiah
- Department of Pediatric and Grown-Up Congenital Heart Diseases, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Sunita Maheshwari
- RXDX Healthcare and Teleradiology Solutions, Bengaluru, Karnataka, India
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17
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Guariento A, Doulamis IP, Staffa SJ, Gellis L, Oh NA, Kido T, Mayer JE, Baird CW, Emani SM, Zurakowski D, Del Nido PJ, Nathan M. Long-term outcomes of truncus arteriosus repair: A modulated renewal competing risks analysis. J Thorac Cardiovasc Surg 2021; 163:224-236.e6. [PMID: 33726908 DOI: 10.1016/j.jtcvs.2021.01.136] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this study, we sought to identify independent risk factors for mortality and reintervention after early surgical correction of truncus arteriosus using a novel statistical method. METHODS Patients undergoing neonatal/infant truncus arteriosus repair between January 1984 and December 2018 were reviewed retrospectively. An innovative statistical strategy was applied integrating competing risks analysis with modulated renewal for time-to-event modeling. RESULTS A total of 204 patients were included in the study. Mortality occurred in 32 patients (15%). Smaller right ventricle to pulmonary artery conduit size and truncal valve insufficiency at birth were significantly associated with overall mortality (right ventricle to pulmonary artery conduit size: hazard ratio, 1.34; 95% confidence interval, 1.08-1.66, P = .008; truncal valve insufficiency: hazard ratio, 2.5; 95% confidence interval, 1.13-5.53, P = .024). truncal valve insufficiency at birth, truncal valve intervention at index repair, and number of cusps (4 vs 3) were associated with truncal valve reoperations (truncal valve insufficiency: hazard ratio, 2.38; 95%, confidence interval, 1.13-5.01, P = .02; cusp number: hazard ratio, 6.62; 95% confidence interval, 2.54-17.3, P < .001). Right ventricle to pulmonary artery conduit size 11 mm or less was associated with a higher risk of early catheter-based reintervention (hazard ratio, 1.54; 95% confidence interval, 1.04-2.28, P = .03) and reoperation (hazard ratio, 1.96; 95% confidence interval, 1.33-2.89, P = .001) on the right ventricle to pulmonary artery conduit. CONCLUSIONS Smaller right ventricle to pulmonary artery conduit size and truncal valve insufficiency at birth were associated with overall mortality after truncus arteriosus repair. Quadricuspid truncal valve, the presence of truncal valve insufficiency at the time of diagnosis, and truncal valve intervention at index repair were associated with an increased risk of reoperation. The size of the right ventricle to pulmonary artery conduit at index surgery is the single most important factor for early reoperation and catheter-based reintervention on the conduit.
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Affiliation(s)
- Alvise Guariento
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Steven J Staffa
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Laura Gellis
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Nicholas A Oh
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Takashi Kido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
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18
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Naimo PS, Buratto E, Konstantinov IE. Truncal valve repair in children. J Thorac Cardiovasc Surg 2020:S0022-5223(20)33304-3. [PMID: 33487419 DOI: 10.1016/j.jtcvs.2020.10.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022]
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19
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Gellis L, Binney G, Alshawabkeh L, Lu M, Landzberg MJ, Mayer JE, Mullen MP, Valente AM, Sleeper LA, Brown DW. Long-Term Fate of the Truncal Valve. J Am Heart Assoc 2020; 9:e019104. [PMID: 33161813 PMCID: PMC7763736 DOI: 10.1161/jaha.120.019104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022]
Abstract
Background Long-term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long-term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow-up time was 12.6 years (interquartile range, 5.0-22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow-up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P<0.001) or stenosis (HR, 4.12; P<0.001) before full truncus arteriosus repair and moderate or greater truncal valve regurgitation at discharge after full repair (HR, 8.60; P<0.001). During follow-up, 33 of 134 patients (25%) progressed to moderate or greater truncal valve regurgitation. A larger truncal valve root z-score before truncus arteriosus full repair and during follow-up was associated with worsening truncal valve regurgitation. Conclusions Long-term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root z-score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.
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Affiliation(s)
- Laura Gellis
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | | | - Laith Alshawabkeh
- Sulpizio Cardiovascular InstituteUniversity of California San DiegoLa JollaCA
| | - Minmin Lu
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Michael J. Landzberg
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - John E. Mayer
- Department of Cardiac SurgeryBoston Children’s HospitalBostonMA
- Department of SurgeryHarvard Medical SchoolBostonMA
| | - Mary P. Mullen
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Anne Marie Valente
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Lynn A. Sleeper
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - David W. Brown
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
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20
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Abstract
OBJECTIVE The objective of this study was to identify patient and hospitalization characteristics associated with in-hospital mortality in infants with truncus arteriosus. METHODS We conducted a retrospective analysis of a large administrative database, the National Inpatient Sample data set of the Healthcare Cost and Utilization Project for the years 2002 to 2017. We also sought to evaluate the resource utilization in the subgroup of subjects with truncus arteriosus and 22q11.2 deletion syndrome. Neonates with truncus arteriosus were identified by ICD-9 and ICD-10 codes. Hospital and patient factors associated with inpatient mortality were analyzed. RESULTS Overall, 3009 neonates met inclusion criteria; a total of 326 patients died during the hospitalization (10.8%). Extracorporeal membrane oxygenation utilization was 7.1%. Univariate and multivariate logistic regression analyses were used to identify risk factors for in-hospital mortality. Significant risk factors for mortality were prematurity (adjusted odds ratio [aOR] = 2.43; 95% confidence interval [CI]: 1.40-4.22; P = .002), diagnosis of stroke (aOR = 26.2; 95% CI: 10.1-68.1; P < .001), necrotizing enterocolitis (aOR = 3.10; 95% CI: 1.24-7.74; P = .015) and presence of venous thrombosis (aOR = 13.5; 95% CI: 6.7-27.2; P < .001). Patients who received extracorporeal membrane oxygenation support or had cardiac catheterization procedure during the hospitalization had increased odds of mortality (aOR = 82.0; 95% CI: 44.5-151.4; P < .001, and aOR = 1.65; 95% CI: 0.98-2.77; P = .060, respectively). CONCLUSION 22q11.2 deletion syndrome was associated with an inverse risk of death despite having more noncardiac comorbidities; this patient subpopulation also had a higher length of stay and increased cost of hospitalization.
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Affiliation(s)
- Mohammed Hamzah
- Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, Ohio
| | - Hasan F Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan
| | - Kshama Daphtary
- Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, Ohio
| | - Rukmini Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
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21
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Naimo PS, Bell D, Fricke TA, d'Udekem Y, Brizard CP, Alphonso N, Konstantinov IE. Truncus arteriosus repair: A 40-year multicenter perspective. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)31137-5. [PMID: 32653289 DOI: 10.1016/j.jtcvs.2020.04.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the long-term surgical outcomes of patients who underwent truncus arteriosus (TA) repair. METHODS Between 1979 and 2018, a total of 255 patients underwent TA repair at 3 Australian hospitals. Data were obtained by review of medical records from initial admission until last cardiology follow-up. RESULTS At the time of TA repair, the median patient age was 44 days, and median weight was 3.5 kg. Early mortality was 13.3% (34 of 255), and overall survival was 76.8 ± 2.9% at 20 years. Neonatal surgery and low operative weight were risk factors for early mortality. Most deaths (82.5%; 47 of 57) occurred within the first year following repair. A coronary artery anomaly and early reoperation were identified as risk factors for late mortality. A total of 175 patients required at least 1 reoperation, with overall freedom of reoperation of 2.9 ± 1.5% at 20 years. Follow-up of survivors was 96% complete (191 of 198). The median duration of follow-up was 16.4 years. At the last follow-up, 190 patients were categorized as New York Heart Association class I/II, and 1 patient was class III. CONCLUSIONS TA repair during the neonatal period presents significant surgical challenges. Neonates with signs of overcirculation should be operated on promptly. A coronary artery anomaly is a risk factor for late mortality. Survival beyond the first year following repair is associated with excellent outcomes.
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Affiliation(s)
- Phillip S Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Douglas Bell
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Tyson A Fricke
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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22
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Sanchez J, Miyake R, Cheng A, Liu T, Iseki S, Kume T. Conditional inactivation of Foxc1 and Foxc2 in neural crest cells leads to cardiac abnormalities. Genesis 2020; 58:e23364. [PMID: 32259372 DOI: 10.1002/dvg.23364] [Citation(s) in RCA: 4] [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: 02/27/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023]
Abstract
Cardiac neural crest cells (cNCCs) are required for normal heart development. cNCCs are a multipotent and migratory cell lineage that differentiates into multiple cell types. cNCCs migrate into the developing heart to contribute to the septation of the cardiac outflow tract (OFT). Foxc1 and Foxc2 are closely related members of the FOX (Forkhead box) transcription factor family and are expressed in cNCC during heart development. However, the precise role of Foxc1 and Foxc2 in cNCCs has yet to be fully described. We found that compound NCC-specific Foxc1;Foxc2 mutant embryos exhibited persistent truncus arteriosus (PTA), ventricular septal defects (VSDs), and thinning of the ventricular myocardium. Loss of Foxc1/c2 expression in cNCCs resulted in abnormal patterns of cNCC migration into the OFT without the formation of the aorticopulmonary septum. Further, loss of Foxc1 expression in cNCCs resulted in normal OFT development but abnormal ventricular septal formation. In contrast, loss of Foxc2 expression in NCCs led to no obvious cardiac abnormalities. Together, we provide evidence that Foxc1 and Foxc2 in cNCCs are cooperatively required for proper cNCC migration, the formation of the OFT septation, and the development of the ventricles. Our data also suggests that Foxc1 expression may play a larger role in ventricular development compared to Foxc2.
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Affiliation(s)
- Joshua Sanchez
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Risa Miyake
- Section of Molecular Craniofacial Embryology, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Andrew Cheng
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Ting Liu
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sachiko Iseki
- Section of Molecular Craniofacial Embryology, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Tsutomu Kume
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Department of Medicine, Northwestern University, Chicago, Illinois
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23
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Ritter A, Werner P, Latney B, Krock BL, Santani A, Bedoukian E, Skraban CM, Deardorff MA, Goldmuntz E. NKX2-6 related congenital heart disease: Biallelic homeodomain-disrupting variants and truncus arteriosus. Am J Med Genet A 2020; 182:1454-1459. [PMID: 32198970 DOI: 10.1002/ajmg.a.61550] [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: 12/09/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/11/2022]
Abstract
Congenital heart defects (CHD) are the most common birth defect and are both clinically and genetically heterogeneous. Truncus arteriosus (TA), characterized by a single arterial vessel arising from both ventricles giving rise to the coronary, pulmonary and systemic arteries, is rare and only responsible for 1% of all CHD. Two consanguineous families with TA were previously identified to have homozygous nonsense variants within the gene NKX2-6. NKX2-6 is a known downstream target of TBX1, an important transcriptional regulator implicated in the cardiac phenotype of 22q11.2 microdeletion syndrome. Herein, we report two siblings with TA presumably caused by compound heterozygous NKX2-6 variants without a history of consanguinity. Two in-house cohorts with conotruncal defects (CTD) were sequenced for variants in NKX2-6 and no additional cases of biallelic NKX2-6 variants were identified. The similar phenotype of these cases, and the clustering of variants that likely result in a truncated protein that disrupts the homeobox domain, suggest that biallelic loss of function for NKX2-6 is a rare genetic etiology for TA in particular, and possibly other types of CHD.
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Affiliation(s)
- Alyssa Ritter
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania, USA.,Divison of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
| | - Petra Werner
- Divison of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
| | - Brande Latney
- Divison of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
| | - Bryon L Krock
- ARUP Institute for Clinical and Experimental Pathology®, ARUP Laboratories, Salt Lake City, Utah, USA.,University of Utah School of Medicine, Department of Pathology, Salt Lake City, Utah, USA
| | - Avni Santani
- Division of Molecular Diagnostics, Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Emma Bedoukian
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania, USA.,The Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Cara M Skraban
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania, USA.,The Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Matthew A Deardorff
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania, USA.,The Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Elizabeth Goldmuntz
- Divison of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
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Naimo PS, Fricke TA, Lee MGY, d'Udekem Y, Brink J, Brizard CP, Konstantinov IE. The quadricuspid truncal valve: Surgical management and outcomes. J Thorac Cardiovasc Surg 2020; 161:368-375. [PMID: 32122575 DOI: 10.1016/j.jtcvs.2020.01.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/13/2019] [Accepted: 01/01/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the outcomes of patients with a quadricuspid truncal valve (TV) and durability of TV repair. METHOD We reviewed 56 patients with truncus arteriosus and a quadricuspid TV who underwent complete repair between 1979 and 2018. RESULTS TV insufficiency was present in 39 patients (mild, n = 22; moderate, n = 14; and severe, n = 3). Fourteen patients had concomitant TV surgery. Early mortality in patients who had concomitant TV surgery was 14% (2 out of 14 patients) and overall survival was 77.1% ± 11.7% at 15 years. Freedom from TV reoperation was 30.3% ± 14.6% at 15 years. Early mortality in patients who did not undergo concomitant TV surgery was 9.5% (4 out of 42 patients) and overall survival was 74.9% ± 6.9% at 15 years. Progression of TV insufficiency requiring TV surgery occurred in 16.7% (7 out of 42 patients). Freedom from TV reoperation was 77.1% ± 7.8% at 15 years. The most common method of repair was tricuspidization of the TV. Freedom from TV reoperation was 64.3% ± 21.0% at 10 years after tricuspidization and 0% at 6 years after other types of TV surgery. Overall follow-up was 97.6% (41 out of 42 patients) complete for survivors with median follow-up of 16.6 years. At last follow-up there was no TV insufficiency in 16 patients, mild insufficiency in 24 patients, and moderate insufficiency in 1 patient. CONCLUSIONS More than one-third of patients with a quadricuspid TV require TV surgery. Tricuspidization of the quadricuspid TV appears to be a durable repair option with good long-term outcomes.
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Affiliation(s)
- Phillip S Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Tyson A Fricke
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Melissa G Y Lee
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
| | - Johann Brink
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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25
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Tinker SC, Gilboa SM, Moore CA, Waller DK, Simeone RM, Kim SY, Jamieson DJ, Botto LD, Reefhuis J. Specific birth defects in pregnancies of women with diabetes: National Birth Defects Prevention Study, 1997-2011. Am J Obstet Gynecol 2020; 222:176.e1-176.e11. [PMID: 31454511 DOI: 10.1016/j.ajog.2019.08.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes is associated with an increased risk for many birth defects and is likely to have an increasing impact on birth defect prevalence because of the rise in diabetes in the United States in recent decades. One of the first analyses in which specific birth defects were assessed for their relationship with both pregestational and gestational diabetes used data from the initial 6 years of the National Birth Defects Prevention Study. That analysis reported strong associations for pregestational diabetes with several birth defects, but few exposures among some of the less common birth defects led to unstable estimates with wide confidence intervals. Since that analysis, the study continued to collect data for another 8 years, including information on approximately 19,000 additional cases and 6900 additional controls. OBJECTIVE Our objective was to use data from the National Birth Defects Prevention Study, the largest population-based birth defects case-control study in the United States, to provide updated and more precise estimates of the association between diabetes and birth defects, including some defects not previously assessed. STUDY DESIGN We analyzed data on deliveries from October 1997 through December 2011. Mothers of case and control infants were interviewed about their health conditions and exposures during pregnancy, including diagnosis of pregestational (type 1 or type 2) diabetes before the index pregnancy or gestational diabetes during the index pregnancy. Using logistic regression, we separately assessed the association between pregestational and gestational diabetes with specific categories of structural birth defects for which there were at least 3 exposed case infants. For birth defect categories for which there were at least 5 exposed case infants, we calculated odds ratios adjusted for maternal body mass index, age, education, race/ethnicity, and study site; for defect categories with 3 or 4 exposed cases, we calculated crude odds ratios. RESULTS Pregestational diabetes was reported by 0.6% of mothers of control infants (71 of 11,447) and 2.5% of mothers of case infants (775 of 31,007). Gestational diabetes during the index pregnancy was reported by 4.7% of mothers of control infants (536 of 11,447) and 5.3% of mothers of case infants (1,653 of 31,007). Pregestational diabetes was associated with strong, statistically significant odds ratios (range, 2.5-80.2) for 46 of 50 birth defects considered. The largest odds ratio was observed for sacral agenesis (adjusted odds ratio, 80.2; 95% confidence interval, 46.1-139.3). A greater than 10-fold increased risk was also observed for holoprosencephaly (adjusted odds ratio, 13.1; 95% confidence interval, 7.0-24.5), longitudinal limb deficiency (adjusted odds ratio, 10.1; 95% confidence interval, 6.2-16.5), heterotaxy (adjusted odds ratio, 12.3; 95% confidence interval, 7.3-20.5), truncus arteriosus (adjusted odds ratio, 14.9; 95% confidence interval, 7.6-29.3), atrioventricular septal defect (adjusted odds ratio, 10.5; 95% confidence interval, 6.2-17.9), and single ventricle complex (adjusted odds ratio, 14.7; 95% confidence interval, 8.9-24.3). For gestational diabetes, statistically significant odds ratios were fewer (12 of 56) and of smaller magnitude (range, 1.3- 2.1; 0.5 for gastroschisis). CONCLUSION Pregestational diabetes is associated with a markedly increased risk for many specific births defects. Because glycemic control before pregnancy is associated with a reduced risk for birth defects, ongoing quality care for persons with diabetes is an important opportunity for prevention.
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Affiliation(s)
- Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - D Kim Waller
- UTHealth, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Regina M Simeone
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shin Y Kim
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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26
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Riley CM, Mastropietro CW, Sassalos P, Buckley JR, Costello JM, Iliopoulos I, Jennings A, Cashen K, Suguna Narasimhulu S, Gowda KMN, Smerling AJ, Wilhelm M, Badheka A, Bakar A, Moser EAS, Amula V. Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis. CONGENIT HEART DIS 2019; 14:1078-1086. [PMID: 31713327 DOI: 10.1111/chd.12849] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/14/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elevated pulmonary vascular resistance (PVR) is common following repair of truncus arteriosus. Inhaled nitric oxide (iNO) is an effective yet costly therapy that is frequently implemented postoperatively to manage elevated PVR. OBJECTIVES We aimed to describe practice patterns of iNO use in a multicenter cohort of patients who underwent repair of truncus arteriosus, a lesion in which recovery is often complicated by elevated PVR. We also sought to identify patient and center factors that were more commonly associated with the use of iNO in the postoperative period. DESIGN Retrospective cohort study. SETTING 15 tertiary care pediatric referral centers. PATIENTS All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016. INTERVENTIONS Descriptive statistics were used to demonstrate practice patterns of iNO use. Bivariate comparisons of characteristics of patients who did and did not receive iNO were performed, followed by multivariable mixed logistic regression analysis using backward elimination to identify independent predictors of iNO use. MAIN RESULTS We reviewed 216 patients who met inclusion criteria, of which 102 (46%) received iNO in the postoperative period: 69 (68%) had iNO started in the operating room and 33 (32%) had iNO initiated in the ICU. Median duration of iNO use was 4 days (range: 1-21 days). In multivariable mixed logistic regression analysis, use of deep hypothermic circulatory arrest (odds ratio: 3.2; 95% confidence interval: 1.2, 8.4) and center (analyzed as a random effect, p = .02) were independently associated with iNO use. CONCLUSIONS In this contemporary multicenter study, nearly half of patients who underwent repair of truncus arteriosus received iNO postoperatively. Use of iNO was more dependent on individual center practice rather than patient characteristics. The study suggests a need for collaborative quality initiatives to determine optimal criteria for utilization of this important but expensive therapy.
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Affiliation(s)
- Christine M Riley
- Department of Pediatrics, Division of Cardiac Critical Care, Children's National Health System, Washington, District of Columbia
| | - Christopher W Mastropietro
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Peter Sassalos
- Department of Cardiac Surgery, Section of Pediatric Cardiovascular Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jason R Buckley
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - John M Costello
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Ilias Iliopoulos
- Department of Pediatrics, Division of Cardiac Critical Care, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aimee Jennings
- Department of Pediatrics, Division of Critical Care, Seattle Children's Hospital, Seattle, Washington
| | - Katherine Cashen
- Department of Pediatrics, Division of Critical Care, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Sukumar Suguna Narasimhulu
- Department of Pediatrics, Division of Cardiac Intensive Care, University of Central Florida College of Medicine, The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida
| | - Keshava M N Gowda
- Department of Pediatrics, Division of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Arthur J Smerling
- Department of Pediatrics, Division of Critical Care, Columbia University College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York, New York, New York
| | - Michael Wilhelm
- Department of Pediatrics, Division of Cardiac Intensive Care, University of Wisconsin, Madison, Wisconsin
| | - Aditya Badheka
- Department of Pediatrics, Division of Critical Care Medicine, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Adnan Bakar
- Department of Pediatrics, Division of Cardiac Critical Care, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Cohen Children's Medical Center, New Hyde Park, New York
| | - Elizabeth A S Moser
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Venu Amula
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
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27
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Talwar S, Siddharth B, Gupta SK, Bhoje A, Choudhary SK. Surgical repair for common arterial trunk with pulmonary dominance, hypoplasia of ascending aorta, and interrupted aortic arch. Ann Pediatr Cardiol 2019; 12:287-291. [PMID: 31516284 PMCID: PMC6716323 DOI: 10.4103/apc.apc_147_18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The arrangement of aortic and pulmonary pathways is extremely variable in the hearts with a common arterial trunk. Almost always, interruption of the aortic arch is seen in the setting of hypoplasia of the ascending aorta and dominance of the pulmonary circulation. This subset poses substantial challenges in surgical repair and portends poor outcomes. In this report, we briefly describe the technique of ascending aorta reconstruction and other aspects of the surgical repair of this rare malformation.
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Affiliation(s)
- Sachin Talwar
- Department of Cardiothoracic Surgery, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Bharat Siddharth
- Department of Cardiothoracic Surgery, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Amolkumar Bhoje
- Department of Cardiothoracic Surgery, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic Surgery, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
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28
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Rao PS. Management of Congenital Heart Disease: State of the Art-Part II-Cyanotic Heart Defects. Children (Basel) 2019; 6:E54. [PMID: 30987364 PMCID: PMC6518252 DOI: 10.3390/children6040054] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 03/15/2019] [Accepted: 03/29/2019] [Indexed: 11/28/2022]
Abstract
In this review management of the most common cyanotic congenital heart defects (CHDs) was discussed; the management of acyanotic CHD was reviewed in Part I of this series. While the need for intervention in acyanotic CHD is by and large determined by the severity of the lesion, most cyanotic CHDs require intervention, mostly by surgery. Different types of tetralogy of Fallot require different types of total surgical corrective procedures, and some may require initial palliation, mainly by modified Blalock-Taussig shunts. Babies with transposition of the great arteries with an intact ventricular septum as well as those with ventricular septal defects (VSD) need an arterial switch (Jatene) procedure while those with both VSD and pulmonary stenosis should be addressed by Rastelli procedure. These procedures may need to be preceded by prostaglandin infusion and/or balloon atrial septostomy in some babies. Infants with tricuspid atresia require initial palliation either with a modified Blalock-Taussig shunt or banding of the pulmonary artery and subsequent staged Fontan (bidirectional Glenn and fenestrated Fontan with extra-cardiac conduit). Neonates with total anomalous pulmonary venous connection are managed by anastomosis of the common pulmonary vein with the left atrium either electively in non-obstructed types or as an emergency procedure in the obstructed types. Babies with truncus arteriosus are treated by surgical closure of VSD along with right ventricle to pulmonary artery conduit. The other defects, namely, hypoplastic left heart syndrome, pulmonary atresia with intact ventricular septum, double-outlet right ventricle, double-inlet left ventricle and univentricular hearts largely require multistage surgical correction. The currently existing medical, trans-catheter and surgical techniques to manage cyanotic CHD are safe and effective and can be performed at a relatively low risk.
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Affiliation(s)
- P Syamasundar Rao
- University of Texas-Houston McGovern Medical School, Children's Memorial Hermann Hospital, Houston, TX 77030, USA.
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29
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Mastropietro CW, Amula V, Sassalos P, Buckley JR, Smerling AJ, Iliopoulos I, Riley CM, Jennings A, Cashen K, Narasimhulu SS, Narayana Gowda KM, Bakar AM, Wilhelm M, Badheka A, Moser EAS, Costello JM. Characteristics and operative outcomes for children undergoing repair of truncus arteriosus: A contemporary multicenter analysis. J Thorac Cardiovasc Surg 2019; 157:2386-2398.e4. [PMID: 30954295 DOI: 10.1016/j.jtcvs.2018.12.115] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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] [Received: 03/30/2018] [Revised: 11/20/2018] [Accepted: 12/22/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We sought to describe characteristics and operative outcomes of children who underwent repair of truncus arteriosus and identify risk factors for the occurrence of major adverse cardiac events (MACE) in the immediate postoperative period in a contemporary multicenter cohort. METHODS We conducted a retrospective review of children who underwent repair of truncus arteriosus between 2009 and 2016 at 15 centers within the United States. Patients with associated interrupted or obstructed aortic arch were excluded. MACE was defined as the need for postoperative extracorporeal membrane oxygenation, cardiopulmonary resuscitation, or operative mortality. Risk factors for MACE were identified using multivariable logistic regression analysis and reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS We reviewed 216 patients. MACE occurred in 44 patients (20%) and did not vary significantly over time. Twenty-two patients (10%) received postoperative extracorporeal membrane oxygenation, 26 (12%) received cardiopulmonary resuscitation, and 15 (7%) suffered operative mortality. With multivariable logistic regression analysis (which included adjustment for center effect), factors independently associated with MACE were failure to diagnose truncus arteriosus before discharge from the nursery (OR, 3.1; 95% CI, 1.3-7.4), cardiopulmonary bypass duration >150 minutes (OR, 3.5; 95% CI, 1.5-8.5), and right ventricle-to-pulmonary artery conduit diameter >50 mm/m2 (OR, 4.7; 95% CI, 2.0-11.1). CONCLUSIONS In a contemporary multicenter analysis, 20% of children who underwent repair of truncus arteriosus experienced MACE. Early diagnosis, shorter duration of cardiopulmonary bypass, and use of smaller diameter right ventricle-to-pulmonary artery conduits represent potentially modifiable factors that could decrease morbidity and mortality in this fragile patient population.
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Affiliation(s)
- Christopher W Mastropietro
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
| | - Venu Amula
- Division of Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
| | - Peter Sassalos
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich
| | - Jason R Buckley
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC
| | - Arthur J Smerling
- Division of Critical Care, Department of Pediatrics, Columbia University College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York, New York, NY
| | - Ilias Iliopoulos
- Division of Cardiac Critical Care, Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine M Riley
- Division of Cardiac Critical Care, Department of Pediatrics, Children's National Health System, Washington, DC
| | - Aimee Jennings
- Division of Critical Care, Department of Pediatrics, Seattle Children's Hospital, Seattle, Wash
| | - Katherine Cashen
- Division of Critical Care, Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Mich
| | - Sukumar Suguna Narasimhulu
- Division of Cardiac Intensive Care, Department of Pediatrics, University of Central Florida College of Medicine, The Heart Center at Arnold Palmer Hospital for Children, Orlando, Fla
| | | | - Adnan M Bakar
- Division of Cardiac Critical Care, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center of NY, New Hyde Park, NY
| | - Michael Wilhelm
- Division of Cardiac Intensive Care, Department of Pediatrics, University of Wisconsin, Madison, Wis
| | - Aditya Badheka
- Division of Critical Care Medicine, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Elizabeth A S Moser
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, Ind
| | - John M Costello
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
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30
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Kanakis M, Kostolny M. Intracommissural and Intramural Left Coronary Artery in a Neonate With Common Arterial Trunk. World J Pediatr Congenit Heart Surg 2019; 10:101-102. [PMID: 30799712 DOI: 10.1177/2150135118800886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Meletios Kanakis
- 1 Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Martin Kostolny
- 1 Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom.,2 Slovak Medical University, Bratislava, Slovakia
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Abstract
Common arterial trunk (CAT), or truncus arteriosus, is a rare form of cyanotic congenital heart disease and is highly associated with DiGeorge syndrome (microdeletion 22q11.2). Prenatal diagnosis is highly feasible, allowing proper delivery planning and postnatal management. The clinical presentation is highly variable depending on the anatomical variation; however, most commonly presenting with mild cyanosis and significant tachypnea, although these patients can often go undetected in the immediate newborn period. Transthoracic echocardiography is adequate for diagnosis and detailed anatomical delineation in the majority. Additional imaging modalities such as cardiac catheterization, computed tomography angiography, or cardiac magnetic resonance imaging can be helpful in those with more complex pulmonary artery (PA) or aortic anatomy, or in the older repaired. The surgical management of CAT is complete repair in the neonatal period with resection of branch PAs from the CAT with placement of a right ventricular (RV)-to-PA conduit and patch closure of the ventricular septal defect. Overall surgical outcomes are excellent in most centers, with the expectation that the child will eventually outgrow the RV-to-PA conduit and require reoperation. Other potential reoperations or postsurgical interventions in addition to the RV-to-PA conduit may involve the truncal valve or branch PAs.
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Affiliation(s)
| | | | - Sujatha Buddhe
- 1 Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Tarek Alsaied
- 3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin Tretter
- 3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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32
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Akrawinthawong K, Yamada T. Idiopathic ventricular tachycardia originating from the parietal band in a patient with a corrected truncus arteriosus. J Cardiovasc Electrophysiol 2018; 30:267-268. [PMID: 30358014 DOI: 10.1111/jce.13777] [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: 10/14/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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Dimopoulos K, Diller GP, Opotowsky AR, D'Alto M, Gu H, Giannakoulas G, Budts W, Broberg CS, Veldtman G, Swan L, Beghetti M, Gatzoulis MA. Definition and Management of Segmental Pulmonary Hypertension. J Am Heart Assoc 2018; 7:JAHA.118.008587. [PMID: 29973393 PMCID: PMC6064837 DOI: 10.1161/jaha.118.008587] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Biomedical Research Unit, National Heart and Lung Institute Royal Brompton Hospital Imperial College, London, United Kingdom
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Alexander R Opotowsky
- Boston Adult Congenital Heart (BACH) and Pulmonary Hypertension Group, Boston Children's Hospital and Brigham and Women's Hospital Harvard Medical School, Boston, MA
| | - Michele D'Alto
- Department of Cardiology, Monaldi di Hospital - Second University of Naples, Italy
| | - Hong Gu
- Beijing Anzhen Hospital Capital Medical University, Beijing, China
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital Aristotle University of Thessaloniki, Greece
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Craig S Broberg
- Knight Cardiovascular Institute Oregon Health and Science University, Portland, OR
| | - Gruschen Veldtman
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lorna Swan
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Biomedical Research Unit, National Heart and Lung Institute Royal Brompton Hospital Imperial College, London, United Kingdom
| | - Maurice Beghetti
- Paediatric Cardiology Unit, University Hospital of Geneva, Switzerland
| | - Michael A Gatzoulis
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique University of Lausanne, Geneva, Switzerland
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Erek E, Temur B, Suzan D, Aydın S, Yıldız O, Kırat B, Demir İH, Ödemiş E. Outcomes of truncus arteriosus repair with bovine jugular vein conduit. Turk Gogus Kalp Damar Cerrahisi Derg 2018; 26:365-9. [PMID: 32082765 DOI: 10.5606/tgkdc.dergisi.2018.14841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 03/15/2018] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to evaluate the outcomes of truncus arteriosus repair in patients undergoing Rastelli type truncus arteriosus. Methods A total of 13 patients (7 males, 6 females; median age 37 days; range, 16 to 60 days) underwent repair of truncus arteriosus using Contegra conduits between January 2011 and March 2 017. P reoperative d iagnosis w as t runcus a rteriosus type 1 (Edwards-Collett) in eight, type 2 in three, type 3 in one, and type 4 in one patient. Contegra conduits used for operations were 14 mm (n=5), 12 mm (n=7), and 16 mm (n=1). Results Early death was seen in two patients (15.4%). The median intensive care and hospital stays were 10 (range, 6 to 14) and 20 (range, 14 to 41) days, respectively. The median follow-up was 36 (range, 2 to 66) months. In four patients (31%), the conduit sizes severely increased during follow-up and reached 23 mm in two patients and 20 mm in one patient, and 18 mm in the other patient. Three patients had moderate distal conduit stenosis. Moderate pulmonary insufficiency was detected in four patients and severe pulmonary insufficiency in one patient. Two patients had moderate truncal valve insufficiency and one patient had moderate residual ventricular septal defect. None of the patients needed reoperation. Conclusion Contegra conduit is a good alternative for repair of truncus arteriosus in infants; however close follow-up is necessary, as distal conduit stenosis and conduit dilatation may develop.
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Abstract
Truncus arteriosus is a congenital cardiac lesion in which failure of embryonic truncal septation results in a single semilunar valve and single arterial trunk providing both pulmonary and systemic circulations. Most patients with this lesion are symptomatic in the neonatal period with cyanosis and/or congestive heart failure and undergo complete repair in the first weeks of life. This review will focus on the anatomy, physiology, and perioperative anesthetic management of patients with truncus arteriosus.
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Affiliation(s)
| | - Michael Eisses
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA
| | - Gregory J Latham
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA
| | - Denise C Joffe
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA.,4 University of Washington Medical Center, Seattle, WA, USA
| | - Faith J Ross
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA
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36
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Ong CS, Krishnan A, Huang CY, Spevak P, Vricella L, Hibino N, Garcia JR, Gaur L. Role of virtual reality in congenital heart disease. CONGENIT HEART DIS 2018; 13:357-361. [PMID: 29399969 DOI: 10.1111/chd.12587] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 12/24/2017] [Accepted: 12/29/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE New platforms for patient imaging present opportunities for improved surgical planning in complex congenital heart disease (CHD). Virtual reality (VR) allows for interactive manipulation of high-resolution representations of patient-specific imaging data, as a supplement to traditional 2D visualizations and 3D printed heart models. DESIGN We present the novel use of VR for the presurgical planning of cardiac surgery in two infants with complex CHD to demonstrate interactive real-time views of complex intra and extracardiac anatomy. RESULTS The use of VR for cardiac presurgical planning is feasible using existing imaging data. The software was evaluated by both pediatric cardiac surgeons and pediatric cardiologists, and felt to be reliable and operated with a very short learning curve. CONCLUSIONS VR with controller-based interactive capability allows for interactive viewing of 3D models with complex intra and extracardiac anatomy. This serves as a useful complement to traditional preoperative planning methods in terms of its potential for group based collaborative discussion, user defined illustrative views, cost-effectiveness, and facility of use.
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Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aravind Krishnan
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chen Yu Huang
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Philip Spevak
- Department of Art as Applied to Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Luca Vricella
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Narutoshi Hibino
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Juan R Garcia
- Department of Art as Applied to Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lasya Gaur
- Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
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Abstract
Yıldırım SV, Yıldırım A. Truncus arteriosus with double aortic arch: A rare association. Turk J Pediatr 2017; 59: 221-223. Truncus arteriosus (TA) is a congenital heart defect often diagnosed in neonatal period; it represents 0.7% of all congenital heart lesions. The pulmonary arteries originate generally above the coronary ostium. Aorto-pulmonary and interventricular defects are believed to represent an abnormality of conotruncal septation. TA is classified into four types, according to Van Praagh and Colette Edwards. Some of congenital heart defects may be associated with TA, such as aortic interruption. In literature, TA with a double aortic arch is observed as a very rare condition. We present here a newborn diagnosed with a combination of TA type 1 and double aortic arch.
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Affiliation(s)
- Selman Vefa Yıldırım
- Department of Pediatric Cardiology, Near East University Medical Faculty, Nicosia, Cyprus
| | - Ali Yıldırım
- Department of Pediatric, Cardiology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
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Monné Rodríguez JM, Chantrey J, Unwin S, Verin R. Cardiac Truncus Arteriosus in an Eastern Black Rhinoceros (Diceros bicornis michaeli). J Comp Pathol 2017; 157:276-279. [PMID: 29169622 DOI: 10.1016/j.jcpa.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/27/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022]
Abstract
This case report describes congenital truncus arteriosus in a 1-month-old Eastern black rhinoceros (Diceros bicornis michaeli). From the first day of life the animal was underweight and from the 22nd day of life displayed respiratory signs that exacerbated with time leading eventually to collapse and death. Post-mortem examination revealed a single truncus arteriosus originating from the right ventricle leading to two separated pulmonary arteries and the aorta, with the ventricular septum showing a focal communicating defect. Based on the gross examination and current human classifications, the truncus arteriosus was classified as type III or A2. This is the first description of persistent truncus arteriosus in an Eastern black rhinoceros.
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Affiliation(s)
- J M Monné Rodríguez
- Department of Veterinary Pathology and Public Health, Institute of Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, UK; Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 268, Zurich, Switzerland.
| | - J Chantrey
- Department of Veterinary Pathology and Public Health, Institute of Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, UK
| | - S Unwin
- North of England Zoological Society, Chester Zoo, Caughall Road, Upton by Chester, Chester, UK
| | - R Verin
- Department of Veterinary Pathology and Public Health, Institute of Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, UK
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39
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Nabati M. An unusual and rare form of truncus arteriosus in an asymptomatic woman. Ultrasound 2017; 25:251-254. [PMID: 29163663 DOI: 10.1177/1742271x17709853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/21/2017] [Indexed: 11/15/2022]
Abstract
Persistent truncus arteriosus is a rare congenital cardiac malformation. It is characterized by a single great artery arising from the heart which supplies the aorta, the origin of coronary arteries and pulmonary arteries. Without surgery, prognosis is poor and 90% of these patients die before one year of age. We report a rare case of an asymptomatic 35-year-old woman with uncorrected persistent truncus arteriosus and hypoplastic right and left pulmonary arteries. Hypoplastic branch pulmonary arteries prevented the development of severe pulmonary arterial hypertension.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Mazandaran University of Medical Sciences, Sari, Iran
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40
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Marathe SP, Naganur SH, Menon S, Orr Y, Cooper SG, Winlaw DS. An Unusual Combination of Truncus Arteriosus, Interrupted Aortic Arch, and Hypoplastic Left Ventricle. World J Pediatr Congenit Heart Surg 2017; 9:714-717. [PMID: 28925321 DOI: 10.1177/2150135117716886] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Truncus arteriosus (common arterial trunk) is known to be associated with interrupted aortic arch in 10% to 15% of cases. However, the association of either of these lesions with a hypoplastic left ventricle is rare. The combination of all three of these lesions along with an intact interventricular septum is virtually unknown with only two cases reported in the literature. We report such a case with its anatomical and surgical management aspects.
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Affiliation(s)
- Supreet P Marathe
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sanjeev H Naganur
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sabarinath Menon
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Yishay Orr
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 School of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stephen G Cooper
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 School of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David S Winlaw
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 School of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
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41
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Stavsky M, Robinson R, Sade MY, Krymko H, Zalstein E, Ioffe V, Novack V, Levitas A. Elevated birth prevalence of conotruncal heart defects in a population with high consanguinity rate. Cardiol Young 2017; 27:109-16. [PMID: 26979327 DOI: 10.1017/S1047951116000202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aetiology of conotruncal heart defects is poorly understood and the birth prevalence varies geographically. The known risk factors for developing conotruncal heart defects are as follows: CHD in siblings, genetic chromosomal abnormalities, paternal age >30 years, high parity, low birth weight, prematurity, and maternal diabetes. OBJECTIVE The aim of this study was to characterise conotruncal heart defects, birth prevalence, mortality, and morbidity in the population of southern Israel, of whom 75% are Jewish and the rest are mostly Bedouin Arabs. METHODS The data were obtained from Soroka University Medical Center database of births and newborns. Conotruncal heart defects cases were identified by ICD9 codes. RESULTS During 1991-2011, there were 247,290 singleton live births and 393 conotruncal heart defects in Soroka University Medical Center. The birth prevalence per 10,000 live births of tetralogy of Fallot, transposition of the great arteries, and truncus arteriosus was 9.5, 5, and 1.8, respectively. In the multivariate analysis, Bedouin descent (adjusted odds ratio 2.40, p35 years (1.66, p=0.004), and siblings with congenital heart defects (1.98, p=0.005) were associated with tetralogy of Fallot, and Bedouin descent (1.61, p=0.05), siblings with congenital heart defects (2.19, p=0.004), and diabetes mellitus (7.15, p<0.001) were associated with transposition of the great arteries. In a univariate analysis, Bedouin descent (p=0.004) and congenital heart defects in siblings (p<0.001) were associated with truncus arteriosus. CONCLUSION We observed higher birth prevalence of conotruncal heart defects compared with the birth prevalence reported worldwide, specifically among the Bedouins, a population characterised with high consanguinity rate. Therefore, genetic counselling and early fetal echocardiograms should be encouraged, especially in high consanguinity rate populations. Naturally, further educational efforts are needed in order to decrease consanguinity and its related consequences.
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Biglino G, Moharem-Elgamal S, Lee M, Tulloh R, Caputo M. The Perception of a Three-Dimensional-Printed Heart Model from the Perspective of Different Stakeholders: A Complex Case of Truncus Arteriosus. Front Pediatr 2017; 5:209. [PMID: 29034225 PMCID: PMC5626947 DOI: 10.3389/fped.2017.00209] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 08/02/2017] [Accepted: 09/15/2017] [Indexed: 12/03/2022] Open
Abstract
The case of an 11-year-old male patient with truncus arteriosus is presented. The patient has a right aortic arch, a repaired truncus arteriosus, pulmonary artery stenosis, as well as conduit stenosis, with a complex surgical plan being discussed. In order to gather additional insight into the patient's anatomy prior to the surgery and to facilitate communication with the patient's parents, a three-dimensional (3D) model of his heart and main vessels was created from computed tomography data. Feedback was collected from different stakeholders. The patient and his parents were both struck by the size of the heart, with the parents further elaborating on how the 3D model was more intuitive a tool than medical images as well as "an helpful talking point to the other members of the family" and potentially also at school. The surgeon and cardiologist commented on gaining better understanding of the 3D relationship between a markedly narrowed right pulmonary artery and the aorta, with the surgeon ultimately coming to a decision of dividing the ascending aorta quite high to access the right pulmonary artery for patch reconstruction and thus planning to arrest the circulation beforehand. The imaging expert remarked on the potential to "improve communication in multidisciplinary meetings," while a medical trainee, who also had a chance to evaluate the model, remarked that "having the model in front of me and being able to see the exact abnormality makes this particular case much more memorable. […] 3D printed models could have immense potential in pathology and anatomy teaching for the training of healthcare professionals."
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Affiliation(s)
- Giovanni Biglino
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Sarah Moharem-Elgamal
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.,University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom.,National Heart Institute, Giza, Egypt
| | - Matthew Lee
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Robert Tulloh
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.,University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Massimo Caputo
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.,University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
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43
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Ramírez-Marroquín S, Curi-Curi PJ, Calderón-Colmenero J, García-Montes JA, Cervantes-Salazar JL. Common Arterial Trunk Repair by Means of a Handmade Bovine Pericardial-Valved Woven Dacron Conduit. World J Pediatr Congenit Heart Surg 2016; 8:69-76. [PMID: 28033080 DOI: 10.1177/2150135116674439] [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: 11/15/2022]
Abstract
BACKGROUND Surgical repair of common arterial trunk (CAT) by means of a homograft conduit has become a standard practice. We report our experience in the correction of this heart disease with a handmade bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early, mid-term, and long-term results. METHODS We designed a retrospective study that included 15 patients with a mean age of 1.5 years (range: three months to eight years), who underwent primary repair of simple CAT. Right ventricular outflow tract was reconstructed in all the cases with this handmade graft that was explanted at the time of its biological stenotic degeneration. A peeling procedure was performed at this time, in order to reconstruct the right ventricle-to-pulmonary artery continuity. RESULTS Overall mortality was 13.3% (one death at the early postoperative primary repair and the other at the mid-term postoperative peeling reoperation). Actuarial survival rate was 93.3%, 86.7%, and 86.7% at 5, 10, and 15 years, respectively. All of the 14 survivors developed stenosis of the handmade conduit at the mid-term period (8 ± 3 years), but after the peeling procedure, 13 survivors remain asymptomatic to date. CONCLUSIONS Primary repair of common arterial trunk using a handmade conduit can be performed with very low perioperative mortality and satisfactory mid-term and long-term results, which can be favorably compared with those reported with the use of homografts. When graft obstruction develops, peeling procedure is a good option because it does not affect the overall survival, although long-term outcomes warrant further follow-up.
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Affiliation(s)
- Samuel Ramírez-Marroquín
- 1 Department of Pediatric Cardiac and Congenital Heart Disease Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Pedro José Curi-Curi
- 1 Department of Pediatric Cardiac and Congenital Heart Disease Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan Calderón-Colmenero
- 2 Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - José Antonio García-Montes
- 2 Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Jorge Luis Cervantes-Salazar
- 1 Department of Pediatric Cardiac and Congenital Heart Disease Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Abstract
An intramural coronary artery in the setting of truncus arteriosus (common arterial trunk) is an uncommon association. Following an uneventful surgical repair, a neonate developed a low cardiac output state deteriorating into cardiac arrest shortly after arrival into the intensive care unit, requiring extracorporeal membrane oxygenation support. Echocardiography and angiography showed occlusion of the left coronary artery, prompting emergency surgical reexploration. A "slit-like" orifice with an intramural left coronary artery was successfully unroofed, allowing full recovery. Full definition of the proximal coronary anatomy beyond the orifices should be investigated preoperatively in truncus arteriosus, as a missed intramural segment could lead to significant morbidity or mortality.
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Affiliation(s)
- Nabil Hussein
- 1 East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Simone Speggiorin
- 1 East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Frances Bu'Lock
- 1 East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Antonio F Corno
- 1 East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, United Kingdom
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45
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Abstract
Thoracic aortic dilation (AD) has commonly been described in conotruncal defects (CTDs), such as tetralogy of Fallot, double outlet right ventricle and transposition of the great arteries, and truncus arteriosus. Several theories for this have been devised, but fairly recent data indicate that there is likely an underlying histologic abnormality, similar to that seen in Marfan and other connective tissue disease. The majority of aortic dissection in the general population occurs after the age of 45 years, and there have been very few case reports of aortic dissection in CTD. Given advances in cardiac surgery and increasing survival over the past several decades, there has been rising concern that, as patients who have survived surgical correction of these defects age, there may be increased morbidity and mortality due to aortic dissection and aortic regurgitation. This review discusses the most recent developments in research into AD in CTD, including associated genetic mutations.
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Affiliation(s)
- W Aaron Kay
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine , Indianapolis, IN , USA
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46
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Justice L, Ellis M, St George-Hyslop C, Donnellan A, Trauth A, Drouillard B, Watt C, Callow L. Utilizing the PCICS Nursing Guidelines in Managing the CICU Patient. World J Pediatr Congenit Heart Surg 2016; 6:604-15. [PMID: 26467875 DOI: 10.1177/2150135115593131] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Pediatric Cardiac Intensive Care Society (PCICS) Nursing Guidelines were developed to provide an evidence-based resource for bedside cardiac intensive care unit nursing care. Guideline topics include postoperative care, hemodynamic monitoring, arrhythmia management, and nutrition. These evidence-based care guidelines were presented at the 10th International Meeting of PCICS and have been utilized in the preparation of this article. They can be accessed at http://www.pcics.org/resources/pediatric-neonatal/. Utilization of these guidelines in practice is illustrated for single ventricle stage 1 palliation, Fontan operation, truncus arteriosus, and atrioventricular septal defect.
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Affiliation(s)
- Lindsey Justice
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Misty Ellis
- Department of Pediatric Critical Care, University of Louisville, Kosair Children's Hospital, Louisville, KY, USA
| | - Cecilia St George-Hyslop
- Department of Cardiac Critical Care. Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amy Donnellan
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amiee Trauth
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brenda Drouillard
- Department of Cardiac Critical Care. Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire Watt
- Department of Cardiac Critical Care. Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Louise Callow
- Michigan Congenital Heart Center, University of Michigan, CS Mott Children's Hospital, Ann Arbor, MI, USA
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47
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Zeng Z, Zhang H, Liu F, Zhang N. Current diagnosis and treatments for critical congenital heart defects. Exp Ther Med 2016; 11:1550-1554. [PMID: 27168772 PMCID: PMC4840484 DOI: 10.3892/etm.2016.3167] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/15/2016] [Indexed: 12/11/2022] Open
Abstract
Congenital heart defects (CHD) affect approximately 7% of infants, and account for 3% of all infant deaths. CHD is most often caused by the defects associated with ductus arteriosus, which is a vessel that usually closes shortly after birth. The types of CHD include tetralogy of fallot, hypoplastic left heart syndrome, pulmonary atresia, total anomalous pulmonary venous return, transposition of great arteries, tricuspid atresia and truncus arteriosus. There are some risk factors that can increase the chance of a fetus developing CHD such as prematurity, an existing CHD in a first-degree relative, genetic syndromes, infections in utero, maternal drug consumptions and disorders. CHD is diagnosed is through different techniques including pulse oximetry, echocardiograms and physical exams. In this review, we examined the current incidence of CHD, the risk factors associated with CHD, the current methods of diagnosis and surgical options used to repair the defects.
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Affiliation(s)
- Zhandong Zeng
- Department of Pediatric Surgery, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Hongwei Zhang
- Department of Pediatric Surgery, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Fengli Liu
- Department of Pediatric Surgery, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Ning Zhang
- Department of Pediatric Surgery, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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48
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Peterson RE, Haynes SE. Complete Atrioventricular Septal Defect with Truncus Arteriosus and Interrupted Aortic Arch in the Fetus. Echocardiography 2016; 33:939-942. [PMID: 26910376 DOI: 10.1111/echo.13200] [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: 11/28/2022] Open
Abstract
Complete atrioventricular septal defect is generally diagnosed on the four-chamber view of the fetal heart. This defect can be accompanied by additional outflow tract lesions, including truncus arteriosus. Although truncus arteriosus in isolation can be associated with interrupted aortic arch, we describe a fetal case with the rare association of all three diagnoses: complete atrioventricular septal defect with truncus arteriosus and interrupted aortic arch. This case points to the importance of evaluating the complete fetal heart even after one congenital cardiac abnormality is noted. The complexity of heart disease has implications for prenatal counseling and postnatal management.
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Affiliation(s)
- Renuka E Peterson
- Division of Cardiology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Susan E Haynes
- Division of Cardiology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
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49
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Rodríguez H, Montero H, Fernández A, Guzman A, Sessa TD. Surgical Correction of Truncus Arteriosus With Unusual Origin of the Right Coronary Artery. World J Pediatr Congenit Heart Surg 2016; 7:407-10. [PMID: 26795902 DOI: 10.1177/2150135115596585] [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] [Received: 04/21/2015] [Accepted: 06/22/2015] [Indexed: 11/17/2022]
Abstract
An 11-year-old male with a diagnosis of truncus arteriosus (common arterial trunk) with origin of the right coronary artery anteriorly from the pulmonary segment of the common trunk underwent reparative surgery. The pulmonary trunk was long, and it had a kink with stenosis that protected the distal pulmonary vascular bed from elevated pressure. Adequate flow allowed well-developed distal branch pulmonary arteries. An oval incision was made in the pulmonary trunk, which created a flap. At its center was the right coronary artery. This flap, which remained attached to the aorta proximally, was then used to close the aortic defect. The segment of the pulmonary trunk with stenosis was resected. The patient's pericardium was used to fashion a valved conduit that was interposed between the right ventricle and the confluence of the pulmonary artery branches.
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Affiliation(s)
| | - Hernán Montero
- Hospital Del Nino Francisco de Icaza Bustamante, Guayaquil, Ecuador
| | | | - Armando Guzman
- The William Novick Global Cardiac Alliance, Memphis, TN, USA
| | - Thomas Di Sessa
- The William Novick Global Cardiac Alliance, Memphis, TN, USA Department of Pediatrics (Cardiology), University of Kentucky, Lexington, KY, USA
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Traisrisilp K, Tongprasert F, Srisupundit K, Luewan S, Sukpan K, Tongsong T. Prenatal differentiation between truncus arteriosus (Types II and III) and pulmonary atresia with ventricular septal defect. Ultrasound Obstet Gynecol 2015; 46:564-570. [PMID: 25594532 DOI: 10.1002/uog.14788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/05/2015] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe antenatal sonographic signs that help in the differentiation of truncus arteriosus Types II and III (TA-II/III) from pulmonary atresia with ventricular septal defect (PA-VSD). METHODS From a database of fetal echocardiographic examinations, we identified fetuses with sonographic features of a single great artery with VSD and relatively normal four-chamber view. Records were reviewed, comparing fetuses with TA-II/III and those with PA-VSD, with particular focus on: 1) characteristics of the overriding vessel, 2) appearance of the semilunar valves, 3) competence of the semilunar valves, 4) presence of major aortopulmonary collateral arteries (MAPCA), 5) main pulmonary artery being without antegrade flow, 6) site of arterial branching from the great artery and 7) other minor features, such as cardiac axis or associated anomalies. RESULTS Seventeen fetuses were identified, eight with TA-II/III and nine with PA-VSD. Among the eight fetuses with TA-II/III, seven had abnormal valves and six had valve regurgitation, compared with none of the nine PA-VSD fetuses. Five TA-II/III fetuses had early branching to supply the lungs, whereas most fetuses with PA-VSD had more distal branching. Notably, in six of the TA-II/III fetuses, the root of the single great artery originated predominantly from the right ventricle, while all but one of the PA-VSD fetuses had typical equal overriding of the VSD. The main pulmonary artery was without antegrade flow in two cases with PA-VSD. Finally, four cases with PA-VSD had MAPCA, in two of which this was identified prenatally. CONCLUSION Identification of abnormal arterial valves or valve regurgitation, site of origin of branching, presence of overriding of the great artery, a main pulmonary artery without antegrade flow and MAPCA are helpful in differentiating between TA-II/III and PA-VSD.
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Affiliation(s)
- K Traisrisilp
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
| | - F Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
| | - K Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
| | - S Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
| | - K Sukpan
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Thailand
| | - T Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
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