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Guthrie S, Bienkowska-Gibbs T, Manville C, Pollitt A, Kirtley A, Wooding S. The impact of the National Institute for Health Research Health Technology Assessment programme, 2003-13: a multimethod evaluation. Health Technol Assess 2016; 19:1-291. [PMID: 26307643 DOI: 10.3310/hta19670] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact. METHODS Interviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research. RESULTS We make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence - its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers - the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality - the Health Technology Assessment journal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine - it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.
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Zhang D, Cui H, Zhang L, Huang Y, Zhu J, Li X. Is maternal smoking during pregnancy associated with an increased risk of congenital heart defects among offspring? A systematic review and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2016; 30:645-657. [PMID: 27126055 DOI: 10.1080/14767058.2016.1183640] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the association between maternal smoking during pregnancy and risk of congenital heart defects (CHDs) among offspring. METHODS PubMed, EMBASE, and Web of Science were searched for eligible studies. The outcomes of interest included risk of any CHD and nine subtypes. We summarized study characteristics and used a random-effects model in meta-analysis, and a two-stage dose-response model was utilized to assess the association between smoking consumption and risk. Statistical heterogeneity was assessed by a chi-squared test of the Cochrane Q statistic and I-squared value. Publication bias was assessed by funnel plots and Egger's test, and trim and fill method was utilized when publication bias existed. RESULTS Forty-three observational epidemiologic studies were included. The pooled risk ratio (RR) of any CHD was 1.11 (95% CI: 1.04, 1.18), but it exhibited substantial statistical heterogeneity (p < 0.001, I2 = 69.0%). In sensitivity analysis, we observed significant associations for atrial septal defect (ASD) and marginally significant associations for septal defects (SPD). The two-stage dose-response analysis showed evidence to support that higher levels of tobacco smoke was associated with an increased risk of septal defects, particularly for ASD and VSD (ventricular septal defect). CONCLUSION Our study presents evidence to support the cardiovascular teratogenic effect of maternal smoking during pregnancy, and their offspring may suffer from approximately a 10% relative increase in the risk of CHDs on average.
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Affiliation(s)
- Dongyu Zhang
- a Department of Epidemiology , University of North Carolina at Chapel Hill Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Hao Cui
- b Department of Health , Zhuhai Maternity and Child Health Hospital , Zhuhai , Guangdong , China
| | | | - Yanjie Huang
- d Department of Health Policy and Management , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | - Jun Zhu
- e National Office for Maternal and Child Health Surveillance of China, West China Second Hospital, Sichuan University , Chengdu , Sichuan , China , and
| | - Xiaohong Li
- f National Center for Birth Defects Monitoring of China, West China Second Hospital, Sichuan University , Chengdu , Sichuan , China
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Wang D, Fang J, Wang R, Sun D, Xia K, Yin W, Zhang S, Sun L. Elevated serum ghrelin, tumor necrosis factor-α and interleukin-6 in congenital heart disease. Pediatr Int 2016; 58:259-64. [PMID: 26256999 DOI: 10.1111/ped.12773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/26/2015] [Accepted: 07/28/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association of congenital heart disease (CHD) with serum ghrelin, tumor necrosis factor-α (TNF-α) and interleukin (IL)-6. METHOD Sixty-three children with CHD, hospitalized between January 2012 and September 2014 at Wuhan Women and Children's Health Care Center, were selected as the study group. Additionally, 28 healthy individuals who had physical examinations at this hospital were selected as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum ghrelin, TNF-α and IL-6. SPSS 18.0 and Comprehensive Meta-analysis 2.0 were used for data analysis. RESULTS There was significant difference in weight, height and body mass index (BMI; all P < 0.05) but not in age or sex (both P > 0.05) between the cyanotic CHD (CCHD), acyanotic CHD (ACHD) and control groups. On one-way analysis of variance serum ghrelin, TNF-α and IL-6 in both the CCHD and ACHD groups had a tendency to be higher compared with the control group (all P < 0.05), whereas, on Pearson correlation analysis, there was a correlation between serum ghrelin and BMI (all P < 0.05), and TNF-α was negatively, and IL-6 positively, correlated with BMI (all P < 0.05). Meta-analysis further demonstrated that serum ghrelin, TNF-α and IL-6 in both the CCHD and ACHD groups were higher than in the control group (all P < 0.05). CONCLUSION Serum ghrelin, TNF-α and IL-6 are elevated in children with CHD, and may play a role in the development and progression of CHD.
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Affiliation(s)
- Dandan Wang
- Department of Cardiovascular Medicine, Wuhan Women and Children's Health Care Center, Wuhan, China
| | - Jian Fang
- Department of Nephrology, Wuhan Women and Children's Health Care Center, Wuhan, China
| | - Ruigeng Wang
- Department of Cardiovascular Medicine, Wuhan Women and Children's Health Care Center, Wuhan, China
| | - Dongming Sun
- Department of Cardiovascular Medicine, Wuhan Women and Children's Health Care Center, Wuhan, China
| | - Kun Xia
- Department of Cardiovascular Medicine, Wuhan Women and Children's Health Care Center, Wuhan, China
| | - Wei Yin
- Department of Cardiovascular Medicine, Wuhan Women and Children's Health Care Center, Wuhan, China
| | - Sai Zhang
- Outpatient Department of Pediatrics, No.1 Hospital of Jilin University, Changchun, China
| | - Liqun Sun
- Outpatient Department of Pediatrics, No.1 Hospital of Jilin University, Changchun, China
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Corno AF. Paediatric and congenital cardiac surgery in emerging economies: surgical 'safari' versus educational programmes. Interact Cardiovasc Thorac Surg 2016; 23:163-7. [PMID: 27001675 DOI: 10.1093/icvts/ivw069] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/22/2016] [Indexed: 11/14/2022] Open
Abstract
To attract the interest of all people potentially involved in humanitarian activities in the emerging economies, in particular giving attention to the basic requirements of the organization of paediatric cardiac surgery activities, the requirements for a successful partnership with the local existing organizations and the basic elements of a patient-centred multidisciplinary integrated approach. Unfortunately, for many years, the interventions in the low and middle income countries were largely limited to short-term medical missions, not inappropriately nicknamed 'surgical safari', because of negative general and specific characteristics. The negative aspects and the limits of the short-term medical missions can be overcome only by long-term educational programmes. The most suitable and consistent models of long-term educational programmes have been combined and implemented with the personal experience to offer a proposal for a long-term educational project, with the following steps: (i) site selection; (ii) demographic research; (iii) site assessment; (iv) organization of surgical educational teams; (v) regular frequency of surgical educational missions; (vi) programme evolution and maturation; (vii) educational outreach and interactive support. Potential limits of a long-term educational surgical programme are: (i) financial affordability; (ii) basic legal needs; (iii) legal support; (iv) non-profit indemnification. The success should not be measured by the number of successful operations of any given mission, but by the successful operations that our colleagues perform after we leave. Considering that the children in need outnumber by far the people able to provide care, in this humanitarian medicine there should be plenty of room for cooperation rather than competition. The main goal should be to provide teaching to local staff and implement methods and techniques to support the improvement of the care of the patients in the long run. This review focuses on the organization of paediatric cardiac activities in the emerging economies, but 'the less privileged parts of the world' can be anywhere, not necessarily limited to economic constraints. Lack of diversity because of social, intellectual, educational and professional growth, the last consisting in cultural stagnation, is responsible for the lack of scientific progress and development.
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Abstract
Surgery is increasingly recognized as an essential component of global health development. This article will review the state of global pediatric surgery, utilizing congenital anomalies as a framework in which to discuss the promise of pediatric surgery in reducing the global burden of disease. Congenital anomalies are responsible for a substantial burden of morbidity and mortality in low- and middle-income countries (LMICs), as well as significant emotional and economic harms to the families of children with congenital anomalies. Limited pediatric surgical capacity in many LMICs has culminated in a devastating burden of avertable disability and death. Pediatric surgery is an effective and cost-effective means to reduce this burden. Pediatric surgeons must continue to drive the growth of global pediatric surgery by engaging in clinical practice, educational partnerships, and research initiatives.
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Affiliation(s)
| | - Diana L Farmer
- Department of Surgery, University of California, Davis, 2221 Stockton Blvd, Suite 3112, Sacramento, CA; UC Davis Children's Hospital, UC Davis Health System, Sacramento, CA; UC Davis School of Medicine, Sacramento, CA.
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Global Epidemiology and Incidence of Cardiovascular Disease. CARDIOVASCULAR DISEASES 2016. [DOI: 10.1016/b978-0-12-803312-8.00004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Quality of Life of Children with Congenital Heart Diseases: A Multicenter Controlled Cross-Sectional Study. Pediatr Cardiol 2015; 36:1588-601. [PMID: 26024647 DOI: 10.1007/s00246-015-1201-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/06/2015] [Indexed: 12/17/2022]
Abstract
To assess the health-related quality of life (QoL) in children with congenital heart diseases (CHD) with a validated questionnaire in comparison with control children. We prospectively recruited 282 children with CHD aged from 8 to 18 years in two tertiary care centers (France and Belgium) and 180 same-age controls in randomly selected French schools. Children's QoL was self-reported with the KIDSCREEN-52 questionnaire and reported by parents with the KIDSCREEN-27. QoL scores of each dimension were compared between CHD and controls and between the classes of disease severity. Both centers were comparable for most demographic and clinical data. Age- and gender-adjusted self-reported QoL scores were lower in CHD children than in controls for physical well-being (mean ± SEM 45.97 ± 0.57 vs 50.16 ± 0.71, p < 0.0001), financial resources (45.72 ± 0.70 vs 48.85 ± 0.87, p = 0.01), peers/social support (48.01 ± 0.72 vs 51.02 ± 0.88, p = 0.01), and autonomy in the multivariate analysis (47.63 ± 0.69 vs 49.28 ± 0.85, p = 0.04). Parents-reported scores were lower in CHD children for physical (p < 0.0001), psychological well-being (p = 0.04), peers/social support (p < 0.0001), and school environment (p < 0.0001) dimensions. Similarly, the disease severity had an impact on physical well-being (p < 0.001), financial resources (p = 0.05), and peers/social support (p = 0.01) for self-reported dimensions, and on physical well-being (p < 0.001), psychological well-being (p < 0.01), peers/social support (p < 0.001), and school environment (p < 0.001) for parents-reported dimensions. However, in multivariate analysis on self-reported QoL, disease severity was significantly associated with the self-perception dimension only. Self-reported QoL of CHD children was similar to that of same-age healthy children in seven of 10 dimensions, but parents-reported QoL was impaired in four of five dimensions.
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Ozolinš TRS, Weston AD, Perretta A, Thomson JJ, Brown NA. Dimethadione embryotoxicity in the rat is neither correlated with maternal systemic drug concentrations nor embryonic tissue levels. Toxicol Appl Pharmacol 2015; 289:89-97. [PMID: 26375719 DOI: 10.1016/j.taap.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/09/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
Pregnant rats treated with dimethadione (DMO), the N-demethylated metabolite of the anticonvulsant trimethadione, produce offspring having a 74% incidence of congenital heart defects (CHD); however, the incidence of CHD has high inter-litter variability (40-100%) that presents a challenge when studying the initiating events prior to the presentation of an abnormal phenotype. We hypothesized that the variability in CHD incidence was the result of differences in maternal systemic concentrations or embryonic tissue concentrations of DMO. To test this hypothesis, dams were administered 300 mg/kg DMO every 12h from the evening of gestational day (GD) 8 until the morning of GD 11 (six total doses). Maternal serum levels of DMO were assessed on GD 11, 12, 13, 14, 15, 18 and 21. Embryonic tissue concentrations of DMO were assessed on GD 11, 12, 13 and 14. In a separate cohort of GD 12 embryos, DMO concentrations and parameters of growth and development were assessed to determine if tissue levels of DMO were correlated with these endpoints. Embryos were exposed directly to different concentrations of DMO with whole embryo culture (WEC) and their growth and development assessed. Key findings were that neither maternal systemic concentrations nor tissue concentrations of DMO identified embryos that were sensitive or resistant to DMO in vivo. Direct exposure of embryos to DMO via WEC also failed to show correlations between embryonic concentrations of DMO with developmental outcomes in vitro. We conclude that neither maternal serum nor embryonic tissue concentrations of DMO predict embryonic outcome.
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Affiliation(s)
- Terence R S Ozolinš
- Department of Biomedical and Molecular Sciences, Program in Pharmacology and Toxicology, Queen's University, Botterell Hall, Kingston, ON K7L 3N6, Canada.
| | - Andrea D Weston
- Currently at Applied Biotechnology/Lead Discovery, Bristol-Myers Squibb, 5 Research Pkwy Wallingford, CT 06492-1996, USA
| | - Anthony Perretta
- Currently at Pfizer Research and Development, Eastern Point Road, Groton, CT 06340, USA
| | - Jason J Thomson
- Currently at Yale Stem Cell Center, Yale School of Medicine, PO Box 208073, New Haven, CT 06520-8073, USA
| | - Nigel A Brown
- Division of Basic Medical Sciences, St. George's University of London, UK SW17 0RE
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Evaluation of regulatory genetic variants in POU5F1 and risk of congenital heart disease in Han Chinese. Sci Rep 2015; 5:15860. [PMID: 26507003 PMCID: PMC4623744 DOI: 10.1038/srep15860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022] Open
Abstract
OCT4 is a transcription factor of the POU family, which plays a key role in embryonic development and stem cell pluripotency. Previous studies have shown that Oct4 is required for cardiomyocyte differentiation in mice and its depletion could result in cardiac morphogenesis in embryo. However, whether the genetic variations in OCT4 coding gene, POU5F1, confer the predisposition to congenital heart disease (CHD) is unclear. This study sought to investigate the associations between low-frequency (defined here as having minor allele frequency (MAF) between 0.1%–5%) and rare (MAF below 0.1%) variants with potential function in POU5F1 and risk of CHD. We conducted association analysis in a two-stage case-control study with a total of 2,720 CHD cases and 3,331 controls in Chinese. The low-frequency variant rs3130933 was observed to be associated with a significantly increased risk of CHD [additive model: adjusted odds ratio (OR) = 2.15, adjusted P = 3.37 × 10−6]. Furthermore, luciferase activity assay showed that the variant A allele led to significantly lower expression levels as compared to the G allele. These findings indicate for the first time that low-frequency functional variant in POU5F1 may contribute to the risk of congenital heart malformations.
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Nguyen N, Pezzella AT. Pediatric cardiac surgery in low- and middle-income countries or emerging economies: a continuing challenge. World J Pediatr Congenit Heart Surg 2015; 6:274-83. [PMID: 25870347 DOI: 10.1177/2150135115574312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas. A contemporary review of past and present initiatives is presented with a subsequent focus on the more challenging areas.
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Affiliation(s)
- Nguyenvu Nguyen
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Mattos SDS, Hazin SMV, Regis CT, Soares de Araújo JS, Albuquerque FCDL, Moser LRDN, Hatem TDP, Gomes de Freitas CP, Mourato FA, Tavares TR, Gomes RGS, Severi R, Santos CR, Ferreira da Silva J, Rezende JL, Vieira PC, de Lima Filho JL. A telemedicine network for remote paediatric cardiology services in north-east Brazil. Bull World Health Organ 2015; 93:881-7. [PMID: 26668441 PMCID: PMC4669725 DOI: 10.2471/blt.14.148874] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 12/21/2022] Open
Abstract
Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.
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Affiliation(s)
- Sandra da Silva Mattos
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Cláudio Teixeira Regis
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | | | | | - Thamine de Paula Hatem
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Felipe Alves Mourato
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Thiago Ribeiro Tavares
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Rossana Severi
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Cícera Rocha Santos
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Juliana Landim Rezende
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Paulo Coelho Vieira
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - José Luiz de Lima Filho
- Laboratório de Imunopatologia Keiso Asami, Universidade Federal de Pernambuco, Recife, Brazil
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Lee YS, Jeng MJ, Tsao PC, Soong WJ, Chou P. Prognosis and Risk Factors for Congenital Airway Anomalies in Children with Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan. PLoS One 2015; 10:e0137437. [PMID: 26334302 PMCID: PMC4559478 DOI: 10.1371/journal.pone.0137437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/26/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The mortality risk associated with congenital airway anomalies (CAA) in children with congenital heart disease (CHD) is unclear. This study aimed to investigate the factors associated with CAA, and the associated mortality risk, among children with CHD. METHODS This nationwide, population-based study evaluated 39,652 children with CHD aged 0-5 years between 2000 and 2011, using the Taiwan National Health Insurance Research Database (NHIRD). We performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses of the data. RESULTS Among the children with CHD, 1,591 (4.0%) had concomitant CAA. Children with CHD had an increased likelihood of CAA if they were boys (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.33-1.64), infants (OR, 5.42; 95%CI, 4.06-7.24), or had a congenital musculoskeletal anomaly (OR, 3.19; 95%CI, 2.67-3.81), and were typically identified 0-3 years after CHD diagnosis (OR, 1.33; 95%CI 1.17-1.51). The mortality risk was increased in children with CHD and CAA (crude hazard ratio [HR], 2.05; 95%CI, 1.77-2.37), even after adjusting for confounders (adjusted HR, 1.76; 95%CI, 1.51-2.04). Mortality risk also changed by age and sex (adjusted HR and 95%CI are quoted): neonates, infants, and toddlers and preschool children, 1.67 (1.40-2.00), 1.93 (1.47-2.55), and 4.77 (1.39-16.44), respectively; and boys and girls, 1.62 (1.32-1.98) and 2.01 (1.61-2.50), respectively. CONCLUSION The mortality risk is significantly increased among children with CHD and comorbid CAA. Clinicians should actively seek CAA during the follow-up of children with CHD.
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Affiliation(s)
- Yu-Sheng Lee
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Mei-Jy Jeng
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Pei-Chen Tsao
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jue Soong
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail: (WJS); (PC)
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail: (WJS); (PC)
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Webb G, Mulder BJ, Aboulhosn J, Daniels CJ, Elizari MA, Hong G, Horlick E, Landzberg MJ, Marelli AJ, O'Donnell CP, Oechslin EN, Pearson DD, Pieper EP, Saxena A, Schwerzmann M, Stout KK, Warnes CA, Khairy P. The care of adults with congenital heart disease across the globe: Current assessment and future perspective. Int J Cardiol 2015; 195:326-33. [DOI: 10.1016/j.ijcard.2015.04.230] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/29/2015] [Indexed: 11/30/2022]
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Prevalence of Congenital Heart Disease in Xinjiang Multi-Ethnic Region of China. PLoS One 2015; 10:e0133961. [PMID: 26317413 PMCID: PMC4552834 DOI: 10.1371/journal.pone.0133961] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/03/2015] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence and risk factors of congenital heart disease among Xinjiang, northwestern part of China is currently unknown. Methods This multiple-ethnic, community-based, cross-sectional study was conducted to estimate the prevalence and distribution of congenital heart disease (CHD) in Xinjiang, northwestern part of China. Four major ethnics, Uygur, Han, Kazak, and Hui children in this region were investigated during February 2010 and May 2012. Results A total of 14,530 children (0–18 yr) were examined. Of these children, 240 (boys, 43.8%, and girls, 56.3%) were identified with CHD, giving an overall prevalence of 16.5‰ (17.7‰ in Uygur, 6.9‰ in Han, 11.4‰ in Kazak, and 38.1‰ in Hui Chinese, respectively). Ventricular septal defect (VSD, 29.2%), atrial septal defect (ASD, 20.8%), patent ductus arteriosus (PDA, 13.7%), acleistocardia (13.7%), Bicuspid aortic valve (7.9%), pulmonary valve stenosis (5.4%), and tetralogy of fallot (TOF, 4.2%) were common cyanotic and cyanotic defects observed. Compared to non-CHD children, children with CHD had a higher percentage of history of abortion, CHD history of family, consanguinity and premature birth (all P<0.05). In CHD children, 24% of mothers caught a cold, 10% had a febrile illness and 6.7% received antibiotic treatment during the first trimester of pregnancy, that were higher than non-CHD group (all P<0.05). Conclusion The overall prevalence of CHD in four ethnic children at ages 0–18 yr in Xinjiang was 16.5‰. VSD, ASD and TOF were the most common acyanotic and cyanotic congenital heart defects, respectively. This study also identified some modifiable risk factors that may contribute to the incidence of CHD among the 4 ethnic groups.
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Kehler L, Biro O, Lazar L, Rigo J, Nagy B. Elevated hsa-miR-99a levels in maternal plasma may indicate congenital heart defects. Biomed Rep 2015; 3:869-873. [PMID: 26623032 DOI: 10.3892/br.2015.510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/04/2015] [Indexed: 01/16/2023] Open
Abstract
The current standard for prenatal screening is mostly based on biochemical marker tests and the use of ultrasonography. There is no secure stand-alone screening marker for congenital heart defects (CHDs). MicroRNAs (miRNAs) that are associated with cardiogenesis enter the maternal peripheral bloodstream during pregnancy and allow non-invasive prenatal testing (NIPT). The present study investigated the plasma expression profile of fetal hsa-miR-99a in maternal blood. Peripheral blood samples were collected from 39 pregnant patients, comprising 22 with CHD-positive fetuses and 17 with CHD-free controls. miRNAs were isolated from the maternal serum and reverse transcription-quantitative polymerase chain reaction was carried out to determine the expression of hsa-miR-99a. While the miRNA concentrations were almost identical among the affected and control groups (5.54 vs. 6.40 ng/µl), significantly upregulated hsa-miR-99a levels were identified in the affected group (1.78×10-2±3.53×10-2 vs. 1.09×10-3±3.55×10-3 ng/µl, P=0.038). In conclusion, according to the present study, hsa-miR-99a is involved in cardiac malformation and may serve as a biomarker during fetal development, and therefore presents as a candidate for monitoring cardiomyogenesis and potential use as a NIPT-biomarker for fetal CHD.
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Affiliation(s)
- Lars Kehler
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Orsolya Biro
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Levente Lazar
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Janos Rigo
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
| | - Balint Nagy
- First Department of Obstetrics and Gynecology, Semmelweis University Budapest, H-1088 Budapest, Hungary
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Riveros R, Riveros-Perez E. Perioperative Considerations for Children With Right Ventricular Dysfunction and Failing Fontan. Semin Cardiothorac Vasc Anesth 2015; 19:187-202. [PMID: 26287019 DOI: 10.1177/1089253215593178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The survival of patients with congenital heart diseases (CHD) has increased in the past decades, resulting in the identification of new characteristics of chronic comorbidities observed in pediatric and adults with CHD. Patients with CHD can present with a broad clinical spectrum of manifestations of congestive heart failure (CHF) at any point throughout their lives that may be related to anatomical or surgical variables. This article focuses on the perioperative assessment of patients with CHD and CHF, with an emphasis on pathophysiologic, diagnostic, and therapeutic alternatives in patients with right ventricular failure and failing Fontan circulation. We also provide descriptions of the effects of sedatives and anesthetics commonly used in this population in diagnostic or invasive procedures.
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219
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Association analysis identifies new risk loci for congenital heart disease in Chinese populations. Nat Commun 2015; 6:8082. [PMID: 26283027 DOI: 10.1038/ncomms9082] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 07/15/2015] [Indexed: 01/08/2023] Open
Abstract
Our previous genome-wide association study (GWAS) identified two susceptibility loci for congenital heart disease (CHD) in Han Chinese. Here we identify additional loci by testing promising associations in an extended 3-stage validation consisting of 6,053 CHD cases and 7,410 controls. We find GW significant (P<5.0 × 10(-8)) evidence of 4 additional CHD susceptibility loci at 4q31.22 (rs1400558, upstream of EDNRA, Pall=1.63 × 10(-9)), 9p24.2 (rs7863990, close to SMARCA2, Pall=3.71 × 10(-14)), 12q24.13 (rs2433752, upstream of TBX3 and TBX5, Pall=1.04 × 10(-10)) and 20q12 (rs490514, in PTPRT, Pall=1.20 × 10(-13)). Moreover, the data from previous European GWAS supports that rs490514 is associated with the risk of CHD (P=3.40 × 10(-3)). These results enhance our understanding of CHD susceptibility.
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Amirah MA, Nada MA, Anna A, Mowafa SH, Ashraf E. The epidemiology of congenital heart diseases in Saudi Arabia: A systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/jphe2015.0723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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221
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Rocheleau CM, Bertke SJ, Lawson CC, Romitti PA, Sanderson WT, Malik S, Lupo PJ, Desrosiers TA, Bell E, Druschel C, Correa A, Reefhuis J. Maternal occupational pesticide exposure and risk of congenital heart defects in the National Birth Defects Prevention Study. ACTA ACUST UNITED AC 2015; 103:823-33. [PMID: 26033688 DOI: 10.1002/bdra.23351] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital heart defects (CHDs) are common birth defects, affecting approximately 1% of live births. Pesticide exposure has been suggested as an etiologic factor for CHDs, but previous results were inconsistent. METHODS We examined maternal occupational exposure to fungicides, insecticides, and herbicides for 3328 infants with CHDs and 2988 unaffected control infants of employed mothers using data for 1997 through 2002 births from the National Birth Defects Prevention Study, a population-based multisite case-control study. Potential pesticide exposure from 1 month before conception through the first trimester of pregnancy was assigned by an expert-guided task-exposure matrix and job history details self-reported by mothers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. RESULTS Maternal occupational exposure to pesticides was not associated with CHDs overall. In examining specific CHD subtypes compared with controls, some novel associations were observed with higher estimated pesticide exposure: insecticides only and secundum atrial septal defect (OR = 1.8; 95% CI, 1.3-2.7, 40 exposed cases); both insecticides and herbicides and hypoplastic left heart syndrome (OR = 5.1; 95% CI, 1.7-15.3, 4 exposed cases), as well as pulmonary valve stenosis (OR = 3.6; 95% CI, 1.3-10.1, 5 exposed cases); and insecticides, herbicides, and fungicides and tetralogy of Fallot (TOF) (OR = 2.2; 95% CI, 1.2-4.0, 13 exposed cases). CONCLUSION Broad pesticide exposure categories were not associated with CHDs overall, but examining specific CHD subtypes revealed some increased odds ratios. These results highlight the importance of examining specific CHDs separately. Because of multiple comparisons, additional work is needed to verify these associations.
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Affiliation(s)
- Carissa M Rocheleau
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Stephen J Bertke
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Christina C Lawson
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Wayne T Sanderson
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky
| | - Sadia Malik
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Tania A Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Erin Bell
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York
| | - Charlotte Druschel
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York.,Center for Environmental Health, New York State Department of Health, Albany, New York
| | - Adolfo Correa
- Departments of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennita Reefhuis
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
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Beltrão BA, Herdman TH, Pascoal LM, Chaves DBR, da Silva VM, de Oliveira Lopes MV. Ineffective breathing pattern in children and adolescents with congenital heart disease: accuracy of defining characteristics. J Clin Nurs 2015; 24:2505-13. [DOI: 10.1111/jocn.12838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 11/29/2022]
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223
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Lee YS, Chen YT, Jeng MJ, Tsao PC, Yen HJ, Lee PC, Li SY, Liu CJ, Chen TJ, Chou P, Soong WJ. The risk of cancer in patients with congenital heart disease: a nationwide population-based cohort study in Taiwan. PLoS One 2015; 10:e0116844. [PMID: 25706872 PMCID: PMC4338195 DOI: 10.1371/journal.pone.0116844] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 12/15/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The relationship between congenital heart disease (CHD) and malignancies has not been determined. This study aimed to explore the association of CHD with malignancies and examine the risk factors for the development of cancer after a diagnosis of CHD. PATIENTS AND METHODS This nationwide, population-based cohort study on cancer risk evaluated 31,961 patients with newly diagnosed CHD using the Taiwan National Health Insurance Research Database (NHIRD) between 1998 and 2006. The standardized incidence ratios (SIRs) for all and specific cancer types were analyzed, while the Cox proportional hazard model was used to evaluate risk factors of cancer occurrence. RESULTS Among patients with newly diagnosed CHD regardless of ages, 187 (0.6%) subsequently developed cancers after a diagnosis of CHD. Patients with CHD had increased risk of cancer (SIR, 1.45; 95% CI, 1.25-1.67), as well as significantly elevated risks of hematologic (SIR, 4.04; 95% CI, 2.76-5.70), central nervous system (CNS) (SIR, 3.51; 95% CI, 1.92-5.89), and head and neck (SIR, 1.81; 95% CI, 1.03-2.94) malignancies. Age (HR, 1.06; 95% CI, 1.05-1.06) and co-morbid chronic liver disease (HR, 1.91; 95% CI, 1.27-2.87) were independent risk factors for cancer occurrence among CHD patients. CONCLUSION Patients with CHD have significantly increased cancer risk, particularly hematologic, CNS, and head and neck malignancies. Physicians who care for patients with CHD should be aware of their predisposition to malignancy after the diagnosis of CHD. Further studies are warranted to clarify the association between CHD and malignancies.
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Affiliation(s)
- Yu-Sheng Lee
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yung-Tai Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
| | - Mei-Jy Jeng
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Pei-Chen Tsao
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pi-Chang Lee
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chia-Jen Liu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jue Soong
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Farmer DL. Standing on the shoulders of giants: a scientific journey from Singapore to stem cells. J Pediatr Surg 2015; 50:15-22. [PMID: 25598087 DOI: 10.1016/j.jpedsurg.2014.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 10/06/2014] [Indexed: 12/18/2022]
Abstract
Cellular therapy was introduced in the early 1980s as adoptive immunotherapy for cancer and has now expanded to stem cell treatment for a wide variety of indications. During the same period, the concept of the fetus as a patient evolved from fantasy to everyday reality. The intersection of these two fields offers great potential for cures in childhood diseases. The fetal treatment of spina bifida is one such disease. Global surgery has also emerged as a cost effective approach to reducing the worldwide burden of childhood disease.
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Affiliation(s)
- Diana Lee Farmer
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA.
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225
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Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries: the unborn child of global surgery. World J Surg 2015; 39:36-40. [PMID: 25135175 PMCID: PMC4300430 DOI: 10.1007/s00268-014-2714-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability.
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Affiliation(s)
- Nicole A. Sitkin
- />Department of Surgery, University of California, Davis, Sacramento, CA USA
| | - Doruk Ozgediz
- />Department of Surgery, Yale University School of Medicine, New Haven, CT USA
| | - Peter Donkor
- />Department of Surgery, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- />Department of Maxillofacial Sciences, Dental School, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Diana L. Farmer
- />Department of Surgery, University of California, Davis, Sacramento, CA USA
- />Department of Surgery, University of California, Davis School of Medicine, University of California, Davis Health System, 2221 Stockton Blvd, Suite 3112, Sacramento, CA 95817 USA
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Maternal rat serum concentrations of dimethadione do not explain intra-litter differences in the incidence of dimethadione-induced birth defects, including novel findings in foetal lung. Toxicology 2014; 326:142-52. [PMID: 25446330 DOI: 10.1016/j.tox.2014.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/25/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
To investigate mechanisms of chemical-induced congenital heart defects (CHD) we have developed a rat model using dimethadione (DMO), the N-demethylated metabolite of the anticonvulsant, trimethadione (TMD). Dosing pregnant rats with 300mg/kg DMO every 12h from the evening of gestational day (GD) 8 until the morning of GD 11 (six total doses) produces a mean 74% incidence of CHD with inter litter variability ranging from 40 to 100%. The goal of this study was to determine if the variability in maternal serum concentrations of DMO on GD 14, a surrogate marker for total exposure, was related to the inter-litter differences in teratogenic outcomes. To test this hypothesis, pregnant rats were dosed as described above and serum levels of DMO assessed on GD 14. On GD 21, foetuses were collected by caesarean section, assessed for a number endpoints and the outcomes were correlated with the GD 14 serum concentrations of DMO. DMO exposure was associated with decreased foetal body weight, increased incidence of sternal defects and CHD, but these endpoints were not meaningfully correlated with maternal concentrations of DMO. Novel findings were decreased viability as measured one-hour following caesarean section, and delayed alveolar maturation. The major conclusions from these studies were first, that serum DMO concentrations on GD 14 did not predict teratogenicity, and second, delayed lung development may contribute to the decreased survival of foetuses at the time of caesarean section.
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227
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McKavanagh P, Booth K, Blair L, McNeilly G, Varadarajan B, Nzewi O. Addressing discrepancies: personal experience of a cardiac mission programme in Africa. Int J Cardiol 2014; 177:794-9. [PMID: 25449501 DOI: 10.1016/j.ijcard.2014.09.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Abstract
The worldwide incidence of cardiovascular disease (CVD) is increasing, reflecting a combination of ongoing infective diseases and a rapid rise in traditional 'western' risk factors. It is estimated that in the next 20 years that CVD be the leading cause of death in developing nations. There are high incidences of rheumatic heart disease, coronary artery disease, cardiomyopathies, uncorrected congenital heart disease and human immunodeficiency virus (HIV) associated disease in many low-income countries. Such high levels combined with a lack of diagnostic tests and therapeutic options means mortality and morbidity rates are high. A number of charities and organizations have tried to address the discrepancy of cardiac care within developing areas although the needs remain great. However there is no one global cardiac organization that coordinates such humanitarian work. The challenges of missionary work include the need for appropriate facilities, financial constraints of clinical consumables, and lack of education of local healthcare staff, making the move away from the mission model difficult. The strategy for delivery of care in developing countries should be long term educational and technical support, so that local case volumes increase. However it must be realized that there are many different levels of local services within developing nations with different health and educational needs, including some countries with very high facilities and skills levels, yet high case loads. This paper highlights the personal experience of our organization and the types of diseases encountered in developing countries.
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Affiliation(s)
- Peter McKavanagh
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom.
| | - Karen Booth
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Laura Blair
- Save a Heart Charity, Belfast, United Kingdom; 352 Healthcare, Belfast, United Kingdom
| | - Graham McNeilly
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Bharathi Varadarajan
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Onyekwelu Nzewi
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
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Abstract
OBJECTIVE This study was designed to estimate the birth prevalence of children with congenital heart disease born in the Gaza Strip during 2010 and to compare these with estimates from elsewhere. METHODS We reviewed the medical records of all children born in 2010 who were diagnosed, treated, and/or followed up in the four paediatric cardiology clinics in the Gaza Strip. Data were also obtained from El Makassed Hospital in East Jerusalem and from the Schneider Hospital, Wolfson Medical Center, and Tel HaShomer Hospital in Israel, where we had referred some of our patients for percutaneous or surgical treatment. RESULTS A total of 598 children with congenital heart disease were detected among the 59,757 children born alive in the Gaza Strip during 2010, yielding a birth incidence of 10 per 1000 live births. The most frequently occurring conditions were ventricular septal defects (28%), ostium secundum atrial septal defects (17%), patent ductus arteriosus (8.5%), and pulmonary valve abnormalities (8%). In this study, 7% of the children died. The actuarial survival at 6 months and 1 year of age was 94% and 93%, respectively, and remained stable over 18 months of follow-up. CONCLUSION The birth incidence of congenital heart disease in the Gaza Strip in 2010 (10 per 1000) is higher than most estimates in Western Europe (8.2 per 1000 live births) and North America (6.9 per 1000 live births) but is similar to estimates from other parts of Asia (9.3 per 1000 live births).
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Li Z, Jun Y, Zhong-Bao R, Jie L, Jian-Ming L. Association between MTHFR C677T polymorphism and congenital heart disease. A family-based meta-analysis. Herz 2014; 40 Suppl 2:160-7. [PMID: 25256053 DOI: 10.1007/s00059-014-4144-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/23/2014] [Indexed: 12/22/2022]
Abstract
Congenital heart disease (CHD) is the most common type of birth defect. It is suspected that polymorphisms in folate metabolism are associated with an increased risk of CHD, but the conclusion remains unclear. Studies have reported that the MTHFR C677T polymorphism was associated with the development of structural congenital heart malformations. The objective of this study was to conduct a meta-analysis of available studies to identify common polymorphisms in the MTHFR gene in children with CHD and their mothers and to test for an association between genotype and disease. In all, 19 eligible studies comprising 4,219 cases and 20,123 controls were included in this meta-analysis. A significant association was found between the MTHFR C677T polymorphism and CHD risk (OR: 1.26; 95 % CI = 1.06-1.51; p = 0.009) with no strong evidence of heterogeneity (I(2) = 39 %) in the fetal analysis. In the maternal analysis, the MTHFR C677T polymorphism was significantly associated with CHD risk (OR = 1.52; 95 % CI = 1.09-2.11; p = 0.01) with significant heterogeneity (I(2) = 63 %).
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Affiliation(s)
- Z Li
- Department of Cardiology, Institute of Medical Research, Taizhou People's Hospital, Yingchun Road 210, 225300, Taizhou, Jiangsu Province, China
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Dixit R, Rai SK, Yadav AK, Lakhotia S, Agrawal D, Kumar A, Mohapatra B. Epidemiology of Congenital Heart Disease in India. CONGENIT HEART DIS 2014; 10:437-46. [PMID: 25196372 DOI: 10.1111/chd.12220] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Congenital heart defects (CHDs) affect a large number of newborns and account for a high proportion of infant mortality worldwide. There are regional differences in the prevalence and distribution pattern of CHDs. The aim of this study is to estimate the distribution pattern and prevalence of CHDs among the population of north-central India and to compare the results with studies in other regions of the country to get an overview of prevalence of CHDs in India. DESIGN We carried out a prospective study in the outpatient department of a tertiary care referral center in north-central India. This study was carried out from January 2011 to April 2014, with 34 517 individuals being recruited for the study. All patients were examined by chest x-ray, electrocardiogram, and 2D echocardiography. Prevalence rate per 1000 individuals examined was calculated. Relative frequencies of individual CHD types as a proportion of total CHDs were also calculated. RESULTS Out of 34 517 individuals examined, 661 were diagnosed with CHDs, giving a prevalence of 19.14 per 1000 individuals. The most common defect was ventricular septal defect (33%), followed by atrial septal defect (19%) and tetralogy of Fallot (16%). The majority of CHD cases (58%) diagnosed were between 0 and 5 years of age. The prevalence of CHDs in adults was 2.4 per 1000 individuals in this cohort, with atrial septal defect (44.5%) being the most frequent defect. CONCLUSION The prevalence of CHDs in our cohort was high, possibly because of the power of the diagnostic methods we used and the inclusion of all age groups. Adults with CHDs may significantly contribute to the prevalence of CHDs in the next generation, and this needs to be considered when estimating prevalence rates. Although several small regional studies have been carried out in India, there is an urgent need to establish a nationwide registry/database for congenital heart defects.
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Affiliation(s)
- Ritu Dixit
- Cytogenetics Laboratory, Department of Zoology, Banaras Hindu University, Varanasi, India
| | - Sunil Kumar Rai
- Cytogenetics Laboratory, Department of Zoology, Banaras Hindu University, Varanasi, India
| | - Abhishek Kumar Yadav
- Cytogenetics Laboratory, Department of Zoology, Banaras Hindu University, Varanasi, India
| | - Siddharth Lakhotia
- Department of Cardiovascular and Thoracic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Damyanti Agrawal
- Department of Cardiovascular and Thoracic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Bhagyalaxmi Mohapatra
- Cytogenetics Laboratory, Department of Zoology, Banaras Hindu University, Varanasi, India
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Abstract
OPINION STATEMENT Adult congenital heart disease (ACHD) patients represent a special population in modern cardiology: though their numbers are growing, and they represent a high-resource utilization subgroup, a robust evidence-base of randomized trials is lacking. Much of the standard therapy is adapted from the treatment of ischemic and idiopathic left ventricle systolic failure, with a small, but growing body of evidence on medical therapy in select ACHD diagnoses. At our institution, for instance, there is a long tradition of using angiotensin antagonists in patients with a systemic right ventricle to prevent deleterious remodeling. The effects of beta-blockers on functional class in ACHD are yet unproven, but there is promising data on pulmonary vasodilators. Control of coronary risk factors and aerobic exercise should be considered for all. Prevention of arrhythmias is important, and multi-site pacing is an emerging therapy. New prognostic tools including natriuretic peptides and CPET are increasingly used to guide earlier initiation of these therapies.
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232
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Cai GJ, Sun XX, Zhang L, Hong Q. Association between maternal body mass index and congenital heart defects in offspring: a systematic review. Am J Obstet Gynecol 2014; 211:91-117. [PMID: 24631708 DOI: 10.1016/j.ajog.2014.03.028] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/27/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the relationship between maternal body mass index and all congenital heart defects (CHDs) combined and 11 individual defects. PubMed, ELSEVIER ScienceDirect, and Springer Link (up to February 2013) were searched, and the reference list of retrieved articles was reviewed. Three authors independently extracted the data. The systematic review included 24 studies, 14 of which were included in a metaanalysis. Statistical software was used to perform all statistical analyses. Fixed-effects or random-effects model was used to pool the results of individual study (expressed as odds ratios [ORs] with 95% confidence intervals [CIs]). A dose-response effect was observed between overweight, moderate obesity, and severe obesity and a pregnancy with any CHD (the pooled ORs: OR, 1.08 [95% CI, 1.02-1.15]; OR, 1.15 [95% CI, 1.11-1.20]; and OR, 1.39 [95% CI, 1.31-1.47], respectively) as well as some individual defects such as hypoplastic left heart syndrome, pulmonary valve stenosis, and outflow tract defects. When we excluded mothers with diabetes mellitus, the pooled ORs for all CHDs combined were 1.12 (95% CI, 1.04-1.20) and 1.38 (95% CI, 1.20-1.59) for moderately obese and severely obese, respectively. The highest increased risk was severely obese mothers for tetralogy of Fallot (OR, 1.94; 95% CI, 1.49-2.51). Being underweight did not increase the risk of any of the aforementioned CHDs but did increase the risk of aortic valve stenosis (OR, 1.47; 95% CI, 1.01-2.15]). The results of our study showed that increasing maternal body mass index was associated with an increasing risk of CHDs; severe obesity was an even greater risk factor for the development of CHDs.
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233
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Egbe A, Uppu S, Stroustrup A, Lee S, Ho D, Srivastava S. Incidences and sociodemographics of specific congenital heart diseases in the United States of America: an evaluation of hospital discharge diagnoses. Pediatr Cardiol 2014; 35:975-82. [PMID: 24563074 DOI: 10.1007/s00246-014-0884-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
Current estimates of the incidence of congenital heart disease (CHD) are derived from small clinical studies and metaanalyses. For the true incidence of CHD in the United States of America to be estimated, a single large representative population must be analyzed. All the data in this study were derived from the Nationwide Inpatient Sample database. The study determined the overall and lesion-specific incidences of CHD diagnoses among all birth hospitalizations in 2008, stratified by race, gender, socioeconomic status, and hospital geographic location. The study identified 13,093 CHD diagnoses among 1,204,887 birth hospitalizations, yielding an incidence of 10.8 per 1,000, with a predominance of mild lesions and septal defects. Atrial septal defect (ASD) and pulmonic stenosis were more common among females, whereas aortic stenosis, coarctation of the aorta, hypoplastic left heart syndrome, and d-transposition of great arteries were more common among males. No racial difference was observed in the overall CHD incidence. However, isolated patent ductus arteriosus (PDA) and ventricular septal defects (VSDs) were more common among Caucasians, whereas ASDs were more common among Hispanics. The incidences of CHD diagnoses were similar for all socioeconomic classes except the lowest socioeconomic class, which had a significantly lower CHD incidence. There was no geographic or seasonal variation in CHD incidence. This study demonstrated the incidence of echocardiographically confirmed CHD diagnosis to be 10.8 per 1,000 live births, marked by a high proportion of mild cardiac lesions and isolated PDAs. The high incidence of isolated PDAs in this study may be explained by the inclusion of only CHD diagnoses during birth hospitalization.
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Affiliation(s)
- Alexander Egbe
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1201, New York, NY, 10029, USA,
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234
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Hoffman JI. The global burden of congenital heart disease. Cardiovasc J Afr 2014; 24:141-5. [PMID: 24217047 PMCID: PMC3721933 DOI: 10.5830/cvja-2013-028] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/17/2013] [Indexed: 11/25/2022] Open
Abstract
Abstract Although the incidence of congenital heart disease (CHD) is similar worldwide, the burden of supporting these patients falls more heavily on countries with high fertility rates. In a country with a fertility rate of about eight per woman, the population has to support four times as many children with CHD as in a country with a fertility rate of two. Countries with the highest fertility rates tend to have the lowest incomes per capita, thus accentuating the disparity. Countries with high fertility rates have more children with congenital heart disease per wage earner. Improving local health services and controlling infectious diseases (diarrhoeal illness, rheumatic fever, measles, rotoviral infection) are important but are mere ‘band-aids’ compared to improving education, empowering women and reducing birth rates.
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Affiliation(s)
- Julien Ie Hoffman
- Department of Paediatrics, Cardiovascular Research Institute, University of California, San Francisco, California, USA
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235
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Ma LG, Zhao J, Ren ZP, Wang YY, Peng ZQ, Wang JF, Ma X. Spatial patterns of the congenital heart disease prevalence among 0- to 14-year-old children in Sichuan Basin, P. R China, from 2004 to 2009. BMC Public Health 2014; 14:595. [PMID: 24924350 PMCID: PMC4073187 DOI: 10.1186/1471-2458-14-595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 05/15/2014] [Indexed: 01/21/2023] Open
Abstract
Background Congenital heart disease (CHD) is the most common type of major birth defects in Sichuan, the most populous province in China. The detailed etiology of CHD is unknown but some environmental factors are suspected as the cause of this disease. However, the geographical variations in CHD prevalence would be highly valuable in providing a clue on the role of the environment in CHD etiology. Here, we investigate the spatial patterns and geographic differences in CHD prevalence among 0- to 14-year-old children, discuss the possible environmental risk factors that might be associated with CHD prevalence in Sichuan Basin from 2004 to 2009. Methods The hierarchical Bayesian model was used to estimate CHD prevalence at the township level. Spatial autocorrelation statistics were performed, and a hot-spot analysis with different distance thresholds was used to identify the spatial pattern of CHD prevalence. Distribution and clustering maps were drawn using geographic information system tools. Results CHD prevalence was significantly clustered in Sichuan Basin in different spatial scale. Typical hot/cold clusters were identified, and possible CHD causes were discussed. The association between selected hypothetical environmental factors of maternal exposure and CHD prevalence was evaluated. Conclusions The largest hot-spot clustering phenomena and the CHD prevalence clustering trend among 0- to 14-year-old children in the study area showed a plausibly close similarity with those observed in the Tuojiang River Basin. The high ecological risk of heavy metal(Cd, As, and Pb)sediments in the middle and lower streams of the Tuojiang River watershed and ammonia–nitrogen pollution may have contribution to the high prevalence of CHD in this area.
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Affiliation(s)
| | | | | | | | | | | | - Xu Ma
- National Research Institute for Family Planning, Beijing 100081, People's Republic of China.
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Egbe A, Uppu S, Lee S, Stroustrup A, Ho D, Srivastava S. Temporal Variation of Birth Prevalence of Congenital Heart Disease in the United States. CONGENIT HEART DIS 2014; 10:43-50. [DOI: 10.1111/chd.12176] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander Egbe
- Division of Pediatric Cardiology; Mount Sinai Medical Center; New York NY USA
| | - Santosh Uppu
- Division of Pediatric Cardiology; Mount Sinai Medical Center; New York NY USA
| | - Simon Lee
- Division of Pediatric Cardiology; Mount Sinai Medical Center; New York NY USA
| | - Annemarie Stroustrup
- Division of Pediatric Cardiology; Mount Sinai Medical Center; New York NY USA
- Department of Preventative Medicine; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Deborah Ho
- Division of Pediatric Cardiology; Mount Sinai Medical Center; New York NY USA
| | - Shubhika Srivastava
- Division of Pediatric Cardiology; Mount Sinai Medical Center; New York NY USA
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237
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Jorgensen M, McPherson E, Zaleski C, Shivaram P, Cold C. Stillbirth: the heart of the matter. Am J Med Genet A 2014; 164A:691-9. [PMID: 24459042 DOI: 10.1002/ajmg.a.36366] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/28/2013] [Indexed: 11/06/2022]
Abstract
We evaluated 2,083 cases within the Wisconsin Stillbirth Service Program (WiSSP) that had autopsy reports or ultrasound data relevant to the heart. Of these, 167/1,782 (9.4%) stillbirths after 20 weeks and 11/301 (3.7%) miscarriages <20 weeks had congenital heart disease (CHD). Cases were classified by type of heart defect and whether it related to cause of death. Among cardiac anomalies that contributed significantly to fetal death, 125/151 (83%) were associated with underlying conditions or syndromes, nearly half of which were chromosomal. The most common forms of CHD in stillborns were severe cyanotic lesions (3%), then ventricular (2.6%) and atrial (1.9%) septal defects. Compared to livebirths, this represents a shift toward more severe cardiac lesions, although all comparable categories, including non-lethal conditions such as atrial septal defect, are more common in stillbirths. Clinical cardiomyopathy was identified as cause of death in 1.2% of stillborns. Cardiomegaly, occurring in 26.7% of all cases and 76.7% of infants born to diabetic mothers, may represent undiagnosed cardiomyopathy and/or may decrease fetal tolerance of hypoxia. In contrast, 78.5% of Turner syndrome infants, all <32 weeks, had small hearts. More attention to cardiac findings can lead to increased understanding of stillbirth causes. Based on our findings, we recommend chromosome studies on all stillbirths and close attention to the heart during second trimester ultrasounds, with chromosome studies offered if CHD is found. Consideration of heart size can result in prenatal identification of infants at risk for stillbirth, particularly large hearts in fetuses of diabetic mothers in the third trimester, which may identify fetal cardiomyopathy before it becomes life-threatening.
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Affiliation(s)
- Michael Jorgensen
- Department of Medical Genetics Services, Marshfield Clinic, Marshfield, Wisconsin
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238
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Wang W, Hou Z, Wang C, Wei C, Li Y, Jiang L. Association between 5, 10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms and congenital heart disease: A meta-analysis. Meta Gene 2013; 1:109-25. [PMID: 25606381 PMCID: PMC4205024 DOI: 10.1016/j.mgene.2013.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 12/15/2022] Open
Abstract
Background Inconsistent results were reported in recent literature regarding the association between methylenetetrahydrofolate reductase (MTHFR) C677T/A1298C polymorphisms and the susceptibility of congenital heart disease (CHD). In this study, we performed a meta-analysis to investigate the associations by employing multiple analytical methods. Methods Literature search was performed and published articles were obtained from PubMed, Embase and CNKI databases based on the exclusion and inclusion criteria. Data were extracted from eligible studies and the crude odds ratios and their corresponding 95% confidence intervals (CIs) were calculated using random or fix effects model to evaluate the associations between the MTHFR C677T/A1298C polymorphisms and CHD development. Subgroup based analysis was performed by Hardy–Weinberg equilibrium, ethnicity, types of CHD, source of control and sample size. Results Twenty-four eligible studies were included in this meta-analysis. Significant association was found between fetal MTHFR C677T polymorphism and CHD development in all genetic models. The pooled ORs and 95% CIs in all genetic models indicated that MTHFR C677T polymorphism was significantly associated with CHD in Asian, but not Caucasian in subgroup analysis. The maternal MTHFR C677T polymorphism was not associated with CHD except for recessive model. Moreover, neither maternal nor fetal MTHFR A1298C polymorphism was associated with CHD. Conclusion The fetal MTHFR C677T polymorphism may increase the susceptibility to CHD. Fetal MTHFR C677T polymorphism was more likely to affect Asian fetus than Caucasian. The MTHFR A1298C polymorphism may not be a risk of congenital heart disease.
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Affiliation(s)
- Wenju Wang
- Kunming Yan'an Hospital, Kunming 650051, Yunnan, People's Republic of China
| | - Zongliu Hou
- Kunming Yan'an Hospital, Kunming 650051, Yunnan, People's Republic of China
| | - Chunhui Wang
- Kunming Yan'an Hospital, Kunming 650051, Yunnan, People's Republic of China
| | - Chuanyu Wei
- Kunming Yan'an Hospital, Kunming 650051, Yunnan, People's Republic of China
| | - Yaxiong Li
- Kunming Yan'an Hospital, Kunming 650051, Yunnan, People's Republic of China
| | - Lihong Jiang
- Kunming Yan'an Hospital, Kunming 650051, Yunnan, People's Republic of China
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239
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Lane DA, Millane TA, Lip GYH. Psychological interventions for depression in adolescent and adult congenital heart disease. Cochrane Database Syst Rev 2013:CD004372. [PMID: 24163137 DOI: 10.1002/14651858.cd004372.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adult and adolescent congenital heart disease is increasing in prevalence as better medical care means more children are surviving to adulthood. People with chronic disease often also experience depression. There are several non-pharmacological treatments that might be effective in treating depression and improving quality of life for adults and young adults with congenital heart disease. The aim of this review was to assess the effects of treatments such as psychotherapy, cognitive behavioural therapies and talking therapies for treating depression in this population. OBJECTIVES To update the previous review on the effects (both harms and benefits) of psychological interventions for treating depression in young adults and adults with congenital heart disease. Psychological interventions include cognitive behavioural therapy, psychotherapy, or 'talking/counselling' therapy for depression. SEARCH METHODS We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2013), MEDLINE (OVID, 1946 to January week 4 2013), EMBASE (OVID, 1980 to 2013 week 05), PsycINFO (OVID, 1806 to January week 5 2013), the Database of Abstracts of Reviews of Effectiveness (DARE) on The Cochrane Library (Issue 1, 2013), BIOSIS (Thomson Reuters, 1969 to 21 February 2013), and CINAHL (January 1980 to February 2013) on 5 February 2013. We did not search abstracts from national and international cardiology and psychology conferences and dissertation abstracts for this update. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials comparing psychological interventions with no intervention for people over 15 years with depression who have congenital heart disease. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts of studies that were potentially relevant to the review. We rejected studies that were clearly ineligible. Two review authors independently assessed the abstracts or full papers for inclusion criteria. We sought further information from the authors where papers contained insufficient information to make a decision about eligibility. MAIN RESULTS We did not identify any randomised controlled trials that met the inclusion criteria. AUTHORS' CONCLUSIONS Depression is common in people with congenital heart disease and can exacerbate the physical consequences of the illness. There are effective pharmacological and non-pharmacological treatments for depression, but we have not been able to identify any trials showing the effectiveness of non-pharmacological treatments. A well-designed randomised controlled trial is needed to assess the effects of psychological interventions for depression in congenital heart disease.
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Affiliation(s)
- Deirdre A Lane
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, UK, B18 7QH
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240
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Wielandner A, Mlczoch E, Prayer D, Berger-Kulemann V. Potential of magnetic resonance for imaging the fetal heart. Semin Fetal Neonatal Med 2013; 18:286-97. [PMID: 23742821 DOI: 10.1016/j.siny.2013.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Significant congenital heart disease (sCHD) affects 3.6 per 1000 births, and is often associated with extracardiac and chromosomal anomalies. Although early mortality has been substantially reduced and the rate of long-term survival has improved, sCHD is, after preterm birth, the second most frequent cause of neonatal infant death. The prenatal detection of cardiac and vascular abnormalities enables optimal parental counselling and perinatal management. Echocardiography (ECG) is the first-line examination and gold standard by which cardiac malformations are defined. However, adequate examination by an experienced healthcare provider with modern technical imaging equipment is required. In addition, maternal factors and the gestational age may lower the image quality. Fetal magnetic resonance imaging (MRI) has been implemented over the last several years and is already used in the clinical routine as a second-line approach to assess fetal abnormalities. MRI of the fetal heart is still not routinely performed. Nevertheless, fetal cardiac MRI has the potential to complement ultrasound in detecting cardiovascular malformations and extracardiac lesions. The present work reviews the potential of MRI to delineate the anatomy and pathologies of the fetal heart. This work also deals with the limitations and continuing developments designed to overcome the current problems in cardiac imaging, including fast fetal heart rates, the lack of ECG-gating, and the presence of fetal movements.
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Affiliation(s)
- Alice Wielandner
- Department of Radiology, Medical University of Vienna, AKH, Vienna, Austria
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241
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Heart Failure in Congenital Heart Disease. Can J Cardiol 2013; 29:753-4. [DOI: 10.1016/j.cjca.2013.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/23/2013] [Accepted: 03/24/2013] [Indexed: 11/17/2022] Open
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242
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Mohsin SS, Haque A, Shaikh AS, Bano S, Hasan BS. Outcome of infants with unrepaired heart disease admitted to the pediatric intensive care unit: single-center developing country perspective. CONGENIT HEART DIS 2013; 9:116-21. [PMID: 23648113 DOI: 10.1111/chd.12075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Congenital heart disease (CHD) has an incidence of ∼0.8-1%. Outcome of previously diagnosed CHD patients awaiting surgery (either correction or palliation) in a developing country setting is unknown. We strive to determine the outcome of patients with CHD awaiting surgery who present to pediatric intensive care unit (PICU) setting with an acute illness. DESIGN Retrospective cross-sectional chart review. SETTING Pediatric intensive care unit of The Aga Khan University Hospital, Karachi, Pakistan. PATIENT Medical records of infants (1-12 months) with CHD awaiting surgery presenting to the PICU with an acute illness between January 2009 and June 2012 were included. Newly diagnosed CHD patients, those not requiring PICU admission, and those transferred to another hospital were excluded. RESULTS A total of 34 infants met the inclusion criteria. Median age at presentation was 5 months. Seventy-four percent of the infants had CHD lesion characterized by increased pulmonary blood flow (shunt lesions). Though none of the patients met the strict criteria for sepsis or pneumonia, 74% were admitted with a diagnosis of pneumonia or sepsis. Only 15% of patient had congestive heart failure as an admitting diagnosis. Oxygen therapy was given to 94% of these patients. Fifty-nine percent of these patients expired during the admission, 95% of those expired had multiorgan dysfunction. CONCLUSION Patients with CHD awaiting surgery and who admitted to the PICU with acute illness are at high risk for mortality. Stringent criteria to diagnose pneumonia or sepsis should be used in these patients.
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Affiliation(s)
- Shazia Samad Mohsin
- Department of Pediatric and Child Health, The Aga Khan University, Karachi, Pakistan
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243
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Xia Y, Hong H, Ye L, Wang Y, Chen H, Liu J. Label-free quantitative proteomic analysis of right ventricular remodeling in infant Tetralogy of Fallot patients. J Proteomics 2013; 84:78-91. [PMID: 23571024 DOI: 10.1016/j.jprot.2013.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/04/2013] [Accepted: 03/30/2013] [Indexed: 12/14/2022]
Abstract
Tetralogy of Fallot (TOF) results in chronic progressive right ventricular (RV) pressure overload and shunt hypoxemia. We investigated the global changes in the proteome of RV among infant patients with and without TOF to gain an insight into early RV remodeling. One hundred and thirty-six differentially expressed proteins were identified using label-free LC-ESI-MS/MS analysis. Western blot results revealed that the expression of 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 2 (PFKFB2) increased significantly in TOF patients; and levels of lysocardiolipin acyltransferase 1 (LCLAT1), lumican (LUM), and versican (VCAN) decreased significantly. QRT-PCR analysis showed that levels of PFKFB2 mRNA were markedly increased, but those of LCLAT1 and LUM were significantly decreased. VCAN mRNA showed no significant change in response to pathophysiology of TOF. The results of immunohistochemical staining were similar to those of Western blot analysis. Results of the proteomic analysis indicated that the level of glycolysis-related proteins had increased and levels of lipid-metabolism-related proteins had decreased. ECM proteins were found to be more down-regulated in TOF in the present study than in previous reports. Taken together, our findings may provide clues to both the metabolic inflexibility and ECM remodeling during the early RV remodeling, which occur in response to chronic hypoxia and long-term pressure overload in TOF patients.
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Affiliation(s)
- Yu Xia
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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244
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Cheng CF, Wang JH. Epidemiologic and demographic evidence of pediatric congenital heart diseases in Taiwan. Pediatr Neonatol 2013; 54:67-8. [PMID: 23590947 DOI: 10.1016/j.pedneo.2012.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022] Open
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245
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Gupta SK, Kothari SS. Prevalence of congenital heart disease. Indian J Pediatr 2013; 80:337-9. [PMID: 23378055 DOI: 10.1007/s12098-013-0970-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
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Lowry AW. Resuscitation and perioperative management of the high-risk single ventricle patient: first-stage palliation. CONGENIT HEART DIS 2013; 7:466-78. [PMID: 22985457 DOI: 10.1111/j.1747-0803.2012.00710.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Infants born with hypoplastic left heart syndrome or other lesions resulting in a single right ventricle face the highest risk of mortality among all forms of congenital heart disease. Before the modern era of surgical palliation, these conditions were universally lethal; recent refinements in surgical technique and perioperative management have translated into dramatic improvements in survival. Nonetheless, these infants remain at a high risk of morbidity and mortality, and an appreciation of single ventricle physiology is fundamental to the care of these high-risk patients. Herein, resuscitation and perioperative management of infants with hypoplastic left heart syndrome are reviewed. Basic neonatal and pediatric life support recommendations are summarized, and perioperative first-stage clinical management strategies are reviewed.
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Affiliation(s)
- Adam W Lowry
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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247
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Abstract
The population of adults with a congenital heart defect (CHD) is increasing, due to improved survival after cardiac surgery. To accommodate the specialised care for these patients, a profound interest in the epidemiology of CHD is required. The exact size of the current population of adults with CHD is unknown, but the best available evidence suggests that currently overall prevalence of CHD in the adult population is about 3000 per million. Regional differences in CHD prevalence have been described, due to both variations in incidence and in mortality. Knowledge of demographic variations of CHD may lead to new aetiological insights and may be useful for preventive therapies. Socioeconomic status, education, urbanisation, climatological factors, ethnicity and patient-related factors, such as comorbidity, lifestyle and healthcare-seeking behaviour, may play a role in CHD incidence and mortality. The higher risk of several major cardiac outcomes in males with CHD might well explain at least partly the increased mortality rate in men. Regional differences in quality of life among CHD patients have been reported and although methodological differences may play a role, sociocultural differences warrant further attention. Socioeconomic outcomes in CHD patients, such as lower education, more unemployment and less relationships, might have a different impact on quality of life in different cultures. To gain more insight into demographic differences around the world large international multicentre studies on the epidemiology of CHD are needed.
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249
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van der Bom T, Bouma BJ, Meijboom FJ, Zwinderman AH, Mulder BJM. The prevalence of adult congenital heart disease, results from a systematic review and evidence based calculation. Am Heart J 2012; 164:568-75. [PMID: 23067916 DOI: 10.1016/j.ahj.2012.07.023] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/24/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE The prevalence of adult patients with congenital heart disease (CHD) has been reported with a high degree of variability. Prevalence estimates have been calculated using birth rate, birth prevalence, and assumed survival and derived from large administrative databases. To report more robust prevalence estimate, we performed a systematic review for studies concerning CHD prevalence in adults. Moreover, to diminish bias of calculated estimates, we conducted an evidence-based calculation for the Netherlands. METHODS A systematic database search was performed to identify reports on the prevalence of adult CHD. Bicuspid aortic valve, mitral valve prolapse, Marfan syndrome, cardiomyopathy, congenital arrhythmia, and spontaneously closed defects were excluded. In addition, CHD prevalence was calculated using birth rate, birth prevalence, and survival estimates. RESULTS Our search yielded 10 publications on the prevalence of CHD in adults. Four reported results from population wide cross-sectional data, whereas in 6, prevalence was calculated. Mean prevalence reported by empirical studies was 3,562 per million when unspecified lesions were included and 2,297 per million when these were excluded. Mean prevalence derived from calculation was 3,536. Our calculated estimate was 3,228 per million adults. Taking these estimates as well as the limitations inherent to their derivation into consideration, the prevalence of CHD in the adult population is approximately 3,000 per million adults. CONCLUSION This systematic review presents a comprehensive overview of publications on the prevalence of CHD in adults. The best available evidence suggests that overall prevalence of CHD in the adult population is in the region of 3,000 per million.
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Affiliation(s)
- Teun van der Bom
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
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Lalani SR, Shaw C, Wang X, Patel A, Patterson LW, Kolodziejska K, Szafranski P, Ou Z, Tian Q, Kang SHL, Jinnah A, Ali S, Malik A, Hixson P, Potocki L, Lupski JR, Stankiewicz P, Bacino CA, Dawson B, Beaudet AL, Boricha FM, Whittaker R, Li C, Ware SM, Cheung SW, Penny DJ, Jefferies JL, Belmont JW. Rare DNA copy number variants in cardiovascular malformations with extracardiac abnormalities. Eur J Hum Genet 2012; 21:173-81. [PMID: 22929023 DOI: 10.1038/ejhg.2012.155] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Clinically significant cardiovascular malformations (CVMs) occur in 5-8 per 1000 live births. Recurrent copy number variations (CNVs) are among the known causes of syndromic CVMs, accounting for an important fraction of cases. We hypothesized that many additional rare CNVs also cause CVMs and can be detected in patients with CVMs plus extracardiac anomalies (ECAs). Through a genome-wide survey of 203 subjects with CVMs and ECAs, we identified 55 CNVs >50 kb in length that were not present in children without known cardiovascular defects (n=872). Sixteen unique CNVs overlapping these variants were found in an independent CVM plus ECA cohort (n=511), which were not observed in 2011 controls. The study identified 12/16 (75%) novel loci including non-recurrent de novo 16q24.3 loss (4/714) and de novo 2q31.3q32.1 loss encompassing PPP1R1C and PDE1A (2/714). The study also narrowed critical intervals in three well-recognized genomic disorders of CVM, such as the cat-eye syndrome region on 22q11.1, 8p23.1 loss encompassing GATA4 and SOX7 and 17p13.3-p13.2 loss. An analysis of protein-interaction databases shows that the rare inherited and de novo CNVs detected in the combined cohort are enriched for genes encoding proteins that are direct or indirect partners of proteins known to be required for normal cardiac development. Our findings implicate rare variants such as 16q24.3 loss and 2q31.3-q32.1 loss, and delineate regions within previously reported structural variants known to cause CVMs.
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Affiliation(s)
- Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA.
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