1
|
Yu J, Lei T, Gao L, Huang Z, Bi Y, He Y, Feng W. Impact of congenital heart disease on clinical outcomes of oral propranolol therapy for Infantile hemangiomas: a propensity score-matched analysis. BMC Pediatr 2025; 25:354. [PMID: 40319231 PMCID: PMC12048930 DOI: 10.1186/s12887-025-05707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 04/23/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Oral propranolol is the first-line treatment for Infantile hemangioma (IH). However, there is a lack of studies indicating whether the congenital heart disease (CHD) makes a difference in oral propranolol therapy (OPT). Previous studies have only confirmed the safety and efficacy of OPT in asymptomatic CHD children. OBJECTIVE This study aimed to evaluate and compare the clinical outcomes in pediatric patients with CHD and those without CHD following OPT and to assess risk factors that may contribute to recurrence. METHODS A total of 310 children who received OPT for IH between January 2020 and January 2023 were included in a retrospective study. The study aimed to assess demographic data, clinical symptoms, auxiliary examinations, and treatment effects. To compare clinical outcomes between children with and without CHD, one-to-one propensity score matching (PSM) was applied. RESULTS Among the 310 patients, 192 (61.94%) had CHD. After propensity-matching analysis, in the presence of CHD, the age at treatment withdrawal was significantly higher (15.0 months vs. 12.0 months, P < 0.05), the treatment duration was longer (12.0 months vs. 10.0 months, P < 0.05), and the recurrence rate was greater (32.9% vs. 5.3%, P < 0.001). No significant difference in the degree of regression was observed between the CHD and non-CHD groups. CONCLUSION Pediatric patients with CHD exhibit a later age at treatment withdrawal, a longer duration of therapy, and a higher recurrence rate compared to those without CHD.
Collapse
Affiliation(s)
- Junsong Yu
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Tao Lei
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Lu Gao
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Zhihong Huang
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yang Bi
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yun He
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
| | - Wei Feng
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
| |
Collapse
|
2
|
Jenson AC, Gregory SW, Taggart NW, Penfold MP. Acute Respiratory Distress and Oxygen Refractory Hypoxemia in a Term Newborn. Pediatr Rev 2025; 46:267-272. [PMID: 40306711 DOI: 10.1542/pir.2023-006076] [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: 03/19/2023] [Accepted: 05/21/2024] [Indexed: 05/02/2025]
Affiliation(s)
- Anders C Jenson
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Seth W Gregory
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; and
| | | | - Michael P Penfold
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; and
| |
Collapse
|
3
|
Zhang D, Jiang L, Chen YN, Pan MF. The diagnostic value of contrast-enhanced transcranial Doppler and contrast-enhanced transthoracic echocardiography for right to left shunt in patent foramen ovale: a systematic review and meta-analysis. Front Neurol 2024; 15:1447964. [PMID: 39157064 PMCID: PMC11327031 DOI: 10.3389/fneur.2024.1447964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024] Open
Abstract
Purpose To evaluate and compare the diagnostic value of contrast-enhanced transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) for right to left shunt (RLS) in patent foramen ovale (PFO) by meta-analysis. Methods The literature included in the Cochrane Library, PubMed, and Embase were searched by using "contrast-enhanced transcranial Doppler (c-TCD), contrast-enhanced transthoracic echocardiography (c-TTE), patent foramen ovale (PFO), and right to left shunt (RLS)" as the keywords from inception through April 30, 2024. The diagnostic accuracy research quality assessment tool (QUADAS-2) was used to evaluate the quality of the included literature. The combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and Diagnostic odds ratio (DOR) were pooled, and a comprehensive ROC curve analysis was performed. Statistical software StataSE 12.0 and Meta-Disc 1.4 were used for data analysis. Results A total of 8,536 articles were retrieved, and 9 articles that met all inclusion criteria were included in this meta-analysis. The meta-analysis results show that the combined sensitivity, specificity, PLR, NLR, DOR, and area under the SROC curve of c-TCD for the diagnose of PFO-RLS were 0.91 (95% CI, 0.88-0.93), 0.87 (95% CI: 0.84-0.91), 6.0 (95% CI, 2.78-12.96), 0.10 (95% CI, 0.06-0.18), 91.61 (95% CI, 26.55-316.10), and 0.9681, respectively; the corresponding values of c-TTE were 0.86 (95% CI, 0.84-0.89), 0.88 (95% CI, 0.84-0.91), 5.21 (95% CI, 2.55-10.63), 0.16 (95% CI, 0.09-0.31), 71.43 (95% CI, 22.85-223.23), and 0.9532. The ROC curve shows that c-TCD has slightly higher diagnostic value for PFO than c-TTE, but there is no significant statistical difference (Z = 0.622, p > 0.05). Deek funnel pattern showed no significant publication bias. Conclusion Both c-TCD and c-TTE have high diagnostic values for PFO-RLS. However, c-TCD has slightly higher sensitivity and lower specificity in diagnosing PFO-RLS compared to c-TTE.Systematic review registration: identifier [CRD42024544169].
Collapse
Affiliation(s)
| | | | | | - Mei-Fang Pan
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, China
| |
Collapse
|
4
|
Deng J, Luo Y, Luo S, Zhan H, Zhou F, Li S. Contrast-enhanced transcranial Doppler for the detection of right-to-left shunt: A new provocation method with a syringe-modified Valsalva maneuver. Brain Behav 2024; 14:e3304. [PMID: 38760914 PMCID: PMC11208165 DOI: 10.1002/brb3.3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/24/2023] [Accepted: 10/18/2023] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Contrast-enhanced transcranial Doppler (cTCD) study has been established as one of the most common investigations for detecting right-to-left shunt (RLS). Although the conventional Valsalva maneuver (c-VM) has been used to increase the sensitivity of cTCD for RLS, efforts are still needed to improve the detection rate further. We proposed a new provocation method with a syringe-modified Valsalva maneuver (sm-VM) during cTCD and compared the efficacy of this strategy with cTCD measured at resting and with the provocation of c-VM. METHODS Consecutive patients with suspicion of RLS who underwent cTCD in our institution between September 27, 2021, and April 1, 2022, were included in this study. Examination of cTCD was performed separately at the resting state and provoked with c-VM and sm-VM. The overall proportion of patients with RLS and their distribution with different RLS grades were compared. RESULTS A total of 389 patients (mean age: 49.37 years, male: 52.2%) were included in this study. The positive rate for RLS was significantly higher for cTCD detected with sm-VM than those detected at resting state and with c-VM (46.8% vs. 21.6% and 34.2%, all p < .05). Besides, cTCD detected with sm-VM was also associated with a higher proportion of patients with grade III RLS than those detected at resting state and with c-VM (11.3% vs. 1.8% and 0%, all p < .05). CONCLUSIONS Compared to cTCD detected at resting state and with c-VM, cTCD with sm-VM could further increase the positive detection rate of RLS.
Collapse
Affiliation(s)
- Jinfeng Deng
- Department of NeurologyThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Yan Luo
- Department of NeurologyThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Shijian Luo
- Department of NeurologyThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Hongrui Zhan
- Department of RehabilitationThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Feng Zhou
- Department of NeurologyThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| | - Songbiao Li
- Cardiovascular CenterThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiChina
| |
Collapse
|
5
|
van de Watering AE, van Rossem SAM, Baron Toaldo M, Beijerink NJ, Hulsman AH, Szatmári V, Santarelli G. Doppler Ultrasonographic Assessment of Abdominal Aortic Flow to Evaluate the Hemodynamic Relevance of Left-to-Right Shunting Patent Ductus Arteriosus in Dogs. Animals (Basel) 2024; 14:1404. [PMID: 38791622 PMCID: PMC11117351 DOI: 10.3390/ani14101404] [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: 04/05/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
In this multicenter, prospective, observational study, abdominal aortic flow was examined with pulsed-wave Doppler ultrasound in dogs with a left-to-right shunting patent ductus arteriosus (PDA) and in apparently healthy dogs. Forty-eight dogs with a PDA and 35 controls were included. In the dogs with a PDA, 37/48 had hemodynamically significant PDAs (hsPDAs) while 11/48 had non-hsPDAs, based on the presence or absence of echocardiographic signs of left-sided volume overload, respectively. In 12 dogs (4/35 control dogs, 7/37 dogs with an hsPDA and 1/11 dogs with a non-hsPDA), the diastole was too short to visualize the end-diastolic flow. Antegrade end-diastolic flow was observed in 30/35 controls and 6/11 dogs with a non-hsPDA. Absent end-diastolic flow was observed in 1/35 control dogs and 3/11 dogs with a non-hsPDA. Retrograde end-diastolic flow was observed in 30/37 dogs with an hsPDA and 1/11 dogs with a non-hsPDA. Twenty-one dogs (15 with an hsPDA and 6 with a non-hsPDA) were reassessed after PDA closure, and, in 19/21, end-diastolic flow was visualized: 17/19 showed an antegrade flow, 1/19 an absent flow and 1/19 a retrograde flow. Sensitivity and specificity of retrograde end-diastolic flow for detection of hsPDAs were 100% and 90%, respectively. In conclusion, ultrasonographic assessment of abdominal aortic flow was feasible in dogs with PDA. However, end-diastolic flow was not always visualized. The presence of a retrograde end-diastolic flow was an accurate finding for discriminating hsPDAs and non-hsPDAs.
Collapse
Affiliation(s)
- Anne E. van de Watering
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, 3584 CS Utrecht, The Netherlands (V.S.); (G.S.)
- Veterinaire Specialisten Vught, Reutseplein 3, 5264 PN Vught, The Netherlands
| | - Sophie A. M. van Rossem
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, 3584 CS Utrecht, The Netherlands (V.S.); (G.S.)
| | - Marco Baron Toaldo
- Division of Cardiology, Clinic for Small Animal Medicine, Vetsuisse Faculty, University of Zurich, 8006 Zürich, Switzerland
| | - Niek J. Beijerink
- Veterinaire Specialisten Vught, Reutseplein 3, 5264 PN Vught, The Netherlands
| | - Alma H. Hulsman
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, 3584 CS Utrecht, The Netherlands (V.S.); (G.S.)
| | - Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, 3584 CS Utrecht, The Netherlands (V.S.); (G.S.)
| | - Giorgia Santarelli
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, 3584 CS Utrecht, The Netherlands (V.S.); (G.S.)
| |
Collapse
|
6
|
Liang Y, Pan Z, Zhu M, Gao R, Wang Y, Cheng Y, Zhang N. Exposure to essential and non-essential trace elements and risks of congenital heart defects: A narrative review. Front Nutr 2023; 10:1121826. [PMID: 36998909 PMCID: PMC10043220 DOI: 10.3389/fnut.2023.1121826] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
Congenital heart defects (CHDs) are congenital abnormalities involving the gross structures of the heart and large blood vessels. Environmental factors, genetic factors and their interactions may contribute to the pathogenesis of CHDs. Generally, trace elements can be classified into essential trace elements and non-essential trace elements. Essential trace elements such as copper (Cu), zinc (Zn), iron (Fe), selenium (Se), and manganese (Mn) play important roles in human biological functions such as metabolic function, oxidative stress regulation, and embryonic development. Non-essential trace elements such as cadmium (Cd), arsenic (As), lead (Pb), nickle (Ni), barium (Ba), chromium (Cr) and mercury (Hg) are harmful to health even at low concentrations. Recent studies have revealed the potential involvement of these trace elements in the pathogenesis of CHDs. In this review, we summarized current studies exploring exposure to essential and non-essential trace elements and risks of CHDs, in order to provide further insights for the pathogenesis and prevention of CHDs.
Collapse
Affiliation(s)
- Yipu Liang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zijian Pan
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mingzheng Zhu
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ruonan Gao
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yijue Wang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yijuan Cheng
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Nannan Zhang
- National Center for Birth Defect Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Nannan Zhang,
| |
Collapse
|