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Evans WN, Acherman RJ, Law IH, Von Bergen NH, Samson RA, Restrepo H. Neonatal complex arrhythmias possibly related to a TTN mutation. J Neonatal Perinatal Med 2017; 10:343-346. [PMID: 28854511 DOI: 10.3233/npm-16120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We describe a neonate born with complex arrhythmias that included concurrent atrial and ventricular tachycardias. Genetic testing demonstrated a mutation in the TTN gene, which codes for titin, a large protein found in striated muscle sarcomeres. The complex arrhythmias were successfully treated with amiodarone and flecainide. The patient remains asymptomatic with normal biventricular function. We speculate that the complex arrhythmias and TTN gene mutation may be related.
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Affiliation(s)
- William N Evans
- Children's Heart Center Nevada, Las Vegas, NV, USA
- Department of Pediatrics, Division of Cardiology, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Ruben J Acherman
- Children's Heart Center Nevada, Las Vegas, NV, USA
- Department of Pediatrics, Division of Cardiology, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Ian H Law
- Children's Heart Center Nevada, Las Vegas, NV, USA
- Department of Pediatrics, Division of Cardiology, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Nicholas H Von Bergen
- Children's Heart Center Nevada, Las Vegas, NV, USA
- Department of Pediatrics, Division of Cardiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Ricardo A Samson
- Children's Heart Center Nevada, Las Vegas, NV, USA
- Department of Pediatrics, Division of Cardiology, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Humberto Restrepo
- Children's Heart Center Nevada, Las Vegas, NV, USA
- Department of Pediatrics, Division of Cardiology, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
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Abstract
Operative survival after the Norwood procedure has significantly improved during the past 10 years. However, there remains attrition among Norwood survivors before reaching planned second-stage palliation. The purpose of this study was to evaluate potential risk factors for interstage mortality among Norwood survivors. All patients undergoing the Norwood procedure at the Medical University of South Carolina from January 1996 through January 2001 were retrospectively reviewed. Patient and procedural variables were examined as potential risk factors for interstage mortality. Among 50 Norwood survivors, 8 (16%) died prior to second-stage palliation. The mean age at death was 102 +/- 72 days (median, 61; range, 35-208). By multivariate analysis, the presence of an arrhythmia in the postoperative period (p = 0.02) and decreased ventricular function at hospital discharge (p = 0.05) were identified as risk factors for interstage mortality. There remains a significant risk for interstage mortality among Norwood survivors. Patients with postoperative arrhythmias and/or decreased ventricular function at discharge are at increased risk for interstage death after Norwood procedure. More frequent follow-up and aggressive medical management of arrhythmia or decreased function may be warranted for these high-risk patients.
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Affiliation(s)
- J M Simsic
- Division of Pediatric Cardiology, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425, USA.
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