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Öcal A, Demirci O, Kahramanoğlu Ö, Ayhan I, Erol N, Yücel İK. Navigating the spectrum of double-outlet right ventricle presentations: Outcomes from a contemporary cohort based on subtypes. Echocardiography 2024; 41:e15790. [PMID: 38456327 DOI: 10.1111/echo.15790] [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] [Received: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Our aim in this study was to investigate the prenatal and postnatal prognosis of double outlet right ventricle (DORV) cases diagnosed prenatally by analyzing the outcomes based on the subtype. METHODS This study is a retrospective chart review. Cases diagnosed with fetal DORV by prenatal ultrasound in the maternal-fetal medicine department of our hospital between 2014 and 2022 were included. Data on maternal characteristics, fetal echocardiographic features (type of DORV), pregnancy and neonatal outcomes (termination of pregnancy [TOP], intrauterine fetal death [IUD], neonatal death [NND], death in infancy (IND), survival) were collected and analyzed. RESULTS Ninety-nine cases of prenatally diagnosed cases of DORV were included. The prenatal diagnosis was right in 97% of the liveborn fetuses. The cases were classified into subtypes, including transposition of great arteries (TGA), Fallot, ventricular septal defect (VSD), remote, and heterotaxy types. The cohort consisted of 32.3% TGA type, 19.1% fallot type, 11.1% VSD type, 2% remote type, and 35.3% heterotaxy type of DORV. An additional cardiac anomaly was observed in 87% and an extra-cardiac anomaly was observed in 54% of the cases. When we excluded the cases with heterotaxy type but without any chromosomal abnormality, additional genetic abnormalities were detected in 42% of the remaining cases. Outcome of pregnancy was livebirth in 68/99 (68.7%), IUFD in 5/99 (5.1%), and TOP in 26/99 (26.3%). Postnatal cardiac surgical repair was performed in 48 cases. Survival among livebirths was 39/68 (57.3%). Twenty-nine neonates or infants who had additional cardiac anomalies and/or genetic abnormalities died before any surgical intervention. The postoperative survival rate was 39/48 (81.2%). CONCLUSION The prognosis in DORV depends on the anatomical subtype, the presence, and severity of associated anomalies. Survival increases in isolated cases without any additional structural or genetic anomalies.
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Affiliation(s)
- Aydın Öcal
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Işıl Ayhan
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nurdan Erol
- Department of Pediatric Cardiology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - İlker Kemal Yücel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
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Yadav M, Rabbani SS, Kidwai MM, Abqari S, Anderson RH, Haseen MA. Double Outlet of Both Ventricles With an Unusual Relationship of the Great Arteries. World J Pediatr Congenit Heart Surg 2024; 15:235-239. [PMID: 37861179 DOI: 10.1177/21501351231203925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Double outlet both ventricles (DOBV) is a rare form of ventriculo-arterial connection wherein the outlet septum is perpendicular to the crest of the apical muscular ventricular septum, thus committing both arterial roots equally to both ventricles. The anomaly has been described in very few reports, with clinical reports being even rarer. We report perhaps the first case of DOBV in which the relationship of the arterial roots themselves is discordant relative to the ventricular topology.
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Affiliation(s)
- Mayank Yadav
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Syed Shamayal Rabbani
- Department of Cardiothoracic Surgery, Jawaharlal Nehru Medical, College and Hospital, Aligarh Muslim University, Aligarh, India
| | - Mohammad Moaaz Kidwai
- Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | - Shaad Abqari
- Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon-Tyne, UK
| | - Mohammad Azam Haseen
- Department of Cardiothoracic Surgery, Jawaharlal Nehru Medical, College and Hospital, Aligarh Muslim University, Aligarh, India
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Josowitz R, Rogers LS. Double outlet right ventricle - the 50% rule has always been about the conus. Curr Opin Cardiol 2024:00001573-990000000-00133. [PMID: 38391276 DOI: 10.1097/hco.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW There has been much variability in the definition of double outlet right ventricle (DORV) spanning the last century. Historically, emphasis has been placed on the assignment of the great arteries to the right ventricle as a definition of DORV. In this review, we aim to underscore the importance of conal muscle, rather than rules surrounding assignment of great arteries to ventricles. We will be outlining the variability in patient anatomy that results from variations in conal muscle development in DORV, which may not fit perfectly into predefined constructs. This anatomic variability directly determines physiology and surgical repair options. RECENT FINDINGS There is a growing appreciation of the utility of cross-sectional imaging in complex DORV, and the generation of patient-specific 3D models with virtual reality simulations for surgical planning. These models improve the prediction of candidacy for biventricular repair and allow the mapping of complex baffle pathways preoperatively. SUMMARY DORV is not a disease entity in itself, but rather a vast spectrum of disorders associated with maldevelopment of conal muscle and often abnormal expansion of one the great vessels. Patient-specific 3D models will be crucial for improved surgical planning and patient outcomes.
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Affiliation(s)
- Rebecca Josowitz
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Tran P, Tedesco V, Kiang S, Karnik S, Nguyen D, Frazier OH, Fraser KH, Wang Y. Personalized Numerical Cardiovascular Model with Weight Growth for Evaluating Pediatric Left Ventricular Assist Devices: Derivation from an Experimental Mock Circulatory Loop. Ann Biomed Eng 2024; 52:302-317. [PMID: 37777691 DOI: 10.1007/s10439-023-03376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
Pediatric patients with heart failure have limited treatment options because of a shortage of donor hearts and compatible left ventricular assist devices (LVADs). To address this issue, our group is developing an implantable pediatric LVAD for patients weighing 5-20 kg, capable of accommodating different physiological hemodynamic conditions as patients grow. To evaluate LVAD prototypes across a wide range of conditions, we developed a numerical cardiovascular model, using data from a mock circulatory loop (MCL) and patient-specific elastance functions. The numerical MCL was validated against experimental MCL results, showing good agreement, with differences ranging from 0 to 11%. The numerical model was also tested under left heart failure conditions and showed a worst-case difference of 16%. In an MCL study with a pediatric LVAD, a pediatric dataset was obtained from the experimental MCL and used to tune the numerical MCL. Then, the numerical model simulated LVAD flow by using an HQ curve obtained from the LVAD's impeller. When the numerical MCL was validated against the experimental MCL, hemodynamic differences ranged between 0 and 9%. These findings suggest that the numerical model can replicate various physiological conditions and impeller designs, indicating its potential as a tool for developing and optimizing pediatric LVADs.
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Affiliation(s)
- Phong Tran
- Innovative Device and Engineering Applications Laboratory, Texas Heart Institute, Houston, TX, USA
| | - Victor Tedesco
- Innovative Device and Engineering Applications Laboratory, Texas Heart Institute, Houston, TX, USA
| | - Simon Kiang
- Innovative Device and Engineering Applications Laboratory, Texas Heart Institute, Houston, TX, USA
| | - Shweta Karnik
- Bioengineering Department, Georgia Institute of Technology, Atlanta, GA, USA
| | - David Nguyen
- Innovative Device and Engineering Applications Laboratory, Texas Heart Institute, Houston, TX, USA
| | - O H Frazier
- Innovative Device and Engineering Applications Laboratory, Texas Heart Institute, Houston, TX, USA
| | | | - Yaxin Wang
- Innovative Device and Engineering Applications Laboratory, Texas Heart Institute, Houston, TX, USA.
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Lacour-Gayet F, Zoghbi J, Gouton M, Roussin R, Bical O, Lucet V, Saint-Pick M, Leca F. Multicentre study on late outcomes of biventricular repair of double outlet right ventricle. Eur J Cardiothorac Surg 2024; 65:ezad423. [PMID: 38134423 DOI: 10.1093/ejcts/ezad423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/08/2023] [Accepted: 12/21/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES The goal of this retrospective multicentre study was to present late surgical outcomes of the treatment of children with double outlet right ventricle (DORV) coming from emerging countries. METHODS The Mécénat Chirurgie Cardiaque brings to France for surgery selected children with simple and complex congenital diseases, including DORV. The patients are operated on in 9 hospitals that specialize in paediatric cardiac surgery. Data are collected from the Mécénat Chirurgie Cardiaque comprehensive database, with a strict postoperative follow-up. The patients included only those who had biventricular repair of DORV with 2 viable ventricles. According to the classification of the Eleventh Revision of the International Classification of Diseases, DORV was defined as a congenital cardiovascular malformation in which both great arteries arise entirely or predominantly from the morphologically right ventricle. RESULTS From January 1996 to January 2022, a total of 81 consecutive DORV biventricular repair operations were performed. There were 6 subtypes of DORV divided into 2 groups: DORV-committed ventricular septal defect (VSD): DORV-VSD (n = 25), DORV-Fallot (n = 34), DORV-transposition of the great arteries (n = 5); and DORV-non-committed (nc) VSD: DORV-ncVSD-no pulmonary stenosis (PS) (n = 7), DORV-ncVSD-PS (n = 5) and DORV-atrioventricular septal defect (AVSD)-PS (n = 5). Four Fontan patients were excluded. Three patients were lost to follow-up (3.4%). The overall perioperative mortality was 7.4% ± 2.6%, 6/81 (95% confidence interval: 2.8%-15.4%) ranging from 0% in DORV-AVSD-PS to 14% for DORV-ncVSD-no PS. The overall 10-year survival was 86%. The early mortality of DORV-ncVSD at 5.9% ± 2.4% (1/17) was similar to that of DORV-committed VSD at 7.8% ± 2.7% (5/64) (P = 0.79). There was a trend towards an optimal outcome for the arterial switch operation and the DORV-AVSD-PS repair. VSD enlargement was significantly more frequent in DORV-ncVSD at 42% (5/12) (P = 0.001). There were low numbers in the complex groups. The number of Fontan cases was noticeably low. The aorta located entirely on the right ventricle represents the fundamental anomaly and the surgical challenge of DORV. CONCLUSIONS Overall survival at 10 years was 86%. This study shows a trend towards satisfactory early and late outcomes in BVR of simple DORV with committed VSD, compared to complex DORV with ncVSD.
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Affiliation(s)
| | - Joy Zoghbi
- Marie Lannelongue Hospital, 133 Avenue de la Resistance, 92350 Le Plessis Robinson, France
| | | | - Régine Roussin
- Fondation Mécénat Chirurgie Cardiaque
- Marie Lannelongue Hospital, 133 Avenue de la Resistance, 92350 Le Plessis Robinson, France
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Priya S, La Russa D, Walling A, Goetz S, Hartig T, Khayat A, Gupta P, Nagpal P, Ashwath R. "From Vision to Reality: Virtual Reality's Impact on Baffle Planning in Congenital Heart Disease". Pediatr Cardiol 2024; 45:165-174. [PMID: 37932525 DOI: 10.1007/s00246-023-03323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
Abstract
This study aims to evaluate the feasibility and utility of virtual reality (VR) for baffle planning in congenital heart disease (CHD), specifically by creating patient-specific 3D heart models and assessing a user-friendly VR interface. Patient-specific 3D heart models were created using high-resolution imaging data and a VR interface was developed for baffle planning. The process of model creation and the VR interface were assessed for their feasibility, usability, and clinical relevance. Collaborative and interactive planning within the VR space were also explored. The study findings demonstrate the feasibility and usefulness of VR in baffle planning for CHD. Patient-specific 3D heart models generated from imaging data provided valuable insights into complex spatial relationships. The developed VR interface allowed clinicians to interact with the models, simulate different baffle configurations, and assess their impact on blood flow. The VR space's collaborative and interactive planning enhanced the baffle planning process. This study highlights the potential of VR as a valuable tool in baffle planning for CHD. The findings demonstrate the feasibility of using patient-specific 3D heart models and a user-friendly VR interface to enhance surgical planning and patient outcomes. Further research and development in this field are warranted to harness the full benefits of VR technology in CHD surgical management.
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Affiliation(s)
- Sarv Priya
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Dan La Russa
- Realize Medical Inc., Ottawa, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Canada
| | - Abigail Walling
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Sawyer Goetz
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Tyler Hartig
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Pankaj Gupta
- Division of Pediatric Cardiology, The Royal Hospital for Children, Glasgow, UK
| | - Prashant Nagpal
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Ravi Ashwath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Anderson RH, Spicer DE, McMahon CJ, Kumar RK, Tretter JT. How best can we name the channels seen in the setting of deficient ventricular septation? Cardiol Young 2024; 34:1-10. [PMID: 38037810 DOI: 10.1017/s1047951123003943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Surgical repair of channels between the ventricles is enhanced when the surgeon knows precisely where to place a patch, or baffle, so as to restore septal integrity. The paediatric cardiologist should provide the necessary information. Communication will be enhanced if the same words are used to account for the structures in question. Currently, however, the same term, namely "ventricular septal defect," is used to account for markedly different areas within the heart. Closure of perimembranous defects found in hearts with concordant or discordant ventriculo-arterial connections restores the integrity of the ventricular septum, at the same time separating the systemic and pulmonary blood streams. When both arterial trunks arise from the right ventricle, in contrast, the surgeon when placing a baffle so as to separate the blood streams, does not close the channel most frequently described as the "ventricular septal defect." In this review, we show that the perimembranous lesions as found in hearts with concordant or discordant ventriculo-arterial connections are the right ventricular entrances to the areas subtended beneath the hinges of the leaflets of the aortic or pulmonary valves. When both arterial trunks arise from the right ventricle, and the channel between the ventricles is directly subaortic, then the channel termed the "ventricular septal defect" is the left ventricular entrance to the comparable space subtended beneath the aortic root. We argue that recognition of these fundamental anatomical differences enhances the appreciation of the underlying morphology of the various lesions that reflect transfer, during cardiac development, of the aortic root from the morphologically right to the morphologically left ventricle.
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Affiliation(s)
- Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, London, UK
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Justin T Tretter
- Department of Pediatric Cardiology, Cleveland Clinic Children's, and Cardiovascular Medicine Department, Heart, Vascular, Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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8
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Wang Z, Li Z. Long-term results of biventricular correction for patients with double outlet right ventricle. Cardiol Young 2023; 33:1367-1377. [PMID: 36039779 DOI: 10.1017/s1047951122002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The purpose of this study was to report outcomes of double outlet right ventricle biventricular repair at a single institution in developing countries and to investigate post-operatively determined risk factors for mortality and late intervention. METHODS Patients with double outlet right ventricle who underwent biventricular repair in our centre from January 2009 to December 2021 were included. RESULTS A total of 96 patients (male/female = 61/35) with biventricular repair were included. According to its specific anatomical type, the appropriate individual surgical plan was selected. Multivariate analysis indicated that prolonged cardiopulmonary bypass time(OR = 1.044; p = 0.012) and pre-operative moderate or above pulmonary hypertension(OR = 24.558; p = 0.023) were independent risk factors for early mortality. Univariate analysis showed that different anatomical types and different surgical methods had similar late intervention and late mortality. Concomitant coarctation of the aorta(OR = 40; p = 0.020) and concomitant ventricular septal defect enlargement(OR = 26.667; p = 0.005) were independent risk factors for late intervention by multivariate analysis. CONCLUSION Selection of appropriate surgical techniques based on different anatomical types often results in similar late outcomes. For patients with concomitant ventricular septal defect enlargement during the operation, it is necessary to fully expand and avoid damage to the conduction bundle. We should timely intervention in patients with coarctation of the aorta and pay attention to the occurrence of left ventricular outflow tract obstruction during follow-up.
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Affiliation(s)
- Zhangwei Wang
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Zhiqiang Li
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
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Erikssen G, Liestøl K, Aboulhosn J, Wik G, Holmstrøm H, Døhlen G, Gjesdal O, Birkeland S, Hoel TN, Saatvedt KJ, Seem E, Thaulow E, Estensen ME, Lindberg HL. Preoperative versus postoperative survival in patients with univentricular heart: a nationwide, retrospective study of patients born in 1990-2015. BMJ Open 2023; 13:e069531. [PMID: 37491095 PMCID: PMC10373731 DOI: 10.1136/bmjopen-2022-069531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES Few data exist on mortality among patients with univentricular heart (UVH) before surgery. Our aim was to explore the results of intention to perform surgery by estimating preoperative vs postoperative survival in different UVH subgroups. DESIGN Retrospective. SETTING Tertiary centre for congenital cardiology and congenital heart surgery. PARTICIPANTS All 595 Norwegian children with UVH born alive from 1990 to 2015, followed until 31 December 2020. RESULTS One quarter (151/595; 25.4%) were not operated. Among these, only two survived, and 125/149 (83.9%) died within 1 month. Reasons for not operating were that surgery was not feasible in 31.1%, preoperative complications in 25.2%, general health issues in 23.2% and parental decision in 20.5%. In total, 327/595 (55.0%) died; 283/327 (86.5%) already died during the first 2 years of life. Preoperative survival varied widely among the UVH subgroups, ranging from 40/65 (61.5%) among patients with unbalanced atrioventricular septal defect to 39/42 (92.9%) among patients with double inlet left ventricle. Postoperative survival followed a similar pattern. Postoperative survival among patients with hypoplastic left heart syndrome (HLHS) improved significantly (5-year survival, 42.5% vs 75.3% among patients born in 1990-2002 vs 2003-2015; p<0.0001), but not among non-HLHS patients (65.7% vs 72.6%; p=0.22)-among whom several subgroups had a poor prognosis similar to HLHS. A total of 291/595 patients (48.9%) had Fontan surgery CONCLUSIONS: Surgery was refrained in one quarter of the patients, among whom almost all died shortly after birth. Long-term prognosis was largely determined during the first 2 years. There was a strong concordance between preoperative and postoperative survival. HLHS survival was improved, but non-HLHS survival did not change significantly. This study demonstrates the complications and outcomes encountering newborns with UVH at all major stages of preoperative and operative treatment.
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Affiliation(s)
- Gunnar Erikssen
- Department of Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Jamil Aboulhosn
- Ahmanson Adult Congenital Heart Disease Center, UCLA, Los Angeles, California, USA
| | - Gunnar Wik
- Department of Pediatrics, Sørlandet Hospital, Kristiansand, Norway
| | - Henrik Holmstrøm
- Department of Women's and Children's, Oslo University Hospital, Oslo, Norway
- Department of Women's and Children's, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gaute Døhlen
- Department of Women's and Children's, Oslo University Hospital, Oslo, Norway
| | - Ola Gjesdal
- Department of Cardiology, Oslo University Hospital rikshospitalet, Oslo, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Tom Nilsen Hoel
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kjell Johan Saatvedt
- Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Egil Seem
- Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Mette E Estensen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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Dey CK, Anand V, Agha M, Karim HMR, N P, Panda CK, Kesavankutty MP. Perioperative Management of Emergency Craniotomes in Children With Cyanotic Congenital Heart Disease: A Case Series. Cureus 2023; 15:e40840. [PMID: 37489199 PMCID: PMC10363277 DOI: 10.7759/cureus.40840] [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] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
While congenital heart disease is not uncommon, cyanotic congenital heart disease (CCHD) accounts for a minor fraction of them. However, when cyanosis is present, it usually indicates a severe or critical illness. Tetralogy of Fallot (TOF) is one of the common CCHDs, representing 7-10% of all congenital cardiac malformations. Double-outlet right ventricle (DORV) is another CCHD similar to the TOF and associated with decreased pulmonary flow, ventricular septal defect (VSD), and aorta receiving blood from both ventricles. Reduced oxygen arterial saturation and increased viscosity by polycythemia induce focal cerebral ischemia, often in the area supplied by the middle cerebral artery leading to brain abscess. Brain abscesses require craniotomy, which is a major surgery. These patients also often show features of sepsis and increased intracranial pressure. The presence of CCHD further complicates the situation, making perioperative management even more challenging. There are studies in the literature on the management of similar cases, and they report successful management in most of them. However, not all such cases need intensive postoperative management. We present four pediatric cases who had either TOF or DORV and had to undergo craniotomy for brain abscess or ventriculoperitoneal shunt placement. We describe case management and highlight the critical features and cases that require prolonged postoperative critical care management.
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Affiliation(s)
- Chandan K Dey
- Trauma and Emergency, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Varun Anand
- Trauma and Emergency, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Mussavvir Agha
- Trauma and Emergency, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Habib Md R Karim
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pharanitharan N
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Chinmaya K Panda
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Manu P Kesavankutty
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Raipur, IND
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11
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Xu Z, Semple T, Gu H, McCarthy KP, Yen Ho S, Li W. Double outlet ventricles: review of anatomic and imaging characteristics. Heart 2022; 109:905-912. [DOI: 10.1136/heartjnl-2022-321955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Hearts with double outlet ventricles and concordant atrioventricular connections account for about 1%–3% of all cases of congenital heart disease. We review hearts with two ventricles and concordant atrioventricular connections with double outlet right ventricle (DORV), double outlet left ventricle (DOLV) and double outlet both ventricles (DOBV) from the morphological and clinical imaging perspectives. These hearts are a heterogeneous group of congenital cardiac malformations with a wide range of pathophysiologies that require an individualised surgical approach based on a precise understanding of the complex cardiovascular anatomy. Owing to their differing temporal, spatial and contrast resolutions, we propose that multimodality imaging provides optimal characterisation of various intracardiac morphological features of double outlet hearts. This approach aids clinical diagnosis for optimising treatment options across these malformations.
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12
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Ponchant K, Nguyen DA, Prsa M, Beghetti M, Sologashvili T, Vallée JP. Three-dimensional printing and virtual reconstruction in surgical planning of double-outlet right ventricle repair. JTCVS Tech 2022; 17:138-150. [PMID: 36820361 PMCID: PMC9938382 DOI: 10.1016/j.xjtc.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives For more than a decade, 3-dimensional (3D) printing has been identified as an innovative tool for the surgical planning of double-outlet right ventricle (DORV). Nevertheless, lack of evidence concerning its benefits encourages us to identify valuable criteria for future prospective trials. Methods We conducted a retrospective study involving 10 patients with DORV operated between 2015 and 2019 in our center. During a preoperative multidisciplinary heart team meeting, we harvested surgical decisions following a 3-increment step process: (1) multimodal imaging; (2) 3D virtual valvular reconstruction (3DVVR); and (3) 3D-printed heart model (3DPHM). The primary outcome was the proportion of predicted surgical strategy following each of the 3 steps, compared with the institutional retrospective surgical strategy. The secondary outcome was the change of surgical strategy through 3D modalities compared with multimodal imaging. The incremental benefit of the 3DVVR and 3DPHM over multimodal imaging was then assessed. Results The operative strategy was predicted in 5 cases after multimodal imaging, in 9 cases after 3DVVR, and the 10 cases after 3DPHM. Compared with multimodal imaging, 3DVVR modified the strategy for 4 cases. One case was correctly predicted only after 3DPHM inspection. Conclusions 3DVVR and 3DPHM improved multimodal imaging in the surgical planning of patients with DORV. 3DVVR allowed a better appreciation of the relationships between great vessels, valves, and ventricular septal defects. 3DPHM offers a realistic preoperative view at patient scale and enhances the evaluation of outflow tract obstruction. Our retrospective study demonstrates benefits of preoperative 3D modalities and supports future prospective trials to assess their impact on postoperative outcomes.
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Key Words
- 3D modality in surgical planning
- 3D printed heart model
- 3D printing
- 3D virtual valvular reconstruction
- 3D, 3-dimensional
- 3DPHM, 3D-printed heart model
- 3DVVR, 3D virtual valvular annulus reconstruction
- CTA, computed tomography angiogram
- DORV, double-outlet right ventricle
- LV, left ventricle
- PA, pulmonary artery
- PV, pulmonary valve
- TGA, transposition of the great arteries
- TTE, transthoracic echocardiography
- VSD, ventricular septal defect
- double-outlet right ventricle
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Affiliation(s)
- Kevin Ponchant
- Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland,Address for reprints: Kevin Ponchant, Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Duy-Anh Nguyen
- Pediatric Cardiology Unit, Children's University Hospital, Geneva, Switzerland
| | - Milan Prsa
- Division of Pediatric Cardiology, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Children's University Hospital, Geneva, Switzerland,Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland
| | - Tornike Sologashvili
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Geneva University Hospitals/Lausanne University Hospital, Geneva/Lausanne, Switzerland,Division of Cardiac Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Vallée
- Cardiovascular Radiology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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13
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Guo HB, Tan JB, Cui YC, Xiong HF, Li CS, Liu YF, Sun Y, Pu L, Xiang P, Zhang M, Hao JJ, Yin NN, Hou XT, Liu JY. Extracorporeal membrane oxygenation in curing a young man after modified Fontan operation: A case report. World J Clin Cases 2022; 10:10614-10621. [PMID: 36312498 PMCID: PMC9602225 DOI: 10.12998/wjcc.v10.i29.10614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/14/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. After the modified Fontan operation, circulation is different from that of patients who are not subjected to the procedure. This paper describe a successful case using ECMO in curing influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The special cardiac structure and circulatory characteristics are explored in this case.
CASE SUMMARY We report a successful case using ECMO in curing influenza A infection in a 23-year-old man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The man was admitted to the intensive care unit with severe acute respiratory distress syndrome as a result of influenza A infection. He was initially treated by veno-venous (VV) ECMO, which was switched to veno-venous-arterial ECMO (VVA ECMO) 5 d later. As circulation and respiratory function gradually improved, the VVA ECMO equipment was removed on May 1, 2018. The patient was successfully withdrawn from artificial ventilation on May 28, 2018 and then discharged from hospital on May 30, 2018.
CONCLUSION After the modified Fontan operation, circulation is different compared with that of patients who are not subjected to the procedure. There are certainly many differences between them when they receive the treatment of ECMO. Due to the special cardiac structure and circulatory characteristics, an individualized liquid management strategy is necessary and it might be better for them to choose an active circulation support earlier.
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Affiliation(s)
- He-Bing Guo
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Jian-Bo Tan
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yong-Chao Cui
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hao-Feng Xiong
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Chuan-Sheng Li
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yu-Feng Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yao Sun
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Lin Pu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Pan Xiang
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ming Zhang
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Jing-Jing Hao
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ning-Ning Yin
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Xiao-Tong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jing-Yuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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14
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Karev E, Stovpyuk OF. Double outlet right ventricle in adults: Anatomic variability, surgical treatment, and late postoperative complications. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1151-1165. [PMID: 36218204 DOI: 10.1002/jcu.23319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
Double outlet right ventricle (DORV) is a highly complex congenital heart disease (CHD) entity, gaining increasing interest due to the rapid progress of cardiac surgery. The number of patients operated for this congenital defect has been growing since 1980s and over following decades with active transitioning of this cohort into the adult medicine. However, the diversity of initial anomaly and performed interventions makes challenging the management of these patients. This is particularly important in the regions where specialized adult CHD cardiology still remains underdeveloped. In this review, we observe the basic principles of DORV nomenclature, main types of the operations and possible late complications. The article focuses on adult patients and offers illustrations from clinical practice.
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Affiliation(s)
- Egor Karev
- The aorta and aortic valve pathology research laboratory, Federal State Budgetary Institution "V. A. Almazov National Medical Research Center" of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Oksana F Stovpyuk
- The aorta and aortic valve pathology research laboratory, Federal State Budgetary Institution "V. A. Almazov National Medical Research Center" of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
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15
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Liang J, Lu B, Zhao X, Wang J, Zhao D, Zhang G, Zhu B, Ma Q, Pan G, Li D. Feasibility analyses of virtual models and 3D printing for surgical simulation of the double-outlet right ventricle. Med Biol Eng Comput 2022; 60:3029-3040. [DOI: 10.1007/s11517-022-02660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
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16
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Gu M, Hu J, Dong W, Zhang W, Jiang Q, Hu R, Zhu Y, Zhu H, Zhang H. Mid-Term Outcomes of Primary Arterial Switch Operation for Taussig-Bing Anomaly. Semin Thorac Cardiovasc Surg 2022; 35:562-571. [PMID: 35691468 DOI: 10.1053/j.semtcvs.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/01/2022] [Indexed: 11/11/2022]
Abstract
To identify risk factors associated with mortality and reintervention on primary arterial switch operation for Taussig-Bing anomaly in 225 cases over a 16-year period. From 2002 to 2017, 225 children with Taussig-Bing anomaly received a primary arterial switch operation at the Shanghai Children's Medical Center. Perioperative data and follow-up results were collected. Univariate and multivariable analysis was used to explore risk factors associated with early mortality. The competing risk analysis was used to identify risk factors related to reintervention. Early mortality was 12.9% (29/225) with a satisfactory long-term survival rate (10-year survival rate 85.0%). The median age at repair was 77 days (interquartile range, IQR, 48-139). The median duration of follow-up was 4.6 (range 0.1-18.3) years. 87 children (38.7%) received concomitant aortic arch repair. Prolonged cardiopulmonary bypass time (a-OR 1.18, 95% confidence interval [CI], 1.09-1.28, p < 0.001) is found to be an independent risk factor for early death. Larger weight at repair tends to be a protective factor (a-OR 0.66, 95% CI, 0.425-1.02, p = 0.060) and intramural coronary artery (a-OR 4.81, 95% CI, 0.927-24.9, p = 0.062) tends to be a risk factor for early mortality. The cumulative incidence rate of overall reintervention was 18.9% (95% CI, 10.3%-27.4%) at 5 years and 32.3% (95% CI, 17,0%-47.6%) at 10 years. No independent risk factors were identified for long-term overall reintervention. Prolonged aortic-cross clamp time was an independent risk factor for long-term right-sided reintervention (adjusted hazard ratio [a-HR] 1.12, 95% CI 1.005-1.25, p = 0.041). Neo-aortic regurgitation was a concern with an incidence rate of moderate or greater neo-AR of 16.1 % (95% CI 7.6%-24.7%) at 10 years. Intramural coronary artery remains a surgical challenge in primary arterial switch operation for the Taussig-Bing anomaly. Larger weight at ASO tends to be a protective factor for early death. Reintervention is frequently necessary but can be performed with satisfactory results.
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Affiliation(s)
- Mingjun Gu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Hu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Dong
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Jiang
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Renjie Hu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifan Zhu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongbin Zhu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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17
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Kumar P, Bhatia M. Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies. Radiol Cardiothorac Imaging 2022; 4:e210089. [PMID: 35923747 PMCID: PMC9308465 DOI: 10.1148/ryct.210089] [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: 03/27/2021] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
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18
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Nguyen MT, Thinh Nguyen TL, Tran VQ, Mai DD, Doan AV. Results of the arterial switch operation for Taussig–Bing variants in the setting of a lower‐middle income country: A single‐institution experience. J Card Surg 2022; 37:725-731. [DOI: 10.1111/jocs.16240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mai Tuan Nguyen
- Department of Cardiovascular Surgery Children Heart Center, National Children's Hospital Hanoi Vietnam
| | - Truong Ly Thinh Nguyen
- Department of Cardiovascular Surgery Children Heart Center, National Children's Hospital Hanoi Vietnam
| | - Vinh Quang Tran
- Department of Cardiovascular Surgery Children Heart Center, National Children's Hospital Hanoi Vietnam
| | - Duyen Dinh Mai
- Department of Cardiovascular Surgery Children Heart Center, National Children's Hospital Hanoi Vietnam
| | - Anh Vuong Doan
- Department of Cardiovascular Surgery Children Heart Center, National Children's Hospital Hanoi Vietnam
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19
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Bielecka‐Dabrowa A, Bikiewicz A, Rybak M, Pawliczak F, Lewek J, Banach M, Maciejewski M. Patient after correction Taussig-Bing anomaly with severe neo-aortic regurgitation after sudden cardiac arrest. Clin Case Rep 2021; 9:e05085. [PMID: 34925830 PMCID: PMC8647201 DOI: 10.1002/ccr3.5085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/06/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022] Open
Abstract
The Taussig-Bing anomaly is a rare cyanotic congenital heart defect treated surgically in the early infancy. The preferred repair procedure is an arterial switch operation combined with ventricular septal defect closure. Despite promising long-term functional outcomes and survival benefits, neo-aortic dysfunction and arrhythmias might be relevant complications.
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Affiliation(s)
- Agata Bielecka‐Dabrowa
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Agata Bikiewicz
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Marek Rybak
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Filip Pawliczak
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Joanna Lewek
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Marek Maciejewski
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
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20
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Jacobs JP, Franklin RCG, Béland MJ, Spicer DE, Colan SD, Walters HL, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI. Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). World J Pediatr Congenit Heart Surg 2021; 12:E1-E18. [PMID: 34304616 DOI: 10.1177/21501351211032919] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC. The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
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Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America
| | - Rodney C G Franklin
- Paediatric Cardiology Department, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Marie J Béland
- Division of Paediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Diane E Spicer
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America.,Johns Hopkins All Children's Hospital, Johns Hopkins University, Saint Petersburg, Florida, United States of America
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - Henry L Walters
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Frédérique Bailliard
- Bailliard Henry Pediatric Cardiology, Raleigh, North Carolina, United States of America.,Duke University, Durham, North Carolina, United States of America
| | - Lucile Houyel
- Congenital and Pediatric Medico-Surgical Unit, Necker Hospital-M3C, Paris, France
| | - James D St Louis
- Department of Surgery and Pediatrics, Children Hospital of Georgia, Augusta University, Augusta, Georgia
| | - Leo Lopez
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Vera D Aiello
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - J William Gaynor
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Otto N Krogmann
- Pediatric Cardiology-Congenital Heart Disease, Heart Center Duisburg, Duisburg, Germany
| | - Hiromi Kurosawa
- Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Bohdan J Maruszewski
- Department for Pediatric and Congenital Heart Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Paul Morris Weinberg
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | - Jeffrey R Boris
- Jeffrey R. Boris, MD LLC, Moylan, Pennsylvania, United States of America
| | - Meryl S Cohen
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Allen D Everett
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jorge M Giroud
- All Children's Hospital, Saint Petersburg, Florida, United States of America
| | - Kristine J Guleserian
- Congenital Heart Surgery, Medical City Children's Hospital, Dallas, Texas, United States of America
| | - Marina L Hughes
- Cardiology Department, Norfolk and Norwich University Hospital NHS Trust, United Kingdom
| | - Amy L Juraszek
- Terry Heart Institute, Wolfson Children's Hospital, Jacksonville, Florida, United States of America
| | - Stephen P Seslar
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States of America
| | - Charles W Shepard
- Children's Heart Clinic of Minneapolis, Minneapolis, Minnesota, United States of America
| | - Shubhika Srivastava
- Division of Cardiology, Department of Cardiovascular Medicine, Nemours Cardiac Center at the Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Adrian Crucean
- Congenital Heart Surgery, Birmingham Women's and Children's Foundation Trust Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Lazaro E Hernandez
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, Florida, United States of America
| | - Rohit S Loomba
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States of America
| | - Lindsay S Rogers
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Stephen P Sanders
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jill J Savla
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elif Seda Selamet Tierney
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Lianyi Wang
- Heart Centre, First Hospital of Tsinghua University, Beijing, China
| | | | - Constantine Mavroudis
- Johns Hopkins University, Baltimore, Maryland, United States of America.,Peyton Manning Children's Hospital, Indianapolis, Indiana, United States of America
| | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
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21
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Weichert J, Weichert A. A 'holistic' sonographic view on congenital heart disease - How automatic reconstruction using fetal intelligent navigation echocardiography (FINE) eases the unveiling of abnormal cardiac anatomy part I: Right heart anomalies. Echocardiography 2021; 38:1430-1445. [PMID: 34232534 DOI: 10.1111/echo.15134] [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: 09/18/2020] [Revised: 04/18/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022] Open
Abstract
Attempting a comprehensive examination of the fetal heart remains challenging for unexperienced operators as it emphasizes the acquisition and documentation of sequential cross-sectional and sagittal views and inevitably results in diminished detection rates of fetuses affected by congenital heart disease. The introduction of four-dimensional spatio-temporal image correlation (4D STIC) technology facilitated a volumetric approach for thorough cardiac anatomic evaluation by the acquisition of cardiac 4D datasets. By analyzing and re-arranging of numerous frames according to their temporal event within the heart cycle, STIC allows visualization of cardiac structures as an endless cine loop sequence of a complete single cardiac cycle in motion. However, post-analysis with manipulation and repeated slicing of the volume usually requires experience and in-depth anatomic knowledge, which limits the widespread application of this advanced technique in clinical care and unfortunately leads to the underestimation of its diagnostic value to date. Fetal intelligent navigation echocardiography (FINE), a novel method that automatically generates and displays nine standard fetal echocardiographic views in normal hearts, has shown to be able to overcome these limitations. Very recent data on the detection of congenital heart defects (CHDs) using the FINE method revealed a high sensitivity and specificity of 98% and 93%, respectively. In this two-part manuscript, we focused on the performance of FINE in delineating abnormal anatomy of typical right and left heart lesions and thereby emphasized the educational potential of this technology for more than just teaching purposes. We further discussed recent findings in a pathophysiological and/or functional context.
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Affiliation(s)
- Jan Weichert
- Department of Gynecology & Obstetrics, Division of Prenatal Medicine, Campus Luebeck, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany
| | - Alexander Weichert
- Elbe Center of Prenatal Medicine and Human Genetics, Hamburg, Germany.,Department of Obstetrics, Charité-Universitätsmedizin Berlin - CCM, Berlin, Germany.,Prenatal Medicine Bergmannstrasse, Berlin, Germany
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Seese L, Turbendian HK, Thibault D, Da Fonseca Da Silva L, Hill K, Castro-Medina M, Viegas M, Da Silva JP, Jacobs JP, Jacobs ML, Shillingford M, Morell VO. Utilization and Outcomes of the Nikaidoh, Rastelli, and REV Procedures: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 2021; 114:800-808. [PMID: 34237293 DOI: 10.1016/j.athoracsur.2021.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Aortic Root Translocation (Nikaidoh), Rastelli, and Réparation à l'Etage Ventriculaire (REV) are repair options for transposition of the great arteries (TGA) with VSD and left ventricular outflow tract obstruction (VSD-LVOTO) or double outlet right ventricle (DORV) TGA type (DORV-TGA). METHODS This retrospective study using the Society of Thoracic Surgeons Congenital Heart Surgery Database evaluates surgical procedure utilization and outcomes of patients undergoing repair of TGA-VSD-LVOTO and DORV-TGA with a Nikaidoh, Rastelli, or REV procedure. RESULTS 293 patients underwent repair at 82 centers (January 2010-June 2019). Most patients underwent a Rastelli (n=165, 56.3%) or a Nikaidoh (n=119, 40.6%) operation; only 3.1% (n=9) underwent a REV. High-volume centers performed the majority of the repairs. Fewer Nikaidoh than Rastelli patients had prior cardiac operations (n=57; 48.7% vs n=102; 63.0%, p=0.004). Nikaidohs had longer median cardiopulmonary bypass (227 minutes [interquartile range (IQR) 167-299] vs 175 minutes [IQR 133-225], p<0.001) and median aortic cross clamp times (131 minutes [IQR 91-175] vs 105 minutes [IQR 82-141], p=0.0015). Operative mortality was 3.1% (95% confidence interval (95% CI) 1.0-7.0%; n=5) for Rastelli, 4.4% (95% CI 1.4-9.9%; n=5) for Nikaidoh, and 11.1% (95% CI 0.3-48.3%, n=1) for REV. The rates of cardiac arrest, unplanned reoperation, mechanical circulatory support, prolonged ventilation, and permanent pacemaker placement were higher in the Nikaidoh population but with 95% CIs overlapping those of the other procedures. CONCLUSIONS Rastelli and Nikaidoh procedures are the prevalent repair strategies for patients with DORV-TGA and TGA-VSD-LVOTO. Most are performed at high volume institutions and early outcomes are similar.
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Affiliation(s)
- Laura Seese
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Harma K Turbendian
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Pediatric Cardiothoracic Surgery, University of Pittsburgh Medical Center, Wolfson Children's Hospital, Jacksonville, FL
| | | | - Luciana Da Fonseca Da Silva
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Kevin Hill
- Duke Clinical Research Institute, Durham, NC
| | - Mario Castro-Medina
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Melita Viegas
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jose P Da Silva
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jeffery P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Marshall L Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Shillingford
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Pediatric Cardiothoracic Surgery, University of Pittsburgh Medical Center, Wolfson Children's Hospital, Jacksonville, FL
| | - Victor O Morell
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA.
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Kumar P, Bhatia M. Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle. J Cardiovasc Imaging 2021; 29:205-227. [PMID: 34080329 PMCID: PMC8318812 DOI: 10.4250/jcvi.2020.0196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 01/22/2023] Open
Abstract
Double-outlet right ventricle (DORV) is a type of ventriculoarterial connection in which both great arteries arise entirely or predominantly from the right ventricle. The morphology of DORV is characterized by a ventricular septal defect (location and relationship with the semilunar valve); bilateral coni and aortomitral continuity; the presence or absence of outflow tract obstruction; tricuspid-pulmonary annular distance; and associated cardiac anomalies. The surgical approach varies with the type of DORV and is based on multiple variables. Computed tomography (CT) is a robust diagnostic tool for the preoperative and postoperative assessment of DORV. Unlike echocardiography and magnetic resonance imaging (MRI), CT imaging is not limited by small acoustic window, need for anaesthesia and can be used in patients with metallic implants. Current generations CT scanners with high spatial and temporal resolution, wide detectors, high-pitch scanning mode, dose-reduction algorithms, and advanced three-dimensional post-processing tools provide a low-risk, high-quality alternative to diagnostic cardiac catheterization or MRI, and have been increasingly utilized in nearly every type of congenital heart defect, including DORV.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, New Delhi, India.
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, New Delhi, India.,Cardiological Society of India, Kolkata, India.,International Regional Committee, India Chapter of the Society of Cardiovascular Computed Tomography, New Delhi, India
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24
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Iyer KS, Garg A, Girotra S, Anderson RH, Azad S, Radhakrishnan S, Iyer PU. Double outlet of both ventricles: morphological, echocardiographic and surgical considerations. Eur J Cardiothorac Surg 2021; 59:688-696. [PMID: 33210147 DOI: 10.1093/ejcts/ezaa378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe the morphology, echocardiographic features and surgical management of the entity appropriately described as 'double outlet of both ventricles'. METHODS Seven patients (5 males, age 0.5-7.5 months) were diagnosed to have a unique form of subarterial ventricular septal defect (VSD) and ventriculo-arterial connection, where a muscular outlet septum straddled the crest of the ventricular septum in a cruciate manner, such that both great arteries were equally committed to both ventricles. Diagnosis was established by echocardiography, with 6 patients submitted to surgical repair by means of intracardiac routing of the left ventricle to the aorta using 2 patches. RESULTS Surgical repair was successful in all 6 patients in whom it was attempted. In addition, 1 patient underwent concomitant repair of aortic coarctation, and 2 had closure of multiple VSDs. We lost 1 patient to follow-up after diagnosis. Follow-up with a range from 3 months to 8 years in the remaining patients revealed all to be clinically well with satisfactory growth of both outflow tracts. CONCLUSIONS We describe a series of patients with the ventriculo-arterial connection best described as 'double outlet of both ventricles'. Diagnosis is readily established by echocardiography. Good early and midterm results can be expected subsequent to surgical repair using 2 patches for interventricular septation.
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Affiliation(s)
- Krishna Subramony Iyer
- Department of Pediatric & Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, India
| | - Ankit Garg
- Department of Pediatric & Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Sumir Girotra
- Department of Pediatric & Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, India
| | - Robert H Anderson
- BioSciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Sushil Azad
- Department of Pediatric & Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Sitaraman Radhakrishnan
- Department of Pediatric & Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Parvathi U Iyer
- Department of Pediatric & Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, India
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Devarakonda BV, Nemani DN, Raja J, Dharan BS, Koshy T. Role of Transesophageal and Epicardial Echocardiography to Assess Surgical Repair in Double-Outlet Left Ventricle. J Cardiothorac Vasc Anesth 2021; 36:1396-1400. [PMID: 33896712 DOI: 10.1053/j.jvca.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022]
Abstract
A double-outlet left ventricle (DOLV) is a congenital cardiac anomaly that rarely is encountered. This case report demonstrates the echocardiographic features of DOLV in the form of the pulmonary artery arising completely from the left ventricle with D-looped ventricles, especially when evaluated by intraoperative transesophageal echocardiography (TEE), along with the correlation of characteristic features with cardiac computerized tomography. The features pertinent to the differentiation of DOLV from double-outlet right ventricle and congenitally corrected transposition of the great arteries by echocardiography have been described. To the authors' knowledge, this was the first report of intraoperative TEE in the case of DOLV. In addition, the use of intraoperative echocardiography to rule out coronary compression as a cause for post-repair ventricular tachycardia, by use of TEE to rule out ventricular dysfunction and regional wall motion abnormalities, as well as epicardial echocardiography to demonstrate normal coronary blood flow, has been reported.
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Affiliation(s)
- Bhargava V Devarakonda
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India.
| | - Dr Nayana Nemani
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Javid Raja
- Department of Cardiothoracic & Vascular Surgery, Sri Manakkula Vinayakar Medical College & Hospital, Pondicherry, India
| | - Baiju S Dharan
- Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Thomas Koshy
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
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Karmegaraj B, Kumar S, Srimurugan B, Sudhakar A, Simpson JM, Vaidyanathan B. 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double-outlet right ventricle. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:423-430. [PMID: 32022380 DOI: 10.1002/uog.21988] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze the incremental benefit of 3D/4D spatiotemporal image correlation (STIC) fetal echocardiography over 2D fetal echocardiography with respect to the accuracy of identification of anatomic details crucial for surgical decision-making and in predicting surgical approach in fetuses with double-outlet right ventricle (DORV). METHODS This was a retrospective study of fetuses with DORV which had undergone both 2D echocardiography and 3D/4D STIC echocardiography and which underwent surgery postnatally in a tertiary pediatric cardiac center in Kerala between October 2015 and March 2019. All such cases with normal atrial arrangement, concordant atrioventricular connections and balanced ventricles were included. 2D and 3D/4D STIC fetal echocardiographic data were analyzed by two experienced observers blinded to the other dataset. Anatomic variables crucial for surgical decision-making, i.e. location and routability of the ventricular septal defect, relationship of the great arteries and presence of outflow obstruction, were compared between the two modalities with respect to agreement with postnatal echocardiography. The accuracy of prenatal prediction of the surgical pathway was compared between 2D and 3D/4D modalities with respect to the procedure undertaken. RESULTS Included in the study were 22 fetuses with DORV which had undergone both 2D and 3D/4D imaging as well as postnatal surgery. Accuracy of prenatal interpretation of all four anatomic variables was significantly higher using 3D/4D STIC than using 2D fetal echocardiography (19/22 (86.4%) vs 8/22 (36.4%), P < 0.001). Surgical procedures included single-stage repair in 14 (63.5%) patients and a multistage approach in eight (36.4%). Prenatal prediction of the surgical pathway was significantly more accurate on 3D/4D STIC than on 2D echocardiography (20/22 (90.9%) vs 12/22 (54.5%), P = 0.021). Prenatal predictive accuracy of single-stage biventricular repair was significantly better for 3D/4D STIC than for 2D echocardiography (14/14 (100%) vs 8/14 (57.1%), P = 0.04). CONCLUSION Addition of 3D/4D STIC to conventional 2D fetal echocardiography confers incremental benefit on the accuracy of identification of anatomic details crucial for surgical decision-making and the prediction of postnatal surgical approach in fetuses with DORV, thereby potentially aiding prenatal counseling. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Karmegaraj
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - S Kumar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - B Srimurugan
- Department of Cardiovascular Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - A Sudhakar
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Vaidyanathan
- The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Double-Outlet Right Ventricle in a Chianina Calf. Animals (Basel) 2021; 11:ani11020318. [PMID: 33513881 PMCID: PMC7910964 DOI: 10.3390/ani11020318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Congenital heart defects have been occasionally reported in cattle and ventricular septal defect represents the most frequently encountered anomaly. The double-outlet right ventricle is a rare congenital ventriculoarterial malformation reported only in certain cattle breeds. We describe this rare and complex congenital cardiac malformation observed in a 10-day-old male Chianina calf. Clinical examination showed tachycardia, tachypnea, jugular pulses, cyanotic mucous membranes and a right apical systolic murmur. Transthoracic echocardiography revealed severe dilation of the right-sided cardiac chambers with a markedly hypoplastic left ventricle. Both aorta and pulmonary artery leaving the right ventricle in parallel alignment with the tricuspid valve were suggestive of a dual-outlet right ventricle. Interventricular and interatrial septal defects were also visualized. Post-mortem examination confirmed the echocardiographic findings. To the authors' knowledge, a similar complex congenital cardiac malformation has not been reported in calves of the Chianina breed to date.
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28
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Chen W, Iroegbu CD, Xie X, Zhou W, Wu M, Wu X, Fan C, Borovjagin AV, Yang J. Individualized Surgical Reconstruction of the Right Ventricle Outflow Tract in Double Outlet Right Ventricle With Mirror Image-Dextrocardia. Front Pediatr 2021; 9:611007. [PMID: 33681097 PMCID: PMC7933223 DOI: 10.3389/fped.2021.611007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/01/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: The purpose of this study was to report our experience in the surgical reconstruction of the right ventricular outflow tract in double outlet right ventricle with a major coronary artery crossing the right ventricular outflow tract in the presence of mirror image-dextrocardia. Methods: From January 2005 to December 2019, 19 double outlet right ventricle patients (median age 4 years) with mirror image-dextrocardia and a major coronary artery crossing the right ventricular outflow tract received surgical repair. An autologous pericardial patch was used to enlarge the right ventricular outflow tract in four patients without pulmonary stenosis and three patients with mild pulmonary stenosis. A valved bovine jugular venous conduit was added to a hypoplastic native pathway in nine patients, among which six patients with moderate pulmonary stenosis received small-sized bovine jugular venous conduit implantation (diameter ≤ 16 mm). In comparison, a large-sized bovine jugular venous conduit (diameter >16 mm) was adopted in a total of three patients with severe pulmonary stenosis. Finally, three patients with preoperative pulmonary hypertension (mean pulmonary artery pressure ≥40 mmHg) did not undergo further intervention of right ventricular outflow tract due to the adequate outflow tract blood flow. Results: There was no hospital mortality. One patient with sub-pulmonary ventricular septal defect and concomitant severe pulmonary hypertension died from respiratory failure 11 months after the operation. Kaplan-Meier survival was 94% at 5, 10 years. Within a mean echocardiographic follow-up of 6.9 ± 3.6 years, a total of two patients received reintervention due to valvular stenosis of the bovine jugular venous conduit (pressure gradient > 50 mmHg at 4 and 9 years) after surgical operation. Actuarial freedom from reoperation was 90 and 72% at 5 and 10 years, respectively. During the last echocardiographic follow-up phase, all the survivors were in NYHA class I. Conclusions: Double outlet right ventricle with mirror image-dextrocardia is a rare and complicated congenital cardiac malformation. Surgical reconstruction of the right ventricular outflow tract should be individualized based on the degree of pulmonary stenosis and the specific anatomical features of each patient. Reconstructing the pulmonary artery using the various sizes of valved bovine jugular venous conduit is a safe and effective surgical method.
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Affiliation(s)
- Wangping Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xia Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenwu Zhou
- Department of Cardiovascular Surgery, The People's Hospital of Hunan Province, Changsha, China
| | - Ming Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xun Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Anton V Borovjagin
- Department of Biomedical Engineering, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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Corno AF, Durairaj S, Skinner GJ. Narrative review of assessing the surgical options for double outlet right ventricle. Transl Pediatr 2021; 10:165-176. [PMID: 33633949 PMCID: PMC7882294 DOI: 10.21037/tp-20-227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The individualized surgical approach in individuals with both arterial trunks arising from the morphologically right ventricle is dictated by the extreme morphological variability encountered in this setting, with each patient being unique. An individualized surgical approach has been designed to take account of the morphological variations, identifying the anatomy with the preoperative three-dimensional CT scan reconstruction. The key features have been considered the distance between tricuspid and pulmonary valves, the size and location of the interventricular communication, and the relationship between the outflow tracts. The surgical approach is tailored, whenever feasible, to create a connection between left ventricle and aorta, but primarily to achieve biventricular repair. Account has been taken of all available surgical options already reported in the literature, identifying the most suitable to provide the best outcomes for each unique morphology. To date, meaningful comparison between different reported surgical series has been difficult because of the marked variation of individual intracardiac morphology, and the lack of reports of specific surgical approaches for well-categorized groups of patients. Our approach, being tailored to the individual cardiac morphology, can be offered to any patient with this ventriculo-arterial connection. Given the difficulties of diagnosis, and the multiple therapeutic indications, very close collaboration between cardiologists and surgeons is indispensable for further progress in the understanding and management of this complex congenital cardiac lesion.
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Affiliation(s)
- Antonio F Corno
- Houston Children's Heart Institute, Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, TX, USA
| | - Saravanan Durairaj
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK
| | - Gregory J Skinner
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK
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Yoo SJ, Saito M, Hussein N, Golding F, Goo HW, Lee W, Lam CZ, Seed M, Dragulescu A. Systematic Approach to Malalignment Type Ventricular Septal Defects. J Am Heart Assoc 2020; 9:e018275. [PMID: 33170057 PMCID: PMC7763733 DOI: 10.1161/jaha.120.018275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Various congenital heart diseases are associated with malalignment of a part of the ventricular septum. Most commonly, the outlet septum is malaligned toward the right or left ventricle. Less commonly, the whole or a major part of the ventricular septum is malaligned in relation to the atrial septal plane. Although the pathological conditions associated with ventricular septal malalignment have been well recognized, the descriptions are often confusing and sometimes incorrect. In this pictorial essay, we introduce our systematic approach to the assessment of malalignment type ventricular septal defects with typical case examples. The systematic approach comprises description of the essential features of malalignment, including the following: (1) the malaligned part of the ventricular septum, (2) the reference structure, (3) the mechanism of malalignment, (4) the direction of malalignment, and (5) the severity of malalignment.
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Affiliation(s)
- Shi-Joon Yoo
- The Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada.,Department of Diagnostic Imaging The Hospital for Sick Children University of Toronto Ontario Canada.,Division of Cardiology Department of Paediatrics The Hospital for Sick Children University of Toronto Ontario Canada
| | - Mika Saito
- The Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada.,Division of Cardiology Department of Paediatrics The Hospital for Sick Children University of Toronto Ontario Canada
| | - Nabil Hussein
- The Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada.,Division of Cardiovascular Surgery Department of Surgery The Hospital for Sick Children University of Toronto Ontario Canada
| | - Fraser Golding
- Department of Pediatrics University of California San Diego School of MedicineRady Children's Hospital, San Diego CA
| | - Hyun Woo Goo
- Department of Radiology Asan Medical Center University of Ulsan College of Medicine Seoul South Korea
| | - Whal Lee
- Department of Diagnostic Imaging Seoul National University Hospital Seoul South Korea
| | - Christopher Z Lam
- The Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada.,Department of Diagnostic Imaging The Hospital for Sick Children University of Toronto Ontario Canada
| | - Mike Seed
- The Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada.,Department of Diagnostic Imaging The Hospital for Sick Children University of Toronto Ontario Canada.,Division of Cardiology Department of Paediatrics The Hospital for Sick Children University of Toronto Ontario Canada
| | - Andreea Dragulescu
- The Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada.,Division of Cardiology Department of Paediatrics The Hospital for Sick Children University of Toronto Ontario Canada
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Gunasekaran T, Sanders RA. Double-outlet right ventricle in a Vietnamese potbellied pig. J Vet Cardiol 2020; 32:49-54. [PMID: 33137659 DOI: 10.1016/j.jvc.2020.09.007] [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] [Received: 04/13/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 11/18/2022]
Abstract
A 6-month-old, neutered male, Vietnamese potbellied pig presented for evaluation of exercise intolerance and intermittent episodes of exertional cyanosis. Initial diagnostic evaluation revealed arterial hypoxemia. Transthoracic echocardiogram revealed double-outlet right ventricle (DORV) and a subaortic ventricular septal defect. Agitated saline contrast study confirmed the entry of saline contrast from the right ventricle into both pulmonary artery and aorta. Due to deterioration of clinical status, the patient was euthanized 3 months later. Gross necropsy examination was performed confirming the congenital cardiac defects noted on the echocardiogram. To the authors knowledge, this is the first case report of DORV in a Vietnamese potbellied pig.
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Affiliation(s)
- T Gunasekaran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States
| | - R A Sanders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, 736 Wilson Rd, East Lansing, MI, 48824, United States.
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32
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The variety of phenotypes behind ‘double outlet right ventricle’: clinical and imaging presentations in four dogs and a cat. J Vet Cardiol 2020; 31:51-60. [DOI: 10.1016/j.jvc.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022]
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Anatomic Risk Factors for Reintervention After Arterial Switch Operation for Taussig-Bing Anomaly. Ann Thorac Surg 2020; 112:163-169. [PMID: 32795522 DOI: 10.1016/j.athoracsur.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to determine the factors related to reintervention, especially for pulmonary stenosis (PS), in patients with Taussig-Bing anomaly (TBA) after the arterial switch operation. METHODS This retrospective study included 34 patients with TBA who underwent the arterial switch operation between 1993 and 2018. Preoperative anatomic and physiologic differences and long-term outcomes were determined using a case-matched control with transposition of the great arteries with ventricular septal defect and TBA with an anterior and rightward aorta. RESULTS At arterial switch operation, median age was 43 days (range, 16 to 102) and median body weight was 3.6 kg (range, 2.8 to 3.8 kg). Aortic arch obstruction and coronary anomalies were present in 64% and 41% of patients, respectively. The hospital mortality rate was 11%, including one cardiac death, and the late mortality rate was 2.9%. Furthermore, 41% patients underwent 26 reinterventions for PS. Patients undergoing PS-related reintervention had a significantly larger native pulmonary artery to aortic annulus size ratio than patients not receiving reintervention (1.69 vs 1.41, P = .02). This ratio was the only predictor of PS-related reintervention; it was significantly higher in the TBA group than in the transposition of great arteries/ventricular septal defect group. The PS-related reintervention was required more in the TBA group than in the transposition of great arteries/ventricular septal defect group. CONCLUSIONS Regardless of complex coronary anatomy and associated anomalies, early and late survival were acceptable. Postoperative PS was strongly associated with having a larger native pulmonary valve, suggesting that an optimal surgical reconstruction was required for achieving an appropriate aortopulmonary anatomic relationship during the arterial switch operation.
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Priya S, Nagpal P, Sharma A, Pandey NN, Jagia P. Imaging Spectrum of Double-Outlet Right Ventricle on Multislice Computed Tomography. J Thorac Imaging 2020; 34:W89-W99. [PMID: 30801451 DOI: 10.1097/rti.0000000000000396] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Double-outlet right ventricle is a complex congenital heart disease that encompasses various common and rare subtypes. Surgical management of these patients needs to be individualized owing to extremely variable morphology and hemodynamics. Imaging plays a crucial role in determination and characterization of outflow tract morphology. The assessment of ventricular septal defect routability with identification of associated anomalies has therapeutic implications in these patients. Multislice computed tomography with advanced 3-dimensional postprocessing techniques and dose-reduction strategies is invaluable in defining the anatomy and morphology of double-outlet right ventricle with simultaneous assessment of associated anomalies.
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Affiliation(s)
- Sarv Priya
- Department of Radiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Liu X, Chen W, Li W, Priest JR, Fu Y, Pang K, Ma B, Han B, Liu X, Hu S, Zhou Z. Exome-Based Case-Control Analysis Highlights the Pathogenic Role of Ciliary Genes in Transposition of the Great Arteries. Circ Res 2020; 126:811-821. [PMID: 32078439 DOI: 10.1161/circresaha.119.315821] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Transposition of the great arteries (TGA) is one of the most severe types of congenital heart diseases. Understanding the clinical characteristics and pathogenesis of TGA is, therefore, urgently needed for patient management of this severe disease. However, the clinical characteristics and genetic cause underlying TGA remain largely unexplored. OBJECTIVE We sought to systematically examine the clinical characteristics and genetic cause for isolated nonsyndromic TGA. METHODS AND RESULTS We recruited 249 patients with TGA (66 family trios) and performed whole-exome sequencing. The incidence of patent ductus arteriosus in dextro-TGA (52.7%) and dextrocardia/mesocardia in congenitally corrected TGA (32.8%) were significantly higher than that in other subtypes. A high prevalence of bicuspid pulmonic valve (9.6%) was observed in patients with TGA. Similar results were observed in a replication group of TGA (n=132). Through a series of bioinformatics filtering steps, we obtained 82 candidate genes harboring potentially damaging de novo, loss of function, compound heterozygous, or X-linked recessive variants. Established congenital heart disease-causing genes, such as FOXH1, were found among the list of candidate genes. A total of 19 ciliary genes harboring rare potentially damaging variants were also found; for example, DYNC2LI1 with a de novo putatively damaging variant. The enrichment of ciliary genes supports the roles of cilia in the pathogenesis of TGA. In total, 33% of the TGA probands had >1 candidate gene hit by putatively deleterious variants, suggesting that a portion of the TGA cases were probably affected by oligogenic or polygenic inheritance. CONCLUSIONS The findings of clinical characteristic analyses have important implications for TGA patient stratification. The results of genetic analyses highlight the pathogenic role of ciliary genes and a complex genetic architecture underlying TGA.
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Affiliation(s)
- Xuanyu Liu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - Wen Chen
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - Wenke Li
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - James R Priest
- Department of Pediatrics, Stanford University School of Medicine, CA (J.R.P.)
| | - Yuanyuan Fu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - Kunjing Pang
- Department of Echocardiography, Fuwai Hospital, Beijing, China (K.P.)
| | - Baihui Ma
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Bianmei Han
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Xuewen Liu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Shengshou Hu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Zhou Zhou
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
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Illmann CF, Hosking M, Harris KC. Utility and Access to 3-Dimensional Printing in the Context of Congenital Heart Disease: An International Physician Survey Study. CJC Open 2020; 2:207-213. [PMID: 32695970 PMCID: PMC7365821 DOI: 10.1016/j.cjco.2020.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background Three-dimensional (3D) printing is a new technology capable of producing patient-specific 3D cardiac models. Methods A cross-sectional survey of pediatric cardiologists was conducted. Members of the Canadian Pediatric Cardiology Association and Congenital Cardiac Interventional Study Consortium were invited to participate. A questionnaire was distributed using Research Electronic Data Capture between May and September 2019. Results were analyzed using descriptive statistics, Fisher exact test, and odds ratio. Results A total of 71 pediatric cardiologists responded. Some 85% (60/71) agreed that patient-specific 3D printed cardiac models are a beneficial tool in treating children with congenital heart disease (CHD); 80% of those (48/60) believe 3D models facilitate communication with colleagues; 49% (35/71) of respondents had access to 3D printing technology; and 77% (27/35) of those were using models for clinical care. Access differed according to geographic location (P = 0.004). Of respondents, Americans were 5.5 times more likely (confidence interval, 1.6-19.2) than Canadians to have access to 3D printing technology. The primary reason for lack of access was financial barriers (50%, 18/36). In clinical practice, surgical planning is the primary use of models (96%, 26/27), followed by interventional catheterization planning (52%, 14/27). Double outlet right ventricle was the most commonly modelled lesion (70%, 19/27). Conclusion 3D printing is a new technology that is beneficial in the care of children with CHD. Access to 3D printing varies by geographic location. In pediatric cardiology, 3D models are primarily used for procedural planning for CHD lesions with complex 3D spatial relationships.
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Affiliation(s)
- Caroline F Illmann
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Hosking
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin C Harris
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Beckerman Z, Mery CM. Commentary: Double-outlet right ventricle—Toward an individualized road map. J Thorac Cardiovasc Surg 2020. [DOI: 10.1016/j.jtcvs.2019.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lu T, Li J, Hu J, Huang C, Tan L, Wu Q, Wu Z. Biventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect using intraventricular conduit. J Thorac Cardiovasc Surg 2019; 159:2397-2403. [PMID: 31564538 DOI: 10.1016/j.jtcvs.2019.07.084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/24/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Biventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect is preferred, but previously developed surgical procedures are complicated and associated with high mortality and morbidity. We developed a technique using an intraventricular conduit to connect the ventricular septal defect and the aorta in this anomaly in patients aged more than 2 years. METHODS Thirty-one patients (age 2-23 years; median, 5.4) with double-outlet right ventricle with noncommitted ventricular septal defect underwent biventricular repair with intraventricular conduit. A 16-mm or 19-mm polytetrafluoroethylene (Gore-Tex; WL Gore & Associates, Flagstaff, Ariz) vascular prosthesis was used to construct the intraventricular conduit rerouting the ventricular septal defect to the aorta, with enlargement of the ventricular septal defect and resecting the hypertrophic muscular bands in the bilateral conus when necessary. Follow-up was made in all patients with a median duration of 93 months (range, 8-140 months). RESULTS One patient died during hospitalization and 1 patient died at 8 months after operation, making the mortality 6.5%. The peak pressure gradient across the left ventricular outflow tract was less than 30 mm Hg in all patients but 1 (3.3%). In the last patient, it increased from 16 mm Hg early after operation to 50 mm Hg at 7 years follow-up. The peak pressure gradient across the right ventricular outflow tract ranged from 6 to 30 mm Hg in all patients. One patient had moderate mitral regurgitation with New York Heart Association class II. One patient had preoperative severe pulmonary arterial hypertension (mean pressure, 50 mm Hg) and was treated with bosentan. Other patients were in New York Heart Association class I. CONCLUSIONS Biventricular repair with intraventricular conduit is a relatively simple and safe procedure for patients aged more than 2 years with double-outlet right ventricle with noncommitted ventricular septal defect, with excellent early and midterm outcomes.
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Affiliation(s)
- Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jia Li
- The Heart Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China
| | - Jianguo Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Yim D, Dragulescu A, Ide H, Seed M, Grosse-Wortmann L, van Arsdell G, Yoo SJ. Essential Modifiers of Double Outlet Right Ventricle: Revisit With Endocardial Surface Images and 3-Dimensional Print Models. Circ Cardiovasc Imaging 2019; 11:e006891. [PMID: 29855425 DOI: 10.1161/circimaging.117.006891] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hearts with double outlet right ventricle are a heterogeneous group of malformations in which a comprehensive diagnostic approach is required for tailored surgical management. This pictorial essay revisits essential modifiers of clinical and surgical importance in management of the patients with double outlet right ventricle using 3-dimensional volume-rendered endocardial surface images and 3-dimensional print models. Special emphasis is paid to the infundibular morphology, including the size and orientation of the outlet septum, relative to the margin of the ventricular septal defect, and the extent of the muscular infundibulum as an additional modifier of the distance between the ventricular septal defect margin and the arterial valve or valves.
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Affiliation(s)
- Deane Yim
- From the Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); Division of Cardiology, Department of Paediatrics, the University of Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); and Division of Cardiovascular Surgery, Department of Surgery (H.I., G.v.A.) and Department of Diagnostic Imaging (M.S., L.G.-W., S.J.-Y.), the Hospital for Sick Children and the University of Toronto, Canada
| | - Andreea Dragulescu
- From the Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); Division of Cardiology, Department of Paediatrics, the University of Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); and Division of Cardiovascular Surgery, Department of Surgery (H.I., G.v.A.) and Department of Diagnostic Imaging (M.S., L.G.-W., S.J.-Y.), the Hospital for Sick Children and the University of Toronto, Canada
| | - Haruki Ide
- From the Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); Division of Cardiology, Department of Paediatrics, the University of Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); and Division of Cardiovascular Surgery, Department of Surgery (H.I., G.v.A.) and Department of Diagnostic Imaging (M.S., L.G.-W., S.J.-Y.), the Hospital for Sick Children and the University of Toronto, Canada
| | - Mike Seed
- From the Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); Division of Cardiology, Department of Paediatrics, the University of Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); and Division of Cardiovascular Surgery, Department of Surgery (H.I., G.v.A.) and Department of Diagnostic Imaging (M.S., L.G.-W., S.J.-Y.), the Hospital for Sick Children and the University of Toronto, Canada
| | - Lars Grosse-Wortmann
- From the Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); Division of Cardiology, Department of Paediatrics, the University of Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); and Division of Cardiovascular Surgery, Department of Surgery (H.I., G.v.A.) and Department of Diagnostic Imaging (M.S., L.G.-W., S.J.-Y.), the Hospital for Sick Children and the University of Toronto, Canada
| | - Glen van Arsdell
- From the Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); Division of Cardiology, Department of Paediatrics, the University of Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); and Division of Cardiovascular Surgery, Department of Surgery (H.I., G.v.A.) and Department of Diagnostic Imaging (M.S., L.G.-W., S.J.-Y.), the Hospital for Sick Children and the University of Toronto, Canada
| | - Shi-Joon Yoo
- From the Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); Division of Cardiology, Department of Paediatrics, the University of Toronto, Canada (D.Y., A.D., M.S., L.G.-W., S.-J.Y.); and Division of Cardiovascular Surgery, Department of Surgery (H.I., G.v.A.) and Department of Diagnostic Imaging (M.S., L.G.-W., S.J.-Y.), the Hospital for Sick Children and the University of Toronto, Canada.
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Gottschalk I, Abel JS, Menzel T, Herberg U, Breuer J, Gembruch U, Geipel A, Brockmeier K, Berg C, Strizek B. Prenatal diagnosis, associated findings and postnatal outcome of fetuses with double outlet right ventricle (DORV) in a single center. J Perinat Med 2019; 47:354-364. [PMID: 30676006 DOI: 10.1515/jpm-2018-0316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022]
Abstract
Objective To assess the spectrum of associated anomalies, the intrauterine course, postnatal outcome and management of fetuses with double outlet right ventricle (DORV). Methods All cases of DORV diagnosed prenatally over a period of 8 years were retrospectively collected in a single tertiary referral center. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. Results Forty-six cases of DORV were diagnosed prenatally. The mean gestational age at first diagnosis was 21+4 weeks (range, 13-37). A correct prenatal diagnosis of DORV was made in 96.3% of the cases. If the relation of the great arteries, the position of the ventricular septal defect (VSD) and additional cardiac anomalies are taken into account, the prenatal diagnosis was correct in 92.6% of the cases. One case was postnatally classified as transposition of the great arteries with subpulmonary VSD and was excluded from further analysis. A total of 41 (91.1%) fetuses with DORV had major additional cardiac anomalies, 30 (66.7%) had extracardiac anomalies and 13 (28.9%) had chromosomal or syndromal anomalies. Due to their complex additional anomalies, five (11.1%) of our 45 fetuses had multiple malformations and were highly suspicious for non-chromosomal genetic syndromes, although molecular diagnosis could not be provided. Disorders of laterality occurred in 10 (22.2%) fetuses. There were 17 terminations of pregnancy (37.8%), two (4.4%) intrauterine and seven (15.6%) postnatal deaths. Nineteen of 22 (86.4%) live-born children with an intention to treat were alive at last follow-up. The mean follow-up among survivors was 32 months (range, 2-72). Of 21 children who had already undergone postnatal surgery, eight (38.1%) achieved biventricular repair and 13 (61.9%) received univentricular palliation. One recently born child is still waiting for surgery. All children predicted prenatally to need a single ventricle palliation, and all children predicted to achieve biventricular repair, ultimately received the predicted type of surgery. After surgery, 14 of 18 (77.8%) children were healthy without any impairment. Conclusion DORV is a rare and often complex cardiac anomaly that can be diagnosed prenatally with high precision. DORV is frequently associated with major additional anomalies, leading to a high intrauterine and postnatal loss rate due to terminations or declined postnatal therapy. Without additional anomalies, the prognosis is good, although approximately 60% of children will have single ventricle palliation.
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Affiliation(s)
- Ingo Gottschalk
- Bereich für Pränatale Medizin und Gynäkologische Sonographie, Universitätsfrauenklinik Köln, Kerpenerstr. 34, 50931 Cologne, Germany
- Division of Prenatal Medicine, University of Cologne, Cologne, Germany
| | - Judith S Abel
- Division of Prenatal Medicine, University of Cologne, Cologne, Germany
| | - Tina Menzel
- Division of Prenatal Medicine, University of Cologne, Cologne, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Konrad Brockmeier
- Department of Pediatric Cardiology, University of Cologne, Cologne, Germany
| | - Christoph Berg
- Division of Prenatal Medicine, University of Cologne, Cologne, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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Townsley MM, Windsor J, Briston D, Alegria J, Ramakrishna H. Tetralogy of Fallot: Perioperative Management and Analysis of Outcomes. J Cardiothorac Vasc Anesth 2019; 33:556-565. [DOI: 10.1053/j.jvca.2018.03.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Indexed: 12/14/2022]
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Implantation of a Stent in a Stenotic Conduit Between the Left Ventricle and Aorta in a Patient Undergone Surgery for a Double Outlet Right Ventricle. J Transl Int Med 2019; 6:194-197. [PMID: 30637208 PMCID: PMC6326031 DOI: 10.2478/jtim-2018-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Reinterventions for surgery complications in adult patients with complex congenital heart disease are often difficult and have a high operative risk. If anatomically possible, a percutaneous approach is an alternative to surgery. We report the case of a 36 year-old patient who underwent surgery for a double outlet right ventricle with transposition of the great arteries and pulmonary stenosis. On the days following the surgery, the patient was hemodynamically unstable due to a stenosis of the intraventricular Dacron conduit between the left ventricle and the aorta. Because of the fragility of the patient, additional surgery was not possible and a percutaneous approach was preferred. A Cheatham Platinum stent mounted on a balloon-in-balloon catheter was implanted with success in the stenotic intraventricular Dacron conduit.
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El-Asmar JM, Degheili JA, Al-Halabi E, Sklansky M. Prenatally Diagnosed Ventricular Inversion, Restrictive Ventricular Septal Defect, Pulmonary Stenosis, Hypertensive Left Ventricle and Double Outlet Right Ventricle: Case Report and Literature Review. Pediatr Cardiol 2019; 40:234-236. [PMID: 30569250 DOI: 10.1007/s00246-018-2048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Abstract
We herein describe, for the first time, the fetal presentation of a case of ventricular inversion, restrictive ventricular septal defect, pulmonary stenosis, hypertensive left ventricle and double outlet right ventricle at 34 weeks of gestational age. Postnatal echocardiography confirmed the prenatal diagnosis. The patient was subsequently successfully palliated with a left ventricle to pulmonary artery conduit. This report illustrates the importance of detailed fetal echocardiography to ensure appropriate delivery and neonatal management, and to optimize outcome.
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Affiliation(s)
- J M El-Asmar
- Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - J A Degheili
- Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - E Al-Halabi
- Department of Anesthesiology, American University of Beirut-Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - M Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Ganesan R, Kumar B, Bhat I, Singh H. Situs Inversus Double Outlet Right Ventricle With Restrictive Interventricular Communication: Role of Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2018; 33:785-790. [PMID: 30017592 DOI: 10.1053/j.jvca.2018.04.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Rajarajan Ganesan
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhupesh Kumar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Imran Bhat
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bennink G, Torii S, Brugmans M, Cox M, Svanidze O, Ladich E, Carrel T, Virmani R. A novel restorative pulmonary valved conduit in a chronic sheep model: Mid-term hemodynamic function and histologic assessment. J Thorac Cardiovasc Surg 2017; 155:2591-2601.e3. [PMID: 29366582 DOI: 10.1016/j.jtcvs.2017.12.046] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/23/2017] [Accepted: 12/09/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the safety and the short-term function of a novel pulmonary valved conduit (Xeltis Pulmonary Valved Conduit; XPV) up to 12 months in a sheep model. METHODS XPV and Hancock bioprosthetic valved conduits (H, used as control) were implanted in adult sheep in the pulmonary artery position. Animals were killed at 2 months (n = 6 XPV), 6 months (n = 6 XPV and n = 3 H), and 12 months (n = 6 XPV) and examined histologically. During follow-up, function of the device as well as diameter of both XPV and H were assessed by transthoracic echocardiography. RESULTS Of 18 animals that received an XPV, 15 survived until they were killed; 3 animals that received H survived the planned observational interval. XPV showed mild neointimal thickening and degradation beginning at 2 months with an ongoing process until 12 months. Only 1 of the 18 animals with XPV had significant calcification at 6 months. Pathologic specimen did not show any significant narrowing of the conduit whereas neointimal thickness showed a peak at 6 months. Inflammatory process reached a maximum at 6 months and the degradation process at 12 months. Gel permeation chromatography analysis showed molecular weight loss beginning at 2 months with a peak at 12 months for the conduit with slower absorption for the leaflets. The wall of the H conduits showed more neointimal thickening, narrowing, and calcification compared with XPV, but the leaflets demonstrated minimal changes. CONCLUSIONS Both conduits demonstrated an acceptable safety and functionality. Significant calcification was rarely observed in the XPV, whereas the H developed more neointimal thickness with calcification of the porcine aortic root portion of the wall.
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Affiliation(s)
- Ger Bennink
- Department of Pediatric Cardio-Thoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
| | | | | | | | | | | | - Thierry Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
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Meng H, Pang KJ, Li SJ, Hsi D, Yan J, Hu SS, Hua ZD, Wang H. Biventricular Repair of Double Outlet Right Ventricle: Preoperative Echocardiography and Surgical Outcomes. World J Pediatr Congenit Heart Surg 2017; 8:354-360. [PMID: 29148310 DOI: 10.1177/2150135117692973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To discuss the key anatomic features of double outlet right ventricle (DORV) assessed by preoperative echocardiography among patients treated with different types of biventricular repair. METHODS Surgical and echocardiographic databases were queried to identify patients who had undergone biventricular repair for DORV and had adequate preoperative echocardiographic imaging. All patients underwent pre- and postoperative echocardiography and clinical evaluation following discharge. RESULTS Two hundred sixty-two patients with DORV met the inclusion criteria of the study. The patients were divided into two groups-intraventricular tunnel repair (IVR) to the aorta (194 [74%] patients) or to the pulmonary artery with either concomitant arterial switch operation or double-root translocation (68 [26%] patients). Among 68 patients undergoing IVR to the pulmonary artery, 50 patients with transposition of the great arteries (TGA) type of DORV and 7 patients with remote ventricular septal defect (VSD) type underwent IVR plus arterial switch operation and 6 patients with TGA type and 5 patients with remote VSD type underwent IVR plus double-root translocation. There were three hospital deaths and one late death (overall operative mortality: 1.5%). CONCLUSION Preoperative echocardiography provided crucial data to estimate the feasibility of intraventricular tunnel creation to either the aorta or the pulmonary artery and to guide the selection of either arterial switch or double-root translocation. Biventricular repair could be achieved with favorable outcomes in most patients with DORV.
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Affiliation(s)
- Hong Meng
- 1 Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kun-Jing Pang
- 1 Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shou-Jun Li
- 2 Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - David Hsi
- 3 Department of Cardiology, Heart and Vascular Institute, Stamford Hospital (A Teaching Affiliate of Columbia University College of Physicians & Surgeons), Stamford, CT, USA
| | - Jun Yan
- 2 Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sheng-Shou Hu
- 2 Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhong-Dong Hua
- 2 Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hao Wang
- 1 Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Single-Stage Correction for Taussig-Bing Anomaly Associated With Aortic Arch Obstruction. Pediatr Cardiol 2017; 38:1548-1555. [PMID: 28752325 DOI: 10.1007/s00246-017-1694-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
Abstract
Taussig-Bing anomaly and aortic arch obstruction are two types of complex congenital cardiac malformations. Almost 50% of patients with Taussig-Bing anomaly have aortic arch obstruction. This report assesses the surgical outcomes of single-stage correction in neonates with both defects. Between November 2006 and November 2015, 39 neonates with Taussig-Bing anomaly and aortic arch obstruction (28 patients with coarctation of the aorta and 11 patients with interrupted aortic arch) underwent a one-stage arterial switch operation and aortic reconstruction. There were three in-hospital deaths and one late death (8 months after the surgery). The short-term survival rate was 92.3% (36/39), and the mid-term survival rate was 89.7% (35/39). Follow-up data were available for all patients who survived the operation (range 6-92 months). Echocardiology showed six cases of recoarctation, three cases of left ventricular outflow tract obstruction, three cases of right ventricular outflow tract obstruction, four cases of pulmonary artery stenosis, five cases of aortic regurgitation, and eight cases of pulmonary regurgitation. Eight patients required a reoperation during the follow-up period with no mortality. All survivors remained in good condition (New York Heart association functional class I or II). Single-stage correction of Taussig-Bing anomaly with aortic arch obstruction in neonates had favorable short- and mid-term outcomes in terms of mobility and reoperation rate. The optimal operative procedure should be chosen according to the position of the coronary arteries and the type of aortic anomaly.
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48
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Kohnken R, Schober K, Godman J, Gardner A, Jenkins T, Schroeder E, Baker P, Dunbar L. Double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) and other complex congenital cardiac malformations in an American Quarter Horse foal. J Vet Cardiol 2017; 20:64-72. [PMID: 29174590 DOI: 10.1016/j.jvc.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 11/17/2022]
Abstract
A 4-week-old American Quarter Horse colt presented with a recent history of diarrhea and decreased activity level. On initial physical examination, the animal was bright and alert and major findings were limited to a loud systolic heart murmur radiating widely over both sides of the thorax. While in the hospital, the clinical condition of the foal warranted further imaging to determine the cause and extent of cardiac disease. A variety of congenital cardiac malformations were identified during echocardiographic examination and autopsy, including a double outlet right ventricle and a subpulmonary interventricular septal defect (Taussig-Bing anomaly), ventricular inversion with atrioventricular discordance, tricuspid valve atresia, a septum primum interatrial septal defect, mitral valve dysplasia with a cleft in the septal mitral valve cusp, aortic, and subaortic stenosis, tubular hypoplasia of the ascending aorta and the aortic arch, a patent ductus arteriosus, an aberrant circumflex coronary artery, and aberrant left and right subclavian arteries. Echocardiographic and postmortem findings of the cardiac defects in this foal are presented and discussed.
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Affiliation(s)
- Rebecca Kohnken
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA.
| | - Karsten Schober
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Jennifer Godman
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Alison Gardner
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Tiffany Jenkins
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA
| | - Eric Schroeder
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Peter Baker
- Department of Laboratory Medicine and Anatomic Pathology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Laura Dunbar
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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Wiedemann N, Hildebrandt N, Henrich M, Henrich E, Schneider M. [Cyanosis in a calf with a double outlet right ventricle]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2017; 45:161077. [PMID: 28905979 DOI: 10.15653/tpg-161077] [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: 11/22/2016] [Accepted: 02/09/2017] [Indexed: 11/22/2022]
Abstract
A 4-day-old female Holstein Friesian calf was presented for evaluation of cyanosis and dyspnea. On auscultation, severe bronchovesicular sounds and a systolic heart murmur of grade IV/VI above the tricuspid valve were found. On echocardiography, a marked dextroposition of the aorta (> 50% originating from the right ventricle), leading to both great arteries arising from the right ventricle - a so-called double-outlet right ventricle - was detected. Two ventricular septal defects were present, one in the perimembranous, subpulmonary region, the other non-committed in the muscular region. The subpulmonary ventricular septal defect was responsible for the shunting of unoxygenated blood into the aorta. Additionally, an aneurysma-like atrial septal defect (type secundum) and a large patent ductus arteriosus were visualized. The main pulmonary artery was severely enlarged without the presence of a stenotic defect. The findings could be verified by angiography. Additionally, a diffuse hypoplastic ascending aorta was visualized. Necropsy confirmed the echocardiographic and angiographic findings.
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Affiliation(s)
- Nicola Wiedemann
- Nicola Wiedemann, Klinik für Kleintiere (Innere Medizin), Klinikum Veterinärmedizin, Justus-Liebig-Universität Gießen, Frankfurter Straße 126, 35392 Gießen, E-Mail:
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Wu Q, Jin Y, Li H, Zhang M. Surgical Treatment for Double Outlet Right Ventricle With Pulmonary Outflow Tract Obstruction. World J Pediatr Congenit Heart Surg 2017; 7:696-699. [PMID: 27834760 DOI: 10.1177/2150135116674440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Double outlet right ventricle (DORV) is a conotruncal anomaly that is a defining element of many types of complex congenital heart disease. Because of a big variety of pathology, there are still some controversies with respect to the definition, classification, and surgical treatment. We report our experience with surgical treatment for DORV (as defined by the "90% rule") with pulmonary outflow tract obstruction (POTO). METHODS From July 2005 to July 2015, 90 patients underwent surgical treatment of DORV with POTO at the First Hospital of Tsinghua University. There were 55 males and 35 females whose age varies from 3 months to 36 years (mean age 7.1 ± 9.0 years old), and body weights ranged from 5 to 63 kg (mean weight 20.4 ± 16.6 kg). Besides DORV, ventricular septal defect, and POTO, this group of patients includes some with additional associated cardiac abnormalities. RESULTS Fourteen patients (15.6%) died. The main cause of death was low cardiac output syndrome. CONCLUSIONS The DORV is usually associated with a variety of cardiac abnormalities and POTO is a common defining feature. Acceptable surgical results can be achieved by individualized surgical treatment of most patients. Some patients may require reoperation, and a close follow-up is needed.
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Affiliation(s)
- Qingyu Wu
- Heart Center, The First Hospital of Tsinghua University, Beijing, China
- Medical Center, Tsinghua University, Beijing, China
| | - Yongqiang Jin
- Heart Center, The First Hospital of Tsinghua University, Beijing, China
- Medical Center, Tsinghua University, Beijing, China
| | - Hongyin Li
- Heart Center, The First Hospital of Tsinghua University, Beijing, China
| | - Mingkui Zhang
- Heart Center, The First Hospital of Tsinghua University, Beijing, China
- Medical Center, Tsinghua University, Beijing, China
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