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Tanimoto K, Hoashi T, Shibagaki K, Ono Y, Komori M, Okuda N, Imai K, Iwai S, Ichikawa H. Long-term outcomes of functional single ventricles associated with heterotaxy syndrome†. Eur J Cardiothorac Surg 2023; 64:ezad311. [PMID: 37688564 DOI: 10.1093/ejcts/ezad311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVES The goal of this study was to determine the long-term surgical outcomes of patients with functional single ventricles associated with heterotaxy syndrome, risk factors for mortality and factors associated with Fontan stage completion. METHODS Overall, 279 patients with a functional single ventricle associated with heterotaxy syndrome who underwent an initial surgical procedure at our institute between 1978 and 2021 were grouped into 4 "eras" based on the surgical year during which the initial procedure was performed: era 1 (1978-1989, n = 71), era 2 (1990-1999, n = 98), era 3 (2000-2009, n = 64) and era 4 (2010-2021, n = 46). Neonatal surgery was more frequent in eras 3 and 4 than in eras 1 and 2. RESULTS Overall, 228 patients had right atrial isomerism; 120 patients (43.0%) had a total anomalous pulmonary venous connection; and 58 patients (20.8%) underwent an initial procedure as neonates. Overall survival rates at 10, 20 and 30 years after the initial procedure were 47.1%, 40.6% and 36.1%, respectively. Neonatal surgery (P < 0.001), total anomalous pulmonary venous connection repair at the initial procedure (P < 0.001) and early era (P < 0.001) were identified as risk factors for mortality, with the last 2 variables being negatively associated with Fontan stage completion (P < 0.001 for both). CONCLUSIONS Although era had a favourable effect on survival, total anomalous pulmonary venous connection with intrinsic pulmonary vein obstruction was associated with both mortality and Fontan stage completion. CLINICAL REGISTRATION NUMBER R19092.
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Affiliation(s)
- Kazuki Tanimoto
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Keisuke Shibagaki
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshikazu Ono
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Motoki Komori
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Okuda
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenta Imai
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shigemitsu Iwai
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Ortega-Zhindón DB, Pérez-Hernández N, Rodríguez-Pérez JM, García-Montes JA, Calderón-Colmenero J, Rivera-Buendía F, Cervantes-Salazar JL. Cardiac Laterality: Surgical Results of Right Atrial Isomerism. Diseases 2023; 11:170. [PMID: 37987281 PMCID: PMC10660862 DOI: 10.3390/diseases11040170] [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: 09/04/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
Right atrial isomerism (RAI) is a complex entity with varying diagnostic and treatment outcomes due to its rarity. Treatment options range from palliative to corrective surgeries, resulting in heterogeneous outcomes. The aim of this study was to analyze the results obtained after cardiac surgery in patients with RAI. A retrospective study was conducted, including patients diagnosed with RAI who underwent cardiac surgery. Their follow-up was from 1 January 2010 to 31 March 2020. Demographic characteristics and perioperative conditions were described. Thirty-eight patients were included, the median age was 4 years (IQR 2-9.2) and 57.9% were men. The main diagnoses were atrioventricular canal (63.2%) and pulmonary stenosis (55.3%). The most common surgical procedures were modified Blalock-Taussig shunt (65.8%) and total cavopulmonary connection with an extracardiac conduit fenestrated without cardiopulmonary bypass (15.9%). We did not find any factors associated with negative outcomes in these patients. The overall survival was 86.8%, with a better outcome in those who did not require reintubation (log rank, p < 0.01). The survival of RAI was similar to other centers. Individuals with RAI should be evaluated rigorously to determine an adequate repair strategy, considering high morbidity and mortality.
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Affiliation(s)
- Diego B. Ortega-Zhindón
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Nonanzit Pérez-Hernández
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.P.-H.); (J.M.R.-P.)
| | - José Manuel Rodríguez-Pérez
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.P.-H.); (J.M.R.-P.)
| | - José A. García-Montes
- Department of Interventional Cardiology in Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Juan Calderón-Colmenero
- Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Frida Rivera-Buendía
- Department of Clinical Research, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Jorge L. Cervantes-Salazar
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
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Chowdhury UK, Anderson RH, Pandey NN, George N, Sankhyan LK, Khan MA, Goja S, Ramakrishnan S, Gupta SK. Long-Term Surgical Outcomes of Patients With Isomeric Right and Left Atrial Appendages. World J Pediatr Congenit Heart Surg 2023; 14:291-299. [PMID: 36794481 DOI: 10.1177/21501351221151049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Objectives: To compare the long-term outcomes of biventricular, univentricular, and so-called one-and-one-half ventricular repairs in patients with left and right isomerism. Methods: Surgical correction was undertaken, between 2000 and 2021, in 198 patients with right, and 233 with left isomerism. Results: The median age at operation was 24 days (interquartile range [IQR]: 18-45) and 60 days (IQR: 29-360) for those with right and left isomerism, respectively. Multidetector computed-tomographic angiocardiography demonstrated more than half of those with right isomerism had superior caval venous abnormalities, and one-third had a functionally univentricular heart. Almost four-fifths of those with left isomerism had an interrupted inferior caval vein, and one-third had complete atrioventricular septal defect. Biventricular repair was achieved in two-thirds of those with left isomerism, but under one-quarter with right isomerism (P < .001). Hazard regression for mortality revealed odds for prematurity at 5.5, pulmonary atresia at 2.81, atrioventricular septal defect with a common valvar orifice at 2.28, parachute mitral valve at 3.73, interrupted inferior caval vein at 0.53, and functionally univentricular heart with a totally anomalous pulmonary venous connection at 3.77. At a median follow-up of 124 months, the probability of survival was 87% for those with left, and 77% for those with right isomerism (P = .006). Conclusions: Multimodality imaging characterizes and delineates the relevant anatomical details, facilitating surgical management of individuals with isomeric atrial appendages. Continuing higher mortality despite surgical intervention in those with right isomerism points to the need for the reassessment of strategies for management.
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Affiliation(s)
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Niraj Nirmal Pandey
- Cardiothoracic Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Niwin George
- Government Medical College, Thiruvananthapuram, India
| | | | - Maroof A Khan
- Cardiothoracic Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Cardiothoracic Centre, 28730All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh Kumar Gupta
- Cardiothoracic Centre, 28730All India Institute of Medical Sciences, New Delhi, India
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Abstract
OBJECTIVE Laterality anomalies are almost always associated with severe cardiac anomalies. Demographic properties, type of the procedures, associated anomalies, and early and mid-term prognosis of four types of laterality anomalies were analysed. METHODS A total of 64 consecutive patients with laterality anomalies were enrolled between July 2014 and July 2020. We grouped the patients as situs solitus dextrocardia (SSD) (n = 12; 18.7%); situs inversus (SI) (n = 16; 25%); right atrial isomerism (RAI) (n = 29; 45.3%); and left atrial isomerism (LAI) (n = 7; 10.9%). TAPVC was only present in the RAI group (31%). Incidence of mitral or tricuspid atresia was higher in the SSD group (25%). All the patients were followed up with a mean of 19.06 ± 17.6 (0.1-72) months. RESULTS Early postoperative mortality was 17 patients, among 107 procedures (15.8%). Twelve patients were in the neonatal period. All ten patients survived after isolated ductal stenting. Fourteen of the deaths were in the RAI group (48.3%). The 3-year survival rates were 85% in LAI, 78.7% in SI, 55.8% in SSD, and 38% in RAI groups. According to the multivariable Cox regression model, mechanical ventilation, kidney injury, RAI, and complex surgery in the neonatal period were independent risk factors for early mortality. CONCLUSION Laterality anomalies are one of the most challenging patients who commonly had univentricular physiology. The most prevalent anomaly was RAI, and RAI had the worst outcome and survival. Ductal stent is an acceptable first intervention during the neonatal period in suitable patients. Complex procedures may carry a high risk of death in the neonatal period.
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Yu CKM, Chan KL, Rocha BA, Ng CWK, Cheung YF. An Unusual Cause of Cyanosis after Fontan Procedure in Right Atrial Isomerism. CASE 2022; 6:50-54. [PMID: 35492294 PMCID: PMC9050578 DOI: 10.1016/j.case.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent or worsening cyanosis after Fontan procedure deserves thorough evaluation. Right-to-left shunt through hepatic vein communication in right atrial isomerism is reported. Detailed delineation of hepatic venous drainage is essential in pre-Fontan assessment.
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Affiliation(s)
- Clement Kwong-man Yu
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Kwok-lap Chan
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Barnabe Antonio Rocha
- Paediatric Cardiothoracic Surgery Unit, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Carol Wing-kei Ng
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Yiu-fai Cheung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
- Correspondence: Professor Yiu-fai Cheung, MD, Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Kowloon, Hong Kong, People's Republic of China.
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Spicer DE, Chowdhury UK, Anderson RH, Pandey NN, Sankhyan LK, George N, Goja S, Malik V. The surgical anatomy of hearts with isomeric atrial appendages-implications for surgical management. Eur J Cardiothorac Surg 2022; 62:6540686. [PMID: 35234855 DOI: 10.1093/ejcts/ezac139] [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: 12/24/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The most severe combinations of cardiac malformations exist in individuals having jumbled-up thoracic and abdominal organs. These patients make up 2 distinct syndromes. As yet, the consensus is lacking on how best to describe the subsets. The subsets are frequently grouped together in terms of 'heterotaxy'. The surgical approaches to the subsets, however, are markedly different. We reviewed our experiences with regard to the anatomy as observed in the autopsy room, by the analysis of computed tomographic studies, and in the operating room, to assess whether the lesions might be segregated on the basis of isomerism of the atrial appendages. METHODS AND RESULTS A review of our findings from the examination of specimens from several archives, along with investigation of a large cohort of patients being prepared for surgical treatment, showed that individuals can uniformly be segregated into subgroups on the basis of isomeric arrangement of the atrial appendages. In all instances, this was made possible by using the criterion of the extent of the pectinate muscles within the appendages as judged relative to the atrial vestibules. Segregation on this basis, which correlated excellently with the bronchial arrangement, sets the scene for an appropriate description of the remainder of the heart, providing the cardiac surgeon with all the inferences required for appropriate surgical intervention. CONCLUSIONS When assessing individuals having the features of so-called 'heterotaxy', it is possible to segregate the groups into subsets of individuals having either isomeric right or left atrial appendages. This approach provides the framework for the assessment of appropriate surgical management.
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Affiliation(s)
- Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatric Cardiology, University of Florida, Gainesville, FL, USA
| | | | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Niraj Nirmal Pandey
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bilaspur, India
| | - Niwin George
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Chowdhury UK, Anderson RH, Spicer DE, Sankhyan LK, Pandey NN, Goja S, Rajasekar P, Arvind B, Pradeep D. Surgical management of hearts with isomeric atrial appendages. J Card Surg 2022; 37:1340-1352. [PMID: 35122446 DOI: 10.1111/jocs.16268] [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: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM On the basis of previously published accounts, coupled with our own experience, we have assessed the surgical approaches to patients with isomeric atrial appendages. METHODS We reviewed pertinent published studies on surgical treatment of individuals with isomeric atrial appendages, with the pertinent surgical details provided by most of the manuscripts. RESULTS Half of patients with right isomerism, and two-thirds of those with left isomerism have bilateral superior caval veins. Azygos extension of the inferior caval vein is reported in three-quarters of those with left isomerism. The coronary sinus is universally absent in right isomerism, along with totally anomalous pulmonary venous connection, and is absent in two-fifths of those with left isomerism. Univentricular atrioventricular connections are expected in up to three-quarters of those with right isomerism. Atrioventricular septal defect is reported in up to four-fifths, more frequently in right isomerism, with such patients typically having discordant ventriculoatrial connections or double outlet right ventricle. Reported mortalities extend to 85% for those with right, and 50% for those with left isomerism. In right isomerism, mortality is up to 54% for systemic-to-pulmonary arterial shunting, up to 75% for univentricular repair, and up to 95% for repair of totally anomalous pulmonary venous connection itself. No more than one-quarter had undergone Fontan completion, with reported mortalities of 21%. CONCLUSION Early surgical results are satisfactory in patients with left isomerism, but disappointing for those with right. Recent advances in cardiac and liver transplantation may offer improved survival.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, USA
| | - Lakshmi K Sankhyan
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bilaspur, India
| | - Niraj N Pandey
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajasekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Doniparthi Pradeep
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Utility of Three-Dimensional Printed Model in Biventricular Repair of Complex Congenital Cardiac Defects: Case Report and Review of Literature. CHILDREN 2022; 9:children9020184. [PMID: 35204905 PMCID: PMC8870194 DOI: 10.3390/children9020184] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 01/14/2023]
Abstract
Heterotaxy is a rare syndrome associated with cardiac complexity, anatomic variability and high morbidity and mortality. It is often challenging to visualize and provide an accurate diagnosis of the cardiac anatomy prior to surgery with the use of conventional imaging techniques. We report a unique case demonstrating how the use of three-dimensional (3D) cardiac printed model allowed us to better understand the anatomical complexity and plan a tailored surgical approach for successful biventricular repair in a patient with heterotaxy syndrome.
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Akalın M, Demirci O, Kumru P, Yücel İK. Heterotaxy syndrome: Prenatal diagnosis, concomitant malformations and outcomes. Prenat Diagn 2022; 42:435-446. [PMID: 35102577 DOI: 10.1002/pd.6110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study is to define cardiac and extracardiac malformations in fetuses with heterotaxy syndrome and to determine perinatal and childhood prognosis. METHODS In this retrospective study, fetuses diagnosed with heterotaxy syndrome on antenatal ultrasonography in a tertiary center between January 2014 and January 2021 were analyzed. Fetuses with heterotaxy syndrome were grouped as right atrial isomerism (RAI) and left atrial isomerism (LAI). RESULTS A total of 62 fetuses, 32 (51.6%) with RAI and 30 (48.4%) with LAI, were included in the study. Extracardiac anomaly was detected in 25% of fetuses with RAI and 44% of fetuses with LAI (p = 0.13). Patients with univentricular repair had a higher childhood mortality than patients with biventricular repair (p = 0.031). The presence of conotruncal anomaly was an independent factor affecting mortality (HR = 5.09, CI 95% 1.09-23.71, p = 0.039). CONCLUSION Hydrops fetalis, univentricular physiology and conotruncal anomalies are associated with poor outcomes in heterotaxy syndrome. The severity of the cardiac malformation is the main determinant of the outcomes. The presence of extracardiac malformations is associated with increased morbidity and mortality.
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Affiliation(s)
- Münip Akalın
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Pınar Kumru
- Department of Obstetrics and Gynaecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - İlker Kemal Yücel
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey
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10
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Pan J, Lin C, Wu C, Chang J. Comparable long‐term results of the extracardiac conduit total cavopulmonary connection in heterotaxy to non‐heterotaxy patients. J Card Surg 2022; 37:941-947. [DOI: 10.1111/jocs.16283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jun‐Yen Pan
- Department of Cardiovascular Surgery Veterans General Hospital Kaohsiung Kaohsiung Taiwan
| | - Chu‐Chuan Lin
- Department of Pediatrics Veterans General Hospital Kaohsiung Kaohsiung Taiwan
| | - Chieh‐Jen Wu
- Department of Cardiovascular Surgery Veterans General Hospital Kaohsiung Kaohsiung Taiwan
| | - Jen‐Ping Chang
- Division of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung Taiwan
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Multimodality imaging of developmental splenic anomalies: tips and pitfalls. Clin Radiol 2022; 77:319-325. [PMID: 35000764 DOI: 10.1016/j.crad.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
Anomalies in number and location may occur during splenic development. This review aims to offer a brief overview of splenic function and embryology and a detailed account of the imaging appearances using different imaging techniques of the normal spleen and various congenital splenic anomalies including (1) abnormal viscero-atrial situs, (2) splenogonadal fusion, (3) intrapancreatic accessory spleen, (4) wandering spleen, and (5) splenosis. Emphasis is placed on the salient features that help radiologists recognise important associations (e.g., asplenia/polysplenia in situs abnormalities), avoid diagnostic pitfalls (e.g., mistaking intrapancreatic accessory spleen as pancreatic neoplasms), and potential complications (e.g., acute torsion in wandering spleen). The correct identification of the said anomalies from more sinister causes, such as malignancies, are essential, where early intervention is necessary.
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12
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6527002. [DOI: 10.1093/ejcts/ezac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/02/2022] [Accepted: 01/30/2022] [Indexed: 11/12/2022] Open
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Ishidou M, Hirose K, Ikai A, Sakamoto K. Primary central pulmonary artery plasty for right atrial isomerism with pulmonary coarctation. Asian Cardiovasc Thorac Ann 2021; 30:540-548. [PMID: 34524926 DOI: 10.1177/02184923211045216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with unbalanced pulmonary artery growth resulting from pulmonary coarctation are considered unsuitable candidates for the Fontan procedure. Particularly, patients with right isomerism pose a challenge. We aimed to investigate the use of primary central pulmonary artery plasty at initial palliation in patients with right isomerism. METHODS We recruited 34 right isomerism patients with pulmonary atresia and pulmonary coarctation who underwent modified Blalock-Taussig shunt with or without primary central pulmonary artery plasty between 1998 and 2014. We classified them into the primary central pulmonary artery plasty (group P) and no primary central pulmonary artery plasty (group N) groups. We retrospectively analyzed reintervention for pulmonary artery after initial palliation, difference in size between the left and right pulmonary arteries, overall survival, success of the Fontan procedure. RESULTS The group P and group N included 25 and 9 patients, respectively. Five (20%) and six (67%) patients in group P and group N, respectively, required reintervention for pulmonary artery after initial palliation (p = 0.017). No patient underwent reintervention for the pulmonary artery before bidirectional cavopulmonary shunt in group P. There was a significant difference in the bilateral pulmonary artery size balance between the groups before bidirectional cavopulmonary shunt (p = 0.041). The two-lung Fontan procedure was successful in 14 (56%) and 1 (11%) patient in group P and group N. CONCLUSION Primary central pulmonary artery plasty may contribute toward improving the balance in the size of the PA and preclude the need for reintervention for PA.
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Affiliation(s)
- Motonori Ishidou
- Department of Cardiovascular Surgery, 13761Mt. Fuji Shizuoka Children's Hospital, Shizuoka City, Japan
| | - Keiichi Hirose
- Department of Cardiovascular Surgery, 13761Mt. Fuji Shizuoka Children's Hospital, Shizuoka City, Japan
| | - Akio Ikai
- Department of Cardiovascular Surgery, 13761Mt. Fuji Shizuoka Children's Hospital, Shizuoka City, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, 13761Mt. Fuji Shizuoka Children's Hospital, Shizuoka City, Japan
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Kharel S, Koirala DP, Shrestha S, Sedai H, Shrestha BM, Homagain S, Kandel S. Heterotaxy syndrome with complex congenital heart disease, facial palsy, and asplenia: A rare newborn finding. Clin Case Rep 2021; 9:e04573. [PMID: 34401157 PMCID: PMC8347632 DOI: 10.1002/ccr3.4573] [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: 02/21/2021] [Revised: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Heterotaxy syndrome is associated with asplenia/polysplenia and complex congenital heart disease. Facial palsy in heterotaxy is very rare. The management is still challenging with a poor prognosis. Proper counseling to the family about the disease course, treatment modalities, and outcomes is essential.
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Affiliation(s)
- Sanjeev Kharel
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | - Dinesh Prasad Koirala
- Department of Gastrointestinal and General SurgeryPediatric Surgery UnitTribhuvan UniversityTeaching HospitalKathmanduNepal
| | - Suraj Shrestha
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | - Hari Sedai
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | | | - Sushan Homagain
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
| | - Suraj Kandel
- Institute of MedicineMaharajgunj Medical CampusKathmanduNepal
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15
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Asai H, Shingu Y, Ikarashi J, Cao Y, Takeyoshi D, Arai Y, Ebuoka N, Tachibana T. Apex rotation as a risk factor for total anomalous pulmonary connection repair in single ventricle. J Card Surg 2021; 36:3078-3084. [PMID: 34080233 DOI: 10.1111/jocs.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mortality-associated concern in patients with right atrial isomerism and extracardiac total anomalous pulmonary venous connection (TAPVC). We evaluated new anatomical risk factors for reducing the space behind the heart after TAPVC repair. METHODS Eighteen patients who underwent TAPVC repair between 2014 and 2020 were enrolled. Sutureless technique was used in 12 patients and conventional repair in six patients. The angle between the line perpendicular to the vertebral body and that from the vertebral body to the apex was defined as the "vertebral-apex angle (V-A angle)." The ratio of postoperative and preoperative angles, indicating the apex's lateral rotation, was compared between patients with and without PVO. RESULTS The median (interquartile range) age and body weight at repair were 102 (79-176) days and 3.8 (2.6-4.8) kg, respectively. The 1-year survival rate was 83% (median follow-up, 29 [11-36] months). PVO occurred in seven patients (39%), who showed an obstruction of one or two branches in the apex side. The postoperative V-A angle (46° [45°-50°] vs. 36° [29°-38°], p = 0.001) and the ratio of postoperative and preoperative V-A angles (1.27 [1.24-1.42] vs. 1.03 [0.98-1.07], p = 0.001) were significantly higher in the PVO group than in the non-PVO group. The cut-off values of the postoperative V-A angle and ratio were 41° and 1.17, respectively. CONCLUSION A postoperative rotation of the heart apex into the ipsilateral thorax was a risk factor for branch PVO after TAPVC repair.
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Affiliation(s)
- Hidetsugu Asai
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Jin Ikarashi
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yuchen Cao
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Daisuke Takeyoshi
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yosuke Arai
- Department of Cardiovascular and Thoracic Surgery, Hokkaido Medical Center For Child Health and Rehabilitation, Sapporo, Japan
| | - Noriyoshi Ebuoka
- Department of Cardiovascular and Thoracic Surgery, Hokkaido Medical Center For Child Health and Rehabilitation, Sapporo, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
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16
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Soofi M, Alpert MA, Barbadora J, Mukerji B, Mukerji V. Human Laterality Disorders: Pathogenesis, Clinical Manifestations, Diagnosis, and Management. Am J Med Sci 2021; 362:233-242. [PMID: 34052215 DOI: 10.1016/j.amjms.2021.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/18/2021] [Accepted: 05/24/2021] [Indexed: 12/22/2022]
Abstract
Human laterality disorders comprise a group of diseases characterized by abnormal location (situs) and orientation of thoraco-abdominal organs and vessels across the left-right axis. Situs inversus totalis is mirror image reversal of thoraco-abdominal organs/great vessels. Situs ambiguus, better known as heterotaxy, is abnormal arrangement of thoraco-abdominal organs across the left-right axis excluding situs inversus totalis. Heterotaxy, also referred to as atrial or atrial appendage isomerism, is characterized by abnormal location of left-sided or right-sided organs with loss of asymmetry of normally paired asymmetric organs. It is associated with a variety of anomalies involving the heart, great vessels, lungs and intra-abdominal organs. Right and left atrial isomerism are associated with multiple complex congenital cardiac and vascular anomalies, many of which are lethal when untreated. Isomerism may also affect the lungs, spleen, liver, gall bladder, and intestines. Innovative surgical therapy of heterotaxy/isomerism has reduced early mortality and markedly improved long-term prognosis.
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Affiliation(s)
- Muhammad Soofi
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Martin A Alpert
- University of Missouri School of Medicine, Columbia, MO, USA.
| | | | - Basanti Mukerji
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA; Dayton VA Medical Center, Dayton, OH, USA
| | - Vaskar Mukerji
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA; Dayton VA Medical Center, Dayton, OH, USA; Kettering Medical Center, Kettering, OH, USA
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17
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Resolution of postnatal shock before open-heart surgery in neonates with prenatal diagnoses. Ann Thorac Surg 2021; 114:202-209. [PMID: 34019856 DOI: 10.1016/j.athoracsur.2021.04.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The impact of prenatal diagnosis (PreND) for congenital heart disease on outcomes after neonatal open heart surgery is undetermined. We hypothesized that PreND has a positive impact on surgical outcomes in terms of immediate postnatal intensive care, which may lead to a decreased risk of persistent shock before surgery. METHODS Among the 949 neonates who underwent open heart surgery between January 2002 and December 2017, 655 patients (69.0%) were diagnosed prenatally (Group-PreND) and 294 patients (31.0%) were diagnosed postnatally (Group-PostND). Procedural complexity, incidence of postnatal shock (Serum lactate >4.0 mmol/L or pH <7.2), hospitalization timing, duration of shock, resolution of shock, and in-hospital mortality were compared between the two groups. RESULTS In Group-PreND, procedure-dependent comprehensive Aristotle score (10.8 vs. 10.0 P < .001), incidence of extra-cardiac anomalies (13.0% vs. 7.1%, P = .008), heterotaxy syndrome (3.8% vs. 1.0%, P = .021), and postnatal shock (244/655, 37.3% vs. 78/294, 26.5%, P = .001) were higher than in Group-postND. However, patients in Group-PreND were hospitalized earlier after birth (0 day vs 5 days, P < .001), experiencing shorter duration of shock (5.3 hours vs 9.0 hours, P = .01), and, consequently, showing higher incidence of shock resolution (212/244, 87% vs. 52/78, 67%, P < .001). In-hospital mortality was comparable between the two groups (P = .070). CONCLUSIONS Postnatal shock is more frequently observed in Group-PreND. However, prenatal awareness of the disease leads to immediate postnatal initiation of intensive care with shorter exposure to shock, leading to higher probability of shock resolution.
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Windsor J, Mukundan C, Stopak J, Ramakrishna H. Analysis of the 2020 European Society of Cardiology (ESC) Guidelines for the Management of Adults With Congenital Heart Disease (ACHD). J Cardiothorac Vasc Anesth 2021; 36:2738-2757. [PMID: 33985885 DOI: 10.1053/j.jvca.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/02/2023]
Abstract
Adult congenital heart disease (ACHD) continues to rapidly increase worldwide. With an estimated 1.5 million adults with ACHD in the USA alone, there is a growing need for better education in the management of these complex patients and multiple knowledge gaps exist. This manuscript comprehensively reviewed the recent (2020) updated European Society of Cardiology Guidelines for the management of ACHD created by the Task Force for the management of adult congenital heart disease of the European Society of Cardiology, with perioperative implications for the adult cardiac anesthesiologist and intensivist who may be called upon to manage these complex patients.
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Affiliation(s)
- Jimmy Windsor
- Clinical Associate Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Chaitra Mukundan
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Joshua Stopak
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Harish Ramakrishna
- Professor of Anesthesiology, Mayo Clinic School of Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, 200 First Street SW, Rochester, MN 55905.
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20
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Extracorporeal Membrane Oxygenation Complicated by an Interrupted Inferior Vena Cava. ASAIO J 2021; 67:e160-e162. [PMID: 33741788 DOI: 10.1097/mat.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Heterotaxy refers to a congenital disorder in which there is a disruption of the normal left-right axis, resulting in duplication of one laterality, and can affect all of the thoracic and abdominal organs. Findings include atrial isomerism, vascular abnormalities affecting the great vessels, ciliary dyskinesia, polysplenia or asplenia, biliary atresia, and gut malrotation. These anomalies can present unique challenges in the critical care setting, particularly in those requiring mechanical circulatory support. Here, we present a patient with acute respiratory distress syndrome requiring venovenous extracorporeal oxygenation which was complicated by a persistent impedance of flow. She was subsequently discovered to have an interrupted inferior vena cava, where lower limb venous drainage returned to the heart via the azygos and hemiazygos systems. We use this case to also highlight other manifestations of heterotaxy which may affect critical care.
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21
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Yilmaz O, Celik OY. Prenatal diagnosis of double-outlet right ventricle with tricuspid valve atresia, anomalous pulmonary vein connection, persistent left superior vena cava, and right atrial isomerism. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:262-264. [PMID: 32880971 DOI: 10.1002/jcu.22908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
Double-outlet right ventricle is a conotruncal cardiac disease in which both the aorta and the pulmonary artery predominantly or completely originate from the right ventricle. Here, we report a complex variant double-outlet right ventricle detected in utero and identified on the basis of a segmental approach.
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Affiliation(s)
- Osman Yilmaz
- Training and Research Hospital, Pediatric Cardiology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Ankara, Turkey
| | - Ozge Yucel Celik
- Training and Research Hospital, Perinatology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Ankara, Turkey
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22
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 817] [Impact Index Per Article: 272.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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23
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Spearman AD, Ginde S, Goot BH, Schaal AM, Feng M, Pan AY, Frommelt MA, Frommelt PC. Echocardiographic Identification of Pulmonary Artery Flow Reversal: An Indicator of Adverse Outcomes in Single Ventricle Physiology. Pediatr Cardiol 2020; 41:1632-1638. [PMID: 32710282 DOI: 10.1007/s00246-020-02421-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/18/2020] [Indexed: 11/24/2022]
Abstract
Individuals with single ventricle congenital heart disease (CHD) undergo multiple staged surgical palliations. Staged single ventricle palliation with a superior cavopulmonary connection (SCPC) in infancy followed by a Fontan in early childhood relies on passive, unobstructed pulmonary blood flow and normal pulmonary vasculature. We hypothesized that patients with echocardiographic identification of retrograde flow in a branch pulmonary artery (PA) after SCPC or Fontan are at increased risk for adverse outcomes. We conducted a retrospective chart review of patients seen at Children's Wisconsin from 1999 to 2019. Inclusion criteria included a history of single ventricle congenital heart disease and surgical palliation with a superior cavopulmonary connection (SCPC). We created two cohorts based on transthoracic echocardiographic identification of branch PA flow patterns: those with color Doppler-defined pulmonary artery flow reversal (PA reversal cohort) and those with normal anterograde flow (Non-reversal cohort). We identified 21 patients in the PA reversal cohort and 539 patients in the Non-reversal cohort. The PA reversal cohort had increased hospital length of stay after SCPC palliation (p < 0.001) and decreased transplant-free survival (p = 0.032), but there was no difference in overall survival (p = 0.099). There was no difference in hospital length of stay after Fontan (p = 0.17); however, the PA reversal cohort was significantly less likely to progress to Fontan palliation during early childhood (p = 0.005). Echocardiographic color Doppler identification of branch PA flow reversal in patients with single ventricle physiology is a high-risk indicator for adverse short- and long-term outcomes.
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Affiliation(s)
- Andrew D Spearman
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Herma Heart Institute, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. .,Cardiovascular Center, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Salil Ginde
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Herma Heart Institute, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.,Cardiovascular Center, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA.,Division of Cardiology, Department of Medicine, Medical College of Wisconsin, 8701 West Watertown Plank, Milwaukee, WI, 53226, USA
| | - Benjamin H Goot
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Herma Heart Institute, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.,Cardiovascular Center, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Amy M Schaal
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Herma Heart Institute, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Mingen Feng
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Amy Y Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Michele A Frommelt
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Herma Heart Institute, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.,Cardiovascular Center, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Peter C Frommelt
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Herma Heart Institute, 9000 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.,Cardiovascular Center, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA
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24
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Jose D, Babu S, Jeevan R, Ramanan S, Kramadhari H, Sukesan S. Intraoperative Transesophageal Echocardiographic Diagnosis of an Unobstructed Supracardiac Total Anomalous Pulmonary Venous Connection in a Case of Single Ventricle Palliative Repair. J Cardiothorac Vasc Anesth 2020; 35:2132-2136. [PMID: 32723587 DOI: 10.1053/j.jvca.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Don Jose
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Ram Jeevan
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sowmya Ramanan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Harshith Kramadhari
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Subin Sukesan
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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25
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Outcomes of the Fontan Operation for Patients With Heterotaxy: A Meta-Analysis of 848 Patients. Ann Thorac Surg 2020; 110:307-315. [DOI: 10.1016/j.athoracsur.2019.11.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 11/20/2022]
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26
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Sehgal L, Das S, Rabbani SS, Gupta S. Intraoperative Conundrum Between Hepatic Vein and Partial Anomalous Pulmonary Vein Connection in a Case of Tetralogy of Fallot With Persistent Left Superior Vena Cava. J Cardiothorac Vasc Anesth 2020; 35:1457-1460. [PMID: 32563628 DOI: 10.1053/j.jvca.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Lakshay Sehgal
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sambhunath Das
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Syed Shamayal Rabbani
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Saurabh Gupta
- Department of Cardiology, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Abstract
Heterotaxy is a generalized term for patients who have an abnormality of laterality that cannot be described as situs inversus. Infants with heterotaxy can have significant anatomic and medical complexity and require personalized, specialized care, including comprehensive anatomic assessment. Common and rare anatomic findings are reviewed by system to help guide a thorough phenotypic evaluation. General care guidelines and considerations unique to this patient population are included. Future directions for this unique patient population, particularly in light of improved neonatal survival, are discussed.
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Affiliation(s)
- Gabrielle C Geddes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Institute, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS#716, Milwaukee, WI 53226, USA.
| | - Sai-Suma Samudrala
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael G Earing
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Institute, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS#716, Milwaukee, WI 53226, USA; Section of Adult Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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28
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Agrawal P, Champaneri B, Jain M, Parmar T, Patel K. Comparison of morphologic profile of congenital heart defects associated with right isomerism and left isomerism in Western Indian population. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_39_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Impact of Gestational Age on Surgical Outcomes in Patients With Functionally Single Ventricle. Ann Thorac Surg 2019; 109:1260-1266. [PMID: 31580862 DOI: 10.1016/j.athoracsur.2019.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/26/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Younger gestational age (GA) is known to be associated with worse outcomes after congenital cardiac surgery. We sought to determine the impact of GA on surgical outcomes of single-ventricle palliation. METHODS Among the 284 patients with functionally single ventricle who were born between January 2005 and December 2014, 50 neonates were born prematurely (GA < 37 weeks) and 113 neonates in the early term period (37 weeks ≤ GA < 39 weeks). Initial palliation was required in 251 patients, whereas 33 patients received primary bidirectional cavopulmonary anastomosis (BCPA). RESULTS BCPA and the completion Fontan operation were performed in 200 and 169 patients, respectively. Overall survival at 5 years were 62.5% ± 2.9%. On Cox regression younger GA (hazard ratio, 1.14 per 1-week decrease; P = .007) was identified as a risk factor for increased interstage mortality (ISM) between initial palliation and BCPA. On subgroup analysis of the preterm or early-term patients with initial palliation (n = 145), younger postmenstrual age at initial palliation was associated with increased ISM before BCPA (hazard ratio, 1.18; P = .005). After BCPA, however, younger GA did not increase the risk of ISM between BCPA and the Fontan operation (P = .47). CONCLUSIONS Younger GA is a risk factor for ISM between initial palliation and BCPA. Deferral of initial palliation may be beneficial to decrease the risk of ISM in patients who were born at preterm or early term. Adverse effects of younger GA on survival disappeared once BCPA was performed.
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30
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Mathis L, Shafer B, Crethers D, Polimenakos AC. Standardized Approach to Intervention for Intestinal Malrotation in Single Ventricle Patients with Heterotaxy Syndrome: Impact on Interstage Attrition and Time to Superior Cavopulmonary Connection. Pediatr Cardiol 2019; 40:1224-1230. [PMID: 31240371 DOI: 10.1007/s00246-019-02136-w] [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: 05/21/2019] [Accepted: 06/13/2019] [Indexed: 01/19/2023]
Abstract
Heterotaxy syndrome (HS) is a significant determinant of outcome in single ventricle (SV) physiology. Attrition rate and time-related events associated with intestinal malrotation (IM) are, yet, to be determined. We sought to evaluate hospital and interstage outcomes in relation with operative intervention for IM (IMO). Twelve SV/HS patients, who underwent IMO, from January 2004 to December 2016, were studied. Early shunt failure, time to superior cavopulmonary connection (SCPC) and interstage attrition were assessed. Since September 2014, based on a comprehensive standardized protocol, IMO was performed at the time of hospitalization for stage-I palliation (S1P) irrespective of clinical manifestations. Patients were assigned to Group A (n = 8): expectant /symptoms-driven versus Group B (n = 4): protocol-driven. At S1P 7 had systemic-to-pulmonary shunt (SPS), 1 SPS with anomalous pulmonary venous return (APVR) repair (Group A) compared to 2 SPS, 1 SPS with APVR repair and 1 Norwood operation (Group B). Median duration from S1P to IMO was 82 days (range 57-336; Group A) compared to 14 days (range 11-31; Group B); p < 0.05. Median age at IMO was 87 days (range 8-345) [Group A: 99 days (range 68-345) vs Group B: 25 days (range 8-39)] (p < 0.05). Early SPS failure occurred in 25% (2 of 8) for Group A compared to none in Group B (p < 0.05). Hospital mortality following IMO was 25% [Group A: 37.5% (3 of 8) vs Group B: 0; p < 0.05]. Interstage survival was 67% [Group A: 50% (4 of 8) vs Group B: 100%; p < 0.05]. Time to SCPC following S1P was 186 days (range 169-218) for Group A compared to 118 days (range 97-161) (Group B); p < 0.05. Operative intervention for IM in SV/HS is associated with significant interstage attrition and might impact the time to SCPC. SPS is at risk for early failure after IMO. A comprehensive standardized concept can mitigate detrimental implications.
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Affiliation(s)
- Lauren Mathis
- Division of Pediatric and Congenital Cardiothoracic Surgery, Children's Hospital of Georgia, 1120 15th Street BAA 8300, Augusta, GA, 30912, USA
| | - Brendan Shafer
- Division of Pediatric and Congenital Cardiothoracic Surgery, Children's Hospital of Georgia, 1120 15th Street BAA 8300, Augusta, GA, 30912, USA
| | | | - Anastasios C Polimenakos
- Division of Pediatric and Congenital Cardiothoracic Surgery, Children's Hospital of Georgia, 1120 15th Street BAA 8300, Augusta, GA, 30912, USA.
- Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
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31
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Ryerson LM, Pharis S, Pockett C, Soni R, Fruitman D, Guleserian KJ, Nater M, Raynor SC, Mackie AS, Dicken B. Heterotaxy Syndrome and Intestinal Rotation Abnormalities. Pediatrics 2018; 142:peds.2017-4267. [PMID: 30049892 DOI: 10.1542/peds.2017-4267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Infants with heterotaxy syndrome (HS) have abnormal lateralization of organs along the right-left body axis. Intestinal rotation abnormalities (IRAs) are a potential source of morbidity and mortality. For this study, our objective was to prospectively observe a cohort of infants with HS and determine the incidence and natural history of IRA. METHODS Infants ≤6 months of age with HS were enrolled in this prospective observational study. Exclusion criteria were other congenital abnormalities that necessitated abdominal surgery. HS was defined as any arrangement of organs that was not situs solitus or situs inversus along with associated congenital heart disease. The investigation for IRA was at the discretion of each participating center. RESULTS Infants were recruited from January 2012 to December 2016. Thirty-eight infants from 7 institutions were included; 22 infants had right isomerism and 16 infants had left isomerism. Twenty-nine infants (76%) were evaluated for IRAs; 21 of 29 evaluations (72%) were abnormal. Eight infants were investigated because of symptoms, and 21 infants were evaluated routinely. The median age at symptom presentation was 46 days (range: 5-171 days). Seven infants had a Ladd procedure; 4 were prophylactic, with 3 as part of a combined procedure, and 3 were emergent. No child suffered acute midgut volvulus over a median follow-up of 1.6 years (range: 0.06-4.93 years). CONCLUSIONS IRAs are common in infants with HS. Infants with symptoms presented by 6 months of age. There was no failure of expectant management resulting in midgut volvulus during a median follow-up of 1.6 years.
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Affiliation(s)
- Lindsay M Ryerson
- Pediatric Cardiac Intensive Care Unit, Stollery Children's Hospital, Edmonton, Alberta, Canada;
| | - Scott Pharis
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Charissa Pockett
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Reeni Soni
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deborah Fruitman
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Melissa Nater
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Stephen C Raynor
- Division of Pediatric Surgery, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska; and
| | | | - Bryan Dicken
- Surgery, University of Alberta, Edmonton, Alberta, Canada
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Emi M, Inamura N. Cardiothoracic Area Ratio Predicts Lethal Pulmonary Venous Obstruction in Patients with Single Ventricle and Total Anomalous Pulmonary Venous Connection. AJP Rep 2018; 8:e174-e179. [PMID: 30250756 PMCID: PMC6138471 DOI: 10.1055/s-0038-1669429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/14/2018] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives When single ventricle (SV) is complicated with total anomalous pulmonary venous connection (TAPVC), the pulmonary vein obstruction (PVO) occurs at a high rate. There are some patients who died from the lethal PVO (l-PVO) which needed PVO release dead due to severe desaturation within 24 hours after birth. The purpose of this study was to find a predictive marker for l-PVO during the fetal period. Methods We enrolled 21 patients diagnosed with SV associated with TAPVC in the antenatal period. Ten patients had supracardiac, five had cardiac, five had infracardiac, and one had mixed TAPVC. We reviewed fetal echocardiography and measured cardiothoracic area ratio (CTAR) and total cardiac dimension (TCD). We divided 21 cases into l-PVO group (6) and non-l-PVO group (15) and compared the fetal echocardiography findings and postnatal prognoses between the groups. Results CTAR at the final fetal echocardiography was 16 to 29% (median: 21) in the l-PVO group and 22 to 38% (median: 28) in the non-l-PVO group ( p = 0.01). TCD/week at the final echocardiography was 0.67 to 1.0 (median: 0.77) in the l-PVO group and 0.78 to 1.2 (median: 0.96) in the non-l-PVO group ( p = 0.02). Conclusion Reduced CTAR in the antenatal period is a good predictor of l-PVO after birth.
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Affiliation(s)
- Misugi Emi
- Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Noboru Inamura
- Kinki Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osakasayama, Osaka, Japan
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Digilio MC, Pugnaloni F, De Luca A, Calcagni G, Baban A, Dentici ML, Versacci P, Dallapiccola B, Tartaglia M, Marino B. Atrioventricular canal defect and genetic syndromes: The unifying role of sonic hedgehog. Clin Genet 2018; 95:268-276. [PMID: 29722020 DOI: 10.1111/cge.13375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 01/29/2023]
Abstract
The atrioventricular canal defect (AVCD) is a congenital heart defect (CHD) frequently associated with extracardiac anomalies (75%). Previous observations from a personal series of patients with AVCD and "polydactyly syndromes" showed that the distinct morphology and combination of AVCD features in some of these syndromes is reminiscent of the cardiac phenotype found in heterotaxy, a malformation complex previously associated with functional cilia abnormalities and aberrant Hedgehog (Hh) signaling. Hh signaling coordinates multiple aspects of left-right lateralization and cardiovascular growth. Being active at the venous pole the secondary heart field (SHF) is essential for normal development of dorsal mesenchymal protrusion and AVCD formation and septation. Experimental data show that perturbations of different components of the Hh pathway can lead to developmental errors presenting with partially overlapping manifestations and AVCD as a common denominator. We review the potential role of Hh signaling in the pathogenesis of AVCD in different genetic disorders. AVCD can be viewed as part of a "developmental field," according to the concept that malformations can be due to defects in signal transduction cascades or pathways, as morphogenetic units which may be altered by Mendelian mutations, aneuploidies, and environmental causes.
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Affiliation(s)
- M C Digilio
- Medical Genetics, Pediatric Cardiology, Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - F Pugnaloni
- Department of Pediatrics, Sapienza University, Rome, Italy
| | - A De Luca
- Casa Sollievo della Sofferenza, IRCCS, Molecular Genetics Unit, San Giovanni Rotondo, Foggia, Italy
| | - G Calcagni
- Medical Genetics, Pediatric Cardiology, Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - A Baban
- Medical Genetics, Pediatric Cardiology, Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - M L Dentici
- Medical Genetics, Pediatric Cardiology, Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - P Versacci
- Department of Pediatrics, Sapienza University, Rome, Italy
| | - B Dallapiccola
- Medical Genetics, Pediatric Cardiology, Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - M Tartaglia
- Medical Genetics, Pediatric Cardiology, Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - B Marino
- Department of Pediatrics, Sapienza University, Rome, Italy
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Niu MC, Dickerson HA, Moore JA, de la Uz C, Valdés SO, Kim JJ, Bard DE, Morris SA, Miyake CY. Heterotaxy syndrome and associated arrhythmias in pediatric patients. Heart Rhythm 2018; 15:548-554. [DOI: 10.1016/j.hrthm.2017.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Indexed: 10/18/2022]
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Vanderlaan RD, Caldarone CA. Surgical Approaches to Total Anomalous Pulmonary Venous Connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018; 21:83-91. [PMID: 29425529 DOI: 10.1053/j.pcsu.2017.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/14/2017] [Indexed: 06/08/2023]
Abstract
Total anomalous pulmonary venous connection (TAPVC) constitutes a spectrum of congenital lesions whereby the pulmonary veins remain connected to systemic venous vessels or aberrantly connect to the right atrium. Definitive management requires surgical intervention and, in patients with obstruction to pulmonary venous flow, urgent operation is required. Use of temporizing catheter-based interventions allow for optimization in hemodynamically unstable neonates. Overall, survival has significantly improved over the past decades through better perioperative management and evolution of surgical approaches to minimize post-repair pulmonary vein stenosis, which persists as a major determinant of long-term outcomes.
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Affiliation(s)
- Rachel D Vanderlaan
- University of Toronto, Division of Cardiac Surgery, Toronto, Ontario, Canada
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MacDonald B, Vetten Z, Andrews D, Ramsay J. Anatomy and Outcomes of Patients with Right Atrial Isomerism: A West Australian Perspective. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rubbo B, Lucas JS. Clinical care for primary ciliary dyskinesia: current challenges and future directions. Eur Respir Rev 2017; 26:26/145/170023. [PMID: 28877972 PMCID: PMC9489029 DOI: 10.1183/16000617.0023-2017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/13/2017] [Indexed: 12/14/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disease that affects the motility of cilia, leading to impaired mucociliary clearance. It is estimated that the vast majority of patients with PCD have not been diagnosed as such, providing a major obstacle to delivering appropriate care. Challenges in diagnosing PCD include lack of disease-specific symptoms and absence of a single, “gold standard”, diagnostic test. Management of patients is currently not based on high-level evidence because research findings are mostly derived from small observational studies with limited follow-up period. In this review, we provide a critical overview of the available literature on clinical care for PCD patients, including recent advances. We identify barriers to PCD research and make suggestions for overcoming challenges. Challenges in PCD must be overcome through international collaboration; networks must build on recent advanceshttp://ow.ly/4d4I30dXzWg
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Affiliation(s)
- Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton, Southampton, UK.,Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University of Southampton, Southampton, UK .,Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kumar I, Bhatia A, Sodhi KS, Khandelwal N. Partial anomalous hepatic venous drainage into left-sided atrium with right isomerism: A case report with review of literature. Indian J Radiol Imaging 2017; 27:177-180. [PMID: 28744078 PMCID: PMC5510315 DOI: 10.4103/0971-3026.209208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Right isomerism, also known as Ivemark syndrome, is an unusual degree of symmetry of some of the abdominothoracic viscera reflecting bilateral right-sidedness. We report an exceedingly rare occurrence of anomalous drainage of the left hepatic vein to the left-sided atrium in a patient of right isomerism. With this case report, we further endorse that the isomerism of atrium might extend beyond the appendages, a view that has been long dismissed by the existing literature.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- GE Radiology Section, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lee SH, Kwon BS, Kim GB, Bae EJ, Noh CI, Lim HG, Kim WH, Lee JR, Kim YJ. Clinical Characteristics and Independent Factors Related to Long-Term Outcomes in Patients with Left Isomerism. Korean Circ J 2017; 47:501-508. [PMID: 28765742 PMCID: PMC5537152 DOI: 10.4070/kcj.2016.0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/13/2016] [Accepted: 12/29/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We studied the results of patient management for left isomerism (LI) and sought to determine factors that may influence survival and prognosis. SUBJECTS AND METHODS We reviewed the medical records of 76 patients who were compatible with LI criteria between 1982 and 2014. RESULTS Of the total study population, 29 patients (38.1%) had functional univentricular heart disease, 43 patients (56.5%) had cardiac anomalies suitable for biventricular hearts, and four patients (5.2%) had normal heart structure. Extracardiac anomalies were noted in 38.1% of the study population, including biliary atresia in 7.8% of all patients. Of the 25 patients who underwent Kawashima procedures, 24.0% developed pulmonary arteriovenous fistulas (PAVFs). During the median follow-up period of 11.4 years (range: 1 day to 32 years), 14 patients died. The 10-year, 20-year, and 30-year survival rates were 87%, 84%, and 76%, respectively. Preoperative dysrhythmia and uncorrected atrioventricular valve regurgitation were significantly associated with late death. There was no significant difference in the number of surgical procedures and in survival expectancy between patients in the functional single-ventricle group and in the biventricular group. However, late mortality was higher in functional single-ventricle patients after 18 years of age. CONCLUSION Patients with LI need to be carefully followed, not only for late cardiovascular problems such as dysrhythmia, valve regurgitation, and the development of PAVFs, but also for noncardiac systemic manifestations.
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Affiliation(s)
- Sun Hyang Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Bo Sang Kwon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Chung Il Noh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hong Gook Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Woong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Yong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
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Imai K, Murata M, Ide Y, Sugano M, Ito H, Kanno K, Ishido M, Fukuba R, Sakamoto K. Long-term outcome of patients with right atrial isomerism after common atrioventricular valve plasty. Eur J Cardiothorac Surg 2017; 51:987-994. [PMID: 28329375 DOI: 10.1093/ejcts/ezx001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/11/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To review long-term outcomes of patients with right atrial (RA) isomerism who underwent common atrioventricular valve (CAVV) plasty. METHODS We retrospectively analysed 59 patients with RA isomerism operated on between January 2004 and April 2016. We divided patients into those with CAVV plasty (CAVV plasty (+), 29 patients) and without CAVV plasty (CAVV plasty (-), 30), and we compared the outcome between the groups. We further divided patients into those with CAVV plasty before bidirectional cavopulmonary shunt (BCPS) operation (group before BCPS, 13 patients) or CAVV plasty with or after BCPS (group with or after BCPS, 16), and we compared the outcome between these groups. We reviewed the outcomes of 7 neonatal patients who underwent CAVV plasty. RESULTS Kaplan-Meier estimated survival rates at 10 years were 70 ± 10% and 69 ± 9% in the CAVV plasty (+) and CAVV plasty (-) groups, respectively ( P = 0.45). Kaplan-Meier estimated survival rates at 10 years were 47 ± 17% and 85 ± 10% in the group before BCPS and group with or after BCPS, respectively ( P = 0.01). Among 7 neonates in the group before BCPS, 4 are alive; Kaplan-Meier estimated survival rates at 1 year and 5 years were 60 ± 20% and 30 ± 24%, respectively. CONCLUSIONS Patients who underwent CAVV plasty with or after BCPS had good outcomes; the outcome of patients with CAVV plasty was the same as that of those without CAVV plasty. Treatment for patients who require CAVV plasty before BCPS, especially neonates, is challenging.
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Yan S, Jianpeng W, Xin Q, Minghui Z, Li Z, Hao W. Right atrial isomerism in children older than 3 years. SPRINGERPLUS 2016; 5:1372. [PMID: 27606160 PMCID: PMC4992477 DOI: 10.1186/s40064-016-3007-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 08/05/2016] [Indexed: 12/02/2022]
Abstract
Background There is a high mortality in infants with right atrial isomerism (RAI). However, less is known about outcome in older children with RAI. This study sought to evaluate those patients with RAI who survived older than 3 years of age without surgical intervention. Results A total of 33 consecutive patients (20 males) were enrolled in the study, mean age 6 years (range 3–32). None of the patients had surgical intervention for the RAI before age 3. Cardiac abnormalities include altered cardiac position (39 %), atrioventricular valve anomaly (87 %), single or functional single ventricle (55 %), pulmonary/subpulmonary obstruction (97 %), abnormal origin of the aorta (100 %), bilateral superior vena cava (67 %), and anomalous pulmonary venous drainage (66 %). Surgical intervention was performed after 3 years of age in 20 patients (61 %). None of them planned or had biventricular repair performed. 10 patients underwent the total cavopulmonary connection procedure, including four (40 %) who had atrioventricular valve (AVV) repair at the same time [all with common atrioventricular valve (CAVV)]. One patient died the day after the operation. A total of 69 % of patients with a CAVV had moderate or severe regurgitation, while 27 % with a single atrioventricular valve had moderate or severe regurgitation. Conclusion Patients with RAI who have survived to early childhood without surgical intervention have complex cardiac abnormalities. Survival after single stage total cavopulmonary connection is good but AVV repair is common.
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Affiliation(s)
- Sun Yan
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, Bei Li Shi Road, Xicheng District, Beijing, 100037 China
| | - Wang Jianpeng
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, Bei Li Shi Road, Xicheng District, Beijing, 100037 China
| | - Quan Xin
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, Bei Li Shi Road, Xicheng District, Beijing, 100037 China
| | - Zhang Minghui
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, Bei Li Shi Road, Xicheng District, Beijing, 100037 China
| | - Zhang Li
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, Bei Li Shi Road, Xicheng District, Beijing, 100037 China
| | - Wang Hao
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, Bei Li Shi Road, Xicheng District, Beijing, 100037 China
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Loomba RS, Nijhawan K, Anderson R. Impact of Era, Type of Isomerism, and Ventricular Morphology on Survival in Heterotaxy: Implications for Therapeutic Management. World J Pediatr Congenit Heart Surg 2016; 7:54-62. [PMID: 26714995 DOI: 10.1177/2150135115601831] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heterotaxy has been demonstrated to reduce survival. There are several different subgroups of patients, however, and no single study has had a large number of patients and analyzed survival across the different subgroups such as patients born in different eras, patients with right and left isomerism, and patients with biventricular or functionally univentricular hearts. This study pools previously reported data from Kaplan-Meier curves and performs such subgroup analysis. METHODS A systematic review of the literature was performed to identify studies reporting survival of patients with the so-called "heterotaxy" by means of Kaplan-Meier survival curves. Data were extracted from these survival curves and then pooled together. A polynomial regression was then used to generate a pooled survival curve. This was done for all patients, those born in a more recent era, those with right and left isomerism, and those with biventricular or functionally univentricular hearts. RESULTS Those born in the more recent era (after 2000) had increased survival compared to the overall cohort. Those with left isomerism tended to have a survival benefit compared to those with right isomerism until about 16 years of age, beyond which those with right isomerism developed a survival benefit. Those with biventricular hearts had a survival benefit compared to those with left isomerism. CONCLUSION Survival in the so-called heterotaxy syndrome is based on several factors, which include era of birth, sidedness of isomerism, and whether the heart is biventricular or functionally univentricular.
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Affiliation(s)
- Rohit S Loomba
- Division of Cardiology, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karan Nijhawan
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robert Anderson
- Institute of Genetic Medicine, Newcastle University, United Kingdom
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Koudieh M, McKenzie ED, Fraser CD. Outcome of Glenn Anastomosis for Heterotaxy Syndrome with Single Ventricle. Asian Cardiovasc Thorac Ann 2016; 14:235-8. [PMID: 16714703 DOI: 10.1177/021849230601400314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A retrospective study was undertaken of 157 patients who underwent a Glenn anastomosis between January 1996 and May 2001. Of these, 33 had heterotaxy syndrome: 20 males and 13 females, with a mean age of 1.26 ± 2.8 years. Twenty-five had right atrial isomerism and 5 had left isomerism. A common atrioventricular valve was found in 24 patients, 18 had bilateral superior venae cavae, and 18 had anomalous pulmonary venous return. Repair was carried out in 8 patients with anomalous pulmonary venous return, and pulmonary artery augmentation was performed in 11. Compared to the 124 patients who had a Glenn operation for single ventricle without heterotaxy, there were significantly longer durations of mechanical ventilation, intensive care unit stay, and inotropic support, as well as higher mortality in the heterotaxy group. Heterotaxy syndrome with single ventricle still has a high rate of morbidity and mortality. Patients with severe atrioventricular valve regurgitation are at risk of early death. Complete Fontan circulation may not be possible in all patients, and Glenn anastomosis may be their final palliation.
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Affiliation(s)
- Mohammed Koudieh
- Division of Congenital Heart Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA.
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Takeuchi K, Murakami A, Hirata Y, Kitahori K, Doi Y, Takamoto S. Surgical Outcome of Heterotaxy Syndrome in a Single Institution. Asian Cardiovasc Thorac Ann 2016; 14:489-94. [PMID: 17130325 DOI: 10.1177/021849230601400610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heterotaxy syndrome encompasses a wide range of anatomical variants including poor pulmonary vascular development. Surgical outcome remains poor in this difficult subgroup. Between April 1996 and November 2004, 27 patients with visceral heterotaxy were enrolled in this study. The median age at presentation was 25 days. There were 11 patients with asplenia and 16 with polysplenia. There were 5 deaths (4 in patients with asplenia, 1 in a patient with polysplenia). All patients with asplenia were scheduled for single-ventricle repair, and 5 completed a modified Fontan procedure. Of the 16 patients with polysplenia, 8 completed 2-ventricle repair and 6 had a modified Fontan. In polysplenia, actuarial survival was 93.8% at 4 months, and remained constant thereafter. In asplenia, survival was 81.8% at 1 month, and 53.0% at 1 year. A significant correlation was found between nonconfluent pulmonary arteries and mortality. The medium-term result in polysplenia was satisfactory, but not in asplenia. Nonconfluent pulmonary arteries carry a high risk of mortality, and a strategy to create pulmonary vascular confluence and satisfactory pulmonary blood flow is mandatory.
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Affiliation(s)
- Koh Takeuchi
- Department of Cardiovascular Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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Teele SA, Jacobs JP, Border WL, Chanani NK. Heterotaxy Syndrome: Proceedings From the 10th International PCICS Meeting. World J Pediatr Congenit Heart Surg 2016; 6:616-29. [PMID: 26467876 DOI: 10.1177/2150135115604470] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A session dedicated to heterotaxy syndrome was included in the program of the Tenth International Conference of the Pediatric Cardiac Intensive Care Society in Miami, Florida in December 2014. An invited panel of experts reviewed the anatomic considerations, surgical considerations, noncardiac issues, and long-term outcomes in this challenging group of patients. The presentations, summarized in this article, reflect the current approach to this complex multiorgan syndrome and highlight future areas of clinical interest and research.
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Affiliation(s)
- Sarah A Teele
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins All Children's Heart Institute, All Children's Hospital, Saint Petersburg and Tampa, FL, USA
| | - William L Border
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikhil K Chanani
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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Alsoufi B, McCracken C, Schlosser B, Sachdeva R, Well A, Kogon B, Border W, Kanter K. Outcomes of multistage palliation of infants with functional single ventricle and heterotaxy syndrome. J Thorac Cardiovasc Surg 2016; 151:1369-77.e2. [DOI: 10.1016/j.jtcvs.2016.01.054] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/22/2015] [Accepted: 01/23/2016] [Indexed: 01/15/2023]
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47
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Ross HJ, Law Y, Book WM, Broberg CS, Burchill L, Cecchin F, Chen JM, Delgado D, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Martin CM, Murphy AM, Singh G, Spray TL, Stout KK. Transplantation and Mechanical Circulatory Support in Congenital Heart Disease. Circulation 2016; 133:802-20. [DOI: 10.1161/cir.0000000000000353] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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48
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Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Law Y, Martin CM, Murphy AM, Ross HJ, Singh G, Spray TL. Chronic Heart Failure in Congenital Heart Disease. Circulation 2016; 133:770-801. [DOI: 10.1161/cir.0000000000000352] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes--for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome.
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Talwar S, Agarwal P, Choudhary SK, Airan B. Functionally Univentricular Heart With Right Atrial Isomerism and Mixed Total Anomalous Pulmonary Venous Drainage. World J Pediatr Congenit Heart Surg 2015; 7:377-80. [PMID: 26701620 DOI: 10.1177/2150135115590457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/12/2015] [Indexed: 11/15/2022]
Abstract
Patients with right atrial isomerism and total anomalous pulmonary venous connection (TAPVC) in a functionally univentricular heart are a challenging subset with a high mortality rate. We present the case of a patient with univentricular heart who had right atrial isomerism and associated mixed TAPVC (supracardiac, cardiac, and infracardiac). The anatomy was delineated precisely, and the patient underwent first-stage univentricular palliation consisting of TAPVC repair and bilateral bidirectional superior cavopulmonary anastomosis.
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Affiliation(s)
- Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palkesh Agarwal
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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