1
|
Cantinotti M, Jani V, Kutty S, Marchese P, Franchi E, Pizzuto A, Viacava C, Assanta N, Santoro G, Giordano R. Neonates and Infants with Left Heart Obstruction and Borderline Left Ventricle Undergoing Biventricular Repair: What Do We Know about Long-Term Outcomes? A Critical Review. Healthcare (Basel) 2024; 12:348. [PMID: 38338232 PMCID: PMC10855671 DOI: 10.3390/healthcare12030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The decision to perform biventricular repair (BVR) in neonates and infants presenting with either single or multiple left ventricle outflow obstructions (LVOTOs) and a borderline left ventricle (BLV) is subject to extensive discussion, and limited information is known regarding the long-term outcomes. As a result, the objective of this study is to critically assess and summarize the available data regarding the prognosis of neonates and infants with LVOTO and BLV who underwent BVR. METHODS In February 2023, we conducted a review study with three different medical search engines (the National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings and free text terms including "congenital heart disease", "outcome", and "borderline left ventricle". The search was refined by adding keywords for "Shone's complex", "complex LVOT obstruction", "hypoplastic left heart syndrome/complex", and "critical aortic stenosis". RESULTS Out of a total of 51 studies, 15 studies were included in the final analysis. The authors utilized heterogeneous definitions to characterize BLV, resulting in considerable variation in inclusion criteria among studies. Three distinct categories of studies were identified, encompassing those specifically designed to evaluate BLV, those focused on Shone's complex, and finally those on aortic stenosis. Despite the challenges associated with comparing data originating from slightly different cardiac defects and from different eras, our results indicate a favorable survival rate and clinical outcome following BVR. However, the incidence of reintervention remains high, and concerns persist regarding residual pulmonary hypertension, which has been inadequately investigated. CONCLUSIONS The available data concerning neonates and infants with LVOTO and BLV who undergo BVR are inadequate and fragmented. Consequently, large-scale studies are necessary to fully ascertain the long-term outcome of these complex defects.
Collapse
Affiliation(s)
- Massimiliano Cantinotti
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Vivek Jani
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA; (V.J.); (S.K.)
| | - Pietro Marchese
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Eliana Franchi
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Alessandra Pizzuto
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Cecilia Viacava
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Nadia Assanta
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Giuseppe Santoro
- Foundation G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (M.C.); (P.M.); (E.F.); (A.P.); (C.V.); (N.A.); (G.S.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| |
Collapse
|
2
|
Kagiyama Y, Kenny D, Hijazi ZM. Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities. Glob Cardiol Sci Pract 2024; 2024:e202407. [PMID: 38404661 PMCID: PMC10886730 DOI: 10.21542/gcsp.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/11/2023] [Indexed: 02/27/2024] Open
Abstract
Various transcatheter interventions for the right ventricular outflow tract (RVOT) have been introduced and developed in recent decades. Transcatheter pulmonary valve perforation was first introduced in the 1990s. Radiofrequency wire perforation has been the approach of choice for membranous pulmonary atresia in newborns, with high success rates, although complication rates remain relatively common. Stenting of the RVOT is a novel palliative treatment that may improve hemodynamics in neonatal patients with reduced pulmonary blood flow and RVOT obstruction. Whether this option is superior to other surgical palliative strategies or early primary repair of tetralogy of Fallot remains unclear. Transcatheter pulmonary valve replacement has been one of the biggest innovations in the last two decades. With the success of the Melody and SAPIEN valves, this technique has evolved into the gold standard therapy for RVOT abnormalities with excellent procedural safety and efficacy. Challenges remain in managing the wide heterogeneity of postoperative lesions seen in RVOT, and various technical modifications, such as pre-stenting, valve ring modification, or development of self-expanding systems, have been made. Recent large studies have revealed outcomes comparable to those of surgery, with less morbidity. Further experience and multicenter studies and registries to compare the outcomes of various strategies are necessary, with the ultimate goal of a single-step, minimally invasive approach offering the best longer-term anatomical and physiological results.
Collapse
Affiliation(s)
- Yoshiyuki Kagiyama
- Department of Pediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin 12, Republic of Ireland
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Damien Kenny
- Department of Pediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Ziyad M. Hijazi
- Department of Cardiovascular Diseases, Sidra Medicine, and Weill Cornell Medical College, Doha, Qatar
| |
Collapse
|
3
|
Ponińska JK, Pelczar-Płachta W, Pollak A, Jończyk-Potoczna K, Truszkowska G, Michałowska I, Szafran E, Bilińska ZT, Bobkowski W, Płoski R. Double Heterozygous Pathogenic Variants in the LOX and PKD1 Genes in a 5-Year-Old Patient with Thoracic Aortic Aneurysm and Polycystic Kidney Disease. Genes (Basel) 2023; 14:1983. [PMID: 38002926 PMCID: PMC10671125 DOI: 10.3390/genes14111983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
Familial thoracic aortic aneurysms and dissections may occur as an isolated hereditary trait or as part of connective tissue disorders with Mendelian inheritance, but severe cardiovascular disease in pediatric patients is extremely rare. There is growing knowledge on pathogenic variants causing the disease; however, much of the phenotypic variability and gene-gene interactions remain to be discovered. We present a case report of a 5.5-year-old girl with an aortic aneurysm and concomitant polycystic kidney disease. Whole exome sequencing was performed, followed by family screening by amplicon deep sequencing and diagnostic imaging studies. In the proband, two pathogenic variants were identified: p.Tyr257Ter in the LOX gene inherited from her mother, and p.Thr2977Ile in the PKD1 gene inherited from her father. All adult carriers of either of these variants showed symptoms of aortic disease. We conclude that the coexistence of two independent genetic variants in the proband may be the reason for an early onset of disease.
Collapse
Affiliation(s)
- Joanna Kinga Ponińska
- Department of Medical Biology, National Institute of Cardiology, 04-628 Warszawa, Poland;
| | - Weronika Pelczar-Płachta
- Department of Pediatric Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Agnieszka Pollak
- Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, 02-106 Warszawa, Poland
| | | | - Grażyna Truszkowska
- Department of Medical Biology, National Institute of Cardiology, 04-628 Warszawa, Poland;
| | - Ilona Michałowska
- Department of Radiology, National Institute of Cardiology, 04-628 Warszawa, Poland
| | - Emilia Szafran
- Department of Pediatric Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warszawa, Poland;
| | - Waldemar Bobkowski
- Department of Pediatric Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, 02-106 Warszawa, Poland
| |
Collapse
|
4
|
Xiang X, Zhu X, Zheng M, Tang Y. Comparison of two echocardiography-based methods for evaluating pediatric left ventricular diastolic dysfunction. Front Pediatr 2023; 11:1206314. [PMID: 37732011 PMCID: PMC10507386 DOI: 10.3389/fped.2023.1206314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives To investigate the consistency between the 2016 America Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline-based recommendations and the body surface area (BSA)-transformed Z value-based cut-off for the assessment of left ventricular diastolic function (LVDF) in children. Methods Clinical data of children with heart failure (HF) and those with a high risk of HF and a low risk of HF were collected from the Children's Hospital of Chongqing Medical University between March 2021 and October 2022. The mitral annular e' velocity, lateral E/e' ratio, left atrial volume index, and peak tricuspid regurgitation velocity were detected by Echocardiography. The cut-off values recommended by the 2016 ASE/EACVI guidelines and the cut-off value based on the BSA-transformed Z value were used to evaluate LVDF. The consistencies and differences of the two criteria were compared. Results A total of 132 children with HF, 189 with a high risk of HF, and 231 with a low risk of HF, were enrolled. The consistency of the two criteria in evaluating LVDF in children with HF and with high risk of HF was moderate, with weighted kappa coefficients of 0.566 and 0.468, respectively (P < 0.001). The positivity rate of left ventricular diastolic dysfunction (LVDD) with Z value-based criteria (HF group, 23.5%; high-risk group, 8.5%) was higher than that with guideline-based criteria (HF group, 15.6%; high-risk group, 3.2%). In children with a low risk of HF, no case with LVDD was found. The consistency between the two criteria for grading the degree of LVDD was moderate, with a kappa coefficient of 0.522 (P = 0.001). The degree of LVDD according to the Z value-based criteria was higher than that of the guideline-based criteria (P = 0.004). Conclusions The Z value-based criteria used to evaluate LVDD in children with HF and high risk of HF may be more conducive to the early identification of LVDD, thereby permitting the possibility of early treatment intervention.
Collapse
Affiliation(s)
| | | | - Min Zheng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yi Tang
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
5
|
Cantinotti M, McMahon CJ, Marchese P, Köstenberger M, Scalese M, Franchi E, Santoro G, Assanta N, Jacquemyn X, Kutty S, Giordano R. Echocardiographic Parameters for Risk Prediction in Borderline Right Ventricle: Review with Special Emphasis on Pulmonary Atresia with Intact Ventricular Septum and Critical Pulmonary Stenosis. J Clin Med 2023; 12:4599. [PMID: 37510714 PMCID: PMC10380858 DOI: 10.3390/jcm12144599] [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: 05/01/2023] [Revised: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of the present review is to highlight the strengths and limitations of echocardiographic parameters and scores employed to predict favorable outcome in complex congenital heart diseases (CHDs) with borderline right ventricle (RV), with a focus on pulmonary atresia with intact ventricular septum and critical pulmonary stenosis (PAIVS/CPS). A systematic search in the National Library of Medicine using Medical Subject Headings and free-text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords "PAIVS/CPS", Ebstein's anomaly, and unbalanced atrioventricular septal defect with left dominance. A total of 22 studies were selected for final analysis; 12 of them were focused on parameters to predict biventricular repair (BVR)/pulmonary blood flow augmentation in PAIVS/CPS. All of these studies presented numerical (the limited sample size) and methodological limitations (retrospective design, poor definition of inclusion/exclusion criteria, variability in the definition of outcomes, differences in adopted surgical and interventional strategies). There was heterogeneity in the echocardiographic parameters employed and cut-off values proposed, with difficultly in establishing which one should be recommended. Easy scores such as TV/MV (tricuspid/mitral valve) and RV/LV (right/left ventricle) ratios were proven to have a good prognostic accuracy; however, the data were very limited (only two studies with <40 subjects). In larger studies, RV end-diastolic area and a higher degree of tricuspid regurgitation were also proven as accurate predictors of successful BVR. These measures, however, may be either operator and/or load/pressure dependent. TV Z-scores have been proposed by several authors, but old and heterogenous nomograms sources have been employed, thus producing discordant results. In summary, we provide a review of the currently available echocardiographic parameters for risk prediction in CHDs with a diminutive RV that may serve as a guide for use in clinical practice.
Collapse
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
- Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Colin Joseph McMahon
- Department of Pediatric Cardiology, Childrens Health Ireland, D12 N512 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Martin Köstenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University Graz, 8036 Graz, Austria
| | - Marco Scalese
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | | | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Xander Jacquemyn
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| |
Collapse
|
6
|
Uhl S, Grieshaber P, Arnold R, Loukanov T, Gorenflo M. Impact of hybrid procedure on pulmonary arterial dimensions and right ventricular load after biventricular repair. J Cardiothorac Surg 2023; 18:65. [PMID: 36750898 PMCID: PMC9906912 DOI: 10.1186/s13019-023-02162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Hybrid procedure with ductal stenting and bilateral pulmonary banding offers a temporary approach in high-risk neonates with complex congenital heart defects aiming biventricular repair. This procedure may also have negative impact concerning post-banding pulmonary stenosis resulting in right ventricular pressure load. METHODS Between 2010 and 2021 we identified 5 patients with interrupted aortic arch and complex congenital heart defect who underwent hybrid procedure and staged biventricular repair ("hybrid-group"). Other 7 cases with interrupted aortic arch were corrected in the neonatal phase without hybrid procedure ("nonhybrid-group"). Detailed intra- and extracardiac features and surgical procedures were documented as well as pulmonary interventions during follow up. Pulmonary vessel size was assessed by diameter of left and right pulmonary artery in absolute and indexed values. RV pressure was evaluated invasively via catheterization. RESULTS Survival in cases with hybrid procedure and staged biventricular repair was 91% for a follow-up time of 40.7 months (95% CI 26-55 months) and 100% in the non-hybrid-group. Postoperative results concerning left ventricular function showed normal LV dimensions and systolic function without relevant stenosis on distal aortic arch. Hybrid procedure was associated with impaired local pulmonary arterial diameter after debanding resulting in increased right ventricular pressure and need for interventions (number intervention per patient: hybrid group 1.7 ± 0.95, non-hybrid group 0.17 ± 0.41; P 0.003). CONCLUSIONS Hybrid procedure in high-risk cases with interrupted aortic arch and staged biventricular repair shows good postoperative results with low perioperative mortality and normal left ventricular function. Due to potential risk of relevant pulmonary stenosis and right ventricular pressure load, follow up examinations must not only focus on left but also on the right heart.
Collapse
Affiliation(s)
- Sebastian Uhl
- Department of Pediatric Cardiology/Congenital Cardiology, Heidelberg University Medical Center, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - Philippe Grieshaber
- grid.5253.10000 0001 0328 4908Cardiovascular Surgery Department, Heidelberg University Medical Center, Heidelberg, Germany
| | - Raoul Arnold
- grid.5253.10000 0001 0328 4908Department of Pediatric Cardiology/Congenital Cardiology, Heidelberg University Medical Center, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Tsvetomir Loukanov
- grid.5253.10000 0001 0328 4908Cardiovascular Surgery Department, Heidelberg University Medical Center, Heidelberg, Germany
| | - Matthias Gorenflo
- grid.5253.10000 0001 0328 4908Department of Pediatric Cardiology/Congenital Cardiology, Heidelberg University Medical Center, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| |
Collapse
|
7
|
Long-term results of one-and-a-half ventricle repair with open azygos vein. Gen Thorac Cardiovasc Surg 2023:10.1007/s11748-022-01897-1. [PMID: 36595159 DOI: 10.1007/s11748-022-01897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The one-and-a-half ventricle repair (1.5VR) is an option for definitive surgery of cardiac defects with hypoplastic right ventricle (RV). The 1.5VR with open azygos vein was reported to provide a theoretical advantage of decompressing the supra vena cava (SVC) or the right atrium in patients with SVC hypertension or severe RV dysfunction. The aim of this study is to review and evaluate our experience with this procedure in the long-term period. METHODS Medical records of the patient undergoing 1.5VR with open azygos vein between January 2000 and December 2019 were reviewed retrospective. Pre- and postoperative echocardiography and cardiac catheterization data were also analyzed. RESULTS 4 patients underwent the 1.5VR with open azygos vein. The median age at time of surgery was 2.2 years, and the median weight was 9.8 kg. The median tricuspid valve (TV) Z-score was - 3.5, the median right ventricular end-diastolic volume (RVEDV) was 54.0% of normal. There were no operative death and early adverse events. Median follow-up time was 17.1 years. There were no late death and re-operation during the follow-up. The postoperative TV diameter and RVEDV were larger than preoperative data in 3 of 4 patients. CONCLUSIONS The 1.5VR with open azygos vein is a good surgical option for congenital heart disease with hypoplastic RV. The TV and RVEDV may grow and biventricular conversion may be possible.
Collapse
|
8
|
Cantinotti M, Marchese P, Giordano R, Franchi E, Assanta N, Koestenberger M, Jani V, Duignan S, Kutty S, McMahon CJ. Echocardiographic scores for biventricular repair risk prediction of congenital heart disease with borderline left ventricle: a review. Heart Fail Rev 2023; 28:63-76. [PMID: 35332415 DOI: 10.1007/s10741-022-10230-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
The aim of this review is to highlight the strengths and limitations of major echocardiographic biventricular repair (BVR) prediction models for borderline left ventricle (LV) in complex congenital heart disease (CHD). A systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords for critical aortic stenosis (AS), borderline LV, complex left ventricular outflow tract (LVOT) obstruction, hypoplastic left heart syndrome/complex (HLHS/HLHC), and unbalanced atrio-ventricular septal defects (uAVSD). Fifteen studies were selected for the final analysis. We outlined what echocardiographic scores for different types of complex CHD with diminutive LV are available. Scores for CHD with LVOT obstruction including critical AS, HLHS/HLHC, and aortic arch hypoplasia have been validated and implemented by several studies. Scores for uAVSD with right ventricle (RV) dominance have also been established and implemented, the first being the atrioventricular valve index (AVVI). In addition to AVII, both LV/RV inflow angle and LV inflow index have all been validated for the prediction of BVR. We conclude with a discussion of limitations in the development and validation of each of these scores, including retrospective design during score development, heterogeneity in echocardiographic parameters evaluated, variability in the definition of outcomes, differences in adopted surgical and Interventional strategies, and institutional differences. Furthermore, scores developed in the past two decades may have little clinical relevance now. In summary, we provide a review of echocardiographic scores for BVR in complex CHD with a diminutive LV that may serve as a guide for use in modern clinical practice.
Collapse
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Dept. Advanced Biomedical Sciences, University of Naples "Federico II", 80131, Naples, Italy.
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Vivek Jani
- Blalock Taussig, Thomas Heart Center, Johns Hopkins Hospital, Baltimore, USA
| | - Sophie Duignan
- Children's Heart Centre, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shelby Kutty
- Blalock Taussig, Thomas Heart Center, Johns Hopkins Hospital, Baltimore, USA
| | | |
Collapse
|
9
|
Walter CC, Escobar-Diaz MC, Cesar S, Garrido BAM, Sanchez-de-Toledo J. Functional and morphometric changes in children after neonatal arterial switch operation for transposition of the great arteries. Ann Pediatr Cardiol 2022; 15:447-452. [PMID: 37152511 PMCID: PMC10158475 DOI: 10.4103/apc.apc_46_22] [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: 03/23/2022] [Revised: 05/05/2022] [Accepted: 12/04/2022] [Indexed: 03/03/2023] Open
Abstract
Background The increase in the survival of patients with D-Transposition of the great arteries (TGA) after arterial switch operation (ASO) has now turned our focus to the evaluation of mid and long-term outcomes. Although most patients are followed by conventional echocardiography, the study of cardiac functionality and morphometric parameters in children with TGA after ASO is scarce. The present study aims to describe the functional and morphometric echocardiographic changes in children after ASO. Methods We performed an observational study in patients aged 1-5 years with TGA who underwent neonatal ASO. Morphometric and functional echocardiographic parameters were analyzed in 21 patients and compared with 52 age-matched healthy controls. Results We found morphological and functional changes, especially in the right ventricle, which is more globular (right ventricle [RV] basal sphericity index 1.5 vs. 1.8, P = 0.016), and with a decreased systolic function compared to healthy controls (fractional area change 51 vs. 58%, P = 0.006; tricuspid annular plane systolic excursion 13 vs. 20 mm, P = 0.001; s' 7 vs. 12 cm/s, P = 0.001). In the speckle-tracking strain imaging, there was a decrease in the longitudinal deformation of the apical septal myocardium (-23% vs. -27%; P = 0.005). Preoperative systemic overload to the right ventricle could be an important factor in the origin of these changes. Conclusions In patients with TGA after ASO, there are morphometric and functional echocardiographic changes, such as globular form and decreased function, especially in the RV; the effect of these changes on long-term outcomes would require prospective follow-up studies.
Collapse
Affiliation(s)
- Carin Cristina Walter
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Maria Clara Escobar-Diaz
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Sergi Cesar
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | | | - Joan Sanchez-de-Toledo
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States
| |
Collapse
|
10
|
Salvatori G, Brindisi G, Colantonio M, Zicari AM. Cardiac hypertrophy and insulin therapy in a pre-term newborn: is there a relationship? Ital J Pediatr 2022; 48:24. [PMID: 35135591 PMCID: PMC8822805 DOI: 10.1186/s13052-022-01216-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) in newborns is a rare condition with heterogeneous etiologies. While the relationship between hyperinsulinism and cardiac hypertrophy (CH) is known, hyperinsulinism has not been reported as cause of HCM. Case presentation We report the case of cardiac hypertrophy (CH) in an Extremely Low Birth Weight (ELBW) infant; this patient underwent insulin therapy after the onset of persistent hyperglycemia due to parenteral nutrition (PN), supporting the hypothesis of a role of iatrogenic hyperinsulinemia in the development of HCM. Conclusions The present case underlines the importance of a close cardiological follow-up in infants undergoing insulin infusion for an alteration in the glucose metabolism.
Collapse
Affiliation(s)
- Guglielmo Salvatori
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Giulia Brindisi
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, Italy. .,Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, Rome, Italy.
| | - Mario Colantonio
- Department of Neonatology, S. Camillo Forlanini Hospital, Rome, Italy
| | - Anna Maria Zicari
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, Italy
| |
Collapse
|
11
|
Comparison of homografts and bovine jugular vein conduits in the pulmonary position in patients <20 years of age. J Thorac Cardiovasc Surg 2021; 164:752-762.e8. [PMID: 35058063 DOI: 10.1016/j.jtcvs.2021.11.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/14/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the performance of homografts and bovine jugular vein (BJV) conduits in the pulmonary position. METHODS All patients with congenital heart disease up to age 20 years who underwent pulmonary valve replacement with homografts or BJV at 3 centers in Australia were evaluated. There were 674 conduits, with 305 (45%) pulmonary homografts (PHs), 303 (45%) BJV conduits, and 66 (10%) aortic homografts (AHs). Endpoints were freedom from reintervention, structural valve degeneration (SVD), and infective endocarditis (IE). Propensity score matching was used to balance the comparison of PH and BJV conduits. RESULTS The median follow-up was 6.4 years (interquartile range, IQR, 3.1-10.7 years). Freedom from reintervention at 5 and 10 years was 92% and 80%, respectively, for PH, 74% and 37% for BJV, and 75% and 47% for AH. BJV conduits had a higher risk of reintervention (P < .001) and SVD (P < .001) compared with PHs. These findings were confirmed with propensity score matching valid for conduit size >15 mm. AHs >15 mm had a higher risk of reintervention (P < .001) and SVD (P < .001) compared with PHs >15 mm. The performance of AHs and BJV conduits was similar across all sizes (reintervention, P = .94; SVD, P = .72). The incidence of IE was 1% for PH, 10% for BJV, and 1.5% for AH. CONCLUSIONS In patients age <20 years with a conduit >15 mm, PHs outperformed BJV conduits and AHs in the pulmonary position. The performance of AH and BJV was comparable. Small conduits (≤15 mm) had similar performance across all conduit types.
Collapse
|
12
|
Kotani Y, Kobayashi Y, Kadowaki S, Kisamori E, Kobayashi J, Kawabata T, Kuroko Y, Kasahara S. Impact of pulmonary artery coarctation on pulmonary artery growth and definitive repair following modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg 2021; 163:1618-1626. [PMID: 34922747 DOI: 10.1016/j.jtcvs.2021.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Pulmonary artery coarctation may pose a risk for pulmonary stenosis and subsequent failure to achieve definitive repair. We sought to assess the impact of pulmonary artery coarctation on pulmonary artery growth. METHODS A retrospective chart review was performed in 130 patients, including 37 single ventricles with a modified Blalock-Taussig shunt as first palliation. Pulmonary artery coarctation was defined as discrete stenosis of the pulmonary artery, with a diameter of less than 3 mm and with the ductus arteriosus connected. Preoperative echocardiography showed pulmonary artery coarctation in 29 patients (22%). Concomitant pulmonary artery plasty was performed in 14 patients with discrete stenosis having a diameter of less than 2 mm. RESULTS Pre-modified Blalock-Taussig shunt left pulmonary artery z-scores were lower in patients with pulmonary artery coarctation than in those without (-4.0 [-5.8, -2.1] vs -1.7 [-2.6, -0.8], P < .001), and this remained the same even after modified Blalock-Taussig shunt (-2.5 [-5.1, -0.5] vs -0.5 [-2.4, 0.8], P = .010). Concomitant pulmonary artery plasty did not result in catch-up growth of the left pulmonary artery (post-modified Blalock-Taussig shunt left pulmonary artery z-score in patients with pulmonary artery plasty: -3.0 (-6.5, -2.0) versus those without: -1.8 (-3.3, -0.3), P = .279). Definitive repair/Fontan completion was achieved in 111 patients (85%), and this was not affected by the presence of pulmonary artery coarctation. CONCLUSIONS Pulmonary artery coarctation affected disproportionate pulmonary artery growth throughout the staged repair, but did not result in failure of definitive repair/Fontan completion. Pulmonary artery plasty during the neonatal period did not contribute to catch-up growth of the left pulmonary artery; therefore, surgical indications and timing should be carefully considered.
Collapse
Affiliation(s)
- Yasuhiro Kotani
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan.
| | - Yasuyuki Kobayashi
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Sachiko Kadowaki
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Eiri Kisamori
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Junko Kobayashi
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Takuya Kawabata
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Yosuke Kuroko
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| |
Collapse
|
13
|
Shi Q, Shan Y, Chen G, Mi Y, Zhong H, Jia B, Zhang H. Mid-term Outcomes for Polytetrafluoroethylene Valved Conduits. Ann Thorac Surg 2021; 114:1778-1785. [PMID: 34717907 DOI: 10.1016/j.athoracsur.2021.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Various conduits for right ventricular outflow tract reconstruction (RVOTR) have been reported but most of them are not available in China. We developed a simple handsewn valved conduit using expanded polytetrafluoroethylene (ePTFE). This study evaluated the mid-term outcomes for this conduit. METHODS This retrospective study included a total of 72 patients who underwent RVOTR with ePTFE valved conduits between January 2014 and June 2020. During follow-up, echocardiograms were performed for all patients and magnetic resonance imaging for patients with repaired Fallot. RESULTS Patients had a median age of 69 (interquartile range, 28-127) months and a median follow-up period of 33 (interquartile range, 9-51) months . There was no early death , but two late deaths (2.78%) occurred. The median conduit size was 18 mm (interquartile range, 18-20) and Z score was +1.3 (interquartile range, +0.6-+2). Peak velocity across the ePTFE valve was 2.38 m/s (95% confidence interval, 2.11 - 2.63 m/s). Pulmonary valve regurgitation was none or trivial in 27 (38.5%) patients, mild in 42 (60.0%) patients and moderate in one (1.4%) patient. Conduit dysfunction occurred in five patients: four developed moderate conduit stenosis and one moderate regurgitation. The right ventricular end diastolic volume index in repaired Fallot was significantly decreased after surgery(171 ml/m2 vs 130 ml/m2, P<0.001).No reintervention or conduit replacement was needed. CONCLUSIONS The handsewn ePTFE valved conduit we developed has appreciable hemodynamic outcomes during the mid-term follow-up period. Long-term follow-up studies are needed to corroborate our findings.
Collapse
Affiliation(s)
- Qiqi Shi
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yaping Shan
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Gang Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yaping Mi
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Hui Zhong
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Bing Jia
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Huifeng Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.
| |
Collapse
|
14
|
Cao Y, Asai H, Okamoto T, Ikarashi J, Tachibana T. Blood-filled, pouch-forming tricuspid septal leaflet in a patient with tricuspid valve dysplasia. Asian Cardiovasc Thorac Ann 2021; 30:213-214. [PMID: 34657483 DOI: 10.1177/02184923211053711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yuchen Cao
- Division of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hidetsugu Asai
- Division of Cardiovascular Surgery, 88282Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Takuya Okamoto
- Division of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jin Ikarashi
- Division of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tsuyoshi Tachibana
- Division of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
| |
Collapse
|
15
|
Forton K, Motoji Y, Caravita S, Faoro V, Naeije R. Exercise stress echocardiography of the pulmonary circulation and right ventricular-arterial coupling in healthy adolescents. Eur Heart J Cardiovasc Imaging 2021; 22:688-694. [PMID: 32380528 DOI: 10.1093/ehjci/jeaa085] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/14/2020] [Accepted: 04/04/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To explore the effects of age and sex in adolescents vs. young or middle-aged adults on pulmonary vascular function and right ventricular-arterial (RV-PA) coupling as assessed by exercise stress echocardiography. METHODS AND RESULTS Forty healthy adolescents aged 12-15 years were compared with 40 young adults aged 17-22 years and 40 middle-aged adults aged 30-50 years. Sex distribution was equal in the three groups. All the subjects underwent an exercise stress echocardiography. A pulmonary vascular distensibility coefficient α was determined from multipoint pulmonary vascular pressure-flow relationships. RV-PA coupling was assessed by the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio, who has been previously validated by invasive study. While cardiac index and mean PAP were not different, adolescents compared to young and middle-aged adults, respectively had higher pulmonary vascular distensibility coefficients α (1.60 ± 0.31%/mmHg vs. 1.39 ± 0.29%/mmHg vs. 1.20 ± 0.35%/mmHg, P < 0.00001). Adolescents and young adults compared to middle-aged adults, respectively had higher TAPSE/PASP ratios at rest (1.24 ± 0.18 mm/mmHg and 1.22 ± 0.17 mm/mmHg vs. 1.07 ± 0.18 mm/mmHg, P < 0.008) and during exercise (0.86 ± 0.24, 0.80 ± 0.15 and 0.72 ± 0.15 mm/mmHg, P < 0.04). The TAPSE/PASP ratio decreased with exercise. There were no sex differences in α or TAPSE/PASP. CONCLUSION Compared to adults, adolescents present with a sex-independent more distensible pulmonary circulation. Resting and exercise RV-PA coupling is decreased in middle-aged adults.
Collapse
Affiliation(s)
- Kevin Forton
- Faculty of Motor Sciences, Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Erasmus Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium.,Department of Cardiology, Erasmus University Hospital, 1070 Brussels, Belgium
| | - Yoshiki Motoji
- Faculty of Motor Sciences, Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Erasmus Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium.,Department of Cardiology, Erasmus University Hospital, 1070 Brussels, Belgium
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS Ospedale San Luca, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Viale G. Marconi, 5, 24044 Dalmine (BG), Italy
| | - Vitalie Faoro
- Faculty of Motor Sciences, Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Erasmus Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium
| | - Robert Naeije
- Faculty of Motor Sciences, Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Erasmus Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium
| |
Collapse
|
16
|
Hebala M, Rao V, Jaber O, Congiu S, Bentham J, Thomson J, van Doorn C. The Ross-Konno operation for neonates and infants with severe aortic incompetence following treatment for critical aortic stenosis. Interact Cardiovasc Thorac Surg 2021; 33:469-473. [PMID: 34297837 DOI: 10.1093/icvts/ivab113] [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: 09/23/2020] [Revised: 10/15/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Aortic valve stenosis in neonates and infants is associated with congestive cardiac failure, and balloon or surgical valvuloplasty provides relief of stenosis. Occasionally severe aortic insufficiency necessitates urgent aortic valve replacement. We reviewed our experience with the Ross-Konno procedure in patients <1 year. METHODS Between October 2013 and May 2020, 36 patients underwent balloon (34) or surgical (2) aortic valvuloplasty for aortic stenosis. Six patients subsequently underwent a Ross-Konno procedure. The median age at operation was 55 (27-116) days and weight was 4.25 (2.5-12) kg. All patients were in severe cardiac failure and had a small aortic annulus with Z-score -3.1 (-1 to -4.4). RESULTS There were no early or late deaths. At the latest follow-up at 39 (13-60) months, ventricular function had improved in all patients and no patient was on anti-failure medication. On echocardiography, there wasno more than trivial aortic regurgitation and no left ventricular outflow tract obstruction. One patient required right ventricle to pulmonary artery conduit replacement and one patient had homograft stenting. CONCLUSIONS Despite the severe preoperative haemodynamic compromise, the urgent Ross-Konno procedure was associated with excellent operative survival and recovery of ventricular function. The need for reintervention to the pulmonary conduit remains a cause for concern.
Collapse
Affiliation(s)
- Muhammed Hebala
- Department of Congenital Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vinay Rao
- Department of Congenital Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Osama Jaber
- Department of Congenital Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stefano Congiu
- Department of Paediatric Cardiac Surgery, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Jamie Bentham
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Thomson
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Carin van Doorn
- Department of Congenital Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
17
|
Kamalı H, Tanıdır İC, Erdem A, Sarıtaş T, Güzeltaş A. The Use of Chronic Total Occlusion (CTO) Wires for Perforation of Atretic Pulmonary Valve; Two Centers Experience. Pediatr Cardiol 2021; 42:1041-1048. [PMID: 33844078 DOI: 10.1007/s00246-021-02578-1] [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: 10/03/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Abstract
Pulmonary valve atresia with intact ventricular septum (PA-IVS) can be treated either surgically or transcatheterly for eligible patients. Perforation of pulmonary valves using chronic total occlusion (CTO) guidewires has been reported as an alternative to radiofrequency (RF) perforation. We sought to report our experience with CTO guidewires for perforation of atretic pulmonary valves and subsequent balloon dilatation (with or without patent ductus arteriosus stenting) in patients with PA-IVS from two centers. A retrospective study was carried out on PA-IVS patients who underwent intervention between March 2014 and September 2019, in which CTO guidewire was employed for pulmonary valve perforation. A total of 26 patients were identified. The median age and weight of the patients were 5.2 days (range 1-21 days) and 3.1 kg (range 2.2-3.8 kg), respectively. All patients were situs solitus, except one patient with left atrial isomerism. The right ventricle (RV) morphology was bipartite in 22/26 patients and tripartite in 4/26 patients. Before the procedure, the mean saturation was 76% (range 70-86%) while the patients were under prostaglandin infusion. The pulmonary valve perforation attempt was performed with the Asahi Conquest Pro 9 CTO wire (n = 6) or Asahi Pro 12 CTO wire (n = 18) and/or Asahi Miracle CTO wire (n = 2). The procedure was successful in 20/26 (77%) patients using CTO wires. We analyzed the efficiency of CTO wire based on the subtypes: Conquest Pro 9 in 6/6 (100%) patients, Conquest Pro 12 in 12/18 (67%) patients, and Miracle in 2/2 (100%) patients. Before CTO wire usage in 3 patients, radiofrequency (RF) perforation was unsuccessful. Among these 3 patients, pulmonary valve perforation was successful in 2 patients with CTO wire; hence, in the remaining patient, perforation was also unsuccessful with CTO wire. After CTO wire perforation was unsuccessful in 6 patients, RF perforation was attempted in 3 patients (2 successful attempts and 1 unsuccessful attempts), and one patient as referred to surgery. Desaturation was persistent in 19 cases, which necessitated ductus arteriosus stenting. Early procedural complication was observed in 3/26 (11%) patients. Two of these patients had vascular complications due to the sheath, which was treated with heparin infusion and streptokinase, and the remaining patient had sudden bradycardia and cardiac arrest during the procedure and did not respond to cardiac resuscitation. CTO wires should be keep in mind for atretic pulmonary valve perforation as a first choice or when RF perforation is unsuccessful.
Collapse
Affiliation(s)
- Hacer Kamalı
- Department of Pediatric Cardiology, Istanbul Health Scıence University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyonmahallesi Turgut Özal Bulvarı Küçükçekmece, 34303, Istanbul, Turkey.
| | - İbrahim Cansaran Tanıdır
- Department of Pediatric Cardiology, Istanbul Health Scıence University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyonmahallesi Turgut Özal Bulvarı Küçükçekmece, 34303, Istanbul, Turkey
| | - Abdullah Erdem
- Department of Pediatric Cardiology, Istanbul Medipol Universıty, Istanbul, Turkey
| | - Türkay Sarıtaş
- Department of Pediatric Cardiology, Istanbul Medipol Universıty, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, Istanbul Health Scıence University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyonmahallesi Turgut Özal Bulvarı Küçükçekmece, 34303, Istanbul, Turkey
| |
Collapse
|
18
|
Abstract
This study aimed to describe the variety of etiologies currently identified in infants with cardiac hypertrophy (CH) and investigate whether there is a relation with hyperinsulinism, echocardiographic characteristics and prognosis. This retrospective cohort study included infants born between 2005 and 2018 with CH measured by echocardiography [interventricular septum (IVS) and/or left ventricular posterior wall (LVPW) thickness with Z-score ≥ 2.0]. Children with congenital heart disease or hypertension were excluded. Underlying diagnosis, echocardiographic and follow-up data were extracted from patient files. Seventy-one infants with CH were included. An underlying cause of CH was identified in two-thirds (n = 47). Most common etiologies of CH were malformation syndromes (n = 23, including Noonan n = 12) and maternal diabetes mellitus (n = 13). Less common causes were congenital hyperinsulinism (n = 3), metabolic- (n = 5), sarcomeric- (n = 2) and neuromuscular disease (n = 1). In half of the identified causes (n = 22) an association with hyperinsulinism was described, including maternal diabetes mellitus (n = 13), malformation syndromes with insulin resistance (n = 6) and congenital hyperinsulinism (n = 3). CH associated with hyperinsulinism was echocardiographically characterized by lower LVPW thickness, higher IVS:LVPW ratio and more frequent sole involvement of the IVS (all, p ≤ 0.02). CH associated with hyperinsulinism normalized more often (41 vs. 0%) with lower mortality rates (14 vs. 44%) compared to CH not associated with hyperinsulinism (all, p ≤ 0.03). Nowadays, an etiology of CH can be identified in the majority of infants. The development of CH is often associated with hyperinsulinism which is mainly characterized by focal hypertrophy of the IVS on echocardiography. Prognosis depends on the underlying cause and is more favorable in CH associated with hyperinsulinism.
Collapse
|
19
|
A statistical comparison of reproducibility in current pediatric two-dimensional echocardiographic nomograms. Pediatr Res 2021; 89:579-590. [PMID: 32330930 DOI: 10.1038/s41390-020-0900-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study is to compare new pediatric nomograms for clinical parameters from 2D echocardiography. METHODS 2D pediatric echocardiographic parameters from four recent nomograms were used for statistical analysis. To assess the accuracy of the predictive models from each study, namely multivariate, linear, and nonlinear regression, mean values and 5th and 95th percentiles (μ ± 1.65σ) were calculated. A Z-score calculator was created. RESULTS Mean values and 5th and 95th percentiles have been provided for a range of BSA (0.15-2.20 m2) for each nomogram assessed in this study. Moreover, plots of Z-scores over the same range of BSA have been generated to assess trends among different studies. For most measurements from the two most recent nomograms, namely Lopez et al. and Cantinotti et al., differences were within a Z-score of 0.5 (Z-score range: 0.001-1.26). Measurements from Sluysmans and Colan and Pettersen et al. were observed to diverge from Lopez et al. at the upper extremities of BSA. Differences among various nomograms emerged at lower extremes of BSA. CONCLUSIONS The two most recent echocardiographic nomograms were observed to have the most statistically similar ranges of normality. Significant deviations in ranges of normality were observed at extremes of BSA. IMPACT Echocardiographic nomograms for pediatric age are discordant. Comparison of current pediatric echocardiographic nomograms. A Z-score calculator was created. Clinical relevance of differences among nomograms is highlighted.
Collapse
|
20
|
Monda E, Fusco A, Della Corte A, Caiazza M, Cirillo A, Gragnano F, Giugliano MP, Citro R, Rubino M, Esposito A, Cesaro A, Di Fraia F, Palmiero G, Di Maio M, Monda M, Calabrò P, Frisso G, Nistri S, Bossone E, Body SC, Russo MG, Limongelli G. Impact of Regular Physical Activity on Aortic Diameter Progression in Paediatric Patients with Bicuspid Aortic Valve. Pediatr Cardiol 2021; 42:1133-1140. [PMID: 33864103 PMCID: PMC8192390 DOI: 10.1007/s00246-021-02591-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/31/2021] [Indexed: 10/27/2022]
Abstract
Patients with bicuspid aortic valve (BAV) have an increased risk of aortic dilation and aortic dissection or rupture. The impact of physical training on the natural course of aortopathy in BAV patients remains unclear. The aim of this study was to evaluate the impact of regular physical activity on aortic diameters in a consecutive cohort of paediatric patients with BAV. Consecutive paediatric BAV patients were evaluated and categorized into two groups: physically active and sedentary subjects. Only the subjects with a complete 2-year follow-up were included in the study. To evaluate the potential impact of physical activity on aortic size, aortic diameters were measured at the sinus of Valsalva and mid-ascending aorta using echocardiography. We defined aortic diameter progression the increase of aortic diameter ≥ 10% from baseline. Among 90 BAV patients (11.5 ± 3.4 years of age, 77% males), 53 (59%) were physically active subjects. Compared to sedentary, physically active subjects were not significantly more likely to have > 10% increase in sinus of Valsalva (13% vs. 8%, p-value = 0.45) or mid-ascending aorta diameter (9% vs. 13%, p-value = 0.55) at 2 years follow-up, both in subjects with sinus of Valsalva diameter progression (3.7 ± 1.0 mm vs. 3.5 ± 0.8 mm, p-value = 0.67) and in those with ascending aorta diameter progression (3.0 ± 0.8 mm vs. 3.2 ± 1.3 mm, p-value = 0.83). In our paediatric cohort of BAV patients, the prevalence and the degree of aortic diameter progression was not significantly different between physically active and sedentary subjects, suggesting that aortic dilation is unrelated to regular physical activity over a 2-year period.
Collapse
Affiliation(s)
- Emanuele Monda
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Adelaide Fusco
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alessandro Della Corte
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Martina Caiazza
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annapaola Cirillo
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Felice Gragnano
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy ,Division of Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Maria Pina Giugliano
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Rodolfo Citro
- Cardiovascular Department, University Hospital “San Giovanni di Dio e Ruggid’Aragona”, Salerno, Italy
| | - Marta Rubino
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Augusto Esposito
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Arturo Cesaro
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy ,Division of Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Francesco Di Fraia
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppe Palmiero
- grid.416052.40000 0004 1755 4122Department of Cardiology, AO deiColli, Monaldi Hospital, Naples, Italy
| | - Marco Di Maio
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marcellino Monda
- grid.9841.40000 0001 2200 8888Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo Calabrò
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy ,Division of Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Giulia Frisso
- grid.4691.a0000 0001 0790 385XDepartment of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Stefano Nistri
- Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy
| | | | - Eduardo Bossone
- grid.413172.2Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Simon C. Body
- grid.189504.10000 0004 1936 7558Department of Anesthesiology, Boston University School of Medicine, Boston, MA USA
| | - Maria Giovanna Russo
- grid.9841.40000 0001 2200 8888Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. .,Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK.
| |
Collapse
|
21
|
Pergola V, Di Salvo G, Fadel B, Galzerano D, Al-Shaid M, Al-Admawi M, Al Amri M, Al-Ahmadi M, Al-Halees Z. The long term results of the Ross procedure: The importance of candidate selection. Int J Cardiol 2020; 320:35-41. [PMID: 32679140 DOI: 10.1016/j.ijcard.2020.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/09/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
The Ross procedure has been considered in children as an optimal surgical procedure due to potential growth of the aortic annulus, lack of anticoagulation requirement, very low morbidity rate and excellent survival. Five-hundred-thirty-six (366 male, mean age 29.4 ± 11.1 years) underwent Ross procedure between 1990 and 2016 and had complete clinical and echocardiographic follow-up. Mean follow-up was 16.3 ± 4.9 years. Patients were divided in 2 groups according to age at surgery. Group 1 consisted of 320 (60%) patients less than 18 years old (223 male, mean age at surgery of 9.5 ± 5.6 years). Group 2 consisted of 216 (40%) patients older than 18 years of age (143 male, mean age at surgery of 26.3 ± 8.2 years). One-hundred-thirty (24%) patients had a redo procedure or surgery. Freedom from all re-operation and or percutaneous reintervention on either the aortic and pulmonary valves was 99% after 1 year, 94% after 5 years, 89% after 10 years, 83% after 15 years and 78% after 20 years. Freedom from redo surgery for AV 99% after 1 year, 94% after 5 years, 90% after 10 years, 81% after 15 years and 80% after 20 years. Freedom from redo surgery for PV was 100% after 1 year, 95% after 5 years, 89% after 10 years, 78% after 15 years and 76% after 20 years. The ideal candidate for Ross operation is a patient with congenital aetiology and an aortic root diameter ≤ 15 mm/m2. A pulmonary fresh preserved homograft seems to perform better on the long term.
Collapse
Affiliation(s)
- Valeria Pergola
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia.
| | - Giovanni Di Salvo
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| | - Bahaa Fadel
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| | - Domenico Galzerano
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| | - Maye Al-Shaid
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| | - Mohammad Al-Admawi
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| | - Mohammed Al Amri
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| | - Mamdouh Al-Ahmadi
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| | - Zohair Al-Halees
- The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia
| |
Collapse
|
22
|
Taha FA, Elshedoudy S, Adel M. Quantitative assessment of contractile reserve of systemic right ventricle in post-Senning children: Incorporating speckle-tracking strain and dobutamine stress echocardiography. Echocardiography 2020; 37:2091-2101. [PMID: 33200504 DOI: 10.1111/echo.14924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The systemic load on the right ventricle (RV) after Senning atrial switch leads to ventricular dysfunction. Quantitative assessment of RV contractile reserve is mandatory to anticipate the need for anti-fibrotic treatment. We aimed to quantitatively assess RV contractile reserve in Senning children by estimating speckle-based global longitudinal strain (GLS) during dobutamine stress echocardiography (DSE). METHODS This prospective study compared thirty-one post-Senning children (group I) and thirty controls (group II). In post-Senning children, echocardiographic RV systolic function using one-plane ejection fraction (RVEF), RV fractional area change (RVFAC), tricuspid annulus plane systolic excursion (TAPSE), its Z-score, and RVGLS were recorded at rest and peak DSE. Contractile reserve was defined as improvement >5% in RVEF, >2% in GLS, and/or to near normal TAPSE. RESULTS RVEF, RVFAC, TAPSE, and TAPSE Z-score were significantly lower in patients than controls [RVEF:40.13 ± 2.93% vs 53.17 ± 3.17% (P < .001*), RVFAC: 21.17 ± 2.37% vs 37.23 ± 2.13% (P < .001*), TAPSE:13.81 ± 1.26 vs 17.45 ± 2.93 mm (P < .001*), TAPSE Z-score: -3.47 ± 0.46 vs -2.09 ± 0.48 (P < .001*)]. Also, RVGLS was significantly impaired in Senning children than controls[ (-11.89 ± 2.31% vs -22.35 ± 6.73% (P < .001*)]. At peak DSE, contractile reserve was not evident as measured by RVEF which increased none significantly to 42.47 ± 2.80% (P = .063). However, RVGLS improved significantly to -15.78 ± 0.93% (P < .001*) and discovered the masked contractile reserve in Senning children. The 19(61.29%) children who showed masked contractile reserve (improvement in RVGLS > 2%) underwent continuation of anti-fibrotic medications. CONCLUSIONS Despite systemic RV function in post-Senning children was impaired at rest and during DSE, RVGLS was useful in quantitative assessment of masked contractile thus promoted continuing anti-fibrotic treatment.
Collapse
Affiliation(s)
- Fatma Aboalsoud Taha
- Congenital Heart Disease Unit, Cardiology Department, Tanta University, Tanta, Egypt
| | - Sahar Elshedoudy
- Congenital Heart Disease Unit, Cardiology Department, Tanta University, Tanta, Egypt
| | - Mona Adel
- Congenital Heart Disease Unit, Cardiology Department, Tanta University, Tanta, Egypt
| |
Collapse
|
23
|
Li MQ, Ding WH, Jin M, Wang ZY, Gu Y, Ye WQ, Lu ZY, Li W. Pulmonary valve annular and right ventricular outflow tract size as predictions values for moderate to severe pulmonary regurgitation after repaired Tetralogy of Fallot. Echocardiography 2020; 37:1627-1633. [PMID: 32969521 DOI: 10.1111/echo.14839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study sought to investigate the variation of right heart structure pre- and post-operation as risk factors for moderate to severe pulmonary regurgitation (PR) after repaired Tetralogy of Fallot and the best "cutoff" values for the transannular patch (TAP). METHODS We collected surgical, echocardiographic, and computed tomographic data of Teralogy of Fallot (TOF) patients over two years and calculated z-score values based on the echocardiographic data. Based on the PR level after follow-up, the patients were divided into two groups, trivial to mild PR and moderate to severe PR. A multivariate logistic regression analysis was performed, and the receiver operating characteristic curve analysis was used to find the best "cutoff" value for risk factors. RESULTS A total of 104 TOF patients were included in our cohort study. From the multivariate analysis, correction strategy (P = .002), difference in zRVOT (OR 1.974, 95% CI 1.354 to 2.878, P < .0001), and zPVA (OR 3.605, 95% CI 1.980 to 6.562, P < .0001) were the significant risk factors for moderate to severe PR. The "cutoff" value for the difference in zPVA that could predict moderate to severe PR in the TAP group was 3, and the optimal "cutoff" value for TAP was -1.4. CONCLUSIONS The TAP is a risk factor for significant PR after surgery. We recommend the optimal "cutoff" value for TAP is -1.4 calculated using Shan-Shan Wang's data set. During the procedure, to limit the RVOT resection and restrict the enlargement of pulmonary annulus within a variation of z-score as 3 would reduce significant PR.
Collapse
Affiliation(s)
- Mo-Qi Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Wen-Hong Ding
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Mei Jin
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Zhi-Yuan Wang
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Yan Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Wen-Qian Ye
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Zhen-Yu Lu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, China
| |
Collapse
|
24
|
Yoldaş T, Örün UA, Doğan V, Özgür S, Kutsal A, Tak S, Dilli D. Transcatheter radiofrequency pulmonary valve perforation in newborns with pulmonary atresia/intact ventricular septum: Echocardiographic predictors of biventricular circulation. Echocardiography 2020; 37:1258-1264. [PMID: 32762137 DOI: 10.1111/echo.14811] [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: 02/04/2020] [Revised: 03/19/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We report a single-institute experience of neonatal transvenous radiofrequency pulmonary valve perforation for pulmonary atresia/intact ventricular septum, with echocardiographic predictors of biventricular circulation. METHODS Data were reviewed retrospectively for all neonates who underwent primary transvenous pulmonary valve perforation for pulmonary atresia/intact ventricular septum between January 2008 and November 2018 at our institution. We compared patients who need systemic-to-pulmonary shunt or ductal stenting with patients who did not need. RESULTS During the study period, 31 patients with pulmonary atresia/intact ventricular septum underwent successful radiofrequency pulmonary valve perforation and balloon dilation of the pulmonary valve. There was no procedure-related mortality. Sixteen patients (52%) needed systemic-to-pulmonary shunt or ductal stenting after initial procedure. Among the survivors (follow-up time of 1 to 11.5 years), 15 patients had a biventricular circulation and 6 patients had 1 and 1⁄2 ventricular circulation. Two patients are awaiting for Fontan operation. Both the TV/MV annulus ratio (>0.85) and tricuspid valve z-score (>-1) were found to be a good predictor of a biventricular outcome in our cohort. CONCLUSIONS Percutaneous radiofrequency pulmonary valve perforation and balloon valvotomy is an effective and safe primary treatment strategy for neonates with pulmonary atresia/intact ventricular septum. Ductal stenting or systemic-to-pulmonary shunt may be required in the majority of patients who had smaller right heart components. Preselection of patients according to tricuspid valve z-score and TV/MV annulus ratio allows predicting biventricular circulation.
Collapse
Affiliation(s)
- Tamer Yoldaş
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Utku Arman Örün
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Vehbi Doğan
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Senem Özgür
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ali Kutsal
- Department of Pediatric Cardiovascular Surgery, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Sercan Tak
- Department of Pediatric Cardiovascular Surgery, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Dilek Dilli
- Department of Neonatology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Health Sciences University, Ankara, Turkey
| |
Collapse
|
25
|
How to interpret a paediatric echocardiography report. BJA Educ 2020; 20:278-286. [DOI: 10.1016/j.bjae.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 11/19/2022] Open
|
26
|
Kumar R, Halder V, Gourav KP, Patel R, Munirathimnam GK, Mandal B, Thingnam SKS. Pulmonary valve neocuspidisation with glutaraldehyde-treated autologous pericardium-A novel technique in pulmonary valve endocarditis. J Card Surg 2020; 35:1725-1728. [PMID: 32579761 DOI: 10.1111/jocs.14659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
Infective endocarditis (IE) is a serious condition leading to heart failure, persistent sepsis. The management of IE involving valve is mainly excision of the infected valve and replacement with a heart valve; which are also at the risk of prosthetic valve endocarditis. Hence repair of the valve with autologous pericardium is much more physiological. We had a 20-year-old male presented with features of heart failure and high-grade fever not responding to optimum medical management. Two-dimensional echocardiogram revealed vegetation on pulmonary valve cusps with the erosion of the left and right cusps. Neo cusps with autologous pericardium offered good hemodynamics with trivial regurgitation. The patient is doing well with normal pulmonary valve function 3 months after surgery. This technique is reliable, economic, and easily reproducible.
Collapse
Affiliation(s)
- Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Halder
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna P Gourav
- Department of Cardiothoracic and Vascular Anesthesiology, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchit Patel
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganesh K Munirathimnam
- Department of Cardiothoracic and Vascular Anesthesiology, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Banashree Mandal
- Department of Cardiothoracic and Vascular Anesthesiology, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam K S Thingnam
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
27
|
A low threshold for neonatal intervention yields a high rate of biventricular outcomes in pulmonary atresia with intact ventricular septum. Cardiol Young 2020; 30:649-655. [PMID: 32321616 DOI: 10.1017/s1047951120000700] [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] [Indexed: 11/07/2022]
Abstract
AIMS Management strategies for pulmonary atresia with intact ventricular septum are variable and are based on right ventricular morphology and associated abnormalities. Catheter perforation of the pulmonary valve provides an alternative strategy to surgery in the neonatal period. We sought to assess the long-term outcome in terms of survival, re-intervention, and functional ventricular outcome in the setting of a 26-year single-centre experience of low threshold inclusion criteria for percutaneous valvotomy. METHODS AND RESULTS Retrospective analysis of patients diagnosed with pulmonary atresia with intact ventricular septum from 1990 to 2016 at a tertiary referral centre, was performed. Of 71 patients, 48 were brought to the catheterisation laboratory for intervention. Catheter valvotomy was successful in 45 patients (94%). Twenty-three patients (51%) also underwent ductus arteriosus stenting. The length of intensive care and hospital stay was significantly shorter, and early re-interventions were significantly reduced in the catheterisation group. There were eight deaths (17%); all within 35 days of the procedure. Of the survivors, only one has required a Fontan circulation. Twenty-eight patients (74%) have undergone biventricular repair and nine patients (24%) have one-and-a-half ventricle circulation. Following successful valvotomy, 80% of patients required further catheter-based or surgical interventions. CONCLUSIONS A low threshold for initial interventional management yielded a high rate of successful biventricular circulations. Although mortality was low in patients who survived the peri-procedural period, the rate of re-intervention remained high in all groups.
Collapse
|
28
|
IJsselhof RJ, Duchateau SDR, Schouten RM, Freund MW, Heuser J, Fejzic Z, Haas F, Schoof PH, Slieker MG. Follow-up after biventricular repair of the hypoplastic left heart complex. Eur J Cardiothorac Surg 2020; 57:644-651. [PMID: 31651943 DOI: 10.1093/ejcts/ezz293] [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: 06/19/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES In hypoplastic left heart complex patients, biventricular repair is preferred over staged-single ventricle palliation; however, there are too few studies to support either strategy. Therefore, we retrospectively characterized our patient cohort with hypoplastic left heart complex after biventricular repair to measure left-sided heart structures and assess our treatment strategy. METHODS Patients with hypoplastic left heart complex who had biventricular repair between 2004 and 2018 were retrospectively reviewed. Operative results were evaluated and echocardiographic mitral valve (MV) and aortic valve (AoV) dimensions, left ventricular length and left ventricular internal diastolic diameter (LVIDd) were measured preoperatively and during follow-up after 0.5, 1, 3, 5 and 10 years. RESULTS In 32 patients, the median age at surgery was 10 (interquartile range 5.0) days. The median follow-up was 6.19 (interquartile range 6.04) years. During the 10-year follow-up, the mean Z-scores increased from -2.82 to -1.49 and from -2.29 to 0.62 for MV and AoV, respectively. Analysis of variance results with post hoc paired t-tests showed that growth of left-sided heart structures was accelerated in the first year after repair, but was not equal, with the MV lagging behind the AoV (P = 0.033), resulting in significantly smaller MV Z-scores compared with AoV Z-scores at 10-year follow-up (P < 0.001). There were 2 (6%) early deaths. The major adverse events occurred in 4 (13%) patients. The surgical or catheter-based reintervention was required in 14 (44%) patients. CONCLUSIONS The growth rate of heart structures was most prominent during the first year after biventricular repair with lower growth rate of the MV compared with the AoV.
Collapse
Affiliation(s)
- Rinske J IJsselhof
- Department of Pediatric Cardiac Surgery, Wilhelmina Children's Hospital (Part of University Medical Center Utrecht), Utrecht, Netherlands
| | - Saniyé D R Duchateau
- Department of Pediatric Cardiac Surgery, Wilhelmina Children's Hospital (Part of University Medical Center Utrecht), Utrecht, Netherlands
| | - Rianne M Schouten
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands
| | - Matthias W Freund
- Department of Pediatric Cardiology, University Pediatric Hospital, Oldenburg, Germany
| | - Jörg Heuser
- Department of Pediatrics, Maxima Medical Center Veldhoven, Veldhoven, Netherlands
| | - Zina Fejzic
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Felix Haas
- Department of Pediatric Cardiac Surgery, Wilhelmina Children's Hospital (Part of University Medical Center Utrecht), Utrecht, Netherlands
| | - Paul H Schoof
- Department of Pediatric Cardiac Surgery, Wilhelmina Children's Hospital (Part of University Medical Center Utrecht), Utrecht, Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital (Part of University Medical Center Utrecht), Utrecht, Netherlands
| |
Collapse
|
29
|
Early Postnatal Echocardiography in Neonates with a Prenatal Suspicion of Coarctation of the Aorta. Pediatr Cardiol 2020; 41:772-780. [PMID: 32034462 DOI: 10.1007/s00246-020-02310-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
Coarctation of the aorta (COA) is suspected prenatally when there is ventricular asymmetry, arterial disproportion, and hypoplasia of the aortic arch/isthmus. The presence of fetal shunts creates difficulty in prenatal confirmation of the diagnosis so serial echocardiography after birth is necessary to confirm or refute the diagnosis. The first neonatal echocardiogram in prenatally suspected cases of COA was assessed for prediction of neonatal COA repair (NCOAR). This included morphological assessment, measurement of the aortic arch and calculation of the distal arch index (DAI = distance between left common carotid and left subclavian artery/diameter of the distal arch). NCOAR was undertaken in 23/60 (38%) cases. Transverse arch, aortic isthmus z-score, and DAI had an area under the receiver operator curve of 0.88 (95% CI 0.77-0.98), 0.86 (95% CI 0.75-0.96), and 0.84 (95% CI 0.74-0.95), respectively for the prediction of NCOAR. Using transverse arch z-score threshold < - 3 gave sensitivity 100%, NPV: 100%, specificity 76%; aortic isthmus z-score < - 3: NPV 92%, specificity 62% and DAI > 1.4: NPV 88%, specificity 78%. The size of the distal aortic arch in infants with a common origin of the innominate artery and left common carotid artery who did not require COA repair was similar to the NCOAR cases (p = 0.22). The early postnatal assessment of the size and morphology of the aortic arch can assist in risk stratification for development of neonatal COA. The branching pattern of the head/neck vessels impacts on the size of the distal aortic arch adding to the complexity of predicting COA based on vessel size.
Collapse
|
30
|
Abushaban L, Rathinasamy J, Sharma PN, Vel MT. Normal reference ranges for the left ventricular mass and left ventricular mass index in preterm infants. Ann Pediatr Cardiol 2020; 13:25-30. [PMID: 32030032 PMCID: PMC6979023 DOI: 10.4103/apc.apc_171_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/22/2019] [Accepted: 06/04/2019] [Indexed: 01/20/2023] Open
Abstract
Objective: The objective of this study is to establish normal reference ranges for the left ventricular mass (LVM) and LVM index (LVMI) in preterm infants according to the body surface area (BSA) and assess their correlation with body weight and gestational age. Subjects and Methods: In a prospective study, 268 preterm babies who fulfilled the criteria for inclusion were examined. Echocardiograms were performed to measure the LVM and LVMI on 0–6 day (s) of life and at weekly intervals until the babies reached 36 weeks. The preterm infants were divided into six groups according to their BSA: 0.07–0.08 m2, 0.09–0.10 m2, 0.11–0.12 m2, 0.13–0.14 m2, 0.15–0.16 m2, and 0.17–0.19 m2. Results: The mean gestational age was 29.8 (±2.38 standard deviation [SD]) weeks, ranging from 24 to 35 weeks. The mean body weight was 1479 (±413 SD) g, ranging from 588 to 3380 g, and the mean BSA was 0.13 m2, ranging from 0.07 to 0.19 m2. The LVM correlated well with the gestational age, body weight, and BSA. The LVMI correlated well with body weight and BSA. Reference ranges with the mean ± SD, range, and interquartile range were calculated for the LVM and LVMI according to the BSA. A significant gradual increase was observed in a LVM with increasing BSA. Overall, a progressive and significant increase in the LVM was observed during the first 9 weeks of life. Conclusion: The LVM and LVMI exhibited a significant correlation with the BSA and body weight. This study provides reference data that can be used as a normal reference tool for the LVM and LVMI for preterm infants based on the BSA.
Collapse
Affiliation(s)
- Lulu Abushaban
- Department of Pediatric Cardiology, Chest Diseases Hospital, Kuwait City, Kuwait.,Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Jebaraj Rathinasamy
- Department of Pediatric Cardiology, Chest Diseases Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Prem N Sharma
- Health Sciences Center, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mariappa Thinakar Vel
- Department of Pediatric Cardiology, Chest Diseases Hospital, Ministry of Health, Kuwait City, Kuwait
| |
Collapse
|
31
|
Olivieri LJ, Jiang J, Hamann K, Loke YH, Campbell-Washburn A, Xue H, McCarter R, Cross R. Normal right and left ventricular volumes prospectively obtained from cardiovascular magnetic resonance in awake, healthy, 0- 12 year old children. J Cardiovasc Magn Reson 2020; 22:11. [PMID: 32013998 PMCID: PMC6998283 DOI: 10.1186/s12968-020-0602-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/13/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pediatric z scores are necessary to describe size and structure of the heart in growing children, however, development of an accurate z score calculator requires robust normal datasets, which are difficult to obtain with cardiovascular magnetic resonance (CMR) in children. Motion-corrected (MOCO) cines from re-binned, reconstructed real-time cine offer a free-breathing, rapid acquisition resulting in cines with high spatial and temporal resolution. In combination with child-friendly positioning and entertainment, MOCO cine technique allows for rapid cine volumetry in patients of all ages without sedation. Thus, our aim was to prospectively enroll normal infants and children birth-12 years for creation and validation of a z score calculator describing normal right ventricular (RV) and left ventricular (LV) size. METHODS With IRB approval and consent/assent, 149 normal children successfully underwent a brief noncontrast CMR on a 1.5 T scanner including MOCO cines in the short axis, and RV and LV volumes were measured. 20% of scans were re-measured for interobserver variability analyses. A general linear modeling (GLM) framework was employed to identify and properly represent the relationship between CMR-based assessments and anthropometric data. Scatter plots of model fit and Akaike's information criteria (AIC) results were used to guide the choice among alternative models. RESULTS A total of 149 subjects aged 22 days-12 years (average 5.1 ± 3.6 years), with body surface area (BSA) range 0.21-1.63 m2 (average 0.8 ± 0.35 m2) were scanned. All ICC values were > 95%, reflecting excellent agreement between raters. The model that provided the best fit of volume measure to the data included BSA with higher order effects and gender as independent variables. Compared with earlier z score models, there is important additional growth inflection in early toddlerhood with similar z score prediction in later childhood. CONCLUSIONS Free-breathing, MOCO cines allow for accurate, reliable RV and LV volumetry in a wide range of infants and children while awake. Equations predicting fit between LV and RV normal values and BSA are reported herein for purposes of creating z scores. TRIAL REGISTRATION clinicaltrials.gov NCT02892136, Registered 7/21/2016.
Collapse
Affiliation(s)
- Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Jiji Jiang
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Karin Hamann
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | | | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert McCarter
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Russell Cross
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| |
Collapse
|
32
|
Paauw ND, Stegeman R, de Vroede MAMJ, Termote JUM, Freund MW, Breur JMPJ. Neonatal cardiac hypertrophy: the role of hyperinsulinism-a review of literature. Eur J Pediatr 2020; 179:39-50. [PMID: 31840185 PMCID: PMC6942572 DOI: 10.1007/s00431-019-03521-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) in neonates is a rare and heterogeneous disorder which is characterized by hypertrophy of heart with histological and functional disruption of the myocardial structure/composition. The prognosis of HCM depends on the underlying diagnosis. In this review, we emphasize the importance to consider hyperinsulinism in the differential diagnosis of HCM, as hyperinsulinism is widely associated with cardiac hypertrophy (CH) which cannot be distinguished from HCM on echocardiographic examination. We supply an overview of the incidence and treatment strategies of neonatal CH in a broad spectrum of hyperinsulinemic diseases. Reviewing the literature, we found that CH is reported in 13 to 44% of infants of diabetic mothers, in approximately 40% of infants with congenital hyperinsulinism, in 61% of infants with leprechaunism and in 48 to 61% of the patients with congenital generalized lipodystrophy. The correct diagnosis is of importance since there is a large variation in prognoses and there are various strategies to treat CH in hyperinsulinemic diseases.Conclusion: The relationship between CH and hyperinsulism has implications for clinical practice as it might help to establish the correct diagnosis in neonates with cardiac hypertrophy which has both prognostic and therapeutic consequences. In addition, CH should be recognized as a potential comorbidity which might necessitate treatment in all neonates with known hyperinsulinism.What is Known:• Hyperinsulinism is currently not acknowledged as a cause of hypertrophic cardiomyopathy (HCM) in textbooks and recent Pediatric Cardiomyopathy Registry publications.What is New:• This article presents an overview of the literature of hyperinsulinism in neonates and infants showing that hyperinsulinism is associated with cardiac hypertrophy (CH) in a broad range of hyperinsulinemic diseases.• As CH cannot be distinguished from HCM on echocardiographic examination, we emphasize the importance to consider hyperinsulinism in the differential diagnosis of HCM/CH as establishing the correct diagnosis has both prognostic and therapeutic consequences.
Collapse
Affiliation(s)
- Nina D. Paauw
- grid.7692.a0000000090126352Department of Obstetrics, Wilhelmina Children’s Hospital Birth Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raymond Stegeman
- grid.7692.a0000000090126352Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Neonatology, Wilhelmina Children’s Hospital Birth Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique A. M. J. de Vroede
- grid.7692.a0000000090126352Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacqueline U. M. Termote
- grid.7692.a0000000090126352Department of Neonatology, Wilhelmina Children’s Hospital Birth Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthias W. Freund
- grid.5560.60000 0001 1009 3608Department of Pediatric Cardiology, Klinikum Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Johannes M. P. J. Breur
- grid.7692.a0000000090126352Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| |
Collapse
|
33
|
François K, De Groote K, Vandekerckhove K, De Wilde H, De Wolf D, Bové T. Small-sized conduits in the right ventricular outflow tract in young children: bicuspidalized homografts are a good alternative to standard conduits. Eur J Cardiothorac Surg 2019; 53:409-415. [PMID: 29029050 DOI: 10.1093/ejcts/ezx354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Downsizing a homograft (HG) through bicuspidalization has been used for more than 2 decades to overcome the shortage of small-sized conduits for reconstruction of the right ventricular outflow tract (RVOT) in young children. Our goal was to investigate the durability of bicuspidalized HGs compared with other small HGs. METHODS A retrospective analysis of 93 conduits ≤20 mm, implanted over 23 years, was performed. The end-points were survival, structural valve degeneration and conduit replacement. The conduits comprised 40 pulmonary HGs, 12 aortic HGs, 17 bicuspidalized HGs and 24 xenografts. RESULTS The median age, mean conduit diameter and z-value at implantation were 1.4 (interquartile range 0.3-3) years, 16.5 ± 2.7 mm and 2.8 ± 1.3, respectively. Valve position was heterotopic in 59 patients and orthotopic in 34 patients. At a mean follow-up period of 7.6 ± 5.9 years, the hospital survival rate was 89%. Freedom from explant at 5 and 10 years was 83 ± 5% and 52 ± 6%, respectively. Freedom from structural valve degeneration was 79 ± 5% at 5 years and 47 ± 6% at 10 years [68 ± 8% for pulmonary HG, 42 ± 16% for bicuspidalized HG, 31 ± 15% for aortic HG and 20 ± 9% for xenografts (log rank P < 0.001)]. Multivariable analysis indicated an increased risk for structural valve degeneration with smaller conduit size (hazard ratio 0.79, 95% confidence interval 0.67-0.94; P < 0.008), extra-anatomic position (hazard ratio 2.71, 95% confidence interval 1.33-5.50; P = 0.006) and the use of xenografts compared with non-downsized pulmonary HGs (hazard ratio 4.90, 95% confidence interval 2.23-10.76; P < 0.001). CONCLUSIONS Appropriately sized pulmonary HGs remain the most durable option for a right ventricular outflow tract conduit in young children. However, when a small pulmonary HG is unavailable, bicuspidalization offers a valid alternative, preferable to xenograft conduits, at mid-term follow-up.
Collapse
Affiliation(s)
- Katrien François
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | | | - Hans De Wilde
- Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
34
|
Iwatani A, Miyake F, Ishido H, Kanai M, Ishiguro A, Iwamoto Y, Kabe K, Masutani S. Postnatal Amelioration of Fetal Right Ventricular Hypoplasia Associated with Large Eustachian Valve: A Case Report. AJP Rep 2019; 9:e357-e360. [PMID: 31754548 PMCID: PMC6864494 DOI: 10.1055/s-0039-3400317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/11/2019] [Indexed: 11/01/2022] Open
Abstract
In fetuses, the Eustachian valve directs oxygenated blood returning from the inferior vena cava into the left atrium via the foramen ovale. If too large, the Eustachian valve can restrict right ventricular inflow, as well as induce postnatal cyanosis via an interatrial right-to-left shunt. We report a fetal case of postnatal amelioration of the tricuspid valve and right ventricle hypoplasia, despite significant right ventricular hypoplasia associated with a large Eustachian valve. Application of an appropriate respiratory management regimen to help reduce pulmonary vascular resistance is of particular importance for the reversal of the right-to-left shunt via the foramen ovale and associated increases in right ventricular inflow.
Collapse
Affiliation(s)
- Ayaka Iwatani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Fumihito Miyake
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hirotaka Ishido
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masayo Kanai
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Akio Ishiguro
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoichi Iwamoto
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| |
Collapse
|
35
|
A Novel Mathematical Model for Correcting the Physiologic Variance of Two-Dimensional Echocardiographic Measurements in Healthy Chinese Adults. J Am Soc Echocardiogr 2019; 32:876-883.e11. [PMID: 31029500 DOI: 10.1016/j.echo.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND To facilitate differentiation between normal and abnormal values, it is necessary to correct echocardiographic measurements for physiologic variance induced by age, gender, and body size variables. METHODS A total of 34 two-dimensional echocardiographic parameters were measured in 1,224 healthy Chinese adults with body mass index < 25.0 kg/m2. An optimized multivariate allometric model and scaling equations were first developed in 858 subjects (group A), and their reliability was then verified in the remaining 366 subjects (group B). The traditional single-variable isometric model in which parameters are linearly corrected by a single body size variable (height, weight, body mass index, or body surface area) was used for comparison. The success of correction was defined as the absence of significant correlations (r > 0.20, P < .05) between the corrected values and age or any body size variables, while maintaining high correlations (r > 0.80) between the corrected and uncorrected values. RESULTS Before correction, all 34 parameters correlated significantly with one or more of the physiologic variables of age and body size and differed significantly between men and women on 29 parameters (85.3%) in both groups. The success rate of correction with the single-variable isometric model was only 11.0% (15 of 136 corrections due to four variable corrections used for each parameter), while use of the optimized multivariate allometric model successfully corrected all 34 parameters (100%) for physiologic variance induced by age and body size variables and eliminated the gender differences in 32 parameters (94.1%). A new set of reference values for corrected echocardiographic measurements independent of age, gender, and body size variables were established. CONCLUSIONS The novel optimized multivariate allometric model developed in this study is superior to traditional the single-variable isometric model in the correction of echocardiographic parameters for physiologic effects of age, gender, and body size variables and thus should be encouraged in both scientific research and clinical practice.
Collapse
|
36
|
Auld B, Carrigan L, Ward C, Justo R, Alphonso N, Anderson B. Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis: A 14-Year Single Centre Review. Heart Lung Circ 2019; 28:632-636. [DOI: 10.1016/j.hlc.2018.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 01/31/2018] [Accepted: 02/18/2018] [Indexed: 11/29/2022]
|
37
|
Rocha LA, Rolo LC, Nardozza LMM, Tonni G, Araujo Júnior E. Z-Score Reference Ranges for Fetal Heart Functional Measurements in a Large Brazilian Pregnant Women Sample. Pediatr Cardiol 2019; 40:554-562. [PMID: 30415382 DOI: 10.1007/s00246-018-2026-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
The objective of this study was to determine the reference values for fetal heart functional measurements at 24 and 34 weeks of gestation and to develop Z-score equations for all measurements. A single-center, prospective, cross-sectional study with normal fetuses between 24 and 34 weeks of gestation was performed. All pregnant women underwent a comprehensive fetal Doppler echocardiogram with anatomical and functional analysis. Measurements of left and right cardiac output, combined cardiac output, mitral and tricuspid valve flow, inferior vena cava flow, and pulmonary vein flow were performed. The Shapiro-Wilk test and histogram evaluation were performed on all variables. Linear regression was used to assess the relationships between measurements and gestational age. A total of 612 pregnant women with singleton and normal fetuses were included. We assessed the reference values and percentiles of cardiac function as a function of gestational age. The variables that were not normally distributed were subjected to logarithmic or square root transformation. Eleven Z-score equations were developed, with equations for left and right ventricle output and combined cardiac output that were dependent on gestational age and with other equations that were independent of gestational age. The present study produced a large database, allowing the demonstration of reference values and percentiles as well as the development of Z-score equations to facilitate the echocardiographic evaluation of fetal heart function.
Collapse
Affiliation(s)
- Luciane Alves Rocha
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Luciano Marcondes Machado Nardozza
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Istituto di Ricerca a Carattere Clinico Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.
| |
Collapse
|
38
|
Marathe SP, Bell D, Betts K, Sayed S, Dunne B, Ward C, Whight C, Jalali H, Venugopal P, Andrews D, Alphonso N. Homografts versus stentless bioprosthetic valves in the pulmonary position: a multicentre propensity-matched comparison in patients younger than 20 years. Eur J Cardiothorac Surg 2019; 56:5309049. [PMID: 30753373 DOI: 10.1093/ejcts/ezz021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/10/2019] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES The aim of this study was to compare the performance of pulmonary homografts with stentless bioprosthetic valves [Medtronic Freestyle™ (Medtronic, Minneapolis, MN, USA)] in the pulmonary position in patients with congenital heart disease (CHD) younger than 20 years. METHODS Between January 2000 and December 2017, 215 patients were retrospectively identified from hospital databases in 3 congenital heart centres in Australia. Valve performance was evaluated using standard criteria. Propensity score matching was used to balance the 2 treatment groups. RESULTS Freedom from reintervention for patients who received a pulmonary homograft (n = 163) was 96%, 88% and 81% at 5, 10 and 15 years and for patients who received a Freestyle™ valve (n = 52) was 98%, 89% and 31% at 5, 10 and 15 years, respectively. Freedom from structural valve degeneration for patients with a homograft was 92%, 87% and 77% at 5, 10 and 15 years and for patients with a Freestyle valve was 96%, 80% and 14% at 5, 10 and 15 years, respectively. In the first 10 years, there was no difference in outcomes [reintervention hazard ratios (HR) = 0.69, 95% confidence intervals (CI) (0.20-2.42), P = 0.56; structural valve degeneration HR = 0.92 (0.34-2.51), P = 0.87]. After 10 years, the recipients of the Freestyle valves were at higher risk of both outcomes [reintervention HR = 7.89; 95% CI (2.79-22.34), P < 0.001; structural valve degeneration HR = 7.41 (2.77-19.84), P < 0.001]. The findings were similar when analysed by implantation in the orthotopic position and in the propensity-matched groups. CONCLUSIONS The Freestyle stentless bioprosthetic valve is a comparable alternative to cryopreserved pulmonary homografts up to 10 years after implantation when implanted in an orthotopic pulmonary position in patients younger than 20 years with CHD.
Collapse
Affiliation(s)
- Supreet P Marathe
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Douglas Bell
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- The Prince Charles Hospital, Brisbane, Australia
| | - Kim Betts
- Department of Epidemiology, Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Sajid Sayed
- Department of Cardiothoracic Surgery, Child and Adolescent Health Service, Princess Margaret Hospital, Perth, Australia
| | - Benjamin Dunne
- Department of Cardiothoracic Surgery, Child and Adolescent Health Service, Princess Margaret Hospital, Perth, Australia
| | - Cameron Ward
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chris Whight
- The Prince Charles Hospital, Brisbane, Australia
| | | | - Prem Venugopal
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David Andrews
- Department of Cardiothoracic Surgery, Child and Adolescent Health Service, Princess Margaret Hospital, Perth, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
39
|
Chen RH, K.T. Chau A, Chow PC, Yung TC, Cheung YF, Lun KS. Achieving biventricular circulation in patients with moderate hypoplastic right ventricle in pulmonary atresia intact ventricular septum after transcatheter pulmonary valve perforation. CONGENIT HEART DIS 2018; 13:884-891. [DOI: 10.1111/chd.12658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/24/2018] [Accepted: 07/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Robin H.S. Chen
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
| | | | - Pak Cheong Chow
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
| | - Tak Cheung Yung
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
| | - Yiu Fai Cheung
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine; University of Hong Kong; Hong Kong SAR
| | - Kin Shing Lun
- Department of Pediatric Cardiology; Queen Mary Hospital; Hong Kong SAR
| |
Collapse
|
40
|
Micelli C, Diarsvitri W, Pia DM, Luhur H. Embolic stroke, left atrial myxoma and gigantism in a patient with Carney complex with additional features suggestive of Marfan syndrome. BMJ Case Rep 2018; 2018:bcr-2018-225093. [PMID: 30077980 PMCID: PMC6078259 DOI: 10.1136/bcr-2018-225093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 01/01/2023] Open
Abstract
A 16-year-old boy presented to the emergency department with a sudden weakness on the right side of the body and was diagnosed as having embolic stroke. Later on, the patient was diagnosed as having Carney complex (CNC). The neurological complication might be caused by left atrial myxoma as a feature of CNC. Surprisingly, the patient showed some additional features such as positive wrist and thumb signs, pectus carinatum deformity and plain flat feet, suggestive of Marfan syndrome. This case demonstrated that both of these syndromes might coexist in the same patient, suggesting that proper diagnostic and management were key factors that affected prognosis. He showed an improved condition after he had received medical treatments, undergone tumour excision and physiotherapy. Further evaluation was needed to improve patient outcomes.
Collapse
Affiliation(s)
- Carlo Micelli
- Department of Community Health, Faculty of Medicine, Hang Tuah University, Surabaya, East Java, Indonesia
| | - Wienta Diarsvitri
- Department of Community Health, Faculty of Medicine, Hang Tuah University, Surabaya, East Java, Indonesia
| | - Dian Maria Pia
- Department of Neurology, Dr. Ramelan Naval Hospital, Surabaya, East Java, Indonesia
| | - Hindarto Luhur
- Department of Radiology, Gotong Royong Hospital, Surabaya, East Java, Indonesia
| |
Collapse
|
41
|
Miyazaki T, Yamagishi M, Maeda Y, Taniguchi S, Fujita S, Hongu H, Yaku H. Long-term outcomes of expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg 2018; 155:2567-2576. [DOI: 10.1016/j.jtcvs.2017.12.137] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 11/24/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
|
42
|
Popal MS, Fu JT, Hu QM, Luo TG, Zheng S, Meng X. Intraoperative method based on tricuspid annular circumference in patients with mild or no tricuspid regurgitation during left-sided cardiac valve surgery for the prophylactic tricuspid annuloplasty. J Thorac Dis 2018; 10:3670-3678. [PMID: 30069365 DOI: 10.21037/jtd.2018.04.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background During left-sided cardiac valve surgery in patients with mild or no tricuspid regurgitation (TR), the tricuspid valve exploration plays a vital role in the decision-making of concomitant tricuspid annuloplasty. Currently lack of an appropriate standard to define tricuspid annular dilatation is a challenge. The aim of this study is to introduce and evaluate an alternative intraoperative method for Tricuspid Valve annuloplasty based on annular circumference that could trace the extent of annular dilatation and predict TR-progression, which can also guide the surgeons to intraoperative decision. Methods From January 2011 to December 2011, 131 patients (73 females, 58 males, and mean age 54±10.8) were selected for the study underwent left-sided cardiac valve surgery at Anzhen Hospital, all the subjects preoperatively diagnosed with non-significant TR. The enrolled subjects were followed-up over 5years for TR-progression. Tricuspid annular circumference (TAC) measurement was performed via special sizer for each patient, and the obtained values divided on the subject's body surface area (BSA) to achieve the tricuspid annular circumference index (TACI). The endpoint was set as the TR-progression by more than two grades, or a final TR grade ≥3+. Results The mean follow up period was 68±3.8 months (range, 60-77 months). In univariate, multivariate and logistic regression analysis three variables were noticed to be associated with TR progression, female gender (P<0.002), body mass index (BMI) (P<0.021), and intraoperatively measured TACI (P<0.001). But in multiple regression the TACI (OR 0.812; 95% CI: 0.748-0.883; P<0.001) was the single parameter which significantly related to TR-progression. Based on the receiver-operator curve (ROC), it was likely to derive an optimal cut-off 80.2 mm/m2 which could predict the postoperative development of TR with acceptable sensitivity and specificity 69%, 89%. Conclusions Patients with mild or no TR undergoing left-sided valve surgery, intraoperative measurement of the TAC proved to be an ideal method to judge the tricuspid-annulus, it is capable to predict TR-progression. For prophylactic tricuspid repair a presumed TACI of 80.2 mm/m2 is recommended as an indicative threshold.
Collapse
Affiliation(s)
- Mohammad Sharif Popal
- No. 9 Ward of Cardiac-valve Surgery & Heart Transplantation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jin-Tao Fu
- No. 9 Ward of Cardiac-valve Surgery & Heart Transplantation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Qiu-Ming Hu
- No. 9 Ward of Cardiac-valve Surgery & Heart Transplantation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tian-Ge Luo
- No. 9 Ward of Cardiac-valve Surgery & Heart Transplantation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shuai Zheng
- No. 9 Ward of Cardiac-valve Surgery & Heart Transplantation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xu Meng
- No. 9 Ward of Cardiac-valve Surgery & Heart Transplantation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| |
Collapse
|
43
|
How many versus how much: comprehensive haemodynamic evaluation of partial anomalous pulmonary venous connection by cardiac MRI. Eur Radiol 2018; 28:4598-4606. [PMID: 29721685 DOI: 10.1007/s00330-018-5428-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the effect of location and number of anomalously connected pulmonary veins and any associated atrial septal defect (ASD) on the magnitude of left-to-right shunting in patients with partial anomalous pulmonary venous connection (PAPVC), and how that influences right ventricular volume loading. METHODS AND RESULTS The cardiac magnetic resonance (CMR) and echocardiography examinations of 26 paediatric patients (mean age, 11.2 ± 5.1 years) with unrepaired PAPVC were analysed. Fourteen patients had right-sided, 11 left-sided and 1 patient bilateral PAPVC. An ASD was present in 11 patients, of which none had a Qp/Qs < 1.5 and 8 had a Qp/Qs≥ 2.0. No patient with isolated left upper PAPVC experienced a Qp/Qs ≥ 2.0 compared to 9/12 patients with right upper PAPVC. Qp/Qs correlated with indexed right ventricle (RV) end-diastolic volume (RVEDVi, r = 0.59, p = 0.002) by CMR and with echocardiographic right ventricular end-diastolic dimension (RVED) z-score (r = 0.68, p = 0.003). A RVEDVi >124 ml/m2 by CMR and a RVED z-score >2.2 by echocardiography identified patients with a Qp/Qs ≥1.5 with good sensitivity and specificity. CONCLUSIONS An asymptomatic patient with a single anomalously connected left upper pulmonary vein and without an ASD is unlikely to have a significant left-to-right shunt. On the other hand, right-sided PAPVC is frequently associated with a significant left-to-right shunt, especially when an ASD is present. KEY POINTS • Patients with PAPVC and ASD routinely have a significant left-to-right shunt. • Patients with right PAPVC are likely to have a significant left-to-right shunt. • Patients with left PAPVC are unlikely to have a significant left-to-right shunt. • CMR is helpful in decision-making for patients with PAPVC.
Collapse
|
44
|
Awori MN, Mehta NP, Mitema FO, Kebba N. Optimal Use of Z-Scores to Preserve the Pulmonary Valve Annulus During Repair of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2018; 9:285-288. [DOI: 10.1177/2150135118757991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The size of the pulmonary annulus measured as a z-score is often used to determine when to insert a transannular patch (TAP). Multiple “cutoffs” are quoted in the literature; this could lead to inappropriate insertion. We aimed to determine whether the use of z-scores derived from different populations may have contributed to the varied “cutoffs” quoted. Methods: PubMed was searched using the terms: “tetralogy,” “Fallot,” “transannular,” “patch,” “mortality,” and “death.” Studies published between January 1, 2005, and October 5, 2017, were included; studies without participants under the age of 18 years and studies that did not describe the operative procedure were excluded. Results: Of 52 papers retrieved, 19 were included representing 2,500 repaired patients; 1,371 (54.8%) had a TAP. Five (26.3%) papers representing 638 patients (25.5%) quoted a z-score “cutoff” and what data set was used; “cutoffs” ranged from −2 to −4 and were derived from 2 different data sets. Three studies quoted a data set that has been shown in previous work to be problematic; the only quoted “cutoffs” of −4 were from two of these studies. Conclusions: Surprisingly few (26.3%) studies mention what pulmonary annulus size “cutoff” was used to decide when to insert a TAP. Z-scores derived from different populations were used by different studies and it is possible that this may have contributed to the varied “cutoffs’ quoted. Recommendations to perform valve-sparing surgery in pulmonary annuli as small as −4 may not be warranted. Future papers should record “cutoffs” employing recommended z-score data set.
Collapse
Affiliation(s)
- Mark Nelson Awori
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Nikita P. Mehta
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Frederick O. Mitema
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Naomi Kebba
- Kenyatta National Hospital, University of Nairobi College of Health Sciences, Nairobi, Kenya
| |
Collapse
|
45
|
Abushaban L, Mariappa TV, Rathinasamy J, Sharma PN. Normal reference ranges for aortic diameters in preterm infants. J Saudi Heart Assoc 2018; 30:86-94. [PMID: 29910578 PMCID: PMC6000894 DOI: 10.1016/j.jsha.2017.09.003] [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: 04/25/2017] [Accepted: 09/24/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To establish normal reference ranges and Z-scores for aortic diameters in preterm infants according to the body surface area and assess their correlation with body weight, body surface area, and gestational age. PATIENTS AND METHODS In a prospective study, 268 preterm infants who fulfilled the criteria for inclusion were examined. Echocardiograms were performed to measure the ascending aorta, transverse aorta, and aortic isthmus diameters on 0 days to 6 days of life and at weekly intervals until the babies reached 36 weeks. Body surface area was divided into 13 groups from 0.07 m2 to 0.19 m2. RESULTS The mean gestational age was 29.8 [± 2.38 standard deviation (SD)] weeks, ranging from 24 weeks to 35 weeks. The mean body weight was 1479 (± 413 SD) g, ranging from 588 g to 3380 g, and the mean body surface area was 0.13 m2, ranging from 0.07 m2 to 0.19 m2. All the aortic diameters correlated well with both body weight and body surface area. Reference ranges with the mean ± SD, range, and Z-scores were calculated for aortic diameters according to the body surface area. A significant gradual increase was observed in ascending aorta, transverse aorta, and aortic isthmus diameters with increasing body surface area. Overall, a progressive and significant increase in ascending aorta, transverse aorta, and aortic isthmus diameters was observed during the first 9 weeks of life. CONCLUSION The ascending aorta, transverse aorta, and aortic isthmus diameters exhibited a significant correlation with the body surface area and body weight. This study provides reference data with Z-scores that can be used as a normal reference tool for the ascending aorta, transverse aorta, and aortic isthmus diameters for preterm infants based on the body surface area.
Collapse
Affiliation(s)
- Lulu Abushaban
- Chest Diseases Hospital, Ministry of Health, Kuwait City, KuwaitaKuwait
- Department of Paediatrics, Kuwait University, Kuwait City, KuwaitbKuwait
| | | | | | - Prem N. Sharma
- Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, KuwaitcKuwait
| |
Collapse
|
46
|
van Ark AE, Molenschot MC, Wesseling MH, de Vries WB, Strengers JLM, Adams A, Breur JMPJ. Cardiac Valve Annulus Diameters in Extremely Preterm Infants: A Cross-Sectional Echocardiographic Study. Neonatology 2018; 114:198-204. [PMID: 29940560 PMCID: PMC6191879 DOI: 10.1159/000488387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND With the increasing incidence of births of very preterm very-low-birth-weight infants, there is a demand for echocardiographic reference values of cardiac dimensions. OBJECTIVES The aim of this study was to provide reference values of cardiac valve annulus diameters in a cohort of extremely preterm very-low-birth-weight neonates and to correlate these with patient characteristics. METHODS Valve diameters of 376 infants of < 32 weeks' gestation and with a birth weight of ≤2,000 g were measured using 2-dimensional echocardiography. Correlations between valve diameters and patient characteristics (birth length/weight, body surface area, gestational age, and sex) were assessed. Birth weight was used to establish linear regression models. Inter- and intraobserver agreement was assessed through intraclass correlation coefficient (ICC) analysis. RESULTS Substantial variability was found (aortic valve mean [standard deviation; range]: 5.0 mm [0.6; 3.7-6.5]; pulmonic valve: 5.8 mm [0.8; 3.4-7.9]; mitral valve: 8.0 mm [1.0; 5.5-10.5]; tricuspid valve: 7.6 mm [1.2; 4.9-10.6]). There was a moderate correlation between birth weight and valve diameter (R2 aortic valve: 0.36; pulmonic valve: 0.20; mitral valve: 0.24; tricuspid valve: 0.24). Adequate intraobserver (ICC range 0.74-0.91) and interobserver agreement (ICC range 0.77-0.89) was found. CONCLUSIONS Our study provides ready-to-use reference values for cardiac valve annulus diameters for extremely preterm infants.
Collapse
Affiliation(s)
- Allard E van Ark
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mirella C Molenschot
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maria H Wesseling
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem B de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan L M Strengers
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arthur Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
47
|
Racial Variation in Echocardiographic Reference Ranges for Left Chamber Dimensions in Children and Adolescents: A Systematic Review. Pediatr Cardiol 2018; 39:859-868. [PMID: 29616292 PMCID: PMC5958170 DOI: 10.1007/s00246-018-1873-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Abstract
Echocardiography plays a critical role in the assessment of cardiac disease. Important differences in echocardiographically derived cardiac chamber dimensions have been previously highlighted in different population groups in adult studies, but this has not been systematically studied in children, whose body size changes throughout childhood. The aim of this study was to review the distribution of available reference ranges for the left cardiac chamber dimensions in older children and adolescents. The following electronic data bases were searched: Medline, Embase and Web of Science were searched to identify studies which have established echocardiographic reference ranges of left heart parameters in children and adolescents from 1975 to December 2017. There was no geographical limitation. All results were imported into Endnote. Retrieved articles were screened and data extracted by two independent reviewers. A total of 4398 studies were retrieved, with 36 studies finally included in this review. 29 (81%) references were from North America and European (Caucasians) populations, with only one study each from Africa and South America. Two-dimensional and M-mode techniques were the most commonly used echocardiography techniques. There were methodological variations in techniques and normalisation of references. Comparison of selected cardiac measures showed significant differences for interventricular septal thickness among Black African, Indian, German and US American children. Available echocardiographic references cannot be generalised to all settings and therefore, there is need for locally relevant reference ranges. Africa and South America are particularly under-represented. Future studies should focus on developing comprehensive echocardiographic reference ranges for children from different racial backgrounds and should use standardised techniques.
Collapse
|
48
|
Di Bernardo S, Mivelaz Y, Epure AM, Vial Y, Simeoni U, Bovet P, Estoppey Younes S, Chiolero A, Sekarski N. Assessing the consequences of gestational diabetes mellitus on offspring's cardiovascular health: MySweetHeart Cohort study protocol, Switzerland. BMJ Open 2017; 7:e016972. [PMID: 29138200 PMCID: PMC5695409 DOI: 10.1136/bmjopen-2017-016972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/24/2017] [Accepted: 08/17/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a state of glucose intolerance with onset during pregnancy. GDM carries prenatal and perinatal risks as well as long-term risks for the mother and her child. GDM may be involved in the foetal programming of long-term cardiovascular health. However, evidence is sparse and the effect of GDM on cardiovascular health is unknown. To address these issues, we will conduct MySweetHeart Cohort study. The objectives are to assess the effect of GDM on offspring's cardiovascular health early in life by using surrogate markers of cardiovascular disease and atherosclerosis. METHODS AND ANALYSIS This is a cohort study of 100 offspring of women with GDM and 100 offspring of women without GDM. At inclusion, a baseline assessment of the mothers will be conducted through means of self-report questionnaires, a researcher-administrated interview, blood pressure and anthropometric measurements, and a maternal blood sampling. Between the 30th and 34th weeks of gestation, a foetal echography will be performed to assess the foetal cardiac structure and function, the fetomaternal circulation and the hepatic volume. At birth, maternal and neonatal characteristics will be assessed. An echocardiography will be performed to assess cardiac structure and function 2-7 days after birth; carotid intima-media thickness will be also measured to assess vascular structure. MySweetHeart Cohort is linked to MySweetHeart Trial (clinicaltrials.gov/ct2/show/NCT02890693), a randomised controlled trial assessing the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention to improve the cardiometabolic and mental health of women with GDM and their offspring. A long-term follow-up of children is planned. ETHICS AND DISSEMINATION Ethical approval has been obtained through the state Human Research Ethics Committee of the Canton de Vaud (study number 2016-00745). We aim to disseminate the findings through regional, national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (clinicaltrials.gov/ct2/show/NCT02872974).
Collapse
Affiliation(s)
- Stefano Di Bernardo
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Mivelaz
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Adina Mihaela Epure
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Obstetrics and Gynaecology Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Umberto Simeoni
- DOHaD Laboratory, Paediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Sandrine Estoppey Younes
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicole Sekarski
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
49
|
Wilder TJ, Van Arsdell GS, Benson L, Pham-Hung E, Gritti M, Page A, Caldarone CA, Hickey EJ. Young infants with severe tetralogy of Fallot: Early primary surgery versus transcatheter palliation. J Thorac Cardiovasc Surg 2017; 154:1692-1700.e2. [DOI: 10.1016/j.jtcvs.2017.05.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/11/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
|
50
|
Lopez L, Colan S, Stylianou M, Granger S, Trachtenberg F, Frommelt P, Pearson G, Camarda J, Cnota J, Cohen M, Dragulescu A, Frommelt M, Garuba O, Johnson T, Lai W, Mahgerefteh J, Pignatelli R, Prakash A, Sachdeva R, Soriano B, Soslow J, Spurney C, Srivastava S, Taylor C, Thankavel P, van der Velde M, Minich L. Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database. Circ Cardiovasc Imaging 2017; 10:e006979. [PMID: 29138232 PMCID: PMC5812349 DOI: 10.1161/circimaging.117.006979] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/19/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity. METHODS AND RESULTS Data collected from healthy nonobese children ≤18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSAα) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5% difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as ≥5% difference. Of the 3566 subjects, 90% had measurable images. Appropriate BSA transformations (BSAα) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement. CONCLUSIONS Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.
Collapse
Affiliation(s)
- Leo Lopez
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.).
| | - Steven Colan
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Mario Stylianou
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Suzanne Granger
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Felicia Trachtenberg
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Peter Frommelt
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Gail Pearson
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Joseph Camarda
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - James Cnota
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Meryl Cohen
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Andreea Dragulescu
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Michele Frommelt
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Olukayode Garuba
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Tiffanie Johnson
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Wyman Lai
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Joseph Mahgerefteh
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ricardo Pignatelli
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ashwin Prakash
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ritu Sachdeva
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Brian Soriano
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Jonathan Soslow
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Christopher Spurney
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Shubhika Srivastava
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Carolyn Taylor
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Poonam Thankavel
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Mary van der Velde
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - LuAnn Minich
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| |
Collapse
|