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Heidari N, Kumaran K, Pagano JJ, Hornberger LK. Natural History of Secundum ASD in Preterm and Term Neonates: A Comparative Study. Pediatr Cardiol 2024; 45:710-721. [PMID: 38366300 DOI: 10.1007/s00246-023-03403-7] [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: 11/17/2023] [Accepted: 12/29/2023] [Indexed: 02/18/2024]
Abstract
Atrial septal defects (ASDs) are common in neonates. Although past studies suggest ASDs ≥ 3 mm in term neonates (TNs) are less likely to close, there is paucity of data regarding the natural history in preterm neonates (PNs), information that would inform surveillance. We sought to compare spontaneous closure rates and need for intervention for ASDs in TNs/near term (≥ 36 weeks) versus PNs (< 36 weeks). We included all TNs and PNs who underwent echocardiography at ≤ 1 month between 2010 and 2018 in our institution with an ASD ≥ 3 mm, without major congenital heart disease, and with repeat echocardiogram(s). Spontaneous resolution was defined as size diminution to < 3 mm or closure. We included 156 TNs (mean gestational age at birth 38.6 ± 1.4 weeks) and 156 PNs (29.6 ± 3.7 weeks) with a mean age at follow-up of 16 ± 19 and 15 ± 21 months, respectively (p = 0.76). Based on maximum color Doppler diameter, in TNs, ASD resolution occurred in 95% of small (3-5 mm), 87% of moderate (5.1-8 mm), and 60% of large (> 8 mm) defects; whereas, in PNs, resolution occurred in 79% of small, 76% of moderate, and 33% of large ASDs. There was a significant association between size and ASD resolution in TNs (p = 0.003), but not PNs (p = 0.17). Overall, ASD resolution rate was higher in TNs (89%) versus PNs (78%) (p = 0.009), and fewer TNs (1%) compared to PNs (7%) required ASD intervention (p = 0.02). Most ASDs identified in TNs and PNs spontaneously resolve. PNs, however, demonstrate lower ASD resolution and higher intervention rates within all size groups. These data should inform follow-up of affected neonates.
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Affiliation(s)
- Negar Heidari
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, WCMC, 8440 112th Street Edmonton, Alberta, T6G 2B7, Canada
| | - Kumar Kumaran
- Division of Neonatology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, Alberta, Canada
| | - Joseph J Pagano
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, WCMC, 8440 112th Street Edmonton, Alberta, T6G 2B7, Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, WCMC, 8440 112th Street Edmonton, Alberta, T6G 2B7, Canada.
- Department of Obstetrics & Gynecology, Lois Hole Hospital for Women, Royal Alexandra Hospital, University of Alberta, 10245 111th Street Edmonton, Alberta, T5G 0B6, Canada.
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Tanghöj G, Naumburg E. Risk factors for isolated atrial septal defect secundum morbidity. Sci Rep 2024; 14:4757. [PMID: 38413680 PMCID: PMC10899192 DOI: 10.1038/s41598-024-55446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 02/23/2024] [Indexed: 02/29/2024] Open
Abstract
Atrial septal defect secundum is a common type of congenital heart defect and even more common among children born premature. The aim of this study was to assess premature birth as a potential associated risk factors for cardiac morbidity in children with isolated ASD II. In this retrospective national registry-based case-control study all children born in Sweden between 2010 and 2015 with an isolated ASD II diagnosis were included. Association between premature birth and cardiac morbidity in children with isolated ASD II was assessed by different outcomes-models using conditional logistic regression and adjustments were made for confounding factors. Overall, 11% of children with an isolated ASD II received treatment for heart failure. Down syndrome was the only independent risk factors for associated with cardiac morbidity in children with ASD II (OR = 2.25 (95%CI 1.25-4.07). Preterm birth in children was not associated with an increased risk of ASD II cardiac morbidity.
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Affiliation(s)
- Gustaf Tanghöj
- Unit of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Estelle Naumburg
- Unit of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
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Faultersack J, Johnstad C, Zhang X, Greco M, Hokanson J. Follow-up of Secundum ASD, Muscular VSD, or PDA Diagnosed During Newborn Hospitalization. RESEARCH SQUARE 2024:rs.3.rs-3871102. [PMID: 38313288 PMCID: PMC10836113 DOI: 10.21203/rs.3.rs-3871102/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background The ideal follow-up of neonates who have a secundum atrial septal defect (ASD), muscular ventricular septal defect (VSD) or patent ductus arteriosus (PDA) remains uncertain. Methods Newborns with findings limited to a secundum ASD, muscular VSD and/or PDA on their last birth hospital echocardiogram and at least one outpatient follow-up echocardiogram performed between 9-1-17 and 9-1-21 were evaluated and patient follow-up assessed through 9-1-23. Results 95 babies met inclusion criteria. 43 babies had a secundum ASD, 41 had a muscular VSD and 54 had a PDA at newborn hospital discharge. 39/95 had more than one intracardiac shunt. 56 were discharged from care, 26 were still in follow-up and 13 were lost to recommended follow-up.No patients required intervention during the follow-up period of 2 to 6 years. Of those 43 with a secundum ASD 16 (37.2%) had demonstrated closure of the ASD and 13 (30.2%) were discharged from care with and ASD < 3.5 mm in diameter. 3/43 infants with secundum ASD had a defect large enough to easily warrant further follow-up. Conclusion Even in this group who had early clinical follow-up recommended by a pediatric cardiologist, no baby discharged from their birth hospitalization with a secundum ASD, muscular VSD or PDA needed any intervention from 2 to 6 years of follow-up. Ongoing follow-up with echocardiography of those infants with a secundum ASD is of greater value than of those with muscular VSD or PDA.
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Dawson-Gore CC, Well A, Wallace S, Teisberg E, Born C, Carberry K, Gottlieb E, Holt DB, Fraser CD, Mery CM. Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair. Cardiol Young 2024; 34:164-170. [PMID: 37309178 DOI: 10.1017/s1047951123001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points. METHODS From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability. RESULTS Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review. CONCLUSIONS Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.
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Affiliation(s)
- Catherine C Dawson-Gore
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery School of Medicine, University of Colorado, Anschutz Medical Campus, AuroraCO, USA
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | - Scott Wallace
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | - Elizabeth Teisberg
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | | | - Kathleen Carberry
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | - Erin Gottlieb
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
| | - Dudley Byron Holt
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, AustinTX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
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Holmes LB, Quinn M, Conant S, Lyons A, Hauser WA, Yerby M, Hernandez-Diaz S. Ascertainment of malformations in pregnancy registries: Lessons learned in the North American AED Pregnancy Registry. Birth Defects Res 2023; 115:1274-1283. [PMID: 37387678 DOI: 10.1002/bdr2.2188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Pregnancy registries, designed to assess the safety of medications and vaccines for the exposed mother and fetus, have been developed since the 1990s. Malformations present in the exposed liveborn or stillborn infant or fetuses in elective terminations are the outcome of greatest concern. The experiences of the North American AED (antiepileptic drug) Pregnancy Registry (NAAPR) can be used to identify the challenges and limitations of a pregnancy registry in identifying congenital malformations. METHODS The NAAPR enrolls pregnant women who are taking one or more AEDs for any medical condition, but primarily to prevent seizures, and an unexposed comparison group. Participants are interviewed by clinical research coordinators (CRCs) at enrollment, later in pregnancy and postpartum. Malformations are identified in the mother's reports and her infant's medical records through age 12 weeks. A teratologist, blinded to exposure status, evaluates each potential malformation identified. RESULTS Among 10,982 pregnancies enrolled between 1997 and 2022, 282 malformations were identified in the 9677 AED-exposed and 15 among the 1305 unexposed infants. Isolated malformations, such as cleft palate, accounted for 84% of the malformations identified. Increased frequencies of oral clefts and myelomeningocele were associated with exposure to several different AEDs. Copies of reports from many diagnostic studies were not obtained and very few pregnancy losses had autopsies. CONCLUSIONS The evaluation of the AED-exposed infants in a pregnancy registry is indirect. Improvements rely on the rapport established with the mothers by the CRCs and the mothers' willingness to assist in obtaining information from her infants' physicians.
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Affiliation(s)
- Lewis B Holmes
- North American AED (Antiepileptic Drug) Pregnancy Registry, Boston, Massachusetts, USA
- Medical Genetics and Metabolism Unit, Mass General for Children, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Moira Quinn
- North American AED (Antiepileptic Drug) Pregnancy Registry, Boston, Massachusetts, USA
| | - Susan Conant
- North American AED (Antiepileptic Drug) Pregnancy Registry, Boston, Massachusetts, USA
| | - Amy Lyons
- North American AED (Antiepileptic Drug) Pregnancy Registry, Boston, Massachusetts, USA
| | - W Allen Hauser
- Department of Neurology and Epidemiology, G. H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Mark Yerby
- North American AED (Antiepileptic Drug) Pregnancy Registry, Boston, Massachusetts, USA
| | - Sonia Hernandez-Diaz
- North American AED (Antiepileptic Drug) Pregnancy Registry, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Gaffar S, Siassi B, Cayabyab R, Ebrahimi M, Barton L, Uzunyan M, Ramanathan R. Outcomes of patent foramen ovale greater than 3 mm at birth in extremely low birthweight infants. BMC Pediatr 2023; 23:293. [PMID: 37322472 PMCID: PMC10268431 DOI: 10.1186/s12887-023-04119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Foramen ovale (FO) is an obligate fetal shunt that typically resolves after birth, although patency throughout life is not uncommon. The natural history of patent FO (PFO) is known in term infants, but less is known about its course in extremely preterm infants. We describe the echocardiographic changes in FO size from birth to discharge in extremely low birth weight (ELBW) infants in this retrospective study. METHODS Cohort was divided based on size of FO at birth. Size of FO at discharge was measured and evaluated relative to postnatal weight gain. Demographics and clinical outcomes were compared between the two groups. RESULTS Of the 54 ELBW infants, 50 were born with FO less than 3 mm in diameter (small), and 4 were born with FO greater than 3 mm (large). Of small defects, the majority (44/50, 88%) did not increase in size with weight gain, and minority (6/50, 12%) increased in size, and three of these 6 patients, FO grew to be slightly larger than 3 mm. In contrast, all large defects (4 of 4, 100%) nearly doubled in size with postnatal growth. These 4 ELBW infants with enlargement of FO had a flap valve evident on echocardiogram obtained prior to discharge, and subsequently closed on outpatient follow-up echocardiograms, although time to resolution was variable (6 months - 3 years). One infant had presumptive resolution because of the presence of flap valve. CONCLUSION No maternal or neonatal demographic characteristics were predictive of FO enlargement, although, demonstrable flap valve on discharge echocardiogram correlated with resolution of FO on outpatient follow-up echocardiogram. Therefore, based on our data, we recommend that ELBW infants born with large FO should have echocardiographic re-evaluation of the atrial septal opening prior to discharge, to specify the presence of a flap valve or lack thereof, which is an important detail that can help a neonatologist determine the need for outpatient cardiac follow-up.
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Affiliation(s)
- Sheema Gaffar
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA.
| | - Bijan Siassi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Rowena Cayabyab
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Mahmood Ebrahimi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Merujan Uzunyan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
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Goh E, Mohammed H, Salmasi MY, Ho S, Benedetto U, Caputo M, Angelini G, Vohra HA. Minimally invasive versus transcatheter closure of secundum atrial septal defects: a systematic review and meta-analysis. Perfusion 2022; 37:700-710. [PMID: 34109866 PMCID: PMC9500175 DOI: 10.1177/02676591211021935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to transcatheter (TC) closure of atrial septal defects (ASD). This systematic review and meta-analysis aims to compare post-operative outcomes of MIS versus TC repair in ASD closure. METHODS PubMed, Medline and EMBASE were searched from inception until June 2018 for randomised and observational studies comparing post-operative outcomes for MIS and TC repair. The studies were reviewed for bias using the ROBINS-I Score and pooled in a meta-analysis using STATA (version 15). RESULTS Six observational studies, involving 1524 patients assessing three primary and five secondary outcomes were included. Evidence suggests TC repair yielded shorter hospital stay (MD = 3.32, 95% CI 1.04-5.60) and lower rates of transient atrial fibrillation (AF) (RR = 0.48, 95% CI 0.20-1.15). TC repair patients also had fewer pericardial effusions (RR = 0.27, 95% CI 0.05-1.54, I2 = 0.0%) and pneumothoraxes (RR = 0.18, 95% CI 0.04-0.80, I2 = 0.0%). However, TC repair results in more minor residual shunts (RR = 6.04, 95% CI 1.69-21.63 in favour of MIS, I2 = 39.0%). No differences were found for incidences of strokes (RR = 1.58, 95% CI 0.23-10.91, I2 = 19.3%), unexpected bleeding (RR = 0.44, 95% CI 0.19-1.04, I2 = 0.0%) and blood transfusion (RR = 0.39, 95% CI 0.09-1.59, I2 = 0.0%). CONCLUSIONS MIS closure for ASD has similar outcomes compared to TC repair. However, the lack of randomised literature related to MIS versus TC repair for ASD closure warrants further evidence in the form of RCTs to further support these findings.
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Affiliation(s)
- Esther Goh
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Haya Mohammed
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | | | - Samantha Ho
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Massimo Caputo
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Gianni Angelini
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
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Jackson NW, Thomason JD, DiFazio MR, Hallman CC. Atrial septal defect in an Airedale terrier. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nathan W. Jackson
- Department of Clinical Sciences College of Veterinary Medicine Kansas State University Manhattan Kansas USA
| | - Justin D. Thomason
- Department of Clinical Sciences College of Veterinary Medicine Kansas State University Manhattan Kansas USA
| | - Matthew R. DiFazio
- Department of Clinical Sciences College of Veterinary Medicine Kansas State University Manhattan Kansas USA
| | - Clay C. Hallman
- Department of Clinical Sciences College of Veterinary Medicine Kansas State University Manhattan Kansas USA
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Hokanson JS, Ring K, Zhang X. A Survey of Pediatric Cardiologists Regarding Non-emergent Echocardiographic Findings in Asymptomatic Newborns. Pediatr Cardiol 2022; 43:837-843. [PMID: 34999921 DOI: 10.1007/s00246-021-02795-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
Echocardiography is often used to assess for significant heart disease in newborns, but there is little information on how to best manage non-emergent echocardiographic findings in asymptomatic babies. We reviewed the literature regarding the natural history of a patent foramen ovale (PFO), atrial septal defect (ASD), ventricular septal defect (PFO), and patent ductus arteriosus (PDA). We surveyed pediatric cardiologists to determine their recommendations for ten echocardiographic findings (PFO, 3 mm ASD, 6 mm ASD, small muscular VSD, small perimembranous VSD, small PDA with left to right shunting, small PDA with bidirectional shunting, trivial mitral insufficiency, trivial aortic insufficiency, and a normally functioning bicuspid aortic valve) in an asymptomatic one-day old with a heart murmur. These ten findings were set in three clinical contexts (an otherwise normal term baby, a baby born at 34 weeks gestation, and a term baby with trisomy 21). 149 survey responses were evaluated. Follow-up was universally recommended for those babies with a 6 mm ASD, a perimembranous VSD and a bicuspid aortic valve and frequently recommended for newborns with a 3 mm ASD, a small muscular VSD and any PDA. Depending on the context, between 17.5 and 23% of respondents recommended follow-up for an isolated PFO. Follow-up typically included repeat echocardiography. Some form of follow-up, typically with repeat echocardiography was recommended for many asymptomatic day-old newborns who had echocardiographic findings which were unlikely to be clinically significant. Given the wide range of recommendations, a consensus guideline could prove useful to clinicians.
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Affiliation(s)
- John S Hokanson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/516c, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Kaitlin Ring
- Department of Agricultural Sciences, University of Wisconsin-Madison, Madison, USA
| | - Xiao Zhang
- Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/516c, 600 Highland Ave, Madison, WI, 53792, USA
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Lim SC, Kwak JG, Cho S, Min J, Lee S, Kwon HW, Kim WH. Outcomes of the Warden Procedure for Anomalous Pulmonary Venous Return to the Superior Vena Cava: A 17-Year Experience. J Chest Surg 2022; 55:206-213. [PMID: 35292601 PMCID: PMC9178303 DOI: 10.5090/jcs.21.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Surgical repair of partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) using the Warden procedure has favorable outcomes. However, there remain some concerns after the Warden procedure, such as sinoatrial nodal dysfunction and systemic or pulmonary venous stenosis. We investigated the outcomes of the Warden procedure for repair of PAPVR to the SVC. Methods This retrospective study included 22 consecutive patients who underwent the Warden procedure for PAPVR between 2002 and 2018. The median age and body weight at operation were 27.5 months (interquartile range [IQR], 5.0–56.8 months) and 13.2 kg (IQR, 6.5–16.0 kg), respectively. The median follow-up duration was 6.2 years (IQR, 3.5–11.6 years). Results There were no cases of early or late mortality. No patients had postoperative heart rhythm problems, except 1 patient who showed transient sinoatrial nodal dysfunction in the immediate postoperative period. Procedure-related complications requiring reintervention occurred in 5 patients, including 3 of 4 SVC stenosis cases and 2 pulmonary venous stenosis cases during follow-up. The rate of freedom from reintervention related to the Warden procedure was 75.9% at 10 years. Conclusion In cases requiring extension or creation of an atrial septal defect to achieve a sufficient venous pathway, or interposition of an entire circumferential conduit between the SVC and right atrium due to the shortness of the SVC in the Warden procedure, stenotic complications of the venous pathway occurred. Careful observation of changes in the pressure gradient or anatomical stenosis is required in such patients.
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Affiliation(s)
- Su Chan Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jooncheol Min
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sangjun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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11
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Maternal Smoking and Congenital Heart Defects, National Birth Defects Prevention Study, 1997-2011. J Pediatr 2022; 240:79-86.e1. [PMID: 34508749 PMCID: PMC8712361 DOI: 10.1016/j.jpeds.2021.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring. STUDY DESIGN We performed a retrospective case-control study using data for cases of CHD (n = 8339) and nonmalformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% CIs. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity. RESULTS Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers ≥35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9). CONCLUSIONS Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.
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Abstract
The most common CHD in the adult patient population is an atrial septal defect due to its asymptomatic nature in early life. However, when diagnosis and treatment are delayed, pulmonary arterial hypertension may develop as a long-term complication, sometimes before adulthood. The presence of PAH adversely affects the results of surgical treatment and may even eliminate the feasibility of surgery in some patients. In such patients who have high pulmonary artery pressure and pulmonary vascular resistance at the margin of inoperability, the response to the acute vasoreactivity test determines the treatment modality.In our retrospective study, a total of 906 patients who underwent ASD closure between January, 2011 and November, 2020, seven of which had undergone the fenestrated patch procedure after they were identified to have high PAP, but positive AVT test response were included. Short-term follow-up of patients with fenestrated ASD patches revealed decreased pulmonary pressure, regression in NYHA classification, and improvement in symptoms.The fenestrated patch technique should be kept in mind as an option to expand the surgical spectrum in the treatment of patients with high pulmonary pressures, where complete closure is risky. It appears that the fenestrated patch technique is a safe approach in the management of pulmonary hypertension in patients with ASD who have pulmonary hypertension, according to short- and midterm follow-up findings.
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Allen JW, Phipps KL, Llamas AA, Barrett KA. Left atrial decompression as a palliative minimally invasive treatment for congestive heart failure caused by myxomatous mitral valve disease in dogs: 17 cases (2018-2019). J Am Vet Med Assoc 2021; 258:638-647. [PMID: 33683957 DOI: 10.2460/javma.258.6.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether left atrial decompression (LAD) would reduce left atrial pressure (LAP) in dogs with advanced myxomatous mitral valve disease (MMVD) and left-sided congestive heart failure (CHF) and to describe the LAD procedure and hemodynamic alterations and complications. ANIMALS 17 dogs with advanced MMVD and left-sided CHF that underwent LAD. PROCEDURES The medical record database was retrospectively reviewed for all LAD procedures attempted in dogs with MMVD and left-sided CHF between October 2018 and June 2019. Data were collected regarding signalment (age, breed, weight, and sex), clinical signs, treatment, physical examination findings, and diagnostic testing before and after LAD. Procedural data were also collected including approach, technique, hemodynamic data, complications, and outcome. RESULTS 18 LAD procedures performed in 17 patients were identified. Dogs ranged in age from 7.5 to 16 years old (median, 11 years) and ranged in body weight from 2.9 to 11.6 kg (6.4 to 25.5 lb) with a median body weight of 7.0 kg (15.4 lb). Minimally invasive creation of an atrial septal defect for the purpose of LAD was successful in all dogs without any intraoperative deaths. Before LAD, mean LAP was elevated and ranged from 8 to 32 mm Hg with a median value of 14 mm Hg (reference value, < 10 mm Hg). Following LAD, there was a significant decrease in mean LAP (median decrease of 6 mm Hg [range, 1 to 15 mm Hg]). Survival time following LAD ranged from 0 to 478 days (median, 195 days). CONCLUSIONS AND CLINICAL RELEVANCE For dogs with advanced MMVD and left-sided CHF, LAD resulted in an immediate and substantial reduction in LAP.
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Ishikawa T, Uchiyama H, Baba T, Ohishi A, Iijima S, Iwashima S. The association between congenital heart disease and small for gestational age with regard to the prevalence and outcomes. Acta Paediatr 2021; 110:1009-1016. [PMID: 32969529 DOI: 10.1111/apa.15587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/04/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the association between small for gestational age (SGA) and the prevalence of congenital heart disease (CHD) and the association of the SGA status with the outcomes among infants with CHD. METHODS Echocardiography was performed within the first 5 days of life in 5664 consecutive infants. Infants were classified into four groups according to the presence or absence of SGA and CHD. All CHD infants were followed up until either spontaneous resolution of all cardiac lesions, invasive intervention or death. All newborns without CHD were followed for mortality until the final follow-up date. RESULTS A total of 303 infants were diagnosed with CHD, while 610 were diagnosed with SGA. Among the CHD infants, 56 were SGA, and 247 were not. A multivariable logistic regression analysis showed that the adjusted odds ratio of SGA (9.71, P < .001) was significantly higher than that of other parameters concerning predictors of invasive intervention or death. The mortality rate in the presence of both SGA and CHD (hazard ratio: 33.6, P < .001) was markedly higher than in the absence of both. CONCLUSION SGA was a significant predictor of invasive intervention for CHD. The combination of CHD and SGA carried a high risk of death beyond that of either alone.
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Affiliation(s)
- Takamichi Ishikawa
- Department of Pediatrics Hamamatsu University School of Medicine Hamamatsu Japan
| | - Hiroki Uchiyama
- Department of Pediatrics Hamamatsu University School of Medicine Hamamatsu Japan
| | - Toru Baba
- Department of Pediatrics Hamamatsu University School of Medicine Hamamatsu Japan
| | - Akira Ohishi
- Department of Pediatrics Hamamatsu University School of Medicine Hamamatsu Japan
| | - Shigeo Iijima
- Department of Pediatrics Hamamatsu University School of Medicine Hamamatsu Japan
| | - Satoru Iwashima
- Department of Pediatrics Hamamatsu University School of Medicine Hamamatsu Japan
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Guslits E, Steurer MA, Nawaytou H, Keller RL. Reply. J Pediatr 2021; 229:312-313. [PMID: 33197491 DOI: 10.1016/j.jpeds.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Elyssa Guslits
- Department of Pediatrics, Critical Care, University of California San Francisco, San Francisco, California
| | - Martina A Steurer
- Department of Pediatrics, Critical Care, University of California San Francisco, San Francisco, California
| | - Hythem Nawaytou
- Department of Pediatrics, Cardiology, University of California San Francisco, San Francisco, California
| | - Roberta L Keller
- Department of Pediatrics, Neonatology, University of California San Francisco, San Francisco, California
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16
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Rohatgi RK, Qureshi MY, Taggart NW. Limited Utility of Surveillance Echocardiograms in Pediatric Patients with Isolated Secundum Atrial Septal Defects. J Am Soc Echocardiogr 2020; 34:197-199. [PMID: 33188870 DOI: 10.1016/j.echo.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Ram K Rohatgi
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - M Yasir Qureshi
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Nathaniel W Taggart
- Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
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Cao C, Li R, Huang J, Zhao Y, Wang Z, Xie Y, Wang S, Zhou R, Lin D, Fan L, Wei X, Zhang Z. Feasibility of Transcatheter Closure of Secundum Atrial Septal Defect in Low Weight Infants Under 2-Year-Old from a 3-year Retrospective Cohort Study. Am J Cardiol 2020; 132:133-139. [PMID: 32753269 DOI: 10.1016/j.amjcard.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/01/2022]
Abstract
We aimed to evaluate the feasibility of interventional treatment of atrial septal defect (ASD) in low weight infants under 2-year-old. Seven hundred and ninety-three secundum ASD patients were divided into 2 groups: 665 were above 2-year-old and 128 were under 2-year-old. The basic conditions before the operation, postoperative complications within 24 hours, and adverse outcomes during a three-year follow-up were compared between the 2 groups using multivariate analysis. There were significant differences in age, weight, and the diameter of the ASD between the 2 groups (p <0.001). The immediate success rate of the procedure was 96.7%. There were no significant differences in the success rate of the procedure, the incidence of residual shunt, arrhythmia, procedure-related arrhythmia, and occluder shedding between 2 groups (p >0.05). Similarly, we found no association between age ≤2-year-old and any adverse outcomes postprocedure within 24 hours, including procedure failure (OR = 0.35; 95%CI: 0.04 to 2.93), residual shunt (OR = 1.07; 95%CI: 0.54 to 2.14), arrhythmia (OR = 0.68; 95%CI: 0.32 to 1.43), or procedure-related arrhythmia (OR = 0.34; 95%CI: 0.04 to 2.87). In the follow-up data, we found no association between age ≤2-year-old and arrhythmia (HR = 0.95; 95%CI: 0.50 to 1.80) and procedure-related arrhythmia (HR = 0.96;95%CI:0.25 to 3.64). Kaplan-Meier survival curves indicated no significant difference in the occurrence of arrhythmia between the 2 groups (log-rank test: p = 0.776). In conclusion, percutaneous ASD closure in young and low weight infants has a high success and low complication rate, along with reliable effects.
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Affiliation(s)
- Chunhui Cao
- Department of Cardiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Ren Li
- Department of Cardiology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Jun Huang
- Department of Emergency Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Yaqin Zhao
- Department of Cardiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Zhonghua Wang
- Department of Cardiology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Yumei Xie
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, China
| | - Shushui Wang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, China
| | - Rong Zhou
- Department of Cardiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Dongxin Lin
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Lingxia Fan
- Department of Cardiology, Chengdu Women's & Children's Central Hospital, Qingyang District, Chengdu, China
| | - Xianglong Wei
- Department of Cardiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China.
| | - Zhiwei Zhang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, China.
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Abstract
Left-to-right shunts represent a significant portion of congenital heart disease. Such lesions are common in isolation, but are frequently seen in conjunction with other, often more complex, congenital heart disease. This review covers basic anatomy, physiology, physical examination findings, diagnosis and management for atrial septal defects, ventricular septal defects, and patent ductus arteriosa.
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Affiliation(s)
- Dale A Burkett
- Division of Pediatric Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, Aurora, CO, USA.
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19
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Alkashkari W, Albugami S, Hijazi ZM. Current practice in atrial septal defect occlusion in children and adults. Expert Rev Cardiovasc Ther 2020; 18:315-329. [PMID: 32441165 DOI: 10.1080/14779072.2020.1767595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Atrial septal defect (ASD) is one of the most common congenital heart diseases (CHD) in children and adults. This group of malformations includes several types of atrial communications allowing shunting of blood between the systemic and the pulmonary circulations. Early diagnosis and treatment carries favorable outcomes. Patients diagnosed during adulthood often present with complications related to longstanding volume overload such as pulmonary artery hypertension (PAH), atrial dysrhythmias, and right (RV) and left (LV) ventricular dysfunction. AREA COVERED This article intended to review all aspects of ASD; anatomy, pathophysiology, clinical presentation, natural history, and indication for treatment. Also, we covered the transcatheter therapy in detail, including the procedural aspect, available devices, and outcomes. EXPERT OPINION There has been a remarkable improvement in the treatment strategy of ASD over the last few decades. Transcatheter closure of ASD is currently accepted as the treatment of choice in most patients with appropriately selected secundum ASDs. This review will focus on the most recent advances in diagnosis and treatment strategy of secundum ASD.
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Affiliation(s)
- Wail Alkashkari
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affairs , Jeddah, Saudi Arabia.,Department of Postgraduate, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia.,Department of Medical Research, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia
| | - Saad Albugami
- Department of Postgraduate, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Ziyad M Hijazi
- Sidra Heart Center, Sidra Medicine , Doha, Qatar.,Weill Cornell Medicine , New York, NY, USA
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20
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Abstract
BACKGROUND There is variation in care of secundum atrial septal defects. Defects <3 mm and patent foramen ovale are not clinically significant. Defects >3 mm are often followed clinically and may require closure. Variation in how these lesions are monitored may result in over-utilisation of routine studies and higher than necessary patient charges. PURPOSE To determine utilisation patterns for patients with secundum atrial septal defects diagnosed within the first year of life and compare to locally developed optimal utilisation standard to assess charge savings. METHODS This was a retrospective chart review of patients with secundum atrial septal defects diagnosed within the first year of life. Patients with co-existing cardiac lesions were excluded. Total number of clinic visits, electrocardiograms, and echocardiograms were recorded. Total charge was calculated based on our standard institutional charges. Patients were stratified based on lesion and provider type and then compared to "optimal utilisation" using analysis of variance statistical analysis. RESULTS Ninety-seven patients were included, 40 had patent foramen ovale (or atrial septal defect <3 mm), 43 had atrial septal defects not requiring intervention and 14 had atrial septal defects requiring intervention. There was a statistically significant difference in mean charge above optimal for these lesions of $1033, $2885, and $5722 (p < 0.02), respectively. There was statistically significant variation of charge among types of provider as well. Average charge savings per patient would be $2530 with total charge savings of $242,472 if the optimal utilisation pathway was followed. CONCLUSION Using optimal utilisation and decreasing variation could save the patient significant unnecessary charges.
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21
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Tobler D, Greutmann M. Simple cardiac shunts in adults: atrial septal defects, ventricular septal defects, patent ductus arteriosus. Heart 2020; 106:307-314. [DOI: 10.1136/heartjnl-2019-314700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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22
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Allen J, Peterson N, Barrett K, Llamas A. Graded balloon atrial septostomy for palliation of congenital pulmonary hypertension in a dog: A case report. J Vet Intern Med 2019; 34:283-288. [PMID: 31769097 PMCID: PMC6979104 DOI: 10.1111/jvim.15666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/10/2019] [Indexed: 12/29/2022] Open
Abstract
CASE DESCRIPTION A 6-month-old intact female Maltese dog was presented for acute onset of syncope. CLINICAL FINDINGS The dog was presented for collapse upon excitement and exercise. It collapsed at discharge and suffered cardiopulmonary arrest. Echocardiography after resuscitation indicated severe pulmonary hypertension without evidence of intracardiac or extracardiac shunting. A presumptive diagnosis of congenital pulmonary hypertension was made. TREATMENT AND OUTCOME Initial treatment with sildenafil was effective at relieving syncope, but the extent of pulmonary hypertension as determined by serial echocardiography was unchanged. Graded balloon atrial septostomy was performed as a palliative procedure. Follow-up echocardiography identified a patent interatrial communication with bidirectional shunting. The dog remained asymptomatic 18 months after treatment. CLINICAL RELEVANCE To the best of our knowledge, this study is the first report in the veterinary literature of graded balloon atrial septostomy performed for therapeutic purposes. Further studies are required to determine if this palliative procedure is a beneficial treatment option for dogs with congenital or severe refractory pulmonary hypertension.
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Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children. Cardiol Young 2019; 29:626-636. [PMID: 31159892 DOI: 10.1017/s1047951119000350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children. METHOD We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children's hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan-Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson's method. RESULTS Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92). CONCLUSION Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.
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Mojadidi MK, Mahmoud AN, Mahtta D, Zaman MO, Elgendy IY, Elgendy AY, Agarwal N, Patel NK, Gertz ZM, Wayangankar SA, Lew DC, Jneid H, Don CW, Meier B, Tobis JM. Incidence and Causes of 30-day Readmissions after Surgical Versus Percutaneous Secundum Atrial Septal Defect Closure: A United States Nationwide Analysis. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2018.1559963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Mohammad K. Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ahmed N. Mahmoud
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dhruv Mahtta
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Muhammad O. Zaman
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Islam Y. Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Akram Y. Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nayan Agarwal
- Interventional Cardiology, Cardiovascular Institute of the South, Houma, Louisiana, USA
| | - Nimesh K. Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M. Gertz
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Siddharth A. Wayangankar
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - David C. Lew
- Florida Heart and Vascular Center, Leesburg, Florida, USA
| | - Hani Jneid
- Division of Cardiology and Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Creighton W. Don
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Jonathan M. Tobis
- Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
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O'Byrne ML, Levi DS. State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart. Interv Cardiol Clin 2018; 8:11-21. [PMID: 30449418 DOI: 10.1016/j.iccl.2018.08.008] [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] [Indexed: 12/21/2022]
Abstract
This article describes current devices and indications for transcatheter device closure of atrial septal defect (TC-ASD) and patent foramen ovale in children and young adults. TC-ASD has a proven record of efficacy and safety, but device erosion raises questions about the relative safety of TC-ASD versus operative open heart surgical ASD closure. New devices for ASD closure with properties to reduce risk of erosion are being developed. Recent studies demonstrating superiority of patent foramen ovale device closure over medical therapy for cryptogenic stroke may lead to changes in practice for structural/interventional cardiologists. Care should be taken in extrapolating data to children and younger adults.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Center for Pediatric Clinical Effectiveness, Leonard Davis Institute, University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Daniel S Levi
- Division of Cardiology, UCLA Mattel Children's Hospital, University of California Los Angeles Medical School, 200 UCLA Medical Plaza #330, Los Angeles, CA 90095, USA
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Le Gloan L, Legendre A, Iserin L, Ladouceur M. Pathophysiology and natural history of atrial septal defect. J Thorac Dis 2018; 10:S2854-S2863. [PMID: 30305945 DOI: 10.21037/jtd.2018.02.80] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Atrial septal defects are among the third most common types of congenital heart disease. This group of malformations includes several types of atrial communications allowing shunting of blood between the systemic and the pulmonary circulations. The nature of shunting across the defect in patients with atrial septal defect is of particular interest. Understanding the underlying mechanisms of interatrial shunts and their natural history will help selecting the best timing for closure, before irreversible cardiac and pulmonary injury occur. This review describes the different pathophysiologic mechanisms involved in the direction and magnitude of blood flow through atrial septal defects. The natural history of an individual born with an isolated atrial septal defect is then discussed, including the impact of a longstanding shunt on survival.
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Affiliation(s)
- Laurianne Le Gloan
- Department of Cardiology, Adult Congenital Heart Disease. Institut du thorax, CHU de Nantes, Université de Nantes, boulevard Jacques Monod, Saint-Herblain, France
| | - Antoine Legendre
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Laurence Iserin
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Magalie Ladouceur
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France.,INSERM U970, PARCC, Paris Descartes University, Sorbonne Paris Cité, Paris, France
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27
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Wang SY, Welch TD, Elfenbein A, Kaplan AV. Spontaneous Closure of a Secundum Atrial Septal Defect. Methodist Debakey Cardiovasc J 2018; 14:60-62. [PMID: 29623173 DOI: 10.14797/mdcj-14-1-60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Spontaneous closure of an atrial septal defect (ASD) is well described in pediatric cardiology but may be less familiar to adult internists and cardiologists. We report a moderately sized 6-mm ASD that closed spontaneously without intervention. A literature review found that a smaller defect size and an early age of diagnosis are the most important predictors of closure. Possible mechanisms of a spontaneous ASD closure include adaptive endothelial migration, limited myocardial proliferation, and fibroblast migration with extracellular matrix deposition.
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Affiliation(s)
- Stephen Y Wang
- aGEISEL SCHOOL OF MEDICINE AT DARTMOUTH, HANOVER, NEW HAMPSHIRE
| | | | - Aryé Elfenbein
- bYALE UNIVERSITY SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT.,cUNIVERSITY OF CALIFORNIA, SAN FRANCISCO, SAN FRANCISCO, CALIFORNIA
| | - Aaron V Kaplan
- aGEISEL SCHOOL OF MEDICINE AT DARTMOUTH, HANOVER, NEW HAMPSHIRE
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O’Byrne ML, Glatz AC, Gillespie MJ. Transcatheter device closure of atrial septal defects: more to think about than just closing the hole. Curr Opin Cardiol 2018; 33:108-116. [PMID: 29076870 PMCID: PMC6112166 DOI: 10.1097/hco.0000000000000476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review current controversies in the transcatheter device closure of ostium secundum atrial septal defects (ASD). RECENT FINDINGS Transcatheter device closure of ASD (TC-ASD) has well established efficacy and safety. For most individual patients with suitable anatomy, TC-ASD is the preferred method for treating ASD. The availability of large multicenter data sets has made it possible to study practice patterns at a range of hospitals across the United States. These studies have revealed differences in practice that were not previously appreciated. Interpretation of the indications for TC-ASD, specifically the definition of right ventricular volume overload varies between hospitals. In response to concern about device erosion, an increasing proportion of patients are being referred for operative ASD closure. Over the last decade, the average age at which ASD closure occurs has decreased. These trends demonstrate previously underappreciated differences in opinion between cardiologists across the country and suggest that further research is necessary to address knowledge gaps limiting consistency of practice. SUMMARY As TC-ASD and congenital interventional cardiology mature as a field, studies of real-world practice provide increasingly valuable information about aspects of care in which there are disagreements about best practices and in which further research is necessary.
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Affiliation(s)
- Michael L O’Byrne
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
- Center for Pediatric Clinical Effectiveness and Cardiac Center Research Core, The Children’s Hospital of Philadelphia, Philadelphia PA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
- Center for Pediatric Clinical Effectiveness and Cardiac Center Research Core, The Children’s Hospital of Philadelphia, Philadelphia PA
| | - Matthew J Gillespie
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
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Geggel RL. Clinical Detection of Hemodynamically Significant Isolated Secundum Atrial Septal Defect. J Pediatr 2017; 190:261-264.e1. [PMID: 28918881 DOI: 10.1016/j.jpeds.2017.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/09/2017] [Accepted: 07/19/2017] [Indexed: 10/18/2022]
Abstract
The diagnosis of secundum atrial septal defect often is delayed. For 310 patients with hemodynamically significant secundum atrial septal defect undergoing closure over a 5-year period at a single medical center, this study reviews the symptoms prompting referral, limitations of physical examination and electrocardiography, and basis for initially missing the diagnosis.
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Affiliation(s)
- Robert L Geggel
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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Abstract
BACKGROUND The prevalence of CHD has been well described worldwide except in Tibet. This study aimed to illustrate the prevalence and composition of CHD in Tibetan children according to altitude. Methods and results In the first part, we prospectively recruited 7088 unselected Tibetan children (4-17 years) from south-west Tibet. The total prevalence of CHD increased from 4.6/1000 below 4200 m to 13.4/1000 above 4700 m, with a female-to-male ratio of 1.3:3.1. The total prevalence and female prevalence of patent ductus arteriosus increased more than 10-fold. Females living above 4700 m had exceptionally high prevalence of patent ductus arteriosus (14.9/1000). The prevalence of atrial septal defect was comparable among different altitudes (3.3-3.8/1000). The prevalence of ventricular septal defect was 1.3/1000 below 4700 m, and no cases were found above this altitude. In the second part, we retrospectively reviewed the clinical data of 383 CHD children in Tibet and 73 children at lower altitudes. The percentage of isolated ventricular septal defect decreased from 54.8 to 3.1%, and the percentage of isolated patent ductus arteriosus increased from 8.2 to 68.4% with elevation. Children living below 4200 m (10.4-13.7%) had a larger proportion of complex CHD than those above this altitude (2.0-3.1%). Of the 20 Tibetan children with complex CHD, 14 (70.0%) lived below 4200 m. CONCLUSIONS A wide variation in CHD prevalence and composition existed in Tibetan children among different altitudes.
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Thomas EG, Higgins C, Westgate MN, Lin AE, Anderka M, Holmes LB. Malformations Surveillance: Comparison between Findings at Birth and Age 1 Year. Birth Defects Res 2017; 110:142-147. [PMID: 28796462 DOI: 10.1002/bdr2.1096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/07/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Malformations surveillance programs among newborn infants are used to determine the prevalence of congenital anomalies. A comparison in the same group of infants between the malformations detected at birth and those detected at 1 year of age will identify errors in the surveillance process and, also, the abnormalities more likely not to be detected at birth, but later in the first year of life. METHODS The malformations identified at birth by Brigham and Women's Hospital (BWH) in the years 2000 and 2005 have been compared with the abnormalities detected in the same infants up to age 1 year by the Massachusetts Birth Defects Monitoring Program. RESULTS The Massachusetts Birth Defects Monitoring Program identified 557 malformed infants in 2000 and 415 in 2005. Of these, 34 (3.5%) of the malformed infants were missed at birth by BWH Surveillance Program. An additional 22 (2.3%) malformed infants had delayed detection, as they were identified later in the first year. The reasons were the fact that: (1) the Surveillance staff reviewed the physicians' recorded findings only on the first day of life; (2) failure of the examining pediatrician to record the presence of a malformation in her/his notes. The most common abnormalities with delayed detection were mild heart defects, such as atrial septal defects. CONCLUSION These findings emphasize the importance in a newborn malformations surveillance program of continued follow up in the first days of life, especially in small, premature infants. Birth Defects Research 110:142-147, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Emma G Thomas
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Cathleen Higgins
- The Birth Defects Monitoring Program, Massachusetts Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health, Boston, Massachusetts
| | - Marie-Noel Westgate
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Angela E Lin
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts.,The Birth Defects Monitoring Program, Massachusetts Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Marlene Anderka
- The Birth Defects Monitoring Program, Massachusetts Center for Birth Defects Research and Prevention at the Massachusetts Department of Public Health, Boston, Massachusetts
| | - Lewis B Holmes
- Active Malformations Surveillance Program, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Diav-Citrin O, Shechtman S, Zvi N, Finkel-Pekarsky V, Ornoy A. Is it safe to use lamotrigine during pregnancy? A prospective comparative observational study. Birth Defects Res 2017; 109:1196-1203. [DOI: 10.1002/bdr2.1058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/13/2017] [Accepted: 04/24/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Orna Diav-Citrin
- The Israeli Teratology Information Service, Israel Ministry of Health; Jerusalem
- The Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Svetlana Shechtman
- The Israeli Teratology Information Service, Israel Ministry of Health; Jerusalem
| | - Naama Zvi
- The Israeli Teratology Information Service, Israel Ministry of Health; Jerusalem
| | | | - Asher Ornoy
- The Hebrew University Hadassah Medical School; Jerusalem Israel
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Refaei M, Islam S, Mackie AS, Atallah J. Correlation of electrocardiogram parameters and hemodynamic outcomes in patients with isolated secundum atrial septal defects. Ann Pediatr Cardiol 2017; 10:152-157. [PMID: 28566823 PMCID: PMC5431027 DOI: 10.4103/0974-2069.205139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The characteristic rSR' pattern in lead V1 on electrocardiogram (ECG) has been described in association with atrial septal defect (ASD) and right ventricular dilation. We aimed to determine if temporal ECG changes can guide a more discriminate and cost-effective screening during follow-up of isolated secundum ASD. METHODS Our study population included all pediatric patients followed at the Stollery Children's Hospital with a secundum ASD, not associated with other significant heart disease, between 2004 and 2010. We collected clinical as well as serial echocardiographic and ECG data. RESULTS We identified 141 patients with ASD, 95% were asymptomatic and 88% referred for a murmur. Moderate-to-large (>5 mm) ASDs were present in 52%. The prevalence of an rSR' pattern was 26% in the overall cohort and 54% in the large ASD group. During median follow-up of 28.7 months, 37 patients underwent surgical or transcatheter closure. Among patients with rSR' on ECG, 78% had moderate-to-large ASD size. In that group, the presence versus the absence of rSR' correlated with lower positive predictive value (PPV) for spontaneous closure (7% vs. 36%; P = 0.01) and higher PPV for device or surgical closure (71% vs. 38%; P = 0.02). CONCLUSION We observed a lower prevalence of rSR' pattern in patients with isolated ASD than previously reported. However, an rSR' pattern had incremental value in predicting the need for surgical or device intervention for closure in moderate-large groups. This can be used to tailor patient echocardiographic screening and caregiver counseling.
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Affiliation(s)
- Mohammad Refaei
- Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Sunjidatul Islam
- Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.,Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew S Mackie
- Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.,Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Atallah
- Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.,Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Baruteau AE, Hascoët S, Fraisse A. Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children. J Thorac Dis 2017; 9:1247-1256. [PMID: 28616275 DOI: 10.21037/jtd.2017.04.47] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND 2D-transesophageal echocardiography (TEE) is routinely performed to guide percutaneous ASD closure in children. We aimed to assess whether two-dimensional (2D)-transthoracic echocardiography (TTE) is a safe alternative for assessment and guidance of atrial septal defect (ASD) closure in unselected children. METHODS We performed a retrospective single-center study including 389 consecutive children aged less than 15-year-old who underwent percutaneous ASD closure under 2D-TEE (1998-2005, n=133) or 2D-TTE (2005-2014, n=256). A balloon calibration was performed in all cases for the Amplatz Septal Occluder choice. RESULTS ASDs were larger and rims deficiencies were more frequent in the TTE-guided group. The procedure was successful in 376 patients [96.7%; 95% confidence interval (CI), 94.4-98.2%]. The success rate tended to be higher in the TTE- versus TEE-guided group (98.0% versus 94.0%, P=0.069). Device migration occurred in 4 patients (1.0%; 95% CI: 0.3-1.6%), all after TEE-guided procedure (P=0.013). Early major adverse events were observed in 5 patients (1.3%; 95% CI: 0.4-3.0%), all in the TEE group (P=0.004). Fluroroscopic time and irradiation dose were not different among the 2 groups (P=0.450 and P=0.130 respectively). After a median follow-up of 7 years (range, 1-16 years), no adverse events was reported. One (0.3%, 95% CI: 0-1.4%) 12-year-old patient developed atrial fibrillation 5 years after the procedure. Pregnancies were uneventful in 72 cases. CONCLUSIONS When a balloon sizing is performed, 2D-TTE imaging is as efficient as 2D-TEE to guide percutaneous ASD closure in children. The procedure can safely be done in spontaneously breathing children under TTE guidance alone in experienced centers.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Sébastien Hascoët
- Department of Paediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris Sud University, Paris, France
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, UK
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Cavalcanti DD, Alves LV, Furtado GJ, Santos CC, Feitosa FG, Ribeiro MC, Menge P, Lira IM, Alves JG. Echocardiographic findings in infants with presumed congenital Zika syndrome: Retrospective case series study. PLoS One 2017; 12:e0175065. [PMID: 28426680 PMCID: PMC5398518 DOI: 10.1371/journal.pone.0175065] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/20/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To report the echocardiographic evaluation of 103 infants with presumed congenital Zika syndrome. Methods An observational retrospective study was performed at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil. 103 infants with presumed congenital Zika syndrome. All infants had microcephaly and head computed tomography findings compatible with congenital Zika syndrome. Zika IgM antibody was detected in cerebrospinal fluid samples of 23 infants. In 80 infants, the test was not performed because it was not available at that time. All infants had negative serology for HIV, syphilis, rubella, cytomegalovirus and toxoplasmosis. A complete transthoracic two-dimensional, M-mode, continuous wave and pulsed wave Doppler and color Doppler echocardiographic (PHILIPS HD11XE or HD15) examination was performed on all infants. Results 14/103 (13.5%) echocardiograms were compatible with congenital heart disease: 5 with an ostium secundum atrial septal defect, 8 had a hemodynamically insignificant small apical muscular ventricular septal defect and one infant with dyspnea had a large membranous ventricular septal defect. The echocardiograms considered normal included 45 infants with a persistent foramen ovale and 16 with a minimum patent ductus arteriosus. Conclusions Preliminarily this study suggests that congenital Zika syndrome may be associated with an increase prevalence of congenital heart disease. However the types of defects noted were septal defects, a proportion of which would not be hemodynamically significant.
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Affiliation(s)
- Danielle Di Cavalcanti
- Department of Pediatrics, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Lucas V. Alves
- Department of Pediatrics, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Geraldo J. Furtado
- Department of Pediatrics, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Cleusa C. Santos
- Department of Pediatric Cardiology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Fabiana G. Feitosa
- Department of Pediatric Cardiology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Maria C. Ribeiro
- Department of Pediatric Cardiology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Paulo Menge
- Department of Pediatric Cardiology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Izabelle M. Lira
- Department of Pediatric Cardiology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
| | - Joao G. Alves
- Department of Pediatric Cardiology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
- * E-mail:
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Ass. Prof. Dr. Andreas Hanslik ist Researcher of the Month Dezember 2016. Wien Klin Wochenschr 2016; 128:930-931. [PMID: 27924455 DOI: 10.1007/s00508-016-1151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Iwashima S, Ishikawa T, Itoh H. Reproductive technologies and the risk of congenital heart defects. HUM FERTIL 2016; 20:14-21. [DOI: 10.1080/14647273.2016.1254352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Satoru Iwashima
- Department of Pediatrics, Chutoen General Medical Center, Kakegawa City, Japan
| | - Takamichi Ishikawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Wyss Y, Quandt D, Weber R, Stiasny B, Weber B, Knirsch W, Kretschmar O. Interventional Closure of Secundum Type Atrial Septal Defects in Infants Less Than 10 Kilograms: Indications and Procedural Outcome. J Interv Cardiol 2016; 29:646-653. [DOI: 10.1111/joic.12328] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yves Wyss
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
| | - Daniel Quandt
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Roland Weber
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Brian Stiasny
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Benedikt Weber
- Clinic for Cardiovascular Surgery; University Hospital of Zurich; Zurich Switzerland
| | - Walter Knirsch
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Oliver Kretschmar
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
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Idilman IS, Ipek A, Balaban M, Keskin HL, Aypar E, Ozkutlu S. Fetal aorta larger than the main pulmonary artery on the three-vessel view: Correlation with postnatal echocardiographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:423-428. [PMID: 26990555 DOI: 10.1002/jcu.22353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/14/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE This study investigated postnatal cardiac anomalies determined by postnatal echocardiography in fetuses with the ascending aorta (AA) diameter larger than that of the main pulmonary artery (MPA) on the three-vessel view (3VV). METHODS The study included 17 pregnancies. The diameters of the AA and MPA were assessed on the 3VV in second-trimester sonographic screening, and all the patients underwent postnatal echocardiography to assess the cardiac outcome. RESULTS In the study population, the mean AA diameter was 3.7 mm (range, 2.2-5.6 mm), and the mean MPA diameter was 3.2 mm (range, 1.8-5.2 mm). The mean AA/MPA ratio was 1.2 (range, 1.1-1.9). According to the postnatal echocardiograms, one of the patients had tetralogy of Fallot. This patient had the highest prenatal AA/MPA ratio (1.9). Among the remaining 16 cases, five had secundum atrial septal defects, with two having concomitant dilatation of the AA. There was one case of isolated dilatation of the AA. CONCLUSIONS Although an AA with a diameter larger than that of the MPA on the 3VV does not usually indicate severe congenital heart disease involving the ventricular outflow tract and/or great arteries, careful prenatal and postnatal echocardiographic examinations are mandatory to determine the presence of congenital heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:423-428, 2016.
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Affiliation(s)
- Ilkay S Idilman
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Ali Ipek
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Mehtap Balaban
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Huseyin Levent Keskin
- Department of Obstetrics and Gynecology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Ebru Aypar
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Suheyla Ozkutlu
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Panagiotopoulou O, Fouzas S, Sinopidis X, Mantagos SP, Dimitriou G, Karatza AA. Congenital heart disease in twins: The contribution of type of conception and chorionicity. Int J Cardiol 2016; 218:144-149. [PMID: 27232926 DOI: 10.1016/j.ijcard.2016.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increased incidence of congenital heart disease (CHD) has been reported in the offspring of monochorionic twin gestations. Assisted reproductive technology (ART), which is related to increased rates of twinning, has also been associated with higher risk of birth defects. We studied the incidence of CHD in a cohort of twins to clarify the contribution of type of conception and chorionicity. METHODS Data concerning 874 live-born twins of which at least one was admitted in our Neonatal Unit during 1995-2012 were analysed. Forty-five % (N=197) of the gestations resulted from ART (in vitro fertilisation or intracytoplasmic sperm insertion). RESULTS In the ART group 32/389 (8.2%) had CHD compared to 21/485 (4.3%) infants conceived naturally (OR 1.90, 95%CI 1.08-3.34, p=0.024). Spontaneous-conception gestations had higher incidence of monochorionic placentation (47/245 versus 4/197, p<0.001), and included younger mothers (29.1±5.2 versus 33.9±5.5years, p<0.001) who had higher parity (median 2 [range 1-7] versus 1 Pinborg (2005), Blondel and Kaminski (2002), Knopman et al. (2014), Kyvik and Derom (2006) ; p<0.001). Multivariable logistic regression analysis showed that ART (OR 2.60, 95% CI 1.24-5.45) and monochorionicity (OR 3.49, 95% CI 1.57-7.77) were significant determinants of CHD, independently of maternal age, parity, and the gender of the offspring. CONCLUSIONS We confirmed that monochorionic twins have increased risk of CHD and we documented a higher incidence of CHD in ART twins independently of chorionicity. We suggest improvement of echocardiographic skills of health care professionals involved in prenatal screening and foetal cardiology referral of ART dichorionic twins with suspicious findings at screening, in addition to all monochorionic gestations.
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Affiliation(s)
- Olga Panagiotopoulou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Sotirios Fouzas
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Xenophon Sinopidis
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Stefanos P Mantagos
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Gabriel Dimitriou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Ageliki A Karatza
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece.
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Behjati-Ardakani M, Golshan M, Akhavan-Karbasi S, Hosseini SM, Behjati-Ardakani MA, Sarebanhassanabadi M. The Clinical Course of Patients With Atrial Septal Defects. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e4649. [PMID: 27713810 PMCID: PMC5045667 DOI: 10.5812/ijp.4649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/24/2016] [Accepted: 03/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) is a common congenital heart disease. OBJECTIVES The aim of this study was to assess the clinical course of ASD, as well as its frequency of spontaneous closure and regression of diameter. METHODS In a study conducted from 2000 to 2011, 192 consecutive patients with an isolated ASD were followed up regularly with periodic echocardiographic evaluations according to a standardized protocol. The study was conducted in two series of patients: infants and children and adults. Infants were classified into three groups based on ASD diameter: small (≤ 5 mm), medium (6 - 9 mm), and large (> 9 mm). In the same manner, the ASD size in children and adults was categorized into three groups: small (≤ 10), medium (10 - 20 mm), and large (> 20 mm). RESULTS The patients consisted of 76 (39.6%) males and 116 (60.4%) females. The mean age of patients at diagnosis was 16.12 ± 15.66 years (range 1 week - 75 years). The mean follow-up duration was 70 ± 9 months (range: 25 - 119 months). The most prevalent age group was adult patients (> 20 years), and most ASDs were of medium size (1 - 2 cm). The most common complication was mild pulmonary hypertension (31 cases, 16.2%), and Eisenmenger phenomenon was the rarest complication (2 cases, 1%). Overall spontaneous closure of ASD occurred in 42 (21.9%) cases. Spontaneous closure in cases with small defects occurred in 18 of 22 (81%) infants and 24 of 81 children > 1 years of age. Regression of ASD size occurred in 2 (9.5%) infants and 3 (3.7%) children. No spontaneous closure was observed in cases with a defect size > 10 mm, and no spontaneous occlusion was detected in adolescents or adults. Seventy-two percent (n = 139) of patients needed surgical repair or transcatheter closure of the ASD. CONCLUSIONS It is concluded that atrial septal defects < 6 mm typically close spontaneously, and ASDs measuring 6 - 9 mm may regress in infants and children. An ASD > 1 cm has little chance of spontaneous closure and may need surgical or device closure. ASD diameter and age at diagnosis are the most important predictors of spontaneous closure and the need for possible surgical or device closure.
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Affiliation(s)
- Mostafa Behjati-Ardakani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | - Mohammad Golshan
- Department of Medicine, Islamic Azad University, Yazd Branch, Yazd, IR Iran
| | | | | | | | - Mohammadtaghi Sarebanhassanabadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Corresponding author: Mohammadtaghi Sarebanhassanabadi, Yazd Cardiovascular Research Center, Afshar Hospital, Yazd, IR Iran. Tel: +98-3535231421, Fax: +98-3535253335, E-mail:
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Representativeness of the German National Register for Congenital Heart Defects: a clinically oriented analysis. Cardiol Young 2016; 26:921-6. [PMID: 26443325 DOI: 10.1017/s1047951115001547] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Approximately 6000 children are born with CHD in Germany each year. It is increasingly rare that these children die from their chronic illness. In the present study, data recorded in the National Register for Congenital Heart Defects with respect to the prevalence of specific lesions and sex distribution are compared with that recorded in a published German prevalence study (Prevalence Study) and with the meta-analysis by van der Linde et al. METHODS A descriptive data analysis was performed using a minimal data set. The demographic data included sex and birth year; the medical data comprised the cardiovascular diagnosis according to the short list of the International Paediatric and Congenital Cardiac Code. RESULTS As the data analysis shows, the National Register is a clinical register including primarily clinical cases/cases relevant to healthcare. The prevalence values and sex ratios recorded in the register are closer to the values given in the literature than those determined by the Prevalence Study. Severe CHD was slightly over-represented in the National Register compared with the van der Linde et al meta-analysis. The deviations with respect to prevalence values are within an acceptable range. CONCLUSION With its 48,000 patients, the National Register plays a unique and important role for research in the field of CHD. Samples from the National Register can be used as a gold standard for future studies, as the patient population registered in it can be considered representative of CHD in Germany and Europe.
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Choi EK, Jung YH, Kim HS, Shin SH, Choi CW, Kim EK, Kim BI, Choi JH. The Impact of Atrial Left-to-Right Shunt on Pulmonary Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia. Pediatr Neonatol 2015; 56:317-23. [PMID: 26328892 DOI: 10.1016/j.pedneo.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/17/2014] [Accepted: 12/30/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) is a well-known complication of prematurity; however, the additional impact of a left-to-right interatrial shunt on this condition remains poorly understood. The aim of the present study was to identify the significance of atrial left-to-right shunt lesions in PH infants with moderate or severe BPD. METHODS The medical records of 383 preterm infants (gestational age of < 32 weeks) who were diagnosed with BPD between 2005 and 2013 were retrospectively reviewed. Baseline characteristics such as interatrial shunts and outcomes were compared between the infants who developed PH (n = 50) and infants who did not (n = 144). Infants with hemodynamically significant residual patent ductus arteriosus were excluded. Among the infants diagnosed with PH (n = 50), the outcomes were compared between the patients with (n = 21) and without atrial shunts (n = 29) at 36 weeks corrected postmenstrual age. RESULTS Fifty (15%) preterm infants with BPD were diagnosed with PH. The number of infants with a history of atrial shunt lesions was significantly higher in the PH group than in the non-PH group (42% vs. 15.3%, respectively). The adjusted odds ratio for PH in the atrial shunt group was 3.8 (95% confidence interval, 1.8-8.0), compared to PH-BPD infants without an atrial shunt. CONCLUSION The presence of an atrial left-to-right shunt was associated with PH in preterm infants with moderate or severe BPD. Close follow up is needed for infants with interatrial shunts, and a more tailored prognostic evaluation and treatment are recommended.
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Affiliation(s)
- Eui Kyung Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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Goldberg JF. Long-term Follow-up of "Simple" Lesions--Atrial Septal Defect, Ventricular Septal Defect, and Coarctation of the Aorta. CONGENIT HEART DIS 2015; 10:466-74. [PMID: 26365715 DOI: 10.1111/chd.12298] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 01/10/2023]
Abstract
Surgery for congenital heart disease has advanced significantly in the past 50 years, such that repair of "simple" lesions, such as atrial septal defect, ventricular septal defect, and coarctation of the aorta carries minimal risk, with mortality risk much less than 1%. It was once thought successful repair of these lesions was definitively corrective. There is mounting evidence, however, that there are long-term complications after these repairs, prompting the need for continued follow-up. This review describes the current understanding of diagnosis, treatment, and long-term outcomes for these patients, with the goal of advocating for lifelong surveillance. As the perioperative care of these repairs has evolved significantly over time, so must the way in which we study these patients in the long-term.
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Affiliation(s)
- Jason F Goldberg
- Section of Pediatric Cardiology, Baylor College of Medicine, Houston, Tex, USA
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What radiologists need to know about the pulmonary–systemic flow ratio (Qp/Qs): What it is, how to calculate it, and what it is for. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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What radiologists need to know about the pulmonary-systemic flow ratio (Qp/Qs): what it is, how to calculate it, and what it is for. RADIOLOGIA 2015; 57:369-79. [PMID: 26070521 DOI: 10.1016/j.rx.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 11/22/2022]
Abstract
Cardiac magnetic resonance imaging (cMRI) provides abundant morphological and functional information in the study of congenital heart disease. The functional information includes pulmonary output and systemic output; the ratio between these two (Qp/Qs) is the shunt fraction. After birth, in normal conditions the pulmonary output is practically identical to the systemic output, so Qp/Qs = 1. In patients with « shunts » between the systemic and pulmonary circulations, the ratio changes, and the interpretation of these findings varies in function of the location of the shunt (intracardiac or extracardiac) and of the associated structural or postsurgical changes. We review the concept of Qp/Qs; the methods to calculate it, with special emphasis on cMRI; and the meaning of the results obtained. We place special emphasis on the relevance of these findings depending on the underlying disease and the treatment the patient has undergone.
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Kurishima C, Inuzuka R, Kuwata S, Iwamoto Y, Sugimoto M, Saiki H, Ishido H, Masutani S, Senzaki H. Influence of Left Ventricular Stiffness on Hemodynamics in Patients With Untreated Atrial Septal Defects. Circ J 2015; 79:1823-7. [PMID: 25993903 DOI: 10.1253/circj.cj-14-1351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although left ventricular (LV) stiffening with age is believed to increase left-to-right shunting in patients with atrial septal defects (ASD), clinical data have not confirmed this. We sought determinants of the pulmonary-to-systemic flow ratio (Qp/Qs) in patients with untreated ASD. METHODS AND RESULTS We retrospectively studied 180 patients with ASD who underwent percutaneous ASD closure between 2007 and 2011. Qp/Qs and LV stiffness were measured before ASD closure.The median age of the subjects was 18 years, and 117 (65.0%) were female. The mean ASD size adjusted for square root of body surface area (BSA) was 14.4±4.2 mm/m, and the Qp/Qs was 2.28±0.74. Adjusted ASD size most strongly related to Qp/Qs (r=0.74, P<0.0001). Multivariate analysis revealed that LV stiffness was a significant predictor of Qp/Qs, independently of adjusted ASD size and vascular resistance (P=0.0015). Based on the multivariate model that accounts for the effects of LV stiffness and vascular resistance, the minimal adjusted diameter that can cause a Qp/Qs of 2.0 was predicted to be 7.3 mm/m. CONCLUSIONS Qp/Qs in ASD can change significantly depending on LV stiffness, suggesting that it would increase with age. An ASD >7.3 mm/m in diameter has the potential to cause significant left-to-right shunting, and may require closure regardless of hemodynamic status at the time of assessment.
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Affiliation(s)
- Clara Kurishima
- Division of Pediatric Cardiology, Saitama Medical University
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Schwerzmann M, Pfammatter JP. Approaching atrial septal defects in pulmonary hypertension. Expert Rev Cardiovasc Ther 2015; 13:693-701. [DOI: 10.1586/14779072.2015.1047763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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