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Abstract
OBJECTIVES The aims of this study were to evaluate the 16-year experience with arterial switch operation at Beijing Children's Hospital and to determine early and late mortality and late morbidity, to explore risk factors for late complications and reintervention, and finally to evaluate whether the neoaortic sinotubular junction reconstruction technique reduces late complications of arterial switch operation. METHODS The clinical data of 185 patients with transposition of the great arteries who underwent arterial switch operation in Beijing Children's Hospital from January 2006 to January 2022 and 30 patients who underwent modified arterial switch operation with neoaortic sinotubular junction reconstruction technique in Fuwai Hospital during the same period were retrospectively analysed. Propensity score matching was also used to match the neoaortic sinotubular junction reconstruction patients in Fuwai Hospital with 30 non-neoaortic sinotubular junction reconstruction patients in Beijing Children's Hospital. RESULTS There were 13 early deaths (7.03%) and five late deaths (3.01%). Nineteen patients (11.45%) developed new aortic valve regurgitation and 28 patients (16.87%) developed aortic root dilation. Late right ventricular outflow tract obstruction occurred in 33 patients (19.88%). Late reintervention occurred in 18 cases (10.84%). Multivariate analysis showed that aorto-pulmonary diameter mismatch, previous pulmonary artery banding, and mild moderate or above new aortic valve regurgitation at discharge were independent risk factors for late new aortic valve regurgitation and aortic root dilation. Low surgical weight was an independent risk factor specific to new aortic valve regurgitation, and bicuspid native pulmonary valve was an independent risk factor specific to aortic root dilation. Older surgical age and aortic root dilation were independent risk factors for late right ventricular outflow tract obstruction. Older surgical age, operation before 2014, late right ventricular outflow tract obstruction, and late aortic root dilation were independent risk factors for late intervention. Propensity score matching showed that new aortic valve regurgitation and aortic root dilation were not followed up in the neoaortic sinotubular junction reconstruction group, while seven cases of aortic root dilation and five cases of new aortic valve regurgitation occurred in the non-neoaortic sinotubular junction reconstruction group, respectively, and the differences were statistically significant (P = 0.003; P = 0.015). CONCLUSIONS The increased incidence of new aortic valve regurgitation, aortic root dilation, and right ventricular outflow tract obstruction as children age is a major concern outcome in the future and may mean more late reintervention. neoaortic sinotubular junction reconstruction technique may reduce the incidence of new aortic valve regurgitation and aortic root dilation, and improve the late prognosis of arterial switch operation. Careful follow-up of neo-aortic valve and root function is imperative, especially in patients with aorto-pulmonary diameter mismatch, previous pulmonary artery banding, mild new aortic valve regurgitation at discharge, low surgical weight, and bicuspid native pulmonary valve structures.
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Affiliation(s)
- Zhangwei Wang
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Ma Kai
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Shoujun Li
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
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Rakha S, Batouty NM, ElDerie AA, Hussein A. Pulmonary, aorta, and coronary arteries post-arterial switch in transposition of great arteries: intermediate-term surveillance utilizing conventional echocardiography and cardiac multislice computed tomography. Ital J Pediatr 2024; 50:122. [PMID: 38926831 PMCID: PMC11210087 DOI: 10.1186/s13052-024-01686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Arterial switch operation (ASO) is the standard surgical choice for D-transposition of great arteries (D-TGA). However, the implications of ASO on pulmonaries, coronaries, and aorta have not been adequately investigated. The current study evaluates arterial morphologic changes post-ASO at intermediate-term surveillance. METHODS From May 2021 to May 2022, patients with D-TGA who underwent ASO for more than six months were recruited. Preoperative and operative data were collected. Patients were assessed using echocardiography (ECHO) and multislice CT angiography (MSCT) to evaluate pulmonary, coronary, and aortic arterial anatomy. RESULTS Twenty patients were included with median age of 11 (10-23.25) days at ASO and 14 (7.25-32.75) months on last follow-up. Neo-aortic regurgitation was detected in 12(60%) and neo-pulmonary regurgitation in 3 (15%). Using ECHO, complete evaluation of pulmonary arteries (PAs) was not achieved in 35% and incomplete coronaries assessment in 40% of cases. No stenosis was detected in coronaries using MSCT, although coronary anomalies were found in 9/20 (45%). Dilated Aortic annulus was detected in 16/20 (80%), dilated aortic root in 18/20 (90%), and dilated sinotubular junction in 70%. Right PA stenosis was diagnosed in 10/20 (50%) and left PA(LPA) stenosis in 7/20 (35%). Although Z-score of PAs did not correlate with aortic data, LPA bending angle was positively correlated to neo-aortic root diameter and Z-score (rho = 0.65,p = 0.016; rho = 0.69,p = 0.01), respectively. CONCLUSION Echocardiography alone is not a conclusive surveillance tool for detecting late post-ASO anatomic changes in D-TGA patients. Cardiac MSCT should be considered for comprehensive evaluation on the intermediate-term follow-up post-ASO to accurately track morphologic abnormalities in the aorta, pulmonary, and coronary arteries.
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Affiliation(s)
- Shaimaa Rakha
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt.
| | - Nihal M Batouty
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Amira Hussein
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
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Walter CC, Escobar-Diaz MC, Cesar S, Garrido BAM, Sanchez-de-Toledo J. Functional and morphometric changes in children after neonatal arterial switch operation for transposition of the great arteries. Ann Pediatr Cardiol 2022; 15:447-452. [PMID: 37152511 PMCID: PMC10158475 DOI: 10.4103/apc.apc_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 12/04/2022] [Indexed: 03/03/2023] Open
Abstract
Background The increase in the survival of patients with D-Transposition of the great arteries (TGA) after arterial switch operation (ASO) has now turned our focus to the evaluation of mid and long-term outcomes. Although most patients are followed by conventional echocardiography, the study of cardiac functionality and morphometric parameters in children with TGA after ASO is scarce. The present study aims to describe the functional and morphometric echocardiographic changes in children after ASO. Methods We performed an observational study in patients aged 1-5 years with TGA who underwent neonatal ASO. Morphometric and functional echocardiographic parameters were analyzed in 21 patients and compared with 52 age-matched healthy controls. Results We found morphological and functional changes, especially in the right ventricle, which is more globular (right ventricle [RV] basal sphericity index 1.5 vs. 1.8, P = 0.016), and with a decreased systolic function compared to healthy controls (fractional area change 51 vs. 58%, P = 0.006; tricuspid annular plane systolic excursion 13 vs. 20 mm, P = 0.001; s' 7 vs. 12 cm/s, P = 0.001). In the speckle-tracking strain imaging, there was a decrease in the longitudinal deformation of the apical septal myocardium (-23% vs. -27%; P = 0.005). Preoperative systemic overload to the right ventricle could be an important factor in the origin of these changes. Conclusions In patients with TGA after ASO, there are morphometric and functional echocardiographic changes, such as globular form and decreased function, especially in the RV; the effect of these changes on long-term outcomes would require prospective follow-up studies.
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Affiliation(s)
- Carin Cristina Walter
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Maria Clara Escobar-Diaz
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Sergi Cesar
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
| | | | - Joan Sanchez-de-Toledo
- Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States
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Wang Z, Li Z, Ding N, Yi H, Zhu Y, Yan D, Li X, Bai S. Incidence and risk factors for late complications after the arterial switch operation. J Card Surg 2022; 37:3117-3132. [PMID: 35790026 DOI: 10.1111/jocs.16745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Zhangwei Wang
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Zhiqiang Li
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Nan Ding
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Hanlu Yi
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Yaobin Zhu
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Daole Yan
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Xiaofeng Li
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Song Bai
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
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Wang SY, Zeng QY, Zhang L, Lv Q, Xie MX. Impact of Coronary Artery Anatomy in Arterial Switch Operation: In-hospital and Post-discharge Outcomes. Curr Med Sci 2022; 42:642-649. [PMID: 35583588 DOI: 10.1007/s11596-022-2591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation (ASO) is currently controversial, and the risk factors for this operation may change in more complicated patients. This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries (TGA) and Taussig-Bing anomaly (TBA). METHODS We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019. The median age at operation was 33 [interquartile range (IQR): 20-71] days. Median follow-up time was 7.2 years (IQR: 4.0-10.3 years). RESULTS Coronary anomalies were present in 86 patients (41.7%), with 9 (4.4%) of them having a single coronary artery. Additional coronary features included intramural courses in 5 (2.4%) patients, ostial stenosis in 1 (0.5%) patient, and accessory coronary artery orifices in 5 (2.4%) patients. There were 32 (15.5%) in-hospital deaths and 8 (4.6%) post-discharge deaths, yielding an overall survival of 81.3%, 80.7% and 79.9% at 1, 5 and 10 years, respectively. Mortality due to ASO has been drastically decreased since 2013. Patients with a single coronary artery had higher rate of in-hospital mortality, but this finding was not statistically significant. The earlier surgical era (OR: 2.756) and a longer cardiopulmonary bypass time (OR: 2.336) were significantly associated with in-hospital mortality, while coronary patterns were not. An intramural coronary artery (HR: 10.034) and a patient age of older than 1 year at the time of ASO (HR: 9.706) were independent predictors of post-discharge mortality. CONCLUSION ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation. However, intramural coronary artery is an independent risk factor for post-discharge mortality. Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.
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Affiliation(s)
- Shu-Yuan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qing-Yu Zeng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China. .,Shenzhen Huazhong University of Science and Technology Insititute, Shenzhen, 518057, China.
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Ming-Xing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China. .,Shenzhen Huazhong University of Science and Technology Insititute, Shenzhen, 518057, China.
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Bibevski S, Ruzmetov M, Ladich E, Mendoza LE, Scholl FG. Reconstruction of the Neopulmonary Root After Coronary Button Harvest for Arterial Switch Operation Using 2-ply Extracellular Matrix (Tyke): A Post-Implant Histology. Front Cardiovasc Med 2020; 7:562136. [PMID: 33195455 PMCID: PMC7661546 DOI: 10.3389/fcvm.2020.562136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022] Open
Abstract
In children with Transposition of the Great Arteries (TGA), the pulmonary artery, and aorta are connected to the heart abnormally resulting in blue blood (deoxygenated) recirculating to the body and red blood (oxygenated) recirculating to the lungs. The arterial switch operation (ASO) is the standard of care for transposition of the great arteries (TGA), and given the low risk of early mortality and satisfactory long-term outcomes, focus is now on managing longer term complications such as neo-aortic root dilatation, and pulmonary artery stenosis. Since May 2016, we have used 2-ply extracellular matrix (ECM; Tyke) for reconstruction of the coronary button defects using a pantaloon patch. We present histology of implanted 2-ply ECM (Tyke) from a patient who went back to surgery for development of subaortic stenosis ~12 months after ASO.
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Affiliation(s)
- Steve Bibevski
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Mark Ruzmetov
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Elena Ladich
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States.,Section of Pathology, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Laura E Mendoza
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Frank G Scholl
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
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Dedemoğlu M, Korun O, Coşkun G, Özdemir F, Yurdakök O, Çiçek M, Biçer M, Yurtseven N, Şaşmazel A, Aydemir NA. The poor long-term outcomes of owl's eye pulmonary reconstruction technique after arterial switch operation. Interact Cardiovasc Thorac Surg 2020; 31:113-120. [PMID: 32500154 DOI: 10.1093/icvts/ivaa067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl's eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl's eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl's eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl's eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate-severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl's eye reconstruction was the only factor independently related to moderate-severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl's eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.
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Affiliation(s)
- Mehmet Dedemoğlu
- Department of Pediatric Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Oktay Korun
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gültekin Coşkun
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Özdemir
- Department of Pediatric Cardiovascular Surgery, Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Okan Yurdakök
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Çiçek
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Biçer
- Department of Pediatric Cardiovascular Surgery, Health Sciences University Erzurum Region Education and Research Hospital, Erzurum, Turkey
| | - Nurgül Yurtseven
- Department of Anesthesia and Reanimation, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Şaşmazel
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan Ali Aydemir
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Santens B, Van De Bruaene A, De Meester P, Gewillig M, Troost E, Claus P, Bogaert J, Budts W. Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study. Int J Cardiol 2020; 316:94-100. [PMID: 32348813 DOI: 10.1016/j.ijcard.2020.04.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 04/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Arterial switch operation (ASO) is today the first-choice surgical treatment for patients with transposition of the great arteries. Long-term outcome data still remain scarce. Moreover, the course of these patients is not uneventful. Therefore, we wanted to evaluate long-term outcome and determine on which variables to focus during follow-up. METHODS Clinical records of 318 patients who underwent ASO between October 1981 and July 2018 were reviewed. Perioperative, post-operative, and interventional data were collected to determine mortality and the need for re-intervention. Descriptive statistics and Kaplan-Meier survival analysis were performed. RESULTS Mean follow-up time was 11.1 SD 8.5 years (range 0-35) with a mean age of 12.5 SD 9.0 years (range 0-37) at latest follow-up. In-hospital mortality was 7.5% and overall survival 90.9% for a maximum follow-up time of 35 years. Causes of early mortality were cardiogenic shock, severe pulmonary hypertension, septic shock and multiple organ failure. Causes of late mortality were cardiogenic shock, severe pulmonary hypertension, pacemaker lead fracture and fire death. Re-intervention free survival at 5-year was 91.6%, at 10-year 90.7%, at 20-year 79.2%. For all survivors, the most frequent sequelae after ASO were pulmonary artery stenosis (80.9%), of which 13.5% needed an intervention. The threshold for intervening on lesions at the level of the pulmonary artery bifurcation was higher and the percutaneous re-intervention rate was higher for non-bifurcation lesions. CONCLUSIONS Despite a relatively high peri-operative mortality, TGA patients have an excellent overall long-term survival. However, a large proportion of patients requires re-interventions, mainly for pulmonary artery stenosis.
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Affiliation(s)
- Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Els Troost
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.
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