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F Pinto F. Changes in heart rate variability after ventricular septal defect closure in children. Where do we stand? Adaptation mechanism, sequela or complications? Rev Port Cardiol 2023; 42:49-52. [PMID: 36460272 DOI: 10.1016/j.repc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Fátima F Pinto
- Professora Auxiliar Convidada da Universidade NOVA de Lisboa, Lisboa, Portugal; Serviço de Cardiologia Pediátrica, CHULC, EPE - Hospital de Santa Marta, Lisboa, Portugal; Centro de Referência de Cardiopatias Congénitas, CHULC, EPE - Hospital de Santa Marta, Lisboa, Portugal; European Network Reference Heart Diseases (Guard-Heart).
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Muhyieddeen A, Sadhale A, Kunchakarra S, Rathod A. Supracristal Ventricular Septal Defect Complicated by Formation of an Aorto-Right Ventricular Outflow Tract Fistula: A Rare Cause of Biventricular Enlargement. Methodist Debakey Cardiovasc J 2021; 17:157-160. [PMID: 34326936 PMCID: PMC8298126 DOI: 10.14797/pefd1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Aorto-right ventricular outflow tract fistulas typically occur secondary to
trauma, infective endocarditis, and sinus of Valsalva aneurysm rupture. We
describe an unusual case of a spontaneous aorto-right ventricular outflow tract
fistula in the absence of such findings, instead forming secondary to a
complicating supracristal ventricular septal defect and leading to dilated
cardiomyopathy.
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Affiliation(s)
- Amer Muhyieddeen
- University of California, San Francisco-Fresno, Fresno, California
| | - Ashwini Sadhale
- University of California, San Francisco-Fresno, Fresno, California
| | - Siri Kunchakarra
- University of California, San Francisco-Fresno, Fresno, California
| | - Ankit Rathod
- University of California, San Francisco-Fresno, Fresno, California
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3
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Assaf A, Berry R, Mantha Y, Zughaib M, Saba S. Isolated Ventricular Septal Aneurysm: A Differential Diagnosis for a Right Sinus of Valsalva Aneurysm. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930930. [PMID: 34023848 PMCID: PMC8164883 DOI: 10.12659/ajcr.930930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND A ventricular septal aneurysm (VSA) is rare and almost always an incidental finding on cardiac imaging. It is rarely an isolated phenomenon and is more commonly associated with other forms of congenital heart disease such a ventricular septal defect (VSD). Differentiating a ventricular septal aneurysm from an aneurysm of the right sinus of Valsalva is crucial as the latter usually has a more aggressive course and may require surgical intervention. Cardiac computed tomography (cardiac CT) or cardiac magnetic resonance imaging (CMR) may help confirm the diagnosis. CASE REPORT We report a case of a 42-year-old obese Japanese man with a past medical history of hyperlipidemia who described occasional effort-related palpitations when climbing stairs over the past few months but no anginal symptoms. Echocardiogram revealed normal left ventricular systolic with a presumed right sinus of Valsalva aneurysm measuring around 1.5 cm. A coronary CTA was obtained to further delineate the aneurysm and revealed normal CT angiographic appearance of a right dominant coronary artery circulation with a small aneurysmal outpouching of the membranous ventricular septum measuring 13×17 mm without any evidence of shunting, along with focal calcification of the medial aspect of the tricuspid annulus. The right sinus of Valsalva appeared normal on coronary CTA. CONCLUSIONS Membranous ventricular septal aneurysm is a rare condition that is almost always an incidental finding on echocardiography and can be mistaken for an aneurysm of the right sinus of Valsalva. Multimodality imaging and high degree of clinical suspicion are needed to accurately diagnose a ventricular septal aneurysm and to achieve favorable outcomes. A VSA usually has a benign course and is rarely a cause of arrythmia, right ventricular outflow obstruction, or valvular insufficiency.
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Affiliation(s)
- Andrew Assaf
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
| | - Ryan Berry
- School of Medicine, Michigan State University, Lansing, MI, U.S.A
| | - Yogamaya Mantha
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, U.S.A
| | - Marcel Zughaib
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
| | - Souheil Saba
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
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Automatic recognition of murmurs of ventricular septal defect using convolutional recurrent neural networks with temporal attentive pooling. Sci Rep 2020; 10:21797. [PMID: 33311565 PMCID: PMC7732853 DOI: 10.1038/s41598-020-77994-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022] Open
Abstract
Recognizing specific heart sound patterns is important for the diagnosis of structural heart diseases. However, the correct recognition of heart murmur depends largely on clinical experience. Accurately identifying abnormal heart sound patterns is challenging for young and inexperienced clinicians. This study is aimed at the development of a novel algorithm that can automatically recognize systolic murmurs in patients with ventricular septal defects (VSDs). Heart sounds from 51 subjects with VSDs and 25 subjects without a significant heart malformation were obtained in this study. Subsequently, the soundtracks were divided into different training and testing sets to establish the recognition system and evaluate the performance. The automatic murmur recognition system was based on a novel temporal attentive pooling-convolutional recurrent neural network (TAP-CRNN) model. On analyzing the performance using the test data that comprised 178 VSD heart sounds and 60 normal heart sounds, a sensitivity rate of 96.0% was obtained along with a specificity of 96.7%. When analyzing the heart sounds recorded in the second aortic and tricuspid areas, both the sensitivity and specificity were 100%. We demonstrated that the proposed TAP-CRNN system can accurately recognize the systolic murmurs of VSD patients, showing promising potential for the development of software for classifying the heart murmurs of several other structural heart diseases.
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Nayak S, Patel A, Haddad L, Kanakriyeh M, Varadarajan P. Echocardiographic evaluation of ventricular septal defects. Echocardiography 2020; 37:2185-2193. [PMID: 33368542 DOI: 10.1111/echo.14511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/18/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022] Open
Abstract
Ventricular septal defects (VSDs) are the most common forms of acyanotic congenital heart disease accounting for 37% of congenital heart disease in children. A VSD is defined by parts of the ventricular septum involved. There are four major types of VSDs: perimembranous, muscular, outlet, and inlet VSDs. Echocardiography is the most important clinical tool to help diagnose and characterize a VSD. Although most VSDs are clinically nonsignificant or close on their own, echocardiography with Doppler and color flow mapping can be used to provide accurate anatomic and hemodynamic evaluation of VSDs in order to determine if surgical or transcatheter-based intervention is needed. Hence, understanding how to use echocardiography to characterize VSDs is of crucial importance when caring for patients with adult congenital heart disease.
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Affiliation(s)
- Srishti Nayak
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Akash Patel
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Lana Haddad
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Mohammad Kanakriyeh
- Loma Linda University Medical Center, University of California, Riverside, California
| | - Padmini Varadarajan
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
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Bedayat A, Jalili MH, Hassani C, Chalian H, Reuhm S, Moriarty J. CT evaluation of unrepaired/incidental congenital cardiovascular diseases in adults. Diagn Interv Imaging 2020; 102:213-224. [PMID: 34102129 DOI: 10.1016/j.diii.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
Congenital heart disease (CHD) affects approximately one million people in the USA with the number increasing by 5% each year. Patients are usually both diagnosed and treated in infancy, however many of them may have subclinical CHD that remains undiagnosed until late adulthood. Patients with complex CHD tend to be symptomatic and are diagnosed at a younger age than those with a single defect. CHDs can be divided into three categories, including cardiac, great vessels and coronary artery anomalies. Recent advances in computed tomography (CT) technology with faster acquisition time and improved spatial resolution allow for detailed evaluation of cardiac morphology and function. The concomitant increased utilization of CT has simultaneously led to more sensitive detection and more thorough diagnosis of CHD. Recognition of and understanding the imaging attributes specific to each anomaly is important for radiologists in order to make a correct and definite diagnosis. This article reviews the spectrum of CHDs, which persist into adulthood that may be encountered by radiologists on CT.
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Affiliation(s)
- Arash Bedayat
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA.
| | - Mohammad H Jalili
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
| | - Cameron Hassani
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
| | - Hamid Chalian
- Department of Radiology, Duke University Medical Center, 27710 Durham, NC, USA
| | - Stefan Reuhm
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
| | - John Moriarty
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, 90095 Los Angeles, CA, USA
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Tang H, Dai Z, Wang M, Guo B, Wang S, Wen J, Li T. Lumped-Parameter Circuit Platform for Simulating Typical Cases of Pulmonary Hypertensions from Point of Hemodynamics. J Cardiovasc Transl Res 2020; 13:826-852. [PMID: 31933143 PMCID: PMC7541384 DOI: 10.1007/s12265-020-09953-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
Pulmonary hypertension (PH) presents unusual hemodynamic states characterized by abnormal high blood pressure in pulmonary artery. The objective of this study is to simulate how the hemodynamics develops in typical PH cases without treatment. A lumped-parameter circuit platform of human circulation system is set up to simulate hemodynamic abnormalities of PH in different etiologies and pathogenesis. Four typical cases are considered, which are distal pulmonary artery stenosis, left ventricular diastolic dysfunction, ventricular septal defect, and mitral stenosis. The authors propose regulation laws for chambers and vessels to adapt the abnormal hemodynamic conditions for each PH case. The occurrence and development of each PH case are simulated over time using the lumped-parameter circuit platform. The blood pressure, blood flow, pressure-volume relations for chambers and vessels are numerically calculated for each case of PH progression. The model results could be a quite helpful to understand the hemodynamic mechanism of typical PHs. Graphical Abstract.
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Affiliation(s)
- Hong Tang
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China.
| | - Ziyin Dai
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China
| | - Miao Wang
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China
| | - Binbin Guo
- School of Biomedical EngineeringDalian University of Technology, Dalian City, China
| | - Shunyu Wang
- The Second Hospital of Dalian Medical University, Dalian City, China
| | - Jiabin Wen
- The Second Hospital of Dalian Medical University, Dalian City, China
| | - Ting Li
- School of Information and Communication EngineeringDalian Minzu University, Dalian City, China
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Kumari V, Shaikh AS, Zakai SB, Kumar N, Bangash SK, Patel N. Incidence of Aortic Regurgitation in Association with Type of Ventricular Septal Defects and its Immediate and Intermediate Outcome after Surgical Closure. Cureus 2019; 11:e5102. [PMID: 31523533 PMCID: PMC6728778 DOI: 10.7759/cureus.5102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction Ventricular septal defect (VSD) is one of the more common congenital heart defects, and aortic regurgitation (AR) is its major complication if it remains unrepaired. We aim to determine the AR incidence in various types of VSD, its immediate and intermediate six to 12-month post-VSD repair outcomes of AR. Methods We conducted a retrospective review of medical records of all children aged 18 years or younger who were diagnosed with single VSD at our institution from 2016 to 2018. VSD was classified according to its location and relation to the tricuspid annulus and semilunar valve. AR severity grading was done according to the American Society of Echocardiography, and vena contracta width (VC) was taken as the main parameter for severity. We defined trivial-to-mild AR as VC width less than 0.3 cm, moderate AR was 0.3-0.6 cm VC width, and severe AR was VC width of more than 0.6 cm. Immediate and intermediate outcomes of surgical closure, such as residual VSD and AR, were observed. Results One hundred ninety patients with isolated single VSD were included in the study. Of those, 114 patients had perimembranous VSD (60.0%), 64 patients had muscular VSD (33.7%), and 12 patients had supracristal VSD (6.3%). The median age of our study cohort was six months, with a male to female ratio of 1.3:1. Aortic valve prolapse (28.9%; n = 55) and AR (23.2%; n = 44) were the most common findings on echocardiographic evaluation of VSD patients. Most cases of VSD with AR had trivial-to-mild AR, (68.2%; n = 30). AR was most commonly seen in supracristal VSD (83.3%; n = 10) followed by perimembranous VSD (28.9%; n = 33). VSD closed spontaneously in 34 patients (17.9%) and 98 patients (51.6%) patients underwent surgery. Residual VSD after surgical closure was present in 57.1% (56) and 17.3% (17) of the patients immediate postoperatively and six- to 12-month postoperative follow-up, respectively. Similarly, residual AR after surgical closure of VSD was present in 32.7% (32) and 15.3% (15) of the patients immediate postoperatively and six- to 12-month postoperative follow-up, respectively. Conclusion The incidence of AR with VSD was very high in our study; AR was most commonly associated with supracristal VSD. After surgical repair, mild AR decreased with time. Early corrective surgery of VSD can prevent this complication and help improve outcomes.
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Affiliation(s)
- Veena Kumari
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Abdul S Shaikh
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Saad B Zakai
- Paediatric Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naresh Kumar
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Sohail K Bangash
- Paediatric Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Najma Patel
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
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9
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Heiberg J, Eckerström F, Rex CE, Maagaard M, Mølgaard H, Redington A, Gatzoulis M, Hjortdal VE. Heart rate variability is impaired in adults after closure of ventricular septal defect in childhood: A novel finding associated with right bundle branch block. Int J Cardiol 2018; 274:88-92. [PMID: 30454724 DOI: 10.1016/j.ijcard.2018.06.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ventricular septal defects (VSDs) generally have benign long-term prognoses, but recent studies have indicated increased pulmonary vascular resistance. A potential tool for monitoring pulmonary artery pressure is heart rate variability, and therefore, the aim of this study was to assess heart rate variability in adults with a surgically repaired or unrepaired VSD. METHODS In a long-term, follow-up study, three groups were included; VSD-patients operated in early childhood, patients with an open VSD, and controls. For each patient, 24-hour Holter monitoring was performed and heart rate variability was assessed. RESULTS In total, 30 participants with a surgically closed VSD, 30 participants with an unrepaired VSD, and 36 controls were included. In the closed VSD group, there was a higher proportion of participants, who had low sNN50 (p = 0.005) and low sNN6% (p = 0.017) than in the other two groups. Similar differences were found when sNN50 was divided into increases and decreases (p = 0.007 and p = 0.005, respectively) as well as sNN6% (p = 0.014 and p = 0.014, respectively). Lastly, there was a higher proportion of patients in the closed VSD group with low rMSSD than in the other two groups (p = 0.005). For the closed VSD group, the proportion of participants with low total sNN50 (p = 0.046) and low total sNN6% (p = 0.046) were higher among participants with a complete right bundle branch block (RBBB) than among participants with no or an incomplete RBBB. CONCLUSIONS Adults who had surgical VSD closure in early childhood had impaired heart rate variability and, particularly, participants with complete RBBB had lower heart rate variability.
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Affiliation(s)
- Johan Heiberg
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Filip Eckerström
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian E Rex
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marie Maagaard
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henning Mølgaard
- Dept. of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Vibeke E Hjortdal
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Gu X, Zhang Q, Sun H, Fei J, Zhang X, Kutryk MJ. Transcatheter Closure Versus Repeat Surgery for the Treatment of Postoperative Left-to-Right Shunts: A Single Center 15-Year Experience. Cardiol Res 2018; 8:286-292. [PMID: 29317971 PMCID: PMC5755660 DOI: 10.14740/cr629e] [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: 11/05/2017] [Accepted: 12/05/2017] [Indexed: 11/28/2022] Open
Abstract
Background Repeat surgery and the percutaneous approach (transcatheter closure (TCC)) have been used for the management of postoperative left-to-right shunts. In this study, we described our 15 years of experience in treating postoperative left-to-right shunts with these two approaches. Methods From February 2002 to February 2017, 50 patients with residual left-to-right shunts, following cardiac surgery, were treated using TCC or repeat surgery. Clinical examination, standard 12-lead electrocardiography, chest X-ray, and a transthoracic echocardiogram were performed before hospital discharge and at all follow-ups. Results The closure rate was 100% in both groups and there was no procedure-related mortality. Patients with TCC had few complications. The procedure time and duration of hospital stay for TCC patients were 58.9 ± 27.7 min and 6.1 ± 0.8 days, respectively. Eleven out of 19 patients receiving reoperation suffered serious complications after surgery, e.g., bleeding and nosocomial infections. The operation time and duration of hospital stay for reoperation patients were 256.7 ± 60.5 min and 17.0 ± 4.0 days, respectively. No other serious complications were seen at all follow-up visits for both groups. Conclusions In conclusions, TCC is safe and effective for the management of postoperative left-to-right shunts, and is associated with few complications, which can be the favored closure strategy over repeat surgery for the management of postoperative left-to-right shunts.
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Affiliation(s)
- Xinghua Gu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Qiuwang Zhang
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Hourong Sun
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Jianchun Fei
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Xiquan Zhang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan 250012, China
| | - Michael J Kutryk
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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11
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Saito C, Fukushima N, Fukushima K, Matsumura G, Ashihara K, Hagiwara N. Factors associated with aortic root dilatation after surgically repaired ventricular septal defect. Echocardiography 2017; 34:1203-1209. [PMID: 28681451 DOI: 10.1111/echo.13622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Aortic root dilatation (ARD) in congenital heart disease is related to aortic aneurysm, rupture, and dissection. This study aimed to investigate the factors associated with ARD in patients with surgically repaired ventricular septal defect (VSD). METHODS This cross-sectional study included 152 patients with surgically repaired VSD. Two definitions of ARD were used: (1) observed Valsalva diameter to body surface area (BSA) ratio >2.1 cm/m2 and (2) absolute value of Valsalva diameter ≥4.0 cm. Odds ratios (ORs) and 95% confidence intervals (CIs) of ARD presence were calculated using multivariate logistic regressions. RESULTS The prevalence of ARD ranged between 8.6% and 32.9%. Using the definition of observed aortic root diameter/BSA >2.1 cm/m2 , patients with nonsubarterial VSD type were more likely to have ARD (OR 5.65, 95% CI; 1.83-17.44, P=.003) than those with subarterial type, and patients with preoperative right- or noncoronary cusp prolapse (R/NCCP) were more likely to have ARD (OR 3.68, 95% CI; 1.20-11.23, P=.022) than patients without preoperative R/NCCP after adjustment for sex, age at repair (ie, shunt duration), VSD size, and postoperative follow-up period. Using the definition of absolute Valsalva diameter ≥4 cm, nonsubarterial VSD type and presence of R/NCCP were also significantly associated with ARD after adjustment for the same covariates. CONCLUSIONS Anatomical and morphological features (nonsubarterial type and presence of preoperative R/NCCP) are independently correlated with ARD in patients with VSD regardless of the different definitions of ARD. Patients with surgically repaired VSD may need careful monitoring for potential ARD development.
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Affiliation(s)
- Chihiro Saito
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Noritoshi Fukushima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Keiko Fukushima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Goki Matsumura
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Maagaard M, Heiberg J, Asschenfeldt B, Ringgaard S, Hjortdal VE. Does functional capacity depend on the size of the shunt? A prospective, cohort study of adults with small, unrepaired ventricular septal defects†. Eur J Cardiothorac Surg 2017; 51:722-727. [DOI: 10.1093/ejcts/ezw420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/18/2016] [Indexed: 11/13/2022] Open
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Small, unrepaired ventricular septal defects reveal poor exercise capacity compared with healthy peers: A prospective, cohort study. Int J Cardiol 2017; 227:631-634. [DOI: 10.1016/j.ijcard.2016.10.086] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/28/2016] [Indexed: 01/16/2023]
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14
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Tougouma SJB, Kissou SLA, Yaméogo AA, Yaméogo NV, Bama A, Barro M, Héma A, Kaguembèga L, Nacro B. [Cardiopathies in children hospitalized at the University hospital Souro Sanou, Bobo-Dioulasso: echocardiographic and therapeutic aspects]. Pan Afr Med J 2016; 25:62. [PMID: 28250886 PMCID: PMC5321158 DOI: 10.11604/pamj.2016.25.62.9508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/25/2016] [Indexed: 12/02/2022] Open
Abstract
Les cardiopathies de l'enfant déterminent en Afrique un problème de santé publique difficile à prendre en charge, de part la densité de la population jeune, le faible niveau socioéconomique et l'insuffisance de plateaux techniques adaptés. Les auteurs rapportent les aspects échocardiographiques et thérapeutiques des cardiopathies de l'enfant dans le département de pédiatrie du CHUSS de Bobo-Dioulasso. Il s'agissait d'une étude transversale descriptive concernant la période de janvier 2013 à décembre 2014 (24 mois). Elle a consisté en une revue documentaire des comptes rendus d'échocardiographies réalisées chez les enfants de moins de 15 ans dans le laboratoire d'échocardiographie du CHUSS et de leurs dossiers de suivi thérapeutique. Durant la période d'étude, 184 examens écho-cardiographiques avaient été réalisés et permis la mise en évidence de 93 cas de cardiopathies de l'enfant, soit 50,50% des cas. Parmi eux, on distinguait 71% (66/93) de cardiopathies congénitales et 29% (27/93) de cardiopathies acquises. Les cardiopathies congénitales les plus fréquentes étaient : la CIV (27,2%), CIA (10,6%), CAV (7,5%), T4F (9,1%), TAC (6%), formes associées (15%). Les cardiopathies acquises étaient dominées par les valvulopathies rhumatismales (48%), la cardiomyopathie dilatée hypokinétique (33,3%) et la tamponnade péricardite (18,5%). L'indication chirurgicale était posée dans 53,7% (50/93) des cas dont 86% (43/50) de cardiopathies congénitales et 14% (7/50) de cardiopathies acquises. 21% (9/43) des cardiopathies congénitales ont bénéficié d'une chirurgie cardiaque. Aucune cardiopathie acquise d'indication thérapeutique chirurgicale n'avait été opérée. Les cardiopathies de l'enfant sont fréquentes à Bobo-Dioulasso. La conception de stratégies multidisciplinaires associées à une optimisation des moyens devraient améliorer la prise en charge de ces cardiopathies.
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Affiliation(s)
- Somnoma Jean-Baptiste Tougouma
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Fasso; Service de Cardiologie, CHUSS de Bobo-Dioulasso, Burkina Fasso
| | - Senkaye-Lagom Aimé Kissou
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Fasso; Service de Pédiatrie, CHUSS de Bobo-Dioulasso, Burkina Fasso
| | - Aimé Arsène Yaméogo
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Fasso; Service de Cardiologie, CHUSS de Bobo-Dioulasso, Burkina Fasso
| | - Nobila Valentin Yaméogo
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Burkina Fasso
| | - Aimé Bama
- Centre Hospitalier Pédiatrique Charles de Gaulle de Ouagadougou, Burkina Fasso
| | - Makoura Barro
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Fasso; Service de Cardiologie, CHUSS de Bobo-Dioulasso, Burkina Fasso
| | - Arsène Héma
- Centre Hospitalier Universitaire Souro Sanou (CHUSS), Burkina Fasso
| | - Larissa Kaguembèga
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Burkina Fasso
| | - Boubacar Nacro
- Service de Pédiatrie, CHUSS de Bobo-Dioulasso, Burkina Fasso; Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Burkina Fasso
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Heggie J, Poirer N, Williams WG, Karski J. Anesthetic Considerations for Adult Cardiac Surgery Patients with Congenital Heart Disease. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1177/108925320300700203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of adults with congenital heart disease surviving into adulthood is increasing. The proportion of adults undergoing revision of a previous repair is increasing in comparison to those that present for a palliative or curative operation. At the Toronto Congenital Cardiac Centre for Adults, 528 patients underwent cardiac surgery between January 1, 1992 and December 31, 2001. The anesthetic management of the surgical correction of simple and complex congenital heart lesions includes general physiologic considerations such as dysrhythmias, hypoxemia, polycythemia, and pulmonary hypertension. Palliative shunts from early childhood have anatomical and physiologic implications for the adult. Preparation for the operating room and postoperative care are natural extensions of the anesthetic management of the surgical correction of the congenital heart lesions. Anesthetic management of septal lesions in the interventional suite and operating room is discussed. Complex lesions such as tetralogy of Fallot, transposition of the great arteries, Glenn anastomosis, and the Fontan operation are reviewed. The anesthetic management of these patients is rewarding but impossible without an integrated team approach involving cardiologists, surgeons, perfusionists, and nursing staff.
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Affiliation(s)
- Jane Heggie
- Department of Cardiovascular Anaesthesia, Toronto General Hospital, University Health Network, Ontario, Canada; Department of Anaesthesia, Eaton-North 3-425, Toronto General Hospital, 200 Elizabeth St., Toronto, Ontario M5G 2C4, Canada
| | - Nancy Poirer
- Department of Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada
| | | | - Jacek Karski
- Cardiovascular Anesthesia, Toronto General Hospital, University Health Network, Ontario, Canada
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16
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Zamor N, Phoon C, Malhotra S, Ngai J. Endocarditic sinus of valsalva fistulae to right ventricular outflow tract in adult ventricular septal defects. J Clin Anesth 2015; 27:347-52. [PMID: 25910533 DOI: 10.1016/j.jclinane.2015.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 08/29/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
Abstract
Surgical repair of congenital ventricular septal defects (VSDs) in adults is quite rare. Most congenital VSDs are repaired in children. Of those adult patients diagnosed as having VSDs, many are not repaired due to irreversible pulmonary vascular disease. Repair in a patient with a VSD and fistula is even more uncommon. From a review of the literature, we found no other case reports with our unique combination of echocardiographic and surgical findings: a supracristal VSD, right and left sinus of Valsalva fistulas into the right ventricular outflow tract, and a pulmonary artery to pulmonary vein fistula in the context of an aseptic endocarditis lesion. We review the important aspects of anesthetic management in an adult with an intracardiac shunt. An adult patient with unrepaired congenital VSD may develop multiple fistulas as a consequence of endocarditis. This patient refused surgery until the progressive dyspnea was worsened by the endocarditis and the fistulas. At the time of surgery, his ventricular ejection fraction measured 47%, the ventricular chambers were enlarged, and the pulmonary to systemic flow ratio measured 2:1. He did well clinically after the VSD and fistulae repair.
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Affiliation(s)
- Natacha Zamor
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, New York University Langone Medical Center, 550 First Ave, TH 530, New York, NY 10016, USA
| | - Colin Phoon
- Department of Pediatrics, Division of Cardiology, New York University Langone Medical Center, New York, NY, USA; NYU Pediatric Cardiology Associates, 23 160 East 32nd St, 2nd fl 24, New York, NY 10016, USA
| | - Sunil Malhotra
- Department of Cardiothoracic Surgery, Division of Pediatric and Adult Congenital Cardiac Surgery, New York University Langone Medical Center, 530 First Ave, Suite 9 V, New York, NY 10016, USA
| | - Jennie Ngai
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, New York University Langone Medical Center, 550 First Ave, TH 530, New York, NY 10016, USA.
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Radhakrishnan BK, Idhrees A M, Devarajan S, Panicker VT, Pillai VV, Varma PK, Karunakaran J. Primary modified bentall's procedure in a case of Laubry-Pezzi syndrome. Ann Thorac Surg 2014; 98:1445-7. [PMID: 25282208 DOI: 10.1016/j.athoracsur.2013.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 11/06/2013] [Accepted: 11/19/2013] [Indexed: 10/24/2022]
Abstract
Modified Bentall's procedure done as part of the primary repair in Laubry-Pezzi syndrome is very rarely described in the literature. We present a case of a 33-year-old man with a subpulmonic venticular septal defect, aneurysmal dilatation of the aortic root and ascending aorta, with an associated patent ductus arteriosus, corrected by the incorporation of Yacoub's techique for ventricular septal defect closure with a modified Bentall's procedure and transpulmonary patent ductus arteriosus ligation. The postoperative course was unremarkable. Early follow-up reports show good biventricular function without residual ventricular septal defect or iatrogenic ventricular outflow tract obstructions.
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Affiliation(s)
- Bineesh K Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Mohammed Idhrees A
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sujith Devarajan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Varghese T Panicker
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Vivek V Pillai
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Praveen K Varma
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jayakumar Karunakaran
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Zhou J, Zhang Y, Gui Y, Chu C, Zhang C, Zhou Q, Zhang Y, Li X, Yan Y. Relationship between isolated mild tricuspid valve regurgitation in second-trimester fetuses and postnatal congenital cardiac disorders. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1677-1682. [PMID: 25154952 DOI: 10.7863/ultra.33.9.1677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES In most cases, the clinical importance of fetal isolated mild tricuspid valve regurgitation is not known. This study evaluated the relationship between fetal isolated mild tricuspid regurgitation in the general obstetric population and postnatal congenital cardiac disorders. METHODS Detailed fetal echocardiography was done between 18 and 24 weeks' gestation to detect tricuspid regurgitation and to exclude complicated cardiac defects. Routine second-trimester targeted organ scans were also performed to exclude extracardiac defects. Follow-up was done until birth. After birth, the cardiac anatomy of the neonates was examined by echocardiography. The association between fetal isolated mild tricuspid regurgitation and postnatal congenital cardiac disorders was assessed by logistic regression analysis. RESULTS No major cardiac disorders were found postnatally. Some minor disorders were found, including a patent foramen ovale, atrial septal defects, a patent ductus arteriosus, and small ventricular septal defects. Fetuses with isolated mild tricuspid regurgitation had a significantly higher likelihood of having ventricular septal defects (odds ratio, 5.80; P = .027) or a patent foramen ovale with atrial septal defects and a patent ductus arteriosus (odds ratio, 11.61; P = .007). There was no significant association between tricuspid regurgitation and an isolated patent foramen ovale or a patent foramen ovale with atrial septal defects in neonates. CONCLUSIONS Fetuses with isolated mild tricuspid regurgitation in the second trimester did not have a higher incidence of major cardiac disorders after birth. The presence of isolated mild tricuspid regurgitation may be an indication of minor postnatal congenital cardiac disorders.
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Affiliation(s)
- Jizi Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Yun Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Yonghao Gui
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Chen Chu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Congcong Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Qiongjie Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Ying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.).
| | - Yingliu Yan
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.).
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Akgun T, Karabay CY, Kocabay G, Oduncu V, Kalayci A, Guler A, Ozveren O, Yilmaz F, Akcakoyun M, Kirma C. Discrepancies between Doppler and catheter gradients in ventricular septal defect: a correction of localized gradients from pressure recovery phenomenon. Int J Cardiovasc Imaging 2013; 30:39-45. [DOI: 10.1007/s10554-013-0291-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
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Abstract
BACKGROUND In this study, we aim to investigate the simulation of the cardiovascular system using an electronic circuit model under normal and pathological conditions, especially the Eisenmenger syndrome. METHODS AND RESULTS The Eisenmenger syndrome includes a congenital communication between the systemic and pulmonary circulation, with resultant pulmonary arterial hypertension and right-to-left reversal of flow through the defect. When pulmonary vascular resistance exceeds systemic vascular resistance, it results in hypoxaemia and cyanosis. The Westkessel model including Resistor-Inductance-Capacitance pi-segments was chosen in order to simulate both systemic and pulmonary circulation. The left and right heart are represented by trapezoidal shape stiffness for better simulation results. The Eisenmenger syndrome is simulated using a resistance (septal resistance) connected between the left ventricle and right ventricle points of the model. Matlab® is used for the model implementation. In this model, although there is a remarkable increase in the pulmonary artery pressure and right ventricle pressure, left ventricle pressure, aortic pressure, aortic flow, and pulmonary compliance decrease in the Eisenmenger syndrome. In addition, left-to-right septal flow reversed in these diseases. CONCLUSION Our model is effective and available for simulating normal cardiac conditions and cardiovascular diseases, especially the Eisenmenger syndrome.
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22
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Kim MG, Chung WJ, Choi CH, Moon J, Shin MS, Han SH, Shin EK. Right coronary cusp prolapse resembling subpulmonic stenosis in an old adult patient with ventricular septal defect. J Cardiovasc Ultrasound 2011; 19:216-20. [PMID: 22259668 PMCID: PMC3259549 DOI: 10.4250/jcu.2011.19.4.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/23/2011] [Accepted: 11/30/2011] [Indexed: 11/22/2022] Open
Abstract
Ventricular septal defect (VSD) can be associated with various complications such as aortic regurgitation (AR). AR in VSD come from a deficiency or hypoplasia of the conal septum which leads to abnormal apposition in diastole and prolapse of the poorly supported noncoronary or right coronary cusp through the VSD into the right ventricle resembling subpulmonic stenosis and subsequently results in distortion of the aortic valve and progressive AR. AR often increases in severity with age and it indicates a worse prognosis. Therefore, appropriate timing of surgical repair in progressive AR in VSD might be important. Until now, many earlier experiences about surgical repair of AR complicating VSD were on adolescents or young adults. We reported a case of AR in 48-year-old male patient with right coronary cusp prolapse complicating the subarterial type of VSD which was properly assessed by echocardiography and was successfully treated with surgical repair. Right coronary cusp or noncoronary cusp prolapse should be suspected in AR complicating VSD through proper echocardiographic assessment and the surgical repair on VSD and distorted aortic valve should be considered in the old patient, as well as the young.
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Affiliation(s)
- Myeong Gun Kim
- Cardiology Division, Heart Center, Gachon University Gil Hospital, Incheon, Korea
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23
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Weston AD, Brown NA, Ozolinš TRS. Co-variation in frequency and severity of cardiovascular and skeletal defects in Sprague-Dawley rats after maternal administration of dimethadione, the N-demethylated metabolite of trimethadione. ACTA ACUST UNITED AC 2011; 92:206-15. [PMID: 21638752 DOI: 10.1002/bdrb.20302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/05/2011] [Accepted: 04/06/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND The anticonvulsant trimethadione is a potent inducer of ventricular septation defects, both clinically and in rodents. Teratogenicity requires its N-demethylation to dimethadione, the proximate teratogen. It was previously demonstrated trimethadione only induced membranous ventricular septation defects in rat (Fleeman et al., 2004), and our present goal is to determine whether direct administration of dimethadione increases the incidence and severity of septation defects. METHODS Pregnant Sprague-Dawley rats were divided into five groups and administered either distilled water (control) or four different regimens of dimethadione. The core treatment was 300 mg/kg dimethadione b.i.d. on gestation day 9, 10 with additional groups given one additional dose of dimethadione 12 hr earlier, 12 hr later or two additional doses 12 hr earlier and later. Caesarian sections occurred on gestation day 21 and fetuses were examined for standard developmental toxicity endpoints. RESULTS The broadest dosing regimen yielded the highest incidence and the most severe heart and axioskeletal findings with a decrease in mean fetal body weight. The overall incidence of ventricular septation defects was 74%, of which 68% were membranous and 9% muscular. Outflow tract anomalies (17%) were also observed, as were malformations of the axioskeleton (97%), but not of the long bones, and of particular interest was the high incidence of sternoschesis. CONCLUSIONS Unlike trimethadione, dimethadione induces more serious muscular septation defects that are believed to be more clinically relevant. This, when taken together with the high incidence of total septation anomalies suggests dimethadione is useful for the study of chemically induced ventricular septation defects.
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Affiliation(s)
- Andrea D Weston
- Department of Developmental and Reprodutive Toxicology, Pfizer Global Research and Development, Groton, Connecticut, USA
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Mongeon FP, Burkhart HM, Ammash NM, Dearani JA, Li Z, Warnes CA, Connolly HM. Indications and Outcomes of Surgical Closure of Ventricular Septal Defect in Adults. JACC Cardiovasc Interv 2010; 3:290-7. [DOI: 10.1016/j.jcin.2009.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 12/13/2009] [Indexed: 11/29/2022]
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Diez-Prieto I, García-Rodríguez B, Ríos-Granja A, Cano-Rábano M, Peña-Penabad M, García CP. Cardiac conotruncal malformations in a family of beagle dogs. J Small Anim Pract 2009; 50:597-603. [PMID: 19814768 DOI: 10.1111/j.1748-5827.2009.00815.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study forms of congenital heart disease present in a family of beagle dogs with a strong prevalence of ventricular septal defect and to document the pathological findings associated with the ventricular septal defects and investigate the mode of transmission. METHODS The animals were investigated by physical examination, radiography, electrocardiography and ultrasonography to diagnose the presence of congenital heart disease. Some animals were diagnosed at post-mortem examination and the dead animals underwent post-mortem examination to verify the presence of ventricular septal defect. An analysis of pedigree was undertaken and two of the affected animals were mated to investigate the mode of transmission. RESULTS Among the 28 dogs evaluated clinically or by post-mortem examination, 14 cases of ventricular septal defect were identified. The post-mortem examination showed some abnormalities of the ventricular outflow region associated with malformation of conotruncal septum development. When two affected dogs were bred, congenital heart disease was present in all of the offspring. CLINICAL SIGNIFICANCE The congenital heart disease identified in this beagle family can be classified as conotruncal malformation, and an autosomal recessive mode of inheritance was suggested by pedigree analysis.
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Affiliation(s)
- I Diez-Prieto
- Universidad de León, Department of Medicina, Cirugía y Anatomía Veterinaria, Leon, Spain
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Senzaki H, Kumakura R, Ishido H, Masutani S, Seki M, Yoshiba S. Left Atrial Systolic Force in Children: Reference Values for Normal Children and Changes in Cardiovascular Disease With Left Ventricular Volume Overload or Pressure Overload. J Am Soc Echocardiogr 2009; 22:939-46. [DOI: 10.1016/j.echo.2009.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Indexed: 10/20/2022]
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Chessa M, Butera G, Negura D, Bussadori C, Giamberti A, Fesslova V, Carminati M. Transcatheter closure of congenital ventricular septal defects in adult: mid-term results and complications. Int J Cardiol 2008; 133:70-3. [PMID: 18234370 DOI: 10.1016/j.ijcard.2007.11.098] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 11/14/2007] [Accepted: 11/25/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Transcatheter treatment of congenital heart defects in adult patients is dramatically changing the way in which this population is being treated. This report outlines mid-term follow-up results and complications in adult patients that underwent transcatheter VSD closure. METHODS The data of 40 adult patients who underwent transcatheter closure of a VSD at our institution were collected prospectively between January 2000 and June 2006. The inclusion criteria for this study were clinical and/or echocardiographic evidence of a significant left-to-right shunt through a muscular VSD (mVSD) or a perimembranous VSD (pVSD). A shunt was considered significant when the following were found: (i) left atrial enlargement, defined as a left atrial-to-aortic ratio >1.5; (ii) left ventricular enlargement (left ventricular overload), defined as a left ventricular end-diastolic diameter >+2 standard deviation (SD) above the mean for the patient's age. Another inclusion criterion was a previous episode of endocarditis. RESULTS 41 procedures were carried out in 40 patients; a mVSD-O was used in 22 patients and a pVSD-O in 18 patients (1 patient had two devices inserted). No deaths occurred; no procedure was aborted. A total of 6 (14.6%) complications occurred. The most frequent complication was a rhythm abnormality (n=4). No device embolization occurred. The median follow-up duration was 36 months (range: 6-81 months). No deaths or cases of endocarditis occurred. One patient who had two devices implanted because of a residual defect after a tetralogy of Fallot repair, had to be operated again 3 months after the second device implantation because of a persistent significant residual leak. CONCLUSIONS Greater experience, possibly of multicentre trials and long-term follow-up are required to better assess the safety and effectiveness of this procedure as an alternative to surgical approaches in adult patients.
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Affiliation(s)
- Massimo Chessa
- Department of Pediatric Cardiology and Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato Hospital, San Donato Milanese, Milan, Italy.
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Bol Raap G, Meijboom FJ, Kappetein AP, Galema TW, Yap SC, Bogers AJJC. Long-term follow-up and quality of life after closure of ventricular septal defect in adults. Eur J Cardiothorac Surg 2007; 32:215-9. [PMID: 17566753 DOI: 10.1016/j.ejcts.2007.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 04/13/2007] [Accepted: 04/16/2007] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To study patients who underwent surgical closure of a congenital ventricular septal defect (VSD) and presenting at adult age. METHODS AND RESULTS A retrospective study was carried out of 28 patients (15 male) operated upon between 1980 and 2004. Patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire. The indication for surgery was volume overload in 11 patients, endocarditis in 8, aortic valve regurgitation in 8 and the combination of a VSD with subvalvular aortic stenosis in 1. Follow-up was complete with a mean duration of follow-up of 13 years. There was no early or late mortality. One patient was reoperated for recurrent VSD. Twenty-five patients underwent echocardiography, which revealed a trivial residual VSD in two and mild aortic regurgitation in 10 (40%) patients. One patient was in atrial fibrillation. Health related quality of life in the dimensions cognitive functioning and sleep differed significantly from that of the general population. CONCLUSION With a relative difference in indications for closure of a VSD in adulthood, surgical closure of VSD at adult age is an adequate and safe procedure, with good results on long-term follow-up. Progression of aortic valve regurgitation is a matter of concern.
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Affiliation(s)
- Goris Bol Raap
- Department of Cardiothoracic Surgery, Thoraxcentre, Erasmus MC University Hospital, Rotterdam, The Netherlands.
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29
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Frey GM, Ott MG, Messerer P, Nasterlack M, Zober A, Queisser-Luft A. Pregnancy protection program in a large chemical company: infant outcomes. J Occup Environ Med 2007; 49:519-25. [PMID: 17495694 DOI: 10.1097/jom.0b013e31804630ea] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate reproductive outcomes in infants relative to maternal exposures in the chemical industry. METHODS Via questionnaires administered after the pregnancy announcement, end of pregnancy, and 1 year later, infant outcomes were documented for 1147 live births. Maternal exposure factors were evaluated relative to birth height and weight, sex ratio, Apgar score at 5 minutes, and major malformations. RESULTS Birth height and weight, sex ratio, and Apgar score did not differ by maternal work area or chemical hazard categories. Major malformations (3.1%) and organ-specific anomalies were consistent with the experience of a regional birth defects registry. Rates of malformation were marginally higher in infants born to women assigned to chemical versus office jobs. CONCLUSIONS Infant outcomes to date have been consistent with comparable findings from population-based studies. Longer-term observation will be needed to assess trends for low-frequency outcomes and more specific maternal exposures.
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Affiliation(s)
- Gunild M Frey
- Occupational Medical and Health Protection Department, BASF Aktiengesellschaft, Ludwigshafen, Germany.
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30
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Fleeman TL, Cappon GD, Hurtt ME. Postnatal closure of membranous ventricular septal defects in Sprague-Dawley rat pups after maternal exposure with trimethadione. ACTA ACUST UNITED AC 2005; 71:185-90. [PMID: 15282739 DOI: 10.1002/bdrb.20011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Congenital membranous ventricular septal defects (VSD) have been shown to close during postnatal development in rats [Solomon et al., Teratology 55:185-194, 1997]. Although they may differ in size, spontaneous and treatment-related VSD are histologically similar; however, the postnatal fate of treatment-induced VSD is not known. The objective of this study was to determine if treatment-induced VSD persist throughout postnatal development. METHODS Groups of 40 female rats were given oral doses of trimethadione (TMD) at 400 mg/kg/day (200 b.i.d.) or 600 mg/kg/day (300 b.i.d.) on Gestation Days (GD) 9 and 10. Twenty dams in each group were designated for Cesarean section and 20 were allowed to deliver and rear their offspring to Postnatal Day (PND) 21. The integrity of the ventricular septum was evaluated in fetuses (GD 21) and pups (PND 21). RESULTS The incidence of membranous VSD was 0.6, 7.6, and 49.8% per litter in the Control, 400, and 600 mg/kg groups, respectively, on GD 21. Both the incidence and severity of VSD increased with dose. The VSD at 400 mg/kg were small in size and initially detected by the presence of blood flowing through the defect from the closed right ventricle. In the 600 mg/kg dose group, the VSD, although still membranous, were larger and more readily detected without the need to examine the blood flow. At 600 mg/kg, not only were the VSD larger than those in the Control or the 400 mg/kg group, 10.1% per litter of the affected fetuses had other vessel anomalies associated with the VSD, which were incompatible with pup survival. On PND 21, VSD was noted in 0.3, 0, and 6.4% per litter evaluated in the Control, 400, and 600 mg/kg groups, respectively. This demonstrates that the small, isolated treatment-related VSD can resolve postnatally; however, the closure of the larger or more severe VSD may be prolonged or may not occur at all. Although TMD exposure reduced group mean fetal weights at both dose levels, there was no difference between the mean weight of fetuses with VSD and those fetuses without VSD in the same group. CONCLUSION Treatment-induced VSD close postnatally, and appears to be a delay in cardiac development not associated with fetal weight. The timing of closure and survivability during closure is dependent on the severity of the VSD. Further characterization of the two sizes of VSD may provide diagnostic clarity; however, the current data support the smaller VSD as a variation with no significant impact on viability and growth, and the more severe VSD to be a malformation.
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Affiliation(s)
- Tammye L Fleeman
- Pfizer Global Research and Development, Groton, Connecticut 06340, USA.
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31
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Barboza JM, Dajani NK, Glenn LG, Angtuaco TL. Prenatal diagnosis of congenital cardiac anomalies: a practical approach using two basic views. Radiographics 2002; 22:1125-37; discussion 1137-8. [PMID: 12235342 DOI: 10.1148/radiographics.22.5.g02se171125] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Structural cardiac anomalies are estimated to occur in 8 of every 1,000 live births. Cardiovascular anomalies are frequently associated with other congenital anomalies because the heart is among the last organs to develop completely in the embryo. The guidelines for routine prenatal evaluation of both the American College of Radiology and the American Institute of Ultrasound in Medicine require evaluation of the fetal heart. The ultrasonographic (US) view that is most commonly used is the four-chamber view, which allows assessment of abnormalities involving the atria and the ventricles. However, this view is not adequate for demonstrating the outflow tracts of the aorta and pulmonary artery. A base view that demonstrates the crossing of the great vessels can be obtained just superior to the four-chamber view. Addition of the base view to routine US evaluation with the four-chamber view increases not only the sensitivity for detection of cardiac anomalies but also the accuracy of diagnosis.
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Affiliation(s)
- Jodi M Barboza
- Departments of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
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