[Risk factors for congenital heart disease in Chinese neonates: a Meta analysis]

Myocardial intramural course may reduce left ventricular ejection fraction of patients suffering from coronary heart disease

Background

Myocardial intramural course (MIC), a benign anatomical lesion, is an abnormal anatomical structure formed due to abnormal blood vessel routing. An increasing number of studies indicate that MIC is associated with coronary heart disease (CHD). However, it remains unclear whether MIC contributes to cardiac function impairment in patients with CHD. Thus, this study is to observe the association between MIC and cardiac function in patients with CHD.

Methods

All participants were recruited from the Department of Cardiology, Peking University People's Hospital from August 2022 to September 2023. A total of 126 patients were diagnosed with MIC by coronary angiography and/or coronary CT angiography. Among them, a total of 39 patients diagnosed with MIC and CHD were enrolled in the MIC-CHD group. Sixty cases of monthly stratified CHD patients were randomly selected, into the CHD group as controls.

Results

The left ventricular ejection fraction (LVEF) of patients in the MIC-CHD group was lower than that in the CHD group (0.62 vs. 0.67, p = 0.0153). LVEF in patients of MIC-CHD was negatively correlated with the systolic stenosis degree of mural coronary artery (MCA) (r = -0.6474, p = 0.0123) and MIC length (r = -0.5712, p = 0.0414).

Conclusions

The combination of MIC in patients with CHD may contribute to the reduction of LVEF, whereas MIC length and the systolic stenosis degree of MCA were negatively correlated with LVEF.

Cardiac Development and Factors Influencing the Development of Congenital Heart Defects (CHDs): Part I

The traditional description of cardiac development involves progression from a cardiac crescent to a linear heart tube, which in the phase of transformation into a mature heart forms a cardiac loop and is divided with the septa into individual cavities. Cardiac morphogenesis involves numerous types of cells originating outside the initial cardiac crescent, including neural crest cells, cells of the second heart field origin, and epicardial progenitor cells. The development of the fetal heart and circulatory system is subject to regulatation by both genetic and environmental processes. The etiology for cases with congenital heart defects (CHDs) is largely unknown, but several genetic anomalies, some maternal illnesses, and prenatal exposures to specific therapeutic and non-therapeutic drugs are generally accepted as risk factors. New techniques for studying heart development have revealed many aspects of cardiac morphogenesis that are important in the development of CHDs, in particular transposition of the great arteries.

Parental non-hereditary teratogenic exposure factors on the occurrence of congenital heart disease in the offspring in the northeastern Sichuan, China

Nonhereditary factors play an important role in the occurrence of congenital heart disease (CHD). This study was to explore the possible parental nonhereditary exposure factors relevant to the occurrence of CHD in the northeastern Sichuan area. A total of 367 children with CHD and 367 children without congenital malformations aged 0 to 14 years old were recruited from the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital between March 2016 and November 2018. This study was designed as a case-control study with 1:1 frequency matching, in which the parents of cases and controls were interviewed with the same questionnaire according to the gestational age of the child, maternal age during pregnancy and the same maternal race/ethnicity. Then, 322 matched case-control pairs were analysed by SPSS 22. Thirty-one suspicious factors were entered into the binary logistic regression analysis after univariate regression analysis of 55 factors (alpha = 0.05). The analysis results showed that 7 factors were significantly associated with the occurrence of CHD. Thus, augmenting maternal mental healthcare, improving the quality of drinking water, obtaining adequate nutrition, maintaining a healthy physical condition during pregnancy, enhancing parents’ level of knowledge and maintaining a healthy lifestyle may lower the occurrence of CHD.

An investigation of the optimal inter-pregnancy interval following pregnancy with a fetus with congenital heart disease

INTRODUCTION

Congenital heart defects (CHD) are one of the most commonly diagnosed congenital malformations in fetuses and newborns. The aim of the study was to determine whether inter-pregnancy interval (IPI), maternal age or number of pregnancies had any influence on the recurrence of congenital heart disease in subsequent pregnancies.

MATERIAL AND METHODS

We found in our database 144 women with subsequent pregnancies after CHD in a previous pregnancy. Each woman was selected according to the eligibility and exclusion criteria. Medical history as well as obstetrics history were recorded. Comparisons of groups with and without a recurrence of CHD were performed. We calculated hazard ratios for recurrence of CHD. We also performed analysis of the impact of confounding variables: maternal age and parity. Missing data were excluded from the analysis. Smoking habits as well as socio-demographic characteristics were not evaluated in this study.

RESULTS

A higher risk of recurrence of CHD correlated with a shorter IPI, with a median of 11 months compared with 24 months for the group of healthy fetuses in subsequent pregnancy. The results were statistically significant. Parity was proven to be an important confounder of the study. Multivariable analysis including parity and maternal age did not affect the confidence intervals of hazard ratios for IPI.

CONCLUSIONS

The optimal IPI to reduce the risk of recurrence of CHD is 24 months. Shorter intervals are related to a higher risk of recurrence of CHD in the next pregnancy and are independent on the age of the woman and parity.