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Rathgeber SL, Hutchison SM, De Souza AM, Lester R, Blydt-Hansen T, Human DG, Guttman O, Oberlander TF, Armstrong KR. A text messaging intervention and quality of life in adolescents with solid organ transplants. Pediatr Transplant 2022; 26:e14219. [PMID: 35142005 DOI: 10.1111/petr.14219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/02/2021] [Accepted: 12/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Facilitating communication between adolescents and HCP outside of appointments may enhance patient experience and outcomes. The purpose of this study was to determine whether SMS enhances the healthcare experience, QoL, and medication adherence in adolescent SOT patients. METHODS This was a prospective observational study of an SMS platform (WelTel Inc) for SOT patients aged 12-19 years. QoL was assessed before and after using the PedsQL™ Transplant Module. Medication adherence was assessed with the frequency of therapeutic tacrolimus levels and variation based on control chart analysis. Patient experience and engagement was evaluated with surveys, response rate to messages, and number of clinical conversations (>2 messages). RESULTS Twenty-three patients were included (median age 15.7 years (IQR 13.6-17.1)). Median intervention duration was 13.5 months (range 4.0-16.7 months). There was a 68% response rate (742/1095) with 375 clinical conversations. The majority of patients reported the intervention provided a positive outlook on their health (17/23), was useful (18/23), and improved their connection to HCPs (17/23). Following the intervention, there was no significant difference in the median scaled QoL scores (pre-intervention: 81 (IQR 76.5-93.3), post-intervention: 78 (IQR 76-93); p = .37), mean percentage of therapeutic tacrolimus levels (pre-intervention: 52 ± 25%, post-intervention: 65 ± 17%; p = .07), or variation on control chart analysis of tacrolimus levels. CONCLUSIONS The WelTel messaging platform provided supplemental clinical care for a group of adolescent SOT patients that enhanced their healthcare experience. Patient QoL and adherence were unchanged following the intervention and remained at a high level.
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Affiliation(s)
- Steven L Rathgeber
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah M Hutchison
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Astrid-Marie De Souza
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Blydt-Hansen
- Division of Nephrology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek G Human
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Orlee Guttman
- Division of Gastroenterology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn R Armstrong
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Bovard JM, DE Souza AM, Harris KC, Human DG, Hosking MCK, Potts JE, Armstrong K, Sandor GGS, Cote AT. Physiological Responses to Exercise in Pediatric Heart Transplant Recipients. Med Sci Sports Exerc 2019; 51:850-857. [PMID: 30629048 DOI: 10.1249/mss.0000000000001889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pediatric heart transplant (HTx) recipients have reduced exercise capacity typically two-thirds of predicted values, the mechanisms of which are not fully understood. We sought to assess the cardiorespiratory responses to progressive exercise in HTx relative to controls matched for age, sex, body size, and work rate. METHODS Fourteen HTx recipients and matched controls underwent exercise stress echocardiography on a semisupine cycle ergometer. Hemodynamics, left ventricular (LV) dimensions, and volumes were obtained and indexed to body surface area. Oxygen consumption (V˙O2) was measured, and arteriovenous oxygen difference was estimated using the Fick Principle. RESULTS At rest, LV mass index (P = 0.03) and volumes (P < 0.001) were significantly smaller in HTx, whereas wall thickness (P < 0.01) and LV mass-to-volume ratio (P = 0.01) were greater. Differences in LV dimensions and stroke volume persisted throughout exercise, but the pattern of response was similar between groups as HR increased. As exercise progressed, heart rate and cardiac index increased to a lesser extent in HTx. Despite this, V˙O2 was similar (P = 0.82) at equivalent work rates as HTx had a greater change in arteriovenous oxygen difference (P < 0.01). CONCLUSIONS When matched for work rate, HTx had similar metabolic responses to controls despite having smaller LV chambers and an attenuated increase in hemodynamic responses. These findings suggest that HTx may increase peripheral O2 extraction as a compensatory mechanism in response to reduced cardiovascular function.
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Affiliation(s)
- Joshua M Bovard
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, CANADA
| | - Astrid M DE Souza
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, CANADA
| | - Kevin C Harris
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, CANADA.,Department of Pediatrics (Cardiology), University of British Columbia, Vancouver, British Columbia, CANADA
| | - Derek G Human
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, CANADA.,Department of Pediatrics (Cardiology), University of British Columbia, Vancouver, British Columbia, CANADA
| | - Martin C K Hosking
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, CANADA.,Department of Pediatrics (Cardiology), University of British Columbia, Vancouver, British Columbia, CANADA
| | - James E Potts
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, CANADA.,Department of Pediatrics (Cardiology), University of British Columbia, Vancouver, British Columbia, CANADA
| | - Kathryn Armstrong
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, CANADA
| | - George G S Sandor
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, CANADA.,Department of Pediatrics (Cardiology), University of British Columbia, Vancouver, British Columbia, CANADA
| | - Anita T Cote
- Department of Pediatrics (Cardiology), University of British Columbia, Vancouver, British Columbia, CANADA.,School of Human Kinetics, Trinity Western University, Langley, British Columbia, CANADA
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Cote AT, Hosking M, Voss C, Human DG, Sandor GGS, Harris KC. Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients. CONGENIT HEART DIS 2018; 13:663-670. [DOI: 10.1111/chd.12629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Anita T. Cote
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- School of Human Kinetics; Trinity Western University; Langley Canada
| | - Martin Hosking
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Christine Voss
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Derek G Human
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - George G. S. Sandor
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Kevin C. Harris
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
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Dallaire F, Fortier-Morissette Z, Blais S, Dhanrajani A, Basodan D, Renaud C, Mathew M, De Souza AM, Dionne A, Blanchard J, Saulnier H, Kaspy K, Rached-d'Astous S, Dahdah N, McCrindle BW, Human DG, Scuccimarri R. Aspirin Dose and Prevention of Coronary Abnormalities in Kawasaki Disease. Pediatrics 2017; 139:peds.2017-0098. [PMID: 28562282 DOI: 10.1542/peds.2017-0098] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acetylsalicylic acid (ASA) is part of the recommended treatment of Kawasaki disease (KD). Controversies remain regarding the optimal dose of ASA to be used. We aimed to evaluate the noninferiority of ASA at an antiplatelet dose in acute KD in preventing coronary artery (CA) abnormalities. METHODS This is a multicenter, retrospective, nonrandomized cohort study including children 0 to 10 years of age with acute KD between 2004 and 2015 from 5 institutions, of which 2 routinely use low-dose ASA (3-5 mg/kg per day) and 3 use high-dose ASA (80 mg/kg per day). Outcomes were CA abnormalities defined as a CA diameter with a z score ≥2.5. We assessed the risk difference of CA abnormalities according to ASA dose. All subjects received ASA and intravenous immunoglobulin within 10 days of fever onset. RESULTS There were 1213 subjects included, 848 in the high-dose and 365 in the low-dose ASA group. There was no difference in the risk of CA abnormalities in the low-dose compared with the high-dose ASA group (22.2% vs 20.5%). The risk difference adjusted for potential confounders was 0.3% (95% confidence interval [CI]: -4.5% to 5.0%). The adjusted risk difference for CA abnormalities persisting at the 6-week follow-up was -1.9% (95% CI: -5.3% to 1.5%). The 95% CI of the risk difference of CA abnormalities adjusted for confounders was within the prespecified 5% margin considered to be noninferior. CONCLUSIONS In conjunction with intravenous immunoglobulin, low-dose ASA in acute KD is not inferior to high-dose ASA for reducing the risk of CA abnormalities.
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Affiliation(s)
- Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Centre de recherche du centre hospitalier universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada;
| | - Zoe Fortier-Morissette
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Centre de recherche du centre hospitalier universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Centre de recherche du centre hospitalier universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | | | - Dania Basodan
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Claudia Renaud
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Mathew Mathew
- Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada; and
| | - Astrid M De Souza
- Cardiology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, Canada
| | - Audrey Dionne
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Joel Blanchard
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Centre de recherche du centre hospitalier universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Harrison Saulnier
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Kimberley Kaspy
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Soha Rached-d'Astous
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Brian W McCrindle
- Labatt Family Heart Center, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada; and
| | - Derek G Human
- Cardiology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, Canada
| | - Rosie Scuccimarri
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
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Duff DK, De Souza AM, Human DG, Potts JE, Harris KC. A novel treadmill protocol for exercise testing in children: the British Columbia Children's Hospital protocol. BMJ Open Sport Exerc Med 2017; 3:e000197. [PMID: 28761700 PMCID: PMC5530101 DOI: 10.1136/bmjsem-2016-000197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Exercise testing in children is widely recommended for a number of clinical and prescriptive reasons. Many institutions continue to use the Bruce protocol for treadmill testing; however, with its incremental changes in speed and grade, it has challenges for practical application in children. We have developed a novel institutional protocol (British Columbia Children's Hospital (BCCH)), which may have better utility in paediatric populations. AIM To determine if our institutional protocol yields similar peak responses in minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER), metabolic equivalents (METS) and heart rate (HR) when compared with the traditional Bruce protocol. METHODS On two different occasions, 70 children (boys=33; girls=37) aged 10-18 years completed an exercise test on a treadmill using each of the protocols. During each test, metabolic gas exchange parameters were measured. HR was monitored continuously during exercise using an HR monitor. RESULTS Physiological variables were similar between the two protocols (median (IQR); rs): VE (L/min) (BCCH=96.7 (72.0-110.2); Bruce=99.2 (75.6-120.0); rs=0.95), peak VO2 (mL/min) (BCCH=2897 (2342-3807); Bruce=2901 (2427-3654); rs=0.94) and METS (BCCH=16.2 (14.8-17.7); Bruce=16.4 (14.7-17.9); rs=0.89). RERs were similar (BCCH=1.00 (0.96-1.02); Bruce=1.03 (0.99-1.07); rs=0.48). Total exercise time (in seconds) was longer for the BCCH protocol: BCCH=915 (829-1005); Bruce=810 (750-919); rs=0.67. CONCLUSION The BCCH protocol produces similar peak exercise responses to the Bruce protocol and provides an alternative for clinical exercise testing in children.
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Affiliation(s)
- D Kathryn Duff
- Department of Sport Science, Douglas College, New Westminster, British Columbia, Canada
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, Canada
| | - Derek G Human
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Kevin C Harris
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Wong KK, Fournier A, Fruitman DS, Graves L, Human DG, Narvey M, Russell JL. Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease. Can J Cardiol 2016; 33:199-208. [PMID: 28043739 DOI: 10.1016/j.cjca.2016.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022] Open
Abstract
Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 newborns have critical congenital heart disease (CCHD). Timely diagnosis affects morbidity, mortality, and disability, and newborn pulse oximetry screening has been studied to enhance detection of CCHD. In this position statement we present an evaluation of the literature for pulse oximetry screening. Current detection strategies including prenatal ultrasound examination and newborn physical examination are limited by low diagnostic sensitivity. Pulse oximetry screening is safe, noninvasive, easy to perform, and widely available with a high specificity (99.9%) and moderately high sensitivity (76.5%). When an abnormal saturation is obtained, the likelihood of having CCHD is 5.5 times greater than when a normal result is obtained. The use of pulse oximetry combined with current strategies has shown sensitivities of up to 92% for detecting CCHD. False positive results can be minimized by screening after 24 hours, and testing the right hand and either foot might further increase sensitivity. Newborns with abnormal screening results should undergo a comprehensive assessment and echocardiography performed if a cardiac cause cannot be excluded. Screening has been studied to be cost neutral to cost effective. We recommend that pulse oximetry screening should be routinely performed in all healthy newborns to enhance the detection of CCHD in Canada.
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Affiliation(s)
- Kenny K Wong
- Pediatric Cardiology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Anne Fournier
- Pediatric Cardiology, CHU Sainte-Justine, University of Montréal, Montréal, Québec, Canada
| | - Deborah S Fruitman
- Pediatric Cardiology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Graves
- Family Medicine, University of Toronto, Toronto, Ontario and WMU Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Derek G Human
- Pediatric Cardiology, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Narvey
- Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L Russell
- Pediatric Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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7
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Sheffield BS, Yip S, Ruchelli ED, Dunham CP, Sherwin E, Brooks PA, Sur A, Singh A, Human DG, Patel MS, Lee AF. Fatal congenital hypertrophic cardiomyopathy and a pancreatic nodule morphologically identical to focal lesion of congenital hyperinsulinism in an infant with costello syndrome: case report and review of the literature. Pediatr Dev Pathol 2015; 18:237-44. [PMID: 25668678 DOI: 10.2350/14-07-1525-cr.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Costello syndrome is characterized by constitutional mutations in the proto-oncogene HRAS, causing dysmorphic features, multiple cardiac problems, intellectual disability, and an increased risk of neoplasia. We report a male infant with dysmorphic features, born prematurely at 32 weeks, who, during his 3-month life span, had an unusually severe and ultimately fatal manifestation of hypertrophic cardiomyopathy and hyperinsulinemic hypoglycemia. Molecular studies in this patient demonstrated the uncommon Q22K mutation in the HRAS gene, diagnostic of Costello syndrome. The major autopsy findings revealed hypertrophic cardiomyopathy, congenital myopathy, and a 1.4-cm pancreatic nodule that was positive for insulin expression and morphologically identical to a focal lesion of congenital hyperinsulinism. Sequencing of KCNJ11 and ABCC8, the 2 most commonly mutated genes in focal lesion of congenital hyperinsulinism, revealed no mutations. While hyperinsulinism is a recognized feature of RASopathies, a focal proliferation of endocrine cells similar to a focal lesion of hyperinsulinism is a novel pathologic finding in Costello syndrome.
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Affiliation(s)
- Brandon S. Sheffield
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Anatomical Pathology, Children's and Women's Health Centre of British Columbia, and Department of Pathology and Laboratory Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC V6H3V4, Canada
| | - Stephen Yip
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Centre for Translational and Applied Genomics, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V6H3V4, Canada
| | - Eduardo D. Ruchelli
- Division of Anatomical Pathology, The Children's Hospital of Philadelphia. 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Christopher P. Dunham
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Anatomical Pathology, Children's and Women's Health Centre of British Columbia, and Department of Pathology and Laboratory Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC V6H3V4, Canada
| | - Elizabeth Sherwin
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Pediatric Cardiology, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 1C50, Vancouver, BC V6H3V4, Canada
| | - Paul A. Brooks
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Pediatric Cardiology, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 1C50, Vancouver, BC V6H3V4, Canada
| | - Amitava Sur
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Department of Neonatal Perinatal Medicine, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, BC V6H3V4, Canada
| | - Avash Singh
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Department of Neonatal Perinatal Medicine, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, BC V6H3V4, Canada
| | - Derek G. Human
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Pediatric Cardiology, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 1C50, Vancouver, BC V6H3V4, Canada
| | - Millan S. Patel
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Department of Medical Genetics and Child and Family Research Institute, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room C234, Vancouver, BC V6H3V4, Canada
| | - Anna F. Lee
- Faculty of Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC, Canada
- Division of Anatomical Pathology, Children's and Women's Health Centre of British Columbia, and Department of Pathology and Laboratory Medicine, University of British Columbia, 4480 Oak Street, Room 2H47, Vancouver, BC V6H3V4, Canada
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Wald RM, Altaha MA, Alvarez N, Caldarone CA, Cavallé-Garrido T, Dallaire F, Drolet C, Grewal J, Hancock Friesen CL, Human DG, Hickey E, Kayedpour C, Khairy P, Kovacs AH, Lebovic G, McCrindle BW, Nadeem SN, Patton DJ, Redington AN, Silversides CK, Tham EB, Therrien J, Warren AE, Wintersperger BJ, Vonder Muhll IF, Farkouh ME. Rationale and Design of the Canadian Outcomes Registry Late After Tetralogy of Fallot Repair: The CORRELATE Study. Can J Cardiol 2014; 30:1436-43. [DOI: 10.1016/j.cjca.2014.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/30/2014] [Accepted: 06/14/2014] [Indexed: 12/17/2022] Open
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Hiebert JD, Auld BC, Sasaki T, Froese NR, Ganshorn MK, Casey ND, Human DG, Gandhi SK. Infant repair of massive aortic aneurysm with prosthetic valved conduit. Ann Thorac Surg 2013; 96:1070-2. [PMID: 23992703 DOI: 10.1016/j.athoracsur.2012.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/11/2012] [Accepted: 12/21/2012] [Indexed: 11/19/2022]
Abstract
A 4-month-old child with severe infantile Marfan syndrome underwent successful repair of an extremely dilated aortic root and severe aortic valve insufficiency using a prosthetic valved conduit.
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Affiliation(s)
- Jake D Hiebert
- Division of Cardiothoracic Surgery, Department of Anesthesia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Abstract
Kingella kingae, a HACEK (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) organism, is a common resident of the upper airway in children; it has been associated with endocarditis in children with pre-existing heart conditions. This case report describes K. kingae endocarditis leading to valvular damage in a previously healthy 18-month-old child. Our patient developed a K. kingae bacteremia that was later complicated by meningitis, septic embolic stroke, and endocarditis of the mitral valve, leading to perforation of the posterolateral leaflet. The patient was initially treated conservatively with cefotaxime but, subsequently, required a mitral valve repair with a pericardial patch and annuloplasty. This report draws attention to the need for clinicians to be aware of the potentially serious complications of K. kingae infection in young children. If K. kingae infection is suspected then therapy should be initiated promptly with a β-lactam, followed by early echocardiographic assessment. This case also highlights the lack of specific guidelines available for K. kingae endocarditis.
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Affiliation(s)
- Anthony A Holmes
- Division of Pediatric Cardiovascular and Thoracic Surgery, BC Children's Hospital, Vancouver, Canada
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Abstract
OBJECTIVES To report the clinical outcomes (early death, late death, and rate of reintervention) and performance of the Contegra conduit as a right ventricle outflow tract implant and to determine the risk factors for early reintervention. METHODS Forty-nine Contegra conduits were implanted between January 2002 and June 2009. Data collection was retrospective. The mean age and follow-up duration of Contegra recipients was 3.5 ± 4.6 years and 4.2 ± 2.0 years, respectively. RESULTS There were three deaths (two early, one late), giving a survival rate of 93.9%. The rate of conduit-related reintervention was 19.6% and was most often due to distal conduit stenosis. Age at implantation of <3 months, receipt of a conduit of 12-16 mm diameter, and a diagnosis of truncus arteriosus were each significant contributors to the rate of reintervention. CONCLUSION The Contegra is a cost-effective and readily available solution. However, there is a limited range of larger calibers, which means that the homograft conduit (>22 mm) remains the first choice of implant in older children. The rates of reintervention are significantly higher with a diagnosis of truncus arteriosus, age at implantation of <3 months, and implantation of conduits sized 12-16 mm.
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Affiliation(s)
- Anthony A Holmes
- Division of Pediatric Cardiovascular and Thoracic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
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12
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Sandor GGS, Human DG, Potts JE. Balloon angioplasty for congenital aortic valve stenosis. Am J Cardiol 2012; 109:1536-7. [PMID: 22546211 DOI: 10.1016/j.amjcard.2012.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
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Carpes LF, Kozak FK, Leblanc JG, Campbell AI, Human DG, Fandino M, Ludemann JP, Moxham JP, Fiori H. Assessment of vocal fold mobility before and after cardiothoracic surgery in children. ACTA ACUST UNITED AC 2011; 137:571-5. [PMID: 21690509 DOI: 10.1001/archoto.2011.84] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess the incidence of vocal fold immobility (VFI) after cardiothoracic surgery in children and to determine the factors potentially associated with this outcome. METHODS Flexible laryngoscopy to assess vocal fold mobility was performed before surgery and within 72 hours after extubation in 100 pediatric patients who underwent cardiothoracic procedures. The 2 operating surgeons recorded the surgical technique and their impression of possible injury to the recurrent laryngeal nerve. The presence of laryngeal symptoms, such as stridor, hoarseness, and strength of cry, after extubation was documented. RESULTS Of 100 children included in this study, 8 had VFI after surgery. Univariate analyses showed that these 8 patients were younger and weighed less than the patients with normal vocal fold movement. Monopolar cautery was used in all patients with VFI. On univariate analysis, factors statistically significantly associated with VFI were circulatory arrest and dissection or ligation of the patent ductus arteriosus, left pulmonary artery, right pulmonary artery, or descending aorta. However, multivariate analyses failed to show these associations. CONCLUSIONS The incidence of VFI after cardiothoracic surgery in our population of children was 8.0% (8 of 100). Of several factors found to be potentially associated with VFI on univariate analysis, none were significant on multivariate analysis. This may be a result of the few patients with VFI. A larger multicenter prospective study would be needed to definitively identify factors associated with the outcome of VFI.
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Affiliation(s)
- Luthiana F Carpes
- Division of Pediatric Otolaryngology, BC Children's Hospital, Vancouver, Canada
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Abstract
A child with complex congenital heart disease in 2008 is very likely to survive a series of surgical and medical interventions, and confront an array of medical and psychosocial stressors that are presently poorly understood. As approaches to medical problems change, careful assessment of those results is essential, and the initial work of the multicentre Pediatric Heart Network is a huge step in the right direction, setting the stage for proper controlled trials of therapies. Major complications, notably ventricular failure, rhythm problems and thromboembolism, will affect nearly one-quarter of survivors, necessitating further interventions. Appropriate educational and psychosocial support for these children and their families is the next challenge for all of us in the field of paediatrics. How ironic would it be to have invested so much in early survival, only to allow the child to fail in life itself.
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Affiliation(s)
- Derek G Human
- BC Children's Hospital and BC Women's Hospital & Health Centre, Vancouver, British Columbia
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Harris KC, Anis AH, Crosby MC, Cender LM, Potts JE, Human DG. Economic evaluation of palivizumab in children with congenital heart disease: a Canadian perspective. Can J Cardiol 2011; 27:523.e11-5. [PMID: 21664100 DOI: 10.1016/j.cjca.2010.12.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 12/30/2009] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a common cause of bronchiolitis in infants. In children with congenital heart disease (CHD), it is associated with significant morbidity and mortality. Palivizumab is a monoclonal antibody that reduces the number of RSV-associated hospitalizations in children with CHD. We sought to assess cost savings and cost-effectiveness of palivizumab in children < 2 years old with hemodynamically significant CHD in a provincially administered RSV prophylaxis program. METHODS A cohort of children who received palivizumab (N = 292) from 2003-2007 was compared to a historical cohort of children (N = 412) from 1998-2003 who met the eligibility criteria for palivizumab prior to initiation of the prophylaxis program. Direct and indirect costs and benefits were determined. RESULTS The direct and indirect costs in the historical cohort were $838 per patient season compared to $9130 per patient season in the palivizumab cohort. Risk of admission was reduced by 42%, and days in hospital were reduced by 83%. The incremental cost of the RSV prophylaxis program was $8292 per patient for 1 RSV season. The incremental cost to prevent 1 day of hospitalization was $15,514. The cost of palivizumab accounted for 87.9% of the cost of prophylaxis. CONCLUSIONS Palivizumab is clinically effective; however, the cost was exceptionally high relative to the outcomes in this population. Given the financial constraints in a public health care setting, more strict criteria for patient selection or reduced drug costs would improve the cost-effectiveness of RSV prophylaxis.
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Affiliation(s)
- Kevin C Harris
- Children's Heart Centre, Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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16
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Robertson CMT, Sauve RS, Joffe AR, Alton GY, Moddemann DM, Blakley PM, Synnes AR, Dinu IA, Harder JR, Soni R, Bodani JP, Kakadekar AP, Dyck JD, Human DG, Ross DB, Rebeyka IM. The registry and follow-up of complex pediatric therapies program of Western Canada: a mechanism for service, audit, and research after life-saving therapies for young children. Cardiol Res Pract 2011; 2011:965740. [PMID: 21629801 PMCID: PMC3099206 DOI: 10.4061/2011/965740] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/15/2011] [Accepted: 02/25/2011] [Indexed: 01/21/2023] Open
Abstract
Newly emerging health technologies are being developed to care for children with complex cardiac defects. Neurodevelopmental and childhood school-related outcomes are of great interest to parents of children receiving this care, care providers, and healthcare administrators. Since the 1970s, neonatal follow-up clinics have provided service, audit, and research for preterm infants as care for these at-risk children evolved. We have chosen to present for this issue the mechanism for longitudinal follow-up of survivors that we have developed for western Canada patterned after neonatal follow-up. Our program provides registration for young children receiving complex cardiac surgery, heart transplantation, ventricular assist device support, and extracorporeal life support among others. The program includes multidisciplinary assessments with appropriate neurodevelopmental intervention, active quality improvement evaluations, and outcomes research. Through this mechanism, consistently high (96%) follow-up over two years is maintained.
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Yeung JP, Human DG, Sandor GGS, De Souza AM, Potts JE. Serial measurements of exercise performance in pediatric heart transplant patients using stress echocardiography. Pediatr Transplant 2011; 15:265-71. [PMID: 21492351 DOI: 10.1111/j.1399-3046.2010.01467.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heart transplantation is an increasingly acceptable therapeutic option for children with end-stage and complex congenital heart disease. With advances in surgery, immunosuppression, and follow-up care, functional outcomes need to be evaluated. We report the results of serial exercise testing performed using stress echocardiography in a cohort of pediatric HTP. HTP (n = 7) exercised on a semi-recumbent ergometer to volitional fatigue. Echocardiography-Doppler measurements, HR, and blood pressure were taken at rest and during staged exercise. Results were compared with healthy CON (n = 12). HTP did significantly less work during exercise (940 vs. 1218 J/kg, p < 0.03). Their SVI (33 vs. 49 mL/m(2), p < 0.003), CI (5.16 vs. 9.25 L/min/m(2), p < 0.0005), and HR (162 vs. 185 bpm, p < 0.02) were lower at peak exercise. HTP had a lower SF at peak exercise (48% vs. 52%, p < 0.03) and an abnormal relationship between the MVCFc and σPS. During follow-up, hemodynamics and left ventricular function remained relatively constant in HTP. HTP are able to exercise safely; however, their exercise tolerance is reduced, and hemodynamics and contractility are diminished. Over time, their hemodynamics and left ventricular function have remained relatively constant.
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Affiliation(s)
- Joanne P Yeung
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
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18
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Andrade JG, Leipsic JA, Campbell AIM, Hung T, Kiess MC, Human DG. An unusual cause of anterior mediastinal mass. J Am Coll Cardiol 2010; 56:610. [PMID: 20688217 DOI: 10.1016/j.jacc.2009.11.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/05/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Jason G Andrade
- Division of Cardiology, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Jeewa A, Culham JAG, Human DG. A case of horseshoe lung and complex congenital heart disease in a term newborn. Pediatr Radiol 2010; 40:206-9. [PMID: 19771424 DOI: 10.1007/s00247-009-1401-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 08/04/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
Abstract
We describe and illustrate a rare association of hypoplastic left heart syndrome, absent hilar left pulmonary artery, and an unusual bronchopulmonary malformation. This case highlights the utility of combination imaging of echocardiography and CT angiography in diagnosing a cyanotic newborn with a chest radiograph that is suspicious for lung hypoplasia.
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Affiliation(s)
- Aamir Jeewa
- Department of Pediatrics, Division of Cardiology, British Columbia Children's Hospital & University of British Columbia, Vancouver, Canada
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Affiliation(s)
- Walter J Duncan
- Department of Pediatrics, British Columbia Children's Hospital and The University of British Columbia, Vancouver, Canada.
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Abstract
We present a case series of pediatric blunt cardiac trauma with a variety of cardiac abnormalities, occurring immediately and after the initial insult. The range of complications and importance of serial evaluations are emphasized.
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Affiliation(s)
- Julie Milligan
- Department of Pediatrics, University of British Columbia and British Columbia's Children's Hospital, Vancouver, Canada
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23
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Jamieson WRE, Cartier PC, Allard M, Boutin C, Burwash IG, Butany J, de Varennes B, Del Rizzo D, Dumesnil JG, Honos G, Houde C, Munt BI, Poirier N, Rebeyka IM, Ross DB, Siu SC, Williams WG, REbeyka IM, David TE, Dyck JD, Feindel CMS, Fradet GJ, Human DG, Lemieux MD, Menkis AH, Scully HE, Turpie AGG, Adams DH, Berrebi A, Chambers J, Chang KL, Cohn LH, Duran CMG, Elkins RC, Freedman R, Huysman HA, Jue J, Perier P, Rakowski H, Schaff HV, Schoen FA, Shah P, Thompson CR, Warnes C, Westaby S, Yacoub MH. Surgical management of valvular heart disease 2004. Can J Cardiol 2004; 20 Suppl E:7E-120E. [PMID: 16804571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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Abstract
OBJECTIVES To describe the clinical features, diagnosis, treatment and outcome of children with Kawasaki disease (KD) treated at a large tertiary care Canadian paediatric hospital and to try to identify correlations between clinical features and the development of coronary artery abnormalities. METHODS The charts of 176 patients diagnosed with typical, atypical or incomplete KD between 1992 and 2000 at British Columbia's Children's Hospital were reviewed. RESULTS The male to female ratio was 1.8:1. The median age was 2.5 years (range two months to 14 years), with 8% nine years or older (42% Caucasian, 43% Asian). Cases occurred steadily throughout the year. One hundred two (58%) patients had typical, 18 (10%) patients had atypical and 56 (32%) patients had incomplete KD. The median time from fever onset to first intravenous immunoglobulin (IVIG) was seven days (range two to 49 days), and treatment began within 10 days of fever onset in 134 (76%) patients. All patients received one or more doses of 2 g/kg IVIG. Forty-two (24%) patients received a second dose for nonresponsiveness, of whom 10 (6%) remained nonresponsive. Eight (5%) patients received intravenous methylprednisolone. Forty-eight (27%) patients developed coronary artery abnormalities, with 10 (6%) echogenic abnormalities, 25 (14%) dilatations and 13 (7%) aneurysms (seven giant). No patient with a normal echocardiogram at four to eight weeks developed an abnormality on subsequent study. Fourteen (8%) patients had persistent abnormalities at last follow-up (median 447 days, range 62 to 3272 days): seven dilations and seven aneurysms (six giant). Five of 13 children (39%) who developed aneurysms failed to meet diagnostic criteria for typical KD, and three of those five aneurysms were present at less than one year after diagnosis. Four of eight (50%) patients receiving intravenous methyl-prednisolone for IVIG nonresponsiveness had or developed aneurysms. One patient died. CONCLUSION Some children diagnosed with KD who fail to meet the diagnostic description develop coronary artery abnormalities. There is a need for a more accurate means of diagnosis to more appropriately use IVIG, an expensive and increasingly scarce resource. The role of corticosteroids remains unclear and a randomized controlled clinical trial to determine their role is needed.
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Duncan WJ, LeBlanc JG, Human DG. Intraoperative rescue by placement of a stent following a surgical coronary arterial injury in a child. Cardiol Young 2004; 14:93-5. [PMID: 15237680 DOI: 10.1017/s1047951104001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An acute injury to a coronary artery was recognized during the surgical construction of the Fontan circulation. Surgical manipulation of the site of injury was not successful in restoring normal myocardial blood flow. A stent was therefore placed intraoperatively under direct vision, with restoration of normal coronary arterial flow acutely and at short-term follow-up.
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Affiliation(s)
- Walter J Duncan
- Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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Patel MS, Taylor GP, Bharya S, Al-Sanna'a N, Adatia I, Chitayat D, Suzanne Lewis ME, Human DG. Abnormal pericyte recruitment as a cause for pulmonary hypertension in Adams-Oliver syndrome. ACTA ACUST UNITED AC 2004; 129A:294-9. [PMID: 15326631 DOI: 10.1002/ajmg.a.30221] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Adams-Oliver syndrome (AOS) consists of congenital scalp defects with variable limb defects of unknown pathogenesis. We report on two children with AOS plus additional features including intrauterine growth retardation (IUGR), cutis marmorata telangiectatica congenita (CMTC), pulmonary hypertension (PH), intracranial densities shown in one case to be sites of active bleeding and osteopenia. Autopsy in one case revealed defective vascular smooth muscle cell/pericyte coverage of the vasculature associated with two blood vessel abnormalities. Pericyte absence correlated with vessel dilatation while hyperproliferation of pericytes correlated with vessel stenosis. These findings suggest a unifying pathogenic mechanism for the abnormalities seen in AOS. These and previously reported cases establish that a subset of AOS patients is at high risk for PH.
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Affiliation(s)
- Millan S Patel
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Bradley TJ, Human DG, Culham JAG, Duncan WJ, Patterson MWH, LeBlanc JG, Sett SS. Clipped tube fenestration after extracardiac Fontan allows for simple transcatheter coil occlusion. Ann Thorac Surg 2003; 76:1923-8. [PMID: 14667614 DOI: 10.1016/s0003-4975(03)01192-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Expensive devices are increasingly used to close a patent fenestration after a modified Fontan operation. We report our 5-year institutional experience of clipped tube fenestration after extracardiac Fontan operation, which allows for simple transcatheter coil occlusion. METHODS We retrospectively reviewed 30 children, median age of 4.0 years (range, 2.4 to 8.8 years) who underwent extracardiac Fontan operation between May 1996 and May 2001, and were fenestrated using a 4- to 8-mm diameter clipped tube graft. RESULTS Ten children had a patent fenestration occluded by transcatheter placement of 15 detachable coils (5- to 8-mm diameter). Aortic oxygen saturations increased on average by 5.5% (2% to 14%) and mean pressures in the Fontan circuit by 2.5 mm Hg (0 to 3 mm Hg). Four had immediate complete occlusion angiographically and 6 had trivial residual shunt, but complete occlusion by echocardiography at follow-up. There have been no immediate complications, late coil embolizations, thromboembolic events, or documented hemolysis within a follow-up after coil implantation of 1.7 years (0.4 to 4.5 years). Spontaneous fenestration closure was documented in 8 patients at cardiac catheterization and 9 patients by echocardiography with consistent improvement in resting transcutaneous oxygen saturation. Two children with a patent fenestration have been considered inappropriate for closure, and there was one early surgical death. There have been no complications related to the tube fenestration modification within a follow-up postoperation of 2.6 years (0.1 to 5.5 years). CONCLUSIONS Clipped tube fenestration after extracardiac Fontan operation is a useful surgical modification that allows for simple transcatheter coil occlusion.
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Affiliation(s)
- Timothy J Bradley
- Cardiac Sciences and Department of Radiology, British Columbia's Children's Hospital, British Columbia, Vancouver, Canada
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Abstract
Pulmonary arterial and intracranial calcifications are rarely found in children. A female infant, the recipient of a twin-twin transfusion syndrome was found, by ultrasound and computed tomography, to have both pulmonary arterial and intracerebral calcification. A rare condition, termed idiopathic arterial calcification of infancy, is the likely cause. This condition carries a poor prognosis and is usually fatal.
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Affiliation(s)
- Olivia C Y Kei
- Faculty of Medicine, Queen's University, Kingston, Canada
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Ebbeson RL, Riley MR, Malleson PN, Human DG, Potts JE. Kawasaki Disease at British Columbia S Children S Hospital. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.36a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Nield LE, Silverman ED, Taylor GP, Smallhorn JF, Mullen JBM, Silverman NH, Finley JP, Law YM, Human DG, Seaward PG, Hamilton RM, Hornberger LK. Maternal anti-Ro and anti-La antibody-associated endocardial fibroelastosis. Circulation 2002; 105:843-8. [PMID: 11854125 DOI: 10.1161/hc0702.104182] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Maternal anti-Ro and anti-La antibodies are associated with congenital heart block (CHB). Although endocardial fibroelastosis (EFE) has been described in isolated cases of autoantibody-mediated CHB, the natural history and pathogenesis of this disease are poorly understood. METHODS AND RESULTS We retrospectively reviewed the clinical history, echocardiography, and pathology of fetuses and children with EFE associated with CHB born to mothers positive for anti-Ro or anti-La antibodies at 5 centers. Thirteen patients were identified, 6 with a prenatal and 7 with a postnatal diagnosis. Six mothers were positive for anti-Ro and anti-La antibodies, and 7 were positive for anti-Ro antibodies only. Only 1 mother had autoimmune disease. Severe ventricular dysfunction was seen in all fetal and postnatal cases. Four fetal and 3 postnatal cases had EFE at initial presentation. However, 2 fetal and 4 postnatal cases developed EFE 6 to 12 weeks and 7 months to 5 years from CHB diagnosis, respectively, even despite ventricular pacing in 6 postnatal cases. Eleven (85%) either died (n=9) or underwent cardiac transplantation (n=2) secondary to the EFE. Pathologic assessment of the explanted heart, available in 10 cases, revealed moderate to severe EFE in 7 and mild EFE in 3 cases, predominantly involving the left ventricle. Immunohistochemistry in 4 cases (including 3 fetuses) demonstrated deposition of IgG in 4 and IgM in 3 and T-cell infiltrates in 3 cases, suggesting an immune response by the affected fetus or child. CONCLUSIONS EFE occurs in the presence of autoantibody-mediated CHB despite adequate ventricular pacing. Autoantibody-associated EFE has a very high mortality rate, whether developing in fetal or postnatal life.
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Affiliation(s)
- Lynne E Nield
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Abstract
BACKGROUND A recently developed implantable loop recorder (ILR) has been used in adult patients whose syncope remains unexplained in spite of extensive investigations. Syncope in the patient with congenital heart disease presents a diagnostic challenge. We applied this technology to a cohort of pediatric patients. METHODS We reviewed our experience with an ILR in patients with congenital heart disease with syncope or palpitations after conventional investigations failed to identify a cause for the symptoms. RESULTS ILRs were implanted in 4 patients with congenital heart disease at 2 centers for investigation of syncope (n = 2), near-syncope (n = 1), and palpitations (n = 1). Implantations were performed at a mean age of 5.9 +/- 0.9 years (4.2 to 7.6 years) and a mean weight of 26.7 +/- 6.6 kg (15.7 to 42.5 kg) with patients under general anesthesia, with no complications. All patients experienced typical symptoms and activated the device appropriately at a median of 86 days (46 to 102) after implantation. Each patient had good-quality data that allowed interpretation of the rhythm. In 2 of 4 cases, a likely cause for the symptoms was identified, with exclusion of more malignant arrhythmic diagnoses in all patients. Escalation of therapy was avoidable in all patients on the basis of the data recorded by the ILR. CONCLUSIONS Recently developed loop recorder technology can be implanted in the young child without difficulty. The ILR proved to be very useful for excluding malignant arrhythmias as a cause of symptoms in these patients at high risk.
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Affiliation(s)
- Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Ontario, Canada
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Abstract
Palliation of complex congenital heart disease, requiring reconstruction of the right ventricular outflow tract (RVOT), is standard practice. Survival of the homograft is a limiting factor. We examined the role of balloon angioplasty (BAP) in prolonging conduit life. Twelve patients underwent 15 BAP procedures between February 1989 and October 1997. The median age at conduit insertion was 28 months with detection of a significant echo gradient 42 months later. Calcification of homografts, with attendant obstruction and valve dysfunction, was present in all patients. BAP was performed within 1 month of echocardiography and reduced the gradient from a median of 57 to 38 mmHg (p < 0.0005). Echocardiographic follow-up showed persistent gradients (median 68 mmHg) and 11/12 patients went on to conduit replacement after BAP. Only one patient had replacement deferred as a result of BAP. Complications requiring intervention occurred in 20% of the procedures and included bleeding and an unusual balloon fracture. Although BAP can reduce the pressure gradient across the RVOT conduit, the effect is transient and the delay of surgery is not due to improved hemodynamic function. Approximately 10% of cases will benefit from BAP alone, but given the high rate of complications, we do not recommend this procedure as a means of prolonging conduit life.
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Affiliation(s)
- S Sanatani
- Division of Cardiology, Room 3F56, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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Cheung YF, Sanatani S, Leung MP, Human DG, Chau AK, Culham JA. Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease. J Am Coll Cardiol 2000; 35:1007-15. [PMID: 10732902 DOI: 10.1016/s0735-1097(99)00644-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease. BACKGROUND The inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent. METHODS Twenty patients underwent 22 implantations of 25 self-expanding Wallstents between December 1993 and June 1997 in two institutions. The mean age and weight were 10.8+/-4.5 years and 30.5+/-14.2 kg, respectively. The patients were divided into two groups: 1) Group I comprised 17 patients with pulmonary arterial stenoses, 2) Group II comprised four patients with venous stenoses (one belonged to both groups). Sixteen patients underwent recatheterization at a median of 5.8 months (range 0.5 to 31, mean 8.1 months) after stenting. Hemodynamic and angiographic changes after the interventional procedures and complications were documented. RESULTS All the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stented vessel increased from 4.1+/-1.5 to 8+/-2 mm (95% increase, p < 0.0001) while the systolic pressure gradient across decreased from 24.6+/-15.8 to 12.1+/-11.4 mm Hg (51% decrease, p = 0.001). In Group II, the dimensional changes of the narrowest segment increased from 4.3+/-0.5 to 7.5+/-0.4 mm (75% increase, p = 0.003), and the pressure gradient reduced from 5.0+/-2.9 to 0.9+/-1.0 mm Hg (82% decrease, p = 0.04) across the stented venous channel. Distal migration of two optimally positioned stents occurred within 24 h of implantation. At recatheterization, significant neointimal ingrowth (>30% of the expanded diameter) was noted in 7 (28%) of the 25 implanted stents. This responded poorly to balloon dilation. Predisposing factors for the neointimal ingrowth included stents of smaller diameter (<9 mm) and longer period after implantation. CONCLUSIONS Self-expanding Wallstent could be deployed easily and safely to relieve vascular stenoses in children. The complications of distal migration, significant neointimal ingrowth and its unyielding design to overdilation limit its application to this patient group.
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Affiliation(s)
- Y F Cheung
- Grantham Hospital, Department of Pediatrics, University of Hong Kong, Aberdeen
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Abstract
PURPOSE To review the clinical outcomes of catheter-directed coil occlusion (coil occlusion) of persistently patent ductus arteriosus (PDA) at a pediatric tertiary care hospital. METHODS A retrospective review of all patients referred to the Cardiac Catheterization Laboratory for coil occlusion at our institution was performed. Twenty-one consecutive patients (12 female) underwent coil occlusion and follow-up between May 1995 and December 1997. We undertook PDA occlusion if: (a) the PDA narrowed to less than 4 mm on echocardiogram and (b) the minimum body weight was approximately 10 kg. Standard right and retrograde left heart catheterization was performed, followed by coil occlusion. Color-flow mapping (CFM) was used intra-procedurally to confirm occlusion of the PDA with a follow-up study several weeks later. RESULTS The median age and weight of the patients were 33 months and 13.2 kg, respectively. Fourteen patients received one coil, with six requiring a second coil and one requiring multiple coils. Initial follow-up was at a median of 2.4 months. At latest follow-up, 2 patients still have persistent flow at the ductal level. The coils were deployed without complication or embolization. CONCLUSIONS A review of our first 21 cases demonstrated three important lessons: (1) the maximum diameter of the PDA suitable for coil occlusion is approximately 3 mm; (2) CFM must show complete obliteration of flow in the catheterization lab in order to ensure occlusion of the PDA at follow-up; and (3) the Jackson detachable system allows for precise placement of the coil, often within another coil.
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Affiliation(s)
- S Sanatani
- Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada
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LeBlanc JG, Russell JL, Sett SS, Potts JE, Human DG, Culham JA. The evolution of ductus arteriosus treatment. Int Surg 2000; 85:1-5. [PMID: 10817422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
The treatment of patent ductus arteriosus (PDA) has evolved over the years. We reviewed 231 non-premature children (group 1) undergoing surgical closure of a PDA between January 1985 and December 1997, and 30 children (group 2) undergoing transcatheter closure from May 1995 to December 1998. The median age and weight at operation in group 1 were 13 months (range, 0.5-174 months) and 9.5 kg (range, 1.9-49.7 kg), respectively. There was one intra-operative death (0.4%) secondary to hemorrhage. Immediate extubation was performed in 208 patients (90%). Intra-operative chest tube use decreased from 73.3% to 10% between the 1985-88 and 1996-97 periods (P < 0.001). Postoperative pneumothoraces occurred in 33/131 (25%) patients with only one patient (0.7%) requiring drainage. Eleven patients had complications including wound infection in four, vocal cord paralysis in three, and left pulmonary artery stenosis in one. The median length of stay (LOS) was 5 days (range, 2-43 days). Follow-up echocardiogram was performed in 146/230 patients (63%) and revealed a residual PDA in six (4%); two being re-ligated, two remaining clinically insignificant, and two spontaneously resolved at 7 and 28 months follow-up. The remaining 84 patients had no clinical signs of a residual PDA. In group 2, where a transcatheter coil occlusion technique was used, the median age and weight at procedure were 31 months (range, 9-320 months) and 14.9 kg (range, 9-69.7 kg), respectively. Vascular complications occurred in four patients (13.3%). One patient developed hemolysis and hemoglobinuria requiring hospital admission. Four patients required a second intervention. At the most recent echocardiographic assessment, four patients (13.3%) had a residual PDA.
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Affiliation(s)
- J G LeBlanc
- Division of Cardiovascular and Thoracic Surgery, Cardiology and Radiology, British Columbia's Children's Hospital, Vancouver, Canada.
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Abstract
A fenestration may improve the immediate postoperative course after a Fontan procedure by preserving the cardiac output. We describe a simple and safe technique of fenestration amenable to coil occlusion, which can be carried out in most cardiac catheterization laboratories.
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Affiliation(s)
- S Sanatani
- Department of Radiology, British Columbia Children's Hospital, Vancouver, Canada
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Abstract
OBJECTIVES To determine the prevalence of Kawasaki disease in older children and to evaluate its clinical presentation, time to diagnosis, and outcome in comparison with younger patients with the disease. METHODOLOGY A retrospective analysis of all patients discharged with a diagnosis of Kawasaki disease at a pediatric tertiary care hospital over a 12-year period. RESULTS A total of 133 patients were included in this study; 7.5% were 9 years of age or older at the time of illness. Patients were grouped by age: infants included children age 1 to 8 years of age and children 9 years of age or older. Older children had a higher frequency of abnormal cardiovascular physical examination (50%) versus children (6%) and infants (10%). The older age group and the infants had a higher prevalence of coronary artery abnormalities and poor left ventricular function than did the 1- to 8-year-olds. Eighty percent of the older children had coronary arteries that were either dilated or aneurysmal, and 30% demonstrated left ventricular dysfunction on initial echocardiography. The number of days to diagnosis after meeting the diagnostic criteria was 5.8 +/- 2.3 for infants, 5.2 +/- 1.5 for older children, and 1.9 +/- 0.3 for children. Older children had a complicated course of Kawasaki disease compared with younger patients. CONCLUSION We found a higher prevalence of older children with Kawasaki disease at our center than has previously been reported. Older patients, as well as infants, had a higher rate of coronary artery abnormalities than did the children between 1 and 8 years of age. Older age at the time of illness or a delay in treatment may be important factors in determining cardiac involvement in Kawasaki disease.
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Affiliation(s)
- T Momenah
- Division of Cardiology, Department of Pediatrics, British Columbia's Children's Hospital and the University of British Columbia, Vancouver, BC, Canada
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Human DG, McIntyre L, Gniewek A, Hanna BD. Technology assessment of nonsurgical closure of patent ductus arteriosus: an evaluation of the clinical effectiveness and costs of a new medical device. Pediatrics 1995; 96:703-6. [PMID: 7567334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To assess the clinical efficacy and cost impact of a new medical device for the nonsurgical closure of patent ductus arteriosus (PDA). METHODS This was a before-after study comparing the most recent 20 surgical procedures with the first 20 nonsurgical procedures for PDA using a new medical device. Clinical outcome, hospital stay, device cost, and physician fees were compared. RESULTS Surgical closure was effective in all 20 patients, with an average cost of $4667. In a similar patient group, nonsurgical closure was achieved in 18 of 20 patients (90%), with an estimated average cost per successful procedure of $4690. A clinically insignificant PDA leak persisted beyond 12 months in four nonsurgically managed patients. CONCLUSION Nonsurgical closure of PDA can be recommended as an effective new medical technique that is not associated with a measurable increase in direct costs and that provides significant indirect and intangible cost advantages.
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Affiliation(s)
- D G Human
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
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Roy DL, McIntyre L, Human DG, Nanton MA, Sherman GJ, Allen LM, Finley JP. Trends in the prevalence of congenital heart disease: comprehensive observations over a 24-year period in a defined region of Canada. Can J Cardiol 1994; 10:821-6. [PMID: 7954017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To determine the prevalence of congenital heart disease (CHD) in the three Maritime provinces, and to study prevalence differences among provinces and defined regions within these provinces. DESIGN Each province was divided by counties into regions. All cases of CHD who were born alive in the study area between 1966 and 1989 were entered in a registry. Prevalences were analyzed for each province and for selected regions per year, per 1000 live births, and by diagnosis made by one year of age and by the 16th birthday. Comparison was then made with prevalences of a group who had severe lesions. INTERVENTIONS Excepting a small number of CHD cases who were diagnosed by autopsy only, diagnosis was made by pediatric cardiologists using appropriate procedures, including cardiac ultrasound and cardiac catheterization. SETTING The only tertiary care centre for children's heart disease in the provinces of Nova Scotia, New Brunswick and Prince Edward Island, areas of relative geographic isolation (combined population of 1.75 million people). MAIN RESULTS A statistically significant positive linear trend occurred in these provinces during the study. The recorded prevalence of CHD in New Brunswick was significantly lower. Pooled prevalences by the first and 16th birthdays (8.0 and 12.5 per 1000 live births, respectively) of two regions of highest prevalence for 1980-86 were significantly higher (P < 0.05) than the pooled prevalence rate of all the remaining regions. Prevalence rates of a group with severe lesions were stable for 1976-86 in all regions. CONCLUSIONS Differences in prevalence of CHD among provinces and regions were related to ascertainment levels. Prevalence of CHD with diagnosis by the first and 16th birthdays were approximately 8.0 and 12.5 per 1000 live births, respectively. The prevalence rate of a severe lesion group was a stable measure.
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Affiliation(s)
- D L Roy
- Department of Cardiology, Izaak Walton Killam Children's Hospital, Halifax, Nova Scotia
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Smith MB, Colford D, Human DG. Perinatal supraventricular tachycardia. Can J Cardiol 1992; 8:565-8. [PMID: 1504910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the incidence, therapy required and prognosis of perinatal supraventricular tachycardia (SVT). DESIGN Retrospective chart review of eight years. SETTING Tertiary level perinatal and pediatric centres in Halifax, Nova Scotia. PATIENTS All newborn infants who developed SVT either in utero or in the first 30 days of life. RESULTS SVT was present in 33 neonates, with a male:female ratio of 2.7:1 and an incidence of 1:4347. Fetal SVT was recorded in nine (group I) but these patients did not differ from those with postnatal SVT (group II) in birthweight, noncardiac illnesses and associated heart disease. Thirty-one of the babies (94%) received digoxin and eight (24%) also required propranolol. All were asymptomatic after 48 h. One late death occurred due to renal failure unrelated to the dysrhythmia. No major congenital heart disease was found in either group. Follow-up over 44 months revealed four late relapses requiring prolonged therapy. CONCLUSIONS Perinatal SVT is a common disorder in a tertiary centre and may represent a transient adaptation phenomenon. It is usually benign, easily treated and rarely associated with major congenital heart disease.
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Affiliation(s)
- M B Smith
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
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Abstract
Sixty-six patients operated on previously for coarctation of the aorta were included in the study. There were 50 children and 16 adults. Invasive and non-invasive gradients were recorded. Anatomical obstruction was evaluated by angiography in 54 patients and the numbers and size of collaterals were quantified. The closest correlation was found between Doppler-estimated gradients and invasive peak-instantaneous gradients (r = 0.87). The relation between anatomical obstruction and invasive peak-to-peak gradients, Doppler gradients and diastolic flow ere discouraging (r = 0.64, 0.54 and 0.35). Liberal indications for angiography or magnetic resonance tomography are recommended.
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Affiliation(s)
- H Wendel
- Department of Paediatrics, Umeå University Hospital, Sweden
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Wendel H, Teien D, Human DG, Nanton MA. Assessment of blood pressures and gradients by automated blood pressure device compared to invasive measurements in patients previously operated on for coarctation of the aorta. Clin Physiol 1992; 12:155-62. [PMID: 1582135 DOI: 10.1111/j.1475-097x.1992.tb00302.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of the study was to compare invasive and non-invasive blood pressure measurements and gradients. Twenty-two children and 16 adults previously operated for coarctation of the aorta were included. Invasive blood pressures were recorded proximally and distally close to the former operation site and non-invasive systolic blood pressures were recorded by an automated sphygmomanometer on right arm and leg. The adults were investigated at rest and during supine exercise. The correlation between invasive and non-invasive measurements of proximal blood pressures in adults at rest and children were the following, r = 0.92, SD 7.6 mmHg (n = 16) and r = 0.85, SD 11 mmHg (n = 22) respectively. The corresponding correlation for the distal blood pressures were the following for adults at rest 0.64, SD 11.9 mmHg and in children r = 0.82, SD 9.2 mmHg. During exercise in adults we found a low correlation when comparing invasive and non-invasive proximal and distal blood pressures and a poor correlation regarding the gradients, r = 0.50, SD 16 mmHg, r = 0.45, SD 15.9 mmHg and r = 0.30, SD 22.9 mmHg respectively (n = 16). We also measured the time interval between cessation of exercise and completion of the blood pressure recordings, which gave a mean interval of 73 sec (range 45-115 sec). During that interval the mean fall in the proximal blood pressure was 37 mmHg (range 20-80 mmHg), and the mean fall of the gradient was from 41 mmHg (range 20-76 mmHg) to 23 mmHg (range 6-56 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Wendel
- Department of Pediatrics, University Hospital of Umeå, Sweden
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Teien D, Karp K, Wendel H, Human DG, Nanton MA. Quantification of left to right shunts by echo Doppler cardiography in patients with ventricular septal defects. Acta Paediatr Scand 1991; 80:355-60. [PMID: 2035331 DOI: 10.1111/j.1651-2227.1991.tb11862.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Thirty-one patients with ventricular septal defect were evaluated with Echo Doppler cardiography and colour flow mapping. The ventricular septal defect area was estimated by measurement of the jet diameter by colour flow mapping. The ventricular septal defect flow was calculated as the product of the cross-sectional area of the ventricular septal defect and the velocity time integral of flow through the defect. In ten patients the diameter obtained by colour flow mapping was compared with the diameter obtained at angiography, r = 0.88 (SD = 0.14 cm). The aortic flow was calculated as the product of left ventricular outflow tract cross-sectional area and the corresponding velocity time integral. QP/QS ratio was estimated as (ventricular defect flow + aortic flow)/aortic flow and compared to estimates by a radionuclide or oximetric method. A correlation of r = 0.95 (SD = 0.23) was found.
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Affiliation(s)
- D Teien
- Department of Clinical Physiology, University of Umeå, Sweden
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Wendel H, Teien D, Human DG, Nanton MA. Noninvasive estimation of aortic valve areas in children with aortic stenosis. Acta Paediatr Scand 1990; 79:1112-5. [PMID: 2267931 DOI: 10.1111/j.1651-2227.1990.tb11392.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fifteen children with aortic stenosis were examined with Echo-Doppler cardiography in order to evaluate the use of the continuity equation to calculate the aortic valve area. The results were compared to invasive estimates of valve area calculated with the Gorlin's equation. A close correlation between the two methods, r = 0.94, was found and it is concluded that even in children an accurate estimate of valve area can be expected with the use of the continuity equation.
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Affiliation(s)
- H Wendel
- Department of Paediatrics, University of Umeå, Sweden
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Dowdle SC, Human DG, Mann MD. Pulmonary ventilation and perfusion abnormalities and ventilation perfusion imbalance in children with pulmonary atresia or extreme tetralogy of Fallot. J Nucl Med 1990; 31:1276-9. [PMID: 2384793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Xenon-133 lung ventilation and perfusion scans were done preoperatively after cardiac catheterization and cineangiocardiography in 19 children; 6 had pulmonary atresia with an intact ventricular septum and hypoplastic right ventricle, 4 pulmonary atresia with associated complex univentricular heart, and 9 extreme Tetralogy of Fallot. The four patients with discrepancies in the sizes of the left and right pulmonary arteries on angiography had marked asymmetry of pulmonary perfusion and ventilation-perfusion imbalance on scintigraphy. Similar degrees of asymmetry and imbalance were present in 6 of the 15 children with equal-size pulmonary vessels. Asymmetry of pulmonary perfusion and ventilation-perfusion imbalance were associated with a poor prognosis.
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Affiliation(s)
- S C Dowdle
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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Sprenger KJ, Human DG. Database management in pediatric cardiology. J Am Coll Cardiol 1990. [DOI: 10.1016/0735-1097(90)92775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The clinical and laboratory findings in 29 children with infective endocarditis over the past 10 years are reviewed retrospectively. Twenty children (70 per cent) had congenital heart disease, five (16 per cent) had rheumatic heart disease, and four (14 per cent) had no underlying cardiac abnormality prior to presentation. Twelve (41 per cent) patients had undergone cardiac surgery prior to developing endocarditis. The most common causative organisms were Staphylococcus aureus, Staphylococcus epidermidis, and viridans streptococci none of which was associated with a significantly greater mortality. There was a high case fatality rate of 35 per cent of children below the age of 6 months and children without an underlying cardiac abnormality were particularly at risk. There is a need for standardization of diagnostic criteria for infective endocarditis to facilitate accurate collaborative epidemiological investigation.
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Abstract
A 24-hour telephone transmission service was established for pediatric echocardiography between a general hospital and a children's hospital 500 km distant. Studies were transmitted in real time for interpretation and diagnosis by a pediatric cardiologist. In the first 9 months of operation, studies were transmitted for 18 children with a median age of 5 months. Image and sound quality was excellent. Complete segmental diagnosis was made in 16 patients, and further study was needed in 2 others. In 8 of the 18 patients a new diagnosis was provided, and in 10 patients diagnosis was confirmed. Congenital heart disease was found in 12 patients, other heart disease in 2 and a normal heart in 4. The population included 2 fetuses whose echocardiograms showed hypoplastic left heart and intracardiac tumor. In 4 patients transport was avoided. This is the first report of echocardiographic transmission by telephone, which was shown to be clearly feasible, cost-effective and diagnostic. It provides emergency access to specialist expertise, and may avoid hazardous and expensive transport of ill children.
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Affiliation(s)
- J P Finley
- Department of Pediatric Cardiology, Izaak Walton Killam Children's Hospital, Halifax, Nova Scotia, Canada
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49
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Abstract
In kwashiorkor the heart is clinically and radiologically small. This study utilises echocardiography, a tool not previously used in this disease, to show that this is due to decreased muscle mass.
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Affiliation(s)
- J W Bergman
- Department of Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, South Africa
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50
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Abstract
Immunological functions were investigated in 10 children with acute rheumatic fever and 11 children with acute nephritis to try and elucidate the cause of heart damage in acute rheumatic fever. Children with acute rheumatic fever and carditis showed an increase in serum IgG, IgA and antistreptococcal antibodies during the acute stage. Lymphocyte transformation responses to phytohaemagglutinin and streptococcal antigens were reduced but this was due to a serum suppressor effect. After recovering from acute rheumatic fever a lymphocytosis and an increased lymphocyte blastogenic response to streptococcal antigen were found. T-cells, T-helper cells and T-suppressor cells showed some changes in acute rheumatic fever but these were not statistically significant in our study. None of the changes in immunological responses that were seen in acute rheumatic fever were found in acute nephritis. These results support the hypothesis that an abnormal immune response to streptococcal products is involved in the development of carditis and the other phenomena observed in acute rheumatic fever.
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Affiliation(s)
- A Benatar
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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