1
|
Chida-Nagai A, Akagawa H, Sawai S, Ma YJ, Yakuwa S, Muneuchi J, Yasuda K, Yamazawa H, Yamamoto T, Takakuwa E, Tomaru U, Furutani Y, Kato T, Harada G, Inai K, Nakanishi T, Manabe A, Takeda A, Jing ZC. Identification of Prostaglandin I2 Synthase Rare Variants in Patients With Williams Syndrome and Severe Peripheral Pulmonary Stenosis. J Am Heart Assoc 2024; 13:e032872. [PMID: 38639351 DOI: 10.1161/jaha.123.032872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Peripheral pulmonary stenosis (PPS) is a condition characterized by the narrowing of the pulmonary arteries, which impairs blood flow to the lung. The mechanisms underlying PPS pathogenesis remain unclear. Thus, the aim of this study was to investigate the genetic background of patients with severe PPS to elucidate the pathogenesis of this condition. METHODS AND RESULTS We performed genetic testing and functional analyses on a pediatric patient with PPS and Williams syndrome (WS), followed by genetic testing on 12 patients with WS and mild-to-severe PPS, 50 patients with WS but not PPS, and 21 patients with severe PPS but not WS. Whole-exome sequencing identified a rare PTGIS nonsense variant (p.E314X) in a patient with WS and severe PPS. Prostaglandin I2 synthase (PTGIS) expression was significantly downregulated and cell proliferation and migration rates were significantly increased in cells transfected with the PTGIS p.E314X variant-encoding construct when compared with that in cells transfected with the wild-type PTGIS-encoding construct. p.E314X reduced the tube formation ability in human pulmonary artery endothelial cells and caspase 3/7 activity in both human pulmonary artery endothelial cells and human pulmonary artery smooth muscle cells. Compared with healthy controls, patients with PPS exhibited downregulated pulmonary artery endothelial prostaglandin I2 synthase levels and urinary prostaglandin I metabolite levels. We identified another PTGIS rare splice-site variant (c.1358+2T>C) in another pediatric patient with WS and severe PPS. CONCLUSIONS In total, 2 rare nonsense/splice-site PTGIS variants were identified in 2 pediatric patients with WS and severe PPS. PTGIS variants may be involved in PPS pathogenesis, and PTGIS represents an effective therapeutic target.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Hiroyuki Akagawa
- Institute for Comprehensive Medical Sciences Tokyo Women's Medical University Tokyo Japan
| | - Saori Sawai
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
| | - Yue-Jiao Ma
- Department of Cardiology, Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China
| | - Satoshi Yakuwa
- Department of Pediatrics Obihiro Kosei Hospital Obihiro Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital Japan Community Healthcare Organization Kitakyusyu Japan
| | - Kazushi Yasuda
- Department of Pediatric Cardiology Aichi Children's Health and Medical Center Obu Japan
| | | | - Toshiyuki Yamamoto
- Division of Gene Medicine, Graduate School of Medical Science Tokyo Women's Medical University Tokyo Japan
| | - Emi Takakuwa
- Department of Surgical Pathology Hokkaido University Hospital Sapporo Japan
| | - Utano Tomaru
- Department of Surgical Pathology Hokkaido University Hospital Sapporo Japan
| | - Yoshiyuki Furutani
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Tatsuya Kato
- Department of Thoracic Surgery Hokkaido University Hospital Sapporo Japan
| | - Gen Harada
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Atsushi Manabe
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
| | - Atsuhito Takeda
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
| | - Zhi-Cheng Jing
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Southern Medical University Guangzhou China
| |
Collapse
|
2
|
Chida-Nagai A, Tonoki H, Makita N, Ishiyama H, Ihara M, Maruo Y, Tsujioka T, Sasaki D, Izumi G, Yamazawa H, Kato N, Ito M, Fujimura M, Sasaki O, Takeda A. A Noonan-like pediatric patient with a de novo CBL pathogenic variant and an RNF213 polymorphism p.R4810K presenting with cardiopulmonary arrest due to left main coronary artery ostial atresia. Am J Med Genet A 2023; 191:2837-2842. [PMID: 37554039 DOI: 10.1002/ajmg.a.63370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/06/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Abstract
Left main coronary artery ostial atresia (LMCAOA) is an extremely rare condition. Here, we report the case of a 14-year-old boy with Noonan syndrome-like disorder in whom LMCAOA was detected following cardiopulmonary arrest. The patient had been diagnosed with Noonan syndrome-like disorder with a pathogenic splice site variant of CBL c.1228-2 A > G. He suddenly collapsed when he was running. After administering two electric shocks using an automated external defibrillator, the patient's heartbeat resumed. Cardiac catheterization confirmed the diagnosis of LMCAOA. Left main coronary artery angioplasty was performed. The patient was discharged without neurological sequelae. Brain magnetic resonance imaging revealed asymptomatic Moyamoya disease. In addition, RNF213 c.14429 G > A p.R4810K was identified. There are no reports on congenital coronary malformations of compound variations of RNF213 and CBL. In contrast, the RNF213 p.R4810K polymorphism has been established as a risk factor for angina pectoris and myocardial infarction in adults, and several congenital coronary malformations due to genetic abnormalities within the RAS/MAPK signaling pathway have been reported. This report aims to highlight the risk of sudden death in patients with RASopathy and RNF213 p.R4810K polymorphism and emphasize the significance of actively searching for coronary artery morphological abnormalities in these patients.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hidefumi Tonoki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
- Medical Genetics Center, Tenshi Hospital, Sapporo, Japan
| | - Naomasa Makita
- Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Maruo
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
- Department of Pediatrics, Tenshi Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
3
|
Takeda A, Ueki M, Abe J, Maeta K, Horiguchi T, Yamazawa H, Izumi G, Chida-Nagai A, Sasaki D, Tsujioka T, Sato I, Shiraishi M, Matsuo M. A case of infantile Barth syndrome with severe heart failure: Importance of splicing variants in the TAZ gene. Mol Genet Genomic Med 2023:e2190. [PMID: 37186429 DOI: 10.1002/mgg3.2190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Barth syndrome (BTHS) is an X-linked disorder characterized by cardiomyopathy, skeletal myopathy, and 3-methylglutaconic aciduria. The causative pathogenic variants for BTHS are in TAZ, which encodes a putative acyltransferase named tafazzin and is involved in the remodeling of cardiolipin in the inner mitochondrial membranes. Pathogenic variants in TAZ result in mitochondrial structural and functional abnormalities. We report a case of infantile BTHS with severe heart failure, left ventricular noncompaction, and lactic acidosis, having a missense c.640C>T (p.His214Tyr) variant in TAZ, which is considered a pathogenic variant based on the previously reported amino acid substitution at the same site (c.641A>G, p.His214Arg). However, in this previously reported case, heart function was compensated and not entirely similar to the present case. Silico prediction analysis suggested that c.640C>T could alter the TAZ messenger RNA (mRNA) splicing process. TAZ mRNAs in isolated peripheral mononuclear cells from the patient and in vitro splicing analysis using minigenes of TAZ found an 8 bp deletion at the 3' end of exon 8, which resulted in the formation of a termination codon in the coding region of exon 9 (H214Nfs*3). These findings suggest that splicing abnormalities should always be considered in BTHS.
Collapse
Affiliation(s)
- Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Ueki
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Jiro Abe
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Kazuhiro Maeta
- KNC Department of Nucleic Acid Drug Discovery, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
| | - Tomoko Horiguchi
- KNC Department of Nucleic Acid Drug Discovery, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Itsumi Sato
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Shiraishi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Matsuo
- KNC Department of Nucleic Acid Drug Discovery, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
- Faculty of Health Sciences, Kobe Tokiwa University, Kobe, Japan
| |
Collapse
|
4
|
Yamaguchi T, Hayashi S, Hayashi D, Matsuyama T, Koitabashi N, Ogiwara K, Noda M, Nakada C, Fujiki S, Furutachi A, Tanabe Y, Yamanaka M, Ishikawa A, Mizukami M, Mizuguchi A, Sugiura K, Sumi M, Yamazawa H, Izawa A, Wada Y, Fujikawa T, Takiguchi Y, Wakui K, Takano K, Nishio SY, Kosho T. Comprehensive genetic screening for vascular Ehlers-Danlos syndrome through an amplification-based next-generation sequencing system. Am J Med Genet A 2023; 191:37-51. [PMID: 36189931 PMCID: PMC10092364 DOI: 10.1002/ajmg.a.62982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/28/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
Vascular Ehlers-Danlos syndrome (vEDS) is a hereditary connective tissue disorder (HCTD) characterized by arterial dissection/aneurysm/rupture, sigmoid colon rupture, or uterine rupture. Diagnosis is confirmed by detecting heterozygous variants in COL3A1. This is the largest Asian case series and the first to apply an amplification-based next-generation sequencing through custom panels of causative genes for HCTDs, including a specific method of evaluating copy number variations. Among 429 patients with suspected HCTDs analyzed, 101 were suspected to have vEDS, and 33 of them (32.4%) were found to have COL3A1 variants. Two patients with a clinical diagnosis of Loeys-Dietz syndrome and/or familial thoracic aortic aneurysm and dissection were also found to have COL3A1 variants. Twenty cases (57.1%) had missense variants leading to glycine (Gly) substitutions in the triple helical domain, one (2.9%) had a missense variant leading to non-Gly substitution in this domain, eight (22.9%) had splice site alterations, three (8.6%) had nonsense variants, two (5.7%) had in-frame deletions, and one (2.9%) had a multi-exon deletion, including two deceased patients analyzed with formalin-fixed and paraffin-embedded samples. This is a clinically useful system to detect a wide spectrum of variants from various types of samples.
Collapse
Affiliation(s)
- Tomomi Yamaguchi
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan.,Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shujiro Hayashi
- Department of Dermatology, Dokkyo Medical University, Mibu, Japan
| | - Daisuke Hayashi
- Department of Dermatology, Osaka Metropolitan University, Osaka, Japan
| | | | - Norimichi Koitabashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenichi Ogiwara
- Department of Pediatrics, Nara Medical University, Nara, Japan
| | - Masaaki Noda
- Department of Hematology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.,Noda Family Clinic, Hiroshima, Japan
| | - Chiai Nakada
- Division of Rheumatology, Yuuai Medical Center, Tomigusuku, Japan
| | - Shinya Fujiki
- Division of Cardiology, Department of Medicine, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Japan.,Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akira Furutachi
- Department of Thoracic and Cardiovascular Surgery, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Yasuhiko Tanabe
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Shibata, Japan
| | - Michiko Yamanaka
- Center for Medical Genetics, St. Luke's International Hospital, Tokyo, Japan
| | - Aki Ishikawa
- Department of Medical Genetics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Miyako Mizukami
- Department of Medical Genetics, Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Pediatrics, Sapporo Maternity Women's Hospital, Sapporo, Japan
| | - Asako Mizuguchi
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makoto Sumi
- Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Division of Clinical Genetics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsushi Izawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.,School of Health Sciences, Shinshu University, Matsumoto, Japan
| | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomomi Fujikawa
- Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuri Takiguchi
- Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiko Wakui
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Kyoko Takano
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Shin-Ya Nishio
- Department of Hearing Implant Science, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomoki Kosho
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan.,Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Japan.,Research Center for Supports to Advanced Science, Shinshu University, Matsumoto, Japan
| |
Collapse
|
5
|
Chida-Nagai A, Tsujino I, Yakuwa S, Akagawa H, Tsujioka T, Taniguchi K, Sasaki O, Izumi G, Yamazawa H, Takeda A. A Cardiac Arrest Case due to Left Coronary Artery Compression in Congenital Heart Disease-Associated Pulmonary Arterial Hypertension. CJC Pediatr Congenit Heart Dis 2022; 1:229-231. [PMID: 37969429 PMCID: PMC10642145 DOI: 10.1016/j.cjcpc.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2023]
Abstract
We report the case of an adult who had a cardiac arrest in the setting of pulmonary hypertension and a previously repaired intermediate atrioventricular septal defect, with left main coronary trunk stenosis due to dilatation of the main pulmonary artery. In patients with pulmonary hypertension exhibiting anginal symptoms, it is advisable to perform chest contrast computed tomography to confirm the pulmonary artery diameter and the presence of coronary artery compression. In addition, our case highlights the importance of early collaboration among specialists during the transition from adolescence to adulthood.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Ichizo Tsujino
- Department of Respiratory, Hokkaido University Hospital, Sapporo, Japan
| | - Satoshi Yakuwa
- Department of Pediatrics, Obihiro Kosei Hospital, Obihiro, Japan
| | - Hiroyuki Akagawa
- Tokyo Women’s Medical University Institute of Integrated Medical Sciences, Tokyo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kota Taniguchi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
6
|
Izumi G, Takeda A, Yamazawa H, Nagai A, Sasaki D, Sato I, Kato N, Tachibana T. Usefulness of Prolonged PR Interval to Predict Atrial Tachyarrhythmia Development Following Surgical Repair of Tetralogy of Fallot. Am J Cardiol 2022; 184:127-132. [PMID: 36127179 DOI: 10.1016/j.amjcard.2022.08.029] [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] [Received: 06/07/2022] [Revised: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Atrial tachyarrhythmias (ATAs), which may occur after tetralogy of Fallot (TOF) surgery, can cause sudden cardiac death. However, ATAs may also develop in response to electrical substrates. This study aims to examine the predictive factors for ATAs by identifying electrical substrates in the atrium obtained from 12-lead electrocardiogram in patients who underwent TOF repair. A total of 144 patients aged >15 years (median, 31.6 years) who underwent TOF repair at Hokkaido University were enrolled. We investigated the correlation between the development of ATAs with age, time interval after initial corrective surgery, brain natriuretic peptide levels, cardiac magnetic resonance parameters (right ventricular end-diastolic volume index, right ventricular end-systolic volume index, right ventricular ejection fraction, right atrial volume index, left ventricular end-diastolic volume index, left ventricular ejection fraction), and 12-lead electrocardiogram parameters (P wave maximum voltage, PR interval, QRS width, number of fragmented QRS). Of the 144 patients, 44 patients (30.6%) developed ATAs. Multivariate analysis revealed time interval after initial corrective surgery (odds ratio 6.7, 95% confidence interval 1.78 to 12.6) and PR interval (odds ratio 2.7, 95% confidence interval: 1.17 to 4.20) as independent risk factors for the development of ATAs. The receiver operating characteristic curve revealed a PR interval cut-off value of >200 milliseconds as predictive of the development of ATAs in patients more than 15 years after initial corrective surgery (area under the curve, 0.658; sensitivity, 71.4%; specificity, 66.4%). The present study demonstrated that a prolonged PR interval is a simple and convenient predictor for the development of ATAs in patients who underwent TOF repair.
Collapse
Affiliation(s)
- Gaku Izumi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ayako Nagai
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Itsumi Sato
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| |
Collapse
|
7
|
Norrish G, Cleary A, Field E, Cervi E, Boleti O, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernandez A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PE, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Gonzales-Lopez E, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, Elliott PM, Kaski JP. Clinical Features and Natural History of Preadolescent Nonsyndromic Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2022; 79:1986-1997. [PMID: 35589160 PMCID: PMC9125690 DOI: 10.1016/j.jacc.2022.03.347] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. OBJECTIVES The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. METHODS Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. RESULTS At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. CONCLUSIONS Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages.
Collapse
Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom,Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Aoife Cleary
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Olga Boleti
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | | | | | | | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania “Luigi Vanvitelli,” Naples, Italy
| | | | | | - Elena Biagini
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | - Luca Ragni
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | | | | | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Chiara Marrone
- Papa Giovanni XXIII Hospital, Bergamo, Italy,Fondazione Toscana G. Monasterio, Massa-Pisa, Italy
| | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite–Universitatsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine, Charite–Universitatsmedizin Berlin, Berlin, Germany,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H. Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vinay Bhole
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, United Kingdom
| | | | - Ferran Gran
- Vall d’Hebron University Hospital, Barcelona, Spain
| | | | | | - Graham Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom
| | | | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca Granda – Ospedale Maggiore Policlinico Milano, Department di Medicina Interna – UOC Cardiologica, Milan, Italy
| | | | | | - Toru Kubo
- Kochi Medical School Hospital, Kochi, Japan
| | | | - Anca Popoiu
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Department of Pediatrics, Children’s Hospital “Louis Turcanu,” Timisoara, Romania
| | | | | | | | | | | | - Perry M. Elliott
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom,St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
| |
Collapse
|
8
|
Norrish G, Ding T, Field E, Cervi E, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Vignati G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, O'Mahony C, Omar RZ, Elliott PM, Kaski JP. Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2022; 15:e010075. [PMID: 35491873 PMCID: PMC7612749 DOI: 10.1161/circep.121.010075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. METHODS The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). RESULTS MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. CONCLUSIONS In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.
Collapse
Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
| | - Tao Ding
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | | | | | | | | | | | | | - Elena Biagini
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | - Luca Ragni
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | | | - Sophie Duignan
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Adrián Fernández
- Fundación Favaloro University Hospital, Buenos Aires, Argentina (A.F.)
| | | | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic (P.K.)
| | - Piers E F Daubeney
- Royal Brompton and Harefield NHS Trust, London, United Kingdom (P.E.F.D.)
| | | | - Sergi Cesar
- Sant Joan de Deu, Barcelona, Spain (G.S.-B., S.C.)
| | - Sabine Klaassen
- Department of Pediatric Cardiology (S.K.), Charite-Universitatsmedizin Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine (S.K.), Charite-Universitatsmedizin Berlin, Germany.,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (S.K.)
| | - Tiina H Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Finland (T.H.O.)
| | - Vinay Bhole
- Birmingham Children's Hospital, United Kingdom (V.B.)
| | - Constancio Medrano
- Fondazione Toscana G. Monasterio, Massa-Pisa, Italy (C.M.).,Hospital General Universitario Gregorio Marañón, Madrid, Spain (C.M.)
| | - Orhan Uzun
- University Hospital of Wales, Cardiff (O.U.)
| | | | - Ferran Gran
- Val d'Hebron University Hospital, Barcelona, Spain (F.G.)
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Italy (G.S.)
| | | | - Graham Stuart
- Bristol Royal Hospital for Children, United Kingdom (G.S.)
| | | | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan (H.Y.)
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom (T.B.)
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Dept di Medicina Interna, UOC Cardiologica, Milano, Italy (M.C.)
| | - Caroline B Jones
- Alder Hey Children's Hospital, Liverpool, United Kingdom (C.B.J.)
| | | | - Toru Kubo
- Kochi Medical School Hospital, Japan (T.K.)
| | | | - Anca Popoiu
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes" Timisoara, Children's Hospital 'Louis Turcanu,' Romania (A.P.)
| | | | - Sujeev Mathur
- Evelina Children's Hospital, London, United Kingdom (S.M.)
| | | | | | | | - Costas O'Mahony
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Rumana Z Omar
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Perry M Elliott
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
| |
Collapse
|
9
|
Izumi G, Takeda A, Yamazawa H, Kato N, Kato H, Tachibana T, Sagae O, Yahagi R, Maeno M, Hoshino K, Saito H. Perioperative junctional ectopic tachycardia associated with congenital heart disease: risk factors and appropriate interventions. Heart Vessels 2022; 37:1792-1800. [PMID: 35469049 DOI: 10.1007/s00380-022-02074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/06/2021] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
The risk factors and the appropriate interventions for perioperative junctional ectopic tachycardia (JET) in congenital heart disease (CHD) surgery have not been sufficiently investigated despite the severity of this complication. This study aimed to examine the risk factors and interventions for perioperative JET. From 2013 to 2020, 1062 surgeries for CHD (median patient age: 4.3 years, range 0.0-53.0) with or without a cardiopulmonary bypass (CPB) were performed at Hokkaido University, Japan. We investigated the correlation between perioperative JET morbidity factors, such as age, genetic background, CPB/aortic cross-clamp (ACC) time, use of inotropes and dexmedetomidine, STAT score, and laboratory indices. The efficacy of JET therapies was also evaluated. Of the 1062 patients, 86 (8.1%) developed JET. The 30-day mortality was significantly high in JET groups (7% vs. 0.8%). The independent risk factors for JET included heterotaxy syndrome [odds ratio (OR) 4.83; 95% confidence interval (CI) 2.18-10.07], ACC time exceeding 90 min (OR 1.90; CI 1.27-2.39), and the use of 3 or more inotropes (OR 4.11; CI 3.02-5.60). The combination of anti-arrhythmic drugs and a temporary pacemaker was the most effective therapy for intractable JET. Perioperative JET after CHD surgery remains a common cause of mortality. Inotrope use was a risk factor for developing JET overall surgery risk. In short ACC surgeries, heterotaxy syndrome could increase the risk of JET, which could develop even without inotrope use in long ACC surgeries. It is crucial not to delay the treatment in cases with unstable hemodynamics caused by this arrhythmia. It is recommended to reduce numbers not dose of inotropes.
Collapse
Affiliation(s)
- Gaku Izumi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan.
| | - Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Hiroki Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan
| | - Osamu Sagae
- Division of Medical Engineering Center, Hokkaido University Hospital, North-15 West-7, Sapporo, 060-8638, Japan
| | - Ryogo Yahagi
- Division of Medical Engineering Center, Hokkaido University Hospital, North-15 West-7, Sapporo, 060-8638, Japan
| | - Motoki Maeno
- Division of Medical Engineering Center, Hokkaido University Hospital, North-15 West-7, Sapporo, 060-8638, Japan
| | - Koji Hoshino
- Department of Anesthesiology and Critical Care Medicine, Faculty of Hokkaido University Hospital, North-15 West-7, Sapporo, 060-8638, Japan
| | - Hitoshi Saito
- Department of Anesthesiology and Critical Care Medicine, Faculty of Hokkaido University Hospital, North-15 West-7, Sapporo, 060-8638, Japan
| |
Collapse
|
10
|
Norrish G, Qu C, Field E, Cervi E, Khraiche D, Klaassen S, Ojala TH, Sinagra G, Yamazawa H, Marrone C, Popoiu A, Centeno F, Schouvey S, Olivotto I, Day SM, Colan S, Rossano J, Wittekind SG, Saberi S, Russell M, Helms A, Ingles J, Semsarian C, Elliott PM, Ho CY, Omar RZ, Kaski JP. External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur J Prev Cardiol 2022; 29:678-686. [PMID: 34718528 PMCID: PMC8967478 DOI: 10.1093/eurjpc/zwab181] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Indexed: 11/24/2022]
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualized estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort. METHODS AND RESULTS A retrospective, longitudinal cohort of 421 patients diagnosed with HCM aged 1-16 years independent of the HCM Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall thickness, left atrial diameter, and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed. Twenty-three patients (5.4%) met the SCD end-point within 5 years, with an overall incidence rate of 2.03 per 100 patient-years [95% confidence interval (CI) 1.48-2.78]. Model validation showed a Harrell's C-index of 0.745 (95% CI 0.52-0.97) and Uno's C-index 0.714 (95% 0.58-0.85) with a calibration slope of 1.15 (95% 0.51-1.80). A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD events with a corresponding C-statistic of 0.702 (95% CI 0.60-0.81). CONCLUSIONS This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualized risk predictions and shared decision-making in children with HCM.
Collapse
Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | | | - Sabine Klaassen
- Department of Paediatric Cardiology, Charite – Universitatsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Centre (ECRC), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Centre for Molecular Medicine (MDC), Charite – Universitatsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H Ojala
- Department of Paediatric Cardiology, New Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Trieste, Italy
| | - Hirokuni Yamazawa
- Department of Paediatrics, Faculty of Medicine and Graduate school of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Anca Popoiu
- Department of Paediatrics, Children’s Hospital ‘Louis Turcanu’, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
| | | | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steve Colan
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Rossano
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Russell
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Adam Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, University College London, London, UK
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| |
Collapse
|
11
|
Chida-Nagai A, Sato H, Sato I, Shiraishi M, Sasaki D, Izumi G, Yamazawa H, Cho K, Manabe A, Takeda A. Risk factors for hospitalisation due to respiratory syncytial virus infection in children receiving prophylactic palivizumab. Eur J Pediatr 2022; 181:539-547. [PMID: 34417646 DOI: 10.1007/s00431-021-04216-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/17/2021] [Revised: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
Respiratory syncytial virus (RSV) is a common pathogen that causes extremely severe respiratory symptoms in the first few weeks and months of life. In infants with cardiopulmonary diseases, RSV infections have a significant clinical impact. Palivizumab, a humanised monoclonal antibody for RSV, has been shown to significantly reduce the rate of hospitalisation of high-risk infants diagnosed with RSV. However, we have experienced a significant number of RSV infections in our institution that required hospitalisation or intensive care, despite the administration of palivizumab. This study aimed to analyse the risk factors associated with severe RSV despite the use of palivizumab. We retrospectively reviewed the medical records of 688 patients who visited or were admitted to our hospital and received palivizumab. Thirty-seven (5.4%) patients required hospitalisation for RSV, despite receiving palivizumab. In addition, 31 of these patients (83.8%) required hospitalisation out of season for palivizumab injection. Preterm birth (≤ 28-week gestation), bronchopulmonary dysplasia (BPD), and trisomy 21 were risk factors for RSV-related hospitalisation in infected patients, despite receiving palivizumab. Furthermore, subgroup analysis of 69 patients with RSV revealed that hemodynamically significant congenital heart disease (CHD) was also a risk factor for RSV-related hospitalisation.Conclusion: Preterm birth (≤ 28 weeks of gestation), BPD, trisomy 21, hemodynamically significant CHD, and CHD requiring surgery or cardiac catheterisation/intervention during infancy could be considered when determining whether year-round administration of palivizumab is appropriate. What is Known: • Respiratory syncytial virus causes severe respiratory symptoms in infants, particularly those with cardiopulmonary diseases. • The use of palivizumab has reduced the rate of hospitalisation of infants diagnosed with RSV. Despite this, the rate of hospitalisation is still high. What is New: • We identified that preterm birth (≤ 28-week gestation), bronchopulmonary dysplasia, trisomy 21, and hemodynamically significant congenital heart disease were risk factors for RSV-related hospitalisation, even after receiving palivizumab treatment. • High-risk infants should be closely monitored and the prolonged use of palivizumab should be considered.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University, Oita, Japan.,Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Itsumi Sato
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Masahiro Shiraishi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kazutoshi Cho
- Maternity and Perinatal Care Center, Hokkaido University Hospital, Sapporo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
| |
Collapse
|
12
|
Yamazawa H, Takeda A, Izumi G, Komaki H, Nishino I. Sudden cardiac death prevention in an Emery-Dreifuss muscular dystrophy patient. Pediatr Int 2022; 64:e15204. [PMID: 35522606 DOI: 10.1111/ped.15204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 02/26/2022] [Accepted: 03/25/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Gaku Izumi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Hirofumi Komaki
- Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|
13
|
Chida-Nagai A, Tsujioka T, Sasaki D, Izumi G, Yamazawa H, Takeda A. An Adolescent Patient With Idiopathic Pulmonary Arterial Hypertension Weaned Off Intravenous Epoprostenol Following Treatment With Selexipag: A Case Report. Front Pediatr 2022; 10:909595. [PMID: 35783314 PMCID: PMC9247454 DOI: 10.3389/fped.2022.909595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
Idiopathic pulmonary arterial hypertension (PAH) is a rare, progressive disease affecting the pulmonary arteries. Epoprostenol, a synthetic prostaglandin analog, is the most potent pharmacological treatment modality used in patients with PAH. However, it requires continuous intravenous infusion, which negatively impacts the patient's quality of life and frequently results in complications, such as catheter-related bloodstream infection. We weaned an adolescent female patient off epoprostenol by gradually introducing oral selexipag over a sustained period, following many years of continuous intravenous epoprostenol use alone. Oral selexipag might have an efficacy comparable to epoprostenol in young patients with PAH.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
14
|
Ueno M, Takeda A, Yamazawa H, Takei K, Furukawa T, Suzuki Y, Chida-Nagai A, Kimura A. A case report: Twin sisters with restrictive cardiomyopathy associated with rare mutations in the cardiac troponin I gene. J Cardiol Cases 2021; 23:154-157. [PMID: 33841591 DOI: 10.1016/j.jccase.2020.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is a rare cardiomyopathy in children, and its prognosis until now, has been poor. Recently some sarcomeric mutations have been reported as disease-causing genes of RCM. However, the genotype-phenotype correlation is not fully understood. Additionally, prognostic factors including sudden death in patients with RCM have not been elucidated. We report our experience in treating twin sisters with RCM or hypertrophic cardiomyopathy with RCM phenotype, both carriers of the same mutation in TNNI3, which encodes one of the major sarcomeric proteins in myofibrils. They were both diagnosed with RCM by cardiac catheterization at the age of 11 years. Despite appropriate follow-up and medical treatment, one died suddenly at the age of 11 years and the other also died at the age of 15 years due to heart failure while awaiting heart transplantation. In addition to our cases, other reports of younger fatal cases with RCM carrying TNNI3 mutations may suggest it as one of the prognostic factors. Genetic diagnosis is important in the clinical diagnosis, management, and treatment of cardiomyopathy. <Learning objective: Our cases involved twin sisters diagnosed with restrictive cardiomyopathy (RCM) with rare mutations in the cardiac troponin I. Based on their clinical course, this mutation appears to have a poor prognosis. It was reported that RCM was caused by sarcomere gene mutations, however, the relationship between genotype and phenotype is not clearly defined. To elucidate the prognosis of this rare disease not only the genetic mutations but the accumulation of various clinical outcomes is important.>.
Collapse
Affiliation(s)
- Michihiko Ueno
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsuhito Takeda
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Kohta Takei
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuo Furukawa
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yasuto Suzuki
- Department of Pediatrics, Kushiro Red Cross Hospital, Kushiro, Hokkaido, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Akinori Kimura
- Department of Molecular Pathogenesis, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
15
|
Shiraishi H, Chida-Nagai A, Taniguchi K, Abe J, Izumi G, Yamazawa H, Ueda Y, Sasaki O, Miyakoshi K, Takeda A. Diagnostic dilemma in a case of obstructive sleep apnoea syndrome with reversible pulmonary hypertension and right heart failure: A case report. Int J Pediatr Otorhinolaryngol 2020; 138:110378. [PMID: 33152969 DOI: 10.1016/j.ijporl.2020.110378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/02/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
Childhood obstructive sleep apnoea syndrome (OSAS) secondary to adenoid hyperplasia is known to give rise to pulmonary hypertension. However, we present a case of a toddler with pulmonary hypertension (PH) and right heart failure due to OSAS, the cause of which is difficult to identify. After the patient underwent an adenotonsillectomy, OSAS disappeared and the PH eventually resolved. Both paediatricians and otolaryngologists should know that paediatric OSAS can occur even in the setting of mild, clinically insignificant palatine tonsil hypertrophy and adenoid hyperplasia. Surgical intervention should be considered without losing the opportunity if it could be the cause of PH.
Collapse
Affiliation(s)
- Haruki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan; Department of Pediatrics, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.
| | - Kota Taniguchi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Jiro Abe
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Yuki Ueda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan; Department of Pediatrics, Tenshi Hospital, Sapporo, Japan
| | - Kosei Miyakoshi
- Department of Otolaryngology, Tenshi Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
16
|
Takeda A, Murayama K, Okazaki Y, Imai-Okazaki A, Ohtake A, Takakuwa E, Yamazawa H, Izumi G, Abe J, Nagai A, Taniguchi K, Sasaki D, Tsujioka T, Basgen J. Advanced pathologic study for definite diagnosis of mitochondrial cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Mitochondrial cardiomyopathy (MCM) is usually recognized as one of the phenotypes of systemic mitochondrial disease. However if there are no cardiac symptoms, it is difficult to make a definite diagnosis because of various cardiovascular phenotypes and no diagnostic criteria in pathological examination. To add myocardial pathology to the diagnostic criteria for mitochondrial respiratory chain disorders, which is the gold standard in the diagnosis of mitochondrial diseases, we performed quantitative analysis of mitochondria using electron microscopy and immunohistopathologic analysis with respiratory chain enzyme antibodies. Ten patients with hypertrophic or restrictive cardiomyopathy who had undergone endomyocardial biopsy were studied. Respiratory chain enzymatic assay and genetic study were performed and four patients were diagnosed with MCM. Using electron microscopy with quantitative analysis, volume density of mitochondria within cardiac muscle cells was significantly increased in the MCM group compared to the non-MCM group (p=0.013). Immunohistopathologic results were compatible with the result of the respiratory chain enzymatic assay. These advanced pathological tests can distinguish MCM from other cardiomyopathies.
Results of immunopathologic study
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Practical Research Project for Rare/Intractable Diseases from the Japan Agency for Medical Research and Development, AMED.
Collapse
Affiliation(s)
- A Takeda
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - K Murayama
- Chiba Children's Hospital, Department of Metabolism, Chiba, Japan
| | - Y Okazaki
- Juntendo University Graduate School of Medicine, Intractable Disease Research Center, Tokyo, Japan
| | - A Imai-Okazaki
- Juntendo University Graduate School of Medicine, Intractable Disease Research Center, Tokyo, Japan
| | - A Ohtake
- Saitama Medical University, Department of Paediatrics, Saitama, Japan
| | - E Takakuwa
- Hokkaido University, Department of Surgical Pathology, Sapporo, Japan
| | - H Yamazawa
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - G Izumi
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - J Abe
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - A Nagai
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - K Taniguchi
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - D Sasaki
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - T Tsujioka
- Hokkaido University, Department of Paediatrics, Sapporo, Japan
| | - J Basgen
- Charles R. Drew University of Science and Medicine, Department of Research, Los Angeles, United States of America
| |
Collapse
|
17
|
Izumi G, Yokoshiki H, Sasaki R, Chiba Y, Yamazawa H, Takeda A. Fast pathway ablation unmasks nodoventricular fibers in a 15-year-old patient with supraventricular tachycardia. Pacing Clin Electrophysiol 2020; 44:395-398. [PMID: 33047312 DOI: 10.1111/pace.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/18/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
We described a 15-year-old boy who underwent the catheter ablation for the nodoventricular (NV) tachycardia that had difficulty in differentiation from atrioventricular nodal reentrant tachycardia with upper common pathway. The modification of the fast pathway revealed an anterograde conduction of the NV fiber. We successfully performed the catheter ablation targeting for the right ventricular insertion site of the NV fiber.
Collapse
Affiliation(s)
- Gaku Izumi
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan
| | - Ryo Sasaki
- Division of Medical Engineering Center, Hokkaido University Hospital, Sapporo, Japan
| | - Yuki Chiba
- Division of Medical Engineering Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
18
|
Takeda A, Murayama K, Okazaki Y, Imai-Okazaki A, Ohtake A, Takakuwa E, Yamazawa H, Izumi G, Abe J, Nagai A, Taniguchi K, Sasaki D, Tsujioka T, Basgen JM. Advanced pathological study for definite diagnosis of mitochondrial cardiomyopathy. J Clin Pathol 2020; 74:jclinpath-2020-206801. [PMID: 32817174 DOI: 10.1136/jclinpath-2020-206801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 11/03/2022]
Abstract
AIMS Mitochondrial cardiomyopathy (MCM) is difficult to make a definite diagnosis because of various cardiovascular phenotypes and no diagnostic criteria in the pathology examination. We aim to add myocardial pathology to the diagnostic criteria for mitochondrial respiratory chain disorders. METHODS Quantitative analysis of mitochondria using electron microscopy and immunohistopathological analysis with respiratory chain enzyme antibodies were performed in 11 patients with hypertrophic or restrictive cardiomyopathy who underwent endomyocardial biopsy for possible MCM . Respiratory chain enzymatic assay in biopsied myocardium and genetic studies were also performed in all the subjects to define MCM. RESULTS Four patients were diagnosed with MCM according to the recent criteria of mitochondrial respiratory chain disorders. Using electron microscopy with quantitative analysis, the volume density of mitochondria within cardiac muscle cells was significantly increased in the MCM group compared with the non-MCM group (p=0.007). Immunohistopathological results were compatible with the result of the respiratory chain enzymatic assay. CONCLUSIONS Pathological diagnosis of MCM could be confirmed by a quantitative study of electron microscopy and immunohistopathological analysis using the mitochondrial respiratory chain enzyme subunit antibody.
Collapse
Affiliation(s)
- Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Atsuko Imai-Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akira Ohtake
- Department of Pediatrics & Clinical Genomics, Saitama Medical University Faculty of Medicine, Saitama, Japan
- Center for Intractable Diseases, Saitama Medical University, Saitama, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Jiro Abe
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ayako Nagai
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kota Taniguchi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - John M Basgen
- Department of Research, Charles R Drew University of Medicine and Science, Los Angeles, California, USA
| |
Collapse
|
19
|
Chida-Nagai A, Sagawa K, Tsujioka T, Fujimoto T, Taniguchi K, Sasaki O, Izumi G, Yamazawa H, Masaki N, Manabe A, Takeda A. Pulmonary vasodilators can lead to various complications in pulmonary "arterial" hypertension associated with congenital heart disease. Heart Vessels 2020; 35:1307-1315. [PMID: 32285188 PMCID: PMC7152743 DOI: 10.1007/s00380-020-01604-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/03/2020] [Indexed: 11/25/2022]
Abstract
Congenital heart disease-associated pulmonary arterial hypertension (CHD-PAH) is one of the major complications in patients with CHD. A timely closure of the left-to-right shunt will generally result in the normalization of the pulmonary hemodynamics, but a few patients have severe prognosis in their early childhood. We hypothesized that wide-ranging pathological mechanism in PAH could elucidate the clinical state of severe CHD-PAH. Using electronic medical records, we retrospectively analyzed six infants with severe CHD-PAH who had treatment-resistant PH. All patients were born with congenital malformation syndrome. After starting on a pulmonary vasodilator, five of the six patients developed complications including pulmonary edema and interstitial lung disease (ILD), and four patients had alveolar hemorrhage. After steroid therapy, the clinical condition improved in four patients, but two patients died. The autopsy findings in one of the deceased patients indicated the presence of recurrent alveolar hemorrhage, pulmonary venous hypertension, ILD, and PAH. Based on the clinical course of these CHD-PAH in patients and the literature, CHD-PAH can occur with pulmonary vascular obstructive disease (PVOD)/pulmonary capillary hemangiomatosis (PCH), ILD, and/or alveolar hemorrhage. The severity of CHD-PAH may depend on a genetic disorder, respiratory infection, and upper airway stenosis. Additionally, pulmonary vasodilators may be involved in the development of PVOD/PCH and ILD. When patients with CHD-PAH show unexpected deterioration, clinicians should consider complications associated with PVOD/PCH and/or pulmonary disease. In addition, the choice of upfront combination therapy for pediatric patients with CHD-PAH should be selected carefully.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takanori Fujimoto
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kota Taniguchi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
| |
Collapse
|
20
|
Izumi G, Takeda A, Yamazawa H, Sasaki O, Kato N, Asai H, Tachibana T, Matsui Y. Forns Index is a predictor of cardiopulmonary bypass time and outcomes in Fontan conversion. Heart Vessels 2019; 35:586-592. [PMID: 31562553 DOI: 10.1007/s00380-019-01515-w] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Abstract
Recent reports suggested that cardiopulmonary bypass (CPB) time is one of the risk factors for postoperative complications after Fontan conversion. Although Fontan conversion may be performed for the patients with hepatic fibrosis after initial Fontan procedure, there is no predictive indicator regarding the liver function associated with hemostasis which can affects CPB time. Thirty-one patients who underwent Fontan conversion using the same surgical procedure (extracardiac conduit conversion with right atrium exclusion) were enrolled. In multivariate analyses including age at Fontan conversion, interval from initial Fontan to conversion, hemodynamic data such as right atrial pressure, ventricular end-diastolic pressure, and cardiac index, hepatic data such as platelet count, prothrombin time international normalized ratios, serum total bilirubin, hyaluronic acid levels, five known indices for hepatic fibrosis (Forns Index, APRI, FIB4, FibroIndex, and MELD-XI), and liver stiffness measured by ultrasound elastography, only the Forns Index remained independently associated with the CPB time (P < 0.01) and blood transfusions (plasma transfusions and platelet concentrations: P < 0.01 for both). The cutoff level for Forns Index to predict the prolonged CPB time (exceeding 240 min) was 4.85 by receiver-operating characteristic curve (area under the curve 0.823, sensitivity 76.9%, and specificity 72.2%). Three patients with Forns Index > 7.0 had poor outcomes with long CPB time and massive blood transfusions in contrast with the other 28 patients. In conclusion, Forns Index could serve as a practical predictor of CPB time and is associated with blood transfusion volume in Fontan conversion.
Collapse
Affiliation(s)
- Gaku Izumi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan.
| | - Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Hidetsugu Asai
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, 060-8638, Japan
| |
Collapse
|
21
|
Mostafa A, Yamazawa H, Uosif M, Moriizumi J. Seasonal behavior of radon decay products in indoor air and resulting radiation dose to human respiratory tract. Journal of Radiation Research and Applied Sciences 2019. [DOI: 10.1016/j.jrras.2014.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A.M.A. Mostafa
- Physics Department, Faculty of Science, Al-Azhar University, Assiut Brunch, Assiut, 71542, Egypt
| | - H. Yamazawa
- Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8603, Japan
| | - M.A.M. Uosif
- Physics Department, Faculty of Science, Al-Azhar University, Assiut Brunch, Assiut, 71542, Egypt
| | - J. Moriizumi
- Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8603, Japan
| |
Collapse
|
22
|
Aikawa T, Takeda A, Oyama-Manabe N, Naya M, Yamazawa H, Koyanagawa K, Ito YM, Anzai T. Progressive left ventricular dysfunction and myocardial fibrosis in Duchenne and Becker muscular dystrophy: a longitudinal cardiovascular magnetic resonance study. Pediatr Cardiol 2019; 40:384-392. [PMID: 30564867 DOI: 10.1007/s00246-018-2046-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/18/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022]
Abstract
This study examined the progression of left ventricular dysfunction and myocardial fibrosis in patients with Duchenne muscular dystrophy (DMD) or Becker muscular dystrophy (BMD) to evaluate the effects of angiotensin-converting enzyme inhibitor (ACEI). Ninety-eight cardiovascular magnetic resonance (CMR) studies in 34 consecutive patients with DMD (n = 21) or BMD (n = 13) were retrospectively reviewed. Left ventricular ejection fraction (LVEF) and the extent of myocardial late gadolinium enhancement (LGE) were semiautomatically quantified. During the study period, five patients had already been treated with ACEI at the first CMR; five were started on ACEI at LVEF ≥ 55% and 10 at LVEF < 55%. All patients had hyperenhanced myocardium on LGE images at the first CMR (median extent, 3.3%; interquartile range 0.1-14.3%). A mixed-effects model for longitudinal data of each patient, adjusted for age, type of muscular dystrophy, steroid use, and ACEI use showed that higher age (β = - 1.1%/year; 95% confidence interval [CI], - 1.8% to - 0.4%; p = 0.005) and no use of ACEI (β = - 3.1%; 95% CI, - 5.4% to - 0.8%; p = 0.009) were significantly associated with a lower LVEF. When ACEI use was stratified by time of initiation (LVEF ≥ 55% vs. < 55%), only ACEI initiation at LVEF < 55% had a beneficial effect on LVEF at each imaging examination (β = 3.7%; 95% CI, 0.9-6.4%; p = 0.010). ACEI use or the time of initiation of ACEI did not significantly affect age-related increase in LGE. ACEI attenuated the age-related decline in LVEF only in patients with DMD or BMD and reduced LVEF, suggesting that further investigation on prophylactic use of cardioprotective therapy in these patients is warranted.
Collapse
Affiliation(s)
- Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan
| |
Collapse
|
23
|
Aikawa T, Takeda A, Oyama-Manabe N, Naya M, Yamazawa H, Koyanagawa K, Ito YM, Anzai T. P1561Prophylactic use of angiotensin converting enzyme inhibitor in patients with duchenne and becker muscular dystrophy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1561] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Aikawa
- Hokkaido University Hospital, Department of Cardiovascular Medicine, Sapporo, Japan
| | - A Takeda
- Hokkaido University Hospital, Department of Pediatrics, Sapporo, Japan
| | - N Oyama-Manabe
- Hokkaido University Hospital, Diagnostic and Interventional Radiology, Sapporo, Japan
| | - M Naya
- Hokkaido University Hospital, Department of Cardiovascular Medicine, Sapporo, Japan
| | - H Yamazawa
- Hokkaido University Hospital, Department of Pediatrics, Sapporo, Japan
| | - K Koyanagawa
- Hokkaido University Hospital, Department of Cardiovascular Medicine, Sapporo, Japan
| | - Y M Ito
- Hokkaido University, Department of Biostatistics, Sapporo, Japan
| | - T Anzai
- Hokkaido University Hospital, Department of Cardiovascular Medicine, Sapporo, Japan
| |
Collapse
|
24
|
Abstract
An interventricular septal hematoma is a rare complication after patch closure of a ventricular septal defect (VSD). We describe three cases of interventricular septal hematomas following patch VSD and discuss their management.
Collapse
Affiliation(s)
- Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Hiromichi Nakajima
- Department of Pediatric Cardiology, Chiba Children's Hospital, Chiba, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Mitsuru Aoki
- Department of Cardiovascular Surgery, Chiba Children's Hospital, Chiba, Japan
| |
Collapse
|
25
|
Affiliation(s)
- H. Yamazawa
- Department of Energy Engineering and Science, Nagoya University: Furo-cho, Chikusa-ku, Nagoya, Japan 464-8603
| | - M. Ota
- Department of Energy Engineering and Science, Nagoya University: Furo-cho, Chikusa-ku, Nagoya, Japan 464-8603
| | - J. Moriizumi
- Department of Energy Engineering and Science, Nagoya University: Furo-cho, Chikusa-ku, Nagoya, Japan 464-8603
| |
Collapse
|
26
|
Izumi G, Senzaki H, Takeda A, Yamazawa H, Takei K, Furukawa T, Inai K, Shinohara T, Nakanishi T. Significance of right atrial tension for the development of complications in patients after atriopulmonary connection Fontan procedure: potential indicator for Fontan conversion. Heart Vessels 2017; 32:850-855. [PMID: 28064364 DOI: 10.1007/s00380-016-0941-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/09/2016] [Accepted: 12/26/2016] [Indexed: 12/19/2022]
Abstract
Elevated right atrial (RA) pressure and progressive RA dilation are thought to play pivotal roles in the development of late complications after atriopulmonary connection (APC) Fontan surgery. However, no clear cut-off value for RA pressure or RA volume has been determined for stratifying the risk of developing Fontan complications. We hypothesized that RA tension, which incorporates information about both RA pressure and volume, might help predict the risk of developing complications. We retrospectively studied 51 consecutive APC Fontan patients (median postoperative period 14 years). RA tension was computed from the RA pressure and RA radius, which was calculated from RA volume measured by RA angiography. The correlation between the cardiac catheterization hemodynamic data and the complications of APC Fontan was investigated. Of the 51 patients, 28 had complications, including liver fibrosis (n = 28), arrhythmia (n = 8), protein-losing enteropathy (n = 1), and RA thrombosis (n = 1). Among the hemodynamic data, RA volume and RA tension, but not RA pressure, were significantly higher in patients with complications than in those without (P = 0.004 and P = 0.001, respectively). The cut-off level for RA tension to predict Fontan complications was 26,131 dyne/cm by receiver operating characteristic curve (area under the curve 0.79, sensitivity 71.4%, and specificity 73.9%). The present study demonstrated the significance of RA tension rather than high venous pressure for the development of Fontan complications. Amid the uncertainty about clinical outcomes, the present results, subject to further validation, may contribute to the indications for Fontan conversion.
Collapse
Affiliation(s)
- Gaku Izumi
- Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan.
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan.
| | - Hideaki Senzaki
- Department of Pediatric Cardiology, Saitama Medical Centre, Saitama Medical University, 1981 Kamoda, Kawagoe, 350-8550, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan
| | - Kohta Takei
- Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan
| | - Takuo Furukawa
- Department of Pediatrics, Hokkaido University Graduate School, North-15 West-7, Sapporo, 060-8638, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Toshio Nakanishi
- Division of Clinical Research for Adult Congenital Heart Disease Life-long Care and Pathophysiology, Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
27
|
Izumi G, Hayama E, Yamazawa H, Inai K, Shimada M, Furutani M, Nishizawa T, Furutani Y, Matsuoka R, Nakanishi T. Compound Mutations Cause Increased Cardiac Events in Children with Long QT Syndrome: Can the Sequence Homology-Based Tools be Applied for Prediction of Phenotypic Severity? Pediatr Cardiol 2016; 37:962-70. [PMID: 27041096 DOI: 10.1007/s00246-016-1378-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/11/2015] [Accepted: 03/21/2016] [Indexed: 11/29/2022]
Abstract
Long QT syndrome (LQTS) can cause syncope, ventricular fibrillation, and death. Recently, several disease-causing mutations in ion channel genes have been identified, and compound mutations have also been detected. It is unclear whether children who are carriers of compound mutations exhibit a more severe phenotype than those with single mutations. Although predicting phenotypic severity is clinically important, the availability of prediction tools for LQTS is unknown. To determine whether the severity of the LQTS phenotype can be predicted by the presence of compound mutations in children is needed. We detected 97 single mutations (Group S) and 13 compound mutations (Group C) between 1998 and 2012, age at diagnosis ranging 0-19 years old (median age is 9.0) and 18.0 years of follow-up period. The phenotypes and Kaplan-Meier event-free rates of the two groups were compared for cardiac events. This study investigated phenotypic severity in relation to the location of mutations in the protein sequence, which was analyzed using two sequence homology-based tools. In results, compound mutations in children were associated with a high incidence of syncope within the first decade (Group S: 32 % vs. Group C: 61 %), requiring an ICD in the second decade (Group S: 3 % vs. Group C: 56 %). Mortality in these patients was high within 5 years of birth (23 %). Phenotypic prediction tools correctly predicted the phenotypic severity in both Groups S and C, especially by using their coupling method. The coupling prediction method is useful in the initial evaluation of phenotypes both with single and compound mutations of LQTS patients. However, it should be noted that the compound mutation makes more severe phenotype.
Collapse
Affiliation(s)
- Gaku Izumi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan. .,Department of Pediatrics, Hokkaido University Graduate School of Medicine, North-15 West-7, Sapporo, 060-8638, Japan.
| | - Emiko Hayama
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, North-15 West-7, Sapporo, 060-8638, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Mitsuyo Shimada
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Michiko Furutani
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Tsutomu Nishizawa
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Yoshiyuki Furutani
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Rumiko Matsuoka
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
28
|
Higashi K, Murakami T, Ishikawa Y, Itoi T, Ohuchi H, Kodama Y, Honda T, Masutani S, Yamazawa H, Senzaki H, Ishikawa S. Efficacy and safety of tolvaptan for pediatric patients with congestive heart failure. Multicenter survey in the working group of the Japanese Society of PEdiatric Circulation and Hemodynamics (J-SPECH). Int J Cardiol 2016; 205:37-42. [DOI: 10.1016/j.ijcard.2015.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/11/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
|
29
|
Hirouchi J, Terasaka Y, Hirao S, Moriizumi J, Yamazawa H. Effect on radioactivity concentration estimation of radon progenies with NaI(Tl) pulse height distribution from considering geometric structure around detector and infiltration of radionuclides. Radiat Prot Dosimetry 2015; 167:206-209. [PMID: 25935009 DOI: 10.1093/rpd/ncv245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The surface radioactivity concentrations of the radon progenies, (214)Pb and (214)Bi, were estimated from NaI(Tl) pulse height distributions during rain. The improvement in estimation errors caused by considering geometric structures around measuring points and infiltration of radionuclides was discussed. The surface radioactivity concentrations were determined by comparing the count rates at the full-energy peak ranges between observation and calculation with the electron-photon transport code EGS5. It was shown that the concentrations can be underestimated by about 30 % unless the obstacles around the detector or infiltration of radionuclides are considered in gamma ray transfer calculations at measuring points, where there are many tall obstacles, or the ground is covered with unpaved areas.
Collapse
Affiliation(s)
- J Hirouchi
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - Y Terasaka
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - S Hirao
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - J Moriizumi
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - H Yamazawa
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| |
Collapse
|
30
|
Yajima K, Hirao S, Moriizumi J, Yamazawa H. Quantitative evaluation of 218Po behaviour in air in an artificial environment. Radiat Prot Dosimetry 2015; 167:130-134. [PMID: 25920782 DOI: 10.1093/rpd/ncv229] [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: 06/04/2023]
Abstract
Experiments were carried out in a small enclosed booth for the purpose of understanding and modelling (218)Po behaviour. The experiment was conducted under two kinds of conditions without and with injection of incense smoke. A working model of (218)Po behaviour was applied to analyse the measured data. Under the condition without incense smoke, temporal changes in aerosol-attached and unattached (218)Po concentrations were successfully reproduced by the model. The deposition rate of unattached fraction and the rate of attachment were determined by the working model. Under the condition with incense smoke, temporal changes in (218)Po concentration were poorly simulated by the model. This can be attributed to the significantly increased aerosol concentration in small size ranges which is not properly considered in the attachment rate calculation in the model.
Collapse
Affiliation(s)
- K Yajima
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - S Hirao
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - J Moriizumi
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - H Yamazawa
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| |
Collapse
|
31
|
Yamazawa H, Yamada S, Xu Y, Hirao S, Moriizumi J. An experimental method for quantitatively evaluating the elemental processes of indoor radioactive aerosol behavior. Radiat Prot Dosimetry 2015; 167:171-175. [PMID: 25935006 DOI: 10.1093/rpd/ncv238] [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: 06/04/2023]
Abstract
An experimental method for quantitatively evaluating the elemental processes governing the indoor behaviour of naturally occurring radioactive aerosols was proposed. This method utilises transient response of aerosol concentrations to an artificial change in aerosol removal rate by turning on and off an air purifier. It was shown that the indoor-outdoor exchange rate and the indoor deposition rate could be estimated by a continuous measurement of outdoor and indoor aerosol number concentration measurements and by the method proposed in this study. Although the scatter of the estimated parameters is relatively large, both the methods gave consistent results. It was also found that the size distribution of radioactive aerosol particles and hence activity median aerodynamic diameter remained not largely affected by the operation of the air purifier, implying the predominance of the exchange and deposition processes over other processes causing change in the size distribution such as the size growth by coagulation and the size dependence of deposition.
Collapse
Affiliation(s)
- H Yamazawa
- Department of Energy Engineering and Science, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - S Yamada
- Department of Energy Engineering and Science, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - Y Xu
- Department of Energy Engineering and Science, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - S Hirao
- Department of Energy Engineering and Science, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - J Moriizumi
- Department of Energy Engineering and Science, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| |
Collapse
|
32
|
Hirao S, Hayashi R, Moriizumi J, Yamazawa H, Tohjima Y, Mukai H. Inverse estimation of radon flux distribution for East Asia using measured atmospheric radon concentration. Radiat Prot Dosimetry 2015; 167:97-101. [PMID: 25904695 DOI: 10.1093/rpd/ncv211] [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: 06/04/2023]
Abstract
In this study, the (222)Rn flux density distribution at surface was estimated in East Asia with the Bayesian synthesis inversion using measurement data and a long-range atmospheric (222)Rn transport model. Surface atmospheric (222)Rn concentrations measured at Hateruma Island in January 2008 were used. The estimated (222)Rn flux densities were generally higher than the prior ones. The area-weighted mean (222)Rn flux density for East Asia in January 2008 was estimated to be 44.0 mBq m(-2) s(-1). The use of the estimated (222)Rn flux density improved the discrepancy of the model-calculated concentrations with the measurements at Hateruma Island.
Collapse
Affiliation(s)
- S Hirao
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusaku, Nagoya 464-8603, Japan
| | - R Hayashi
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusaku, Nagoya 464-8603, Japan
| | - J Moriizumi
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusaku, Nagoya 464-8603, Japan
| | - H Yamazawa
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusaku, Nagoya 464-8603, Japan
| | - Y Tohjima
- Center for Global Environmental Research, National Institute for Environmental Studies, Tsukuba 305-8506, Japan
| | - H Mukai
- Center for Global Environmental Research, National Institute for Environmental Studies, Tsukuba 305-8506, Japan
| |
Collapse
|
33
|
Hirouchi J, Yamazawa H, Hirao S, Moriizumi J. Estimation of surface anthropogenic radioactivity concentrations from NaI(Tl) pulse-height distribution observed at monitoring station. Radiat Prot Dosimetry 2015; 164:304-315. [PMID: 25313172 DOI: 10.1093/rpd/ncu305] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/06/2014] [Indexed: 06/04/2023]
Abstract
A method of estimating surface radioactivity concentrations of key anthropogenic radionuclides from NaI(Tl) pulse-height distribution observed at a monitoring station (MS) was discussed. In the estimation, a realistic assumption on geometric distribution of source and obstacles around the detector of the MS including the infiltration of radionuclides into the ground was used and the results were compared with ones with a commonly used assumption of a uniformly distributed plane source. The surface radioactivity concentration was determined by comparing the count rates at the full-energy peak ranges between observation and calculation with an electron-photon transport code EGS5. It was shown that the estimated absolute values of concentration differed by a factor of ∼1.5 depending on the assumption of infiltration depth. The estimated surface concentrations of (131)I, (134)Cs and (137)Cs were in good agreement with ones determined by the in situ measurements with an HPGe detector and the cumulative values of daily surface depositions.
Collapse
Affiliation(s)
- J Hirouchi
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - H Yamazawa
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - S Hirao
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - J Moriizumi
- Department of Energy Engineering and Science, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| |
Collapse
|
34
|
Yamazawa H, Murakami T, Takeda A, Takei K, Furukawa T, Nakajima H. Serum concentration of procollagen type III amino-terminal peptide is increased in patients with successfully repaired coarctation of the aorta with left ventricular hypertrophy. Pediatr Cardiol 2015; 36:555-60. [PMID: 25311763 DOI: 10.1007/s00246-014-1049-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/09/2014] [Accepted: 10/05/2014] [Indexed: 01/19/2023]
Abstract
Pathological left ventricular hypertrophy (LVH) with myocardial fibrosis is an independent risk factor for cardiovascular mortality. Previous studies indicated that patients with coarctation of the aorta (CoA) have increased left ventricular mass (LVM) including LVH, even after successful CoA repair. It is unclear whether the increased LVM is pathological one with cardiac fibrosis. Group A consisted of 17 patients with successfully repaired CoA. Group B consisted of 17 postoperative subjects who matched the age and postoperative periods of group A. Group C comprised 28 subjects for the geometric standard of the left ventricle. The LVM index (LVMI) and the relative wall thickness (RWT) of group A and B were compared with the values of 17 age-matched subjects from group C. The serum concentration of procollagen type III amino-terminal peptide (P-III-P), a biomarker for myocardial fibrosis, in group A was compared with the concentration in group B. The correlations between the serum P-III-P concentration and LVMI and RWT were studied in group A and non-A group. In group A, RWT and LVMI were significantly higher than those in group C (0.37 ± 0.05 vs. 0.31 ± 0.02, p < 0.01; 44.8 ± 11.2 vs. 36.5 ± 7.6, p = 0.04, respectively), and the serum P-III-P concentration was significantly higher than that in group B (1.59 ± 0.74 vs. 1.07 ± 0.33, p = 0.04). Serum P-III-P concentrations were well correlated with RWT and LVMI (r = 0.89, p < 0.01; r = 0.63, p < 0.01, respectively) in group A. LVH in patients with successfully repaired CoA may have an abnormal pathogenesis associated with myocardial fibrosis.
Collapse
Affiliation(s)
- Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University School of Medicine, North 15 West 7, Kitaku, Sapporo, Hokkaido, 060-8638, Japan,
| | | | | | | | | | | |
Collapse
|
35
|
Yamazawa H, Takeda A, Takei K, Furukawa T. Primary prevention of sudden cardiac death in a low-risk child with familial hypertrophic cardiomyopathy: the role of cardiac magnetic resonance imaging. Clin Res Cardiol 2013; 103:75-7. [DOI: 10.1007/s00392-013-0631-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
|
36
|
Murakami T, Takeda A, Yamazawa H, Tateno S, Kawasoe Y, Niwa K. Aortic pressure wave reflection in patients after successful aortic arch repair in early infancy. Hypertens Res 2013; 36:603-7. [PMID: 23407242 DOI: 10.1038/hr.2013.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 11/10/2022]
Abstract
Despite the apparently successful surgical repair of aortic coarctation, subsequent cardiovascular complications have sometimes been encountered. Aortic pressure wave reflection is one of the risk factors for developing cardiovascular diseases, and an enhancement of the pressure wave reflection has been reported in patients after aortic arch repair. To clarify this issue, the increase in pressure wave reflection was evaluated in patients <15 years old who underwent aortic arch repair. This study enrolled 35 patients after aortic arch repair in early infancy. All patients underwent cardiac catheterization, and in 20 patients, there was no pressure difference within the repaired aortic arch. The aortic pressure waveforms in patients after successful aortic arch repair were recorded using a pressure sensor-mounted catheter, and the augmentation index in the ascending aorta was calculated. The augmentation index in patients after an aortic arch repair was increased compared with control subjects, although there was no pressure difference between the ascending and descending aorta (P<0.0001). The increase in the augmentation index was correlated with the patient's age (r=0.8932, P<0.0001) and with the left ventricular posterior wall thickness (r=0.4075, P=0.0373). In patients who undergo aortic arch repair, the pressure wave reflection is accelerated, even when the aortic arch repair is 'successful'. This increase is one of the possible causes of left ventricular hypertrophy.
Collapse
Affiliation(s)
- Tomoaki Murakami
- Department of Pediatrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | | | | | | | | | | |
Collapse
|
37
|
Mostafa AMA, Tamaki K, Moriizumi J, Yamazawa H, Iida T. The weather dependence of particle size distribution of indoor radioactive aerosol associated with radon decay products. Radiat Prot Dosimetry 2011; 146:19-22. [PMID: 21521771 DOI: 10.1093/rpd/ncr097] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study was performed to measure the activity size distribution of aerosol particles associated with short-lived radon decay products in indoor air at Nagoya University, Nagoya, Japan. The measurements were performed using a low pressure Andersen cascade impactor under variable meteorological conditions. The results showed that the greatest activity fraction was associated with aerosol particles in the accumulation size range (100-1000 nm) with a small fraction of nucleation mode (10-100 nm). Regarding the influence of the weather conditions, the decrease in the number of accumulation particles was observed clearly after rainfall without significant change in nucleation particles, which may be due to a washout process for the large particles.
Collapse
Affiliation(s)
- A M A Mostafa
- Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan.
| | | | | | | | | |
Collapse
|
38
|
Yamazawa H. Accuracy of the Doppler-derived pressure gradient in pediatric patients with aortic valvular stenosis: is the correction for pressure recovery necessary? Hokkaido Igaku Zasshi 2010; 85:225-231. [PMID: 20718206] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Doppler echocardiography derived peak instantaneous systolic pressure gradient (peak instantaneous Doppler PG), the mean PG (mean Doppler PG) and the aortic valvular area are the accepted standard for determining the prognosis and optimal timing of intervention because of good agreement between Doppler-derived and catheter-measured PGs in adult patients with aortic valvular stenosis. However, several investigators reported that pressure recovery can cause discrepancies between Doppler-derived and catheter-measured PGs, so that the correction for pressure recovery has been proposed. In pediatric patients with aortic valvular stenosis, the discrepancy between Doppler-derived and catheter-measured PGs and the correction for pressure recovery have not been studied well. Therefore, the purpose of current study was to clarify the role of echocardiography for estimating the prognosis and optimal timing of intervention and to assess the influence of pressure recovery on the Doppler-derived PG in pediatric patients with aortic valvular stenosis. Thirteen pediatric patients with aortic valvular stenosis were studied with echocardiography and cardiac catheterization. PG determined by the catheterization was compared with PG determined by the echocardiography with linear regression and Bland and Altman analysis. As result, Doppler-derived PGs corrected for pressure recovery did not correlated well with catheter-measured PGs. By contrast, Doppler-derived PGs correlated well with catheter-measured PGs. In particular, the mean Doppler PG correlated excellently with the mean catheter PG. In conclusion, the mean Doppler PG demonstrated an excellent correlation with the mean catheter PG without the correction for pressure recovery. Thus, the mean Doppler PG is useful in order to determine the prognosis and optimal timing of intervention in pediatric patients with aortic valvular stenosis.
Collapse
Affiliation(s)
- Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| |
Collapse
|
39
|
Agematsu K, Aoki M, Naito Y, Inuzuka R, Yamazawa H, Sugamoto K, Nakajima H, Fujiwara T. [Short-term outcome of extracardiac lateral tunnel using the atrial free wall and autologous pericardium]. Kyobu Geka 2008; 61:741-747. [PMID: 18697453] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Several modifications to the original Fontan procedure have been proposed in order to decrease postoperative morbidity. Lateral tunnel and extracardiac total cavo-pulmonary connection are 2 such modifications. PATIENTS Between August 2005 and December 2005, the extracardiac lateral tunnel procedure was performed in 5 patients. The age at operation ranged from 19 to 59 months (median 24 months) and the weight ranged from 9.2 to 16.1 kg (median 11.4 kg). RESULTS There was no mortality. The mean operation time was 466 +/-118 minutes. The mean cardiopulmonary bypass time was 198 +/- 61 minutes. The mean durations of intubation, intensive care unit stay, drainage tube use, and hospital stay were 1 +/- 1, 7 +/- 3, 12 +/- 5 and 30 +/- 2 days, respectively. Postoperative catheterization findings demonstrated that the mean superior venous caval pressure, inferior venous caval pressure, ventricular volume and ventricular ejection fraction were 10.0 +/- 1.4 mmHg, 11.0 +/- 2.4 mmHg, 140 +/- 47% of normal and 58.0 +/- 6.8% , respectively. CONCLUSIONS The short-term results of the extracardiac lateral tunnel compared favorably with the results of different types of Fontan operation. In addition this procedure has the potential for growth and anticoagulation therapy is unnecessary.
Collapse
Affiliation(s)
- K Agematsu
- Department of Cardiovascular Surgery, Chiba Children's Hospital, Chiba, Japan
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Murakami T, Ueno M, Takeda A, Yakuwa S, Yamazawa H, Murashita T, Imamura M, Konishi T. [Fontan completion after balloon angioplasty of multiple pulmonary artery stenosis in a child with pulmonary atresia with intact ventricular septum; report of a case]. Kyobu Geka 2006; 59:157-9. [PMID: 16482913] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 5-year-old boy was referred to our institute for cardiac evaluation having been previously seen at another center. He had been diagnosed a pulmonary atresia with intact ventricular septum just after birth, and undergone Blalock-Taussig shunts. Although his central pulmonary artery pressure was high (mean pressure 26 mmHg) after bilateral Blalock-Taussig shunts, multiple peripheral pulmonary artery stenosis protected his pulmonary vascular bed from pressure load. We released the multiple pulmonary artery stenosis partly by catheter intervention and partly by surgical operation, and staged Fontan operation was completed. The surgery in combination with catheter therapies would expand the indication of Fontan-type operation, and it would contribute to the patients' postoperative prognosis.
Collapse
Affiliation(s)
- Tomoaki Murakami
- Department of Pediatrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Iskandar D, Iida T, Yamazawa H, Moriizumi J, Koarashi J, Yamasoto K, Yamasaki K, Shimo M, Tsujimoto T, Ishikawa S, Fukuda M, Kojima H. The transport mechanisms of 222Rn in soil at Tateishi as an anomaly spot in Japan. Appl Radiat Isot 2005; 63:401-8. [PMID: 15950479 DOI: 10.1016/j.apradiso.2005.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Revised: 02/17/2005] [Accepted: 03/29/2005] [Indexed: 10/25/2022]
Abstract
The (222)Rn concentration profiles in soil have been measured at an anomaly spot in Tateishi, Japan. In winter, the concentrations were low and showed a negative gradient with depth, but in other seasons, the concentration had both positive and negative gradients with depth, and dramatically changed by time. On the assumption that there was ventilation in deep layers and with driving forces of wind and temperatures, these phenomena were successfully explained. This finding would contribute to a numerical model for (222)Rn transport in soil.
Collapse
Affiliation(s)
- D Iskandar
- Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8603, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Belot Y, Watkins BM, Edlund O, Galeriu D, Guinois G, Golubev AV, Meurville C, Raskob W, Täschner M, Yamazawa H. Upward movement of tritium from contaminated groundwaters: a numerical analysis. J Environ Radioact 2005; 84:259-70. [PMID: 15990205 DOI: 10.1016/j.jenvrad.2004.07.007] [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] [Received: 09/25/2002] [Revised: 07/16/2004] [Accepted: 07/19/2004] [Indexed: 05/03/2023]
Abstract
This paper describes a research-oriented modelling exercise that addresses the problem of assessing the movement of tritium from a contaminated perched aquifer to the land surface. Participants were provided with information on water table depth, soil characteristics, hourly meteorological and evapotranspiration data. They were asked to predict the upward migration of tritium through the unsaturated soil into the atmosphere. Eight different numerical models were used to calculate the movement of tritium. The modelling results agree within a factor of two, if very small time and space increments are used. The agreement is not so good when the near-surface soil becomes dry. The modelling of the alternate upward and downward transport of tritium close to the ground surface generally requires rather complex models and detailed input because tritium concentration varies sharply over short distances and is very sensitive to many interactive factors including rainfall amount, evapotranspiration rate, rooting depth and water table position.
Collapse
Affiliation(s)
- Y Belot
- Environment Consultant, 40 rue du Mont Valerien, 92210 Saint Cloud, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
|
44
|
|
45
|
Yamazawa H, Nakajima N, Wakamura S, Arakaki N, Yamamoto M, Ando T. Synthesis and characterization of diepoxyalkenes derived from (3Z,6Z,9Z)-trienes: lymantriid sex pheromones and their candidates. J Chem Ecol 2001; 27:2153-67. [PMID: 11817072 DOI: 10.1023/a:1012255201380] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
All stereoisomers of three diepoxyalkenes derived from (3Z,6Z,9Z)-trienes with a C21, C19, or C18 straight chain, lymantriid sex pheromones and their candidates, were synthesized by MCPBA oxidation of optically active epoxyalkadienes. Their chromatographic behaviors were examined with GC and LC equipped with achiral and chiral columns. Detailed inspection of the mass spectra of these epoxides indicated the following diagnostic ions for determining the chemical structures: m/z 128, 167, M-87 and M-85 for (Z)-cis-3,4-cis-6,7-diepoxy-9-enes; m/z 111, M-125 and M-69 for (Z)-cis-6,7-cis-9,10-diepoxy-3-enes; and m/z M-125 and M-139 for (Z)-cis-3,4-cis-9,10-diepoxy-6-enes. Mass chromatographic analysis that monitored these fragment ions revealed the existence of a new pheromonal compound with a C21 chain in an extract from virgin females of a lymantriid species, Perina nuda F. The three diepoxyalkenes were converted into the corresponding DMDS adducts, which showed characteristic ions from fragmentation between the two thiomethyl groups, reflecting the position of an original double bond.
Collapse
Affiliation(s)
- H Yamazawa
- Graduate School of Bio-Applications and Systems Engineering, Tokyo University of Agriculture and Technology, Koganei, Japan
| | | | | | | | | | | |
Collapse
|
46
|
Yamamoto M, Takeuchi Y, Ohmasa Y, Yamazawa H, Ando T. Chiral HPLC resolution of monoepoxides derived from 6,9-dienes and its application to stereochemistry assignment of fruit-piercing noctuid pheromone. Biomed Chromatogr 1999; 13:410-7. [PMID: 10477899 DOI: 10.1002/(sici)1099-0801(199910)13:6<410::aid-bmc902>3.0.co;2-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/08/2022]
Abstract
The resolution of insect pheromonal cis-monoepoxy racemates derived from (Z,Z)-6,9-dienes was examined employing chiral HPLC columns, and the results showed that a normal-phase column (Chiralpak AD) was suitable for both 6,7- and 9,10-epoxides with a C(17)-C(23) straight chain, as was a reversed-phase column (Chiralcel OJ-R) for the 6, 7-epoxides. To determine the absolute configuration of each separated enantiomer applying a modified Mosher's method, the epoxy ring was opened by methanolysis, and the (1)H-NMR data of (S)- and (R)-MTPA esters of the methoxyalcohols produced were analyzed. Further, the hydrogenated product of each enantiomer was chromatographed on the OJ-R column referring to the corresponding authentic chiral compounds with a saturated chain, which were prepared by a Sharpless epoxidation reaction. These analyses showed that the levorotatory 6,7- and 9,10-epoxides with shorter t(R)s possess 6S,7R and 9R,10S configuration, respectively, and the dextrorotatory enantiomers with longer t(R)s possess the opposite configuration. Utilizing this chiral HPLC, it was revealed that an abdominal tip extract of the fruit-piercing moth, Oraesia excavata Butler (Lepidoptera: Noctuidae), included (9S,10R)-(Z)-9, 10-epoxy-6-henicosene as a main sex pheromone component. The synthetic 9,10-epoxide with this configuration, which was separated from the racemate, exhibited stronger activity in electrophysiological and field tests against male moths than the enantiomer.
Collapse
Affiliation(s)
- M Yamamoto
- Graduate School of Bio-Applications and Systems Engineering, Tokyo University of Agriculture and Technology, Koganei, Tokyo 184-8588, Japan
| | | | | | | | | |
Collapse
|
47
|
Chino M, Yamazawa H. Development of an atmospheric 222Rn concentration model using a hydrodynamic meteorological model: II. Three-dimensional research-purpose model. Health Phys 1996; 70:55-63. [PMID: 7499153 DOI: 10.1097/00004032-199601000-00009] [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: 05/21/2023]
Abstract
This paper describes a new type of three-dimensional numerical model for 222Rn transport in an atmospheric boundary layer. The model is a combination of a prognostic hydrodynamic meteorological model including a turbulence closure model and an atmospheric diffusion model for 222Rn. The first part provides the second part with the meteorological conditions needed for calculations of the 222Rn transport and diffusion. The model is capable of giving consideration to horizontal source distribution, complex terrain, and non-uniform and non-steady atmosphere. The model's results were compared with 222Rn field measurements in a mountain-valley area and represented qualitatively a typical diurnal variation of the 222Rn concentration in nocturnal drainage flows. The model was also applied to the transport of 222Rn in a seacoast area. These results indicated that the model could be effective as a research tool for numerical analysis of 222Rn behavior under various atmospheric conditions.
Collapse
Affiliation(s)
- M Chino
- Department of Environmental Safety Research, Japan Atomic Energy Research Institute, Ibaraki-Ken, Japan
| | | |
Collapse
|
48
|
Chino M, Yamazawa H, Iida T. Development of an atmospheric 222Rn concentration model using a hydrodynamic meteorological model: I. One-dimensional practical model. Health Phys 1996; 70:47-54. [PMID: 7499151 DOI: 10.1097/00004032-199601000-00008] [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: 05/21/2023]
Abstract
A one-dimensional numerical model for 222Rn transport in an atmospheric boundary layer was developed. The model consists of two parts: a prognostic hydrodynamic model including a turbulence closure model and an atmospheric diffusion model for 222Rn. The first part predicts meteorological conditions to provide the second part with vertical turbulence conditions which affects the vertical motion of 222Rn near the Earth's surface. Calculations with the model are compared with 222Rn concentrations measured during a variety of meteorological conditions, from clear days with high radiation and low winds to cloudy days of low radiation with high winds. The model's results represent well the typical diurnal variations of the 222Rn concentrations.
Collapse
Affiliation(s)
- M Chino
- Department of Environmental Safety Research, Japan Atomic Energy Research Institute, Ibaraki-Ken, Japan
| | | | | |
Collapse
|
49
|
Kosuge T, Yokota M, Sugiyama K, Yamamoto T, Mure T, Yamazawa H. Studies on bioactive substances in crude drugs used for arthritic diseases in traditional Chinese medicine. II. Isolation and identification of an anti-inflammatory and analgesic principle from the root of Angelica pubescens Maxim. Chem Pharm Bull (Tokyo) 1985; 33:5351-4. [PMID: 3879591 DOI: 10.1248/cpb.33.5351] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
50
|
Kosuge T, Yokota M, Sugiyama K, Mure T, Yamazawa H, Yamamoto T. Studies on bioactive substances in crude drugs used for arthritic diseases in traditional Chinese medicine. III. Isolation and identification of anti-inflammatory and analgesic principles from the whole herb of Pyrola rotundifolia L. Chem Pharm Bull (Tokyo) 1985; 33:5355-7. [PMID: 3879592 DOI: 10.1248/cpb.33.5355] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|