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Rosenthal LL, Grinninger C, Pozza RD, Fischer M, Zimmerling L, Ulrich SM, Kari FA, Haas NA, Michel S, Hörer J, Hagl C. Impact of the operative technique on mid- and long-term results following paediatric heart transplantation. ESC Heart Fail 2024; 11:1602-1611. [PMID: 38378979 DOI: 10.1002/ehf2.14718] [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: 05/10/2023] [Revised: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
AIMS The aim of this study is to evaluate and compare the impact of the bicaval technique versus the biatrial technique (by Lower and Shumway) in paediatric heart transplant patients. Only a few studies investigate this matter regarding the long-term outcome after paediatric heart transplantation. We compared the two surgical methods regarding survival, the necessity of pacemaker implantation. METHODS AND RESULTS All 134 patients (aged <18 years) - (group-1) biatrial (n = 84), versus (group-2) bicaval (n = 50), who underwent heart transplantation between October 1988 and December 2021, were analysed. Freedom from events were estimated using the Kaplan-Meier method. Potential differences were analysed using the log rank test and Cox proportional hazard models. Mean ± standard deviation: Bypass time (per minutes) was higher in the group 1 as compared with group 2 (P = 0.050). Survival was not significantly different (P = 0.604) in either groups. Eighteen patients required permanent pacemaker implantation in the group 1 and only one patient required it in the group 2 (P = 0.001). CONCLUSIONS Paediatric heart transplantation using bicaval technique results similar long-term survival compared with the biatrial technique. The incidence of atrial rhythm disorders was significantly higher in the biatrial group, requiring a higher frequency of pacemaker implantation in this group. As a results, the bicaval technique has replaced the biatrial technique in our centre.
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Affiliation(s)
- L Lily Rosenthal
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilian University, Munich, Germany
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
- Munich Heart Alliance (MHA) - DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Carola Grinninger
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Robert Dalla Pozza
- Department of Congenital and Pediatric Herat Surgery, German Herat Center Munich, Technische Universität München, Munich, Germany
| | - Marcus Fischer
- Department of Congenital and Pediatric Herat Surgery, German Herat Center Munich, Technische Universität München, Munich, Germany
| | - Linda Zimmerling
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilian University, Munich, Germany
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Sarah M Ulrich
- Department of Congenital and Pediatric Herat Surgery, German Herat Center Munich, Technische Universität München, Munich, Germany
| | - Fabian A Kari
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilian University, Munich, Germany
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
- Munich Heart Alliance (MHA) - DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Nikolaus A Haas
- Department of Congenital and Pediatric Herat Surgery, German Herat Center Munich, Technische Universität München, Munich, Germany
| | - Sebastian Michel
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilian University, Munich, Germany
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
- Munich Heart Alliance (MHA) - DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Jürgen Hörer
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilian University, Munich, Germany
- Munich Heart Alliance (MHA) - DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
- Department for Pediatric Cardiology and Intensive Care, Ludwig Maximilian University, Munich, Germany
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Boever J, Nussbaum C, Arnold L, Haas NA, Dold SK, Oberhoffer FS, Jakob A. Long-Term Microvascular Changes in Multisystem Inflammatory Syndrome in Children. JAMA Pediatr 2024; 178:304-306. [PMID: 38227331 PMCID: PMC10912942 DOI: 10.1001/jamapediatrics.2023.6022] [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: 08/20/2023] [Accepted: 10/31/2023] [Indexed: 01/17/2024]
Abstract
This case-control study investigates changes in microcirculation and endothelial function in the acute phase of multisystem inflammatory syndrome in children and 3 to 6 months after onset.
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Affiliation(s)
- Julie Boever
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Claudia Nussbaum
- Division of Neonatology, Department of Paediatrics, Dr von Hauner Children’s Hospital, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Leonie Arnold
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nikolaus A. Haas
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Simone K. Dold
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Felix S. Oberhoffer
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - André Jakob
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Nowak S, Jakob A, Dalla Pozza R, Michel S, Haas NA, Pattathu J. Familiar Disposition of May-Thurner Syndrome-A Case Series. Life (Basel) 2024; 14:221. [PMID: 38398730 PMCID: PMC10890414 DOI: 10.3390/life14020221] [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: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
May-Thurner syndrome is a venous compression syndrome of the pelvic vessels that represents a relevant risk factor for thrombus formation. The standard procedure to secure a diagnosis is venography, followed by endovascular therapy as the preferred treatment choice if the patient is symptomatic. In our case series, there are three related patients with May-Thurner syndrome. A 16-year-old female was admitted with pulmonary embolism, dyspnoea and hip pain. The compression syndrome was diagnosed with interventional venography, and the patient received venous stent implantation. Due to her family history, we also suspected her mother to be affected by the syndrome and elucidated the diagnosis shortly afterwards by invasive venography. Subsequently, we examined the patient's 19-year-old brother, and magnetic resonance imaging confirmed May-Thurner syndrome. A similar case series has not been published before. In this case, the family relation indicates a possible hereditary aspect of May-Thurner syndrome. This hypothesis should be the subject of further research. In conclusion, it is essential to assess family history thoroughly when treating patients with May-Thurner syndrome.
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Affiliation(s)
| | | | | | | | | | - Joseph Pattathu
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, 81377 Munich, Germany (N.A.H.)
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Hascoët S, Bentham JR, Giugno L, Betrián-Blasco P, Kempny A, Houeijeh A, Baho H, Sharma SR, Jones MI, Biernacka EK, Combes N, Georgiev S, Bouvaist H, Martins JD, Kantzis M, Turner M, Schubert S, Jalal Z, Butera G, Malekzadeh-Milani S, Valdeolmillos E, Karsenty C, Ödemiş E, Aldebert P, Haas NA, Khatib I, Wåhlander H, Gaio G, Mendoza A, Arif S, Castaldi B, Dohlen G, Carere RG, Del Cerro-Marin MJ, Kitzmüller E, Hermuzi A, Carminati M, Guérin P, Tengler A, Fraisse A. Outcomes of transcatheter pulmonary SAPIEN 3 valve implantation: an international registry. Eur Heart J 2024; 45:198-210. [PMID: 37874971 DOI: 10.1093/eurheartj/ehad663] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND AIMS Transcatheter pulmonary valve implantation (TPVI) is indicated to treat right-ventricular outflow tract (RVOT) dysfunction related to congenital heart disease (CHD). Outcomes of TPVI with the SAPIEN 3 valve that are insufficiently documented were investigated in the EUROPULMS3 registry of SAPIEN 3-TPVI. METHODS Patient-related, procedural, and follow-up outcome data were retrospectively assessed in this observational cohort from 35 centres in 15 countries. RESULTS Data for 840 consecutive patients treated in 2014-2021 at a median age of 29.2 (19.0-41.6) years were obtained. The most common diagnosis was conotruncal defect (70.5%), with a native or patched RVOT in 50.7% of all patients. Valve sizes were 20, 23, 26, and 29 mm in 0.4%, 25.5%, 32.1%, and 42.0% of patients, respectively. Valve implantation was successful in 98.5% [95% confidence interval (CI), 97.4%-99.2%] of patients. Median follow-up was 20.3 (7.1-38.4) months. Eight patients experienced infective endocarditis; 11 required pulmonary valve replacement, with a lower incidence for larger valves (P = .009), and four experienced pulmonary valve thrombosis, including one who died and three who recovered with anticoagulation. Cumulative incidences (95%CI) 1, 3, and 6 years after TPVI were as follows: infective endocarditis, 0.5% (0.0%-1.0%), 0.9% (0.2%-1.6%), and 3.8% (0.0%-8.4%); pulmonary valve replacement, 0.4% (0.0%-0.8%), 1.3% (0.2%-2.4%), and 8.0% (1.2%-14.8%); and pulmonary valve thrombosis, 0.4% (0.0%-0.9%), 0.7% (0.0%-1.3%), and 0.7% (0.0%-1.3%), respectively. CONCLUSIONS Outcomes of SAPIEN 3 TPVI were favourable in patients with CHD, half of whom had native or patched RVOTs.
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Affiliation(s)
- Sebastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - James R Bentham
- Leeds Teaching Hospitals NHS Trust, Yorkshire Heart Centre, Leeds, UK
| | - Luca Giugno
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Pedro Betrián-Blasco
- Hospital Universitario Vall d'Hebron, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Aleksander Kempny
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Ali Houeijeh
- Centre Hospitalier Universitaire de Lille, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 2 Av. Oscar Lambret, 59000 Lille, France
| | - Haysam Baho
- King Faisal Specialist Hospital, Department of Paediatric Cardiology and Adults with congenital heart diseases, Jeddah, Saudi Arabia
| | - Shiv-Raj Sharma
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Matthew I Jones
- Evelina London Children's Hospital & St Thomas' Hospital, Departement of Paediatric Cardiology and Adults with Congenital Heart Diseases, Westminster Bridge Rd, London SE1 7EH, United Kingdom
| | - Elżbieta Katarzyna Biernacka
- Cardinal Stefan Wyszyński Institute of Cardiology, Department of Congenital Heart Diseases, Alpejska 42, 04-628 Warsaw, Poland
| | - Nicolas Combes
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Clinique Pasteur, Department of Cardiology, 31000 Toulouse, France
| | - Stanimir Georgiev
- Department of Congenital Heart Disease and Pediatric Cardiogy, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Hélène Bouvaist
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Jose Diogo Martins
- Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central-EPE, Lisbon, Portugal
| | - Marinos Kantzis
- Glenfield Hosp, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Leicester, United Kingdom
| | - Mark Turner
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Stephan Schubert
- Centre for Congenital Heart Defects, Heart and Diabetes Centre Universitario North Rhine Westphalia, Department for Congenital Heart Defects, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Zakaria Jalal
- Pediatric and congenital heart diseases department, Bordeaux University Hospital, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, CRCTB INSERM U1045, Bordeaux, France
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Estibaliz Valdeolmillos
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - Clement Karsenty
- CHU Hôpital des enfants, Department of Paediatric Cardiology, Toulouse, France
| | - Ender Ödemiş
- Koç University Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Davutpaşa Cd, 34010 Istanbul, Turkey
| | - Philippe Aldebert
- CHU Timone, Assistance Publique des Hôpitaux de Marseille, 278 rue Saint-Pierre, 13385 Marseille, France
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Ihab Khatib
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Rambam Healthcare Campus, Haifa, Israel
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israël
| | - Håkan Wåhlander
- Paediatric Heart Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital and Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gianpiero Gaio
- Paediatric Cardiology, Ospedali dei Colli, Luigi Vanvitelli University of Campania, Str. Vicinale Reggente, 66/82, 80131 Naples, Italy
| | - Alberto Mendoza
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Av de Cordoba s/n, 28041 Madrid, Spain
| | - Sayqa Arif
- University Hospital Birmingham NHS Trust, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Child and Woman's Health, University of Padua, Via VIII Febbraio, 2, 35122 Padua, Italy
| | - Gaute Dohlen
- University hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Oslo, Norway
| | - Ronald G Carere
- St Paul's Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Maria Jesus Del Cerro-Marin
- Department of Paediatric Cardiology and Adults Congenital Heart Disease, H. Ramón y Cajal University Hospital, Madrid, Spain
| | - Erwin Kitzmüller
- Vienna General Hospital (AKH), Vienna Medical University, Vienna, Austria
| | - Antony Hermuzi
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital Newcastle upon Tyne, Newcastle, United Kingdom
| | - Mario Carminati
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Patrice Guérin
- Centre Hospitalier Universitaire de Nantes, Department of Cardiology, 1 Pl. Alexis-Ricordeau, 44093 Nantes, France
| | - Anja Tengler
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Alain Fraisse
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
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Guerlich K, Patro-Golab B, Barnacle A, Baumann U, Eicken A, Fraser AG, Gruszfeld D, Haas NA, Jonker AH, Kammermeier M, Kenny D, Kolaček S, Lapatto R, Maconochie I, Mader S, McGauran G, Melvin T, Muensterer O, Piscoi P, Romano A, Saxena AK, Schneider DT, Turner MA, Walle JV, Koletzko B. European expert recommendations on clinical investigation and evaluation of high-risk medical devices for children. Acta Paediatr 2023; 112:2440-2448. [PMID: 37485905 DOI: 10.1111/apa.16919] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
Several high-risk medical devices for children have become unavailable in the European Union (EU), since requirements and costs for device certification increased markedly due to the EU Medical Device Regulation. The EU-funded CORE-MD project held a workshop in January 2023 with experts from various child health specialties, representatives of European paediatric associations, a regulatory authority and the European Commission Directorate General Health and Food Safety. A virtual follow-up meeting took place in March 2023. We developed recommendations for investigation of high-risk medical devices for children building on participants' expertise and results of a scoping review of clinical trials on high-risk medical devices in children. Approaches for evaluating and certifying high-risk medical devices for market introduction are proposed.
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Affiliation(s)
- Kathrin Guerlich
- Child Health Foundation (Stiftung Kindergesundheit), c/o Dr. von Hauner Children's Hospital, Munich, Germany
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
| | - Bernadeta Patro-Golab
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
- European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
| | - Alex Barnacle
- Department of Interventional Radiology, Great Ormond St Hospital for Children, London, UK
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE)
| | - Ulrich Baumann
- European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
- Paediatric Gastroenterology and Hepatology Hannover Medical School, Hannover, Germany
| | - Andreas Eicken
- German Heart Center Munich, Munich, Germany
- Association for European Paediatric and Congenital Cardiology (AEPC)
- European Society of Cardiology (ESC)
| | - Alan G Fraser
- European Society of Cardiology (ESC)
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
- Biomedical Alliance in Europe
| | - Dariusz Gruszfeld
- Neonatal Department and NICU, Children's Memorial Health Institute, Warsaw, Poland
- European Society for Pediatric and Neonatal Intensive Care (ESPNIC)
| | - Nikolaus A Haas
- Division of Pediatric Cardiology and Intensive Care, LMU University Hospital, LMU, Munich, Germany
| | | | - Michael Kammermeier
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
| | - Damien Kenny
- Association for European Paediatric and Congenital Cardiology (AEPC)
- Children's Health Ireland (CHI) at Crumlin and Mater Hospitals, Dublin, Ireland
| | - Sanja Kolaček
- European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
- Medical Faculty, University of Zagreb, Zagreb, Croatia
| | - Risto Lapatto
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- European Academy of Paediatrics (EAP)
- European Society of Endocrinology (ESE)
- European Society for Paediatric Endocrinology (ESPE)
- Society for Study of Inborn Errors of Metabolism (SSIEM)
- European Reference Network on Rare Endocrine Conditions (EndoERN)
- European Reference Network for Hereditary Metabolic Disorders (MetabERN)
| | - Ian Maconochie
- Imperial College NHS Healthcare Trust, London, UK
- European Society for Emergency Medicine (EUSEM)
| | - Silke Mader
- Parent Organisation European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Gearóid McGauran
- Health Products Regulatory Authority, Dublin, Ireland
- Royal College of Physicians of Ireland
| | - Tom Melvin
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU Medical Center, Munich, Germany
- European Paediatric Surgeons' Association (EUPSA)
| | - Paul Piscoi
- Health Technology Unit B6, Directorate General for Health (DG SANTE), European Commission, Brussels, Belgium
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Amulya K Saxena
- European Paediatric Surgeons' Association (EUPSA)
- Chelsea and Westminster NHS Fdn Trust, Imperial College London, London, UK
| | - Dominik T Schneider
- Klinikum Dortmund, University Witten/Herdecke, Dortmund, Germany
- German Society of Pediatrics and Adolescent Medicine (Deutsche Gesellschaft für Kinder- und Jugendmedizin - DGKJ)
| | - Mark A Turner
- European Academy of Paediatrics (EAP)
- Department of Women's and Children's Health, Instiute of Life Cycle and Medical Sciences, University of Liverpool, Liverpool, UK
- Royal College of Paediatrics and Child Health
- European Society for Developmental, Perinatal and Paediatric Pharmacology
- conect4children
| | - Johan Vande Walle
- Department of Pediatric Nephrology, University Hospital Ghent, Ghent, Belgium
- European Society of Pediatric Nephrology (ESPN), Chair of the European Pediatric Dialysis Working group (EPDWG)
- International Pediatric Nephrology Association (IPNA)
- European Rare Kidney Disease Reference Network (ERKNet)
| | - Berthold Koletzko
- Child Health Foundation (Stiftung Kindergesundheit), c/o Dr. von Hauner Children's Hospital, Munich, Germany
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU, Munich, Germany
- European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
- European Academy of Paediatrics (EAP)
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Pattathu J, Michel S, Tengler AI, Mandilaras G, Jakob A, Dalla Pozza R, Haas NA. Case report: Beneficial long-term effect of the atrial-flow-regulator device in a pediatric patient with idiopathic pulmonary arterial hypertension and recurring syncope. Front Cardiovasc Med 2023; 10:1197985. [PMID: 37745101 PMCID: PMC10516292 DOI: 10.3389/fcvm.2023.1197985] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
We report the long-term effect after successfully implanting an 8 mm Atrial-flow-regulator (AFR) device in a 7-year-old girl with idiopathic pulmonary hypertension with persistent syncope under triple therapy with significant improvement after implantation and absence of any further syncope. Early Implantation of the AFR device (Occlutech, Germany) can be efficient and safe interventional therapy option for pulmonary arterial hypertension with a history of syncope.
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Braun A, Mühlberg R, Fischer M, Haas NA, Meyer Z. Liver stiffness in Fontan patients: the effect of respiration and food intake. Front Med (Lausanne) 2023; 10:1192017. [PMID: 37746087 PMCID: PMC10512863 DOI: 10.3389/fmed.2023.1192017] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives For several years, patients with single ventricle hearts have been palliated according to the Fontan principle. One well known long-term consequence in these patients is the Fontan-associated liver disease and fibrosis, which occurs due to the chronically increased Central Venous Pressure (CVP) after Fontan palliation. It carries an increased risk of liver cirrhosis and hepatocellular carcinoma over time. Liver elastography (LE) is a non-invasive, safe, and feasible ultrasound method to determine liver stiffness and the stage of liver fibrosis. Usually, this examination must be performed in a sober condition and strict inspiratory hold to optimize the results and may therefore be difficult to perform on children as a routine examination. However, the influence of food intake and respiration on these results in Fontan patients is unclear. To optimize the implementation for this examination especially in children, the effects of food intake and breathing maneuvers on liver stiffness in patients with Fontan circulation were investigated. Methods For this prospective study, 25 Fontan patients (group 1) and 50 healthy volunteers (group 2) were examined. The two groups were additionally divided into two age categories (group 1a: 10-19 years; group 1b: 20-29 years; group 2a: 15-19 years; group 2b: 20-25 years). Liver stiffness was measured by liver elastography once before food intake (=T0, with 6 h of fasting). Subsequently the participants consumed a standardized chocolate drink (500 mL) with nutritional distribution corresponding to a standardized meal (600 kcal). Liver stiffness was then determined 15, 30, 45, 60, 90, 120, 150, and 180 min after ingestion. Each measurement of liver stiffness was performed during maximal inspiratory and expiratory holds. The study was reviewed and approved by the responsible ethics committee. Results In group 2 there was a significant increase in liver stiffness after food intake at T15, T30, and T45 during inspiration measurements (T0 = 4.0 kPa vs. T15 = 4.9 kPa, difference = 22.5%; T0 = 4.0 kPa vs. T30 = 4.9 kPa difference = 22.5%; T0 = 4.0 kPa vs. T45 = 4.3 kPa difference = 7.5%), as well as during expiration at T15 and T30 (T0 = 4.5 kPa vs. T15 = 5.1 kPa, difference = 14.7%; T0 = 4.5 kPa vs. T30 = 4.9 kPa difference = 7.8%). Whereas in Fontan patients (group 1) liver stiffness did not differ significantly at any time between fasting (T0) and postprandial values. The respiratory maneuvers in the healthy subjects (group 2) differed significantly only before food intake (T0) (group 2: insp = 3.97 kPa vs. exp. = 4.48 kPa difference = 11.3%). In the Fontan group (group 1), there was no significant difference between the respiratory phases at any point. The different age categories showed no significant difference in liver stiffness. Conclusion With these results we could demonstrate for the first time that in Fontan patients the time of food intake (i.e., fasting) has no clinical significance for the values obtained in liver elastography. We could also demonstrate that the breathing maneuvers during the examination had only minimal clinical impact on the results of liver elastography in patients with normal circulation and no effect in patients with Fontan-circulation. Consequently, liver elastography for Fontan patients is reliable independently of food intake and breathing maneuvers and can also be performed on younger patients, who are unable to follow breathing commands or longer fasting periods, without any impairment of the results. These results should encourage a routine use of LE in the follow-up of Fontan patients.
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Oberhoffer FS, Dalla-Pozza R, Jakob A, Haas NA, Mandilaras G, Li P. Energy drinks: effects on pediatric 24-h ambulatory blood pressure monitoring. A randomized trial. Pediatr Res 2023; 94:1172-1179. [PMID: 37061642 PMCID: PMC10444612 DOI: 10.1038/s41390-023-02598-y] [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: 11/29/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Energy drinks (EDs) are popular beverages among minors. To date, clinical studies investigating ED-induced effects on the pediatric cardiovascular system are sparse. This study aimed to investigate the effects of a single, bodyweight-adjusted ED dosage on 24-h ambulatory blood pressure monitoring (ABPM) in healthy children and adolescents. METHODS This study was a randomized, single-blind, placebo-controlled, crossover clinical trial. Study participants received a single, bodyweight-adjusted ED amount or a placebo drink on 2 consecutive days at similar morning hours. Twenty-four-hour ABPM was assessed via an automated oscillometric blood pressure device after beverage consumption on both study days. RESULTS A total of 17 healthy children and teenagers (13.90 (12.29-17.89) years) were included in the final analysis. The ED consumption led, compared to the placebo intake, to a significantly higher 24-h systolic (115.90 (110.22-118.04) vs. 110.64 (108.09-115.45) mmHg, p = 0.013) and diastolic blood pressure (66.08 (64.20-68.32) vs. 62.63 (61.40-66.46) mmHg, p = 0.005). CONCLUSIONS The single, bodyweight-adjusted ED consumption is linked with a significantly higher systolic as well as diastolic 24-h blood pressure in healthy children and adolescents. Minors, particularly those with an increased cardiovascular morbidity, should be discouraged from drinking EDs. IMPACT Energy drinks (EDs) are consumed by many children and teenagers. While adverse cardiovascular events after ED consumption were reported in the literature, the effects of these beverages on the pediatric 24-h blood pressure profile have not been systematically evaluated yet. In our manuscript, we demonstrate for the first time that acute ED consumption is associated with a significantly higher 24-h systolic blood pressure and diastolic blood pressure in healthy minors.
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Affiliation(s)
- Felix S Oberhoffer
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377, Munich, Germany.
| | - Robert Dalla-Pozza
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377, Munich, Germany
| | - André Jakob
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Nikolaus A Haas
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Guido Mandilaras
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Pengzhu Li
- Division of Pediatric Cardiology and Intensive Care, University Hospital, LMU Munich, 81377, Munich, Germany
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Thomas C, Mandilaras G, Rabenhorst D, Oberhoffer FS, Fischer M, Haas NA, Fernandez Rodriguez S. Vagal Asystoles in a Boy With Prader-Willi Syndrome. Pediatrics 2023; 152:e2022058216. [PMID: 37539482 DOI: 10.1542/peds.2022-058216] [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] [Accepted: 03/13/2023] [Indexed: 08/05/2023] Open
Abstract
Prader-Willi syndrome (PWS) is a genetic hormonal disorder of the hypothalamic-pituitary-axis resulting in mental retardation, muscle hypotonia, hypogonadism, and hyperphagia leading to significant obesity. Cardiovascular morbidity and mortality in adult patients with PWS is higher than in healthy controls and mainly secondary to massive obesity. In childhood, mortality may result from respiratory or gastrointestinal illnesses. We present a case of a 10-year-old boy with PWS who experienced recurrent and asymptomatic episodes of sinus pauses caused by the ingestion of large gulps of apple juice, which could be provoked and reproduced. The asystoles could not be provoked by any other vagal maneuvers and an initial diagnostic workup revealed no indication for structural heart disease. Because of the asymptomatic character of the asystoles, no treatment was initially provided. When he re-presented 3 months later after a clinically relevant syncope at school, pacemaker therapy was initiated, and he has demonstrated no subsequent sinus pauses or syncopes. Regarding the rising awareness of subtle cardiac alterations including autonomic dysfunction and electrocardiogram changes in young patients with PWS and especially the occurrence of unexplained sudden deaths in childhood that may be precipitated by arrhythmia, we suggest that the utility of periodic screening for arrhythmia risk should be evaluated in children with PWS.
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Affiliation(s)
- Clara Thomas
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Guido Mandilaras
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Dorothee Rabenhorst
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Felix S Oberhoffer
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Silvia Fernandez Rodriguez
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
- med4kidz Kinder- und Jugendmedizinisches Zentrum, Herz und Lungenzentrum Bayreuth, Bayreuth, Germany
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Lersch R, Mandilaras G, Schrader M, Anselmino F, Haas NA, Jakob A. Have we got the optimal treatment for refractory Kawasaki disease in very young infants? A case report and literature review. Front Pediatr 2023; 11:1210940. [PMID: 37576144 PMCID: PMC10419265 DOI: 10.3389/fped.2023.1210940] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
A small group of patients with Kawasaki disease (KD) demonstrates resistance to standard therapy, putting them at high risk for an unfavorable prognosis, especially regarding coronary artery aneurysms. Although adding corticosteroids to first-line i.v. immunoglobulins (IVIGs) is considered beneficial, and despite timely treatment initiation, very young infants, in particular, can present an unfavorable clinical course. We report on a 3-month-old boy with a clinically severe KD phenotype involving the early development of giant coronary artery aneurysms. Because of his poor response to the first course of IVIG and prednisolone, we administered infliximab. His clinical condition improved after that, and his temperature dropped. Inflammatory markers however did not recover completely, and he remained subfebrile. In addition, as the coronary artery dimensions deteriorated, a second IVIG course was administered and prednisolone continued at the initial dosage. Although fever and routine inflammatory parameters normalized, close follow-up investigations revealed both still increasing coronary artery dimensions and renewed rise in inflammatory parameters, necessitating two more infliximab administrations in addition to continuous prednisolone. Because of the coronary artery dimensions (left anterior descending artery, 4.9 mm, Z-score 11.1; right coronary artery 5.8 mm, Z-score 15.5), dual platelet inhibitory therapy with ASA and later clopidogrel combined with low-molecular heparin was indicated. Four weeks after his initial KD diagnosis, we detected no renewed increase in inflammatory markers; at that time, we observed a slight reduction in coronary dimensions. In summary, despite timely guideline-fulfilling therapy, the prolonged clinical course of this very young infant with KD entailing the development of giant coronary artery aneurysms makes us question whether this age group may benefit from early, even more intense therapy.
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Affiliation(s)
- Robert Lersch
- Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig-Maximillian-University Munich, Munich, Germany
| | - Guido Mandilaras
- Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig-Maximillian-University Munich, Munich, Germany
| | - Meike Schrader
- Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig-Maximillian-University Munich, Munich, Germany
| | | | - Nikolaus A. Haas
- Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig-Maximillian-University Munich, Munich, Germany
| | - André Jakob
- Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig-Maximillian-University Munich, Munich, Germany
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Zeiger E, Jakob A, Dalla Pozza R, Fischer M, Tengler A, Ulrich SM, Arnold L, Weismann CG, Schulze-Neick I, Haas NA, Pattathu J. Evaluation of the diagnostic and prognostic potential of optical coherence tomography (OCT) of the pulmonary arteries during standardised right heart catheterisation in patients with pulmonary hypertension: a cross-sectional single-centre experience. Cardiovasc Diagn Ther 2023; 13:453-464. [PMID: 37405017 PMCID: PMC10315434 DOI: 10.21037/cdt-22-421] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/03/2023] [Indexed: 07/06/2023]
Abstract
Background Pulmonary hypertension (PH) is diagnosed based on an invasive evaluation of the mean pulmonary artery (PA) pressure. The morphological assessment of the pulmonary arteries was only recently not feasible. With the advent of optical coherence tomography (OCT)-imaging, an accessible tool allows to study PA morphology longitudinally. The primary hypothesis was that OCT distincts the PA structure of PH patients from control subjects. The secondary hypothesis was that PA wall thickness (WT) correlates with the progression of PH. Methods This is a retrospective monocentric study of 28 paediatric patients with (PH group) and without PH (control group) who had undergone cardiac catheterisation including OCT imaging of the PA branches. OCT parameters analysed were WT and the quotient of WT and diameter (WT/DM) and those were compared between the PH group and the control group. In addition, the OCT parameters were aligned with the haemodynamic parameters to evaluate the potential of OCT as a risk factor for patients with PH. Results WT and WT/DM in the PH group were significantly higher compared to the control group {WT: 0.150 [0.230, range (R): 0.100-0.330] vs. 0.100 [0.050, R: 0.080-0.130] mm, P<0.001; WT/DM: 0.06 [0.05] vs. 0.03 [0.01], P=0.006}. There were highly significant correlations between WT and WT/DM with the haemodynamic parameters mean pulmonary arterial pressure (mPAP) [Spearman correlation coefficient (rs) =0.702, P<0.001; rs=0.621, P<0.001], systolic pulmonary arterial pressure (sPAP) (rs=0.668, P<0.001; rs=0.658, P<0.001) and WT and pulmonary vascular resistance (PVR) (rs=0.590, P=0.02). Also, there was a significant correlation between WT and WT/DM and the risk factors quotient of mPAP and mean systemic arterial pressure (mSAP) (mPAP/mSAP) (rs=0.686, P<0.001; rs=0.644, P<0.001) and pulmonary vascular resistance index (PVRI) (rs=0.758, P=0.002; rs=0.594, P=0.02). Conclusions OCT can detect significant differences in WT of the PA in patients with PH. Furthermore, the OCT parameters correlate significantly with haemodynamic parameters and risk factors for patients with PH. More investigations are required to evaluate to what extent the impact of OCT can contribute to the clinical care of children with PH.
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Affiliation(s)
- Emilie Zeiger
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - André Jakob
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Robert Dalla Pozza
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Fischer
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Anja Tengler
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Sarah M. Ulrich
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Leonie Arnold
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Constance G. Weismann
- Department of Clinical Sciences, Pediatric Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ingram Schulze-Neick
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Nikolaus A. Haas
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Joseph Pattathu
- Department of Paediatric Cardiology and Paediatric Intensive Care, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Walser M, Schlichtiger J, Dalla-Pozza R, Mandilaras G, Tengler A, Ulrich S, Oberhoffer FS, Oberhoffer-Fritz R, Böhm B, Haas NA, Jakob A. Oscillometric pulse wave velocity estimated via the Mobil-O-Graph shows excellent accuracy in children, adolescents and young adults: an invasive validation study. J Hypertens 2023; 41:597-607. [PMID: 36723480 DOI: 10.1097/hjh.0000000000003374] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS Increased arterial stiffness, measured as arterial pulse wave velocity (PWV) is associated with an elevated cardiovascular risk. Although noninvasive PWV measurement methods have been validated by invasive measurement, there is little such data on pediatric patients. The purpose of this study was to 'fill the gap' by validating PWV obtained by Mobil-O-Graph in children, adolescents in comparison to young adults. METHODS Sixty patients (25 male, mean age 16.6 years; range 3-35 years) were included in this study. Fifty-one patients underwent cardiac catheterization after a heart transplantation (HTX) and nine for interventional atrial septal defect-closure. Specific invasive pulse wave velocities were assessed for the ascending aorta (aPWV) and entire central aorta (cPWV). These invasive PWV results were compared to simultaneously measured brachial cuff readings using Mobil-O-Graph (oPWV) stratified by age in two groups (PEDIATRICS <18 years|ADULTS ≥18 years). RESULTS Correlation analysis showed a positive linear relation between both invasive PWV measurements and the oPWV in all ages (cPWV/oPWV: r = 0.417, aPWV/oPWV: r = 0.628; P < 0.001). The oPWV data agreed better with the aPWV in mean-value comparisons and correlations with mean difference in PEDIATRICS was 0.41 ± 0.41 m/s (95% confidence interval 0.27-0.55). We also found the cPWV to be faster than the aPWV particularly in adults. In addition, cPWV correlated closer with age ( r = 0.393, P < 0.05). CONCLUSION Estimated oPWV using the Mobil-O-Graph demonstrated excellent accuracy in adults and pediatric patients. Therefore, the Mobil-O-Graph can be implemented as an ambulatory PWV measuring tool for pediatric cardiovascular risk stratification. CLINICAL TRIAL REGISTRATION German clinical trial registration, DRKS00015066.
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Affiliation(s)
- Matthias Walser
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - Jenny Schlichtiger
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - Robert Dalla-Pozza
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - Guido Mandilaras
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - Anja Tengler
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - Sarah Ulrich
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - Felix Sebastian Oberhoffer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - Renate Oberhoffer-Fritz
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Birgit Böhm
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
| | - André Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich
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Tabib A, Mortezaeian H, Mahdavi M, Khalili Y, Haas NA, Mohammadhoseini S. Long-term outcome of interventional approaches for treatment of coronary artery fistulas: a retrospective cohort study in a great referral center. Egypt Heart J 2023; 75:22. [PMID: 36971984 PMCID: PMC10043114 DOI: 10.1186/s43044-023-00339-4] [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: 07/01/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Despite the spontaneous regression of many cases of coronary artery fistulas (CAFs), symptomatic patients or cases with severe shunting may require therapeutic interventions. In the present study, we aimed to assess the outcome of treatment of CAFs using interventional approaches. METHODS This retrospective cohort study was performed on 29 patients with CAFs that were referred to our tertiary center between 2009 and 2019. Baseline characteristics were collected by reviewing the hospital files, and the patients were followed up to assess long-term outcomes with a mean follow-up of 3.3 years. RESULTS Overall, in 29 patients in our cohort study, 82.9% suffered from isolated CAFs and in the remaining cases, concurrent congenital abnormalities did exist. For treatment, coils (Cook, Pfm, Ev3) were used in 79.3%, ADO II(AGA) in 18.3%, vascular plug (AGA) in 3.4%, and a combination of coil/ vascular plug/amplatzer in 3.4%. Postoperative complications were reported in 4 patients as external iliac artery thrombosis, transient PSVT, ST-T wave changes and mild pericardial effusion that were all managed successfully with no adverse sequels. No coronary artery injury, device dislocation, dissection, ischemia or coronary dilatation occurred, and there was no death. As larger fistulas were treated by a retrograde approach through the right side of the heart, there was significant correlation between residual shunts and the mode of closure approach; the majority of the residual shunts occurred in patients in the retrograde approach group. CONCLUSIONS Trans-catheter approach for treating CAFs leads to appropriate long-term outcome with minimal potential side effects.
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Affiliation(s)
- Avisa Tabib
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hojjat Mortezaeian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yasaman Khalili
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care University Hospital Munich LMU, Ludwing Maximilians University Marchioninstr, Munich, Germany
| | - Sepideh Mohammadhoseini
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Mandilaras G, Happel CM, Funk CM, Haas NA, Freund M, Fischer M. Transient Recurrent Laryngeal Nerve Palsy after Interventional Therapy. Thorac Cardiovasc Surg 2023; 71:e1-e7. [PMID: 36549306 DOI: 10.1055/a-2003-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hoarseness due to laryngeal nerve injury is a known complication after cardiothoracic surgery involving the aortic arch. However, this complication is only rarely reported after catheter interventions. RESULTS In this article we present the unusual case of a left-sided vocal cord paralysis in four patients after primary stenting of a re-coarctation, re-dilatation of a stented coarctation, a primary stenting of the left pulmonary artery (LPA), and prestenting for percutaneous pulmonary valve implantation with dilation of the LPA. After implanting bare metal stents, it is common practice, whilst contemplating the diameters of the adjacent structures, to optimize the stent diameter in a two-step procedure and dilate the stent until a maximum diameter is achieved and there is no residual gradient after applying this technique. Four of our patients experienced hoarseness after the intervention and a vocal cord paralysis was diagnosed. Angiography revealed no signs of extravasation or dissection. Clinical symptoms improved over the course of the following 6 months; patients with interventions at the aortic arch showed a complete remission, patients with procedures involving the LPA showed only mild regression of the symptoms. CONCLUSION To our knowledge, this complication (Ortner's syndrome, cardiovocal syndrome) after such interventions has rarely been reported before. Although a rare complication, the recognition of these symptoms may support colleagues in managing affected patients. In addition, awareness for hoarseness after interventional therapies and systematic screening for this complication might help to identify patients at risk in the future.
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Affiliation(s)
- Guido Mandilaras
- Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany
| | - Christoph M Happel
- Department of Pediatric Cardiology and Pediatric Intensive Care, MHH, Hannover, Niedersachsen, Germany
| | - Christoph M Funk
- Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany
| | - Nikolaus A Haas
- Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany
| | - Matthias Freund
- Department for Neonatology, Pediatric Intensive Care, Pediatric Cardiology, Pediatric Pneumology and Allergology, Oldenburg Hospital, Oldenburg, Niedersachsen, Germany
| | - Marcus Fischer
- Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich, LMU, Munich, Germany
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Haas NA, Jakob A, Pattathu J. 7/w mit Blässe, Unwohlsein, Palpitationen und Müdigkeit. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Michel SG, Menon AK, Haas NA, Hörer J. Cavopulmonary support with a modified cannulation technique in a failing Fontan patient. Interact Cardiovasc Thorac Surg 2022; 35:6565356. [PMID: 35394531 PMCID: PMC9297500 DOI: 10.1093/icvts/ivac090] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Failing Fontan patients present a unique challenge for mechanical circulatory support. We report on a 17-year-old patient with Fontan failure and preserved ventricular function who underwent mechanical cavopulmonary support using a novel cannulation technique.
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Affiliation(s)
- Sebastian G Michel
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich , Munich, Germany
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich , Munich, Germany
| | | | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University Munich , Germany
| | - Jürgen Hörer
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich , Munich, Germany
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich , Munich, Germany
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Haas NA, Jakob A, Pattathu J. 11/m mit Leistungsschwäche und Synkope. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gomes D, Le L, Perschbacher S, Haas NA, Netz H, Hasbargen U, Delius M, Lange K, Nennstiel U, Roscher AA, Mansmann U, Ensenauer R. Predicting the earliest deviation in weight gain in the course towards manifest overweight in offspring exposed to obesity in pregnancy: a longitudinal cohort study. BMC Med 2022; 20:156. [PMID: 35418073 PMCID: PMC9008920 DOI: 10.1186/s12916-022-02318-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/22/2021] [Accepted: 02/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Obesity in pregnancy and related early-life factors place the offspring at the highest risk of being overweight. Despite convincing evidence on these associations, there is an unmet public health need to identify "high-risk" offspring by predicting very early deviations in weight gain patterns as a subclinical stage towards overweight. However, data and methods for individual risk prediction are lacking. We aimed to identify those infants exposed to obesity in pregnancy at ages 3 months, 1 year, and 2 years who likely will follow a higher-than-normal body mass index (BMI) growth trajectory towards manifest overweight by developing an early-risk quantification system. METHODS This study uses data from the prospective mother-child cohort study Programming of Enhanced Adiposity Risk in CHildhood-Early Screening (PEACHES) comprising 1671 mothers with pre-conception obesity and without (controls) and their offspring. Exposures were pre- and postnatal risks documented in patient-held maternal and child health records. The main outcome was a "higher-than-normal BMI growth pattern" preceding overweight, defined as BMI z-score >1 SD (i.e., World Health Organization [WHO] cut-off "at risk of overweight") at least twice during consecutive offspring growth periods between age 6 months and 5 years. The independent cohort PErinatal Prevention of Obesity (PEPO) comprising 11,730 mother-child pairs recruited close to school entry (around age 6 years) was available for data validation. Cluster analysis and sequential prediction modelling were performed. RESULTS Data of 1557 PEACHES mother-child pairs and the validation cohort were analyzed comprising more than 50,000 offspring BMI measurements. More than 1-in-5 offspring exposed to obesity in pregnancy belonged to an upper BMI z-score cluster as a distinct pattern of BMI development (above the cut-off of 1 SD) from the first months of life onwards resulting in preschool overweight/obesity (age 5 years: odds ratio [OR] 16.13; 95% confidence interval [CI] 9.98-26.05). Contributing early-life factors including excessive weight gain (OR 2.08; 95% CI 1.25-3.45) and smoking (OR 1.94; 95% CI 1.27-2.95) in pregnancy were instrumental in predicting a "higher-than-normal BMI growth pattern" at age 3 months and re-evaluating the risk at ages 1 year and 2 years (area under the receiver operating characteristic [AUROC] 0.69-0.79, sensitivity 70.7-76.0%, specificity 64.7-78.1%). External validation of prediction models demonstrated adequate predictive performances. CONCLUSIONS We devised a novel sequential strategy of individual prediction and re-evaluation of a higher-than-normal weight gain in "high-risk" infants well before developing overweight to guide decision-making. The strategy holds promise to elaborate interventions in an early preventive manner for integration in systems of well-child care.
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Affiliation(s)
- Delphina Gomes
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sarah Perschbacher
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nikolaus A Haas
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Heinrich Netz
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Uwe Hasbargen
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kristin Lange
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Uta Nennstiel
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Adelbert A Roscher
- Department of Pediatrics, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Regina Ensenauer
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany. .,Institute of Child Nutrition, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany.
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19
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Brunner BS, Thierij A, Jakob A, Tengler A, Grab M, Thierfelder N, Leuner CJ, Haas NA, Hopfner C. 3D-printed heart models for hands-on training in pediatric cardiology - the future of modern learning and teaching? GMS J Med Educ 2022; 39:Doc23. [PMID: 35692357 PMCID: PMC9174069 DOI: 10.3205/zma001544] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/05/2021] [Accepted: 01/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This project aims to develop a new concept in training pediatric cardiologists to meet the requirements of interventional cardiac catheterizations today in terms of complexity and importance. This newly developed hands-on training program is supposed to enable the acquisition of certain skills which are necessary when investigating and treating patients in a catheter laboratory. METHODS Based on anonymous CT-scans of pediatric patients' digital 3D heart models with or without cardiac defects were developed and printed three-dimensionally in a flexible material visible under X-ray. Hands-on training courses were offered using models of a healthy heart and the most common congenital heart defects (CHD). An evaluation was performed by quantifying fluoroscopy times (FL-time) and a questionnaire. RESULTS The acceptance of theoretical and practical contents within the hands-on training was very positive. It was demonstrated that it is possible to master various steps of a diagnostic procedure and an intervention as well as to practice and repeat them independently which significantly reduced FL-time. The participants stated that the hands-on training led to more confidence in interventions on real patients. CONCLUSION With the development of a training module using 3D-printed heart models, basic and advanced training in the field of diagnostic cardiac examinations as well as interventional therapies of CHD is possible. The learning effect for both, practical skills and theoretical understanding, was significant which underlines the importance of integrating such hands-on trainings on 3D heart models in education and practical training.
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Affiliation(s)
- Barbara S. Brunner
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Alisa Thierij
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Andre Jakob
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Anja Tengler
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Maximilian Grab
- LMU Klinikum, Clinic and Polyclinic for Cardiac Surgery, Munich, Germany
| | | | | | - Nikolaus A. Haas
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Carina Hopfner
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
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20
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Rosenthal LL, Ulrich SM, Zimmerling L, Brenner P, Müller C, Michel S, Hörer J, Netz H, Haas NA, Hagl C. Pediatric heart transplantation in infants and small children under 3 years of age: Single center experience - "Early and long-term results". Int J Cardiol 2022; 356:45-50. [PMID: 35395286 DOI: 10.1016/j.ijcard.2022.04.002] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation. PATIENTS AND METHODS 46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time. RESULTS Median (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm2) were 13.2 (5.7-19.5), 0.9 (0.2-2.0), 6.8 (4.3-10.0) and 14.2 (12.3-15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years - in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality. CONCLUSION Pediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival.
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Affiliation(s)
- L Lily Rosenthal
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Sarah Marie Ulrich
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Linda Zimmerling
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany
| | - Paolo Brenner
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Christoph Müller
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Sebastian Michel
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Jürgen Hörer
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Heinrich Netz
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Nikolaus A Haas
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Christian Hagl
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Munich Heart Alliance (MHA) - DZHK, Ludwig Maximilians University Munich, Department for Epidemiology and Prevention of Cardiovascular Diseases, Pettenkoferstr. 8a & 9, D- 80336 Munich, Germany.
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21
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Orban M, Dietl M, Dischl D, von Samson-Himmelstjerna P, Neubarth-Mayer J, Strüven A, Tengler A, Jakob A, Fischer M, Rizas K, Petzold T, Orban M, Braun D, Hausleiter J, Hagl C, Haas NA, Mehilli J, Pozza RD, Massberg S, Ulrich S. Assessment of sex- and age-dependency of risk factors for intimal hyperplasia in heart transplant patients using the high resolution of optical coherence tomography. Int J Cardiol 2022; 358:17-24. [DOI: 10.1016/j.ijcard.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/26/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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22
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Marwali EM, Lopolisa A, Sani AA, Rayhan M, Roebiono PS, Fakhri D, Haas NA, Slee A, Portman MA. Indonesian Study: Triiodothyronine for Infants Less than 5 Months Undergoing Cardiopulmonary Bypass. Pediatr Cardiol 2022; 43:726-734. [PMID: 34851445 DOI: 10.1007/s00246-021-02779-8] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
This study evaluates the efficacy and safety of oral triiodothyronine on time to extubation for infants less than 5 months undergoing heart surgery in Indonesia, and primarily relates to patients in emerging programs with high malnutrition and mortality. In this randomized, double-blind, placebo-controlled trial, oral triiodothyronine (T3, Tetronine®) 1 μg/kg-body weight/dose or placebo (saccharum lactis) was administered via nasogastric tube every 6 h for 60 h to treatment group. A total of 120 patients were randomized into T3 (61 patients) and placebo (59 patients) groups. The majority of the patients had moderate to severe malnutrition (55.83%) with a high post-operative mortality rate of 23.3%. The T3 group showed significantly higher serum FT3 levels from 1 until 48 h post cross-clamp removal (p < 0.0001), lower incidence of low cardiac output syndrome at both 6 h (28 [45.9%] vs. 39 [66.1%] patients, p = 0.03, OR 2.3, 95% CI: 1.10-4.81) and 12 h after cross-clamp removal (25 [41.7%] vs. 36 [63.2%], p = 0.02, OR 2.40, 95% CI: 1.14-5.05). Although not statistically significant, the treatment group had shorter median (IQR) intubation time (2.59 [1.25-5.24] vs. 3.77 [1.28-6.64] days, p = 0.16, HR 1.36, 95% CI: 0.88-2.09)] and lower mortality (10 [16.4%] vs. 18 [30.5%], p = 0.07]. Patients with Aristotle score < 10.0 (low risk) receiving T3 had faster extubation than placebo patients (p = 0.021, HR of 1.90, 95% CI: 1.10-3.28) and were significantly less likely to require CPR or experience infection (p = 0.027, OR 8.56, 95% CI:0.99-73.9 and p = 0.022, OR 4.09 95% CI: 1.16-14.4, respectively). Oral T3 supplementation reduced overall incidence of low cardiac output syndrome and significantly reduced the time to extubation in low-risk patients. Therefore, prophylactic oral T3 administration may be beneficial in these patients.Trial Registration: ClinicalTrials.gov NCT02222532.
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Affiliation(s)
- Eva Miranda Marwali
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. .,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. .,National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman, Kav 87, Slipi, West Jakarta, 11420, Indonesia.
| | - Albert Lopolisa
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Alvin A Sani
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Muhammad Rayhan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Poppy S Roebiono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Pediatric Cardiology Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dicky Fakhri
- Pediatric Cardiac Surgery Unit, National Cardiovascular Center Harapan Kita, Department of Cardiothoracic Vascular Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Medical Hospital of the University of Munich, Munich, Germany
| | - April Slee
- Axio Research, Seattle Children's Hospital and Research Institute, Seattle, USA
| | - Michael A Portman
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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23
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Jakob A, Bohlig S, König M, Nussbaum C, Dalla-Pozza R, Hermann M, Haas NA, Pastor-Villaescusa B. Kawasaki disease and increased cardiovascular risk: Is there a link to circulating glycocalyx biomarkers? Microvasc Res 2022; 140:104269. [PMID: 34699846 DOI: 10.1016/j.mvr.2021.104269] [Citation(s) in RCA: 2] [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: 06/15/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
AIMS Kawasaki disease (KD) is an acute systemic vasculitis with possible long-term impact of general cardio-vascular health. An endothelial glycocalyx disorder during the disease's acute phase might predispose to long-term vascular anomalies leading to endothelial dysfunction and atherosclerosis. To investigate any association between increased cardiovascular risk and endothelial glycocalyx, we assessed circulating glycocalyx components in patients with a KD history, and analysed their association with acute-phase clinical features and more importantly, with patients' current cardiovascular risk factors. METHODS This prospective observational cohort study included 51 subjects: 31 patients with a history of KD, and 20 healthy subjects matched for age and sex. We analysed serum syndecan-1 and hyaluronan via ELISA. We assessed features reported during the acute phase of KD such as blood counts, C-reactive protein (CRP) levels and coronary artery aneurysms (CAA), and their current blood pressure and lipid markers in relation to measured glycocalyx components. RESULTS Our multivariate analysis revealed that hyaluronan and syndecan-1 levels were not associated with KD. However, the latter exhibited a significant association with acute-phase blood count alterations in patients with KD. Furthermore, significant interactions of hyaluronan and syndecan-1 with certain cardiovascular risk factors like blood lipids and blood pressure were only present in KD patients. CONCLUSION Vasculitis during KD's acute phase might predispose to a long-term endothelial glycocalyx alteration, influenced by other factors having a vascular impact such as blood pressure and circulating lipids. CLINICAL TRIAL REGISTRATION German Clinical Trials Register on 25th February 2016, DRKS00010071 https://www.drks.de/drks_web/.
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Affiliation(s)
- André Jakob
- Ludwig-Maximilians-University of Munich, Department of Pediatric Cardiology, Marchioninistr. 15, 81377 Munich, Germany.
| | - Sarah Bohlig
- Ludwig-Maximilians-University of Munich, Department of Pediatric Cardiology, Marchioninistr. 15, 81377 Munich, Germany
| | - Miriam König
- Ludwig-Maximilians-University of Munich, Department of Pediatric Cardiology, Marchioninistr. 15, 81377 Munich, Germany
| | - Claudia Nussbaum
- Div. of Neonatology, Dr. von Hauner Children's Hospital, LMU Munich, 80337 Munich, Germany
| | - Robert Dalla-Pozza
- Div. of Neonatology, Dr. von Hauner Children's Hospital, LMU Munich, 80337 Munich, Germany
| | - Mathias Hermann
- Ludwig-Maximilians-University of Munich, Department of Pediatric Cardiology, Marchioninistr. 15, 81377 Munich, Germany
| | - Nikolaus A Haas
- Ludwig-Maximilians-University of Munich, Department of Pediatric Cardiology, Marchioninistr. 15, 81377 Munich, Germany
| | - Belén Pastor-Villaescusa
- Ludwig-Maximilians-University of Munich, Department of Pediatric Cardiology, Marchioninistr. 15, 81377 Munich, Germany
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24
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Stiller B, Zartner P, Dähnert I, Haas NA, Schubert S, Kanaan M, Berger F, Ewert P, Schmoor C, Grohmann J. Prospective multicenter study of the breakable babystent for treatment of aortic coarctation in newborns and infants. Catheter Cardiovasc Interv 2022; 99:1529-1537. [PMID: 35170186 DOI: 10.1002/ccd.30133] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/22/2022]
Abstract
To assess the efficacy and safety of a breakable BabyStent to treat complex aortic coarctation (CoA) in early childhood. Although recommended in several guidelines, there is no approved aortic stent for young infants, because of the dilemma between two mandatory requirements: expandable up to adult size on the one hand, and small enough to fit through a baby's femoral artery on the other. Prospective interventional, multi-center clinical trial with the breakable Osypka BabyStent® (OBS). The OBS is a low-profile, 15-mm long cobalt-chromium stent, pre-mounted on a 6 mm balloon and inserted via a 4 Fr sheath. After implantation, its diameter is adjustable from 6 to 12 mm by balloon dilation. Further dilation opens predefined joints enabling unrestricted growth. Nineteen patients (9 male), median age 112 days (range: 7-539), median body weight 5.6 kg (range: 2.4-8.4) were deemed high risk and underwent stent implantation. Of those, 74% suffered from re-CoA following surgery, 53% had additional cardiac and 21% noncardiac malformations. Our primary combined endpoint was fulfilled: All stents were implanted in the desired region, and a >50% intrastenotic diameter-extension was achieved in 15 patients (78.9%, 80% confidence interval [62.2; 90.5], 95% confidence interval [54.4; 93.9]). Secondary endpoint confirmed that the OBS fits the baby's femoral vessel diameter. All children survived the procedure and 12-month follow-up. This stent enables percutaneous stenting of complex aortic coarctation to treat high-risk newborns and infants.
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Affiliation(s)
- Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Zartner
- Department of Pediatric Cardiology, Kinderherzzentrum am Universitätsklinikum, Bonn, Germany
| | - Ingo Dähnert
- Department of Pediatric Cardiology, Heart Centre Leipzig, Helios Klinik GmbH, Leipzig, Germany
| | - Nikolaus A Haas
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Majed Kanaan
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.,Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Berlin, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre of the State of Bavaria and the Technical University, Munich, Germany.,German Center for Cardiovascular Research, Munich, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Grohmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Centre Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
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25
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Thomas C, Johler SM, Hermann M, Fischer M, Thorsteinsdottir J, Schichor C, Haas NA. Takotsubo cardiomyopathy in a 12-year-old boy caused by acute brainstem bleeding-a case report. Transl Pediatr 2021; 10:3110-3117. [PMID: 34976778 PMCID: PMC8649596 DOI: 10.21037/tp-21-181] [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: 04/21/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022] Open
Abstract
Takotsubo cardiomyopathy is characterized by acute and reversible severe left ventricular dysfunction due to intensive emotional or physical stress followed by catecholamine excess. Traditionally it is most common in postmenopausal women, whereas only few cases have been described in childhood. In our case a previously well 12-year-old boy presented with severe cardiogenic shock due to dramatically impaired left ventricular function requiring significant inotropic support and invasive mechanical ventilation. Interestingly, cardiac catheterization, myocardial tissue histology and biochemical laboratory tests did not yield a definitive diagnosis. As his cardiac function improved gradually within several days and deep sedation could be weaned, he was then found to suffer from hemiparesis and absence of protective airway reflexes on neurological examination during the weaning process. Subsequent brain imaging studies revealed a brainstem bleeding due to a fistulous arteriovenous malformation (AVM) appearing to be only a few days old. After endovascular coiling and subsequent microsurgical resection of the malformation, he recovered completely. Our present case demonstrated, that brainstem bleeding could precipitate Takotsubo cardiomyopathy manifesting hemodynamic collapse. Severe ventricular impairment has been described in many adults with subarachnoid hemorrhage; however, this condition is extremely rare among children. When severe cardiogenic shock is diagnosed, precipitating factors such as intracranial processes should be ruled out on a regular basis.
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Affiliation(s)
- Clara Thomas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Sarah M Johler
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Matthias Hermann
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Jun Thorsteinsdottir
- Department for Neurosurgery, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Christian Schichor
- Department for Neurosurgery, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
| | - Nikolaus A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, Munich, Germany
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26
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Schmithausen A, Tengler A, Birnbaum J, Haas NA, Rosenthal LL, Orban M, Hagl C, Dalla Pozza R, Jakob A, Fischer M, Ulrich SM. Quality of life and patient satisfaction with outpatient care after heart transplantation in adult and pediatric patients - room for improvement? Transpl Int 2021; 34:2578-2588. [PMID: 34709681 DOI: 10.1111/tri.14147] [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: 07/24/2021] [Revised: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
Reduced adherence after heart transplantation increases the risk for acute rejection. Therefore, the aim of this study was to evaluate the patient's satisfaction with outpatient care and quality of life (QOL) after pediatric and adult heart transplantation. Observational study after pediatric (n = 22) and adult (n = 65) heart transplantation and the parents of the pediatric patients (n = 22) to evaluate the patients' satisfaction with outpatient care and QOL. Established standardized questionnaires were used for patient satisfaction (ZAP survey) and QOL (SF36); the latter was compared with the cohort of the BGS98 survey (BGS98 cohort). ZAP score: excellent results with almost all values >80. QOL: pediatric cohort showed significantly higher values in physical functioning (P = 0.041) and role physical (P = 0.003) but significantly lower values in the sub-scale general health (P = 0.02) compared to adult cohort. In comparison with BGS98 cohort, children showed almost similar results, whereas adult cohort showed worse values in physical and emotional functioning, but higher values regarding general health. The QOL of patients after pediatric heart transplantation is comparable to a standardized reference population in Germany, whereas adult patients show reduced physical and emotional functioning, but better values regarding general health. The patients' satisfaction with the outpatient care is very high.
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Affiliation(s)
- Alexander Schmithausen
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anja Tengler
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julia Birnbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Laura L Rosenthal
- Department of Heart Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Madeleine Orban
- Department of Cardiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Hagl
- Department of Heart Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andre Jakob
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sarah M Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Becker J, Haas NA, Vlaho S, Heineking B, Wortmann SB, Rabenhorst D, Thomas C, Brunet T. Cytosolic Phosphoenolpyruvate Carboxykinase Deficiency: Cause of Hypoglycemia-Induced Seizure and Death. Neuropediatrics 2021; 52:398-402. [PMID: 33445193 DOI: 10.1055/s-0040-1722685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cytosolic phosphoenolpyruvate carboxykinase (PEPCK) deficiency (MIM 261680, EC 4.1.1.32, encoded by PCK1) is a rare disorder of gluconeogenesis presenting with recurrent hypoglycemia, hepatic dysfunction, and lactic acidosis. We report on a previously healthy 3-year-old boy who was initially admitted under the suspicion of a febrile seizure during an upper airway infection. Diagnostic workup revealed hypoglycemia as well as a cerebral edema and ruled out an infection. After a complicated course with difficult to treat symptomatic seizures, the child died on the 5th day of admission due to progressive cerebral edema. The metabolic screening showed elevated urinary lactate and Krebs cycle intermediates in line with a primary or secondary energy deficit. Due to the unclear and fatal course, trio exome sequencing was initiated postmortem ("molecular autopsy") and revealed the diagnosis of cytosolic PEPCK deficiency based on the compound heterozygosity of a known pathogenic (c.925G > A, p.(Gly309Arg)) and a previously unreported (c.724G > A, p.(Gly242Arg)) variant in PCK1 (NM_002591.3). Sanger sequencing ruled out the disease and carrier status in three older brothers. Molecular autopsy was performed due to the unclear and fatal course. The diagnosis of a cytosolic PEPCK deficiency not only helped the family to deal with the grief, but especially took away the fear that the siblings could be affected by an unknown disease in the same manner. In addition, this case increases the genetic and phenotypic spectrum of cytosolic PEPCK deficiency.
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Affiliation(s)
- Johanna Becker
- Department of Pediatric Cardiology and Intensive Care, Klinikum der Universität München, LMU, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Klinikum der Universität München, LMU, Munich, Germany
| | - Stefan Vlaho
- Department of Pediatrics, Altoetting-Burghausen, Altoetting, Germany
| | - Beatrice Heineking
- Department of Pediatric Cardiology and Intensive Care, Klinikum der Universität München, LMU, Munich, Germany
| | - Saskia B Wortmann
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria.,Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorothée Rabenhorst
- Department of Pediatric Cardiology and Intensive Care, Klinikum der Universität München, LMU, Munich, Germany
| | - Clara Thomas
- Department of Pediatric Cardiology and Intensive Care, Klinikum der Universität München, LMU, Munich, Germany
| | - Theresa Brunet
- Institute of Human Genetics, Technical University Munich, Munich, Germany
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28
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Hopfner C, Jakob A, Tengler A, Grab M, Thierfelder N, Brunner B, Thierij A, Haas NA. Design and 3D printing of variant pediatric heart models for training based on a single patient scan. 3D Print Med 2021; 7:25. [PMID: 34463879 PMCID: PMC8406574 DOI: 10.1186/s41205-021-00116-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background 3D printed models of pediatric hearts with congenital heart disease have been proven helpful in simulation training of diagnostic and interventional catheterization. However, anatomically accurate 3D printed models are traditionally based on real scans of clinical patients requiring specific imaging techniques, i.e., CT or MRI. In small children both imaging technologies are rare as minimization of radiation and sedation is key. 3D sonography does not (yet) allow adequate imaging of the entire heart for 3D printing. Therefore, an alternative solution to create variant 3D printed heart models for teaching and hands-on training has been established. Methods In this study different methods utilizing image processing and computer aided design software have been established to overcome this shortage and to allow unlimited variations of 3D heart models based on single patient scans. Patient-specific models based on a CT or MRI image stack were digitally modified to alter the original shape and structure of the heart. Thereby, 3D hearts showing various pathologies were created. Training models were adapted to training level and aims of hands-on workshops, particularly for interventional cardiology. Results By changing the shape and structure of the original anatomy, various training models were created of which four examples are presented in this paper: 1. Design of perimembranous and muscular ventricular septal defect on a heart model with patent ductus arteriosus, 2. Series of heart models with atrial septal defect showing the long-term hemodynamic effect of the congenital heart defect on the right atrial and ventricular wall, 3. Implementation of simplified heart valves and addition of the myocardium to a right heart model with pulmonary valve stenosis, 4. Integration of a constructed 3D model of the aortic valve into a pulsatile left heart model with coarctation of the aorta. All presented models have been successfully utilized and evaluated in teaching or hands-on training courses. Conclusions It has been demonstrated that non-patient-specific anatomical variants can be created by modifying existing patient-specific 3D heart models. This way, a range of pathologies can be modeled based on a single CT or MRI dataset. Benefits of designed 3D models for education and training purposes have been successfully applied in pediatric cardiology but can potentially be transferred to simulation training in other medical fields as well.
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Affiliation(s)
- Carina Hopfner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Andre Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Anja Tengler
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Grab
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Barbara Brunner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alisa Thierij
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
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29
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Vanhie E, VandeKerckhove K, Haas NA, De Wolf D. Atrial flow regulator for drug-resistant pulmonary hypertension in a young child. Catheter Cardiovasc Interv 2021; 97:E830-E834. [PMID: 33650782 DOI: 10.1002/ccd.29590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/12/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022]
Abstract
This case describes the successful implantation of an Occlutech Atrial Flow Regulator in a young child with idiopathic pulmonary hypertension and recurrent syncope despite targeted combination therapy, with subsequent relief of symptoms.
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Affiliation(s)
- Ellen Vanhie
- Department of Pediatrics, Pediatric Cardiology, Amsterdam University Hospital, Amsterdam, The Netherlands
| | - Kristof VandeKerckhove
- Department of Pediatrics, Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Nikolaus A Haas
- Department of Pediatrics, Pediatric Cardiology, LMU Klinikum, München, Germany
| | - Daniel De Wolf
- Department of Pediatrics, Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Pediatric Cardiology, Brussel University Hospital, Brussels, Belgium
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30
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Affiliation(s)
- Eric M Horlick
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto Ontario.
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, Munich, Germany
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31
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Grab M, Hopfner C, Gesenhues A, König F, Haas NA, Hagl C, Curta A, Thierfelder N. Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training. J Vis Exp 2021. [PMID: 33522517 DOI: 10.3791/62063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training physicians' wire-skills as well as improving planning of interventional procedures. The aim of this study was to develop a manufacturing process of patient-specific 3D-printed models for cardiovascular interventions. To create a 3D-printed elastic phantom, different 3D-printing materials were compared to porcine biological tissues (i.e., aortic tissue) in terms of mechanical characteristics. A fitting material was selected based on comparative tensile tests and specific material thicknesses were defined. Anonymized contrast-enhanced CT-datasets were collected retrospectively. Patient-specific volumetric models were extracted from these datasets and subsequently 3D-printed. A pulsatile flow loop was constructed to simulate the intraluminal blood flow during interventions. Models' suitability for clinical imaging was assessed by x-ray imaging, CT, 4D-MRI and (Doppler) ultrasonography. Contrast medium was used to enhance visibility in x-ray-based imaging. Different catheterization techniques were applied to evaluate the 3D-printed phantoms in physicians' training as well as for pre-interventional therapy planning. Printed models showed a high printing resolution (~30 µm) and mechanical properties of the chosen material were comparable to physiological biomechanics. Physical and digital models showed high anatomical accuracy when compared to the underlying radiological dataset. Printed models were suitable for ultrasonic imaging as well as standard x-rays. Doppler ultrasonography and 4D-MRI displayed flow patterns and landmark characteristics (i.e., turbulence, wall shear stress) matching native data. In a catheter-based laboratory setting, patient-specific phantoms were easy to catheterize. Therapy planning and training of interventional procedures on challenging anatomies (e.g., congenital heart disease (CHD)) was possible. Flexible patient-specific cardiovascular phantoms were 3D-printed, and the application of common clinical imaging techniques was possible. This new process is ideal as a training tool for catheter-based (electrophysiological) interventions and can be used in patient-specific therapy planning.
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Affiliation(s)
- Maximilian Grab
- Department of Cardiac Surgery, Ludwig Maximilian University Munich; Chair of Medical Materials and Implants, Technical University of Munich;
| | - Carina Hopfner
- Department Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University Munich
| | - Alena Gesenhues
- Department of Radiology, Ludwig Maximilian University Munich
| | - Fabian König
- Department of Cardiac Surgery, Ludwig Maximilian University Munich; Chair of Medical Materials and Implants, Technical University of Munich
| | - Nikolaus A Haas
- Department Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University Munich
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University Munich
| | - Adrian Curta
- Department of Radiology, Ludwig Maximilian University Munich
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32
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Grimm K, Lehner A, Fernandez Rodriguez S, Orban M, Fischer M, Rosenthal LL, Jakob A, Haas NA, Dalla Pozza R, Kozlik-Feldmann R, Ulrich SM. Conversion to everolimus in pediatric heart transplant recipients is a safe treatment option with an impact on cardiac allograft vasculopathy and renal function. Clin Transplant 2020; 35:e14191. [PMID: 33315277 DOI: 10.1111/ctr.14191] [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: 09/22/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) and nephrotoxicity affect long-term survival after heart transplantation (HTX). Studies, mostly conducted in adults, showed a positive effect of everolimus (EVL) on these problems. We describe the effects of conversion of the immunosuppressive therapy to an everolimus including regime on CAV, renal function, and safety in heart transplanted children/adolescents. METHODS This retrospective single-center study included 36 participants (mean time after HTX 6.3 ± 4.7 years). Descriptive pre/post-comparisons were performed with an observation period partially up to 4 years. Impact on CAV was assessed based on intravascular imaging and Stanford grading. Safety analysis included cytomegalovirus (CMV)-infection and acute rejection. RESULTS In terms of CAV (9 out of 36 patients) four showed no progression, three an improvement, one a worsening; one new diagnosis. The average CrCl showed a significant improvement 6, 12, and 24 months after conversion regarding all patients (n = 29). There was no acute rejection or CMV-infection. CONCLUSION Conversion to an EVL-based therapy after pediatric HTX is a safe immunosuppressive regime without increasing risk of acute rejection or CMV-infection. There was some evidence of reduction in progression of CAV and a significant improvement of the renal function.
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Affiliation(s)
- Kathrin Grimm
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anja Lehner
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Silvia Fernandez Rodriguez
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Madeleine Orban
- Department of Cardiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Laura L Rosenthal
- Department of Pediatric Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andre Jakob
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Pediatric Cardiology, UKE Hamburg, Hamburg, Germany
| | - Sarah M Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Tengler A, Ulrich S, Fischer M, Pastor-Villaescusa B, Kanaan M, Pozza RD, Haas NA, Jakob A. Rationale and feasibility of transcatheter pulmonary valve implantation in small conduits with the Edwards Sapien valves. Int J Cardiol 2020; 325:45-50. [PMID: 33049296 DOI: 10.1016/j.ijcard.2020.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/15/2020] [Revised: 09/06/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conduit dilatation above 110% and TPVI in conduits <16 mm is not recommended. However, if we want to reach normal values for RVOT diameters and diminish reintervention rates, pushing these boundaries is essential. METHODS Analysis of subsequent patients who underwent TPVI with Edwards Sapien valves in conduits ≤16 mm between 2010 and 2020. RESULTS In n = 33 cases median age was 13 years (5-20 y) and median weight 47 kg (15-91 kg). Preexisting RVOT grafts were n = 28 Contegra® conduits and n = 5 homografts (12 mm n = 15; 14 mm n = 11; 16 mm n = 7). Implanted were the Sapien (n = 8), Sapien XT (n = 10) and Sapien 3 valve (n = 15) with 20 mm (n = 4), 23 mm (n = 19), 26 mm (n = 9) and 29 mm (n = 1). Mean minimal RVOT diameter after TPVI was 22,7 ± 2,3 mm (18-30 mm) which is 150% of the mean minimal RVOT diameter before TPVI (15,1 ± 4,3 mm). Covered stents were used in n = 10 cases. Contained conduit rupture occurred in n = 7 cases (21%). Residual RVOT gradients of 5,7 ± 4,9 mmHg (0-18 mmHg) showed adequate RV unloading. CONCLUSION TPVI could be performed successfully in all patients. Dilatation above 150% and a valve/conduit diameter ratio up to 2,4 were well tolerated. There was a considerable amount of conduit rupture but all were confined without further need for intervention or surgery.
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Affiliation(s)
- Anja Tengler
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany.
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - Belén Pastor-Villaescusa
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, LMU Ludwig Maximilians University Munich, 80337 Munich, Germany
| | - Majed Kanaan
- Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; Department for Congenital Heart Defects, University Hospital Aachen, 52074 Aachen, Germany
| | - Robert Dalla Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - Nikolaus A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - André Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
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34
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Langhammer F, Lehner A, Haas NA, Jakob A. Percutaneous pulmonary valve implantation in a dysfunctional Trifecta® bioprothesis after high-pressure balloon fracturing. Catheter Cardiovasc Interv 2020; 95:1310-1313. [PMID: 32073737 DOI: 10.1002/ccd.28781] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/11/2022]
Abstract
A percutaneous pulmonary valve-in-valve (PPVIV) implantation in small surgical tissue valves may be limited due to the valve's initial diameter. Fracturing of the valve's integrity by high-pressure balloons may enhance the diameter and facilitate subsequent PPVIV with a large valve. To the best of our knowledge, the Trifecta® valve seemed not to be accessible for fracturing. We report a case of successful 19-mm Trifecta valve fracturing, followed by PPVIV using a 26-mm Edwards SAPIEN 3 valve in pulmonary position. By repetitively using a high-pressure balloon 5 mm larger than the labeled valve size, we were able to fracture the valve's integrity and implant a 26-mm valve thereafter. Therefore, Trifecta valve appears to be suitable for valve ring fracturing and subsequent PPVIV in certain patients.
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Affiliation(s)
- Florian Langhammer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Anja Lehner
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - André Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
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35
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Haas NA, Schirmer KR. Handlungsempfehlungen nach der Leitlinie „Abklärung eines Herzgeräusches im Kindes- und Jugendalter“. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-019-0659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Maksymenko AV, Kuzmenko YL, Dovhaliuk AA, Motrechko OO, Herrmann FE, Haas NA, Lehner A. Percutaneous closure of patent ductus arteriosus with the Nit-Occlud ® patent ductus arteriosus device in 268 consecutive cases. Ann Pediatr Cardiol 2019; 12:206-211. [PMID: 31516276 PMCID: PMC6716305 DOI: 10.4103/apc.apc_151_18] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The pfm Nit-Occlud® patent ductus arteriosus (PDA) device is well established for interventional closure of PDA. However, there are still limited data concerning its efficacy and follow-up in larger patient groups. Aims This study aimed to evaluate the safety and efficacy of the Nit-Occlud® PDA device, implanted both through transpulmonary and transaortic approach, in a large cohort. Methods From July 2008 to December 2015, 268 consecutive patients were admitted for transcatheter closure of a PDA and were treated with the Nit-Occlud® coil. Clinical, echocardiographic, and angiographic data were evaluated. Results The median age was 5.2 years (range, 5 months to 62 years), and the median weight was 19.3 kg (range: 5.5-97 kg). Ten (3.7%) patients had weight <10 kg. The most common ductus types treated were Krichenko Type E and A (44.0% and 33.2%, respectively). Twelve (4.5%) patients were treated for residual shunting after surgical PDA closure. The median diameter at the narrowest point was 1.5 mm (range: 0.4-4 mm), the median size of the ampulla was 5 mm (range: 1-15 mm), and the median length was 9 mm (range: 2-25 mm). Device implantation could be successfully achieved in all cases. Closure rates documented immediately after the procedure, at 3-10 days, 1 month, and 6 months after intervention were 62%, 95.1%, 97.8%, and 98.5%, respectively. With the exception of one minor thromboembolic event, there were no procedure-related complications. Conclusion Closure of PDA with various anatomic variations and sizes can be performed effectively and safely using the Nit-Occlud® coil.
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Affiliation(s)
- Andrii V Maksymenko
- Department of Interventional Cardiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Yulia L Kuzmenko
- Department of Interventional Cardiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Arkadii A Dovhaliuk
- P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Oleksandra O Motrechko
- Department of Interventional Cardiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Florian E Herrmann
- Department of Cardiac Surgery, Ludwig Maximilians University, Klinikum der Universität München, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilians University, Klinikum der Universität München, Munich, Germany
| | - Anja Lehner
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilians University, Klinikum der Universität München, Munich, Germany
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Lehner A, Dashkalova T, Ulrich S, Fernandez Rodriguez S, Mandilaras G, Jakob A, Dalla-Pozza R, Fischer M, Schneider H, Tarusinov G, Kampmann C, Hofbeck M, Dähnert I, Kanaan M, Haas NA. Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve - German experience. Expert Rev Med Devices 2019; 16:829-834. [PMID: 31432698 DOI: 10.1080/17434440.2019.1653180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: After encouraging results with the Edwards Sapien and XT valves, this study aimed to review procedural data and early outcomes for the Sapien 3 valves for transcatheter pulmonary valve replacement (TPVR). Methods: We performed a multicenter, retrospective analysis of cases who underwent a Sapien 3 TPVR between 2015 and 2017 in 7 centers in Germany with a follow-up of up to 2 years. Results: 56 patients could be enrolled (weight 58,5 ± 25,0 kg; 53% Tetralogy of Fallot, 45% native RVOT). Most procedures were two-stage procedures (82,1%) with 100% prestenting. Valve sizes were 20 mm (n = 1), 23 mm (n = 15), 26 mm (n = 27), 29 mm (n = 13). Procedural success rate was 96.4%. Two patients underwent surgical valve implantation after balloon rupture during TPVR. Follow-up data were available up to 24-month post TPVR. The rate of patients with ? moderate and severe pulmonary regurgitation decreased to 0% after TPVR, peak systolic gradient decreased from 24,2 (SD±20,9) mmHg to 7,1 mmHg (SD±5,0). There were no endocarditis, severe tricuspid valve impairment or stent fractures. Conclusions: With the Edwards Sapien 3 valve, the patient pool for TPVR can be substantially extended. Continued data collection is necessary to verify long-term results.
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Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Tsvetina Dashkalova
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Silvia Fernandez Rodriguez
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Guido Mandilaras
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Andre Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Robert Dalla-Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Heike Schneider
- Department for Pediatric Cardiology and Intensive Care, Heart Center Goettingen, Georg-August-University Goettingen , Goettingen , Germany
| | - Gleb Tarusinov
- Department for Pediatric Cardiology, Heart Center Duisburg , Duisburg , Germany
| | - Christoph Kampmann
- Department for Pediatric Cardiology, University Medical Center Mainz , Mainz , Germany
| | - Michael Hofbeck
- Department for Pediatric Cardiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Ingo Dähnert
- Department for Pediatric Cardiology, Heart Center Leipzig , Leipzig , Germany
| | - Majed Kanaan
- Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum , Bad Oeynhausen , Germany
| | - Nikolaus A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
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Haas NA, Fernandez-Rodriguez S, Dalla Pozza R, Fischer M, Ulrich S, Jakob A, Lehner A. Microcatheter-assisted stenting of the tortuous vertical ductus arteriosus via femoral access in a duct-dependent pulmonary circulation. Int J Cardiol 2019; 285:103-107. [PMID: 30851992 DOI: 10.1016/j.ijcard.2019.01.062] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/24/2018] [Accepted: 01/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stenting of the patent ductus arteriosus (PDA) has been accepted as alternative option to surgical shunting to enable additional pulmonary blood flow or for palliation of patients with a truly duct-dependent pulmonary circulation. The procedure can be challenging given the variable and often tortuous anatomy of the PDA and various technical approaches are reported. OBJECTIVE To report an alternative technique to treat tortuous ducts with microcatheter assistance and by transfemoral approach. METHODS We applied this technique of PDA stenting in 5 consecutive patients (4/5 age < 1 week, weight 2,7-3,2 kg; 1/5 re-do PDA stenting at 6,5 month and 5,9 kg). A soft coronary guidewire was advanced by microcatheter assistance into the branch pulmonary arteries and thereafter replaced by an extrastiff guidewire to enable the placement of long coronary stents. RESULTS Successful PDA stenting with this stepwise approach and with femoral access only could be achieved in all patients (n = 5/5). A single stent was used in 2 patients (one with re-do stenting and previous stents). 3/5 patients had 2 stents implanted by telescopic technique. Stent sizes used were 4,5 × 15 mm (n = 2) and 4,5 × 18 mm (n = 6). No guide wire or stent dislodgement appeared through all procedures with microcatheter assistance. CONCLUSIONS This technique enables PDA stenting via transfemoral approach in complex and tortuous ducts and thereby offers an attractive addition to the interventional management of truly duct-dependent pulmonary circulation.
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Affiliation(s)
- N A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany.
| | - S Fernandez-Rodriguez
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - R Dalla Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - M Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - S Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - A Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - A Lehner
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
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Paluszek C, Brenner P, Pichlmaier M, Haas NA, Dalla-Pozza R, Hagl C, Hakami L. Risk Factors and Outcome of Post Fallot Repair Junctional Ectopic Tachycardia (JET). World J Pediatr Congenit Heart Surg 2019; 10:50-57. [PMID: 30799715 DOI: 10.1177/2150135118813124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Junctional ectopic tachycardia (JET) is a common arrhythmia causing hemodynamic impairment following corrective cardiac surgery such as tetralogy of Fallot (TOF) repair. METHODS We report our experience with postoperative JET following surgical repair of TOF. The retrospective study was done from 2003 to 2012 with a total of 105 patients who underwent TOF repair. These patients' clinical and electrocardiographic data (pre-, intra-, and postoperative) were monitored to identify risk factors for the occurrence of JET and to evaluate the outcome of the affected patients. RESULTS Incidence-Fourteen patients developed JET, with only four patients going directly from sinus rhythm to JET. In all others, either a transient atrioventricular (AV) block or a junctional rhythm preceded JET, mostly intraoperatively, showing a significant relation ( P = .010). Age-Patients with JET were of younger age ( P = .025) and had longer cardiopulmonary bypass ( P = .044) and aortic cross-clamping times ( P = .038). Increased cost and care-The occurrence of JET was associated with a longer stay in the intensive care unit (ICU) and a prolonged need for inotropic support and mechanical ventilation. Time to rate control correlated with length of ICU and hospital stay. MORTALITY All JET patients converted into sinus rhythm, one of them died shortly after cessation of JET and two patients subsequently developed a first-degree AV block. CONCLUSION The occurrence of JET remains an important complication during the initial postoperative period by increasing mechanical ventilation time, the need for inotropic support, and prolonging the length of ICU and hospital stay. Risk factors are younger age, longer aortic cross-clamping/bypass times, and intraoperative arrhythmias.
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Affiliation(s)
- Corinna Paluszek
- 1 Department of Pediatric and Congenital Heart Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Paolo Brenner
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Maximilian Pichlmaier
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Nikolaus A Haas
- 3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Robert Dalla-Pozza
- 3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Christian Hagl
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Lale Hakami
- 1 Department of Pediatric and Congenital Heart Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
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Hascoet S, Dalla Pozza R, Bentham J, Carere RG, Kanaan M, Ewert P, Biernacka EK, Kretschmar O, Deutsch C, Lecerf F, Lehner A, Kantzis M, Kurucova J, Thoenes M, Bramlage P, Haas NA. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. EUROINTERVENTION 2019; 14:1378-1385. [DOI: 10.4244/eij-d-18-01035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lehner A, Herrmann FE, Mehilli J, Haas NA. Edwards Sapien 3 transcatheter aortic valve implantation for management of severe aortic regurgitation in a teenage patient with corrected atrioventricular septal defect and progressive left ventricular dysfunction. Catheter Cardiovasc Interv 2018; 93:E244-E247. [DOI: 10.1002/ccd.27975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/02/2018] [Accepted: 10/19/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Anja Lehner
- Department of Pediatric Cardiology and Intensive CareMunich University Hospital, Ludwig Maximilians University Munich Germany
| | - Florian E. Herrmann
- Department of Cardiac SurgeryMunich University Hospital, Ludwig Maximilians University Munich Germany
| | - Julinda Mehilli
- DZHK (Center for Cardiovascular Research), Partner Site Munich Heart AllianceMunich University Hospital, Ludwig Maximilians University Munich Germany
- Department of CardiologyMunich University Hospital, Ludwig Maximilians University Munich Germany
| | - Nikolaus A. Haas
- Department of Pediatric Cardiology and Intensive CareMunich University Hospital, Ludwig Maximilians University Munich Germany
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Mueller GC, Michel-Behnke I, Knirsch W, Haas NA, Abdul-Khaliq H, Gitter R, Dittrich S, Dähnert I, Uhlemann F, Schubert S, Tarusinov G, Happel C, Bertram H, Sieverding L, Eicken A, Kozlik-Feldmann R, Weil J. Feasibility, safety and diagnostic impact of endomyocardial biopsies for the diagnosis of myocardial disease in children and adolescents. EUROINTERVENTION 2018; 14:1089-1095. [DOI: 10.4244/eij-d-18-00128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Haas NA, Bach S, Vcasna R, Laser KT, Sandica E, Blanz U, Jakob A, Dietl M, Fischer M, Kanaan M, Lehner A. The risk of bacterial endocarditis after percutaneous and surgical biological pulmonary valve implantation. Int J Cardiol 2018; 268:55-60. [DOI: 10.1016/j.ijcard.2018.04.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/30/2018] [Indexed: 02/04/2023]
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Gomes D, von Kries R, Delius M, Mansmann U, Nast M, Stubert M, Langhammer L, Haas NA, Netz H, Obermeier V, Kuhle S, Holdt LM, Teupser D, Hasbargen U, Roscher AA, Ensenauer R. Late-pregnancy dysglycemia in obese pregnancies after negative testing for gestational diabetes and risk of future childhood overweight: An interim analysis from a longitudinal mother-child cohort study. PLoS Med 2018; 15:e1002681. [PMID: 30372451 PMCID: PMC6205663 DOI: 10.1371/journal.pmed.1002681] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maternal pre-conception obesity is a strong risk factor for childhood overweight. However, prenatal mechanisms and their effects in susceptible gestational periods that contribute to this risk are not well understood. We aimed to assess the impact of late-pregnancy dysglycemia in obese pregnancies with negative testing for gestational diabetes mellitus (GDM) on long-term mother-child outcomes. METHODS AND FINDINGS The prospective cohort study Programming of Enhanced Adiposity Risk in Childhood-Early Screening (PEACHES) (n = 1,671) enrolled obese and normal weight mothers from August 2010 to December 2015 with trimester-specific data on glucose metabolism including GDM status at the end of the second trimester and maternal glycated hemoglobin (HbA1c) at delivery as a marker for late-pregnancy dysglycemia (HbA1c ≥ 5.7% [39 mmol/mol]). We assessed offspring short- and long-term outcomes up to 4 years, and maternal glucose metabolism 3.5 years postpartum. Multivariable linear and log-binomial regression with effects presented as mean increments (Δ) or relative risks (RRs) with 95% confidence intervals (CIs) were used to examine the association between late-pregnancy dysglycemia and outcomes. Linear mixed-effects models were used to study the longitudinal development of offspring body mass index (BMI) z-scores. The contribution of late-pregnancy dysglycemia to the association between maternal pre-conception obesity and offspring BMI was estimated using mediation analysis. In all, 898 mother-child pairs were included in this unplanned interim analysis. Among obese mothers with negative testing for GDM (n = 448), those with late-pregnancy dysglycemia (n = 135, 30.1%) had higher proportions of excessive total gestational weight gain (GWG), excessive third-trimester GWG, and offspring with large-for-gestational-age birth weight than those without. Besides higher birth weight (Δ 192 g, 95% CI 100-284) and cord-blood C-peptide concentration (Δ 0.10 ng/ml, 95% CI 0.02-0.17), offspring of these women had greater weight gain during early childhood (Δ BMI z-score per year 0.18, 95% CI 0.06-0.30, n = 262) and higher BMI z-score at 4 years (Δ 0.58, 95% CI 0.18-0.99, n = 43) than offspring of the obese, GDM-negative mothers with normal HbA1c values at delivery. Late-pregnancy dysglycemia in GDM-negative mothers accounted for about one-quarter of the association of maternal obesity with offspring BMI at age 4 years (n = 151). In contrast, childhood BMI z-scores were not affected by a diagnosis of GDM in obese pregnancies (GDM-positive: 0.58, 95% CI 0.36-0.79, versus GDM-negative: 0.62, 95% CI 0.44-0.79). One mechanism triggering late-pregnancy dysglycemia in obese, GDM-negative mothers was related to excessive third-trimester weight gain (RR 1.72, 95% CI 1.12-2.65). Furthermore, in the maternal population, we found a 4-fold (RR 4.01, 95% CI 1.97-8.17) increased risk of future prediabetes or diabetes if obese, GDM-negative women had a high versus normal HbA1c at delivery (absolute risk: 43.2% versus 10.5%). There is a potential for misclassification bias as the predominantly used GDM test procedure changed over the enrollment period. Further studies are required to validate the findings and elucidate the possible third-trimester factors contributing to future mother-child health status. CONCLUSIONS Findings from this interim analysis suggest that offspring of obese mothers treated because of a diagnosis of GDM appeared to have a better BMI outcome in childhood than those of obese mothers who-following negative GDM testing-remained untreated in the last trimester and developed dysglycemia. Late-pregnancy dysglycemia related to uncontrolled weight gain may contribute to the development of child overweight and maternal diabetes. Our data suggest that negative GDM testing in obese pregnancies is not an "all-clear signal" and should not lead to reduced attention and risk awareness of physicians and obese women. Effective strategies are needed to maintain third-trimester glycemic and weight gain control among otherwise healthy obese pregnant women.
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Affiliation(s)
- Delphina Gomes
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Division of Experimental Pediatrics and Metabolism, University Children's Hospital, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Social Paediatrics and Adolescent Medicine, Division of Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rüdiger von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Division of Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martha Nast
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martina Stubert
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lena Langhammer
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nikolaus A. Haas
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Heinrich Netz
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Viola Obermeier
- Institute of Social Paediatrics and Adolescent Medicine, Division of Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefan Kuhle
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Division of Experimental Pediatrics and Metabolism, University Children's Hospital, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lesca M. Holdt
- Institute of Laboratory Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Uwe Hasbargen
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Adelbert A. Roscher
- Department of Pediatrics, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Regina Ensenauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Division of Experimental Pediatrics and Metabolism, University Children's Hospital, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Social Paediatrics and Adolescent Medicine, Division of Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Division of Pediatric Cardiology and Intensive Care, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- * E-mail:
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Hascoet S, Pozza RD, Bentham J, Petit J, Tahhan N, Carere RG, Kantzis M, Ewert P, Biernacka EK, Kretschmar O, Deutsch C, Thoenes M, Bramlage P, Haas NA. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lehner A, Kantzis M, Haas NA. Edwards Sapien XT® pulmonic valve compression after resuscitation and successful redilatation. Catheter Cardiovasc Interv 2018; 92:522-525. [DOI: 10.1002/ccd.27644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/25/2018] [Accepted: 04/02/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Pediatric Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Marinos Kantzis
- Department for Pediatric Cardiology; Center for Congenital Heart Defects Heart and Diabetes Center NRW, Ruhr University Bochum; Bad Oeynhausen Germany
| | - Nikolaus A. Haas
- Department for Pediatric Cardiology and Pediatric Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
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Haas NA, Carere RG, Kretschmar O, Horlick E, Rodés-Cabau J, de Wolf D, Gewillig M, Mullen M, Lehner A, Deutsch C, Bramlage P, Ewert P. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN XT transcatheter heart valve system. Int J Cardiol 2018; 250:86-91. [DOI: 10.1016/j.ijcard.2017.10.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/14/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022]
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Dalla Pozza R, Lehner A, Ulrich S, Näbauer M, Haas NA, Heineking B. Takotsubo Cardiomyopathy Complicating Percutaneous Pulmonary Valve Implantation in a Child. World J Pediatr Congenit Heart Surg 2017; 11:NP37-NP40. [DOI: 10.1177/2150135117697314] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Takotsubo cardiomyopathy describes a sudden onset cardiomyopathy with acute impairment of left ventricular function and spontaneous resolution over time. Only a few cases of Takotsubo cardiomyopathy in childhood have been described. We report the case of a 12-year-old girl with repaired tetralogy of Fallot who experienced acute onset of left ventricular dysfunction without coronary arterial involvement, suggesting Takotsubo cardiomyopathy, during an interventional catheterization procedure. Cardiogenic shock necessitated mechanical circulatory support with extracorporeal membrane oxygenator for ten days and mechanical ventilation for 12 days. The girl recovered without sequelae. Percutaneous pulmonary valve implantation was performed four months later without complications. Unusual aspects of this case include the use of mechanical circulatory support during the recovery phase of Takotsubo cardiomyopathy in a patient with congenital heart disease.
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Affiliation(s)
- Robert Dalla Pozza
- Department of Paediatric Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - Anja Lehner
- Department of Paediatric Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - Sarah Ulrich
- Department of Paediatric Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - Michael Näbauer
- Department of Paediatric Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - Nikolaus A. Haas
- Department of Paediatric Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - B. Heineking
- Department of Paediatric Cardiology, Ludwig-Maximilians University, Munich, Germany
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Haas NA, Kock L, Bertram H, Boekenkamp R, De Wolf D, Ditkivskyy I, Freund MW, Gewillig M, Happel CM, Herberg U, Karthasyan E, Kozlik-Feldmann R, Kretschmar O, Kuzmenko Y, Milanesi O, Mueller G, Pongiglione G, Schubert S, Tarusinov G, Kampmann C. Interventional VSD-Closure with the Nit-Occlud ® Lê VSD-Coil in 110 Patients: Early and Midterm Results of the EUREVECO-Registry. Pediatr Cardiol 2017; 38:215-227. [PMID: 27847970 DOI: 10.1007/s00246-016-1502-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 05/05/2016] [Accepted: 10/26/2016] [Indexed: 11/25/2022]
Abstract
In August 2010, the Nit-Occlud® Lê (EUREVECO) became available for transcatheter coil occlusion of ventricular septal defects (VSDs). Retrospective European Registry for VSD Closure using the Nit-Occlud® Lê-VSD-Coil; analysis of the feasibility, results, safety and follow-up of VSD-closure over a 3-year period in 18 European centers. In 102 of 111 patients (female 66), successful VSD closure was performed (mean age 8.2 years, mean weight 28.82 kg), 81 perimembranous VSDs (48 with aneurysm), 30 muscular VSDs, mean procedure time was 121.1 min, and mean fluoroscopy time was 26.3 min. Short- and midterm term follow-up was possible in 100/102 patients, there was 1 embolization and 1 explantation after 24 months. Immediate complete closure occurred in 49 of 101 patients (48.5%), trivial residual shunt was present in 51 (50.0%), closure rate was 95% after 6 months and 97% after 1 year. Out of the 102 patients, there were 2 severe complications (1.8%) (1 severe hemolysis, 1 embolization) and 8 moderate/transient (=7.2%) including 1 transient AV block. During a mean follow-up period of 31.3 months (range 24-48) and a total follow-up time of 224.75 patient years, no further problems occurred. VSD closure with the Nit-Occlud® Lê VSD coil is feasible and safe with a minimal risk of severe side effects. The long-term effects and safety require further clinical follow-up studies.
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Affiliation(s)
- Nikolaus A Haas
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Ludwigs Maximilian Universität München, Munich, Germany.
| | - Laura Kock
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Harald Bertram
- Department of Pediatric Cardiology and Pediatric Intensive Care, Children's Hospital Hannover Medical School, Hannover, Germany
| | - Regina Boekenkamp
- Department for Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Daniel De Wolf
- Department for Pediatric Cardiology, Ghent University Hospital, UZ Ghent, Ghent, Belgium
| | - Igor Ditkivskyy
- Department of Interventional Cardiology, National Amosov Institute of Cardio-Vascular Surgery, Kiev, Ukraine
| | - Matthias W Freund
- Department for Pediatric Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc Gewillig
- Department for Pediatric Cardiology, University Hospital Leuven, Louvain, Belgium
| | - Christoph M Happel
- Department for Congenital Heart Defects, Heart and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Ulrike Herberg
- Department for Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Edvard Karthasyan
- Center for Congenital Heart Defects and Pediatric Cardiology, Research Institution for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology and Pediatric Intensive Care, Klinikum der Ludwigs Maximilian Universität München, Munich, Germany
| | - Oliver Kretschmar
- Department for Pediatric Cardiology/Congenital Heart Defects, University Children's Hospital Zurich, Zurich, Switzerland
| | - Yulia Kuzmenko
- Department of Pediatric Cardiology, The Scientific Practical Children's Cardiac Center, Kiev, Ukraine
| | - Ornella Milanesi
- Department of Women and Children's Health Pediatric Cardiac Unit, University Hospital of Padova, Padua, Italy
| | - Goetz Mueller
- Department for Pediatric Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Giacomo Pongiglione
- Department for Pediatric Cardiology and Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital, Rome, Vatican, Italy
| | - Stephan Schubert
- Department for Congenital Heart Defects/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Gleb Tarusinov
- Center for Congenital Heart Defects, Pediatric Cardiology, Heart Centre Duisburg, Evangelic Hospital Niederrhein, Duisburg, Germany
| | - Christoph Kampmann
- Department for Pediatric Cardiology, University Children's Hospital, Mainz, Germany
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Birnbaum J, Ulrich SM, Schramm R, Hagl C, Lehner A, Fischer M, Haas NA, Heineking B. Transient severe tricuspid regurgitation after transplantation of an extremely oversized donor heart in a child-Does size matter? A case report. Pediatr Transplant 2017; 21. [PMID: 27925367 DOI: 10.1111/petr.12863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 12/01/2022]
Abstract
In pediatric heart transplantation, the size of the donor organ is an important criterion for organ allocation. Oversized donor hearts are often accepted with good results, but some complications in relation to a high donor-recipient ratio have been described. Our patient was transplanted for progressive heart failure in dilated cardiomyopathy. The donor-to-recipient weight ratio was 3 (donor weight 65 kg, recipient weight 22 kg). The intra-operative echocardiography before chest closure showed excellent cardiac function, no tricuspid valve regurgitation, and a normal central venous pressure. After chest closure, central venous pressure increased substantially and echocardiography revealed a severe tricuspid insufficiency. As other reasons for right ventricular dysfunction, that is, myocardial ischemia, pulmonary hypertension, and rejection, were excluded, we assumed that the insufficiency was caused by an alteration of the right ventricular geometry. After 1 week, the valve insufficiency regressed to a minimal degree. In pediatric heart transplant patients with a high donor-to-recipient weight ratio, the outlined complication may occur. If other reasons for right ventricular heart failure can be ruled out, this entity is most likely caused by an acute and transient alteration of the right ventricular geometry that may disappear over time.
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Affiliation(s)
- J Birnbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - S M Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - R Schramm
- Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - C Hagl
- Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - A Lehner
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M Fischer
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - N A Haas
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - B Heineking
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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