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Ponzoni M, Alamri R, Peel B, Haller C, Coles J, Vanderlaan RD, Honjo O, Barron DJ, Yoo SJ. Longitudinal Evaluation of Congenital Cardiovascular Surgical Performance and Skills Retention Using Silicone-Molded Heart Models. World J Pediatr Congenit Heart Surg 2024:21501351241237785. [PMID: 38646823 DOI: 10.1177/21501351241237785] [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] [Indexed: 04/23/2024]
Abstract
Objective: Hands-on surgical training (HOST) for congenital heart surgery (CHS), utilizing silicone-molded models created from 3D-printing of patients' imaging data, was shown to improve surgical skills. However, the impact of repetition and frequency of repetition in retaining skills has not been previously investigated. We aimed to longitudinally evaluate the outcome for HOST on two example procedures of different technical difficulties with repeated attempts over a 15-week period. Methods: Five CHS trainees were prospectively recruited. Repair of coarctation of the aorta (CoA) and arterial switch operation (ASO) were selected as example procedures of relatively low and high technical difficulty. Procedural time and technical performance (using procedure-specific assessment tools by the participant, a peer-reviewer, and the proctor) were measured. Results: Coarctation repair performance scores improved after the first repetition but remained unchanged at the follow-up session. Likewise, CoA procedural time showed an early reduction but then remained stable (mean [standard deviation]: 29[14] vs 25[15] vs 23[9] min at 0, 1, and 4 weeks). Conversely, ASO performance scores improved during the first repetitions, but decreased after a longer time delay (>9 weeks). Arterial switch operation procedural time showed modest improvements across simulations but significantly reduced from the first to the last attempt: 119[20] versus 106[28] min at 0 and 15 weeks, P = .049. Conclusions: Complex procedures require multiple HOST repetitions, without excessive time delay to maintain long-term skills improvement. Conversely, a single session may be planned for simple procedures to achieve satisfactory medium-term results. Importantly, a consistent reduction in procedural times was recorded, supporting increased surgical efficiency.
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Affiliation(s)
- Matteo Ponzoni
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rawan Alamri
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brandon Peel
- Center for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Coles
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel D Vanderlaan
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Center for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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2
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Kadowaki S, Parker M, Wang J, Mueller B, Steve Fan CP, Li J, Honjo O. A modified intraventricular balloon method for functional assessment of hearts from donation after circulatory death. JTCVS Open 2024; 18:104-117. [PMID: 38690439 PMCID: PMC11056455 DOI: 10.1016/j.xjon.2024.01.009] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 05/02/2024]
Abstract
Objective Functional assessment of hearts during ex-vivo heart perfusion is not well-established. Conventional intraventricular balloon methods for large animals sacrifice the mitral valve. This study assessed the effectiveness of the modified intraventricular balloon method in comparison with other modalities used during working mode in juvenile pigs. Methods Following asphyxia circulatory arrest, hearts were ischemic for 15 minutes and then reperfused on an ex-vivo device for 2 hours before switching to working mode. Left ventricular pressure was continuously measured during reperfusion by a saline-filled balloon fixated in the left atrium. Spearman Correlation Coefficients with linear regression lines with confidence intervals were analyzed. Results Maximum dp/dt at 90 minutes of reperfusion and minimum dp/dt at 60 minutes of reperfusion showed a moderate positive correlation to that in working mode, respectively (Rs = 0.61, P = .04 and Rs = 0.60, P = .04). At 60 minutes of reperfusion, minimum dp/dt showed moderate positive correlation to tau (Rs = 0.52, P = .08). Myocardial oxygen consumption during reperfusion consistently decreased at least 30% compared to working mode (at 90 minutes as the highest during reperfusion, 3.3 ± 0.8; in working mode, 5.6 ± 1.4, mLO2/min/100 g, P < .001). Conclusions Functional parameters of contractility and relaxation measured during reperfusion by the modified balloon method showed significant correlations to respective parameters in working mode. This mitral valve sparing technique can be used to predict viability and ventricular function in the early phase of ex-vivo heart perfusion without loading the heart during working mode.
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Affiliation(s)
- Sachiko Kadowaki
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marlee Parker
- Division of Perfusion Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jian Wang
- Division of Perfusion Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brigitte Mueller
- Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jing Li
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Deng MX, Haller C, Moss K, Saha S, Runeckles K, Fan CPS, Langanecha B, Floh A, Guerguerian AM, Honjo O. Early outcomes of moderate-to-high-risk pediatric congenital cardiac surgery and predictors of extracorporeal circulatory life support requirement. Front Pediatr 2024; 12:1282275. [PMID: 38523837 PMCID: PMC10957634 DOI: 10.3389/fped.2024.1282275] [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: 08/23/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background Cardiopulmonary failure refractory to medical management after moderate-to-high-risk congenital cardiac surgery may necessitate mechanical support with veno-arterial extracorporeal membrane oxygenation (ECMO). On the extreme, ECMO can also be initiated in the setting of cardiac arrest (extracorporeal cardiopulmonary resuscitation, ECPR) unresponsive to conventional resuscitative measures. Methods This was a single-center retrospective cohort study of patients (n = 510) aged <3 years old who underwent cardiac surgery with cardiopulmonary bypass with a RACHS-1 score ≥3 between 2011 and 2014. Perioperative factors were reviewed to identify predictors of ECMO initiation and mortality in the operating room (OR) and the intensive care unit (ICU). Results A total of 510 patients with a mean surgical age of 10.0 ± 13.4 months were included. Among them, 21 (4%) patients received postoperative ECMO-12 were initiated in the OR and 9 in the ICU. ECMO cannulation was associated with cardiopulmonary bypass duration, aortopulmonary shunt, residual severe mitral regurgitation, vaso-inotropic score, and postprocedural lactate (p < 0.001). Of the 32 (6%) total deaths, 7 (22%) were ECMO patients-4 were elective OR cannulations and 3 were ICU ECPR. Prematurity [hazard ratio (HR): 2.61, p < 0.01), Norwood or Damus-Kaye-Stansel procedure (HR: 4.29, p < 0.001), postoperative left ventricular dysfunction (HR: 5.10, p = 0.01), residual severe tricuspid regurgitation (HR: 6.06, p < 0.001), and postoperative ECMO (ECPR: HR: 15.42, p < 0.001 vs. elective: HR: 5.26, p = 0.01) were associated with mortality. The two patients who were electively cannulated in the ICU survived. Discussion Although uncommon, postoperative ECMO in children after congenital cardiac surgery is associated with high mortality, especially in cases of ECPR. Patients with long cardiopulmonary bypass time, residual cardiac lesions, or increased vaso-inotropic requirement are at higher risk of receiving ECMO. Pre-emptive or early ECMO initiation before deterioration into cardiac arrest may improve survival.
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Affiliation(s)
- Mimi Xiaoming Deng
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kasey Moss
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Sudipta Saha
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Kyle Runeckles
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Alejandro Floh
- Department of Critical Care Medicine, Labatt Family Heart Centre, Toronto, ON, Canada
| | | | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Kobayashi Y, Li J, Parker M, Wang J, Nagy A, Fan CPS, Runeckles K, Okumura M, Kadowaki S, Honjo O. Impact of Hemoglobin Level in Ex Vivo Heart Perfusion on Donation After Circulatory Death Hearts: A Juvenile Porcine Experimental Model. Transplantation 2024:00007890-990000000-00683. [PMID: 38446085 DOI: 10.1097/tp.0000000000004954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Ex vivo heart perfusion (EVHP) of donation after circulatory death (DCD) hearts has become an effective strategy in adults; however, the small circulating volume in pediatrics poses the challenge of a low-hemoglobin (Hb) perfusate. We aimed to determine the impact of perfusate Hb levels during EVHP on DCD hearts using a juvenile porcine model. METHODS Sixteen DCD piglet hearts (11-14 kg) were reperfused for 4 h in unloaded mode followed by working mode. Metabolism, cardiac function, and cell damage were compared between the low-Hb (Hb, 5.0-5.9 g/dL; n = 8) and control (Hb, 7.5-8.4 g/dL; n = 8) groups. Between-group differences were evaluated using 2-sample t-tests or Fisher's Exact tests. RESULTS During unloaded mode, the low-Hb group showed lower myocardial oxygen consumption (P < 0.001), a higher arterial lactate level (P = 0.001), and worse systolic ventricular function (P < 0.001). During working mode, the low-Hb group had a lower cardiac output (mean, 71% versus 106% of normal cardiac output, P = 0.010) and a higher arterial lactate level (P = 0.031). Adjusted cardiac troponin-I (P = 0.112) did not differ between the groups. Morphological myocyte injury in the left ventricle was more severe in the low-Hb group (P = 0.028). CONCLUSIONS Low-Hb perfusate with inadequate oxygen delivery induced anaerobic metabolism, resulting in suboptimal DCD heart recovery and declined cardiac function. Arranging an optimal perfusate is crucial to organ protection, and further endeavors to refine the priming volume of EVHP or the transfusion strategy are required.
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Affiliation(s)
- Yasuyuki Kobayashi
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jing Li
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Marlee Parker
- Division of Perfusion Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jian Wang
- Division of Perfusion Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anita Nagy
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Kyle Runeckles
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Michiru Okumura
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sachiko Kadowaki
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Luo S, Haller C, Nield LE, Deng MX, Varenbut J, Honjo O. Coronary artery lesions are associated with adverse cardiac events in children undergoing supravalvular aortic stenosis repair. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae017. [PMID: 38331410 PMCID: PMC10948283 DOI: 10.1093/icvts/ivae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/24/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES The aim of this study was to identify the prevalence and anatomic characteristics of coronary artery lesions and their associated postoperative risk in patients undergoing supravalvular aortic stenosis repair. METHODS The association between structural risk factors, postoperative ST-segment changes, and major adverse cardiac events was explored using logistic regression and the Fisher's exact test. RESULTS In 51 consecutive patients with supravalvular aortic stenosis treated between 2000 and 2017, a total of 48 coronary lesions were identified in 27 patients (53%). Prominent ostial ridge (type I) was the most common coronary lesion, followed by small ostium with (IIIb) or without (IIIa) diffuse long-segment coronary narrowing, and adhesion of the coronary cusp (type II). There were 54 concomitant coronary procedures, including 43 primary corrections and 11 revisions. Thirty-three patients underwent supravalvular aortic stenosis repair with a bifurcated patch, of which 13 (39.4%) had right coronary artery distortion/kinking requiring patch plication (n = 8) and reimplantation (n = 5). Postoperative major adverse cardiac events (MACE) occurred in 9 patients (17.6%), including 3 deaths, 4 needing mechanical circulatory support, and 6 experiencing ventricular arrhythmias. Twenty-two patients (43.1%) had postoperative ST-segment changes, including 13 early changes that resolved within 24 h and 9 persistent changes lasting >24 h. Patients with type III lesions were associated with postoperative persistent ST-segment change (P = 0.04) and these lesions independently predicted postoperative MACE (P = 0.02). Patients with pre-existing coronary lesions were at elevated risk of right coronary artery distortion/kinking (P = 0.045). CONCLUSIONS The prevalence of ST-segment changes and MACE is high in patients undergoing supravalvular aortic stenosis repair. The preoperative presence of complex coronary lesions is the most important predictor for postoperative major adverse cardiac events.
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Affiliation(s)
- Shuhua Luo
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Christoph Haller
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Lynne E Nield
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mimi Xiaoming Deng
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jaymie Varenbut
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Osami Honjo
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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6
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Gershon A, Nagy A, Somers GR, Yoo SJ, Shaikh F, Honjo O, Siddaway R, Chen H. A Pediatric Primary Cardiac Spindle Cell Neoplasm With a Rare PDGFRA::USP8 Gene Fusion: A Case Report. Pediatr Dev Pathol 2024:10935266231221903. [PMID: 38401149 DOI: 10.1177/10935266231221903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
We report a case of a primary cardiac spindle cell neoplasm with concerning histological features and a rare PDGFRA::USP8 gene fusion in a 3 year old boy. The patient presented with a large cardiac mass predominantly in the right ventricle, originating from the ventricular septum. The mass was resected with grossly negative margins. Pathology revealed an unclassified spindle cell neoplasm with a PDGFRA::USP8 gene fusion. This gene fusion has only been previously reported twice in the medical literature, one in a pediatric cardiac sarcoma and the other in an abdominal soft tissue tumor in an adult woman. The patient is alive and well with no evidence of recurrence 11 months after excision.
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Affiliation(s)
- Ariel Gershon
- Medical Genetics and Genomics, University of Toronto, Toronto, ON, Canada
| | - Anita Nagy
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada
| | - Gino R Somers
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical imaging, University of Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | - Furqan Shaikh
- Department of Paediatrics, University of Toronto, ON, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, ON, Canada
| | - Robert Siddaway
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Haiying Chen
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada
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7
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Langanecha BD, Kesavan S, Schwartz SM, Honjo O, Seed M, Fan CPS, Dragulescu A, Taylor KL, Floh AA. Reintervention Before Bidirectional Cavopulmonary Shunt and Intermediate Outcomes in Children with Single Ventricle Who Underwent Main Pulmonary Artery Banding. Pediatr Cardiol 2023; 44:1839-1846. [PMID: 37522934 DOI: 10.1007/s00246-023-03242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
Unplanned reinterventions following pulmonary artery banding (PAB) in single ventricle patients are common before stage 2 palliation (S2P) but associated risk factors are unknown. We hypothesized that reintervention is more common when PAB is placed at younger age and with a looser band, reflected by lower PAB pressure gradient. Retrospective single center study of single ventricle patients undergoing PAB between Jan 2000 and Dec 2020. The association with reintervention and successful S2P was modeled using exploratory cause-specific hazard regression. A multivariable model was developed adjusting for clinical and statistically relevant predictors. The cumulative proportion of patients undergoing reintervention were summarized using a competing risk model. 77 patients underwent PAB at median (IQR) 47 (24-66) days and 3.73 (3.2-4.5) kg. Within18 months of PAB, 60 (78%) reached S2P, 9 (12%) died, 1 (1%) transplanted and 7 (9%) were alive without S2P. Within 18 months of PAB 10 (13%) patients underwent reintervention related to pulmonary blood flow modification: PAB adjustment (n = 6) and conversion to Damus-Kaye-Stansel/Blalock-Taussig-Thomas shunt (n = 4). 6/10 (60%) reached S2P following reintervention. A trend toward higher intervention in patients with a genetic syndrome (p-0.06) and weight < 3 kg (p-0.057) at time of PAB was noted. Only genetic syndrome was a risk factor associated with poor outcome (p-0.025). PAB has a reasonable outcome in SV patients with unobstructed systemic and pulmonary blood flow, but with a high reintervention rate. Only a quarter of patients with genetic syndromes reach S2P and further study is required to explore the benefits from an alternative palliative strategy.
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Affiliation(s)
- Bhavikkumar D Langanecha
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Sajith Kesavan
- Department of Paediatric Pulmonary and Critical Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Steven M Schwartz
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Osami Honjo
- Labatt Family Heart Centre, Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Mike Seed
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Chun-Po S Fan
- Ted Rogers Computational Program, The University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andreea Dragulescu
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Katherine L Taylor
- Division of Cardiac Anaesthesia, Department of Anaesthesia, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Alejandro A Floh
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada
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Lynch A, Jeewa A, Maurich A, Mazwi M, Jean-St-Michel E, Floh A, Zaulan O, Yoo SJ, Langanecha B, Honjo O. Canada's First Successful Paediatric Total Artificial Heart Implant. CJC Pediatr Congenit Heart Dis 2023; 2:494-497. [PMID: 38205433 PMCID: PMC10777196 DOI: 10.1016/j.cjcpc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Aine Lynch
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Maurich
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mjaye Mazwi
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Alejandro Floh
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Oshri Zaulan
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bhavik Langanecha
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Pisesky A, Honjo O, Villemain O, Dragulescu A. The Use of 3-Dimensional Echocardiography for Tricuspid Valve Surgery in Hypoplastic Left Heart Syndrome. CJC Pediatr Congenit Heart Dis 2023; 2:498-500. [PMID: 38205437 PMCID: PMC10777197 DOI: 10.1016/j.cjcpc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/10/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Andrea Pisesky
- The Labatt Family Heart Centre, Department of Pediatric, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Olivier Villemain
- The Labatt Family Heart Centre, Department of Pediatric, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- The Labatt Family Heart Centre, Department of Pediatric, the Hospital for Sick Children, Toronto, Ontario, Canada
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10
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Argo MB, Barron DJ, Bondarenko I, Eckhauser A, Gruber PJ, Lambert LM, Paramananthan T, Rahman M, Winlaw DS, Yerebakan C, Alsoufi B, DeCampli WM, Honjo O, Kirklin JK, Prospero C, Ramakrishnan K, St Louis JD, Turek JW, O'Brien JE, Pizarro C, Anagnostopoulos PV, Blackstone EH, Jacobs ML, Jegatheeswaran A, Karamlou T, Stephens EH, Polimenakos AC, Haw MP, McCrindle BW. Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction. J Thorac Cardiovasc Surg 2023; 166:1300-1313.e2. [PMID: 37164059 DOI: 10.1016/j.jtcvs.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To compare patient characteristics and overall survival for infants with critical left heart obstruction after hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) versus nonhybrid management (eg, Norwood, primary transplantation, biventricular repair, or transcatheter/surgical aortic valvotomy). METHODS From 2005 to 2019, 1045 infants in the Congenital Heart Surgeons' Society critical left heart obstruction cohort underwent interventions across 28 institutions. Using a balancing score propensity analysis, 214 infants who underwent hybrid palliation and 831 infants who underwent nonhybrid management were proportionately matched regarding variables significantly associated with mortality and variables noted to significantly differ between groups. Overall survival between the 2 groups was adjusted by applying balancing scores to nonparametric estimates. RESULTS Compared with the nonhybrid management group, infants who underwent hybrid palliation had lower birth weight, smaller gestational age, and higher prevalence of in-utero interventions, noncardiac comorbidities, preoperative mechanical ventilation, absent interatrial communication, and moderate or severe mitral valve stenosis (all P values < .03). Unadjusted 12-year survival after hybrid palliation and nonhybrid management, was 55% versus 69%, respectively. After matching, 12-year survival after hybrid palliation versus nonhybrid management was 58% versus 63%, respectively (P = .37). Among matched infants born weighing <2.5 kg, 2-year survival after hybrid palliation versus nonhybrid management was 37% versus 51%, respectively (P = .22). CONCLUSIONS Infants born with critical left heart obstruction who undergo hybrid palliation have more high-risk characteristics and anatomy versus infants who undergo nonhybrid management. Nonetheless, after adjustment, there was no significant difference in 12-year survival after hybrid palliation versus nonhybrid management. Mortality remains high, and hybrid palliation confers no survival advantage, even for lower-birth-weight infants.
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Affiliation(s)
- Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wis; Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Igor Bondarenko
- Division of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, Mich
| | - Aaron Eckhauser
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Peter J Gruber
- Division of Cardiothoracic Surgery, Yale New Haven Children's Hospital, New Haven, Conn
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Tharini Paramananthan
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maha Rahman
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David S Winlaw
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, Louisville, Ky
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James K Kirklin
- Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Ala
| | - Carol Prospero
- Division of Pediatric Cardiology, Nemours Children's Hospital Delaware, Wilmington, Del
| | - Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, Tenn
| | - James D St Louis
- Division of Pediatric and Congenital Cardiac Surgery, Children's Hospital of Georgia, Augusta, Ga
| | - Joseph W Turek
- Department of Surgery, Duke Children's Hospital and Health Center, Durham, NC
| | - James E O'Brien
- Division of Pediatric Cardiovascular Surgery, Children's Mercy Kansas City, Kansas City, M
| | - Christian Pizarro
- Cardiothoracic Surgery, Nemours Children's Hospital Delaware, Wilmington, Del
| | - Petros V Anagnostopoulos
- Division of Pediatric Cardiothoracic Surgery, University of Wisconsin Health American Family Hospital, Madison, Wis
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marshall L Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Anastasios C Polimenakos
- Division of Pediatric and Congenital Cardiac Surgery, Children's Hospital of Georgia, Augusta, Ga
| | - Marcus P Haw
- Department of Pediatric Cardiovascular Surgery, Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Brian W McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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11
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Kucher NM, Marquez AM, Guerguerian AM, Moga MA, Vargas-Gutierrez M, Todd M, Honjo O, Haller C, Goco G, Floh AA. Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort. Pediatr Crit Care Med 2023; 24:e531-e539. [PMID: 37439601 DOI: 10.1097/pcc.0000000000003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVES During pediatric cardiac arrest, contemporary guidelines recommend dosing epinephrine at regular intervals, including in patients requiring extracorporeal membrane oxygenation (ECMO). The impact of epinephrine-induced vasoconstriction on systemic afterload and venoarterial ECMO support is not well-defined. DESIGN Nested retrospective observational study within a single center. The primary exposure was time from last dose of epinephrine to initiation of ECMO flow; secondary exposures included cumulative epinephrine dose and arrest time. Systemic afterload was assessed by mean arterial pressure and use of systemic vasodilator therapy; ECMO pump flow and Vasoactive-Inotrope Score (VIS) were used as measures of ECMO support. Clearance of lactate was followed post-cannulation as a marker of systemic perfusion. SETTING PICU and cardiac ICU in a quaternary-care center. PATIENTS Patients 0-18 years old who required ECMO cannulation during resuscitation over the 6 years, 2014-2020. Patients were excluded if ECMO was initiated before cardiac arrest or if the resuscitation record was incomplete. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 92 events in 87 patients, with 69 events having complete data for analysis. The median (interquartile range) of total epinephrine dosing was 65 mcg/kg (37-101 mcg/kg), with the last dose given 6 minutes (2-16 min) before the initiation of ECMO flows. Shorter interval between last epinephrine dose and ECMO initiation was associated with increased use of vasodilators within 6 hours of ECMO ( p = 0.05), but not with mean arterial pressure after 1 hour of support (estimate, -0.34; p = 0.06). No other associations were identified between epinephrine delivery and mean arterial blood pressure, vasodilator use, pump speed, VIS, or lactate clearance. CONCLUSIONS There is limited evidence to support the idea that regular dosing of epinephrine during cardiac arrest is associated with increased in afterload after ECMO cannulation. Additional studies are needed to validate findings against ECMO flows and clinically relevant outcomes.
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Affiliation(s)
- Nicholas M Kucher
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alexandra M Marquez
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael-Alice Moga
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Mariella Vargas-Gutierrez
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mark Todd
- Department of Respiratory Therapy, The Hospital for Sick Children, Toronto, ON, Canada
| | - Osami Honjo
- Labatt Family Heart Centre, Division of Cardiac Surgery, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Christoph Haller
- Labatt Family Heart Centre, Division of Cardiac Surgery, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Geraldine Goco
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alejandro A Floh
- Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
- Labatt Family Heart Centre, Division of Pediatric Cardiology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
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12
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Argo MB, Barron DJ, Eghtesady P, Yerebakan C, DeCampli WM, Alsoufi B, Honjo O, Jacobs JP, Paramananthan T, Rahman M, Lambert LM, Jegatheeswaran A, Carrillo SA, Husain SA, Ramakrishnan K, Caldarone CA, Karamlou T, Nelson J, Mannie C, Romano JC, Turek JW, Blackstone EH, Galantowicz ME, Kirklin JK, Mitchell ME, McCrindle BW. Outcomes After Hybrid Palliation for Infants With Critical Left Heart Obstruction. J Am Coll Cardiol 2023; 82:1427-1441. [PMID: 37758438 DOI: 10.1016/j.jacc.2023.07.020] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/02/2023] [Accepted: 07/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Hybrid palliation (bilateral pulmonary artery banding with or without ductal stenting) is an initial management strategy for infants with critical left heart obstruction and serves as palliation until subsequent operations are pursued. OBJECTIVES This study sought to determine patient characteristics and factors associated with subsequent outcomes for infants who underwent hybrid palliation. METHODS From 2005 to 2019, 214 of 1,236 prospectively enrolled infants within the Congenital Heart Surgeons' Society's critical left heart obstruction cohort underwent hybrid palliation across 24 institutions. Multivariable hazard modeling with competing risk methodology was performed to determine risk and factors associated with outcomes of biventricular repair, Fontan procedure, transplantation, or death. RESULTS Preoperative comorbidities (eg, prematurity, low birth weight, genetic syndrome) were identified in 70% of infants (150 of 214). Median follow-up was 7 years, ranging up to 17 years. Overall 12-year survival was 55%. At 5 years after hybrid palliation, 9% had biventricular repair, 36% had Fontan procedure, 12% had transplantation, 35% died without surgical endpoints, and 8% were alive without an endpoint. Factors associated with transplantation were absence of ductal stent, older age, absent interatrial communication, smaller aortic root size, larger tricuspid valve area z-score, and larger left ventricular volume. Factors associated with death were low birth weight, concomitant genetic syndrome, cardiopulmonary bypass use during hybrid palliation, moderate to severe tricuspid valve regurgitation, and smaller ascending aortic size. CONCLUSIONS Mortality remains high after hybrid palliation for infants with critical left heart obstruction. Nonetheless, hybrid palliation may facilitate biventricular repair for some infants and for others may serve as stabilization for intended functional univentricular palliation or primary transplantation.
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Affiliation(s)
- Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA; Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital, St Louis, Missouri, USA
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
| | - Williams M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, Louisville, Kentucky, USA
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Tharini Paramananthan
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maha Rahman
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - S Adil Husain
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, Tennessee, USA
| | | | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer Nelson
- Division of Pediatric Cardiovascular Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Chelsea Mannie
- Division of Pediatric Cardiothoracic Surgery, St Louis Children's Hospital, St Louis, Missouri, USA
| | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph W Turek
- Department of Surgery, Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark E Galantowicz
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - James K Kirklin
- Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian W McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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13
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Morgan CT, Chetan D, Varenbut J, Haller C, Seed M, Mertens LL, Honjo O. Mechanical atrioventricular valve replacement in patients with single ventricle palliation. Eur J Cardiothorac Surg 2023; 64:ezad317. [PMID: 37707524 DOI: 10.1093/ejcts/ezad317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/26/2023] [Accepted: 09/12/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES Atrioventricular valve (AVV) replacements in patients with single-ventricle circulations pose significant surgical risks and are associated with high morbidity and mortality. METHODS From 1997 to 2021, 16 consecutive patients with functionally single-ventricle physiology underwent mechanical AVV replacement. Primary outcome was transplant-free survival. Secondary outcomes included major postoperative morbidity. RESULTS The median age of AVV replacement was 2 years old (interquartile range 0.6-3.8 years). All AVV replacements were performed with a St. Jude Medical mechanical valve, median 24 mm (range, 19-31mm). Extracorporeal membrane oxygenation (ECMO) was required in 4 patients. Operative mortality was 38% (6/16). There were 2 late deaths and 3 transplants. Transplant-free survival was 50% at 1 year, 37.5% at 5 years, and 22% at 10 years. Transplant-free survival was higher for patients with preserved ventricular function (P = 0.01). Difference in transplant-free survival at 1 year was 75% vs 25%, at 5 years was 62.5% vs 12.5% and at 10 years was 57% vs 0%. Three (19%) patients had complete heart block requiring permanent pacemaker insertion. 6 of 13 patients (46%) patients reached Fontan completion (3 patients operated at/after Fontan). Significant bleeding events occurred in 8 patients (50%) with 3 patients suffering major cerebrovascular accidents. There were 6 events of valve thrombosis in 5 patients, resulting in 2 deaths and 2 heart transplants. CONCLUSIONS Mechanical valve replacement carries significant morbidity and mortality risk. While it successfully salvages about half of patients with preserved ventricular function, careful consideration of alternative options should be made before embarking upon mechanical valve replacement.
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Affiliation(s)
- Conall T Morgan
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Devin Chetan
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Jaymie Varenbut
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto
| | - Mike Seed
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Luc L Mertens
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto
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14
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Argo MB, Barron DJ, Eghtesady P, Alsoufi B, Honjo O, Yerebakan C, DeCampli WM, Jacobs JP, Carrillo SA, Jegatheeswaran A, Karamlou T, Paramananthan T, Rahman M, Lambert LM, Nelson J, Caldarone CA, Husain SA, Galantowicz ME, Ramakrishnan K, Kirklin JK, Turek JW, Mannie C, Blackstone EH, Mitchell ME, McCrindle BW. Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction. J Thorac Cardiovasc Surg 2023; 166:943-954.e1. [PMID: 36804212 DOI: 10.1016/j.jtcvs.2023.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/15/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine patient characteristics and outcomes after Norwood versus comprehensive stage II (COMPSII) for infants with critical left heart obstruction who had prior hybrid palliation (bilateral pulmonary artery banding ± ductal stent). METHODS From 23 Congenital Heart Surgeons' Society institutions (2005-2020), 138 infants underwent hybrid palliation followed by either Norwood (n = 73, 53%) or COMPSII (n = 65). Baseline characteristics were compared between Norwood and COMPSII groups. Parametric hazard model with competing risk methodology was used to determine risk and factors associated with outcomes of Fontan, transplantation, or death. RESULTS Infants who underwent Norwood versus COMPSII had a higher prevalence of prematurity (26% vs 14%, P = .08), lower birth weight (median 2.8 vs 3.2 kg, P < .01) and less frequent ductal stenting (37% vs 99%; P < .01). Norwood was performed at a median age of 44 days and median weight of 3.5 kg, versus COMPSII at 162 days and 6.0 kg (both P < .01). Median follow-up was 6.5 years. At 5 years after Norwood and COMPSII, respectively; 50% versus 68% had Fontan (P = .16), 3% versus 5% had transplantation (P = .70), 40% versus 15% died (P = .10), and 7% versus 11% are alive without transition, respectively. For factors associated with either mortality or Fontan, only preoperative mechanical ventilation occurred more frequently in the Norwood group. CONCLUSIONS Higher prevalence of prematurity, lower birth weight, and other patient-related characteristics in the Norwood versus COMPSII groups may influence differences in outcomes that were not statistically significant for this limited risk-adjusted cohort. The clinical decision regarding Norwood versus COMPSII after initial hybrid palliation remains challenging.
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Affiliation(s)
- Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wis; Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, Louisville, Ky
| | - Osami Honjo
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tharini Paramananthan
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maha Rahman
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jennifer Nelson
- Division of Pediatric Cardiovascular Surgery, Children's Mercy Kansas City, Kansas City, Mo
| | | | - S Adil Husain
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Mark E Galantowicz
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, Tenn
| | - James K Kirklin
- Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Ala
| | - Joseph W Turek
- Department of Surgery, Duke Children's Hospital and Health Center, Durham, NC
| | - Chelsea Mannie
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Children's Wisconsin, Milwaukee, Wis
| | - Brian W McCrindle
- Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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15
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Laks JA, Lynch A, Honjo O, Grosse-Wortmann L, Chitayat D, Dipchand AI. Heart transplantation in neonatal Marfan syndrome: Saving life in a rare and fatal condition. Pediatr Transplant 2023; 27:e14560. [PMID: 37377051 DOI: 10.1111/petr.14560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Neonatal Marfan syndrome is a rare disease with mortality in the first year of life reported as high as 95% predominantly due to progressive heart failure from valvar regurgitation and cardiomyopathy. Multisystem involvement and uncertain prognosis have historically precluded transplant candidacy, and current management options are of limited success. CASE REPORT We present a baby girl with a postnatal diagnosis of neonatal Marfan syndrome who at 1 year of age underwent mitral valve and tricuspid valve repair with postoperative profound left ventricular and moderate right ventricular dysfunction necessitating biventricular assist device (BiVAD) support and subsequent heart transplant. A number of noncardiac issues persisted in our patient; however, she enjoyed a good quality of life for the initial 3 years posttransplant. Unfortunately, she subsequently developed rapidly progressive coronary allograft vasculopathy (CAV) with progressive deterioration in function and cardiac arrest. CONCLUSION To our best knowledge, this is only the second case of neonatal Marfan syndrome to undergo heart transplant reported in the literature and the first with BiVAD support as a bridge to candidacy. This is also the first case of neonatal Marfan syndrome associated with intragenic duplication. This case though demonstrating that earlier listing, ventricular assist device (VAD) support and even primary transplant as treatment in neonatal Marfan syndrome should all be considered viable options but also portends a cautionary tale given the spectrum of comorbidities in this rare and severe disorder.
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Affiliation(s)
- Jessica A Laks
- Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Aine Lynch
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiovascular Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anne I Dipchand
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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16
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Norozi K, Subasri M, Diaz LA, Honjo O. Left atrial appendage aneurysm in pediatrics: Case study and literature review. Front Cardiovasc Med 2023; 10:1211619. [PMID: 37636313 PMCID: PMC10449248 DOI: 10.3389/fcvm.2023.1211619] [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: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Left atrial appendage aneurysm (LAAA) is a rare cardiac pathology that is often identified in adulthood. There are a myriad of presentations related to atrial appendage enlargement, but most are asymptomatic. Pediatric cases of LAAA are extremely rare. We report a case of an incidental giant LAAA found in a healthy 6-year-old boy. He was successfully treated with surgical resection. A review of the literature shows that the presentation of LAAA in pediatrics likely involves cardiac or respiratory symptoms but can also be incidental findings. Similar to adults, diagnosis requires cardiac imaging, with echocardiography being the mainstay. Surgical intervention is indicated in symptomatic and most asymptomatic patients to prevent complications. More research is warranted into the optimal timing of surgery and alternative surgical approaches for complex cases.
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Affiliation(s)
- Kambiz Norozi
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
- Department of Paediatric Cardiology, Medical School Hannover, Hannover, Germany
| | - Mathushan Subasri
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Luis Altamirano Diaz
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
| | - Osami Honjo
- Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
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17
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Belfiore A, Maurich A, Honjo O, Mazwi M, Jean-St-Michel E, Deng M, Lynch A, Zaulan O, Jeewa A. Pitfalls and Possibilities of Ventricular Assist Device Support in Congenitally Corrected Transposition of the Great Arteries in Children. ASAIO J 2023; 69:e397-e400. [PMID: 36881646 DOI: 10.1097/mat.0000000000001909] [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: 03/09/2023] Open
Abstract
Congenitally corrected transposition of the great arteries (ccTGAs) represents a complex form of congenital heart disease that is associated with several cardiac complications. Herein is a case series of three children with ccTGA and ventricular assist device (VAD) inserted for systemic right ventricle failure at a single institution. All patients remained hemodynamically stable postimplant and were successfully discharged from the intensive care unit to undergo postoperative rehabilitation. All three patients received an orthotopic heart transplant with uneventful posttransplant courses. This case series provides insight into the medical management and technical feasibility of VAD support in children with ccTGA with end-stage heart failure.
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Affiliation(s)
- Alyssa Belfiore
- From the Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Maurich
- From the Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mjaye Mazwi
- From the Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emilie Jean-St-Michel
- From the Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mimi Deng
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aine Lynch
- From the Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Oshri Zaulan
- Division of Pediatric Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aamir Jeewa
- From the Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Luo S, Deng MX, Honjo O. Modified central shunt in pulmonary atresia with diminutive pulmonary arteries. Asian Cardiovasc Thorac Ann 2023:2184923231168468. [PMID: 37020336 DOI: 10.1177/02184923231168468] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The commonly used central shunt (i.e. direct connection of the divided main pulmonary artery to the ascending aorta) to facilitate the growth of the diminutive branch pulmonary artery in patients with pulmonary atresia with major aortopulmonary collateral arteries can cause main pulmonary artery distortion, and subsequent disproportional branch pulmonary artery flow and growth. This report describes a novel technique of shunt construction to minimize pulmonary artery torque and tension by using a modified central shunt constructed from autologous pericardium that is anastomosed in an end-to-side fashion to the lateral aspect of the ascending aorta. This shunt will serve as an intermediary conduit to facilitate the main pulmonary artery anastomosis while minimizing torque and tension on the main pulmonary artery. The tension-free connection between the main pulmonary artery and the aorta enabled by the modified central shunt supports proportional pulmonary artery flow and growth in patients with pulmonary atresia, ventricular septal defect, or multiple aortopulmonary collateral arteries and concomitant diminutive native pulmonary arteries.
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Affiliation(s)
- Shuhua Luo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Department of Cardiovascular Surgery, 34753West China Hospital of Sichuan University, Chengdu, China
| | - Mimi X Deng
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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19
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Lynch A, Jeewa A, Maurich A, Mazwi M, Jean-St-Michel E, Zaulan O, Floh A, Yoo S, Langanecha B, Honjo O. A Report of the First Pediatric Total Artificial Heart Implant in Canada. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1349] [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: 04/05/2023] Open
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20
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Langanecha B, Jeewa A, Mazwi M, Zaulan O, Jean-St-Michel E, Haller C, Honjo O, Lynch A, George K, Fazari L, Maurich A. Pulmonary Artery Banding to Optimize Ventricular Interaction after Lvad Explant Following Myocardial Recovery. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.832] [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: 04/05/2023] Open
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21
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Floh AA, Das S, Haranal M, Laussen PC, Crawford-Lean L, Fan CPS, Mertens LL, Runeckles K, Honjo O. Comparison between Del Nido and conventional blood cardioplegia in pediatric open-heart surgery. Perfusion 2023; 38:337-345. [PMID: 35143733 PMCID: PMC9932617 DOI: 10.1177/02676591211054978] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Del Nido cardioplegia (DNc) was designed for superior myocardial protection during cardiopulmonary bypass (CPB). We conducted a retrospective review to explore if DNc was associated with increase in systemic ventricle dysfunction (sVD) following pediatric CPB. METHODS AND RESULTS This single-center, retrospective study included 1534 patients undergoing CPB between 2013 and 2016, 997 prior to center-wide conversion to DNc and 537 following. The primary outcome was new postoperative ≥moderate sVD by echocardiogram. Secondary outcomes included sVD of any severity and right ventricular dysfunction. Data was evaluated by interrupted time-series analysis. Groups had similar cardiac diagnoses and surgical complexity. Del Nido cardioplegia was associated with longer median (IQR) CPB [117 (84-158) vs 108 (81-154), p = 0.04], and aortic cross-clamp [83 (55-119) vs 76 (53-106), p = 0.03], and fewer cardioplegia doses [2 (1-2) vs 3 (2-4), p < 0.0001]. Mortality was similar in both groups. Frequency of sVD was unchanged following DNc, including predetermine subgroups (neonates, infants, and prolonged cross-clamp). Logistic regression showed a significant rise in right ventricular dysfunction (OR 5.886 [95% CI: 0.588, 11.185], p = 0.03) but similar slope. CONCLUSIONS Use of DNc was not associated with increased in reported sVD, and provided similar myocardical protection to the systemic ventricle compared to conventional cardioplegia but may possibly impact right ventricular function. Studies evaluating quantitative systolic and diastolic function are needed.
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Affiliation(s)
- Alejandro A Floh
- Department of Critical Care
Medicine, Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada,Alejandro A Floh, Department of Critical
Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON
M5C 1X8, Canada.
| | - Shubhadeep Das
- Department of Critical Care
Medicine, Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
| | - Maruti Haranal
- Division of Cardiovascular Surgery,
Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
| | - Peter C Laussen
- Department of Critical Care
Medicine, Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
| | - Lynn Crawford-Lean
- Perfusion Services, Hospital for
Sick Children, University
of Toronto, Toronto, ON, Canada
| | - Chun-Po S Fan
- Cardiovascular Data Management
Centre, University
of Toronto, Toronto, ON, Canada
| | - Luc L Mertens
- Labatt Family Heart Centre,
Division of Pediatric Cardiology, Department of Pediatrics, Hospital for Sick
Children, University
of Toronto, Toronto, ON, Canada
| | - Kyle Runeckles
- Cardiovascular Data Management
Centre, University
of Toronto, Toronto, ON, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery,
Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
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22
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An KR, Deng MX, Freud LR, Honjo O. Repair of Aberrant Right Subclavian Artery Causing Dysphagia Lusoria via Partial Median Sternotomy. World J Pediatr Congenit Heart Surg 2023; 14:235-238. [PMID: 36380596 PMCID: PMC10080363 DOI: 10.1177/21501351221137826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While unusual, aberrant right subclavian artery (ARSCA) can occasionally be a source of significant dysphagia in children. We present a case of a 13-year-old female who reported a three-year history of dysphagia to solid foods and was found to have ARSCA on a barium swallow study and computed tomography scan of the chest. We reimplanted the ARSCA into the right carotid artery in end-to-side fashion using a partial median sternotomy approach. At six months follow-up, her symptoms had completely resolved, and her postoperative echocardiogram showed an unobstructed reimplanted ARSCA. Meeting presentation: AATS 102nd Annual Meeting; May 14, 2022; Boston, MA.
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Affiliation(s)
- Kevin R An
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, Hospital for Sick Children, 7938University of Toronto, Toronto, Ontario, Canada
| | - Mimi X Deng
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, Hospital for Sick Children, 7938University of Toronto, Toronto, Ontario, Canada
| | - Lindsay R Freud
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, 7938University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, Hospital for Sick Children, 7938University of Toronto, Toronto, Ontario, Canada
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23
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Chetan D, Szabo AB, Fan CPS, Morgan CT, Villemain O, Chaturvedi RR, Benson LN, Honjo O. Melody Mitral Valve Is a Promising Alternative to Mechanical Valve Replacement for Young Children. Ann Thorac Surg 2023; 115:778-783. [PMID: 36470568 DOI: 10.1016/j.athoracsur.2022.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to compare outcomes of Melody mitral valve to mechanical mitral valve replacement (MVR) for young children. DESCRIPTION Children who underwent Melody MVR from 2014 to 2020 were case-matched to mechanical MVR patients. Transplant-free survival and cumulative incidence of reintervention were compared. A subanalysis was performed for infants aged < 1 year (9 Melody MVRs and their matches). EVALUATION Twelve children underwent Melody MVR. Two children (17%) salvaged from mechanical support died. Five of 10 survivors (50%) had subsequent MVR. At 1 and 3 years, transplant-free survival (Melody: 83%, 83%; mechanical: 83%, 67%; P = .180) and reintervention (Melody: 9%, 39%; mechanical: 0%, 18%; P = .18) were equivalent between groups. For children < 1 year of age, Melody MVR had a modest survival benefit (Melody: 89%, 89%; mechanical: 80%, 60%; P = .046), while rate of reintervention remained equivalent (Melody: 13%, 32%; mechanical: 0%, 22%; P = .32). CONCLUSIONS For patients < 1 year old, Melody MVR offers a promising alternative and is a reasonable bridge to mechanical MVR, which can be performed safely at an older age. Further studies are necessary to corroborate these findings.
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Affiliation(s)
- Devin Chetan
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adrienn B Szabo
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po S Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Conall T Morgan
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Olivier Villemain
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv R Chaturvedi
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lee N Benson
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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24
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Donahoe LL, Patel S, Tole S, Zorzi AP, Huang L, Honjo O, de Perrot M. Osteosarcoma emboli presenting as chronic thromboembolic pulmonary hypertension in a child. Pediatr Hematol Oncol 2023; 40:65-69. [PMID: 36701380 DOI: 10.1080/08880018.2022.2053767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 13-year-old girl presented with hypoxemia during adjuvant chemotherapy for an osteosarcoma of the left distal femur. She underwent an amputation complicated by a post-operative pulmonary embolism (PE). Three months post-operatively, she was admitted to hospital with severe hypoxemia and diagnosed with pulmonary hypertension on echocardiogram in the context of extensive bilateral PE on computed tomography. She was planned for elective pulmonary thromboendarterectomy, but rapidly deteriorated requiring emergent surgery. At the time of surgery, she was found to have extensive tumor emboli throughout both pulmonary arteries. She recovered well post-operatively but died 2 months later from progressive disease.
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Affiliation(s)
- Laura L Donahoe
- Toronto CTEPH Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Serina Patel
- Children's Hospital, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Soumitra Tole
- Children's Hospital, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Alexandra P Zorzi
- Children's Hospital, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Lennox Huang
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Toronto CTEPH Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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25
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Kadowaki S, Siraj MA, Chen W, Wang J, Parker M, Nagy A, Steve Fan C, Runeckles K, Li J, Kobayashi J, Haller C, Husain M, Honjo O. Cardioprotective Actions of a Glucagon-like Peptide-1 Receptor Agonist on Hearts Donated After Circulatory Death. J Am Heart Assoc 2023; 12:e027163. [PMID: 36695313 PMCID: PMC9973624 DOI: 10.1161/jaha.122.027163] [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] [Indexed: 01/26/2023]
Abstract
Background Heart transplantation with a donation after circulatory death (DCD) heart is complicated by substantial organ ischemia and ischemia-reperfusion injury. Exenatide, a glucagon-like peptide-1 receptor agonist, manifests protection against cardiac ischemia-reperfusion injury in other settings. Here we evaluate the effects of exenatide on DCD hearts in juvenile pigs. Methods and Results DCD hearts with 15-minutes of global warm ischemia after circulatory arrest were reperfused ex vivo and switched to working mode. Treatment with concentration 5-nmol exenatide was given during reperfusion. DCD hearts treated with exenatide showed higher myocardial oxygen consumption (exenatide [n=7] versus controls [n=7], over 60-120 minutes of reperfusion, P<0.001) and lower cardiac troponin-I release (27.94±11.17 versus 42.25±11.80 mmol/L, P=0.04) during reperfusion compared with controls. In working mode, exenatide-treated hearts showed better diastolic function (dp/dt min: -3644±620 versus -2193±610 mm Hg/s, P<0.001; Tau: 15.62±1.78 versus 24.59±7.35 milliseconds, P=0.02; lateral e' velocity: 11.27 ± 1.46 versus 7.19±2.96, P=0.01), as well as lower venous lactate levels (3.17±0.75 versus 5.17±1.44 mmol/L, P=0.01) compared with controls. Higher levels of activated endothelial nitric oxide synthase (phosphorylated to total endothelial nitric oxide synthase levels: 2.71±1.16 versus 1.37±0.35, P=0.02) with less histological evidence of endothelial damage (von Willebrand factor expression: 0.024±0.007 versus 0.331±0.302, pixel/μm, P=0.04) was also observed with exenatide treatment versus controls. Conclusions Acute treatment of DCD hearts with exenatide limits myocardial and endothelial injury and improves donor cardiac function.
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Affiliation(s)
- Sachiko Kadowaki
- Division of Cardiovascular SurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - M. Ahsan Siraj
- Department of Medicine, Ted Rogers Centre for Heart Research, Peter Munk Cardiac CentreUniversity of TorontoTorontoOntarioCanada
| | - Weiden Chen
- Division of Cardiovascular SurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of SurgeryUniversity of TorontoTorontoOntarioCanada,Department of Cardiac SurgeryGuangzhou Women and Children’s Medical CenterGuangzhouChina
| | - Jian Wang
- Division of Perfusion ServicesThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Marlee Parker
- Division of Perfusion ServicesThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Anita Nagy
- Division of PathologyThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Chun‐Po Steve Fan
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Labatt Family Heart CentreUniversity Health Network, The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Kyle Runeckles
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Labatt Family Heart CentreUniversity Health Network, The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Jing Li
- Division of Cardiovascular SurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Junko Kobayashi
- Division of Cardiovascular SurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of SurgeryUniversity of TorontoTorontoOntarioCanada,Department of Cardiovascular SurgeryOkayama University HospitalOkayamaJapan,Department of Cardiovascular SurgeryFaculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityOkayamaJapan
| | - Christoph Haller
- Division of Cardiovascular SurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Mansoor Husain
- Department of Medicine, Ted Rogers Centre for Heart Research, Peter Munk Cardiac CentreUniversity of TorontoTorontoOntarioCanada
| | - Osami Honjo
- Division of Cardiovascular SurgeryThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of SurgeryUniversity of TorontoTorontoOntarioCanada
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26
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Vaikom House A, David D, Aguet J, Dipchand AI, Honjo O, Jean-St-Michel E, Seed M, Yoo SJ, Barron DJ, Lam CZ. Quantification of lymphatic burden in patients with Fontan circulation by T2 MR lymphangiography and associations with adverse Fontan status. Eur Heart J Cardiovasc Imaging 2023; 24:241-249. [PMID: 36327421 DOI: 10.1093/ehjci/jeac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS To quantify thoracic lymphatic burden in paediatric Fontan patients using MRI and correlate with clinical status. METHODS AND RESULTS Paediatric Fontan patients (<18-years-old) with clinical cardiac MRI that had routine lymphatic 3D T2 fast spin echo (FSE) imaging performed from May 2017 to October 2019 were included. 'Lymphatic burden' was quantified by thresholding-based segmentation of the 3D T2 FSE maximum intensity projection image and indexed to body surface area, performed by two independent readers blinded to patient status. There were 48 patients (27 males) with median age at MRI of 12.9 (9.4-14.7) years, time from Fontan surgery to MRI of 9.1 (5.9-10.4) years, and follow-up time post-Fontan surgery of 9.4 (6.6-11.0) years. Intraclass correlation coefficient between two observers for lymphatic burden was 0.96 (0.94-0.98). Greater lymphatic burden correlated with post-Fontan operation hospital length of stay and duration of chest tube drainage (rs = 0.416, P = 0.004 and rs = 0.439, P = 0.002). Median lymphatic burden was greater in patients with chylous effusions immediately post-Fontan (178 (118-393) vs. 113 (46-190) mL/m2, P = 0.028), and in patients with composite adverse Fontan status (n = 13) defined by heart failure (n = 3), transplant assessment (n = 2), recurrent effusions (n = 6), Fontan thrombus (n = 2), and/or PLE (n = 6) post-Fontan (435 (137-822) vs. 114 (51-178) mL/m2, P = 0.003). Lymphatic burden > 600 mL/m2 was associated with late adverse Fontan status with sensitivity of 57% and specificity of 95%. CONCLUSION Quantification of MR lymphatic burden is a reliable tool to assess the lymphatics post-Fontan and is associated with clinical status.
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Affiliation(s)
- Aswathy Vaikom House
- Division of Pediatric Cardiology, Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA.,Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Dawn David
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Julien Aguet
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario M5T 1W7, Canada
| | - Anne I Dipchand
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Emilie Jean-St-Michel
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Mike Seed
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario M5T 1W7, Canada
| | - David J Barron
- Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario M5T 1W7, Canada
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27
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Huuskonen A, Hui L, Runeckles K, Hui W, Barron DJ, Friedberg MK, Honjo O. Growth of unrepaired hypoplastic proximal aortic arch and reintervention rate after aortic coarctation repair. J Thorac Cardiovasc Surg 2022; 165:1631-1640.e1. [PMID: 36202666 DOI: 10.1016/j.jtcvs.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Treatment of tubular hypoplasia of the aortic arch (THAA) associated with aortic coarctation (CoA) remains controversial. We aimed to evaluate growth of unrepaired hypoplastic proximal aortic arches (PAAs) after surgical repair for CoA. METHODS Preoperative and follow-up echocardiographic images of 139 patients who underwent CoA repairs from 2005 to 2012 were reviewed. THAA was defined as PAA z-score <-3 and non-THAA group z-score ≥-3. Reintervention rates due to aortic obstruction were assessed using competing risk models and diameters of the aorta were compared with Mann-Whitney U tests. RESULTS Fifty patients (36%) had THAA and 89 (64%) had non-THAA. The survival rate was 94% at 10 years. The overall reintervention rate at 10 years was 9% in the THAA group and 16% in the non-THAA group (P = .54). The catheter reintervention rate at ten years was 2% in the THAA group and 16% in the non-THAA group (P = .031). The surgical reintervention rate at ten years was 7% in the THAA group and 0% in the non-THAA group (P = .016). All 4 patients who required surgical reintervention were in the THAA group and 3 patients with PAA obstruction had preoperative PAA z-scores -3.6, -4.2, and -4.3. Follow-up echocardiograms showed PAA catch-up growth in the THAA group compared with the non-THAA group (preoperative z-score of -3.6 vs -2.3, and at 7 years of -1.1 vs -1.2; P < .001). CONCLUSIONS Unrepaired PAA hypoplasia grows after CoA repair. Reintervention rates were comparable between groups but those with THAA had higher surgical reintervention rates.
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28
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Fujioka T, Akazawa Y, Ide H, Karur GR, Bannan B, Grosse-Wortmann L, Sun M, Hui W, Slorach C, Honjo O, Friedberg MK. Reversal of right ventricular pressure loading improves biventricular function independent of fibrosis in a rabbit model of pulmonary artery banding. J Physiol 2022; 600:3689-3703. [PMID: 35801377 DOI: 10.1113/jp283165] [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] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
Right ventricular (RV) pressure loading leads to RV and left ventricular (LV) dysfunction through RV hypertrophy, dilatation and fibrosis. Relief of RV pressure load improves RV function. However, the impact and mechanisms on biventricular reverse-remodelling and function are only partially characterized. We evaluated the impact of RV pressure overload relief on biventricular remodelling and function in a rabbit model of reversible pulmonary artery banding (PAB). Rabbits were randomized to three groups: (1) Sham-operated controls (n = 7); (2) PAB (NDef, n = 7); (3) PAB followed by band deflation (Def, n = 5). Sham and NDef animals were sacrificed at 6 weeks after PAB surgery. Def animals underwent PAB deflation at 6 weeks and sacrifice at 9 weeks. Biventricular geometry, function, haemodynamics, hypertrophy and fibrosis were compared between groups using echocardiography, magnetic resonance imaging, high-fidelity pressure-tipped catheters and histology. RV pressure loading caused RV dilatation, systolic dysfunction, myocyte hypertrophy and LV compression which improved after PAB deflation. RV end-diastolic pressure (RVEDP) decreased after PAB deflation, although remaining elevated vs. Sham. LV end-diastolic pressure (LVEDP) was unchanged following PAB deflation. RV and LV collagen volumes in the NDef and Def group were increased vs. Sham, whereas RV and LV collagen volumes were similar between NDef and Def groups. RV myocyte hypertrophy (r = 0.75, P < 0.001) but not collagen volume was related to RVEDP. LV myocyte hypertrophy (r = 0.58, P = 0.016) and collagen volume (r = 0.56, P = 0.031) correlated with LVEDP. In conclusion, relief of RV pressure overload improves RV and LV geometry, hypertrophy and function independent of fibrosis. The long-term implications of persistent fibrosis and increased biventricular filling pressures, even after pressure load relief, need further study. KEY POINTS: Right ventricular (RV) pressure loading in a pulmonary artery banding rabbit model is associated with RV dilatation, left ventricular (LV) compression; biventricular myocyte hypertrophy, fibrosis and dysfunction. The mechanisms and impact of RV pressure load relief on biventricular remodelling and function has not been extensively studied. Relief of RV pressure overload improves biventricular geometry in conjunction with improved RV myocyte hypertrophy and function independent of reduced fibrosis. These findings raise questions as to the importance of fibrosis as a therapeutic target.
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Affiliation(s)
- Tao Fujioka
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yohei Akazawa
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Haruki Ide
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gauri Rani Karur
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Badr Bannan
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Mei Sun
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Wei Hui
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Slorach
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Honjo O. Integrating Novel Physiologic Data into Decision-Making in Congenital Heart Surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:19-27. [PMID: 35835512 DOI: 10.1053/j.pcsu.2022.02.001] [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: 11/10/2021] [Revised: 01/20/2022] [Accepted: 02/03/2022] [Indexed: 11/11/2022]
Abstract
Optimal decision-making to determine the type and timing of surgical intervention for various congenital heart disease (CHD) requires adequate understanding and interpretation of anatomic and physiologic data obtained from various imaging modalities. Cardiac magnetic resonance (CMR) has revolutionized the way we evaluate the anatomy and physiology of CHD. In addition to 2- and 3-dimensional anatomic data and volumetry, phase-contrast CMR allows quantitative measurements of cardiac output, pulmonary blood flow, pulmonary-to-systemic flow ratio, the amount of intracardiac shunt, valve regurgitation, and aortopulmonary collateral flows. This review article describes the utilization of CMR-derived flow data in surgical decision-making in three distinct subgroups: (1) patients with borderline left ventricle (LV) with emphasis on the ascending aortic flow and other physiologic parameters, (2) single ventricle patients who undergo bidirectional cavopulmonary shunt with emphasis on the impact of superior vena cava blood flow on postoperative physiology, and (3) patients with pulmonary atresia and major aortopulmonary collateral arteries with emphasis on the impact of total pulmonary blood flow and systemic-to-pulmonary flow ratio on clinical outcomes.
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Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Nield LE, Morgan CT, Diab S, Vera MA, Runeckles K, Friedberg MK, Dragulescu A, Honjo O, Taylor K, Moga MA, Manlhiot C, Miner SE, Mertens L. Prospective Assessment of Coronary Artery Flows Before and After Cardiopulmonary Bypass in Children With a Spectrum of Congenital Heart Disease. CJC Pediatr Congenit Heart Dis 2022; 1:119-128. [PMID: 37970492 PMCID: PMC10642097 DOI: 10.1016/j.cjcpc.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2023]
Abstract
Background Normative data for the effect of cardiopulmonary bypass (CPB) on coronary artery Doppler velocities by transesophageal echocardiography in paediatric patients with congenital heart disease (CHD) are lacking. The objective of the study was to prospectively examine the effects of CPB on coronary artery flow patterns by transesophageal echocardiography before and after CPB in children with CHD. Methods All cases undergoing CHD surgery at the Hospital for Sick Children, Toronto, were eligible. The excluded cases included Norwood operation, heart transplantation, or weight <2.5 kg. Coronary Dopplers and coronary flow reserve (CFR) for the right coronary artery (RCA) and left anterior descending (LAD) were obtained. Multivariable analyses using linear regression models were performed, adjusted for age and cross-clamp time. Results From May 2017 to June 2018, 69 children (median age at surgery: 0.7 years, interquartile range [IQR]: 0.4-3.7 years; median weight: 7.4 kg, IQR: 5.8-13.3 kg) were included. They were grouped into shunt lesions (N = 26), obstructive lesions (N = 26), transposition of the great arteries (N = 5), and single ventricle (N = 12). N = 39 (57%) were primary repairs, and 56 (81%) had 1 CPB run. For RCA and LAD peak velocities, there was an increase from pre- to post-CPB in RCA peak 39 cm/s (IQR: 30-54 cm/s) to 65 cm/s (IQR: 47-81 cm/s), P < 0.001, mean CFR 1.52 (IQR: 1.25-1.81), and LAD peak 49 cm/s (IQR: 39-60 cm/s) to 70 cm/s (IQR: 52-90 cm/s), P < 0.001, mean CFR 1.48 (IQR: 1.14-1.77). Conclusions Coronary flow velocities increase from pre- to post-CPB in congenital heart lesions. CFR is consistent across all lesions but is relatively low compared with the adult population.
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Affiliation(s)
- Lynne E. Nield
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Conall T. Morgan
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simone Diab
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria Angeles Vera
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyle Runeckles
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark K. Friedberg
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katherine Taylor
- Department of Anaesthesia and Pain Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael-Alice Moga
- Division of Cardiac Intensive Care, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven E.S. Miner
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Labatt Family Heart Centre, Division of Cardiology, the Hospital for Sick Children, Toronto, Ontario, Canada
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Li Q, Hussein N, Zhang Y, Fang Y, Wang Y, An Q, Honjo O, Luo S. Clinical Translation Of Surgical Simulated Closure Of A Ventricular Septum Defect. Interact Cardiovasc Thorac Surg 2022; 35:6590651. [PMID: 35604086 PMCID: PMC9486874 DOI: 10.1093/icvts/ivac122] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/03/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septal defect(VSD) closure simulation translates to better patient outcomes. METHODS Seven trainees were divided into two groups. Experienced-fellows group included four senior trainees who had performed>five VSD closures. Residents group consisted of three residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a four-week simulation requiring each participant to complete two VSD closures on 3D-printed models per week. One-month later all trainees returned for a posttest operation in real patients. All performances were recorded, blinded and scored independently by two cardiac surgeons using the validated Hands-On Surgical Training-Congenital Heart Surgery(HOST-CHS). Predefined surgical outcomes were analyzed. RESULTS The median HOST-CHS score increased significantly from week one to four [50(39,58) vs.73(65,74), p < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition[HOST-CHS score 72.5(71, 74)vs.54(51, 60), p < 0.001], with better patients outcomes including shorter total cross-clamp time[pretest: 86(70,99) vs.posttest: 60(53, 64) min, p = 0.006], and reduced incidence of major patch leak requiring multiple pump runs[pretest: 4/11vs.posttest: 0/9, p = 0.043]. After simulation, the technical performance and surgical outcomes of residents were comparable to experienced-fellows in real patients, except for significantly longer cross-clamp time[Residents : 76.5(71.7,86.8)vs.Experienced-fellows : 60(53,64) min, p = 0.002]. CONCLUSIONS Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.
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Affiliation(s)
- Qi Li
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Nabil Hussein
- Department of Congenital Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, England, United Kingdom
| | - Yunyi Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yibing Fang
- Department of Cardiovascular Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, 400038, China
| | - Yue Wang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Shuhua Luo
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
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Lynch A, Jeewa A, Minn E, Arathoon K, Ashkanase J, Honjo O, Floh A, Jean-St-Michel E. Outcomes of Children with Hypoplastic Left Heart Syndrome and Systemic Ventricular Dysfunction on Guideline Directed Medical Therapy. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.218] [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: 11/29/2022] Open
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34
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Townsend M, Jeewa A, Adachi I, Al Aklabi M, Honjo O, Armstrong K, Buchholz H, Conway J. Ventricular Assist Device Use in Single Ventricle Circulation. Can J Cardiol 2022; 38:1086-1099. [DOI: 10.1016/j.cjca.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 01/09/2023] Open
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35
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Proulx C, Floh A, Jeewa A, Pulcine E, Muthusami P, Brandão LR, Honjo O, Vargas C, Maurich A, Mazwi M. Successful Pediatric Mechanical Thrombectomy for HeartMate 3-Related Intracranial Thromboembolism. World J Pediatr Congenit Heart Surg 2022; 13:242-244. [PMID: 35238712 PMCID: PMC8894621 DOI: 10.1177/21501351221075840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thromboembolic events post left ventricular assist devices (LVAD) implantation remain a major cause of morbidity and mortality. Mechanical thrombectomy for the treatment of pediatric intracranial thromboembolic events have been reported in LVADs, but never following HeartMate 3 (HM3) implantation. We present the case of an 8-year-old, 26.5 kg male with dilated cardiomyopathy and decompensated heart failure who presented with extensive intracranial thromboembolism in the early postoperative period following HM3 implantation and underwent successful mechanical thrombectomy with a favorable neurological outcome.
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Affiliation(s)
- Catherine Proulx
- Department of Critical Care Medicine, 7979The Hospital for Sick Children, Toronto, Canada
| | - Alejandro Floh
- Department of Critical Care Medicine, 7979The Hospital for Sick Children, Toronto, Canada.,Division of Cardiology, 7979The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, 12366University of Toronto, Toronto, Canada
| | - Aamir Jeewa
- Division of Cardiology, 7979The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, 12366University of Toronto, Toronto, Canada
| | - Elizabeth Pulcine
- Division of Neurology, 7979The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, 12366University of Toronto, Toronto, Canada
| | - Prakash Muthusami
- Department of Diagnostic Imaging, 7979The Hospital for Sick Children, Toronto, Canada
| | - Leonardo R Brandão
- Division of Haematology/Oncology, 7979The Hospital for Sick Children, Toronto, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, 7979The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, 12366University of Toronto, Toronto, Canada
| | - Carolina Vargas
- Division of Neurology, 7979The Hospital for Sick Children, Toronto, Canada
| | - Andrea Maurich
- Division of Cardiology, 7979The Hospital for Sick Children, Toronto, Canada
| | - Mjaye Mazwi
- Department of Critical Care Medicine, 7979The Hospital for Sick Children, Toronto, Canada.,Division of Cardiology, 7979The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, 12366University of Toronto, Toronto, Canada
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36
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Deng MX, Jeewa A, Honjo O. Iatrogenic ventricular septal defect during right ventricular assist device insertion in congenitally corrected transposition of the great arteries. J Card Surg 2022; 37:1080-1082. [PMID: 35083800 DOI: 10.1111/jocs.16277] [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] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
This case report describes the management of a large iatrogenic ventricular septal defect (VSD) created by the coring device during systemic ventricular assist device (right ventricular assist device [RVAD]) insertion in a 16-year-old patient with congenitally corrected transposition of the great arteries. The VSD was closed by a bovine pericardial patch and the ventriculotomy was extended laterally to relocate the VAD sewing ring. After RVAD implantation, the patient initially remained cyanotic, potentially due to a tiny VSD patch leak with right-to-left shunting. Hypoxia was successfully corrected by rescue nitric oxide infusion and the patient was bridged to transplant after 91 days.
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Affiliation(s)
- Mimi X Deng
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Aamir Jeewa
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
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Honjo O, Dipchand AI. Commentary: Kidney at the heart of the matter. J Thorac Cardiovasc Surg 2021; 164:2034-2035. [PMID: 35045925 DOI: 10.1016/j.jtcvs.2021.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Anne I Dipchand
- Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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38
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Gill K, Arbic N, Seed M, Honjo O, Ryan G, Jaeggi E. Inadvertent irreversible closure of arterial duct following therapeutic use of transplacental indomethacin in a fetus with severe Ebstein's anomaly and circular shunt. Ultrasound Obstet Gynecol 2021; 58:940-942. [PMID: 34453368 DOI: 10.1002/uog.24758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
We report on a fetal case of Ebstein's anomaly with severe tricuspid regurgitation, functional pulmonary atresia and progressive circular shunting (CS) across a widely patent ductus arteriosus (DA) and regurgitant pulmonary valve, contributing to significant systemic hypoperfusion. To mitigate the extent of CS and allow the pregnancy to continue, maternal non-steroidal anti-inflammatory drug (NSAID) therapy with indomethacin was started at 33 + 5 weeks to induce DA constriction. Rather than achieving the desired narrowing of the DA, the treatment led to its complete closure and only minimal antegrade flow across the pulmonary valve. While closure of the DA resulted in the anticipated improvement in fetal hemodynamics, at birth, the child was at risk of severe hypoxemia and its consequences due to the lack of adequate pulmonary perfusion. Reduction and eventual discontinuation of the NSAID treatment did not result in DA reopening. Our experience illustrates the risk of unintended irreversible DA closure when NSAIDs are used to treat CS. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Gill
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Ontario Fetal Centre, University of Toronto, Toronto, Canada
| | - N Arbic
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Ontario Fetal Centre, University of Toronto, Toronto, Canada
| | - M Seed
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Ontario Fetal Centre, University of Toronto, Toronto, Canada
| | - O Honjo
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Ontario Fetal Centre, University of Toronto, Toronto, Canada
| | - G Ryan
- Ontario Fetal Centre, University of Toronto, Toronto, Canada
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - E Jaeggi
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Ontario Fetal Centre, University of Toronto, Toronto, Canada
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Broda CR, Alonso-Gonzalez R, Ghanekar A, Gulamhusein A, McDonald M, Luk A, Kobulnik J, Billia F, Heggie J, Jariani M, Honjo O, Barron D, Hickey E, Roche SL. Fate of the liver in the survivors of adult heart transplant for a failing Fontan circulation. J Heart Lung Transplant 2021; 41:283-286. [PMID: 34953719 DOI: 10.1016/j.healun.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/23/2021] [Accepted: 10/31/2021] [Indexed: 02/07/2023] Open
Abstract
The Fontan circulation has inherent long-term vulnerabilities such that adult Fontan patients now comprise the largest, most rapidly growing subgroup of adult congenital heart disease referred for transplant assessment. Almost all have Fontan Associated Liver Disease (FALD). There is an absence of mid to late hepatic outcome data after heart transplant alone. Therefore, we analyzed outcomes of survivors of heart only transplant in patients with failing Fontan circulation. Including all 10 of our adult Fontan patients surviving >1 year after isolated heart transplant, we report evolution of their clinical features, bloodwork, hemodynamic data, and liver ultrasound findings over a median of 4.7 years. Nonprogression of FALD, resolution of ascites and freedom from hepatocellular carcinoma in the mid-term highlight the outcomes in this selected group once normal cardiac output and venous pressures are established by heart transplant.
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Affiliation(s)
- Christopher R Broda
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Pediatric and Adult Congenital Heart Disease, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Rafael Alonso-Gonzalez
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aliya Gulamhusein
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Centre for Liver Disease, Francis Family Liver Clinic, University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Luk
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Kobulnik
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Filio Billia
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Heggie
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marjan Jariani
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Barron
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edward Hickey
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Pediatric and Adult Congenital Heart Disease, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Susan L Roche
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Deng MX, Nedadur R, Roche SL, Barron DJ, Honjo O. Heart transplant for failing fontan with situs inversus and aortic aneurysm: Utilization of lateral tunnel fontan pathway for systemic venous reconstruction. J Heart Lung Transplant 2021; 41:263-265. [PMID: 34865961 DOI: 10.1016/j.healun.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/03/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mimi Xiaoming Deng
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - Rashmi Nedadur
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - S Lucy Roche
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - David J Barron
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
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Deng M, Morgan C, Runeckles K, Fan C, Jaeggi E, Honjo O. IMPACT OF TRUNCAL VALVE REGURGITATION ON LEFT VENTRICULAR FUNCTION AND GEOMETRY IN COMMON ARTERIAL TRUNK: A CASE-MATCH CONTROLLED STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.202] [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: 10/20/2022] Open
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42
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Amir T, Alraddadi H, Barron D, Honjo O. Outcomes of balloon valvuloplasty versus surgical valvotomy in congenital aortic stenosis: A systematic review and meta-analysis. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100243] [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: 11/24/2022] Open
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43
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Honjo O, Kadowaki S. Commentary: Key is reproducibility. JTCVS Tech 2021; 9:124-125. [PMID: 34647079 PMCID: PMC8501239 DOI: 10.1016/j.xjtc.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sachiko Kadowaki
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Varenbut J, Vanderlaan RD, Lam CZ, Honjo O. Anterior Translocation of the Right Pulmonary Artery to Relieve Bronchial Compression in Truncus Arteriosus With Interrupted Aortic Arch. World J Pediatr Congenit Heart Surg 2021; 13:111-113. [PMID: 34519557 DOI: 10.1177/21501351211037320] [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] [Indexed: 11/16/2022]
Abstract
We report an anterior translocation of the right pulmonary artery procedure to relieve severe left bronchial obstruction that was caused by right pulmonary artery stent placement in a 1-year-old patient with truncus arteriosus and interrupted aortic arch. After neonatal repair, the patient re-presented with severe truncal valve regurgitation, right pulmonary artery stenosis, and severe biventricular dysfunction, which was treated with truncal valve repair and right pulmonary artery plasty. The patient suffered from left bronchial compression from right pulmonary artery stent placement, which was successfully treated by the translocation procedure. Bronchial stenosis was successfully relieved by the translocation procedure. Indications, advantages, and disadvantages of this procedure are discussed.
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Affiliation(s)
- Jaymie Varenbut
- 70384Schulich School of Medicine & Dentistry, London, Canada.,Labatt Family Heart Centre, 7979The Hospital for Sick Children, Toronto, Canada
| | - Rachel D Vanderlaan
- Labatt Family Heart Centre, 7979The Hospital for Sick Children, Toronto, Canada
| | - Christopher Z Lam
- 7979The Hospital for Sick Children, Toronto, Canada.,7938University of Toronto, Toronto, Canada
| | - Osami Honjo
- Labatt Family Heart Centre, 7979The Hospital for Sick Children, Toronto, Canada.,7938University of Toronto, Toronto, Canada
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Haranal M, Laks J, Cushing SL, Mazwi M, Jeewa A, Honjo O. Relieving bronchial compression due to cardiomegaly: The role of aortopexy when left ventricular assist device support just is not enough. Asian Cardiovasc Thorac Ann 2021; 30:601-603. [PMID: 34405710 DOI: 10.1177/02184923211034677] [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] [Indexed: 11/16/2022]
Abstract
Enlarged cardiac structures, especially those on left side have the potential to cause airway compression in pediatric patients with chronic heart failure, owing to their proximity to and impact on the trachea-bronchial tree. Ventricular assist devices are effective in decompressing such hearts thereby alleviating airway problems. Aortopexy serves as an effective airway decompressive measure in cases with persistent airway compression despite effective cardiac decompression by ventricular assist devices. We report a case of 1-year-old male patient with dilated cardiomyopathy in whom airway compression persisted despite ventricular assist device implantation. Aortopexy was effective in relieving airway compression allowing for subsequent extubation and successful heart transplantation.
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Affiliation(s)
- Maruti Haranal
- Department of Cardiovascular Surgery, 7979The Hospital for Sick Children, The University of Toronto, Canada
| | - Jessica Laks
- Department of Cardiology, 7979The Hospital for Sick Children, The University of Toronto, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, 7979The Hospital for Sick Children, The University of Toronto, Canada
| | - Mjaye Mazwi
- Department of Critical Care Medicine, 7979The Hospital for Sick Children, The University of Toronto, Canada
| | - Aamir Jeewa
- Department of Cardiology, 7979The Hospital for Sick Children, The University of Toronto, Canada
| | - Osami Honjo
- Department of Cardiovascular Surgery, 7979The Hospital for Sick Children, The University of Toronto, Canada
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46
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Hussein N, Honjo O, Barron DJ, Yoo SJ. Supravalvular aortic stenosis repair: surgical training of 2 repair techniques using 3D-printed models. Interact Cardiovasc Thorac Surg 2021; 33:966-968. [PMID: 34378022 DOI: 10.1093/icvts/ivab198] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022] Open
Abstract
There are a number of techniques used in the surgical treatment of supravalvular aortic stenosis with excellent results; however, junior surgeons' experience may be limited due to its rare nature. Simulation with 3D-printed models provides a safe platform for surgeons to rehearse surgical techniques prior to patient application but must replicate all features of surgical anatomy. Here, we describe how software manipulation can be used to accurately reproduce the surgical anatomy in supravalvular aortic stenosis and be used to train surgeons in 2 different techniques.
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Affiliation(s)
- Nabil Hussein
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Osami Honjo
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David J Barron
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Diagnostic-Imaging and Division of Cardiology, Department of Paediatrics Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Honjo O. Commentary: Ross procedure is indeed a safe and durable option for critical aortic valve disease in neonates and infants. J Thorac Cardiovasc Surg 2021; 163:376-377. [PMID: 34454735 DOI: 10.1016/j.jtcvs.2021.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Honjo O, Kadowaki S. Commentary: Atrioventricular valve insufficiency: Achilles' heel in single-ventricle physiology. J Thorac Cardiovasc Surg 2021; 163:1178-1179. [PMID: 34340850 DOI: 10.1016/j.jtcvs.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Sachiko Kadowaki
- Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Akazawa Y, Fujioka T, Ide H, Yazaki K, Honjo O, Sun M, Friedberg MK. Impaired right and left ventricular function and relaxation induced by pulmonary regurgitation are not reversed by tardive antifibrosis treatment. Am J Physiol Heart Circ Physiol 2021; 321:H38-H51. [PMID: 34048283 DOI: 10.1152/ajpheart.00467.2020] [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] [Indexed: 11/22/2022]
Abstract
Pulmonary regurgitation (PR) after repair of tetralogy of Fallot (rTOF) is associated with progressive right (RV) and left (LV) ventricular dysfunction and fibrosis. However, angiotensin II receptor blockade therapy has shown mixed and often disappointing results. The aim of this study was to serially assess changes in biventricular remodeling, dysfunction, and interactions in a rat model of isolated severe PR and to study the effects of angiotensin II receptor blockade. PR was induced in Sprague-Dawley rats by leaflet laceration. Shams (n = 6) were compared with PR (n = 5) and PR + losartan treatment (n = 6). In the treatment group, oral losartan (50 mg·kg-1·day-1) was started 6 wk after PR induction and continued for 6 wk until the terminal experiment. In all groups, serial echocardiography was performed every 2 wk until the terminal experiment where biventricular myocardium was harvested and analyzed for fibrosis. PR and PR + losartan rats experienced early progressive RV dilatation by 2 wk which then stabilized. RV systolic dysfunction occurred from 4 wk after insult and gradually progressed. In PR rats, RV dilatation caused diastolic LV compression and impaired relaxation. PR rats developed increased RV fibrosis compared with shams. Although losartan decreased RV fibrosis, RV dilatation and dysfunction were not improved. This suggests that RV dilatation is an early consequence of PR and affects LV relaxation. RV dysfunction may progress independent of further remodeling. Reduced RV fibrosis was not associated with improved RV function and may not be a viable therapeutic target in rTOF with predominant RV volume loading.NEW & NOTEWORTHY The time-course of RV dilatation and the mechanisms of biventricular dysfunction caused by PR have not been well characterized and the effect of losartan in volume-overloaded RV remains controversial. Our findings suggest that severe PR induces early onset of RV dilatation and dysfunction with little progression after the first 4 wk. The RV dilatation distorts LV geometry with associated impaired LV relaxation. Losartan reduced RV fibrosis but did not reverse RV dilatation and dysfunction.
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Affiliation(s)
- Yohei Akazawa
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tao Fujioka
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kana Yazaki
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mei Sun
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
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Howell A, Ashkanase J, Laks J, George K, Fazari L, Maurich A, Mazwi M, Honjo O, Jeewa A, Bulic A, Jean-St-Michel E. Sustained Ventricular Fibrillation in a Conscious Pediatric LVAD Patient. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2131] [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: 10/21/2022] Open
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