1
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van der Meulen MH, Herkert JC, den Boer SL, du Marchie Sarvaas GJ, Blom N, ten Harkel AD, Breur HM, Rammeloo LA, Tanke R, Marcelis C, van de Laar IM, Verhagen JM, Lekanne dit Deprez RH, Barge-Schaapveld DQ, Baas A, Sammani A, Christiaans I, van Tintelen JP, Dalinghaus M. Genetic Evaluation of A Nation-Wide Dutch Pediatric DCM Cohort: The Use of Genetic Testing in Risk Stratification. Circ Genom Precis Med 2022; 15:e002981. [DOI: 10.1161/circgen.120.002981] [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: 11/16/2022]
Abstract
Background:
This study aimed to describe the current practice and results of genetic evaluation in Dutch children with dilated cardiomyopathy and to evaluate genotype-phenotype correlations that may guide prognosis.
Methods:
We performed a multicenter observational study in children diagnosed with dilated cardiomyopathy, from 2010 to 2017.
Results:
One hundred forty-four children were included. Initial diagnostic categories were idiopathic dilated cardiomyopathy in 67 children (47%), myocarditis in 23 (16%), neuromuscular in 7 (5%), familial in 18 (13%), inborn error of metabolism in 4 (3%), malformation syndrome in 2 (1%), and “other” in 23 (16%). Median follow-up time was 2.1 years [IQR 1.0–4.3]. Hundred-seven patients (74%) underwent genetic testing. We found a likely pathogenic or pathogenic variant in 38 children (36%), most often in
MYH7
(n = 8). In 1 patient initially diagnosed with myocarditis, a pathogenic
LMNA
variant was found. During the study, 39 patients (27%) reached study endpoint (SE: all-cause death or heart transplantation). Patients with a likely pathogenic or pathogenic variant were more likely to reach SE compared with those without (hazard ratio 2.8; 95% CI 1.3–5.8,
P
= 0.007), while transplant-free survival was significantly lower (
P
= 0.006). Clinical characteristics at diagnosis did not differ between the 2 groups.
Conclusions:
Genetic testing is a valuable tool for predicting prognosis in children with dilated cardiomyopathy, with carriers of a likely pathogenic or pathogenic variant having a worse prognosis overall. Genetic testing should be incorporated in clinical work-up of all children with dilated cardiomyopathy regardless of presumed disease pathogenesis.
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Affiliation(s)
| | - Johanna C. Herkert
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
| | | | | | - Nico Blom
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
| | - Arend D.J. ten Harkel
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
- Dept of Pediatric Cardiology, Univ of Amsterdam, Academic Medical Center, Amsterdam (A.D.J.H.)
| | - Hans M.P.J. Breur
- Dept of Pediatric Cardiology, Univ of Utrecht, Wilhelmina Children’s Hospital, Univ Medical Center Utrecht, Utrecht (H.M.P.J.B.)
| | - Lukas A.J. Rammeloo
- Dept of Pediatric Cardiology, Amsterdam Univ Medical Center, location Free Univ Medical Center, Amsterdam (L.A.J.R.)
| | - Ronald Tanke
- Dept of Pediatric Cardiology, Radboud Univ Medical Center, Nijmegen (R.T.)
| | - Carlo Marcelis
- Dept of Genetics, Radboud Univ Medical Center, Nijmegen (C.M.)
| | - Ingrid M.B.H. van de Laar
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | - Judith M.A. Verhagen
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | | | | | - Annette Baas
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Arjan Sammani
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Imke Christiaans
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
- Dept of Clinical Genetics, Univ of Leiden, Leiden Univ Medical Center, Leiden (D.Q.C.M.B-S., I.C.)
| | - J. Peter van Tintelen
- Dept of Clinical Genetics, Amsterdam Univ Medical Center, location AMC, Amsterdam (R.H.L.D., J.P.T.)
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Michiel Dalinghaus
- Dept of Pediatric Cardiology, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (M.H.M., M.D.)
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2
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van den Bosch E, Bogers AJJC, Roos-Hesselink JW, van Dijk APJ, van Wijngaarden MHEJ, Boersma E, Nijveld A, Luijten LWG, Tanke R, Koopman LP, Helbing WA. Long-term follow-up after transatrial-transpulmonary repair of tetralogy of Fallot: influence of timing on outcome. Eur J Cardiothorac Surg 2021; 57:635-643. [PMID: 31872208 PMCID: PMC7078865 DOI: 10.1093/ejcts/ezz331] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 11/14/2022] Open
Abstract
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OBJECTIVES Our goal was to report the long-term serial follow-up after transatrial–transpulmonary repair of tetralogy of Fallot (TOF) and to describe the influence of the timing of the repair on outcome. METHODS We included all patients with TOF who had undergone transatrial–transpulmonary repair between 1970 and 2012. Records were reviewed for patient demographics, operative details and events during the follow-up period (death, pulmonary valve replacement, cardiac reinterventions and hospitalization/intervention for arrhythmias). In patients with elective early primary repair of TOF after 1990, a subanalysis of the optimal timing of TOF repair was performed. RESULTS A total of 453 patients were included (63% male patients; 65% had transannular patch); 261 patients underwent primary elective repair after 1990. The median age at TOF repair was 0.7 years (25th–75th percentile 0.3–1.3) and decreased from 1.7 to 0.4 years from before 1990 to after 2000, respectively (P < 0.001). The median follow-up duration after TOF repair was 16.8 years (9.6–24.7). Events developed in 182 (40%) patients. In multivariable analysis, early repair of TOF (<6 months) [hazard ratio (HR) 3.06; P < 0.001] and complications after TOF repair (HR 2.18; P = 0.006) were found to be predictive for an event. In a subanalysis of the primary repair of TOF after 1990, the patients (n = 125) with elective early repair (<6 months) experienced significantly worse event-free survival compared to patients who had elective repair later (n = 136). In multivariable analysis, early repair (HR 3.00; P = 0.001) and postoperative complications (HR 2.12; P = 0.010) were associated with events in electively repaired patients with TOF. CONCLUSIONS Transatrial–transpulmonary repair of TOF before the age of 6 months may be associated with more events during the long-term follow-up period.
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Affiliation(s)
- Eva van den Bosch
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Aagje Nijveld
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Linda W G Luijten
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ronald Tanke
- Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Laurens P Koopman
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Willem A Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands
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3
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van der Meulen M, den Boer S, du Marchie Sarvaas GJ, Blom N, Ten Harkel ADJ, Breur HMPJ, Rammeloo LAJ, Tanke R, Bogers AJJC, Helbing WA, Boersma E, Dalinghaus M. Predicting outcome in children with dilated cardiomyopathy: the use of repeated measurements of risk factors for outcome. ESC Heart Fail 2021; 8:1472-1481. [PMID: 33547769 PMCID: PMC8006605 DOI: 10.1002/ehf2.13233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 12/02/2022] Open
Abstract
Aims We aimed to determine whether in children with dilated cardiomyopathy repeated measurement of known risk factors for death or heart transplantation (HTx) during disease progression can identify children at the highest risk for adverse outcome. Methods and results Of 137 children we included in a prospective cohort, 36 (26%) reached the study endpoint (SE: all‐cause death or HTx), 15 (11%) died at a median of 0.09 years [inter‐quartile range (IQR) 0.03–0.7] after diagnosis, and 21 (15%) underwent HTx at a median of 2.9 years [IQR 0.8–6.1] after diagnosis. Median follow‐up was 2.1 years [IQR 0.8–4.3]. Twenty‐three children recovered at a median of 0.6 years [IQR 0.5–1.4] after diagnosis, and 78 children had ongoing disease at the end of the study. Children who reached the SE could be distinguished from those who did not, based on the temporal evolution of four risk factors: stunting of length growth (−0.42 vs. −0.02 length Z‐score per year, P < 0.001), less decrease in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) (−0.26 vs. −1.06 2log pg/mL/year, P < 0.01), no decrease in left ventricular internal diastolic dimension (LVIDd; 0.24 vs. −0.60 Boston Z‐score per year, P < 0.01), and increase in New York University Pediatric Heart Failure Index (NYU PHFI; 0.49 vs. −1.16 per year, P < 0.001). When we compared children who reached the SE with those with ongoing disease (leaving out the children who recovered), we found similar results, although the effects were smaller. In univariate analysis, NT‐proBNP, length Z‐score, LVIDd Z‐score, global longitudinal strain (%), NYU PHFI, and age >6 years at presentation (all P < 0.001) were predictive of adverse outcome. In multivariate analysis, NT‐proBNP appeared the only independent predictor for adverse outcome, a two‐fold higher NT‐proBNP was associated with a 2.8 times higher risk of the SE (hazard ratio 2.78, 95% confidence interval 1.81–3.94, P < 0.001). Conclusions The evolution over time of NT‐proBNP, LVIDd, length growth, and NYU PHFI identified a subgroup of children with dilated cardiomyopathy at high risk for adverse outcome. In this sample, with a limited number of endpoints, NT‐proBNP was the strongest independent predictor for adverse outcome.
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Affiliation(s)
- Marijke van der Meulen
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
| | - Susanna den Boer
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
| | - Gideon J du Marchie Sarvaas
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico Blom
- Leiden University Medical Center, Department of Pediatric Cardiology, University of Leiden, Leiden, The Netherlands.,Academic Medical Center, Department of Pediatric Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Arend D J Ten Harkel
- Leiden University Medical Center, Department of Pediatric Cardiology, University of Leiden, Leiden, The Netherlands
| | - Hans M P J Breur
- Department of Pediatric Cardiology, University of Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A J Rammeloo
- Department of Pediatric Cardiology, Free University of Amsterdam, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald Tanke
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands.,Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
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4
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van der Meulen MH, Boer SD, du Marchie Sarvaas GJ, Blom NA, ten Harkel ADJ, Breur HMPJ, Rammeloo LAJ, Tanke R, Helbing WA, Boersma E, Dalinghaus M. Does Repeated Measurement of a 6-Min Walk Test Contribute to Risk Prediction in Children with Dilated Cardiomyopathy? Pediatr Cardiol 2020; 41:223-229. [PMID: 31713652 PMCID: PMC7072046 DOI: 10.1007/s00246-019-02244-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
A single 6-min walk test (6MWT) can be used to identify children with dilated cardiomyopathy (DCM) with a high risk of death or heart transplantation. To determine if repeated 6MWT has added value in addition to a single 6MWT in predicting death or heart transplantation in children with DCM. Prospective multicenter cohort study including ambulatory DCM patients ≥ 6 years. A 6MWT was performed 1 to 4 times per year. The distance walked was expressed as percentage of predicted (6MWD%). We compared the temporal evolution of 6MWD% in patients with and without the study endpoint (SE: all-cause death or heart transplantation), using a linear mixed effects model. In 57 patients, we obtained a median of 4 (IQR 2-6) 6MWTs per patient during a median of 3.0 years of observation (IQR 1.5-5.1). Fourteen patients reached a SE (3 deaths, 11 heart transplantations). At any time during follow-up, the average estimate of 6MWD% was significantly lower in patients with a SE compared to patients without a SE. In both patients groups, 6MWD% remained constant over time. An absolute 1% lower 6MWD% was associated with an 11% higher risk (hazard) of the SE (HR 0.90, 95% CI 0.86-0.95 p < 0.001). Children with DCM who died or underwent heart transplantation had systematically reduced 6MWD%. The performance of all patients was stable over time, so repeated measurement of 6MWT within this time frame had little added value over a single test.
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Affiliation(s)
- Marijke H. van der Meulen
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Susanna den Boer
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gideon J. du Marchie Sarvaas
- Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nico A. Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Arend D. J. ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans M. P. J. Breur
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A. J. Rammeloo
- Department of Pediatric Cardiology, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald Tanke
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem A. Helbing
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Boersma
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Cardiology, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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5
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van Huis M, Schoenmaker NJ, Groothoff JW, van der Lee JH, van Dyk M, Gewillig M, Koster L, Tanke R, Lilien M, Blom NA, Mertens L, Kuipers IM. Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease. Pediatr Nephrol 2016; 31:1499-508. [PMID: 27189482 PMCID: PMC4943969 DOI: 10.1007/s00467-016-3362-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/13/2016] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left ventricular dysfunction is an important co-morbidity of end-stage renal disease (ESRD) and is associated with a poor prognosis in the adult population. In pediatric ESRD, left ventricular function is generally well preserved, but limited information is available on early changes in myocardial function. The aim of this study was to investigate myocardial mechanics in pediatric patients with ESRD using speckle-tracking echocardiography (STE). METHODS Echocardiographic studies, including M-mode, tissue Doppler imaging (TDI) and STE, were performed in 19 children on dialysis, 17 transplant patients and 33 age-matched controls. Strain measurements were performed from the apical four-chamber and the short axis view, respectively. RESULTS The interventricular and left ventricular posterior wall thickness was significantly increased in dialysis and transplant patients compared to healthy controls. No significant differences were found in shortening fraction, ejection fraction and systolic tissue Doppler velocities. Dialysis and transplant patients had a decreased mean longitudinal strain compared to healthy controls, with a mean difference of 3.1 [95 % confidence interval (CI) 2.0-4.4] and 2.7 (95 % CI 1.2-4.2), respectively. No differences were found for radial and circumferential strain. CONCLUSIONS Speckle-tracking echocardiography may reveal early myocardial dysfunction in the absence of systolic dysfunction measured by conventional ultrasound or TDI in children with ESRD.
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Affiliation(s)
- Maike van Huis
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center (AMC) Amsterdam/University of Amsterdam, Amsterdam, The Netherlands.
| | - Nikki J. Schoenmaker
- />Department of Pediatric Nephrology, Emma Children’s Hospital, Academic Medical Center (AMC) Amsterdam/University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap W. Groothoff
- />Department of Pediatric Nephrology, Emma Children’s Hospital, Academic Medical Center (AMC) Amsterdam/University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- />Pediatric Clinical Research Office, Emma Children’s Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Maria van Dyk
- />Department of Pediatric Nephrology, University Hospital Leuven, Leuven, Belgium
| | - Marc Gewillig
- />Department of Pediatric Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Linda Koster
- />Department of Pediatric Nephrology, University Medical Center (UMC) St. Radboud/Radboud University, Nijmegen, The Netherlands
| | - Ronald Tanke
- />Department of Pediatric Cardiology, UMC St. Radboud/Radboud University, Nijmegen, The Netherlands
| | - Marc Lilien
- />Department of Pediatric Nephrology, Wilhelmina Children’s Hospital, UMC Utrecht/Utrecht University, Utrecht, The Netherlands
| | - Nico A. Blom
- />Department of Pediatric Cardiology, Emma Children’s Hospital, AMC Amsterdam/University of Amsterdam, Amsterdam, The Netherlands
| | - Luc Mertens
- />Cardiology, The Hospital for Sick Children, The University of Toronto, Toronto, ON Canada
| | - Irene M. Kuipers
- />Department of Pediatric Cardiology, Emma Children’s Hospital, AMC Amsterdam/University of Amsterdam, Amsterdam, The Netherlands
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6
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Luijten LW, van den Bosch E, Duppen N, Tanke R, Roos-Hesselink J, Nijveld A, van Dijk A, Bogers AJ, van Domburg R, Helbing WA. Long-term outcomes of transatrial–transpulmonary repair of tetralogy of Fallot. Eur J Cardiothorac Surg 2014; 47:527-34. [DOI: 10.1093/ejcts/ezu182] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Honing-Hemmers AM, van Putten WK, Gewillig M, Mast G, Talsma M, Tanke R, de Wolff D, Sreeram N. Immediate and intermediate results of stent therapy for aortic coarctation. Neth Heart J 2003; 11:245-249. [PMID: 25696223 PMCID: PMC2499897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES The aim of the study was to assess the immediate and intermediate outcomes of stent therapy for coarctation or recoarctation of the aorta. SETTING Tertiary referral centres. METHODS A case review of all patients who have undergone stent implantation for coarctation of aorta in the Netherlands and Belgium. RESULTS Stents were implanted in 33 patients (mean age 21±16 years) and successful outcome occurred acutely in 32 of these 33 patients. Peak systolic blood pressure decreased from 149±37 to 124±24 mmHg. The pressure gradient decreased from 37±16 to 7±7 mmHg. The diameter of the coarctation segment increased from 7.3±3.8 to 13.3±3.9 mm. Three patients had major complications and three had minor complications. During a mean follow-up of 21±17 months recoarctation was found in ten patients, seven of whom have undergone further procedures. There were no deaths at follow-up. CONCLUSIONS Stent implantation is a good alternative to balloon dilation in selected patients with coarctation of the aorta. However, follow-up evaluation reveals a varying incidence of recoarctation and the long-term outcomes need to be determined.
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8
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Abstract
BACKGROUND/PURPOSE The aim of this study was to analyze whether a ductal left-to-right (L-R) shunt will prolong extracorporeal membrane oxygenation (ECMO) in neonates with severe pulmonary hypertension. This report discusses the onset and termination of a ductal L-R shunt and its potential influences on ECMO when pulmonary hypertension decreases during venoarterial bypass. METHODS Twenty-nine neonates were monitored during veno-arterial ECMO, using bedside echocardiography with 12-hour interval observations. RESULTS Up to 43% of the patients showed this type of shunt already after 12 hours on bypass. In total, this type of ductal shunt was found between 12 and 72 hours on ECMO in 62% of the patients. After 72 hours, the ductal L-R shunt no longer was detected. In 38% of the patients, no ductal L-R shunt was found during ECMO. Comparisons between these 2 patient groups showed a significantly longer ECMO duration in patients with ductal L-R shunt (P <.007). The mean prolongation time was 46 hours. Also, a significant decrease of left atrium to aorta ratio (P <.01) was observed during ECMO in the ductus group after closure of the duct, illustrating the decrease in volume load for the left heart and lungs. CONCLUSIONS Ductal L-R shunting is related with a substantial prolongation of the ECMO course (mean prolongation of almost 2 days). The authors suggest that on one side, the ductal L-R shunt will lead to pulmonary hypercirculation and on the other side, postductal stealing from the descending aortic circulation will lead to prerenal failure. Possibly because of interactions with pulmonary and renal function, a ductal L-R shunt will, among other factors, interfere with weaning from ECMO, resulting in a prolonged bypass time.
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Affiliation(s)
- R Tanke
- Department of Neonatology, Children's Heart Center, Nijmegen, The Netherlands
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9
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Abstract
Over recent years, echo-Doppler cardiography has shown that a small, sometimes silent, arterial duct exists in more patients than previously recognized. To know the incidence of an arterial duct subsequent to therapy, we studied retrospectively our patients undergoing open-heart surgery and surgical or catheter closure. Three groups of patients were studied: those with patency of the duct subsequent to open heart surgery without any sign of patency before or during surgery, those with persistent duct after surgical ligation and those with persistent patency after attempted catheter occlusion with the Rashkind device. In the first group (of 431 children) four (0.9%) had persistence of this duct, of which three were silent. In the second group, patency persisted in four of 100 patients (4%), three being silent. In the last group there were five persisting shunts, three producing no murmur, in 30 patients (17%). We compared our results with those reported in the literature and conclude that echo-Doppler cardiography is needed to detect persistent shunting across a duct after therapy, since most of the residual ducts in this study were silent. This means that clinical findings alone cannot be relied upon, and careful echo-Doppler cardiography is essential. Also, the process of closure of a persistent duct by surgical ligation or transcatheter intervention is no guarantee of success. The risk of infective endocarditis is important in such persistent ducts and, at present, it is unknown either for a small, silent duct or in a persistent duct that remains open after attempted transcatheter closure, but now is in association with a foreign body.
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Affiliation(s)
- B Raaijmaakers
- Children's Heart Centre, University Hospital Nijmegen, The Netherlands.
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10
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Benatar A, Tanke R, Roef M, Meyboom EJ, Van de Wal HJ. Mid-term results of the modified Senning operation for cavopulmonary connection with autologous tissue. Eur J Cardiothorac Surg 1995; 9:320-4. [PMID: 7546805 DOI: 10.1016/s1010-7940(05)80190-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED The aim of this study was to determine the results and mid-term outcome of a modified Senning technique using autologous tissue for total cavopulmonary connection. The study involved 31 children, 8 with tricuspid atresia and 23 with complex congenital heart disease. In this operation, a flap of autologous atrial free wall tissue was used to tunnel inferior vena caval blood to the pulmonary arteries. An additional Damus-Kay-Stansel operation was required in 9 patients with subaortic obstruction. RESULTS the early mortality rate was 16% (5 out of 31 patients) and there were four late deaths. COMPLICATIONS Pleural effusions were encountered in 17 patients, of whom 4 had a concomitant pericardial effusion. Diaphragmatic paralysis was diagnosed in five patients, one of whom underwent surgical plication. Median hospital stay was 26 days. The 1- to 5-year actuarial survival was 68.6%. Follow-up ranged from 10 months to 7.1 years, mean 3.2 years. A serious atrial arrhythmia was diagnosed in one patient and another one died, possibly from rhythm disorders. Exercise tolerance and quality of life has improved in all but one of the survivors. Although follow-up is short, we have thus far witnessed a low incidence of hemodynamic and rhythm disturbances with this modification of the cavopulmonary connection.
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Affiliation(s)
- A Benatar
- Children's Heart Centre, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands
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Andriessen P, Tanke R, Fiselier T. [Congenital complete atrioventricular block in neonatal lupus erythematosus]. Tijdschr Kindergeneeskd 1993; 61:178-82. [PMID: 8266312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fetal bradycardia of 60 beats per minute was diagnosed in the 22nd week of a normal pregnancy. Echocardiography showed a complete fetal atrioventricular heart block. The fetal heart was without structural abnormalities. Auto-antibodies (Ro/SS-A and antinuclear antibodies) could be demonstrated in both mother and child. The mother, however, showed no signs or symptoms of a connective tissue disease. We describe neonatal lupus erythematosus as an important cause of congenital heart block.
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Affiliation(s)
- P Andriessen
- Afd. Kindergeneeskunde, Academisch Ziekenhuis Nijmegen
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